RESUMO
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 126â049 in 2019 to 77â000 (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 (16â368) compared to 2019 (25â446). Hospital admissions decreased significantly (p < 0.01) in 2020 (9810) compared to 2018 (11â698) and 2019 (10â247). 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.
During the COVID-19 pandemic in 2020, lockdown policies restricted movement of people and non-COVID-19 healthcare services were de-escalated. In a large district, Metro East, in Cape Town, South Africa, this resulted in a 1.8-fold decline in primary healthcare clinic visits in children less than 5 years of age. Routine immunizations were negatively impacted with a 1.2-fold decline in the uptake of the first dose of measles vaccine at 6 months of age and a 1.4-fold decline in the number of fully immunized children at 1 year of age. Hospital admissions decreased significantly from 10â247 and 11â698 in 2019 and 2018, respectively, to 9810 admissions in 2020. Although fewer deaths (119) were reported in hospitals in Metro East District, Cape Town, South Africa in 2020, the deaths per number of admissions increased from 2.3% (96/4163) in 2019 to 3.8% (95/2498) in Tygerberg Hospital, where 80% (95/119) of deaths were recorded. Measures instituted during the COVID-19 pandemic in 2020 thus disrupted the access to healthcare services for children. This resulted in an immediate, and potential future, indirect effect on child health and survival in Cape Town.
