Drastic reduction of orthopaedic services at an urban tertiary hospital in South Africa during COVID-19: Lessons for the future response to the pandemic

Waters, Rob; Dey, Roopam; Laubscher, Maritz; Dunn, Robert; Maqungo, Sithombo; McCollum, Graham; Nortje, M; Roche, Steven; Hilton, Thomas L.; Held, Michael

doi:10.7196/samj.2021.v111i3.15263

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…These findings were valid for pediatric and adult populations across specialty clinics [ 20 – 22 ]. Moreover, reports from South Africa also showed a drastic decrease in outpatient visits [ 23 ] and a substantial decrease in the number of patients presenting to the emergency care during the lockdown period due to COVID 19 [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Trends of follow-up clinic visits and admissions three-months before and during COVID-19 pandemic at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: an interrupted time series analysis

Abebe

Worku

Moges

et al. 2021

BMC Health Serv Res

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Background Following the first report of the COVID-19 case in Ethiopia on March 13, 2020, the country promptly adopted a lockdown policy to contain the virus’s spread. Responding to the healthcare burden imposed by the COVID-19 pandemic had to be coupled with ensuring essential health care services. This study assessed the impact of COVID-19 on the trends in hospital visits and admissions at Tikur Anbessa Specialized Hospital by comparing the rate of follow-up clinic visits and admissions for the 3 months before and after the first report of the COVID-19 case. Methods A retrospective, time-series study examined the trend in follow-up visits and admissions between December 11, 2019, to June 7, 2020, with the 1st case of the COVID-19 report in Ethiopia (March 13, 2020) as a reference time. To control seasonal effects and random fluctuation, we have compared health care utilization to its equivalent period in 2018/19. A data extraction tool was used to collect secondary data from each unit’s electronic medical recordings and logbooks. Results A total of 7717 visits from eight follow-up clinics and 3310 admissions were collected 3 months before the onset of COVID-19. During the following 3 months after the onset of the pandemic, 4597 visits and 2383 admissions were collected. Overall, a 40.4% decrease in follow-up visits and a 28% decline in admissions were observed during the COVID-19 pandemic. A drop in the daily follow-up visits was observed for both genders. The number of visits in all follow-up clinics in 2019/2020 decreased compared to the same months in 2018/19 (p < 0.05). Follow-up visits were substantially lower for renal patients (− 68%), patients with neurologic problems (− 53.9%), antiretroviral treatment clinics (− 52.3%), cardiac patients (− 51.4%). Although pediatric emergency admission was significantly lower (− 54.1%) from the baseline (p = 0.04), admissions from the general pediatric and adult wards did not show a significant difference. Conclusions A decline in follow-up clinic visits and emergency admissions was observed during the first months of the COVID-19 pandemic. This will increase the possibility of avoidable morbidity and mortality due to non-COVID-19-related illnesses. Further studies are needed to explore the reasons for the decline and track the pandemic’s long-term effects among non-COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Trends of follow-up clinic visits and admissions three-months before and during COVID-19 pandemic at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: an interrupted time series analysis

Abebe

Worku

Moges

et al. 2021

BMC Health Serv Res

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“…Our data was consistent with our colleagues in Cape Town, comparing a tertiary hospital in Cape Town to one in Johannesburg; however, our study further looked at the availability and prohibition of alcohol, and the effects thereof. 25 Our study showed a significant increase in admissions of 112% from when alcohol was banned in alert level 4, to when it was available in alert level 3 (3a) (Figure 4). The change in admissions between alert levels 4, 3 (3a) and 3 (3b) suggests the influence alcohol has on orthopaedic trauma.…”

Section: Discussionmentioning

confidence: 58%

The impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg

et al. 2022

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BACKGROUND: The novel coronavirus (SARS-CoV-2), commonly known as Covid-19, has caused a global economic and healthcare crisis. Many countries tried to curb the spread of the virus by implementing various lockdown restrictions to reduce transmission. The Republic of South Africa (RSA) implemented an alcohol ban as one of the lockdown restrictions. The objectives were to describe the effect of the lockdown alert levels and alcohol availability on orthopaedic trauma admissions, compared to the preceding two years. METHODS: A retrospective review of clinical records was conducted. Data included orthopaedic trauma admissions for the five-month period in a facility in Johannesburg from 27 March to 31 August in the years 2018, 2019 and 2020. Lockdown alert levels were categorised according to the Department of Health which included the ban, reintroduction and re-banning of alcohol consumption. Data collected for 2018, 2019 and 2020 included demographics of sex and age, as well as fracture location, open or closed injuries, polytrauma patients and gunshot injuries. RESULTS: Overall, 672, 621 and 465 patients were admitted in 2018, 2019 and 2020, respectively. There was a decrease of 25% of orthopaedic trauma admissions during the five-month lockdown period in 2020 compared to 2019 (p-value = 0.020) and 30% from 2020 compared to 2018 (p-value = 0.010). In 2020, admissions increased by 112% (n = 82) from alert level 4, when alcohol was banned, to alert level 3 (3a), when alcohol was reintroduced. Admissions decreased by 33% (n = 51) from alert level 3 (3a) to alert level 3 (3b), when alcohol was re-banned. Motor vehicle accidents (MVAs) were the commonest cause of admissions in alert level 3 (3a), accounting for 41% (n = 56). Covid-19 tests were positive in 10% (n = 34) of the 346 tests performed on orthopaedic trauma admissions CONCLUSION: Our study showed the decrease in orthopaedic trauma admissions due to the Covid-19 lockdown regulations. Furthermore, our study demonstrated the impact of alcohol availability on orthopaedic trauma admissions in a central academic hospital in Johannesburg. Level of evidence: Level 4.

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“…[7,8] The restrictions were relaxed to some extent with migration to level 4 lockdown on 1 May 2020, and were eased further under level 3 on 1 June, when the sale of alcohol was permitted between Monday and Thursday, during daytime only. [9] Navsaria et al [10] and Waters et al [11] reported a decline in trauma cases in Cape Town during the hard lockdown period, but we are not aware that the situation has been evaluated in the northern part of SA.…”

Section: Researchmentioning

confidence: 99%

The impact of COVID-19 national lockdown on orthopaedic trauma admissions in the northern part of South Africa: A multicentre review of tertiary- and secondary-level hospital admissions

Rachuene

Masipa²,

Dey

et al. 2021

S Afr Med J

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Drastic reduction of orthopaedic services at an urban tertiary hospital in South Africa during COVID-19: Lessons for the future response to the pandemic

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 11 publications

References 20 publications

Trends of follow-up clinic visits and admissions three-months before and during COVID-19 pandemic at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: an interrupted time series analysis

Trends of follow-up clinic visits and admissions three-months before and during COVID-19 pandemic at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: an interrupted time series analysis

The impact of the COVID-19 lockdown restrictions on orthopaedic trauma admissions in a central academic hospital in Johannesburg

The impact of COVID-19 national lockdown on orthopaedic trauma admissions in the northern part of South Africa: A multicentre review of tertiary- and secondary-level hospital admissions

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