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 initial 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 or at the transitions to the less stringent Level 4 and 3 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 Level 5, 4 and 3 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 60 days through the Level 5, 4 and 3 lockdowns. 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 46 523 people made 89 476 clinic visits during the observation period from 27 January to 30 June 2020. Women and girls accounted for 67% of the visits. The researchers found that the most common reason for a clinic visit was ART follow-up care, comprising 43% of all visits, followed by visits for minor ailments, child health and hypertension.

This work has also helped call attention to the need to minimise risk of transmission at healthcare centres for older-aged, high risk individuals with chronic diseases.

“Perhaps a silver lining to the Covid-19 epidemic has been its motivation to help improve chronic care delivery worldwide. To do so, AHRI is partnering with colleagues at the University of KwaZulu-Natal (UKZN) and the Department of Health to explore novel forms of healthcare delivery through increased use of community-based treatment and differentiated models of care,” added Dr Siedner.

The study is published in the scientific journal BMJ Open, and can be accessed here.

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