Article Text

Original research
Effect of COVID-19 lockdown on hospital admissions and mortality in rural KwaZulu-Natal, South Africa: interrupted time series analysis
  1. Amy McIntosh1,
  2. Max Bachmann1,
  3. Mark J Siedner2,3,
  4. Dickman Gareta2,
  5. Janet Seeley2,4,
  6. Kobus Herbst2,5
  1. 1Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
  2. 2Africa Health Research Institute, KwaZulu-Natal, South Africa
  3. 3Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  5. 5DSI-MRC South African Population Research Infrastructure Network, Durban, South Africa
  1. Correspondence to Dr Amy McIntosh; A.Mcintosh{at}doctors.org.uk

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.

  • public health
  • COVID-19
  • paediatrics
  • epidemiology
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Footnotes

  • Twitter @dickmangareta

  • Contributors MB, MJS, JS and KH conceived the study aims and hypothesis. KH and DG provided AHRI Hospital Information System data. AM and MB designed the study and conducted the statistical analysis, with advice from MJS. AM drafted the manuscript and prepared the tables, figures and final version for publication, with substantial amendment and oversight from MB. All authors discussed the results, critically revised the study and approved the final version of the manuscript.

  • Funding The Africa Health Research Institute is funded by Wellcome Trust (award 201433/Z/16/Z).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted for AHRI to collect and use data from patients attending the clinics and hospital by the University of KwaZulu-Natal Biomedical Research Ethics Committee (number and title: BE290/16 ‘A longitudinal population-based platform for epidemiology and intervention research'). This was a secondary analysis on this anonymised data set with permission from AHRI, so further ethical approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Statistical coding available on reasonable request from corresponding author. AHRI Hospital Information System data are available on request at https://data.ahri.org/index.php/home.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.