Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa.
S Afr Med J. 2020 Dec 15;0(0):13185.
Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing.
To assess the impact of the local COVID-19 outbreak on routine child health services.
The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed.
During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged <5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources.
Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impact of the COVID-19 outbreak on child health, as well as strategies to mitigate these.
现有证据表明，儿童较少受到与 COVID-19 直接相关的发病率和死亡率的影响，但大流行的间接影响对其健康和福祉构成了重大风险。
评估当地 COVID-19 疫情对常规儿童卫生服务的影响。
利用夸祖鲁-纳塔尔省（KZN）省级卫生服务的地区卫生信息系统数据集，提取 2018 年 1 月至 2020 年 6 月期间与儿童健康相关的每月数据。评估服务获取、服务提供和儿童健康状况的哨兵指标的时间和地理变化。
在 COVID-19 疫情在 KZN 爆发后的 2020 年 4 月至 6 月期间，<5 岁儿童的就诊率（36%；p=0.001）和住院率（50%；p=0.005）显著下降，仅略有恢复就诊。在服务提供指标中，疫苗接种覆盖率恢复最快，维生素 A 补充、驱虫和食物补充仍然较低。母婴和新生儿保健服务的提供和获取方面的变化不那么明显，尽管存在地区间差异，表明在获取和提供母婴和新生儿保健服务方面存在不平等。2020 年 5 月报告新生儿保健机构死亡人数暂时增加了 47%，可能归因于 COVID-19 相关的服务中断和卫生资源转移。
多项指标显示服务获取、服务提供和儿童健康状况均受到干扰。需要进一步研究以确定 COVID-19 疫情对儿童健康的中长期影响，以及减轻这些影响的策略。
