BMJ Open (Oct 2020)

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

  • Guy Harling,
  • Maryam Shahmanesh,
  • Mark J Siedner,
  • Kobus Herbst,
  • Nothando Ngwenya,
  • Janet Seeley,
  • John D Kraemer,
  • Mark J Meyer,
  • Thobeka Mngomezulu,
  • Patrick Gabela,
  • Siphephelo Dlamini,
  • Dickman Gareta,
  • Nomathamsanqa Majozi,
  • Emily Wong,
  • Collins Iwuji,
  • Willem Hanekom

DOI
https://doi.org/10.1136/bmjopen-2020-043763
Journal volume & issue
Vol. 10, no. 10

Abstract

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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.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.