Naidoo Kimesh Loganathan, Dorward Jienchi, Chinniah Kogielambal, Lawler Melissa, Nattar Yugendhree, Bottomley Christian, Archary Moherndran
Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
King Edward VIII Hospital, Congella, Durban, South Africa.
PLOS Glob Public Health. 2024 Sep 18;4(9):e0002829. doi: 10.1371/journal.pgph.0002829. eCollection 2024.
Vulnerable children from poor communities with high HIV and Tuberculosis(TB) burdens were impacted by COVID-19 lockdowns. Concern was raised about the extent of this impact and anticipated post-pandemic surges in mortality. Interrupted time series segmented regression analyses were done using routinely collected facility-level data of children admitted for medical conditions at four South African referral hospitals. Monthly admission and mortality data over 60 months from 01 April 2018 to 31 January 2023 was analysed using models which included dummy lockdown level variables, a dummy post-COVID period variable, Fourier terms to account for seasonality, and excess mortality as a proxy for healthcare burden. Of the 45 015 admissions analysed, 1237(2·75%) demised with significant decreases in admissions during all the lockdown levels, with the most significant mean monthly decrease of 450(95%, CI = 657·3, -244·3) p<0·001 in level 5 (the most severe) lockdown. There was evidence of loss of seasonality on a six-month scale during the COVID periods for all admissions (p = 0·002), including under-one-year-olds (p = 0·034) and under-five-year-olds (p = 0·004). No decreases in mortality accompanied decreased admissions. Post-pandemic surges in admissions or mortality were not identified in children with acute gastroenteritis, acute pneumonia and severe acute malnutrition.During the COVID-19 pandemic, paediatric admissions in 4 hospitals serving communities with high levels of HIV, TB and poverty decreased, similar to global experiences; however, there was no change in in-hospital mortality. No post-pandemic surge in admissions or mortality was documented. Differences in the impact of pandemic control measures on the transmission of childhood infections and access to health care may account for differing outcomes seen in our setting compared to the global experiences. Further studies are needed to understand the impact of pandemic control measures on healthcare provision and transmission dynamics and to better inform future responses amongst vulnerable child populations.
来自艾滋病毒和结核病负担较重的贫困社区的弱势儿童受到了新冠疫情封锁措施的影响。人们对这种影响的程度以及疫情后预计的死亡率激增表示担忧。利用南非四家转诊医院常规收集的因医疗状况入院儿童的机构层面数据，进行了中断时间序列分段回归分析。使用包含虚拟封锁级别变量、虚拟新冠疫情后时期变量、用于解释季节性的傅里叶项以及超额死亡率作为医疗负担代理指标的模型，分析了2018年4月1日至2023年1月31日期间60个月的月度入院和死亡率数据。在分析的45015例入院病例中，有1237例（2.75%）死亡，在所有封锁级别期间入院人数均显著下降，在第5级（最严格）封锁期间平均每月下降幅度最大，为450例（95%，置信区间=657.3，-244.3），p<0.001。在新冠疫情期间，所有入院病例（p=0.002），包括一岁以下儿童（p=0.034）和五岁以下儿童（p=0.004），均出现了为期六个月的季节性丧失迹象。入院人数减少并未伴随死亡率下降。在患有急性肠胃炎、急性肺炎和重度急性营养不良的儿童中，未发现疫情后入院人数或死亡率激增。在新冠疫情期间，为艾滋病毒、结核病高发且贫困程度高的社区提供服务的4家医院的儿科入院人数减少，这与全球情况类似；然而，住院死亡率没有变化。没有记录到疫情后入院人数或死亡率激增的情况。与全球情况相比，疫情防控措施对儿童感染传播和获得医疗服务的影响存在差异，这可能解释了我们研究中的不同结果。需要进一步研究以了解疫情防控措施对医疗服务提供和传播动态的影响，并为未来弱势儿童群体的应对措施提供更好的信息。
