The effects of COVID-19 lockdown measures on health and healthcare services in Uganda

The impacts of COVID-19 on older adults in Uganda and Ethiopia: Perspectives from non-governmental organization staff and volunteers

The COVID-19 pandemic had a substantial impact on older adults, especially in Sub-Saharan Africa (SSA). To support older adults during this time, non-governmental organizations (NGOs) coordinated programs to help provide for basic needs related to food and water security and healthcare. This research explores the attitudes, perceptions and experiences of NGO staff and volunteers who provided support to older adults in SSA in rural East Africa during the COVID-19 pandemic. In-depth interviews (n = 28) were conducted with NGO staff and volunteers in Uganda and Ethiopia between September and December of 2022. Overall, NGO staff and volunteers reported high levels of knowledge surrounding the COVID-19 pandemic and stated that one positive of the COVID-19 pandemic was the improved hygiene practices. However, the NGO staff and volunteers also reported that the pandemic and the associated public health measures exacerbated pre-existing social inequalities, such as increasing pre-existing levels of food insecurity. The exacerbation of pre-existing social inequalities may be one reason for the increased reliance on NGO services. The learnings from the COVID-19 pandemic and associated public health measures can be utilized to create targeted strategies to mitigate the negative impacts of future public health crises on vulnerable populations.

The impact of the COVID-19 lockdown on social and economic welfare in Uganda

BACKGROUND

As a measure to slow down the transmission of Coronavirus disease (COVID-19), governments around the world placed their countries under various stringent lockdown measures. Uganda is one of the countries that had a strict lockdown in Africa. This qualitative study explored the social and economic impacts of the COVID-19 lockdown in both an urban (Kampala) and rural (Wakiso) setting in Central Uganda.

METHODS

The study used focus group discussions (FGDs), household interviews, and key informant interviews (KIIs). 14 FGDs were conducted among several stakeholders including community health workers, health professionals, and members of the community. 40 household interviews were conducted among low, middle, and high-income households, while 31 KIIs were held among policy makers, non-governmental organisations, and the private sector. Data were analysed thematically in NVivo 2020 (QSR International).

RESULTS

Findings from the study are presented under six themes: family disruption; abuse of children's rights; disruption in education; food insecurity; impact on livelihoods; and violation of human rights. The study found that the COVID-19 lockdown led to family breakups, loss of family housing, as well as increased both caring responsibilities and gender-based violence especially towards females. Children's welfare suffered through increased child labour, sexual exploitation, and early marriages. The extended closure of schools led to delayed educational milestones, poor adaptation to home-based learning, and increased school drop-out rates. Increased food insecurity led to changes in feeding patterns and reduced food varieties. Livelihoods were negatively affected hence people depleted their savings and capital. Unlawful detention and beating by law enforcement officers increased during the lockdown.

CONCLUSION

Future pandemic planning needs to consider the consequences of lockdown on the social and economic wellbeing of communities hence put in place appropriate mitigation measures during and after the outbreak.

Effect of COVID-19 on paediatric TB service delivery and patients' comfort receiving TB services in Cameroon and Kenya during COVID: a qualitative assessment

BACKGROUND

The outbreak of COVID-19 has caused a setback to the gains achieved in tuberculosis (TB) control by impairing TB diagnosis, delaying treatment initiation and aggravating TB deaths. This study explored the effect of COVID-19 on paediatric TB services provided through the Catalysing Paediatric TB Innovations (CaP-TB) project among caregivers of children receiving TB services and healthcare workers (HCWs) providing TB services in Cameroon and Kenya.

METHODS

From March to September 2021, in-depth interviews (44) were conducted with caregivers whose children under 5 years had gone through TB services and programme managers (10) overseeing the CaP-TB project. Focus group discussions were conducted with HCWs (07) and community health workers (04) supporting TB care services. Transcripts were coded and analysed by using MAXQDA V.12.

RESULTS

The COVID-19 pandemic has caused fear and anxiety among HCWs and caregivers. This fear was motivated by stigma related to COVID-19 and affected the ability to screen patients for TB due to the similarity of symptoms with COVID-19. The health-seeking behaviour of patients was affected, as many caregivers avoided hospitals and those accessing the facilities concealed their sickness due to fear of testing positive or being vaccinated. In addition, COVID-19 mitigation strategies implemented by both government and health facilities to curb the spread of the virus limited patient access to paediatric healthcare services. These included temporary closure of health facilities due to COVID-19 infections among staff, transfer of services to other spaces, spacing out patient appointments and reduced time spent with patients.

CONCLUSIONS

The outbreak of COVID-19 has induced fear and stigma that affected patients' health-seeking behaviour and provider attitudes towards paediatric TB service delivery. In addition, facility and governmental measures put in place to mitigate COVID-19 impact negatively affected paediatric service delivery. Training for health personnel, timely provision of personal protective equipments and appropriate communication strategies could help mitigate COVID-19 impact on paediatric TB service delivery.

Enhancing the capacity of community health workers in prevention and control of epidemics and pandemics in Wakiso district, Uganda: evaluation of a pilot project

BACKGROUND

Community Health Workers (CHWs) play a crucial role in outbreak response, including health education, contact tracing, and referral of cases if adequately trained. A pilot project recently trained 766 CHWs in Wakiso district Uganda on epidemic and pandemic preparedness and response including COVID-19. This evaluation was carried out to generate evidence on the outcomes of the project that can inform preparations for future outbreaks in the country.

METHODS

This was a qualitative evaluation carried out one year after the project. It used three data collection methods: 30 in-depth interviews among trained CHWs; 15 focus group discussions among community members served by CHWs; and 11 key informant interviews among community health stakeholders. The data was analysed using a thematic approach in NVivo (version 12).

RESULTS

Findings from the study are presented under four themes. (1) Improved knowledge and skills on managing epidemics and pandemics. CHWs distinguished between the two terminologies and correctly identified the signs and symptoms of associated diseases. CHWs reported improved communication, treatment of illnesses, and report writing skills which were of great importance including for managing COVID-19 patients. (2) Enhanced attitudes towards managing epidemics and pandemics as CHWs showed dedication to their work and more confidence when performing tasks specifically health education on prevention measures for COVID-19. (3) Improved health practices such as hand washing, vaccination uptake, and wearing of masks in the community and amongst CHWs. (4) Enhanced performance in managing epidemics and pandemics which resulted in increased work efficiency of CHWs. CHWs were able to carry out community mobilization through door-to-door household visits and talks on community radios as part of the COVID-19 response. CHWs were also able to prioritize health services for the elderly, and support the management of patients with chronic diseases such as HIV, TB and diabetes by delivering their drugs.

CONCLUSIONS

These findings demonstrate that CHWs can support epidemic and pandemic response when their capacity is enhanced. There is need to invest in routine training of CHWs to contribute to outbreak preparedness and response.

Impact of the COVID-19 pandemic and policy response on access to and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda and Zambia

Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18-49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18-49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.

Patient-provider experiences with chronic non-communicable disease care during COVID-19 lockdowns in rural Uganda: A qualitative analysis

Non-communicable diseases (NCDs) are a growing health burden in Sub-Saharan Africa and especially Uganda, where they account for over one third of all deaths. During the COVID-19 pandemic, public health control measures such as societal "lockdowns" had a significant impact on longitudinal NCD care though no studies have looked at the lived experience around NCD care during the pandemic. Our objective was to understand the experience of NCD care for both patients and providers in southwestern Uganda during the COVID-19 pandemic. We conducted in-depth, in-person qualitative interviews with 20 patients living with hypertension, diabetes, and/or cardiac disease purposefully selected from the outpatient clinics at Mbarara Regional Referral Hospital and 11 healthcare providers from public health facilities in Mbarara, southwestern Uganda. We analyzed transcripts according to conventional content analysis. We identified four major themes that emerged from the interviews; (1) difficulty accessing medication; (2) food insecurity; (3) barriers to the delivery of NCD clinical care and (4) alternative forms of care. Pre-existing challenges with NCD care were exacerbated during COVID-19 lockdown periods and care was severely disrupted, leading to worsened patient health and even death. The barriers to care were exacerbations of underlying systemic problems with NCD care delivery that require targeted interventions. Future work should leverage digital health interventions, de-centralizing NCD care, improving follow-up, providing social supports to NCD patients, and rectifying supply chain issues.

Health workers' adherence to the malaria test, treat and track strategy during the COVID-19 pandemic in malaria high transmission area in Eastern Uganda

BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic affected malaria control activities in sub-Saharan Africa (SSA) resulting in 690,000 excess deaths in the year 2021. The authors hypothesized that COVID-19 affected the World Health Organization (WHO) Test, Treat and Track (T3) strategy that has been implemented in Uganda since 2010. In this study, health worker's adherence to the T3 strategy during COVID-19 pandemic in Eastern Uganda was studied by assessing their knowledge, skills and practices.

METHODS

A cross-sectional study utilizing mixed quantitative and qualitative data collections methods was conducted at Mbale Regional Referral Hospital in Eastern Uganda between November and December in 2020. Data were captured on demographics, knowledge, skills and practices for both health workers (HWs) and patients. Quantitative data were analysed using STATA 15.0 and reported as descriptive statistics, proportions and statistical associations. Moreover, qualitative data were collected via key informant interviews (KII) among purposively sampled study participants and analysed thematically using NVIVO software. Ethical approval was obtained prior to the study.

RESULTS

A total of 436 study participants, of whom 103/436 (24%) and 333/436 (76%) were HWs and patients, respectively were studied. Among the HWs with mean age of 34 years (SD = 8.8 years), 81/103 (79%) had good practices, most 63/103 (61%) had good knowledge, and only 11/103 (10.7%) had good skills. Specifically, on the cadres, the laboratory personnel 19/103 (18%) had good knowledge 14/19 (74%) OR: 2.0 (95% CI 0.7-6) and were highly skilled OR: 4.6 (95% CI 1.2-18.1; P < 0.0150) compared to other cadres, respectively. Among the patients whose age ranged 3 months to 80 years (mean 17.8 years) and females 177/333 (53%); a majority 257/333 (77%) were tested, of whom 139/333 (42%) tested positive. Out of the positive cases, 115/333 (35%) were treated and tracked. About 75/333 (23%) were not tested but treated for malaria. Of the 168/239 (70.3%) patients tested, 115/168 (68.5%) were positive and treated, P = 0.0001. The KII revealed low level of In-service training, overwhelming number of patients and stock-out of supplies as a key factor for poor HW adherence to T3 strategy.

CONCLUSIONS

During COVID-19 pandemic period HWs adherence to T3 initiative was low as 27% malaria patients did not receive treatment.

Mass distribution campaign of long-lasting insecticidal nets (LLINs) during the COVID-19 pandemic in Uganda: lessons learned

BACKGROUND

Uganda implemented its third mass campaign to distribute long-lasting insecticidal nets (LLINs) in 2020 during the COVID-19 pandemic. This context necessitated modification of implementation guidelines. The mass campaign's objective was to ensure that at least 85% of the targeted population had access to LLINs.

METHODS

Revised implementation guidelines were followed while conducting the LLIN distribution campaign. Lessons learned were captured from documented activities and reports.

RESULTS

A total of 27,789,044 mosquito nets were distributed in 11,287,392 households, with an average of 5.1 persons per household. Household coverage of the LLIN distribution was 94.1%. The 2020/2021 campaign design was modified to follow COVID-19 Standard Operating Procedures (SOPs). These included using Personal Protective Equipment (PPE), e-platforms for training and briefing meetings, electronic data management systems and door-to-door household registration and distribution of LLINs.

CONCLUSIONS

Campaign modifications due to the COVID-19 pandemic were effective in implementing mass distribution of LLINs despite the disruptions and restrictions. The campaign's net coverage far exceeded its objective. Electronic data management was critical in monitoring and reporting distribution activities.