Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis

Siedner, Mark J, Kraemer, John D, Meyer, Mark J, Harling, Guy, Mngomezulu, Thobeka, Gabela, Patrick, Dlamini, Siphephelo, Gareta, Dickman, Majozi, Nomathamsanqa, Ngwenya, Nothando, Seeley, Janet, Wong, Emily, Iwuji, Collins, Shahmanesh, Maryam, Hanekom, Willem and Herbst, Kobus (2020) Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis. BMJ Open, 10 (10). a043763 1-10. ISSN 2044-6055

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Abstract

Objectives
We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN).

Design
Observational cohort

Setting
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.

Outcome measures
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.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 23 Sep 2020 09:55
Last Modified: 06 Oct 2020 13:00
URI: http://sro.sussex.ac.uk/id/eprint/93918

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