Children’s healthcare takes a back seat during COVID-19

The COVID-19 pandemic has had profound impact on children’s healthcare provision.
Considered lower risk candidates for COVID-19, children's healthcare has been neglected during the pandemic. (Photo by Omotayo Kofoworola on Unsplash)

When the pandemic emerged, children were considered to be at a lower risk of infection and developing complications than adults, prompting the country to take an adult-centred approach to COVID-19.

This has resulted in children’s basic healthcare needs being neglected during the pandemic, explained Eastern Cape District clinical specialist paediatrician Dr Nomlindo Makubalo.

Child health services were sidelined from facilities and, at provincial level, there was no emphasis placed on ensuring that children’s essential services are not disrupted.

“Nurses running child health services were redistributed to focus on COVID-19 and there was no plan for dealing with children during the closure of public healthcare facilities,” said Makubalo.

She stated that following the outbreak of the pandemic, children’s needs were sacrificed for those of adults, as no community healthcare workers were deployed to see to children.

“There was no integration of services Community healthcare workers who should be our gatekeepers at community level to protect vulnerable children were redirected to contact tracing and testing. Opportunities were also lost during household visits, as their focus was only on COVID-19,” she said.

Huge gap in the system

Makubalo added: “In hospitals, there were no plans to cater for children with COVID-19. Children’s wards were sacrificed for adults. This left a huge gap in the system as in some hospitals there were no beds to admit sick children. There were no isolation wards for PUI (person under investigation) and confirmed cases, and no additional human resource for paediatrics.”


Three major effects

According to Professor Neil McKerrow, head of paediatric and child health at KwaZulu-Natal Department of Health, the pandemic had three key effects on children’s healthcare services: The closure or reduction of routine child health services during the first wave to release staff for COVID-19 tracing activities; a decline in preventative programmes; and an increase in neonatal deaths due to the impact on capacity to offer respiratory support to newborns.

“In KwaZulu-Natal, the direct impact of the virus on children has been limited. Children under 18 account of 12.3% of COVID-19 positive tests; 4% of COVID-19 admissions to hospital; and just 0,6% of COVID-19 deaths. COVID-19 deaths account for 1% of in-hospital deaths in children under five,” said McKerrow.

In the Eastern Cape, there has been an increase in severe acute malnutrition cases and an increase in fatality rates due to malnutrition. There was also an increase in diarrheal admission due to the rotavirus and an increase in diarrheal case fatalities.

In the Western Cape, the adult-centred COVID-19 efforts to prevent the spread of infections led to a significant drop in the coverage of essential child health services. According to the Children and COVID advocacy brief series, developed by the Children’s Institute, primary healthcare services for children under five dropped by almost 25%, leading to a decrease in the screening and treatment of acute malnutrition, HIV and tuberculosis (TB).

Routine health services take a knock

According to senior paediatrician Dr Gary Reubenson, there was a decline in routine health services in Gauteng such as vaccination, growth monitoring, antenatal care, TB and HIV services.

“The consequences are already being felt with children presenting with more advanced disease than previously. The impact will likely be with us for many years, particularly related to vaccine-preventable diseases,” said Reubenson.

Makubalo emphasised that community health workers should be utilised to focus on maternal and child health services with clear activities and expected outcomes to strengthen the health system, improve outcomes and support children better. Hotlines created for COVID-19 should also be integrated for maternal and child health services.

“We need hotlines that are going to support both clinicians and the community. Dedicated maternal and child health ambulances are critical to improving outcomes. Radio slots should be used to promote child health survival strategies like immunisation and breastfeeding,” said Makubo. – Health-e News


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