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

被引：198

作者：

Ahmed, Syed A. K. Shifat ^{[1
]}

Ajisola, Motunrayo ^{[2
]}

Azeem, Kehkashan ^{[3
]}

Bakibinga, Pauline ^{[4
]}

Chen, Yen-Fu ^{[5
]}

Choudhury, Nazratun Nayeem ^{[1
]}

Fayehun, Olufunke ^{[6
]}

Griffiths, Frances ^{[5
,7
]}

Harris, Bronwyn ^{[5
]}

Kibe, Peter ^{[4
]}

Lilford, Richard J. ^{[8
]}

Omigbodun, Akinyinka ^{[9
]}

Rizvi, Narjis ^{[3
]}

Sartori, Jo ^{[8
]}

Smith, Simon ^{[5
]}

Watson, Samuel, I ^{[5
,8
]}

Wilson, Ria ^{[5
]}

Yeboah, Godwin ^{[10
]}

Aujla, Navneet ^{[5
]}

Azam, Syed Iqbal ^{[3
]}

Diggle, Peter J. ^{[11
]}

Gill, Paramjit ^{[5
]}

Iqbal, Romaina ^{[3
]}

Kabaria, Caroline ^{[4
]}

Kisia, Lyagamula ^{[4
]}

Kyobutungi, Catherine ^{[4
]}

Madan, Jason J. ^{[12
]}

Mberu, Blessing ^{[4
]}

Mohamed, Shukri F. ^{[4
,5
]}

Nazish, Ahsana ^{[3
]}

Odubanjo, Oladoyin ^{[13
]}

Osuh, Mary E. ^{[14
]}

Owoaje, Eme ^{[15
]}

Oyebode, Oyinlola ^{[5
]}

Porto de Albuquerque, Joao ^{[10
]}

Rahman, Omar ^{[16
]}

Tabani, Komal ^{[3
]}

Taiwo, Olalekan John ^{[17
]}

Tregonning, Grant ^{[10
]}

Uthman, Olalekan A. ^{[5
]}

Yusuf, Rita ^{[1
]}

机构：

[1] Independent Univ Bangladesh, Ctr Hlth Populat & Dev, Dhaka, Bangladesh

[2] Univ Ibadan, Natl Inst Hlth Res Project, Ibadan, Oyo State, Nigeria

[3] Aga Khan Univ, Community Hlth Sci Dept, Karachi, Pakistan

[4] African Populat & Hlth Res Ctr, Nairobi, Kenya

[5] Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry, W Midlands, England

[6] Univ Ibadan, Fac Social Sci, Dept Sociol, Ibadan, Oyo State, Nigeria

[7] Univ Witwatersrand, Sch Publ Hlth, Ctr Hlth Policy, Johannesburg, South Africa

[8] Univ Birmingham, Inst Appl Hlth Res, Coll Med & Dent Sci, Birmingham, W Midlands, England

[9] Univ Ibadan, Coll Med, Fac Clin Sci, Dept Obstet & Gynaecol, Ibadan, Oyo State, Nigeria

[10] Univ Warwick, Inst Global Sustainable Dev, Coventry, W Midlands, England

[11] Univ Lancaster, Lancaster Med Sch, Lancaster, England

[12] Univ Warwick, Warwick Med Sch, Warwick Clin Trials Unit, Coventry, W Midlands, England

[13] Nigerian Acad Sci, Lagos, Nigeria

[14] Univ Ibadan, Coll Med, Dept Periodontol & Community Dent, Fac Dent, Ibadan, Oyo State, Nigeria

[15] Univ Ibadan, Fac Publ Hlth, Coll Med, Dept Community Med, Ibadan, Oyo State, Nigeria

[16] Univ Liberal Arts Bangladesh, Dhaka, Bangladesh

[17] Univ Ibadan, Dept Geog, Fac Social Sci, Ibadan, Oyo State, Nigeria

来源：

BMJ GLOBAL HEALTH | 2020年 / 5卷 / 08期

关键词：

health policy; health systems; public health; other infection; disease; disorder; or injury; qualitative study; DOMESTIC VIOLENCE; MODEL;

D O I：

10.1136/bmjgh-2020-003042

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

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.

引用

页数：17

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