Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: a longitudinal cohort study

Abstract

Objectives Public health interventions designed to interrupt COVID-19 transmission could have deleterious impacts on primary healthcare access. We sought to identify whether implementation of the nationwide lockdown (shelter-in-place) order in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). Design Prospective, longitudinal cohort study Setting Data were analyzed from the Africa Health Research Institute Health and Demographic Surveillance System, which includes prospective data capture of clinic visits at eleven primary healthcare clinics in northern KwaZulu-Natal Participants A total of 36,291 individuals made 55,545 clinic visits during the observation period. Exposure of Interest We conducted an interrupted time series analysis with regression discontinuity methods to estimate changes in outpatient clinic visitation from 60 days before through 35 days after the lockdown period. Outcome Measures Daily clinic visitation at ambulatory clinics. In stratified analyses we assessed visitation for the following sub-categories: child health, perinatal care and family planning, HIV services, non-communicable diseases, and by age and sex strata. Results We found no change in total clinic visits/clinic/day from prior to and during the lockdown (-6.9 visits/clinic/day, 95%CI -17.4, 3.7) or trends in clinic visitation over time during the lockdown period (-0.2, 95%CI -3.4, 3.1). We did detect a reduction in child healthcare visits at the lockdown (-7.2 visits/clinic/day, 95%CI -9.2, -5.3), which was seen in both children <1 and children 1-5. In contrast, we found a significant increase in HIV visits immediately after the lockdown (8.4 visits/clinic/day, 95%CI 2.4, 14.4). No other differences in clinic visitation were found for perinatal care and family planning, non-communicable diseases, or among adult men and women. Conclusions In rural KZN, the ambulatory healthcare system was largely resilient during the national-wide lockdown order. A major exception was child healthcare visitation, which declined immediately after the lockdown but began to normalize in the weeks thereafter. Future work should explore efforts to decentralize chronic care for high-risk populations and whether catch-up vaccination programs might be required in the wake of these findings.

Child Healthcare and Immunizations in Sub-Saharan Africa During the COVID-19 Pandemic

“…However, these findings are new and bear potential significant implications. Local health workers anecdotally reported they had the feeling that people could not afford routine care (from transport fees to visit fees for those over 5 years of age), and our data provide, to the best of our knowledge, the first evidence of a possible drop in access for basic but priority pediatric services in remote areas, while similar rates have already been reported in the adult population of South Africa (6). A similar scenario is currently happening in the United States, where a recent nationwide analysis of vaccine information found that measles, mumps, and rubella vaccinations had dropped by 50% during the COVID-19 outbreak (6).…”

SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium

“…Besides the potential impact of COVID-19 on fetal-maternal health, the emergence of a new and highly contagious virus, including the unprecedented containment and social isolation measures, might have created (exceptional) challenges for perinatal and child healthcare [15]. In Belgium, it is common practice for pregnant women to consult with several types of health care professionals (HCPs) throughout their pregnancy (i.e., obstetrician, midwife, general practitioner (GP) or medical specialist).…”

Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes at Mpilo Central Hospital.

“…Our experience of working during this time has been of increased challenges and adversity associated with logistical, resource, and sta ng di culties. Interestingly, a study of the effects of Covid-19 lockdown measures on access to primary care in rural South Africa had similar unexpected results (20).…”