P3.H151: Effect of the COVID pandemic on healthcare access among children with Down syndrome in Peru.

Background: Health care access was significantly burdened during the COVID pandemic. In Peru, over 9,000 people with Down Syndrome had impaired healthcare access due to stringent limits over appointment availability in several specialties and even closures of hospitals and clinics. We sought to study the effect of the COVID pandemic on healthcare access among children with Down Syndrome in Peru.

Methods: From October 2022 to April 2023, we interviewed parents of children with Down Syndrome aged 2-12 years old and who were affiliated to the Peruvian Down Syndrome Society. We collected children’s demographics, past diagnoses, whether they needed medical care and in which specialties, medical appointments attended, and perceived satisfaction with services received, during 2019 and 2021. The primary outcome was any change in perceived satisfaction between 2019 and 2021 using conditional regressions. The secondary outcome was perceived changes in healthcare access and utilization assessed as the gap between needing and receiving medical care.

Results: 223 parents of children with Down Syndrome consented to participate in the survey, 72 provided complete information. The median age in children was 8.9 years old (IQR 7-11). Developmental delay (75%) and cardiac conditions (41%) were the most reported comorbidities. 43% of the children (n=96) received at least one medical appointment in both 2019 and 2021; 68.2% (n=152) in 2019, and 53.8% (n=120) in 2021. Among those with complete information, perceived satisfaction was 10.9 (95%CI 4.8, 16.9) points lower in 2021 compared to 2019 for patients who had at least 1 medical appointment, and slightly greater among those who received pediatric care, 11.8 (95%CI 3.4, 20.1), after adjusting for potential confounders such as severity of disability, education attainment, and type of insurance. Comparing 2019 to 2021, more caregivers experienced barriers such as getting referrals (40% vs 49%), approved pre-authorizations (15% vs 22%), obtaining medications(17% vs 19%) and transportation (24% vs 30%). There was a gap in medical care for all specialities except for pediatrics during 2021 compared to 2019. The biggest shift was in early interventions with a gap of 0.8% in 2019 and 62% in 2021.

Conclusion: Understanding the COVID-19 response at the public health level in a low to middle income country may offer a viable route to leverage greater access and coverage of healthcare in future conflict and humanitarian settings. Implementation of telemedicine tools could reduce disparities in medical care of children with Down Syndrome, especially in emergency situations. General pediatricians should be well trained and prepared to provide medical care for this population, as they will likely be the first responders in future pandemics.