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Effect of COVID-19 lockdown on hospital admissions and mortality in rural KwaZulu-Natal, South Africa: interrupted time series analysis.
BMJ Open. 2021 03 18; 11(3):e047961.BO

Abstract

OBJECTIVE

To assess the effect of lockdown during the 2020 COVID-19 pandemic on daily all-cause admissions, and by age and diagnosis subgroups, and the odds of all-cause mortality in a hospital in rural KwaZulu-Natal (KZN).

DESIGN

Observational cohort.

SETTING

Referral hospital for 17 primary care clinics in uMkhanyakude District.

PARTICIPANTS

Data collected by the Africa Health Research Institute on all admissions from 1 January to 20 October: 5848 patients contributed to 6173 admissions.

EXPOSURE

Five levels of national lockdown in South Africa from 27 March 2020, with restrictions decreasing from levels 5 to 1, respectively.

OUTCOME MEASURES

Changes and trends in daily all-cause admissions and risk of in-hospital mortality before and at each stage of lockdown, estimated by Poisson and logistic interrupted time series regression, with stratification for age, sex and diagnosis.

RESULTS

Daily admissions decreased during level 5 lockdown for infants (incidence rate ratio (IRR) compared with prelockdown 0.63, 95% CI 0.44 to 0.90), children aged 1-5 years old (IRR 0.43, 95% CI 028 to 0.65) and respiratory diagnoses (IRR 0.57, 95% CI 0.36 to 0.90). From level 4 to level 3, total admissions increased (IRR 1.17, 95% CI 1.06 to 1.28), as well as for men >19 years (IRR 1.50, 95% CI 1.17 to 1.92) and respiratory diagnoses (IRR 4.26, 95% CI 2.36 to 7.70). Among patients admitted to hospital, the odds of death decreased during level 5 compared with prelockdown (adjusted OR 0.48, 95% CI 0.28 to 0.83) and then increased in later stages.

CONCLUSIONS

Level 5 lockdown is likely to have prevented the most vulnerable population, children under 5 years and those more severely ill from accessing hospital care in rural KZN, as reflected by the drop in admissions and odds of mortality. Subsequent increases in admissions and in odds of death in the hospital could be due to improved and delayed access to hospital as restrictions were eased.

Authors+Show Affiliations

Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK A.Mcintosh@doctors.org.uk.Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.Africa Health Research Institute, KwaZulu-Natal, South Africa. Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.Africa Health Research Institute, KwaZulu-Natal, South Africa.Africa Health Research Institute, KwaZulu-Natal, South Africa. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.Africa Health Research Institute, KwaZulu-Natal, South Africa. DSI-MRC South African Population Research Infrastructure Network, Durban, South Africa.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33737445

Citation

McIntosh, Amy, et al. "Effect of COVID-19 Lockdown On Hospital Admissions and Mortality in Rural KwaZulu-Natal, South Africa: Interrupted Time Series Analysis." BMJ Open, vol. 11, no. 3, 2021, pp. e047961.
McIntosh A, Bachmann M, Siedner MJ, et al. Effect of COVID-19 lockdown on hospital admissions and mortality in rural KwaZulu-Natal, South Africa: interrupted time series analysis. BMJ Open. 2021;11(3):e047961.
McIntosh, A., Bachmann, M., Siedner, M. J., Gareta, D., Seeley, J., & Herbst, K. (2021). Effect of COVID-19 lockdown on hospital admissions and mortality in rural KwaZulu-Natal, South Africa: interrupted time series analysis. BMJ Open, 11(3), e047961. https://doi.org/10.1136/bmjopen-2020-047961
McIntosh A, et al. Effect of COVID-19 Lockdown On Hospital Admissions and Mortality in Rural KwaZulu-Natal, South Africa: Interrupted Time Series Analysis. BMJ Open. 2021 03 18;11(3):e047961. PubMed PMID: 33737445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of COVID-19 lockdown on hospital admissions and mortality in rural KwaZulu-Natal, South Africa: interrupted time series analysis. AU - McIntosh,Amy, AU - Bachmann,Max, AU - Siedner,Mark J, AU - Gareta,Dickman, AU - Seeley,Janet, AU - Herbst,Kobus, Y1 - 2021/03/18/ PY - 2021/3/19/entrez PY - 2021/3/20/pubmed PY - 2021/3/24/medline KW - COVID-19 KW - epidemiology KW - paediatrics KW - public health SP - e047961 EP - e047961 JF - BMJ open JO - BMJ Open VL - 11 IS - 3 N2 - OBJECTIVE: To assess the effect of lockdown during the 2020 COVID-19 pandemic on daily all-cause admissions, and by age and diagnosis subgroups, and the odds of all-cause mortality in a hospital in rural KwaZulu-Natal (KZN). DESIGN: Observational cohort. SETTING: Referral hospital for 17 primary care clinics in uMkhanyakude District. PARTICIPANTS: Data collected by the Africa Health Research Institute on all admissions from 1 January to 20 October: 5848 patients contributed to 6173 admissions. EXPOSURE: Five levels of national lockdown in South Africa from 27 March 2020, with restrictions decreasing from levels 5 to 1, respectively. OUTCOME MEASURES: Changes and trends in daily all-cause admissions and risk of in-hospital mortality before and at each stage of lockdown, estimated by Poisson and logistic interrupted time series regression, with stratification for age, sex and diagnosis. RESULTS: Daily admissions decreased during level 5 lockdown for infants (incidence rate ratio (IRR) compared with prelockdown 0.63, 95% CI 0.44 to 0.90), children aged 1-5 years old (IRR 0.43, 95% CI 028 to 0.65) and respiratory diagnoses (IRR 0.57, 95% CI 0.36 to 0.90). From level 4 to level 3, total admissions increased (IRR 1.17, 95% CI 1.06 to 1.28), as well as for men >19 years (IRR 1.50, 95% CI 1.17 to 1.92) and respiratory diagnoses (IRR 4.26, 95% CI 2.36 to 7.70). Among patients admitted to hospital, the odds of death decreased during level 5 compared with prelockdown (adjusted OR 0.48, 95% CI 0.28 to 0.83) and then increased in later stages. CONCLUSIONS: Level 5 lockdown is likely to have prevented the most vulnerable population, children under 5 years and those more severely ill from accessing hospital care in rural KZN, as reflected by the drop in admissions and odds of mortality. Subsequent increases in admissions and in odds of death in the hospital could be due to improved and delayed access to hospital as restrictions were eased. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/33737445/Effect_of_COVID_19_lockdown_on_hospital_admissions_and_mortality_in_rural_KwaZulu_Natal_South_Africa:_interrupted_time_series_analysis_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=33737445 DB - PRIME DP - Unbound Medicine ER -