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Sanya RE, Karugu CH, Binyaruka P, Mohamed SF, Kisia L, Kibe P, Mashasi I, Mhalu G, Bunn C, Deidda M, Mair FS, Grieve E, Gray CM, Mtenga S, Asiki G. Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania. Glob Health Action 2024; 17:2345970. [PMID: 38774927 PMCID: PMC11123500 DOI: 10.1080/16549716.2024.2345970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services. OBJECTIVES We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania. METHODS A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access. RESULTS We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; p = 0.011). CONCLUSIONS COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.
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Affiliation(s)
- Richard E. Sanya
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline H. Karugu
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Peter Binyaruka
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shukri F. Mohamed
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Lyagamula Kisia
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Peter Kibe
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Irene Mashasi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Manuela Deidda
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S. Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cindy M. Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Sally Mtenga
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Gershim Asiki
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Scholfield S, Kavembe GD, Duncan RR, Ragama BO, Mecha J, Orwa A, Otomu G, Wanga E, Astleford J, Gutto J, Kibwage I, Ogato J, Verma A, Brennan K, Huck J, Mitlin D, Nirmalan M. A cross-sectional survey on the effectiveness of public health campaigns for changing knowledge, attitudes, and practices in Kenyan informal settlements during the COVID-19 pandemic. PLoS One 2023; 18:e0294202. [PMID: 38134188 PMCID: PMC10745220 DOI: 10.1371/journal.pone.0294202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/26/2023] [Indexed: 12/24/2023] Open
Abstract
We performed two cross-sectional surveys across three informal settlements in Kenya (within Kisii county, Nairobi, and Nakuru county) to study the effectiveness of public health interventions during the COVID-19 pandemic. A total of 720 participants were surveyed from 120 randomly selected geographical locations (240 participants/settlement/survey), and a coordinated health promotion campaign was delivered between the two surveys by trained staff. Information relating to knowledge, attitudes, and practices (KAP) were collected by trained field workers using a validated questionnaire. The main outcomes showed improvements in: (i) mask-wearing (% of participants 'Always' using their mask increased from 71 to 74%, and the percentage using their masks 'Sometimes' decreased from 15% to 6%; p<0.001); (ii) practices related to face mask usage (% of subjects covering the mouth and nose increased from 91 to 95%, and those covering only part of their face decreased from around 2.5% to <1%; p<0.001). Significant improvements were also seen in the attitudes and expectations relating to mask wearing, and in the understanding of government directives. Over 50% of subjects in the post-campaign survey reported that social distancing was not possible in their communities and fears associated with COVID-19 testing were resistant to change (unchanged at 10%). Access to COVID-19 testing facilities was limited, leaving a large proportion of people unable to test. As willingness to take a COVID-19 test did not change between surveys (69 vs 70%; p = 0.57), despite increased availability, we recommend that policy level interventions are needed, aimed at mitigating adverse consequences of a positive test. Improvements of KAPs in the more crowded urban environment (Nairobi) were less than at settlements in rural or semi-urban settings (Nakuru and Kisii). We conclude that coordinated public health campaigns are effective in facilitating the change of KAPs amongst people living amidst challenging socio-economic conditions in informal settlements.
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Affiliation(s)
- Steven Scholfield
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
| | | | - Rodney R. Duncan
- Department of Monitoring and Evaluation, Central Kenya Conference of SDA, Nairobi, Kenya
| | - Bernhards O. Ragama
- Centre for Research and Therapeutic Sciences, Strathmore University and Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Jared Mecha
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Albert Orwa
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Geoffrey Otomu
- Department of Medicine, Kisii Teaching and Referral Hospital, Kisii, Kenya
| | - Erick Wanga
- Adventist Development and Relief Agency (ADRA), Nairobi, Kenya
| | - James Astleford
- Adventist Development and Relief Agency (ADRA), Nairobi, Kenya
| | - John Gutto
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
| | | | - Julius Ogato
- Division of Health Systems Strengthening, Ministry of Health, Nairobi, Kenya
| | - Arpana Verma
- Division of Population Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Keith Brennan
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
| | - Jonathan Huck
- MCGIS, Department of Geography, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - Diana Mitlin
- Global Development Institute, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - Mahesh Nirmalan
- Faculty of Biology, Medicine and Health University of Manchester, Manchester, United Kingdom
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