Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa.
S Afr Med J. 2022 Apr 4;112(4):279-287.
Major causes of under-5 child deaths in South Africa (SA) are well recognised, and child mortality rates are falling. The focus of child health is therefore shifting from survival to disease prevention and thriving, but local data on the non-fatal disease burden are limited. Furthermore, COVID-19 has affected children's health and wellbeing, both directly and indirectly.
To describe the pattern of disease on admission of children at different levels of care, and assess whether this has been affected by COVID-19.
Retrospective reviews of children's admission and discharge registers were conducted for all general hospitals in iLembe and uMgungundlovu districts in KwaZulu-Natal Province, SA, from January 2018 to September 2020. The Global Burden of Disease framework was adapted to create a data capture sheet with four broad diagnostic categories and 37 specific cause categories. Monthly admission numbers were recorded per cause category, and basic descriptive analysis was completed in Microsoft Excel.
Overall, 36 288 admissions were recorded across 18 hospital wards, 32.0% at district, 49.8% at regional and 18.2% at tertiary level. Communicable diseases, perinatal conditions and nutritional deficiencies (CPNs) accounted for 37.4% of admissions, non-communicable diseases (NCDs) for 43.5% and injuries for 17.1%. The distribution of broad diagnostic categories varied across levels of care, with CPNs being more common at district level and NCDs more common at regional and tertiary levels. Unintentional injuries represented the most common cause category (16.6%), ahead of lower respiratory tract infections (16.1%), neurological conditions (13.6%) and diarrhoeal disease (8.4%). The start of the local COVID-19 outbreak coincided with a 43.1% decline in the mean number of monthly admissions. Admissions due to neonatal conditions and intentional injuries remained constant during the COVID-19 outbreak, while those due to other disease groups (particularly respiratory infections) declined.
Our study confirms previous concerns around a high burden of childhood injuries in our context. Continued efforts are needed to prevent and treat traditional neonatal and childhood illnesses. Concurrently, the management of NCDs should be prioritised, and evidence-based strategies are sorely needed to address the high injury burden in SA.
南非（SA）5 岁以下儿童死亡的主要原因众所周知，儿童死亡率正在下降。因此，儿童健康的重点正从生存转移到疾病预防和茁壮成长，但当地关于非致命性疾病负担的数据有限。此外，COVID-19 直接和间接影响了儿童的健康和福祉。
描述不同级别护理入院儿童的疾病模式，并评估 COVID-19 是否对此产生了影响。
对南非夸祖鲁-纳塔尔省伊莱姆贝和乌姆古伦杜卢夫地区所有综合医院的儿童入院和出院登记进行回顾性审查，时间为 2018 年 1 月至 2020 年 9 月。采用全球疾病负担框架，创建了一个数据采集表，其中包含四个广泛的诊断类别和 37 个特定病因类别。按病因类别记录每月入院人数，并在 Microsoft Excel 中完成基本描述性分析。
总体而言，在 18 个病房中记录了 36288 例入院，其中 32.0%在地区一级，49.8%在地区一级，18.2%在三级。传染病、围产期疾病和营养缺乏症（CPNs）占入院人数的 37.4%，非传染性疾病（NCDs）占 43.5%，损伤占 17.1%。不同级别的护理中，广泛诊断类别的分布不同，CPNs 在地区一级更为常见，NCDs 在地区和三级更为常见。意外伤害是最常见的病因类别（16.6%），其次是下呼吸道感染（16.1%）、神经疾病（13.6%）和腹泻病（8.4%）。当地 COVID-19 疫情爆发之际，每月平均入院人数下降了 43.1%。COVID-19 疫情期间，新生儿疾病和故意伤害导致的入院人数保持不变，而其他疾病组（特别是呼吸道感染）导致的入院人数下降。
我们的研究证实了先前对我们背景下儿童高伤害负担的担忧。需要继续努力预防和治疗传统的新生儿和儿童疾病。同时，应优先管理非传染性疾病，迫切需要制定基于证据的策略来解决南非的高伤害负担问题。
