A new study from Africa Health Research Institute (AHRI) about the effect of the Covid-19 lockdown on access to healthcare found a largely resilient primary healthcare system in rural KwaZulu-Natal (KZN) among adults, but some early warning signs for child health.

In the uMkhanyakude district, visits for perinatal care and family planning remained consistent after the lockdown went into effect, and HIV care visits briefly increased just after the lockdown. However, vaccination and growth monitoring visits for children dropped by 50% just after the lockdown, with a slow return to near normal as the Level 5 lockdown ended.

The study set out to explore the impact of the Covid-19 lockdown on access to basic healthcare services in a rural setting. Despite anticipating an immediate and substantial drop in clinic visits during the lockdown period, the authors report there was no overall reduction in the number of adult visits per clinic per day during Level 5 of lockdown.

This is a positive finding for uMkhanyakude, where around one in five adult men and two in five adult women are living with HIV. The rate of new tuberculosis infections in the area is one of the highest in the world, and there is a large burden of diseases such as diabetes and hypertension. It is therefore crucial that residents have access to chronic medication and care.

“Our findings point to an unexpected resilience in the rural primary healthcare system for access to chronic and essential basic health services during the early stages of lockdown,” said AHRI Faculty Member Dr Mark Siedner, who is lead author on the paper. “However, recent modelling in low and middle-income countries suggests that even modest reductions in child healthcare could result in hundreds of thousands of additional deaths. Future work should assess whether the drop we found in child health visits will result in longer term health effects. Catch-up vaccinations campaigns, for example, might be required to limit the fallout.”

Study staff recorded information about each person attending clinics, and the reason for clinic attendance, in 11 clinics in the rural uMkhanyakude area of northern KwaZulu-Natal. They compared these data for the 60 days prior to the lockdown with the Level 5 lockdown period itself. The analysis relied on AHRI’s unique ‘Clinic Link’ system, which connects detailed demographic information from the Institute’s long-standing and pivotal household surveillance programme to clinic visit records. Clinic Link is done in partnership with the Department of Health. Overall, a total of 36,291 people made 55,545 clinic visits during the observation period from 27 January to 29 April 2020.

“It is expected that as the non-pharmaceutical measures against Covid-19 continue, people will start to experience additional barriers to accessing healthcare,” added AHRI Faculty Member and senior author on the paper, Dr Kobus Herbst. “We are also concerned that once there is more widespread community transmission of Covid-19, issues such as social fear and reduced access to public health services may lead to more people getting very ill and dying of non-Covid related illnesses. Future work should therefore explore efforts to decentralise chronic care for those at high-risk.”

The study is published as a preprint on medRxiv, and has not yet been peer reviewed.

(Top photo: Signage for Somkhele Clinic. Ben Gilbert, Wellcome)