Changes in pediatric healthcare utilization in Hunan Province, China, during the COVID-19 pandemic: a multi-center cross-sectional study

Characteristics and influencing factors of caregivers' healthcare preferences for young children under COVID-19 lockdown: a cross-sectional study in Shanghai, China

BACKGROUND

Missed or delayed child healthcare caused by the COVID-19 lockdown has threatened young children's health and has had an unpredictable influence on caregivers' child healthcare preferences. This study investigated caregivers' child healthcare preferences and the factors that influence them among families with young children (0-3 years) during the lockdown in Shanghai.

METHODS

Participants in this cross-sectional study were enrolled through random encounter sampling. Questionnaires were distributed online from June 1 to November 10, 2022, in Shanghai. A total of 477 valid questionnaires were received. The demographics of caregivers and their families, children's characteristics, COVID-19-related information, and caregivers' healthcare preferences were analyzed. The statistical analyses included frequency and percentage, chi-square tests, and multinomial logistic regression.

RESULTS

Caregivers preferred child healthcare professionals in the community health service system (CHS; 47.6%) followed by hospital pediatricians (40.0%) during lockdown. Caregivers with the following characteristics preferred CHS: those with an annual household income of CNY 200,000-300,000, those whose youngest children were aged 8-12 months, and those who experienced early childhood physical development issues. Caregivers preferred hospitals if they had experienced healthcare-seeking-related difficulties in accessing professional guidance from hospital pediatricians.

CONCLUSIONS

During pandemic lockdowns, policymakers should allocate more resources to CHS to meet caregivers' childcare demands. Moreover, special attention should be given to the healthcare needs for CHS among families with specific demographics.

TRIAL REGISTRATION

Approval was obtained from the Ethics Committee of Shanghai Jiao Tong University School of Medicine School of Public Health (SJUPN-202,109; June 1, 2022).

Characteristics and spectrum changes of PICU cases during the COVID-19 pandemic: a retrospective analysis

Objective

This study aims to compare the changes in the disease spectrum of children admitted to the Pediatric Intensive Care Units (PICU) during the COVID-19 pandemic with the three years prior to the pandemic, exploring the impact of the COVID-19 pandemic on the disease spectrum of PICU patients.

Methods

A retrospective analysis was conducted on critically ill children admitted to the PICU of Hunan Children's Hospital from January 2020 to December 2022, and the results were compared with cases from the same period between January 2017 and December 2019. The cases were divided into pre-pandemic period (January 2017-December 2019) with 8,218 cases, and pandemic period (January 2020-December 2022) with 5,619 cases. General characteristics, age, and gender were compared between the two groups.

Results

Compared to the pre-pandemic period, there was a 31.62% decrease in the number of admitted children during the pandemic period, and a 52.78% reduction in the proportion of respiratory system diseases. The overall mortality rate decreased by 87.81%. There were differences in age and gender distribution between the two periods. The length of hospital stay during the pandemic showed no statistical significance, whereas hospitalization costs exhibited statistical significance.

Conclusion

The COVID-19 pandemic has exerted a certain influence on the disease spectrum of PICU admissions. Implementing relevant measures during the pandemic can help reduce the occurrence of respiratory system diseases in children. Considering the changes in the disease spectrum of critically ill PICU children, future clinical prevention and treatment in PICUs should continue to prioritize the respiratory, neurological, and hematological oncology systems.

Impact of COVID-19 Related Restrictions on Infections in Children with Cancer or after Hematopoietic SCTA

BACKGROUND

Infections are a major concern for immunocompromised children. We investigated whether non-pharmaceutical interventions (NPIs) implemented in the general population during the coronavirus disease 2019 (COVID-19) pandemic in Germany had an impact on frequency, type and severity of infections in these patients.

PATIENTS AND METHODS

We analyzed all admissions to the clinic of pediatric hematology, oncology and stem cell transplantation (SCT) with (suspected) infection or fever of unknown origin (FUO) from 2018 to 2021.

RESULTS

We compared a 27-month period before NPIs (Pre-COVID: 01/2018-03/2020; 1041 cases) with a 12-month period with underlying NPIs (COVID: 04/2020-03/2021; 420 cases). During the COVID period the number of in-patient stays with FUO or infections decreased (38,6 cases/month vs. 35,0 cases/month), the median duration of hospital stays was longer (8 d (CI95: 7-8 d) vs. 9 d (CI95: 8-10 d) P=0,02)), the mean number of antibiotics per case increased (2,1 (CI95: 2,0-2,2) vs. 2,5 (CI95: 2,3-2,7); P=0,003)) and a substantial reduction of viral respiratory and gastrointestinal infections per case was seen (0,24 vs. 0,13; P<0,001). Notably, there was no detection of respiratory syncytial virus, influenza and norovirus, between May 2020 and March 2021. Based on need of intensive care measures and further parameters we conclude that severe (bacterial) infections were not significantly reduced by NPIs.

CONCLUSIONS

Introduction of NPIs in the general population during the COVID-pandemic substantially reduced viral respiratory and gastrointestinal infections in immunocompromised patients, while severe (bacterial) infections were not prevented.

Impact of school closures on pediatric ambulance transport in Japan

BACKGROUND

After the coronavirus disease (COVID-19) pandemic, nationwide school closures were implemented in many countries. This study aimed to determine the impact of the school closures on pediatric ambulance transport, comparing the situation before and after the COVID-19 pandemic.

METHODS

This retrospective observational study was conducted using data from the Kochi-Iryo.net database. In Kochi prefecture, schools were closed from March 6 to May 24, 2020. Pediatric emergency transport during the school closure period in 2020 was compared with that in the same period in 2019 (before the COVID-19 pandemic) and in 2021 (when schools were not closed). Statistical analysis comprised χ² tests with Bonferroni adjustments for multiple testing. To adjust for patient backgrounds, we also performed multiple logistic regression analyses for numbers of pediatric ambulance transports.

RESULTS

The rate of pediatric ambulance transports was significantly lower (p = 0.008) in 2020 (276; 3.97%) than in 2019 (391; 4.87%), but there was no significant difference (p = 0.360) between 2019 (391; 4.87%) and 2021 (352; 4.56%). Multivariable analysis revealed similar trends (2019 vs. 2020: OR 0.86, 95% CI 0.73-1.00; 2019 vs. 2021: OR 0.96, 95% CI 0.82-1.11). Regarding the characteristics of pediatric ambulance transport journeys, there were no significant differences in 2019, 2020, and 2021 in terms of sex, severity, locations of ambulance stations, and disease classification.

CONCLUSIONS

There was a decrease in pediatric ambulance transportation due to the public health interventions for COVID-19, including school closures. However, this decrease was not solely due to school closures.

COVID-19 Pandemic and Hospital Efficiency in Iran: Insight from an Interrupted Time Series Analysis and Pabon Lasso Model

Background

Limited evidence exists on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on hospital efficiency worldwide. This study aimed to investigate the impact of the COVID-19 pandemic on public hospitals in Iran.

Methods

In this quasi-experimental study, monthly data on the average length of stay (ALoS), bed occupancy rate (BOR), bed turnover rate (BTR) and bed turnover interval (BTI) were collected for 58 months (36 months before and 22 months after the COVID-19 outbreak in Iran) from the health information systems of all 18 public hospitals affiliated with Kermanshah University of Medical Sciences in Kermanshah province, Iran. We used interrupted time series analysis and the Pabon Lasso model to investigate the impact of the COVID-19 pandemic on hospital efficiency.

Results

The monthly average ALoS, BOR, BTR and BTI before (after) the COVID-19 pandemic was 3.30 (3.48) days, 70.14% (49.37), 6.78 (4.81) patients per bed and 1.15 (2.88) days, respectively. The study indicated that a statistically significant decrease in ALoS of 0.29 and BOR of 25.09 in the first month following the COVID-19 pandemic. Compared with the before pandemic period, we observed a significant increase in the monthly trend of ALoS (coefficient = 0.021; p = 0.015), BOR (coefficient = 1.30; p = 0.002), and BTR (coefficient = 0.08, p = 0.012). We found a significant decrease in the monthly trend in BTI (coefficient = -0.11, p = 0.009) after the COVID-19 pandemic when compared with before the pandemic. Based on the Pabon Lasso model, before (after) the pandemic, 29.4% (29.4%) of the hospitals were located in zone 1 as an inefficient area, and 17.6% (35.3%) of hospitals were located in zone 3 as an efficient area.

Conclusion

The study demonstrated that the BOR and BTR decreased substantially after the outbreak of COVID-19. In contrast, the ALoS and BTI have significantly increased following the COVID-19 pandemic. We also found that hospitals' performance in both periods was poor, and only 30% of hospitals were located in the efficient zone (zone three) based on the Pabon Lasso model. Further studies aimed at identifying the main factors affecting lower efficiency among hospitals in Iran are recommended.

Impact of COVID-19 on paediatric admissions to a Chinese hospital: a single-centre retrospective chart review

OBJECTIVE

To explore the impact of the COVID-19 on the distribution, type and patterns of diseases in hospitalised children under local antiepidemic measures.

DESIGN

Retrospective chart review.

SETTING

Electronic medical records of patients hospitalised in the paediatric department of a tertiary hospital in South China from 21 January 2019 to 20 January 2021.

PARTICIPANTS

Records of 2139 patients.

OUTCOME MEASURES

Data were analysed before and during the COVID-19 pandemic. Disease characteristics were analysed based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Features of the length of hospital stay were investigated. Categorical variables involving more than three groups were analysed using an overall χ² test, followed by pairwise comparisons.

RESULTS

During the COVID-19 outbreak period, paediatric hospitalisation was reduced by 29.6%, from 1255 to 884. The proportions of infection-related diseases (36.3% (455 cases) vs 20.8% (184 cases)), respiratory system-related diseases (22.5% (283 cases) vs 9.4% (83 cases)); and endocrine, nutritional and metabolic diseases (17.1% (214 cases) vs 9.2% (81 cases)) decreased significantly, whereas that of musculoskeletal and connective tissue diseases increased from 11.0% (138 cases) to 20.1% (178 cases), thereby becoming the most common reason for hospitalisation. The proportions of diseases of the nervous system (12.4% (156 cases) to 18.8% (166 cases)) and mental and behavioural disorders (0.2% (3 cases) to 2.1% (19 cases)) increased significantly. The average length of hospital stay increased after the outbreak (7.57±6.53 vs 8.36±6.87).

CONCLUSION

The number of hospitalisation cases decreased during the COVID-19 period. The prominent decreases in hospitalisation associated with infections and respiratory system diseases were likely attributed to the improved epidemic prevention work, enhancement of people's health awareness and fear of possible exposure to COVID-19. Describing the impact of COVID-19 on disease patterns may provide a reference for resource planning during the pandemic.

Changes in inpatient admissions before and during COVID-19 outbreak in a large tertiary hospital in Shanghai

Background

The coronavirus disease 2019 (COVID-19) outbreak caused a significant strain on healthcare resources and utilization worldwide. However, the impact of COVID-19 outbreak on patient hospitalization was barely known. This study aimed to determine the impact of the outbreak on the pattern of inpatient hospital admissions to help allocate health care resources during a pandemic.

Methods

This retrospective study included patients who were hospitalized in a tertiary teaching hospital in Shanghai between 1 January and 30 April across the years 2017 to 2020. The number of hospitalizations during the study period from 2017 to 2020 were 30,605, 31,464, 32,812 and 24,163, respectively. Changes in patient volumes and the frequency of the International Classification of Diseases and Related Health Problem Tenth Edition (ICD-10) codes before and after the onset of the COVID-19 outbreak were analyzed and presented as absolute and relative differences with 95% confidence intervals between periods of different years.

Results

Overall inpatient hospital admissions decreased by 26.35% between January and April 2020, compared to the same period in 2019. The average age of patients in 2020 was higher compared to those from 2017 to 2019. Conversely, the proportions of self-paying patients and non-local patients were significantly lower between January and April 2020 compared to the same period in the previous three years. The top five ICD-10 codes remained common before and during the pandemic. Admissions associated with antineoplastic radiation therapy, chemotherapy, and immunotherapy increased in frequency and proportion by 2020 (difference, 5.6%, 95% CI: 4.4% to 6.8%), and increased proportions were observed for liver and intrahepatic bile duct malignancies (2.18%, 95% CI: 1.15% to 3.21%), cerebral infarction (2.27%, 95% CI: 0.54% to 4.00%), and chronic kidney disease (3.56%, 95% CI: 1.79% to 5.33%).

Conclusions

There was a significant reduction in the number of inpatients and a marked change in admission diagnoses during the COVID-19 outbreak. Our findings are useful for making informed decisions on hospital management and reallocation of available health care resources during a pandemic.

The impact of COVID-19 on paediatric emergency department visits. A one-year retrospective study

BACKGROUND

The number of paediatric emergency department (ED) visits and hospital admissions was recorded in a tertiary referral centre during the first year of the COVID-19, March 2020-February 2021, and compared with those of the preceding year.

METHODS

The number of visits and admissions and the reason of visit and admission were prospectively recorded from 15,087 patients' files.

RESULTS

A substantial decline in the total number of visits and increase in the admission rate were documented during the COVID-19 year compared to the preceding year (10691 vs 4396 patients, 22.59% vs 18.15% (OR: 1.316, CI 95%: 1.208-2.242, p < 0.0001), respectively). Fever and/or respiratory symptoms were the commonest reported symptoms in both periods. Possible explanations include: (i) restricted overall infection transmission due to confinement and self-protective measures, (ii) avoidance of unnecessary hospital visits in the absence of severe symptoms and (iii) reduced or delayed access to medical care due to parental fear of children's exposure to COVID-19.

CONCLUSION

This study is the first worldwide to investigate the impact of COVID-19 on ED visits and admissions throughout the whole year of the pandemic, and to highlight the need for re-evaluation of future protective strategies to infections, adjustment of health-care systems and parental education so that medical care in a health-care setting is sought in a more appropriate manner.

IMPACT

A significant decline in paediatric ED visits and increase in the admission rate was observed during the first year of COVID-19 in a tertiary referral centre, possibly due to reduced overall infection transmission, limited ED overuse, but also ED underuse due to parental fear of children's exposure to SARS-CoV-2. COVID-19 may serve as an opportunity for societies to re-evaluate future strategies to infections, adjust health-care systems accordingly, and reinforce parents to seek medical care more appropriately. Although the incidence of critical illness in children due to COVID-19 and in general is low, special attention should be devoted to identifying children at risk early.