{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:18:56Z","timestamp":1779931136859,"version":"3.53.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"US National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100016962","name":"Department of Science and Innovation, South Africa","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016962","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute for Communicable Diseases of the National Health Laboratory Service"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"United Kingdom Foreign"},{"name":"Commonwealth and Development Off","award":["221003\/Z\/20\/Z"],"award-info":[{"award-number":["221003\/Z\/20\/Z"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The coronavirus disease 2019 (COVID-19) pandemic caused severe disruptions to healthcare in many areas of the world, but data remain scarce for sub-Saharan Africa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We evaluated trends in hospital admissions and outpatient emergency department (ED) and general practitioner (GP) visits to South Africa\u2019s largest private healthcare system during 2016\u20132021. We fit time series models to historical data and, for March 2020\u2013September 2021, quantified changes in encounters relative to baseline.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The nationwide lockdown on 27 March 2020 led to sharp reductions in care-seeking behavior that persisted for 18 months after initial declines. For example, total admissions dropped 59.6% (95% confidence interval [CI], 52.4\u201366.8) during home confinement and were 33.2% (95% CI, 29\u201337.4) below baseline in September 2021. We identified 3 waves of all-cause respiratory encounters consistent with COVID-19 activity. Intestinal infections and non\u2013COVID-19 respiratory illnesses experienced the most pronounced declines, with some diagnoses reduced 80%, even as nonpharmaceutical interventions (NPIs) relaxed. Non-respiratory hospitalizations, including injuries and acute illnesses, were 20%\u201360% below baseline throughout the pandemic and exhibited strong temporal associations with NPIs and mobility. ED attendances exhibited trends similar to those for hospitalizations, while GP visits were less impacted and have returned to pre-pandemic levels.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found substantially reduced use of health services during the pandemic for a range of conditions unrelated to COVID-19. Persistent declines in hospitalizations and ED visits indicate that high-risk patients are still delaying seeking care, which could lead to morbidity or mortality increases in the future.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac055","type":"journal-article","created":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T12:18:09Z","timestamp":1643113089000},"page":"e1000-e1010","source":"Crossref","is-referenced-by-count":18,"title":["Direct and Indirect Effects of the Coronavirus Disease 2019 Pandemic on Private Healthcare Utilization in South Africa, March 2020\u2013September 2021"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7341-9193","authenticated-orcid":false,"given":"Amanda C","family":"Perofsky","sequence":"first","affiliation":[{"name":"Fogarty International Center, National Institutes of Health , Bethesda, Maryland , United 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C","family":"Pulliam","sequence":"additional","affiliation":[{"name":"South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University , Stellenbosch , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Viboud","sequence":"additional","affiliation":[{"name":"Fogarty International Center, National Institutes of Health , Bethesda, Maryland , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Cohen","sequence":"additional","affiliation":[{"name":"Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa"},{"name":"School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South 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