Abstract
BackgroundNon-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse.AimThis study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 wave.SettingTwo public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning site.MethodsA rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptively.ResultsQualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetes.ConclusionThis study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation.
Highlights
In South Africa, there is a significant unmet need for care for non-communicable diseases (NCDs), which already account for nearly 60% of all deaths.[1]
Data were collected using semi-structured interviews with facility managers and professional healthcare workers in both sites involved in NCD care and management (n = 9), with community health workers (CHWs), professional nurses and managers from the non-profit organisation (NPO) employed in their catchment areas (n = 11) and with patients living with NCDs, type-2 diabetes and hypertension (n = 8) (Table 1)
A study looking at the impact of COVID-19 on the number of specimens sent to the Tygerberg public sector laboratories showed a significant decline in the number of tests for NCDs between March and June 2020 compared with the same period in 2019.9 In this study, we found a sharp decrease in the number of hemoglobin A1c (HbA1c) tests carried out in 2020 compared with 2019
Summary
In South Africa, there is a significant unmet need for care for non-communicable diseases (NCDs), which already account for nearly 60% of all deaths.[1] It is estimated that 4 million South Africans have diabetes and 18 million have hypertension, with high rates of both groups being undiagnosed and uncontrolled. When the first coronavirus disease 2019 (COVID-19) wave hit South Africa in March 2020, it was found that older adults and patients with comorbidities were more likely to suffer from severe disease and death.[3] Amongst these comorbidities, NCDs, in particular diabetes and hypertension, were reportedly associated with a poor COVID-19 prognosis.[4] Maintaining quality care and treatment of people with these conditions was regarded as critical. Non-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse
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