Diarrhoeal admissions among children aged <5 years in public sector facilities in Western Cape Province, South Africa, before and during the COVID-19 pandemic (2019–2021)

Background.The COVID‑19 pandemic in South Africa (SA) had several effects, including the implementation of public health and social measures (PHSM) such as mobility limitations, social (physical) distancing, mask‑wearing and hand hygiene promotion. This led to behavioural shifts, and potentially impacted the transmission dynamics of other infectious diseases, including acute diarrhoea among children. Objective. To investigate changes in acute diarrhoea hospital admissions in children aged <5 years in Western Cape Province, SA.Methods.We conducted a retrospective analysis of diarrhoea admissions from January 2019 to November 2021. We estimated changes in rates and trends of diarrhoea admissions during the pandemic compared with pre‑pandemic periods using interrupted time series analysis, adjusting for key characteristics. Results.There were 17 204 children admitted for diarrhoea during the study period, of whom 54% were male, and almost half (48%) were aged <1 year. COVID‑19 PHSM were associated with a 24% step reduction in diarrhoea admissions compared with the pre‑COVID‑19 period (incidence rate ratio (IRR) 0.76, 95% confidence interval (CI) 0.69 ‑ 0.84). This was followed by an average 2% per month increase in diarrhoea admission incidence during the pandemic (IRR 1.02, CI 1.01 ‑ 1.02). Conclusion.There was a marked reduction in diarrhoea admissions during the strictest PHSM implementation. Interventions such as hand hygiene and physical distancing likely contributed to these observed changes. This study underscores the importance of ongoing public health interventions to mitigate diarrhoeal diseases among children and prevent hospitalisation.