The Impact of COVID-19 on Non-Communicable Diseases

Strengthening the primary health care for non-communicable disease prevention and control in the post-pandemic period: a perspective from China

Non-communicable diseases (NCDs) have become the leading cause of deaths in China and many other countries worldwide. To call for actions in strengthening primary health care (PHC) and accelerate NCD prevention and control in the post-pandemic era in China, the 2023 Duke Kunshan Health Forum focused on innovative approaches and lessons learned during the pandemic that can be applied in addressing NCD challenges. In this article we summarize key points discussed by the participants in three areas: PHC as the foundation and ultimate solution for NCD prevention and control, post-pandemic opportunities to accelerate the NCD program with innovative approaches, and an action framework proposed by the Forum collaborators to address remaining challenges and achieve NCD control objectives in China. The core of the suggested action framework is to offer people-centered, lifetime, comprehensive, continued, and quality NCD prevention and control services, which rely on an integrated healthcare system connecting the primary, secondary, and tertiary levels of care. To achive this objective, six interconnected actions are recommended in the framework: prioritizing and integrating NCD in PHC and Universal Health Coverage (UHC) framework, engaging multiple stakeholders, directing resources to PHC for quality NCD services, leveraging advantages of new technology, encouraging the use of PHC and improving services, and strengthening best practice sharing.

Essential Health Services Delivery Status During COVID-19 Pandemic in Ethiopia: A National Mixed-Methods Survey of Primary Healthcare Units

Background

Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19.

Methods

A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically.

Results

The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities.

Conclusion

The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.

Communicable and Non-communicable Diseases Diagnosis and Treatment Service Availability at Primary Health Care Units During COVID-19 Outbreak in Ethiopia

Background

Non-communicable diseases (NCDs) pose a substantial global health challenge, resulting in an annual death toll of over 15 million individuals aged 30 to 69. Ethiopia, categorized as COVID-19 vulnerable, grapples with NCD treatment challenges. This study aims to assess disease service availability at primary health units in Ethiopia during the pandemic.

Methods

A facility-based cross-sectional study was conducted from October to December 2021 across regions, encompassing 452 facilities: 92 health centers, 16 primary hospitals, 344 health posts, and 43 districts. Facility selection, based on consultation with regional health bureaus, included high, medium, and low performing establishments. The study employed the WHO tool for COVID-19 capacity assessment and evaluated services for various diseases using descriptive analysis.

Results

Results reveal service disruptions in the past year: hospitals (55.6%), health centers (21.7%), districts (30.2%), and health posts (17.4%). Main reasons were equipment shortages (42%), lack of skilled personnel (24%), and insufficient infection prevention supplies (18.8%). While tuberculosis treatment was fully available in 23% of health posts and malaria services in 65.7%, some health centers lacked HIV/AIDS, cardiovascular, mental health, and cervical cancer services. Most communicable and non-communicable disease diagnoses and treatments were fully accessible at primary hospitals, except for cervical cancer (56.3%) and mental health (62.5%) services.

Conclusion

Significant gaps exist in expected services at primary health units. Improving disease care accessibility necessitates strengthening the supply chain, resource management, capacity building, and monitoring systems.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

The Impact of the COVID-19 Pandemic on People With Lymphedema in an Endemic Area for Lymphatic Filariasis in Brazil

Objectives: To investigate the repercussions of the COVID-19 pandemic on lymphedema patients from an endemic area of lymphatic filariasis. Methods: The study descriptive compared sociodemographic and clinical aspects, risk of falling and quality of life, prior and during the COVID-19 pandemic in 28 lymphedema patients, older than 18 years old and under investigation of filarial infection. For the evaluation of functional mobility, the Time Up and Go test and The Medical Outcome Study Short Form-36 Health for quality of life, was used. Results: An increase in interdigital and dermal lesions, a higher frequency of acute dermatolymphangioadenitis crises and risk of falling, worsening of quality of life in the domains of physical functioning, general health, vitality, and mental health during the pandemic was observed. Conclusion: Our findings of clinical worsening and quality of life of patients during the COVID-19 pandemic indicate the need to reinforce the goal of the Lymphatic Filariasis Program regarding the follow-up of these patients in the actions of the Global Program for the Elimination of Lymphatic Filariasis, due to the discontinuity in the care during the pandemic.