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Nakamya P, Komakech A, Migamba SM, Biribawa C, Kwesiga B, Bulage L, Ario AR, Ocom F. Trends and geospatial distribution of stillbirths in Uganda, 2014-2020. BMC Pregnancy Childbirth 2024; 24:249. [PMID: 38589779 PMCID: PMC11000338 DOI: 10.1186/s12884-024-06434-x] [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: 03/14/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Uganda with 17.8 stillbirths per 1,000 deliveries in 2021, is among the countries with a high burden of stillbirths globally. In 2014, Uganda adopted the World Health Organization Every New-born Action Plan (ENAP), which targets < 10 stillbirths per 1,000 deliveries by 2035. Little is known about the trends of stillbirth burden since ENAP was introduced. We assessed the temporal, and spatial distribution of stillbirths, in Uganda, 2014-2020, to inform programming for safe pregnancies and deliveries. METHODS We obtained and analysed stillbirth surveillance data from the District Health Information System, 2014-2020. A stillbirth was defined as the death of a foetus > 28 weeks of pregnancy or weighing > 1000 g before or during birth and reported to a health facility. We calculated annual incidence rates of stillbirths per 1,000 deliveries at district, regional, and national levels. We used logistic regression to determine the significance of trends. RESULTS The overall national annual incidence of stillbirths decreased from 24/1,000 deliveries in 2014 to 17/1,000 deliveries in 2020. During the same period, reporting rates declined from 71% in 2014 to 46% in 2020. The central region continuously had the highest incidence rate for the past 5 years despite the largest decline (OR = 0.79; CI = 0.77-0.83, P < 0.001) while the eastern region had the smallest decline (OR = 0.59; CI = 0.57-0.61, P < 0.001). Districts with persistently high annual incidence rates of stillbirths (> 30/1000) included Mubende, Kalangala, Hoima, and Nebbi. There was no difference in the reporting rates of the most- vs. least-affected districts. CONCLUSION Even with suboptimal reporting, the incidence of stillbirths remained above the national target. Specific areas in the country appear to have particularly high stillbirth rates. We recommend continuous capacity building in managing pregnant women with an emphasis on the most affected districts, and investigation into the reasons for low reporting.
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Affiliation(s)
- Petranilla Nakamya
- Uganda National Institute of Public Health, Kampala, Uganda.
- National Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda.
| | - Allan Komakech
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | - Benon Kwesiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex R Ario
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Felix Ocom
- National Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
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Ojewale LY, Mukumbang FC. Access to healthcare services for people with non-communicable diseases during the COVID-19 pandemic in Ibadan, Nigeria: a qualitative study. BMC Health Serv Res 2023; 23:1231. [PMID: 37946244 PMCID: PMC10636991 DOI: 10.1186/s12913-023-10278-0] [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: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Desirable outcomes for people with non-communicable diseases (NCDs) are achieved when they access routine monitoring and care services. Expectedly, the COVID-19 pandemic severely impacted access to healthcare services, leading to poor health outcomes among people with NCDs. We aimed to [1] explore the delays in accessing healthcare services and [2] understand alternative actions adopted by people with NCDs to overcome these delays. METHODS We conducted an exploratory qualitative research guided by the "Three Delays" model to unpack the barriers to healthcare access for people living with NCDs in Ibadan, Nigeria. The "Three Delays" model conceptualizes the reasons for negative/adverse healthcare outcomes related to the patient's decision-making to seek healthcare, reaching an appropriate healthcare facility, and receiving adequate care at the healthcare facility. Twenty-five (25) people with NCDs were purposively selected from the University College Hospital's medical outpatient department to participate in in-depth interviews. Interview recordings were transcribed verbatim and analyzed using a deductive-inductive hybrid thematic analysis. RESULTS At the level of individual decision-making, delays were related to fear of contracting COVID-19 in the hospital (considered a hotspot of the COVID-19 pandemic). Regarding reaching an appropriate healthcare facility, delays were mainly attributed to the intra- and inter-city lockdowns, limiting the movements of persons. For those who successfully arrived at the healthcare facilities, delays were related to the unavailability of healthcare professionals, prioritization of COVID-19 patients, and mandatory adherence to COVID-19 protocols, including COVID-19 testing. To overcome the delays mentioned above, people with NCDs resorted to (i) using private healthcare facilities, which were more costly, (ii) using virtual consultation through mobile phone Apps and (iii) self-management, usually by repeating previously prescribed prescriptions to obtain medication. CONCLUSION Pandemic conditions provide unique challenges to people with chronic illnesses. Recognizing the need for continuous access to monitoring and care services under such conditions remains critical. Alternative health service provision approaches should be considered in pandemic situations, including remote healthcare services such as Mobile health apps (mHealth) that can help manage and prevent NCDs.
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Bose B, Alam SA, Pörtner CC. Impacts of the COVID-19 Lockdown on Healthcare Inaccessibility and Unaffordability in Uganda. Am J Trop Med Hyg 2023; 109:527-535. [PMID: 37580028 PMCID: PMC10484254 DOI: 10.4269/ajtmh.23-0144] [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: 03/07/2023] [Accepted: 06/29/2023] [Indexed: 08/16/2023] Open
Abstract
Several studies have reported adverse consequences of the COVID-19 lockdowns on the utilization of healthcare services across Africa. However, little is known about the channels through which lockdowns impacted healthcare utilization. This study focuses on unaffordability as a reason for not utilizing healthcare services. We estimate the causal impacts of the COVID-19 lockdown on healthcare inaccessibility and affordability in Uganda relative to the nonlockdown periods of the pandemic. We use nationally representative longitudinal household data and a household fixed-effects model to identify the impact of the lockdown on whether households could not access medical treatment and whether the reason for not getting care was the lack of money. We find that the lockdown in Uganda was associated with an 8.4% higher likelihood of respondents being unable to access healthcare when treatment was needed relative to the nonlockdown periods. This implies a 122% increase in the share of respondents unable to access healthcare. As lockdown restrictions eased, the likelihood of being unable to access medical treatment decreased. The main reason for the increase in inaccessibility was the lack of money, with a 71% increase in the likelihood of respondents being unable to afford treatment. We find little evidence that the effects of the lockdown differed by wealth status or area of residence. Our results indicate the need for policymakers to consider immediate social support for households as a strategy for balancing the disruptions caused by lockdowns.
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Affiliation(s)
- Bijetri Bose
- Fielding School of Public Health, University of California, Los Angeles, California
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Shamma A. Alam
- Department of International Studies, Dickinson College, Carlisle, Pennsylvania
| | - Claus C. Pörtner
- Department of Economics, Seattle University, Seattle, Washington
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
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Muddu M, Semitala FC, Kimera ID, Musimbaggo DJ, Mbuliro M, Ssennyonjo R, Kigozi SP, Katwesigye R, Ayebare F, Namugenyi C, Mugabe F, Mutungi G, Longenecker CT, Katahoire AR, Schwartz JI, Ssinabulya I. Using the RE-AIM framework to evaluate the implementation and effectiveness of a WHO HEARTS-based intervention to integrate the management of hypertension into HIV care in Uganda: a process evaluation. Implement Sci Commun 2023; 4:102. [PMID: 37626415 PMCID: PMC10463385 DOI: 10.1186/s43058-023-00488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) HEARTS packages are increasingly used to control hypertension. However, their feasibility in persons living with HIV (PLHIV) is unknown. We studied the effectiveness and implementation of a WHO HEARTS intervention to integrate the management of hypertension into HIV care. METHODS This was a mixed methods study at Uganda's largest HIV clinic. Components of the adapted WHO HEARTS intervention were lifestyle counseling, free hypertension medications, hypertension treatment protocol, task shifting, and monitoring tools. We determined the effectiveness of the intervention among PLHIV by comparing hypertension and HIV outcomes at baseline and 21 months. The RE-AIM framework was used to evaluate the implementation outcomes of the intervention at 21 months. We conducted four focus group discussions with PLHIV (n = 42), in-depth interviews with PLHIV (n = 9), healthcare providers (n = 15), and Ministry of Health (MoH) policymakers (n = 2). RESULTS Reach: Among the 15,953 adult PLHIV in the clinic, of whom 3892 (24%) had been diagnosed with hypertension, 1133(29%) initiated integrated hypertension-HIV treatment compared to 39 (1%) at baseline. Among the enrolled patients, the mean age was 51.5 ± 9.7 years and 679 (62.6%) were female. EFFECTIVENESS Among the treated patients, hypertension control improved from 9 to 72% (p < 0.001), mean systolic blood pressure (BP) from 153.2 ± 21.4 to 129.2 ± 15.2 mmHg (p < 0.001), and mean diastolic BP from 98.5 ± 13.5 to 85.1 ± 9.7 mmHg (p < 0.001). Overall, 1087 (95.9%) of patients were retained by month 21. HIV viral suppression remained high, 99.3 to 99.5% (p = 0.694). Patients who received integrated hypertension-HIV care felt healthy and saved more money. Adoption: All 48 (100%) healthcare providers in the clinic were trained and adopted the intervention. Training healthcare providers on WHO HEARTS, task shifting, and synchronizing clinic appointments for hypertension and HIV promoted adoption. IMPLEMENTATION WHO HEARTS intervention was feasible and implemented with fidelity. Maintenance: Leveraging HIV program resources and adopting WHO HEARTS protocols into national guidelines will promote sustainability. CONCLUSIONS The WHO HEARTS intervention promoted the integration of hypertension management into HIV care in the real-world setting. It was acceptable, feasible, and effective in controlling hypertension and maintaining optimal viral suppression among PLHIV. Integrating this intervention into national guidelines will promote sustainability.
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Affiliation(s)
- Martin Muddu
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda.
| | - Fred Collins Semitala
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Derick Kimera
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda
| | | | - Mary Mbuliro
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda
| | - Rebecca Ssennyonjo
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda
| | | | - Rodgers Katwesigye
- Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda
| | | | | | | | | | | | | | - Jeremy I Schwartz
- Section of General Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Isaac Ssinabulya
- Mulago Hospital Complex, Uganda Heart Institute, Kampala, Uganda
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Kabami J, Owaraganise A, Beesiga B, Okiring J, Kakande E, Chen YH, Mwangwa F, Akatukwasa C, Nangendo J, Muyindike W, Semitala FC, Roh ME, Kamya MR. Effect of the COVID-19 lockdown on the HIV care continuum in Southwestern Uganda: A time series analysis. PLoS One 2023; 18:e0289000. [PMID: 37561727 PMCID: PMC10414556 DOI: 10.1371/journal.pone.0289000] [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: 12/15/2022] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION In Uganda, COVID-19 lockdown policies curbed the spread of SARS-CoV-2, but their effect on HIV care is poorly understood. OBJECTIVES We examined the effects of COVID-19 lockdown policies on ART initiation, missed visits, and viral suppression in Uganda. METHODS We conducted a time series analysis using data from a dynamic cohort of persons with HIV enrolled between March 2017 and September 2021 at HIV clinics in Masaka and Mbarara Regional Referral Hospitals in Southwestern Uganda. Poisson and fractional probit regression were used to predict expected monthly antiretroviral therapy initiations, missed visits, and viral suppression based on pre-lockdown trends. Observed and expected trends were compared across three policy periods: April 2020-September 2021 (overall), April-May 2020 (1st lockdown), and June-August 2021 (2nd lockdown). RESULTS We enrolled 7071 Persons living with HIV (PWH) (nMasaka = 4150; nMbarara = 2921). Average ART duration was 34 and 30 months in Masaka and Mbarara, respectively. During the 18-month post-lockdown period, monthly ART initiations were lower than expected in both Masaka (51 versus 63 visits; a decrease of 12 [95% CI: -2, 31] visits) and Mbarara (42 versus 55 visits; a decrase of 13 [95% CI: 0, 27] visits). Proportion of missed visits was moderately higher than expected post-lockdown in Masaka (10% versus 7%; 4% [95% CI: 1%, 7%] absolute increase), but not in Mbarara (13% versus 13%; 0% [95% CI: -4%, 6%] absolute decrease). Viral suppression rates were moderate-to-high in Masaka (64.7%) and Mbarara (92.5%) pre-lockdown and remained steady throughout the post-lockdown period. CONCLUSION The COVID-19 lockdown in Uganda was associated with reductions in ART initiation, with minimal effects on retention and viral suppression, indicating a resilient HIV care system.
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Affiliation(s)
- Jane Kabami
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Elijah Kakande
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Florence Mwangwa
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | | | | | - Winnie Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fred C. Semitala
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Michelle E. Roh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
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Chippaux JP. COVID-19 impacts on healthcare access in sub-Saharan Africa: an overview. J Venom Anim Toxins Incl Trop Dis 2023; 29:e20230002. [PMID: 37405230 PMCID: PMC10317188 DOI: 10.1590/1678-9199-jvatitd-2023-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
This overview aimed to describe the situation of healthcare access in sub-Saharan Africa, excluding South Africa, during the COVID-19 pandemic. A PubMed® search from March 31, 2020, to August 15, 2022, selected 116 articles. Healthcare access and consequences of COVID-19 were assessed based on comparisons with months before its onset or an identical season in previous years. A general reduction of healthcare delivery, associated with the decline of care quality, and closure of many specialty services were reported. The impact was heterogeneous in space and time, with an increase in urban areas at the beginning of the pandemic (March-June 2020). The return to normalcy was gradual from the 3rd quarter of 2020 until the end of 2021. The impact of COVID-19 on the health system and its use was attributed to (a) conjunctural factors resulting from government actions to mitigate the spread of the epidemic (containment, transportation restrictions, closures of businesses, and places of entertainment or worship); (b) structural factors related to the disruption of public and private facilities and institutions, in particular, the health system; and (c) individual factors linked to the increase in costs, impoverishment of the population, and fear of contamination or stigmatization, which discouraged patients from going to health centers. They have caused considerable socio-economic damage. Several studies emphasized some adaptability of the healthcare offer and resilience of the healthcare system, despite its unpreparedness, which explained a return to normal activities as early as 2022 while the COVID-19 epidemic persisted. There appears to be a strong disproportion between the moderate incidence and severity of COVID-19 in sub-Saharan Africa, and the dramatic impact on healthcare access. Several articles make recommendations for lowering the socioeconomic consequences of future epidemics to ensure better management of health issues.
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Affiliation(s)
- Jean-Philippe Chippaux
- Paris Cité University, Research Institute for Development, Mother and child in tropical environment: pathogens, health system and epidemiological transition, Paris, France
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Isaac Derick K, Khan Z. Prevalence, Awareness, Treatment, Control of Hypertension, and Availability of Hypertension Services for Patients Living With Human Immunodeficiency Virus (HIV) in Sub-Saharan Africa (SSA): A Systematic Review and Meta-analysis. Cureus 2023; 15:e37422. [PMID: 37182060 PMCID: PMC10173023 DOI: 10.7759/cureus.37422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Sub-Saharan Africa (SSA) is faced with a dual burden of hypertension and human immunodeficiency virus (HIV). In this review we sought to determine the prevalence, awareness, and control of hypertension among persons living with HIV (PLHIV), and the availability of hypertension services at the HIV care points in SSA. We searched the PubMed, Embase, Scopus, Cochrane library, Global index Medicus, African Journal online, and WHO Institutional Repository for Information Sharing (IRIS) for studies on the epidemiology of hypertension, and hypertension services for PLHIV in SSA. Twenty-six articles were identified for the review, with 150,886 participants; weighted mean of age 37.5 years and female proportion of 62.6%. The pooled prevalence was 19.6% (95% confidence interval [CI], 16.6%, 22.5%); hypertension awareness was 28.4% (95% CI, 15.5%, 41.3%), and hypertension control was 13.4% (95% CI, 4.7%, 22.1%). HIV-related factors like CD4 count, viremia, and antiretroviral therapy regimen were not consistently associated with prevalent hypertension. However, high body mass index (BMI) above 25 kg/m2 [odds ratio: 1.64, 95% CI (1.26, 2.02)] and age above 45 years [odds ratio: 1.44, 95% CI (1.08, 1.79)] were associated with prevalent hypertension. Even when PLHIV on ART were more likely to be screened for hypertension and monitored, there was infrequent screening and treatment of hypertension in most HIV clinics. Most studies recommended integrating of HIV and hypertension services. We report a high prevalence of hypertension in a relatively young population of PLHIV with suboptimal screening, treatment, and control of hypertension. We recommend strategies to integrate HIV and hypertension services.
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Affiliation(s)
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Bart's Heart Centre UK, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control. J Hum Hypertens 2023; 37:213-219. [PMID: 35246602 PMCID: PMC8896410 DOI: 10.1038/s41371-022-00655-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022]
Abstract
Multi-month dispensing (MMD) is a patient-centered approach in which stable patients receive medicine refills of three months or more. In this pre-post longitudinal study, we determined hypertension and HIV treatment outcomes in a cohort of hypertensive PLHIV at baseline and 12 months of receiving integrated MMD. At each clinical encounter, one healthcare provider attended to both hypertension and HIV needs of each patient in an HIV clinic. Among the 1,082 patients who received MMD, the mean age was 51 (SD = 9) years and 677 (63%) were female. At the start of MMD, 1,071(98.9%) patients had achieved HIV viral suppression, and 767 (73.5%) had achieved hypertension control. Mean blood pressure reduced from 135/87 (SD = 15.6/15.2) mmHg at the start of MMD to 132/86 (SD = 15.2/10.5) mmHg at 12 months (p < 0.0001). Hypertension control improved from 73.5% to 78.5% (p = 0.01) without a significant difference in the proportion of patients with HIV viral suppression at baseline and at 12 months, 98.9% vs 99.0% (p = 0.65). Patients who received MMD with elevated systolic blood pressure at baseline were less likely to have controlled blood pressure at 12 months (OR-0.9, 95% CI, 0.90,0.92). Overall, 1,043 (96.4%) patients were retained at 12 months. Integrated MMD for stable hypertensive PLHIV improved hypertension control and sustained optimal HIV viral suppression and retention of patients in care. Therefore, it is feasible to provide integrated MMD for both hypertension and HIV treatment and achieve dual control in the setting of sub-Saharan Africa.
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Chippaux JP. [Impact of COVID-19 on public health in sub-Saharan Africa]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2023; 207:150-164. [PMID: 36628105 PMCID: PMC9816877 DOI: 10.1016/j.banm.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2022] [Indexed: 01/09/2023]
Abstract
Objective This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa. Method A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years. Results The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system. Conclusion Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.
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Musoke D, Nalinya S, Lubega GB, Deane K, Ekirapa-Kiracho E, McCoy D. The effects of COVID-19 lockdown measures on health and healthcare services in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001494. [PMID: 36963035 PMCID: PMC10021763 DOI: 10.1371/journal.pgph.0001494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/20/2022] [Indexed: 01/24/2023]
Abstract
Many countries across the world instituted lockdowns as a measure to prevent the spread of COVID-19. However, these lockdowns had consequences on health systems. This study explored effects of the COVID-19 lockdown measures on health and healthcare services in Uganda. The qualitative study employed focus group discussions (FGDs), household interviews, and key informant interviews (KIIs) in both an urban (Kampala district) and rural (Wakiso district) setting in central Uganda. Fourteen FGDs were conducted among community members, local leaders, community health workers, and health practitioners. Interviews were conducted among 40 households, while 31 KIIs were held among various stakeholders including policy makers, non-governmental organisations, and the private sector. Data was analysed by thematic analysis with the support of NVivo 2020 (QSR International). Findings from the study are presented under four themes: maternal and reproductive health; child health; chronic disease services; and mental health. Maternal and reproductive health services were negatively affected by the lockdown measures which resulted in reduced utilisation of antenatal, postnatal and family planning services. These effects were mainly due to travel restrictions including curfew, and fear of contracting COVID-19. The effects on child health included reduced utilisation of services which was a result of difficulties faced in accessing health facilities because of the travel restrictions. Patients with chronic conditions could not access health facilities for their routine visits particularly due to suspension of public transport. Depression, stress and anxiety were common due to social isolation from relatives and friends, loss of jobs, and fear of law enforcement personnel. There was also increased anxiety among health workers due to fear of contracting COVID-19. The COVID-19 lockdown measures negatively affected health, and reduced access to maternal, reproductive and child health services. Future interventions in pandemic response should ensure that their effects on health and access to health services are minimised.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kevin Deane
- The Open University, Milton Keynes, United Kingdom
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
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Izudi J, Kiragga AN, Kalyesubula P, Okoboi S, Castelnuovo B. Effect of the COVID-19 pandemic restrictions on outcomes of HIV care among adults in Uganda. Medicine (Baltimore) 2022; 101:e30282. [PMID: 36086721 PMCID: PMC10980429 DOI: 10.1097/md.0000000000030282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
Uganda enforced several stringent restrictions such as night-time curfews, travel bans, school closure, and physical and social distancing among others that constituted a national lockdown to prevent the spread of the Coronavirus disease 2019 (COVID-19). These restrictions disrupted the delivery of health services but the impact on outcomes of human immunodeficiency virus (HIV) care has not been rigorously studied. We evaluated the effect of the COVID-19 pandemic restrictions on outcomes of HIV care among people living with HIV (PLHIV) aged ≥15 years in Kampala, Uganda. We designed a nonrandomized, quasi-experimental study using observational data retrieved from six large HIV clinics and used the data to construct two cohorts: a comparison cohort nonexposed to the restrictions and an exposed cohort that experienced the restrictions. The comparison cohort consisted of PLHIV commenced on anti-retroviral therapy (ART) between March 1, 2018, and February 28, 2019, followed for ≥1 year with outcomes assessed in March 2020, just before the restrictions were imposed. The exposed cohort comprised of PLHIV started on ART between March 1, 2019, and February 28, 2020, followed for ≥1 year with outcomes assessed in June 2021. The primary outcomes are retention, viral load testing, viral load suppression, and mortality. We employed inverse probability of treatment weighting using propensity score (IPTW-PS) to achieve comparability between the two cohorts on selected covariates. We estimated the effect of the restriction on the outcomes using logistic regression analysis weighted by propensity scores (PS), reported as odds ratio (OR) and 95% confidence interval (CI). We analyzed data for nine, 952 participants, with 5094 (51.2%) in the exposed group. The overall mean age was 32.7 ± 8.8 years. In the exposed group relative to the comparison group, viral load testing (OR, 1.68; 95% CI, 1.59-1.78) and viral load suppression (OR, 1.34; 95% CI, 1.110-1.63) increased while retention (OR, 0.76; 95% CI, 0.70-0.81) and mortality (OR, 0.75; 95% CI, 0.64-0.88) reduced. Among PLHIV in Kampala, Uganda, viral load testing and suppression improved while retention and mortality reduced during the COVID-19 pandemic restrictions due to new approaches to ART delivery and the scale-up of existing ART delivery models.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Data Science and Evaluations (DSE) Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Agnes N. Kiragga
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
- Data Science and Evaluations (DSE) Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Philip Kalyesubula
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Okoboi
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
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Kowsalya A, Chaudhary S, Sen S, Shanmugam M, Narayanamoorthy JK, Jain S, Sundar B. Neuro-ophthalmological manifestations of diabetes mellitus during COVID-19-related lockdown in India. Indian J Ophthalmol 2022; 70:3398-3402. [PMID: 36018129 DOI: 10.4103/ijo.ijo_558_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The coronavirus disease 19 (COVID-19) pandemic has resulted in a huge impact on the health care system. Diversion of health care workforce toward management of a high number of COVID-19 cases and lockdown restrictions have affected the follow-up of patients. The objective of this study was to analyze the impact of this situation on the control of diabetes, eventually resulting in related neuro-ophthalmological complications. Methods This retrospective case series included diabetic patients visiting the neuro-ophthalmology clinic at a tertiary care eye center in India from 25 March 2020 to 25 September 2020 during the lockdown. The incidence of diabetes-related neuro-ophthalmological complications, including third, fourth, sixth nerve palsies and non-arteritic anterior ischemic optic neuropathy (NAION) was evaluated and compared with that of the same period during 2019. Results Overall disease incidence rate was significantly higher in the year 2020 (60.2%) compared to the previous year of 2019 (29.8%). The proportion of third nerve palsy (4.8% vs 16.3%, P < 0.001) and NAION (0.3% vs 14.3%, P < 0.001) had increased. Even though the percentage of sixth nerve palsy was 25% in 2020, this was not significantly different from 2019. There was a reduction in the percentage of fourth nerve palsy cases from the year 2019 to 2020. Conclusion There was a significant increase in diabetes-related neuro-ophthalmic complications during the COVID-19 lockdown. This can possibly be attributed to worsening of glycemic control in diabetic patients.
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Affiliation(s)
- Akkayasamy Kowsalya
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sameer Chaudhary
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sagnik Sen
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | | | - Shreya Jain
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Balagiri Sundar
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Virtual management of hypertension: lessons from the COVID-19 pandemic-International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1435-1448. [PMID: 35579481 DOI: 10.1097/hjh.0000000000003205] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts' opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.
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Yan LD, Matuja SS, Pain KJ, McNairy ML, Etyang AO, Peck RN. Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review. Hypertension 2022; 79:898-905. [PMID: 35272495 PMCID: PMC9010372 DOI: 10.1161/hypertensionaha.121.17949] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA. METHODS In September 2021, we conducted a search in MEDLINE, Embase, and Scopus, limited to English language studies published since 1990, and found a total of 1169 articles. Forty-seven original studies were included, with 32 on COVID-19 and 15 on other emerging viruses. RESULTS Seven articles, including those with the largest sample size and most robust study design, found an association between preexisting hypertension or CVD and COVID-19 severity or death. Ten smaller studies found no association, and 17 did not calculate statistics to compare groups. Two studies assessed the impact of COVID-19 on incident CVD, with one finding an increase in stroke admissions. For other emerging viruses, 3 studies did not find an association between preexisting hypertension or CVD on West Nile and Lassa fever mortality. Twelve studies examined other emerging viral infections and incident CVD, with 4 finding no association and 8 not calculating statistics. CONCLUSIONS Growing evidence from COVID-19 suggests viruses, hypertension, and CVD interact on multiple levels in SSA, but research gaps remain especially for other emerging viral infections. SSA can and must play a leading role in the study and control of emerging viral infections, with expansion of research and public health infrastructure to address these interactions.
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Affiliation(s)
- Lily D Yan
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah S Matuja
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Kevin J Pain
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Margaret L McNairy
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Robert N Peck
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Interventions Trial Unit, Mwanza, Tanzania
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Izudi J, Kiragga AN, Okoboi S, Bajunirwe F, Castelnuovo B. Adaptations to HIV services delivery amidst the COVID-19 pandemic restrictions in Kampala, Uganda: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000908. [PMID: 36962823 PMCID: PMC10022311 DOI: 10.1371/journal.pgph.0000908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
The enforcement of the coronavirus disease (COVID-19) pandemic restrictions disrupted health services delivery and currently, there is a limited understanding regarding measures employed by health facilities to ensure delivery of human immunodeficiency virus (HIV) services amidst the interruptions. We, therefore, designed a qualitative study to explore the measures for continuity of HIV services during the COVID-19 pandemic restrictions in Kampala, Uganda. This study was conducted at six large primary health care facilities in the Kampala Metropolitan area. Qualitative data were collected from anti-retroviral therapy (ART) focal persons and lay health workers namely linkage facilitators and peer mothers through key informant interviews (KIIs). Overall, 14 KIIs were performed, 10 with lay health workers and 4 with ART focal persons. Data were audio-recorded, transcribed verbatim, and analyzed using the content approach, and the results were presented as themes along with participant quotations. Five themes emerged to describe measures for continuity of HIV services. The measures included: 1) leveraging the use of mobile phone technology to support ART adherence counseling, psychosocial care, and reminders concerning clinic appointments and referrals; 2) adoption of novel differentiated service delivery models for ART like the use of motorcycle taxis and introduction of an individualized ART delivery model for patients with non-disclosed HIV status; 3) scale-up of existing differentiated service delivery models for ART, namely multi-month dispensing of antiretroviral drugs (ARVs), fast-track ARV refill, home-based ARV refill, peer ART delivery, use of community pharmacy model, and community client-led ART delivery model; and, 4) reorientation of health facility functioning to the COVID-19 pandemic restrictions characterized by the use of nearby health facilities for ARV refill and viral load monitoring, transportation of healthcare providers and flexible work schedules and reliance on shift work. We found several measures were adopted to deliver HIV care, treatment, and support services during the COVID-19 pandemic restrictions in Kampala, Uganda. We recommend the scale-up of the new measures for service continuity in the post-COVID-19 period.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Agnes N Kiragga
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Stephen Okoboi
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
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Tessema GA, Kinfu Y, Dachew BA, Tesema AG, Assefa Y, Alene KA, Aregay AF, Ayalew MB, Bezabhe WM, Bali AG, Dadi AF, Duko B, Erku D, Gebrekidan K, Gebremariam KT, Gebremichael LG, Gebreyohannes EA, Gelaw YA, Gesesew HA, Kibret GD, Leshargie CT, Meazew MW, Mekonnen A, Mirkuzie AH, Mohammed H, Tekle DY, Tesfay FH. The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response. BMJ Glob Health 2021; 6:e007179. [PMID: 34853031 PMCID: PMC8637314 DOI: 10.1136/bmjgh-2021-007179] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O'Malley's methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.
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Affiliation(s)
- Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Yohannes Kinfu
- University of Canberra, Canberra, Australian Capital Territory, Australia
- College of Medicine, Qatar University, Doha, Qatar
| | - Berihun Assefa Dachew
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kefyalew Addis Alene
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Atsede Fantahun Aregay
- Monash University, Clayton, Victoria, Australia
- School of Nursing, Mekelle University, Mekelle, Ethiopia
| | - Mohammed Biset Ayalew
- Department of Pharmacy, University of New England, Armidale, New South Wales, Australia
- Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia
| | | | - Ayele Geleto Bali
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Menzies Health Research Institute, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bereket Duko
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | | | - Kidane Tadesse Gebremariam
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Lifelong Health, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Lemlem Gebremedhin Gebremichael
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Pharmacology, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Yalemzewod Assefa Gelaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Population Child Health Research Group, School of Women's and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hailay Abrha Gesesew
- Public Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Epidemiology, School of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Getiye Dejenu Kibret
- Public Health, Debre Markos University, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Cheru Tesema Leshargie
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Alemayehu Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Alemnesh H Mirkuzie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Dejen Yemane Tekle
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Deakin University, Institute of Health Transformation, Melbourne, Victoria, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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Preventing the Next Pandemic: The Case for Investing in Circulatory Health - A Global Coalition for Circulatory Health Position Paper. Glob Heart 2021; 16:66. [PMID: 34692391 PMCID: PMC8516006 DOI: 10.5334/gh.1077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.
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Atim MG, Kajogoo VD, Amare D, Said B, Geleta M, Muchie Y, Tesfahunei HA, Assefa DG, Manyazewal T. COVID-19 and Health Sector Development Plans in Africa: The Impact on Maternal and Child Health Outcomes in Uganda. Risk Manag Healthc Policy 2021; 14:4353-4360. [PMID: 34703344 PMCID: PMC8541793 DOI: 10.2147/rmhp.s328004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/08/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Health Sector Development Plans (HSDPs) aim to accelerate movement towards achieving sustainable development goals for health, reducing inequalities, and ending poverty. Reproductive, maternal, newborn and child health (RMNCH) services are vulnerable to economic imbalances, including health insecurity, unmet need for healthcare, and low health expenditure. The same vulnerability influences the potential of a country to combat global outbreaks such as the COVID-19. We aimed to provide some important insights into the impacts of COVID-19 on RMNCH indicators and outcomes of the HSDP in Uganda. METHODS We conducted a descriptive study of secondary data obtained from the Ugandan government-led portals, supplemented by analyses of relevant articles published up to 06 May 2021 and deposited in PubMed. RESULTS Through synthesizing actionable and relevant evidence, we realized that RMNCH in Uganda is highly affected by the COVID-19 pandemic and the lockdown measures. The impact was across immunization, antenatal, sexual and reproductive health, emergency and obstetric, and postnatal care services. There was a decline sharply by 9.6% for under-five vitamin A coverage, 9% for DPT3HibHeb3 coverage, 6.8% for measles vaccination coverage, 6% for isoniazid preventive therapy coverage, and 3% for facility-based deliveries. Maternal and under-five deaths increased by 7.6% and 4%, respectively. Outreaches were rarely conducted in the lockdown period. CONCLUSION The COVID-19 pandemic has created a multitude of questions regarding the optimal policies to mitigate the disease while minimizing the unintended detrimental consequences of RMNCH. The lockdown restrictions threatened to reverse the progress made on the national HSDP for RMNCH. In Uganda, where young women are vulnerable to early marriage, unintended pregnancies, and unsafe abortion, access to RMNCH services should continue regardless of the COVID-19 status in the country. We urge that Uganda and other African countries should build resilient and sustainable health systems that can withstand emerging diseases like the COVID-19.
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Affiliation(s)
- Mary Gorret Atim
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Violet Dismas Kajogoo
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Mafie District Hospital, Mafia Island, Pwani Region, Tanzania
| | - Demeke Amare
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Food and Drug Administration Authority (EFDA), Addis Ababa, Ethiopia
| | - Bibie Said
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Kibong’oto National Tuberculosis Hospital, Kilimanjaro, Tanzania
| | - Melka Geleta
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yilkal Muchie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- All Africa Leprosy and Rehabilitation Training (ALERT) Centre, Addis Ababa, Ethiopia
| | - Hanna Amanuel Tesfahunei
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Hager Biomedical Research Institute, Asmara, Eritrea
| | - Dawit Getachew Assefa
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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