Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study.

BACKGROUND: During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. METHODS: We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. FINDINGS: The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. INTERPRETATION: Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.

The impact of Covid-19 pandemic related lockdown on clubfoot practice: Type of study design: Retrospective cross-sectional study.

ABSTRACT: We investigated whether the number of pediatric patients with congenital clubfoot treated with the Ponseti method decreased during the Covid-19 pandemic or not in a rural area. So we aimed to guide orthopedic surgeons and health infrastructure for future pandemics to be prepared in hospitals of rural areas for the treatment of children with congenital clubfoot.One hundred and fifty-four patients with clubfoot who were admitted to our clinic were evaluated retrospectively from March 2017 to December 2020. Institutional hospital electronic database was used to detect the number of weeks between the birth and first cast performed in clinic and the number of casts been applied and unilaterality or bilaterality. Patients were divided into four groups, which included pandemic period and three previous years. Recorded data were analyzed statistically to detect if there is a difference between the numbers of the patients in pandemic period and three previous years.The number of patients with clubfoot admitted to our hospital between March 2020 and December 2020 increased by 140% compared to previous year. There was a statistically significant difference between the average number of cast applications of Group 4 and other groups (P <.001). Achilles tenotomy was performed in 44 (61.1%) of 72 patients admitted during the pandemic period. Only 4 (13.3%) out of 30 patients admitted between March 2019 and December 2019 were performed Achilles tenotomy.We detected an increase in the number of clubfoot cases admitted to our rural-based hospital during the Covid-19 pandemic, treated with casting or surgically. We think this is because of preventive measures during the pandemic, which caused parents could not reach urban for treatment.

US Rural Surgeons Leading During COVID-19: Where Are They Now?

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.