Table 4

Studies on accessing healthcare services

First author (Journal)Country (ies)Type of studyMain subjectObjectivesAge (n)Lockdown /school closure and time of data collectionOutcome measuresOther factors (inequalities)Summary of results
Li M, et al. (PlosOne)29China (Wuhan)Analysis of register of perinatal dataPerinatal servicesTo compare the indications for caesarean delivery (CD) and the birth weights of newborns during and pre-lockdownN=3432 (out of 3,442) pregnant women who gave birth during lockdown and 7159 (out of 29,799) matched pregnant before lockdown.On 23 January 2020, the municipal government of Wuhan announced the lockdown of the entire city. Data were collected until March 14. Control group: from 1 January 2019 to 22 January 2020.Type of delivery. The neonates’ data including birth weight, clinical symptoms, Apgar score, and outcomesThere was no differences in CD between the observation and control groups. Birth weight in the observation group was heavier than that in the control group among those with >34 gestational weeks (p<0.05). There was no significant difference in neonatal asphyxia between the two groups.
Keays G, et al. (Health Promot Chronic Dis Prev Can)30Canada (Montreal Children’s Hospital)Data from the Canadian Hospitals Injury Reporting and Prevention Programme (CHIRPP)Use of healthcare services (ED)To evaluate if injury-related ED visits during the COVID-19 pandemic decrease.General population stratified by ageCompare data from a 2 months period during the COVID-19 lockdown (March 16 to May 15) to the same period in previous years (1993–2019).Visits to ED due to injuries: motor vehicle collisions, sports-related injuries and injuries that occurred during recreational activities.No dataCompared with the 2015–2019 average, the decrease was smallest in children aged 2–5 years (35% decrease), and greatest in the group aged 12–17 years (83%). More children aged 6–17 years presented with less urgent injuries during the COVID-19 lockdown.
Cheek JA, et al. (Emerg Med Australas)31Australia (four hospitals from Victoria)Analysis of ED registerUse of healthcare services (ED)To determine if changes to community-based services have affected paediatric ED attendances for mental health issues and neonates during the COVID-19 pandemic.<18 years and neonatal visitsClosure of borders to non-residents on 20 March 2020.Compare total visits to the ED, visits for mental health diagnoses and neonatal visits.There was 47.2% decrease in total presentations (26 871 vs 14,170), with significant difference in daily mean. Conversely, there was a 35% (485 vs 656) increase in mental health, while neonatal presentations did not change (2% increase, 498 vs 507.
Palladino F, et al. (Neurol Sci)32Italy. Santobono-Pausilipon Children’s Hospital (Southern Italy)Repeated cross-sectional study of clinical registersClinical health, seizuresTo compare the 2020 admissions for seizures at the ED with previous yearPatients (4–14 years) attending the ED for seizures n=57 Median age: 8.03 yearsCompare March 9 to up to May 4 and the same period for 2019Diagnoses previous (epilepsy) or notUse of devices, how contact with healthcare services57 patients 20 of them new patients compared with 13 in 2019 and other differences.
Dopfer C, et al. (BMC Pediatr)33Germany (Hanover)Healthcare services. ED utilisationRegistry of paediatric EDTo investigate paediatric emergency
Healthcare utilisation in a tertiary care centre
N=5424 visits in the study period. Mean age 7.1 yearsSchool closures beginning on March 16, and an official lockdown of public life, on 23 March 2020. Analysis: March 18 to April 14 in 2019 and March 16 to April 12 in 2020.Number of visits; ICD-10 diagnosesAge, sexIn 2020, case numbers decreased by 63.8% compared with the same period of 2019. The % of visits to children<1 year increased in 2020. The disease category with increased daily ER visits after the lockdown began was malignant/ neoplastic disease.
Valitutti F, et al. (Front Pediatr)34Italy (Campania region)Healthcare services use before afterED registryTo highlight the impact of the COVID-19 pandemic on ED consultationMean age=5.4 years in 2019 and 5.9 years in 2020Registers of trimester March–May 2019 vs registers of trimester March–May 2020Number of consultations, diagnoses, causes of emergency visitsMean paediatric ED daily consultations were 326.3 (95% CI 299.9 to 352.7) in March–May 2019 and 101.4 (95% CI 77.9 to 124.9) in March–May 2020 (p<0.001).
Chandir S, et al. (Vaccine)35Pakistan (Sindh)Analysis of Electronic Immunisation RegistryHealthcare services. Preventive measures. ImmunisationTo measure the reduction in daily immunisation rates in Sindh province, report antigen-wise coverage, and dropout rates for 0–23 month children, identify baseline characteristics associated with dropout, and observe the spatial distribution of immunisation activity.0–23 month childrenLockdown starting on 23 March 2020, was initially extended to May 9,2020. It was a complete ban on movement, and exemptions were given only to essential service providers, including health (including immunisation), law enforcement, utility, and telecommunications.Primary outcome of the analysis was the receipt of EPI recommended vaccinations (BCG, polio, penta, PCV10, rotavirus, and measles) during the COVID-19 lockdown period. Analysis of data from 23 September 2019 to 11 July 2020.There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared with baseline. The highest decline was seen for BCG (40.6% (958/2360) immunisation at fixed sites. Around 8438 children/day were missing immunisation during the lockdown. Enrolments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts.
Chelo D, et al. (Pediatr Pathol)36CameroonBefore after approachHospitalisation and mortality in the main paediatric hospital in YaoundeTo analyse the consequences of the pandemic on hospitalisation and on mortality in a paediatric hospital.Children (age not specified) paediatric ageockdown started on March 17.
Analysis: 1 to 30 June 2020 and covered the period from 1 January 2016 to 31 May 2020.
Hospitalisation rates and mortality rates by periodsA drastic drop in hospitalisation was noted coinciding with partial lockdown. At the same time, the number of deaths per month doubled though the causes remained the same as in the past.
  • BCG, bacillus Calmette Guerin; ED, emergency department; EPI, expanded programme on immunization; ICD, International clasification of disease.