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Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.

ABSTRACT: INTRODUCTION:With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. METHODS:In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. RESULTS:Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. CONCLUSION:Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.

SUBMITTER: Ahmed SAKS

PROVIDER: S-EPMC7443197 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.

Ahmed Syed A K Shifat SAKS Ajisola Motunrayo M Azeem Kehkashan K Bakibinga Pauline P Chen Yen-Fu YF Choudhury Nazratun Nayeem NN Fayehun Olufunke O Griffiths Frances F Harris Bronwyn B Kibe Peter P Lilford Richard J RJ Omigbodun Akinyinka A Rizvi Narjis N Sartori Jo J Smith Simon S Watson Samuel I SI Wilson Ria R Yeboah Godwin G Aujla Navneet N Azam Syed Iqbal SI Diggle Peter J PJ Gill Paramjit P Iqbal Romaina R Kabaria Caroline C Kisia Lyagamula L Kyobutungi Catherine C Madan Jason J JJ Mberu Blessing B Mohamed Shukri F SF Nazish Ahsana A Odubanjo Oladoyin O Osuh Mary E ME Owoaje Eme E Oyebode Oyinlola O Porto de Albuquerque Joao J Rahman Omar O Tabani Komal K Taiwo Olalekan John OJ Tregonning Grant G Uthman Olalekan A OA Yusuf Rita R

BMJ global health 20200801 8

<h4>Introduction</h4>With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.<h4>Methods</h4>In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 condition ...[more]

PMID: 32819917

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Project description:BackgroundThe COVID-19 pandemic lockdown has posed numerous unique challenges for cancer patients, families and healthcare workers. However, the reports on psychosocial issues associated with such situations are scarce. This study aims to determine the psychosocial issues faced by cancer patients during COVID-19 pandemic lockdown.MethodsCancer patients irrespective of diagnosis and treatment status were assessed for fear of progression (FOP), distress and quality of life (QOL) using Fear of Progression- Short Form, Distress Thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) 30, respectively. The demographics, disease and treatment related details were obtained from case record form. Psychological issues and concerns were collected using a structured interview. Descriptive statistics, Mann Whitney U-test and Linear Regression were performed using SPSS ver 20.0.ResultsAmong the 219 patients, 118 (52.5%) had either interruption in their on-going cancer treatment or the initiation of cancer treatment was delayed as a result of COVID-19 lockdown. Overall, 74% of the patients experienced distress, 55.3% experienced FOP and 58% had low global health status. Pain followed by fatigue remained as major issues among patients during lockdown. Interruption in treatment and logistical issues were strongly associated with increased distress (p = 0.026) and FOP (p = 0.004). Global health status (p = 0.037), emotional functioning (p = 0.000), social functioning (p = 0.000) and financial concerns (p = 0.046) differed significantly between patients with and without treatment interruption. Age (β = -0.159), mode of transport (β = -0.135), challenges in meeting daily needs (β = -0.245) and being out-casted by the society (β = -0.227) predicted distress.ConclusionMore than half of the patients had interruptions in their treatment as a result of COVID-19 lockdown. Cancer patients have had increased physical and psychological concerns as a result of the pandemic situation and its associated changes. Specific guidelines ought to be framed for providing continued and holistic cancer care for patients during such lockdown.

Project description:Globally, ambient air pollution claims ~9 million lives yearly, prompting researchers to investigate changes in air quality. Of special interest is the impact of COVID-19 lockdown. Many studies reported substantial improvements in air quality during lockdowns compared with pre-lockdown or as compared with baseline values. Since the lockdown period coincided with the onset of the rainy season in some tropical countries such as Nigeria, it is unclear if such improvements can be fully attributed to the lockdown. We investigate whether significant changes in air quality in Nigeria occurred primarily due to statewide COVID-19 lockdown. We applied a neural network approach to derive monthly average ground-level fine aerosol optical depth (AODf) across Nigeria from year 2001-2020, using the Multi-angle Implementation of Atmospheric Correction (MAIAC) AODs from Terra and Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) satellites, AERONET aerosol optical properties, meteorological and spatial parameters. During the year 2020, we found a 21% or 26% decline in average AODf level across Nigeria during lockdown (April) as compared to pre-lockdown (March), or during the easing phase-1 (May) as compared to lockdown, respectively. Throughout the 20-year period, AODf levels were highest in January and lowest in May or June, but not April. Comparison of AODf levels between 2020 and 2019 shows a small decline (1%) in pollution level in April of 2020 compare to 2019. Using a linear time-lag model to compare changes in AODf levels for similar months from 2002 to 2020, we found no significant difference (Levene's test and ANCOVA; α = 0.05) in the pollution levels by year, which indicates that the lockdown did not significantly improve air quality in Nigeria. Impact analysis using multiple linear regression revealed that favorable meteorological conditions due to seasonal change in temperature, relative humidity, planetary boundary layer height, wind speed and rainfall improved air quality during the lockdown.

Project description:ObjectiveThe COVID-19 pandemic resulted in medical institutes being shut down. Face-to-face activities were shifted to online medium. The unpredictability of the situation impacted medical faculty and students alike, creating panic and anxiety. Since these students are to take hold of the healthcare system of the country soon, it is important to learn their perspective on how COVID impacted them. Therefore, this study aimed to explore the lived experiences of Pakistani medical students in-depth by a qualitative observation of their personal and educational experiences.DesignA phenomenological qualitative study interviewing medical students of Pakistan was conducted.Participants/methodologyThis study was designed to interview medical and dental students from various cities in Pakistan using a semistructured, open-ended questionnaire. A total of 34 interviews were recorded and transcripts were prepared. All authors (SI, SS, IA and MS) were involved in the thematic analysis of the data, whereby transcripts were read thoroughly, and codes were developed. Similar codes were then combined to generate themes.ResultsThree major themes emerged after the analysis of results. The students' 'diverse experiences' of panic and anxiety or excitement were high initially but gradually reduced as time progressed. The 'unprecedented academic experiences' of students included teaching/learning, communication and technical challenges that they faced during online classes. Despite facing a lot of challenges, the students still saw 'light at the end of the tunnel' and looked forward to going back to their college.ConclusionThe effects of COVID on the physical, psychological, social and academic life of medical students were enormous. It is highly recommended that institutes and faculty provide support for personal and professional development of students in these unprecedented times in the form of counselling, provision of technical facilities or leniency in fee process. Peer support is also considered crucial in reducing anxiety among students.

Project description:The people living in Onne are highly vulnerable to PAH exposure due to constant exposure to black soot through oral, dermal, and inhalation routes. This work aims to determine the PAHs profile of selected soils in Onne, to determine the health risks associated with PAHs exposure through the soil, and to determine the impact of reduced industrial and other activities on the PAHs profile and associated public health risks. This study evaluated 16 priority polycyclic aromatic hydrocarbon (PAHs) pollutants in soil samples from the four (4) major clans in Onne using a gas chromatography flame ionization detector (GC-FID) during and after the COVID-19 lockdown. The results showed a differential presence of PAHs during and after the lockdown. Of the 16 priority PAHs, 10 and 8 PAHs were respectively detected during and after the COVID-19 lockdown. High molecular weight PAHs such as benzo(k)fluoranthene and benzo(a)anthracene were major contributors during the lockdown, while low molecular weight PAHs such as naphthalene, acenaphthylene, and fluorene were present at higher levels after the lockdown. An assessment of health risk by incremental lifetime cancer risks revealed that the entire population of Onne might be at risk of cancer development across periods, though a higher risk was presented during the lockdown. In addition, children under the age of 18 may be at greater risk. To the best of our knowledge, there is no previous report on the impact of the COVID-19 lockdown on soil PAH profile and health risks, with particular attention to the Onne industrial host community. Earlier work considered the ecological risks of heavy metals on dumpsites in Onne. Taken together, the PAH-contaminated soil in Onne poses an immediate health concern. Therefore, reduced anthropological activities, as evident during the COVID-19 lockdown, may play a role in exposure and cancer risk reduction. While there may not be another lockdown due to the challenging impacts associated with a physical lockdown, firmly controlled economic activity can be a solution if embraced by stakeholders. The COVID-19-lockdown was encumbered with restricted movements and security checks, which limited the number of samples collected. However, the Local Government Council (Department of the Environment) granted permission for the researchers to work with a minimal threat to their lives.

Dataset Information

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.

Publications

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.

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