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Agogo GO, Munywoki PK, Audi A, Auko J, Aol G, Oduor C, Kiplangat S, Ouma A, Komo T, Herman-Roloff A, Munyua P, Bigogo G. The effect of COVID-19 pandemic on healthcare seeking in an urban informal settlement in Nairobi and a rural setting in western Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002968. [PMID: 38630844 PMCID: PMC11023466 DOI: 10.1371/journal.pgph.0002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
The COVID-19 pandemic caused widespread changes and disruptions to healthcare seeking behavior. There are limited studies on the effect of the COVID-19 pandemic on healthcare seeking patterns in low-and middle-income countries (LMICs), especially in settings with inequitable access to healthcare in rural and urban informal settlements. We investigated the effect of the COVID-19 pandemic on reported healthcare seeking at health facilities and chemists using morbidity data from participants in an ongoing population-based infectious disease surveillance platform in Asembo in Siaya County, a rural setting in western Kenya and Kibera, an urban informal settlement in Nairobi County. We described healthcare seeking patterns before (from 1st January 2016 to 12th March 2020) and during the pandemic (from 13th March 2020 to 31st August 2022) by gender and age for any reported illness and select clinical syndromes using frequencies and percentages. We used a generalized estimating equation with an exchangeable correlation structure to assess the effect of the pandemic on healthcare seeking adjusting for gender and age. Overall, there was a 19% (adjusted odds ratio, aOR: 0.81; 95% Confidence Interval, CI: 0.79-0.83) decline in odds of seeking healthcare at health facilities for any illness in Asembo during the pandemic, and a 30% (aOR: 0.70; 95% CI: 0.67-0.73) decline in Kibera. Similarly, there was a decline in seeking healthcare by clinical syndromes, e.g., for ARI, aOR: 0.76; 95% CI:0.73-0.79 in Asembo, and aOR: 0.68; 95% CI:0.64-0.72 in Kibera. The pandemic resulted in increased healthcare seeking at chemists (aOR: 1.23; 95% CI: 1.20-1.27 in Asembo, and aOR: 1.40; 95% CI: 1.35-1.46 in Kibera). This study highlights interruptions to healthcare seeking in resource-limited settings due to the COVID-19 pandemic. The pandemic resulted in a substantial decline in seeking care at health facilities, and an increase of the same at chemists.
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Affiliation(s)
- George O. Agogo
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Patrick K. Munywoki
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Allan Audi
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Joshua Auko
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - George Aol
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Clifford Oduor
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Samuel Kiplangat
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Terry Komo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Amy Herman-Roloff
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Peninah Munyua
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
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van de Berg S, Charles T, Dörre A, Katz K, Böhm S. Epidemiology of common infectious diseases before and during the COVID-19 pandemic in Bavaria, Germany, 2016 to 2021: an analysis of routine surveillance data. Euro Surveill 2023; 28:2300030. [PMID: 37824248 PMCID: PMC10571495 DOI: 10.2807/1560-7917.es.2023.28.41.2300030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 10/14/2023] Open
Abstract
BackgroundUnprecedented non-pharmaceutical interventions to control the COVID-19 pandemic also had an effect on other infectious diseases.AimWe aimed to determine their impact on transmission and diagnosis of notifiable diseases other than COVID-19 in Bavaria, Germany, in 2020 and 2021.MethodsWe compared weekly cases of 15 notifiable infectious diseases recorded in Bavaria between 1 January 2016 and 31 December 2021 in time series analyses, median age and time-to-diagnosis using Wilcoxon rank sum test and hospitalisation rates using univariable logistic regression during three time periods: pre-pandemic (weeks 1 2016-9 2020), pandemic years 1 (weeks 10-52 2020) and 2 (2021).ResultsWeekly case numbers decreased in pandemic year 1 for all diseases assessed except influenza, Lyme disease and tick-borne encephalitis; markedly for norovirus gastroenteritis (IRR = 0.15; 95% CI: 0.12-0.20) and pertussis (IRR = 0.22; 95% CI: 0.18-0.26). In pandemic year 2, influenza (IRR = 0.04; 95% CI: 0.02-0.09) and pertussis (IRR = 0.11; 95% CI: 0.09-0.14) decreased markedly, but also chickenpox, dengue fever, Haemophilus influenzae invasive infection, hepatitis C, legionellosis, noro- and rotavirus gastroenteritis and salmonellosis. For enterohaemorrhagic Escherichia coli infections, median age decreased in pandemic years 1 and 2 (4 years, interquartile range (IQR): 1-32 and 3 years, IQR: 1-18 vs 11 years, IQR: 2-42); hospitalisation proportions increased in pandemic year 1 (OR = 1.60; 95% CI: 1.08-2.34).ConclusionReductions for various infectious diseases and changes in case characteristics in 2020 and 2021 indicate reduced transmission of notifiable diseases other than COVID-19 due to interventions and under-detection.
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Affiliation(s)
- Sarah van de Berg
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Tanja Charles
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, Munich, Germany
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Torres MJ, Coste J, Canouï-Poitrine F, Pouchot J, Rachas A, Carcaillon-Bentata L. Impact of the First COVID-19 Pandemic Wave on Hospitalizations and Deaths Caused by Geriatric Syndromes in France: A Nationwide Study. J Gerontol A Biol Sci Med Sci 2023; 78:1612-1626. [PMID: 36702778 DOI: 10.1093/gerona/glad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The fear of contracting coronavirus disease 2019 (COVID-19) and the preventive measures taken during the health crisis affected both people's lifestyles and the health system. This nationwide study aimed to investigate the impact of the first wave of the COVID-19 pandemic on hospitalizations and mortality related to geriatric syndromes (GS) in older adults in France. METHODS The French National Health Data System was used to compare hospital admissions (excluding the main diagnosis of COVID-19) and mortality rates (using multiple-cause and initial-cause analyses, and both including or excluding confirmed/probable COVID-19) related to 10 different GS (dementia, other cognitive disorders and symptoms, delirium/disorientation, depression, undernutrition/malnutrition, dehydration, pressure ulcer, incontinence, fall/injury and femoral neck fracture) from January to September 2020 to rates observed in previous years. Analyses were stratified by age, sex, place of residence or place of death, and region. RESULTS Hospitalization rates for all GS decreased during the first lockdown compared to the same periods in 2017-19 (from -59% for incontinence to -13% for femoral neck fractures). A dose-response relationship was observed between reduced hospitalizations and COVID-19-related mortality rates. Conversely, for almost all GS studied, excess mortality without COVID-19 was observed during this lockdown compared to 2015-17 (from +74% for delirium/disorientation to +8% for fall/injury), especially in nursing homes and at home. CONCLUSIONS In France, during the first lockdown, a substantial decrease in hospitalizations for GS was accompanied by excess mortality. This decline in the use of services, which persisted beyond lockdown, may have a mid- and long-term impact on older adults' health.
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Affiliation(s)
- Marion J Torres
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Joël Coste
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, Creteil, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Antoine Rachas
- Department of Strategy, Studies and Statistics, French National Health Insurance (Cnam), Paris, France
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Burger MMRL, Large KE, Liu Y, Coyle MC, Gamanya CT, Etter JF. Future Strategic Priorities of the Swiss Decentralized Healthcare System: A COVID-19 Case Study. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:250-268. [PMID: 36417256 PMCID: PMC9620901 DOI: 10.3390/epidemiologia3020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic exposed a multitude of vulnerabilities in Switzerland's decentralized healthcare system and highlighted the urgent need to strengthen Switzerland's capacity to respond to health crises and disease outbreaks. In this article, we draw on three distinct areas of analysis of the current functioning of the Swiss healthcare system to examine its strengths and weaknesses, which can serve as a basis for future considerations and strategic priorities. First, we analyze the different levels of nine non-pharmaceutical interventions (NPIs), as defined by the ETH KOF Stringency Index and implemented in the Swiss cantons of Zurich, Vaud, and Ticino, compared with the rate of positive COVID-19 cases, hospitalizations, and deaths. We find that there was no strong correlation between the severity of the nine non-pharmaceutical interventions implemented and lower rates of positive COVID-19 cases, hospitalizations, and deaths. Second, we examine the challenges of Switzerland's decentralized healthcare system through a literature review and with empirical data obtained from semi-structured interviews with health professionals in Switzerland. We conclude our analysis with the role of central authorities during the COVID-19 pandemic. The results demonstrate that during a national emergency in Switzerland, taking into account other factors that influence the success of a pandemic strategy, there is an opportunity for a more unified, centralized response to reduce the social and economic toll of the pandemic without necessarily risking greater health damage. We recommend that the Swiss federal government use a combination of decentralized and centralized public health and policy approaches and promote greater private-public collaboration with direct communication channels among policymakers, public health stakeholders, and the public to improve pandemic preparedness and response.
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Affiliation(s)
- Miriam Mi-Rim Lee Burger
- Institute of Global Health, University of Geneva, 9 Chemin de Mines, 1202 Geneva, Switzerland;
- Global Studies Institute, Rue des Vieux-Grenadiers 10, 1205 Geneva, Switzerland; (K.E.L.); (Y.L.); (M.C.C.); (C.T.G.)
- Correspondence:
| | - Kaitlin Elizabeth Large
- Global Studies Institute, Rue des Vieux-Grenadiers 10, 1205 Geneva, Switzerland; (K.E.L.); (Y.L.); (M.C.C.); (C.T.G.)
| | - Yiqi Liu
- Global Studies Institute, Rue des Vieux-Grenadiers 10, 1205 Geneva, Switzerland; (K.E.L.); (Y.L.); (M.C.C.); (C.T.G.)
| | - Melissa Cigdem Coyle
- Global Studies Institute, Rue des Vieux-Grenadiers 10, 1205 Geneva, Switzerland; (K.E.L.); (Y.L.); (M.C.C.); (C.T.G.)
| | - Cherish Tariro Gamanya
- Global Studies Institute, Rue des Vieux-Grenadiers 10, 1205 Geneva, Switzerland; (K.E.L.); (Y.L.); (M.C.C.); (C.T.G.)
| | - Jean-François Etter
- Institute of Global Health, University of Geneva, 9 Chemin de Mines, 1202 Geneva, Switzerland;
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Goyal DK, Mansab F, Naasan AP, Iqbal A, Millar C, Franklin G, Thomas S, McFadden J, Burke D, Lasserson D. Restricted access to the NHS during the COVID-19 pandemic: Is it time to move away from the rationed clinical response? THE LANCET REGIONAL HEALTH. EUROPE 2021; 8:100201. [PMID: 34423329 PMCID: PMC8372453 DOI: 10.1016/j.lanepe.2021.100201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Daniel K Goyal
- Consultant Physician & COVID Co-Lead, Lorn & Islands Hospital, Oban, NHS Highlands, Scotland, UK; Clinical Lecturer, Health Systems, University of Gibraltar, Gibraltar
- Corresponding author.
| | - Fatma Mansab
- Researcher, COVID-19 Team, Public Health Gibraltar; Clinical Lecturer, Postgraduate Medical School, University of Gibraltar
| | - Adeeb P Naasan
- Senior House Officer in General Internal Medicine and Covid-19 Response Co-ordinator, Lorn & Islands Hospital, Oban, NHS Highlands, Scotland, UK
| | - Amir Iqbal
- Senior Clinical Lead, Covid-19 Remote Monitoring of Patients During Response & Recovery, NHS Grampian, Scotland, UK
| | - Colin Millar
- Consultant Physician, Covid Co-Lead, Lorn & Islands Hospital, Oban, NHS Highlands, Scotland, UK
| | - Grant Franklin
- Consultant Acute Medicine, Raigmore Hospital, NHS Highlands, Inverness, Scotland, UK
| | - Stephen Thomas
- Consultant Respiratory Physician, Raigmore Hospital, NHS Highlands, Inverness, Scotland, UK
| | - John McFadden
- General Practitioner, Burnfield Medical Practice, NHS Highlands, Scotland, UK
| | - Derek Burke
- Head of Clinical Governance and GMC Suitable Person, Gibraltar Health Authority, Gibraltar (formerly Consultant in Paediatric Emergency Medicine and Medical Director Sheffield Children's NHS FT)
| | - Daniel Lasserson
- Professor of Acute Ambulatory Care, University of Warwick; Clinical Lead for Ambulatory Outreach Team, Oxford University Hospital, Oxford, UK
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