The safety of children is something over which they have no agency, and the latest stats released by the Children’s Institute at the University of Cape Town (UCT) highlight this fact.
According to the institute’s recent advocacy briefs, data from the Western Cape shows falls increased by 5% (more children falling out of attendants’ arms, falling off beds, falling down stairs), burns increased by 10% (85% liquid burns, mainly in the kitchen) and dog bites increased by 13% (mostly by family dogs).
“It is not surprising that we saw the highest increase in these injuries during the level five lockdown period, when everyone was confined to home,” said the authors of the brief, Shanaaz Mathews, Yolande Baker, Carla Brown and Joan van Niekerk.
They said lockdown measures “have the potential to increase children’s exposure to risks in the home for both intentional and unintentional injuries”. This is because children were confined to their homes with “disrupted schedules and stressed parents, who were facing loss of income, potential joblessness or juggling working from home”.
On the upside, the combination of the lockdown and ban on alcohol sales meant children were far less at the mercy of drunk drivers.
The Red Cross War Memorial Children’s Hospital trauma unit showed a 15% decrease in the number of children treated for unintentional injuries during the lockdown, from 6,568 in 2019 to 5,647 in 2020.
“This decrease is largely due to a 56% reduction in road traffic injuries during the hard lockdown (March to June 2020) compared to the same period in 2019. This reduction is mainly due to fewer cars on the roads, children not at school and a ban on alcohol sales during level five lockdown,” said the authors.
The pedestrian injuries recorded were mainly children playing in streets and driveways and crossing unsafe roads, and these injuries increased to pre-lockdown levels as soon as SA moved to level one in October 2020.
It is hoped the advocacy briefs (the violence and trauma brief is one of seven) will inform not only policymakers, but anyone whose line of work involves having to make decisions that affect children.
These numbers highlight an already existing crisis in the country.
According to the brief, pre-pandemic numbers from the SA Burden of Disease Study show “children under five years old and older adolescents bear the brunt of child injury deaths”.
The leading causes of child injury deaths in the country vary by age and include road traffic injuries (36%), homicide (28%), other unintentional injuries such as burns and drowning (27%) and suicide (8.5%).
Rising unemployment and food prices increased pressure on poor households, with 47% of households running out of money to buy food during the hard lockdown.
— Prof Michael Hendricks
Fatal injuries are the “tip of the iceberg” as non-fatal injuries affect much larger numbers of children, with long-lasting health effects and disability burdens.
The effect of the pandemic on the wellbeing of children stretches far beyond violence and trauma.
Throughout the pandemic, numbers suggest children’s health has been sacrificed in many ways on the altar of adult counterparts.
In some cases, the numbers also show that with proper effort to rectify this, child health can improve to higher levels than before the pandemic, but we have a long way to go.
Primary healthcare visits in children under five dropped by 23% during the pandemic, and this led to major gaps in testing and treatment of HIV, TB and malnutrition.
“Elective surgeries for children were cancelled, and many children with disabilities were unable to access care,” said Lori Lake of the Children’s Institute.
“The data show hospital admissions for diarrhoea and pneumonia decreased but in-hospital mortality increased, raising concerns about life-threatening delays in seeking care.”
The primary healthcare headcount for children under five was 2,072,002 but dropped to 1,588,727 in the province.
The concerning picture that has emerged from the Western Cape is likely far worse in other provinces with fewer resources.
Speaking from the Eastern Cape, public sector paediatrician Dr Nomlindo Makubalo said: “We are seeing an increase in diarrhoea from rotavirus as so many children had missed their immunisations. When we ask parents, they say the clinic was closed or money was so tight over this time that they could not travel to the clinic.”
She said many complicated TB cases in children were not adequately treated, as services had been diverted to the Covid-19 crisis, and much defaulting on antiretroviral treatment had occurred for the same reason.
This was all against a backdrop of rising child hunger.
Prof Michael Hendricks of the department of paediatrics and child health at UCT said: “Rising unemployment and food prices increased pressure on poor households, with 47% of households running out of money to buy food during the hard lockdown.”
He said despite families’ efforts to shield their children, child hunger has remained high, with one in seven households reporting a child went hungry in April 2021.
At the same time the disruption of routine health services made it harder to identify and support children at risk of malnutrition.
According to the advocacy briefs released on Tuesday, “concerted efforts by child health practitioners and community health workers helped ensure some of these services were fully restored, with measles immunisation recovering to 95% (a 5% increase on coverage in 2019). However, it will require time, ongoing advocacy and proactive decision-making to address the significant and potentially life-threatening backlogs in elective surgeries.”
Prof Maylene Shung-King, a public health specialist at UCT, said: “The assertions by key experts for the advocacy briefs showed how the country overlooked the disastrous collateral damage on many aspects of children’s lives in response to the pandemic. Their needs were sidelined and these advocacy briefs highlight those.”
