The COVID-19-pandemic-related economic and social crises are leading to huge challenges for all spheres of human life across the globe. Various challenges highlighted by this pandemic include, but are not limited to, the need for global health cooperation and security, better crisis management, coordinated funding in public health emergencies, and access to measures related to prevention, treatment and control. This systematic review explores health, economic and social development issues in a COVID-19 pandemic context and aftermath. Accordingly, a methodology that focuses on identifying relevant literature with a focus on meta-analysis is used. A protocol with inclusion and exclusion criteria was developed, with articles from 15 December 2019 to 15 March 2022 included in the study. This was followed by a review and data analysis. The research results reveal that non-pharmaceutical measures like social distancing, lockdown and quarantine have created long-term impacts on issues such as changes in production and consumption patterns, market crashes resulting in the closure of business operations, and the slowing down of the economy. COVID-19 has exposed huge health inequalities across most countries due to social stratification and unequal distribution of wealth and/or resources. People from lower socio-economic backgrounds lack access to essential healthcare services during this critical time for both COVID-19 and other non-COVID ailments. The review shows that there is minimal literature available with evidence and empirical backup; similarly, data/studies from all countries/regions are not available. We propose that there is a need to conduct empirical research employing a trans-disciplinary approach to develop the most effective and efficient strategies to combat the pandemic and its aftermath. There is a need to explore the social and ecological determinants of this contagious infection and develop strategies for the prevention and control of COVID-19 or similar infections in future.

Background: Type 2 diabetes is a major public health burden in the South-East Asian region. Persons with disabilities have a higher predilection for developing type 2 diabetes. Objective: The objective of this study was to estimate the prevalence of type 2 diabetes among persons with physical, development, sensory, and psychiatric disabilities in the South-East Asian regional countries. Methods: The Medline database was searched through PubMed using a specifically developed search strategy to identify observational studies that looked at the prevalence of type 2 diabetes among persons with various types of disabilities. Specific inclusion–exclusion criteria were used to shortlist the most relevant studies. The AXIS tool was used to assess the risk of bias in the identified studies. Data were extracted from the final list of studies and meta-analyzed using a random-effects model. Forest plot was used to study the pooled estimate and funnel plot was studied to assess publication bias. Subgroup analysis of prevalence of diabetes among persons with psychiatric and physical disabilities was performed. Results: A total of 771 papers were identified for screening. Of them, 740 were excluded and 31 were included in the full-text review. Finally, 12 studies were included in the meta-analysis. The prevalence of type 2 diabetes among persons with disabilities was 12.8% (95% confidence interval [CI]: 8.8%–16.8%). The studies showed a wide heterogeneity. The funnel plot did not show any publication bias. Subgroup analysis showed that while the prevalence of type 2 diabetes in persons with psychiatric disabilities was 14.0% (95% CI: 9%–18.9%), it was 10.6% (95% CI: 3.6%–17.6%) among persons with other forms of physical disabilities. Conclusion: The prevalence of type 2 diabetes is high among persons with disabilities. There is a need for well-conducted systematic studies in the South-East Asian region on prevalence of type 2 diabetes among persons with disabilities.

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the “Medicine at people’s doorstep” (Makkalai Thedi Maruthuvam — MTM) scheme in which screening and medications for NCDs are delivered at people’s doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community. We analysed the MTM policy document using the intersectionality-based policy analysis framework. This analysis was supplemented further with literature review to enhance understanding of the various intersecting axes of inequities, such as gender discrimination, caste oppression, poverty, disabilities and geographical access barriers. The MTM policy document, while it removes the physical access barrier, does not frame the problem of NCDs from an intersectionality perspective. This can increase the chances of inequities in access to NCD services persisting despite this scheme. We also recommend interventions for the short, intermediate and long term to make NCD care more accessible. Creation of a gender, caste, class, geographical access, and disabilities disaggregated database of patients with NCDs, using this database for monitoring the delivery of MTM services, dynamic mapping of vulnerability of the target populations for delivery of MTM services and long term ongoing digital surveillance of factors inducing inequities to access of NCD services can all help reduce inequities in access to NCD care.

Background: Persons with disabilities have a higher risk for and poorer outcomes of type 2 diabetes. Primary health care providers face several challenges in providing primary diabetes care for them. This study was conducted to explore the challenges faced by primary health care providers in delivering primary diabetes services to persons with disabilities. Methods: We performed a qualitative research study by conducting in-depth interviews among 13 primary health care providers including medical officers, staff nurses, community health workers and a physiotherapist. We adopted a grounded theory approach to data collection and analysis. Results: Primary health care providers often could only prescribe medications to persons with diabetes by proxy due to poor accessibility of the facilities. They felt that these patients also had poor compliance to treatment. They felt that the lack of standard guidelines for diet and exercise for persons with disabilities prevented them from giving them appropriate advice on the same and even if they did, persons with disabilities would find it very difficult to adopt dietary changes and physical activity as they were dependent on others for even their daily activities. They also felt that they couldn’t perform annual screening tests due to lack of accessibility to higher facilities. Some primary care providers did local innovations such as formation of peer support groups, utilization of resources of other programs to reach out to persons with disabilities and innovative physical activity techniques to care for persons with disabilities. They recommended that there is a need for specific guidelines for management of diabetes among persons with disabilities, treatment of chronic diseases among persons with disabilities must be incentivized and there must be intersectoral coordination between social welfare department and health department to achieve the goal of care for persons with disabilities.Conclusions: Primary health care providers faced substantial challenges in providing primary diabetes care for persons with disabilities. There is a need for an effective public health policy to address these challenges.

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