The Impact of The COVID-19 Pandemic on the Management of Chronic Disease in South Africa: A Systematic Review

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Abstract

Introduction:

The abrupt development of the coronavirus (COVID-19) pandemic has posed a threat to persons with chronic diseases' compliance with treatment, which is critical to improving their health, life expectancy, and lowering death and morbidity rates. The public health control measures for the pandemic have been heavily politicized. The focus on the COVID-19 epidemic has resulted in a neglect for chronic disease management. As a result, the goal of this study was to review the literature in order to gain a broader perspective on how the COVID-19 pandemic has impacted chronic disease management, as well as to investigate various strategies to deal with similar occurrences in the future when faced with medical emergencies, in order to reduce the potential harm of these measures to non-communicable disease control.

Methodology:

To analyze and identify full-text studies relevant to the influence of COVID-19 on the management of chronic diseases conducted in an African environment from 2019 to 2021, the suggested reporting items for systematic reviews and meta-analyses were used. Six databases were searched to find relevant studies, which include CINAHL Plus (EBSCO), PubMed, Google Scholar, Medline, ProQuest, and APA PsychINFO. Researchers performed a quality assessment for each included paper prior to data synthesis, as well as a formal risk-of-bias assessment.

Results:

Out of 119 abstracts reviewed, 17 full-text studies were included. Three themes were identified: the impact of COVID-19 on the healthcare system; the psychological impact on people with chronic diseases and healthcare providers; and the digitalization of healthcare services. The majority of studies were conducted in South Africa and other African countries in collaboration with western countries. The majority of studies focused on lessons learned during periods of strict public health measures, however a few empirical investigations of patients or healthcare providers were done. It is recommended that African countries should develop an integrated community-based non-communicable disease (NCD) and infectious disease care model and protocols, initiate innovative ways of central dispensing, pre-packaging and home delivery of medications to stable patients, use of telemedicine, and emphasize mental health services during medical emergencies.

Contribution:

The study’s findings could improve policy implementation regarding the management of chronic diseases during a medical emergency; in this case, COVID-19. It could also improve self-care management. The main goal is to maintain adherence and compliance with treatment to reduce complications and the disease burden. The study mainly focused on the African context.

Conclusion:

The literature revealed that the COVID-19 pandemic has had a severe impact on the management of chronic diseases and disrupted access to related healthcare services in terms of prevention, diagnosis, routine clinical care, and self-care. In addition, the mental health of both patients and healthcare providers has been affected. Chronic diseases should also be considered a public health emergency and should be given the same attention and priority as infectious diseases during a pandemic to reduce the burden of disease, especially in low and middle-income African countries already experiencing a shortage of resources. Rather than depending on the researcher's opinion, viewpoint, and notes taken during the COVID-19 lockdown, primary investigations should be done to address the inadequacies brought to light on the management of chronic diseases due to COVID-19.

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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2024)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals

Yogini V. Chudasama, Clare Gillies, Francesco Zaccardi … (2020)

Currently most global healthcare resources are focused on coronavirus disease (COVID-19). This resource reallocation could disrupt the continuum of care for patients with chronic diseases. We aimed to evaluate the global impact of COVID-19 on routine care for chronic diseases. (see Table 1 ) Table 1 Responses from healthcare professionals who completed the online survey between March 31 and April 23, 2020. Table 1 Survey questions No. (%) Healthcare profession (n = 202) Primary care physician 75 (37.1) Hospital physician 40 (19.8) Nurse 46 (22.8) Other 41 (20.3)    How are you continuing to provide routine chronic disease management care for your patients? (n = 202) Face-to-face 29 (14.4) Telephone 90 (44.6) Both (face-to-face and telephone) 70 (34.7) Other 13 (6.4)    How has the management of chronic disease care for your patients been since the outbreak of COVID-19? (n = 202) Very poor 9 (4.5) Poor 39 (19.3) Fair 96 (47.5) Good 52 (25.7) Excellent 6 (3.0)    What effect do you think changes in healthcare services has had on your patients with chronic disease since the outbreak of COVID-19? (n = 200) No effect 5 (2.5) Mild effect 61 (30.5) Moderate effect 92 (46.0) Severe effect 42 (21.0)    How frequently have your patients been impacted by medication shortages since the start of COVID-19? (n = 201) Never 32 (15.9) Rarely 37 (18.4) Sometimes 96 (47.8) Often 35 (17.4) Always 1 (0.5)    Has the mental health of your patients worsened since the outbreak of COVID-19? (n = 200) Yes (most patients) 41 (20.5) Yes (some patients) 118 (59.0) No, it has stayed the same 36 (18.0) No, it has improved 5 (2.5) We developed an English language nine-item online survey targeted at healthcare professionals (HCPs) across the globe, using a drop-down menu format. Prior to dissemination the survey was tested by a group of HCPs for the time to complete and to ensure no questions were distressing. The survey was administered between March 31 and April 23, 2020. The survey link was posted to social media (including Twitter, Facebook, and Instagram), websites, and mailing lists. The posts were sharable to facilitate snowball sampling. Informed consent was obtained. Descriptive analyses were performed. 202 HCPs from 47 countries responded; 47% from Europe, 20% Asia, 12% South America, 10% Africa, 9% North America, 2% Oceania. 75 (37%) were primary care physicians, 40 (20%) hospital physicians, 46 (23%) nurses, and 41 (20%) other HCPs (Table). Only 14% reported continuing face-to-face care for all consultations, whilst the majority reported a change to either a proportion (35%) or all now being carried out by telephone (45%). HCPs who selected other (6%), highlighted use of telemedicine where online video consultations were being used through Zoom, Skype, WhatsApp, Facebook messenger. Some reported home visits, or cancellation of all outpatient appointments. Diabetes (38%) was the condition reported to be most impacted by the reduction in healthcare resources due to COVID-19, followed by chronic obstructive pulmonary disease (COPD, 9%), hypertension (8%), heart disease (7%), asthma (7%), cancer (6%) and depression (6%) (Figure). Additionally, the two most common co-occurring chronic diseases for which care was impacted by COVID-19 were diabetes and hypertension (30%), diabetes and COPD (13%), heart failure and COPD (8%) (Figure). Whilst the overall management of chronic disease care for patients was reported to be fair (48%) or good (26%), most HCPs (67%) rated moderate or severe effects on their patients due to changes in healthcare services since the outbreak. Moreover, 80% reported the mental health of their patients worsened during COVID-19 (Table). Findings from this global survey showed HCPs have adapted to new ways of delivering care using telemedicine in order to reduce face-to-face contacts. Adapting new ways of virtual healthcare and digital technologies is imperative to allow HCPs to continue routine appointments. Further, the use of apps can support self-management of chronic conditions, i.e. continuous glucose monitoring enables support with diabetes. However, the majority of people with non-communicable diseases live in low-middle income countries, where these technologies may not be widely available or practical [1]. Moreover, those with multiple chronic conditions may rely heavily on regular check-ups or hospital appointments to manage risk factors, are left trying to adapt to non-face-to-face interactions, or experiencing delay in treatment which may potentially have severe consequences. Limitations of this survey include that it was only disseminated in English, as part of our networks we may have preferentially approached those working in diabetes. Also, difficulty in obtaining responses from HCPs when workloads may have already increased considerably. There will be heterogeneity between countries in that some countries are currently not as affected by the virus compared to others, and regulations of lockdown and social distancing differ by country, thus further research is required. To avoid a rise in non-COVID-19-related morbidity and mortality, including increased depression and anxiety, it is important that patients with chronic diseases continue to receive care in spite of the pandemic [2]. Our study found that this is currently being done through face-to-face consultation in clinics (away from COVID-19 patients) or through virtual communication.Fig. 1 Fig. 1 Chronic disease and comorbidities most impacted by COVID-19 due to the reduction in care, based on responses by healthcare professionals who completed the online survey between March 31 and April 23, 2020 Fig. 1 Funding/support The National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC-EM). Ethical approval and informed consent All participants gave informed consent at the start of the survey and no confidential data was collected, as all responses remained completely anonymous. This study has been approved by the University of Leicester College of Life Sciences Committee for Research Ethics Concerning Human Subjects (Non-NHS). Declaration of competing interest The authors have no conflict of interest to declare.

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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

Syed A K Shifat Ahmed, Motunrayo Ajisola, Kehkashan Azeem … (2020)

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.