Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis.
Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis.
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DOI：
10.1136/bmjopen-2020-043763
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发表时间：
2020-10-05
期刊：
影响因子：
2.9
通讯作者：
Herbst K
中科院分区：
文献类型：
--
作者：
Siedner MJ;Kraemer JD;Meyer MJ;Harling G;Mngomezulu T;Gabela P;Dlamini S;Gareta D;Majozi N;Ngwenya N;Seeley J;Wong E;Iwuji C;Shahmanesh M;Hanekom W;Herbst K
我们评估了南非封锁令的实施是否影响夸祖鲁纳塔尔省 (KZN) 农村地区的门诊就诊。观察队列数据对来自 KZN 北部 11 个初级保健诊所的数据进行了分析。观察期间共有 46 523 人进行了 89 476 次就诊。我们进行了中断时间序列分析，以估计诊所就诊的变化，重点关注从封锁前到 5 级、4 级和 3 级封锁期的过渡。每日门诊就诊。在分层分析中，我们评估了以下子类别的探访情况：儿童健康、围产期护理和计划生育、艾滋病毒服务、非传染性疾病以及按年龄和性别分层。我们发现，在实施 5 级封锁时（平均就诊次数/诊所/天从 90.3 次变为 84.6 次，95% CI -16.5 至 3.1），或过渡到不太严格的 4 级和 3 级封锁时，/诊所/天的总就诊次数没有变化。我们确实发现，在 5 级封锁开始时，儿童医疗就诊次数减少了 50% 以上，从 11.9 次/天减少到 4.7 次（-7.1 次/诊所/天，95%CI -8.9 至 5.3），对于年龄 <1 岁和 1-5 岁的儿童来说都是如此，并在第一次封锁措施后的 3 个月内逐渐恢复到封锁前。相比之下，我们发现在 5 级封锁开始时，成年人的诊所就诊次数没有下降，或者与艾滋病毒护理相关（从 37.5 到 45.6，每天/诊所 8.0 次就诊，95%CI 2.1 到 13.8）。在 KZN 农村地区，我们发现，在封锁的前 4 个月内，儿童医疗保健就诊量显着减少，尽管是暂时的，但成人门诊护理服务的总体恢复能力良好。未来的工作应探讨流行病对初级保健提供的影响以及儿童探视减少对该地区结果的长期影响。
We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). Observational cohort Data were analysed from 11 primary healthcare clinics in northern KZN. A total of 46 523 individuals made 89 476 clinic visits during the observation period. 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. 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. 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). 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.
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