Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis.
BMJ Open
; 10(10): e043763, 2020 10 05.
Article
em En
| MEDLINE
| ID: mdl-33020109
ABSTRACT
OBJECTIVES:
We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN).DESIGN:
Observational cohortSETTING:
Data were analysed from 11 primary healthcare clinics in northern KZN.PARTICIPANTS:
A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOMEMEASURES:
Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories 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 at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8).CONCLUSIONS:
In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumonia Viral
/
Atenção Primária à Saúde
/
Saúde Pública
/
Infecções por Coronavirus
/
Assistência Ambulatorial
/
Acessibilidade aos Serviços de Saúde
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Adult
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article