Impact of COVID-19 pandemic on paediatric services at a referral centre in Pakistan: lessons from a low-income and middle-income country setting

摘要

The COVID-19 pandemic has disrupted health and health systems worldwide, and most countries have still not recovered from the immediate effects of the increased mortality and morbidity due to severe acute respiratory syndrome coronavirus 2 infection. This, in addition to the devastating economic consequences of the prolonged lockdowns, will challenge both developed and developing countries irrespective of their health infrastructure for years to come. It is predicted that these adverse health consequences will disproportionately affect the most vulnerable members of society—our children. Although most children are going to recover uneventfully from the infection, the impact of the disruption on the usual care of children such as school, sports and health-related activities including routine immunisations and preventative care visits is predicted to have severe consequences for the health of children in our part of the world. In a country where routine immunisation coverage was already poor prepandemic, a huge number of children have now missed and will further miss their vaccinations. The consequences unfortunately are already being seen, with multiple new measles and diphtheria cases being reported across the country. One of the serious challenges we are facing is with our National Polio Program, where approximately 25 000 polio workers have been diverted to help with the COVID-19 response. The national campaign has been postponed where 40 million children under the age of 5 years were going to be vaccinated. Vaccination centres have been closed during most of this period. There is also a growing concern among paediatrics providers that this lack of access to preventative and specialised care to millions of children will ultimately lead to a huge surge in preventable morbidity and mortality. In an attempt to address this problem, we have systematically studied the disruption in clinical activity at our Children’s Hospital at the Aga Khan University, Karachi, and have observed patterns that would help to get routine clinical care back on track.