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.

Autor:	Ahmed SAKS; Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh., Ajisola M; National Institute for Health Research Project, University of Ibadan, Ibadan, Oyo State, Nigeria., Azeem K; Community Health Sciences Department, Aga Khan University, Karachi, Pakistan., Bakibinga P; African Population and Health Research Center, Nairobi, Kenya., Chen YF; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Choudhury NN; Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh., Fayehun O; Department of Sociology, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria., Griffiths F; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK f.e.griffiths@warwick.ac.uk.; Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa., Harris B; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Kibe P; African Population and Health Research Center, Nairobi, Kenya., Lilford RJ; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK., Omigbodun A; Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria., Rizvi N; Community Health Sciences Department, Aga Khan University, Karachi, Pakistan., Sartori J; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK., Smith S; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Watson SI; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK., Wilson R; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Yeboah G; Institute for Global Sustainable Development, University of Warwick, Coventry, UK., Aujla N; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Azam SI; Community Health Sciences Department, Aga Khan University, Karachi, Pakistan., Diggle PJ; Lancaster Medical School, Lancaster University, Lancaster, UK., Gill P; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Iqbal R; Community Health Sciences Department, Aga Khan University, Karachi, Pakistan., Kabaria C; African Population and Health Research Center, Nairobi, Kenya., Kisia L; African Population and Health Research Center, Nairobi, Kenya., Kyobutungi C; African Population and Health Research Center, Nairobi, Kenya., Madan JJ; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK., Mberu B; African Population and Health Research Center, Nairobi, Kenya., Mohamed SF; African Population and Health Research Center, Nairobi, Kenya.; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Nazish A; Community Health Sciences Department, Aga Khan University, Karachi, Pakistan., Odubanjo O; Nigerian Academy of Science, Lagos, Nigeria., Osuh ME; Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria., Owoaje E; Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria., Oyebode O; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Porto de Albuquerque J; Institute for Global Sustainable Development, University of Warwick, Coventry, UK., Rahman O; University of Liberal Arts Bangladesh, Dhaka, Bangladesh., Tabani K; Community Health Sciences Department, Aga Khan University, Karachi, Pakistan., Taiwo OJ; Department of Geography, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria., Tregonning G; Institute for Global Sustainable Development, University of Warwick, Coventry, UK., Uthman OA; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Yusuf R; Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2020 Aug; Vol. 5 (8).
DOI:	10.1136/bmjgh-2020-003042
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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