Patterns of disease on admission to children’s wards and changes during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa
Authors:   Health Systems Strengthening Unit, Health Systems Trust, Durban, South Africa, Jensen C , Yannigan Y ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, Mafanya N ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, Majozi N ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, Martin T ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, Mnuguni T ,   Department of Paediatrics and Child Health, General Justice Gizenga Mpanza Regional Hospital, KwaZulu-Natal Department of Health, South Africa; African Paediatric Fellowship Programme, Moodley K ,   Department of Paediatrics and Child Health, KwaZulu-Natal Department of Health, South Africa, Morgan M E ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, Moses K ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa, Ntombela Z ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, Pansegrouw A E ,   Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Ramsden D ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, van Lobenstein J ,   Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Paediatrics and Child Health, General Justice Gizenga Mpanza Regional Hospital, KwaZulu-Natal Department of Health, South Africa, McKerrow N H ,   Department of Paediatrics and Child Health, Pietermaritzburg Hospital Complex, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, KwaZulu-Natal Department of Health, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
Published: April 2022

Background. Major causes of under-5 child deaths in South Africa (SA) are well recognised, and child mortality rates are falling. The focus of child health is therefore shifting from survival to disease prevention and thriving, but local data on the non-fatal disease burden are limited. Furthermore, COVID-19 has affected children’s health and wellbeing, both directly and indirectly. Objectives. To describe the pattern of disease on admission of children at different levels of care, and assess whether this has been affected by COVID-19. Methods. Retrospective reviews of children’s admission and discharge registers were conducted for all general hospitals in iLembe and uMgungundlovu districts in KwaZulu-Natal Province, SA, from January 2018 to September 2020. The Global Burden of Disease framework was adapted to create a data capture sheet with four broad diagnostic categories and 37 specific cause categories. Monthly admission numbers were recorded per cause category, and basic descriptive analysis was completed in Microsoft Excel. Results. Overall, 36 288 admissions were recorded across 18 hospital wards, 32.0% at district, 49.8% at regional and 18.2% at tertiary level. Communicable diseases, perinatal conditions and nutritional deficiencies (CPNs) accounted for 37.4% of admissions, non-communicable diseases (NCDs) for 43.5% and injuries for 17.1%. The distribution of broad diagnostic categories varied across levels of care, with CPNs being more common at district level and NCDs more common at regional and tertiary levels. Unintentional injuries represented the most common cause category (16.6%), ahead of lower respiratory tract infections (16.1%), neurological conditions (13.6%) and diarrhoeal disease (8.4%). The start of the local COVID-19 outbreak coincided with a 43.1% decline in the mean number of monthly admissions. Admissions due to neonatal conditions and intentional injuries remained constant during the COVID-19 outbreak, while those due to other disease groups (particularly respiratory infections) declined. Conclusions. Our study confirms previous concerns around a high burden of childhood injuries in our context. Continued efforts are needed to prevent and treat traditional neonatal and childhood illnesses. Concurrently, the management of NCDs should be prioritised, and evidence-based strategies are sorely needed to address the high injury burden in SA.