scholarly journals Effect of COVID-19 lockdown on hospital admissions and mortality in rural KwaZulu-Natal, South Africa: interrupted time series analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047961 ◽  
Author(s):  
Amy McIntosh ◽  
Max Bachmann ◽  
Mark J Siedner ◽  
Dickman Gareta ◽  
Janet Seeley ◽  
...  
Keyword(s):  
South Africa ◽  
Time Series ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Time Series Regression ◽  
Content Type ◽  
Kwazulu Natal ◽  
Level 3 ◽  
Observational Cohort

ObjectiveTo assess the effect of lockdown during the 2020 COVID-19 pandemic on daily all-cause admissions, and by age and diagnosis subgroups, and the odds of all-cause mortality in a hospital in rural KwaZulu-Natal (KZN).DesignObservational cohort.SettingReferral hospital for 17 primary care clinics in uMkhanyakude District.ParticipantsData collected by the Africa Health Research Institute on all admissions from 1 January to 20 October: 5848 patients contributed to 6173 admissions.ExposureFive levels of national lockdown in South Africa from 27 March 2020, with restrictions decreasing from levels 5 to 1, respectively.Outcome measuresChanges and trends in daily all-cause admissions and risk of in-hospital mortality before and at each stage of lockdown, estimated by Poisson and logistic interrupted time series regression, with stratification for age, sex and diagnosis.ResultsDaily admissions decreased during level 5 lockdown for infants (incidence rate ratio (IRR) compared with prelockdown 0.63, 95% CI 0.44 to 0.90), children aged 1–5 years old (IRR 0.43, 95% CI 028 to 0.65) and respiratory diagnoses (IRR 0.57, 95% CI 0.36 to 0.90). From level 4 to level 3, total admissions increased (IRR 1.17, 95% CI 1.06 to 1.28), as well as for men >19 years (IRR 1.50, 95% CI 1.17 to 1.92) and respiratory diagnoses (IRR 4.26, 95% CI 2.36 to 7.70). Among patients admitted to hospital, the odds of death decreased during level 5 compared with prelockdown (adjusted OR 0.48, 95% CI 0.28 to 0.83) and then increased in later stages.ConclusionsLevel 5 lockdown is likely to have prevented the most vulnerable population, children under 5 years and those more severely ill from accessing hospital care in rural KZN, as reflected by the drop in admissions and odds of mortality. Subsequent increases in admissions and in odds of death in the hospital could be due to improved and delayed access to hospital as restrictions were eased.

scholarly journals Hospitalization for ischemic stroke was affected more in independent cases than in dependent cases during the COVID-19 pandemic: An interrupted time series analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261587
Author(s):  
Hiroyuki Nagano ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Daisuke Takada ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Time Series ◽  
Ischemic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
State Of Emergency ◽  
Its Analysis ◽  
Care Systems ◽  
The Impact

Background The pandemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study is to assess the impact of the COVID-19 pandemic on the number of hospital admissions for ischemic stroke by severity in Japan. Methods We analysed administrative (Diagnosis Procedure Combination—DPC) data for cases of inpatients aged 18 years and older who were diagnosed with ischemic stroke and admitted during the period April 1 2018 to June 27 2020. Levels of change of the weekly number of inpatient cases with ischemic stroke diagnosis after the declaration of state of emergency were assessed using interrupted time-series (ITS) analysis. The numbers of patients with various characteristics and treatment approaches were compared. We also performed an ITS analysis for each group (“independent” or “dependent”) divided based on components of activities of daily living (ADL) and level of consciousness at hospital admission. Results A total of 170,294 cases in 567 hospitals were included. The ITS analysis showed a significant decrease in the weekly number of ischemic stroke cases hospitalized (estimated decrease: −156 cases; 95% confidence interval (CI): −209 to −104), which corresponds to −10.4% (95% CI: −13.6 to −7.1). The proportion of decline in the independent group (−21.3%; 95% CI: −26.0 to −16.2) was larger than that in the dependent group (−8.6%; 95% CI: −11.7 to −5.4). Conclusions Our results show a marked reduction in hospital admissions due to ischemic stroke after the declaration of the state of emergency for the COVID-19 pandemic. The independent cases were affected more in proportion than dependent cases.

scholarly journals Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e043763
Author(s):  
Mark J Siedner ◽  
John D Kraemer ◽  
Mark J Meyer ◽  
Guy Harling ◽  
Thobeka Mngomezulu ◽  
...  
Keyword(s):  
South Africa ◽  
Time Series ◽  
Time Series Analysis ◽  
Primary Healthcare ◽  
Interrupted Time Series ◽  
Care Provision ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Child Healthcare ◽  
Clinic Visits

ObjectivesWe evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN).DesignObservational cohortSettingData were analysed from 11 primary healthcare clinics in northern KZN.ParticipantsA total of 46 523 individuals made 89 476 clinic visits during the observation period.Exposure of interestWe conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods.Outcome measuresDaily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata.ResultsWe found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI −16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (−7.1 visits/clinic/day, 95% CI −8.9 to 5.3), both for children aged <1 year and 1–5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8).ConclusionsIn rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.

scholarly journals Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis

2021 ◽  
pp. jech-2021-216613
Author(s):  
Trevor Hill ◽  
Carol Coupland ◽  
Denise Kendrick ◽  
Matthew Jones ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Hospital Admissions ◽  
Unintentional Injury ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Home Safety ◽  
Safety Equipment ◽  
Admission Rates ◽  
Children Under 5

BackgroundUnintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a ‘natural experiment’ for evaluating the scheme’s impact on hospital admissions for unintentional injuries.MethodsControlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision.Results57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (−0.33% (−0.47% to −0.18%)) but did not decline in control areas (0.04% (−0.11%–0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended.ConclusionsA national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.

Do policy and training changes influence patterns of police use of force? An interrupted time-series analysis

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alexis Rain Rockwell ◽  
Stephen A. Bishopp ◽  
Erin A. Orrick
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Use Of Force ◽  
Interrupted Time Series ◽  
Unintended Consequences ◽  
Interrupted Time Series Analysis ◽  
Police Use Of Force ◽  
Content Type ◽  
Series Analysis ◽  
And Training

PurposeThe current study examines the effect of changing a specific use-of-force policy coupled with de-escalation training implementation on patterns of police use of force.Design/methodology/approachAn interrupted time-series analysis was used to examine changes in police use-of-force incident records gathered from a large, southwestern US metropolitan police department from 2013 to 2017 based on a TASER policy change and de-escalation training implementation mid-2015.FindingsResults demonstrate that changes to use-of-force policy regarding one type of force (i.e. use of TASERs) coinciding with de-escalation training influence the prevalence of use-of-force incidents by increasing the reported police use-of-force incidents after the changes were implemented. This finding is somewhat consistent with prior literature but not always in the desired direction.Practical implicationsWhen police departments make adjustments to use-of-force policies and/or trainings, unintended consequences may occur. Police administrators should measure policy and training outcomes under an evidence-based policing paradigm prior to making those adjustments.Originality/valueThis study is the first to measure the effects of changing use-of-force policy and implementing de-escalation techniques in training on patterns of police use of force and shows that these changes can have a ripple effect across types of force used by police officers.

scholarly journals Effects of an integrated respiratory service on Chronic Obstructive Pulmonary Disease hospital admissions in England: An interrupted time series analysis

2020 ◽  
pp. 135581962097405 ◽  
Author(s):  
Martha MC Elwenspoek ◽  
Tim Jones ◽  
James W Dodd
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Pulmonary Disease ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
Chronic Obstructive ◽  
Interrupted Time Series Analysis ◽  
Obstructive Pulmonary Disease

Objectives To investigate the effects of an admission avoidance pathway within a new integrated respiratory service on the number of Chronic Obstructive Pulmonary Disease (COPD)-related hospital admissions in England. Methods We used interrupted time series analysis to estimate the effects of the admission avoidance pathway on COPD hospital admissions, length of stay, and 30-day readmissions. We included all unplanned admissions with COPD as primary diagnosis using Hospital Episode Statistics, comparing the intervention region with a demographically similar control region in the two years before and one year after the implementation of the new service. Results Unplanned hospital admissions for COPD exacerbations followed a clear seasonal pattern, peaking in early winter. We found no evidence that the admission avoidance pathway influenced the rate of hospital admissions or 30-day readmissions. We found weak evidence of a trend change in length of stay following the launch of the admission avoidance pathway. Conclusions Our study adds to the growing body of evidence that suggests that additional admission avoidance capacity alone does not lead to a measurable reduction in admissions or length of stay. Further investigation is required to understand the reasons why. A longer follow-up may be required to see some of the potential benefits.

scholarly journals Has the Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus Increased Trimethoprim-Sulfamethoxazole Use and Resistance?: a 10-Year Time Series Analysis

2012 ◽  
Vol 56 (11) ◽  
pp. 5655-5660 ◽  
Author(s):  
Jameson B. Wood ◽  
Donald B. Smith ◽  
Errol H. Baker ◽  
Stephen M. Brecher ◽  
Kalpana Gupta
Keyword(s):  
Staphylococcus Aureus ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Rate Of Change ◽  
Interrupted Time Series Analysis ◽  
Methicillin Resistant ◽  
Content Type ◽  
Series Analysis ◽  
The Relationship

ABSTRACTThere are an increasing number of indications for trimethoprim-sulfamethoxazole use, including skin and soft tissue infections due to community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA). Assessing the relationship between rates of use and antibiotic resistance is important for maintaining the expected efficacy of this drug for guideline-recommended conditions. Using interrupted time series analysis, we aimed to determine whether the 2005 emergence of CA-MRSA and recommendations of trimethoprim-sulfamethoxazole as the preferred therapy were associated with changes in trimethoprim-sulfamethoxazole use and susceptibility rates. The data from all VA Boston Health Care System facilities, including 118,863 inpatient admissions, 6,272,661 outpatient clinic visits, and 10,138 isolates were collected over a 10-year period. There was a significant (P= 0.02) increase in trimethoprim-sulfamethoxazole prescriptions in the post-CA-MRSA period (1,605/year) compared to the pre-CA-MRSA period (1,538/year). Although the overall susceptibility ofEscherichia coliandProteusspp. to trimethoprim-sulfamethoxazole decreased over the study period, the rate of change in the pre- versus the post-CA-MRSA period was not significantly different. The changes in susceptibility rates ofS. aureusto trimethoprim-sulfamethoxazole and to methicillin were also not significantly different. The CA-MRSA period is associated with a significant increase in use of trimethoprim-sulfamethoxazole but not with significant changes in the rates of susceptibilities among clinical isolates. There is also no evidence for selection of organisms with increased resistance to other antimicrobials in relation to increased trimethoprim-sulfamethoxazole use.

scholarly journals Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 218 ◽  
Author(s):  
Tivani P. Mashamba-Thompson ◽  
Paul K. Drain ◽  
Desmond Kuupiel ◽  
Benn Sartorius
Keyword(s):  
South Africa ◽  
Time Series ◽  
Maternal Mortality ◽  
Point Of Care ◽  
Maternal Mortality Ratio ◽  
Interrupted Time Series ◽  
Poisson Regression Analysis ◽  
Kwazulu Natal ◽  
Mortality Ratio ◽  
The Impact

Background: Syphilis infection has been associated with an increased risk of HIV infection during pregnancy which poses greater risk for maternal mortality, and antenatal syphilis point-of-care (POC) testing has been introduced to improve maternal and child health outcomes. There is limited evidence on the impact of syphilis POC testing on maternal outcomes in high HIV prevalent settings. We used syphilis POC testing as a model to evaluate the impact of POC diagnostics on the improvement of maternal mortality in KwaZulu-Natal, South Africa. Methods: We extracted 132 monthly data points on the number of maternal deaths in facilities and number of live births in facilities for 12 tertiary healthcare facilities in KwaZulu-Natal (KZN), South Africa from 2004 to 2014 from District Health Information System (DHIS) health facility archived. We employed segmented Poisson regression analysis of interrupted time series to assess the impact of the exposure on maternal mortality ratio (MMR) before and after the implementation of antenatal syphilis POC testing. We processed and analyzed data using Stata Statistical Software: Release 13. (Stata, Corp LP, College Station, TX, USA). Results: The provincial average annual maternal mortality ratio (MMR) was estimated at 176.09 ± 43.92 ranging from a minimum of 68.48 to maximum of 225.49 per 100,000 live births. The data comprised 36 temporal points before the introduction of syphilis POC test exposure and 84 after the introduction in primary health care clinics in KZN. The average annual MMR for KZN from 2004 to 2014 was estimated at 176.09 ± 43.92. A decrease in MMR level was observed during 2008 after syphilis POC test implementation, followed by a rise during 2009. Analysis of the MMR trend estimates a significant 1.5% increase in MMR trends during the period before implementation and 1.3% increase after implementation of syphilis POC testing (p < 0.001). Conclusion: Although our finding suggests a brief reduction in the MMR trend after the implementation of antenatal syphilis POC testing, a continued increase in syphilis rates is seen in KwaZulu-Natal, South Africa. The study used one of the most powerful quasi-experimental research methods, segmented Poisson regression analysis of interrupted time series to model the impact of syphilis POC on maternal outcome. The study finding requires confirmation by use of more rigorous primary study design.

scholarly journals Excess Deaths and Hospital Admissions for COVID-19 Due to a Late Implementation of the Lockdown in Italy

2020 ◽  
Vol 17 (16) ◽  
pp. 5644 ◽  
Author(s):  
Raffaele Palladino ◽  
Jordy Bollon ◽  
Luca Ragazzoni ◽  
Francesco Barone-Adesi
Keyword(s):  
Intensive Care Unit ◽  
Time Series ◽  
Intensive Care ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
National Data ◽  
Epidemic Curve ◽  
Early Implementation ◽  
Excess Deaths

In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%) reduction, respectively. We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic.

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