COVID-19 Lockdown Effect on Healthcare Utilization and In-hospital Mortality in Children Under 5 Years in Cape Town, South Africa: a Cross-sectional Study

Overview

Journal J Trop Pediatr

Specialties Pediatrics
Tropical Medicine

Date 2023 Oct 13

PMID 37830545

Authors

Noradin Elmi

Liezl Smit

Thandi Wessels

Moleen Zunza

Helena Rabie

Affiliations

Soon will be listed here.

Abstract

Background: COVID-19 pandemic measures resulted in the de-escalation of non-COVID-19 healthcare provision.

Methods: A retrospective cross-sectional study of routinely collected data was done to investigate the effect of COVID-19 policies on the healthcare utilization and mortality of children younger than 5 years in Eastern Cape Town, South Africa. We compared visits to primary and urgent care facilities, hospitalization, in-hospital deaths, and vaccine uptake from 1 January to 31 December 2020 to similar periods in 2018 and 2019.

Results: During April and May 2020, the most restricted period, visits to primary care facilities declined from 126 049 in 2019 to 77 000 (1.8-fold; p < 0.05). This corresponded with a 1.2-fold reduction in the provision of the first dose of measles vaccine at 6 months compared to 2019. Throughout 2020 there was a 4-fold decline in the number of fully immunized children at 1 year of age (p = 0.84). Emergency room visits fell by 35.7% in 2020 (16 368) compared to 2019 (25 446). Hospital admissions decreased significantly (p < 0.01) in 2020 (9810) compared to 2018 (11 698) and 2019 (10 247). The in-hospital mortality rate increased from 2.3% (96/4163) in 2019 to 3.8% (95/2498) (p < 0.01) in Tygerberg Hospital, where 80% (95/119) of deaths were recorded. Twelve of the 119 (10%) deaths occurred in HIV-positive children (p = <0.01).

Conclusion: Measures instituted during the COVID-19 pandemic disrupted access to healthcare services for children. This resulted in an immediate, and potential future, indirect effect on child morbidity and mortality in Cape Town.

Citing Articles

The effect of the SARS-CoV2 pandemic and lockdown on non-Covid ICU admissions: Experience from a South African tertiary hospital.

Murphy S, Zwane K, Williams K, Omar S South Afr J Crit Care. 2024; 40(1):e1435.

PMID: 38989476 PMC: 11232567. DOI: 10.7196/SAJCC.2024.v40i1.1435.

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