Lower respiratory tract infection admissions and deaths among children under 5 years in public sector facilities in the Western Cape Province, South Africa, before and during the COVID-19 pandemic (2019 - 2021)

Abstract

Background. The COVID‐19 pandemic resulted in the implementation of strict public health and social measures (PHSMs) (including mobility restrictions, social distancing, mask‐wearing and hand hygiene), limitations on non‐essential healthcare services, and public fear of COVID‐19 infection, all of which potentially affected transmission and healthcare use for other diseases such as lower respiratory tract infections (LRTIs). Objective. To determine changes in LRTI hospital admissions and in‐facility mortality in children aged <5 years in the Western Cape Province during the pandemic. Methods. We conducted a retrospective analysis of LRTI admissions and in‐facility deaths from January 2019 to November 2021. We estimated changes in rates and trends of LRTI admissions during the pandemic compared with pre‐pandemic period using interrupted time series analysis, adjusting for key characteristics. Results. There were 36 277 children admitted for LRTIs during the study period, of whom 58% were male and 51% were aged 28 days ‐ 1 year. COVID‐19 restrictions were associated with a 13% step reduction in LRTI admissions compared with the pre‐COVID‐19 period (incidence rate ratio (IRR) 0.87, 95% confidence interval (CI)) 0.80 ‐ 0.94). The average LRTI admission trend increased on average by 2% per month during the pandemic (IRR 1.02, 95% CI 1.02 ‐ 1.04). Conclusions. The COVID‐19 surges and their associated measures were linked to declining LRTI admissions and in‐facility deaths, likely driven by a combination of reduced infectious disease transmission and reduced use of healthcare services, with effects diminishing over time. These findings may inform future pandemic response policies.

Keywords

• Lower respiratory tract infections
• children
• South Africa
• COVID-19 pandemic