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
Yıl 2023,
Cilt: 56 Sayı: 3, 141 - 145, 21.01.2024
Gulsum Ozen
,
Dilek Sarici
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.
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. 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. WHO Coronavirus (COVID-19) Dashboard. Global Situation. Available
at: https://COVID19.who.int/. (Accessed January 20, 2023).
- 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. 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. 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. 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. 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. 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. 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. 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. Şimşek Orhon F. Genişletilmiş Bağışıklama Programına Her Yönüyle
Bakış. Osmangazi Tıp Dergisi. 2020; 6-14.
- 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Sağlık Harcamaları İstatistikleri, 2021. Available at: https://data.
tuik.gov.tr/Kategori/GetKategori?p=Saglik-ve-Sosyal-Koruma-101.
(Accessed January 20, 2023).
- 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).
Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması
Yıl 2023,
Cilt: 56 Sayı: 3, 141 - 145, 21.01.2024
Gulsum Ozen
,
Dilek Sarici
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.
Proje Numarası
(E. Kurul – 2012-KAEK-15/2403, 26/10/2021)
Kaynakça
- 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. WHO Coronavirus (COVID-19) Dashboard. Global Situation. Available
at: https://COVID19.who.int/. (Accessed January 20, 2023).
- 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. 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. 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. 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. 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. 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. 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. 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. Şimşek Orhon F. Genişletilmiş Bağışıklama Programına Her Yönüyle
Bakış. Osmangazi Tıp Dergisi. 2020; 6-14.
- 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Sağlık Harcamaları İstatistikleri, 2021. Available at: https://data.
tuik.gov.tr/Kategori/GetKategori?p=Saglik-ve-Sosyal-Koruma-101.
(Accessed January 20, 2023).
- 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).