Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Öz

Amaç: Pandemi dünya çapında birçok merkezde sağlık hizmetlerine erişimi sekteye uğratmıştır. Hastalık Kontrol ve Önleme Merkezleri (CDC), pandemi hastaneleri ile diğer hastaneleri ayırarak, doktorların acil başvurulara öncelik vermesini, elektif ameliyatları ertelemesini ve mümkünse ayaktan hasta muayenelerini tele-sağlık çağrılarına dönüştürmelerini tavsiye etmiştir. Bu süreçte dünyada sağlam çocuk takiplerinde ve rutin çocukluk çağı aşılamasında duraksamalar oldu. Bu çalışma ile pandeminin rutin bağışıklama takvimi, yenidoğan tarama programı, kronik hastalık takipleri ve poliklinik ziyaretlerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya rutin bağışıklama çağındaki 401 çocuk ve ebeveynleri dahil edildi. Pandemi öncesi ve sırasında polikliniğe başvuru özellikleri ile çocukluk çağı aşılama ve yenidoğan tarama programına uyumları sorgulandı. Bulgular: 2021 yılına kıyasla 2022’de hem üst solunum yolu enfeksiyonu semptomu gösteren hasta sayısında hem de bu hastaların hastaneye başvurularında anlamlı artış saptandı. 2022 yılında ishal semptomu olanlarda hastaneye başvuru oranları artarken alt solunum yolu enfeksiyonu semptomu olan hastaların ise tamamına yakını her iki dönemde de hastaneye başvurduklarını belirttiler. Türkiye'de pandemi sürecinde rutin aşılama ve yenidoğan tarama programlarının başarıyla yürütüldüğü görüldü. Çocukların kronik hastalık takiplerine 2021 yılında önemli ölçüde ara verildiği öğrenildi. Sonuç: Bu çalışma, Türkiye'de Covid-19 pandemisinin farklı dönemlerinde sağlık sisteminin 3 ana bileşeninin (poliklinik ziyaretleri, sağlıklı çocuk kontrolleri ve kronik hastalık takipleri) nasıl etkilendiğini göstermiştir. Çocukluk çağı aşılamalarında ve neonatal tarama programındaki başarılı yönetim, pandemi ve pandemi dışı hastanelerin ayrılmasıyla kronik hastalık takibinde de sağlanmalıdır. Pandemi sürecinde sağlık sisteminde uygulanan stratejilerin güçlü ve zayıf yönlerini belirlemek, gelecekte oluşabilecek benzer durumlar için alınacak önlemler konusunda yol gösterici olacaktır.

Anahtar Kelimeler

• Covid-19
• Pandemi
• Aşılama
• Yenidoğan tarama programı
• Poliklinik başvuruları

Proje Numarası

(E. Kurul – 2012-KAEK-15/2403, 26/10/2021)

The Continuity of Well Child and Chronic Disease Check Ups During Covid- 19 Pandemic and Comparison of Its Effect on Outpatient Visits in Early and Late Period

Öz

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

Anahtar Kelimeler

• Neonatal Screening
• Pandemic
• Covid-19
• Vaccination
• outpatient visits
• Childhood

Destekleyen Kurum

This research received no external funding. Study approved by the Institutional ethical commite ((E. Kurul – 2012-KAEK-15/2403, 26/10/2021)

Proje Numarası

(E. Kurul – 2012-KAEK-15/2403, 26/10/2021)

Teşekkür

We wish to express our profound appreciation to Prof Dr Medine Aysin TASAR who doesn't hesitate her support in the discussion of the present paper. We thank to Prof. Dr. Dario Iafusco, who checked the study for English language rules.

Kaynakça

1. 1. Madhav N, Oppenheim B, Gallivan M, Mulembakani P, Rubin E, Wolfe N. Pandemics: Risks, Impacts, and Mitigation. In: Jamison DT, Gelband H, Horton S, et al., eds. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; November 27, 2017.
2. 2. WHO Coronavirus (COVID-19) Dashboard. Global Situation. Available at: https://COVID19.who.int/. (Accessed January 20, 2023).
3. 3. Ozen G, Zanfardino A, Ozen G, Acan B, Piscopo A, Casaburo F, et al. Comparison of emotional approaches of medical doctors against COVID-19 pandemic: Eastern and Western Mediterranean countries. Int J Clin Pract. 2021;75(12):e14973. doi:10.1111/ijcp.14973
4. 4. Centers for Disease Control and Prevention. Interim Guidance for routine and ınfluenza ımmunization services during the COVID-19 pandemic. Available at: https://www.cdc.gov/vaccines/pandemic-guidance/ index.html. Published 2020. Updated June 20, 2021. (Accessed January 20, 2023).
5. 5. Bramer CA, Kimmins LM, Swanson R, Kuo J, Vranesich P, Jacques- Carroll LA, et al. Decline in child vaccination coverage during the COVID-19 pandemic - Michigan Care Improvement Registry, May 2016-May 2020. Am J Transplant. 2020;20(7):1930-1. doi:10.1111/ ajt.16112
6. 6. Buonsenso D, Cinicola B, Kallon MN, Iodice F. Child healthcare and ımmunizations in Sub-Saharan Africa during the COVID-19 pandemic. Front Pediatr. 2020;8:517. doi:10.3389/fped.2020.00517
7. 7. MacDonald NE, Comeau JL, Dubé È, Bucci LM. COVID-19 and missed routine immunizations: designing for effective catch-up in Canada. Can J Public Health. 2020;111(4):469-472. doi:10.17269/ s41997-020-00385-4
8. 8. Harris RC, Chen Y, Côte P, Ardillon A, Nievera MC, Ong-Lim A, et al. Impact of COVID-19 on routine immunisation in South-East Asia and Western Pacific: Disruptions and solutions. Lancet Reg Health West Pac. 2021;10:100140. doi:10.1016/j.lanwpc.2021.100140.

9. 9. Erdogan SS, Gur TF, Dogan B. Assessment of children and adolescent presenting to the dermatology outpatient clinic in Turkey during the coronavirus disease-2019 pandemic. North Clin Istanb. 2021;8(4):340-344. doi:10.14744/nci.2020.90836
10. 10. Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges. To the Point (blog); Commonwealth Fund, May 19, 2020. doi:10.26099/ds9e-jm36.
11. 11. Şimşek Orhon F. Genişletilmiş Bağışıklama Programına Her Yönüyle Bakış. Osmangazi Tıp Dergisi. 2020; 6-14.
12. 12. Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, et al. Pediatric severe acute respiratory syndrome Coronavirus 2 (SARSCoV- 2): Clinical presentation, ınfectivity, and immune responses. J Pediatr. 2020;227:45-52.e5. doi:10.1016/j.
13. 13. Third Round of The Global Pulse Survey on Continuity of Essential Health Services During the COVID-19 Pandemic: November–December 2021. WHO/2019-nCoV/EHS_continuity/survey/2022.1. World Health Organization, Geneva 2022. (Accessed January 20, 2023).
14. 14. World Health Organization. WHO and UNICEF warn of a decline in vaccinations during COVID-19 (2020). Available at: https://www. who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline- in-vaccinations-during-COVID 19pandemic. (Accessed January 20, 2023).
15. 15. COVID-19 pandemic leads to major backsliding on childhood vaccinations, new WHO, UNICEF data shows; 2022. Available at: https:// www.who. int/news/item/15-07-2021-COVID-19-pandemic-leads- to-major-backsliding-on-childhood-vaccinations-new-who-unicef- data-shows. (Accessed January 20, 2023).
16. 16. World Health Organization Regional Office for Europe (WHO/Europe). Guidance on routine immunization services during COVID-19 pandemic in the WHO European Region, 20 March 2020. Copenhagen: WHO/ Europe; 2020. Available at: https://apps.who.int/iris/handle/ 10665/334123 (Accessed January 20, 2023).
17. 17. Aizawa Y, Katsuta T, Sakiyama H, Tanaka-Taya K, Moriuchi H, Saitoh A. Changes in childhood vaccination during the coronavirus disease 2019 pandemic in Japan. Vaccine. 2021;39(29):4006-12. doi:10.1016/j.vaccine.2021.05.050.
18. 18. McDonald HI, Tessier E, White JM,Woodruff M, Knowles C, Bates C, et al. Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020. Euro Surveill. 2020;25(19):2000848. doi:10.2807/1560-7917.ES.2020.25.19.2000848.
19. 19. Masresha BG, Luce R Jr, Weldegebriel G, Katsande R, Gasasira A, Mihigo R. The impact of a prolonged ebola outbreak on measles elimination activities in Guinea, Liberia and Sierra Leone, 2014-2015. Pan Afr Med J. 2020;35:8. doi:10.11604/pamj.supp.2020.35.1.19059.
20. 20. Başaran B, Soytutan Çağlar I, Aygun A, Ozdemir TA, Kulali B. Health Statistics Yearbook 2019. General Directorate of Health Information Systems, Ministry of Health, Ankara, 2021. ISBN: 978-975-590- 793-2
21. 21. Kaçmaz Ersü N, Ersü A, Öztürk YK, Helvacı M, Öngel K. Gastroenterit tanısı ile hastanede yatan çocukların özellikleri ve ebeveynlerin rotavirüs aşısı hakkındaki bilgi düzeyleri. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi. 2016;6(3):203- 8.
22. 22. Mehrotra A Chernew M Linetsky D, Hatch H, Cutler DM, Schneider EC. The impact of COVID-19 on outpatient visits in 2020: Visits remained stable, despite a late surge in cases. Commonwealth Fund; February 22, 2021. Available at: 10.26099/bvhf-e411 . (Accessed January 20, 2022).
23. 23. Sağlık Harcamaları İstatistikleri, 2021. Available at: https://data. tuik.gov.tr/Kategori/GetKategori?p=Saglik-ve-Sosyal-Koruma-101. (Accessed January 20, 2023).
24. 24. Centers for Disease Control and Prevention, The Influenza Hospitalization Surveillance Network (FluSurv-NET), Available at: https:// www.cdc.gov/flu/weekly/influenza-hospitalization-surveillance.htm. (Accessed January 20, 2023).