There has been a significant decline in children visiting hospitals and clinics during the covid-19 pandemic: Could children’s health be neglected in trying to manage the number of infections among adults?
In March 2020, South Africa implemented a nationwide lockdown in response to the coronavirus outbreak. The country faced multiple restrictions, economic activity was disrupted and limits on attendance at healthcare facilities were placed on hospitals and clinics to manage the number of infections.
For the government to manage the health system, children had to take a back seat as adults were more at risk of infection than children. This meant adult health was prioritised in clinics and hospitals over children’s health.
A study conducted by the University of Cape Town showed that children accounted for 4% of covid-19 positive cases, while adults accounted for 95%. This resulted in children’s needs being side-lined by the health system; resources were allocated to helping adults. Divisions in healthcare facilities such as paediatric wards were converted into covid-19 wards, with care and paediatrics personnel mandated to care for infected adults.
The health system’s prioritisation of covid-19 adult patients, and efforts to ensure there was prevention of infection among them, resulted in a striking decline in the number of admissions of children in primary healthcare facilities.
Mothers in a pandemic
Children in low- and middle-income countries such as South Africa are more likely to deal with challenges when accessing quality healthcare during the pandemic. The world at large responded with a ‘‘one size fits all’’ approach, which was to lock down countries and limit economic activity to ensure that social distancing was maintained to lessen the number of infections.
The hardships faced by children needing medical attention during the covid-19 pandemic can be better told through the stories of two mothers from different parts of Gauteng province. Nompumelelo Sibisi (26), mother of a two-year-old girl, from a small mining town in the west of the province, speaks of her fears and reservations about going to public healthcare facilities in her township.
Zola Ntenjwa (26), a young mother from Fourways, Sandton, relates her story of how she tested positive a few hours after giving birth at a private health facility.
In July 2021, when South Africa was facing the third wave of the pandemic, Sibisi grew very uncomfortable with visiting her local clinic due to fear of exposing herself and her child to the virus. “In local clinics there is no separation of lines; both adults and children queue in the same lines and you find there are people who are drunk in those lines; that cough without covering their mouths, and you don’t even know who has covid-19. So, I would fear for my life and my child’s life,” said Sibisi.
Her fears were worsened by the lack of adherence to the covid-19 protocols at health facilities. “Even though the security officers sanitised us when we got there, they did not take our temperature and they didn’t even make sure there was social distancing on the benches we were sitting on,” she said.
With all these experiences she contemplated going to private healthcare facilities instead, but she decided that getting treatment over the counter would be more accessible and convenient under these conditions. Sibisi explained, “Ever since I noticed that going to public clinics puts my child in danger, I never take my child there anymore. I have decided to buy over-the-counter medication.”
Sibisi’s experience is not unique, as many mothers faced similar circumstances with healthcare facilities around the same time. Ntenjwa, a young mother of two, was confronted with the reality of testing positive for covid-19 immediately after delivering her child at a private clinic in Sandton.
With the reality of being separated from her newly born baby during her isolation period, she soon had to deal with her older child not being able to access her immunisation due to the suspension of some healthcare services.
“With my older child at the clinic, they told me it was not a must for her to receive her immunisation as long as I came back within a year, and that would be when the numbers of infections had died down. That was such a relief to hear as I knew that me and my kids were protected,” she said. “But with my new baby it was a must to go to the clinic, as he still had to receive his first shots, but getting help would take longer as clinics were short-staffed and we would be helped in groups of five.”
Living under a pandemic, the private healthcare system became an expense for Ntenjwa. She then decided to switch from private hospital to public as this would be more feasible for her.
Ntenjwa shares one of the experiences that scared her and made her reluctant to take her children frequently to clinics or hospitals: “Because the number of nurses was not enough during the hard lockdown, there was a day I visited the clinic and they were helping us in numbers of five. Even though there was social distancing among the mothers, I just didn’t feel safe at all,” she said. “I was scared that I would leave this room infected and go infect everyone at home.”
Frontline care workers putting children first?
Lesedi Ntsane, a student nurse at a mother-and-child hospital in Johannesburg, spoke to Wits Vuvuzela about her experience of being a nurse caring for children during a pandemic.
Ntsane, a nurse without much field work experience, had to quickly adjust and accept that her practical learning experience in nursing would be the most challenging as a nurse still new on her journey as a frontline worker.
Ntsane details the daily protocol they would follow in the hospitals to ensure infections of covid-19 were managed, and children were still able to receive healthcare. She explained that during the high peaks of infection, in the hospital they would not encourage parents to come due to the fear of infecting one another. They always encouraged them to start at clinics first, then if the matter was more serious and required to be treated in hospital, then a referral and transfer of the patient would be made.
“We also encouraged parents to stay at home and treat any sickness that is not an emergency, such as flu,” Ntsane said.
However, with covid-19 numbers rising daily and children also getting sick from other illnesses, parents would still have to take their children to hospital to get treated. The hospitals developed a new manner of managing covid-19 while still being able to treat children without putting anyone at risk of contracting the virus.
“We treated every child patient like in the triage. We had red, yellow and green bands. Red was patients that needed emergency help now, yellow was for patients that needed to be at the hospital but not as big an emergency as red. When it came to green, some of the child patients would be turned back home as their emergencies could still be treated even when they came the following day,” Ntsane said.
The health care system in South Africa was also affected by the shortage of frontline workers. This put a strain on healthcare workers of having to work long hours and with having too many patients to attend to at once.
“The nurse ratio should be one to two, meaning I should be seeing two patients at once, but during covid-19 this has changed; the ratio is now one to five. I am attending to five patients at once. This really decreases the quality care a nurse can provide. You really try to attend to everyone’s need and provide quality care, but at times we might lack,” Ntsane explained.
Sindiswa Dlamini a paediatrics and child-health doctor at Chris Hani Baragwanath Hospital, told Wits Vuvuzela the decrease in the number of children admitted to hospitals and clinics was probably caused by communities not being aware that all clinical services were still open during the hard lockdowns in the country, and soon after the number of infections declined there would be follow-ups.
“I can’t speak for everyone, but where I work once things had calmed down, children with chronic diseases were being followed up at specific clinics and in the hospital. They were called and given new dates to be reviewed,” said Dlamini.
Can children be affected in the long run?
According to a study done by Scientific Electronic Library Online (SciELO) in KwaZulu-Natal, since the beginning of lockdown in March 2020 there was a decrease of 37% in clinical admissions and 50% in hospital admissions of children.
This indirect effect of covid-19 rose from reduced health coverage for children and the diversion of resources to try and contain covid-19.
Prof Haroon Salooje in the paediatric and child health department at Wits University told Wits Vuvuzela the decline in the number of children being admitted to health care was also caused by the reduction of infection of diseases such as diarrhoea and pneumonia, or any common viral disease in children such as influenza.
“The same covid-19 measures that helped protect against covid have also helped in reducing many infections of disease in children,” said Salooje.
The government has not had any child-centred approach for health systems to follow, to ensure that the number of children admitted to hospitals and clinics during covid-19 pandemic does not decrease further.
“There is nothing special that is being done in hospitals and clinics. It is back to the usual standard of care in health facilities,” said Salooje.
The impact of covid-19 on children is still under ongoing research. The main focus is still on looking at providing enough healthcare for adults to stop the spread of the virus.
Ntsane told Wits Vuvuzela the healthcare system still has a lot to improve when it comes to providing care for children. Mobile clinics in townships should still be considered, especially during a pandemic.
FEATURED IMAGE: Hand sanitising dispensers at a children’s hospital. Photo: Natasha Joos