COVID-19 and non-communicable diseases in the Eastern Mediterranean Region: the need for a syndemics approach to data reporting and healthcare delivery

Nassereddine, Ghiwa; Habli, Samia; Slama, Slim; Sen, Kasturi; Rizk, Anthony; Sibai, Abla Mehio

doi:10.1136/bmjgh-2021-006189

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…41 Additionally, it is widely warned that uncontrolled diabetes and hypertension are important predictors of COVID-19 severity and mortality. 3,[42][43][44][45] As our study did not explore such prolonged risk; further studies are needed in the Uganda setting.…”

Section: Diabetes/hypertensionmentioning

confidence: 89%

Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study

Komasawa,

Aung,

Nsereko

et al. 2023

RMHP

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Background:The COVID-19 pandemic and its measures have had a profound impact on universal access to health services. We investigated the impact of the closure of the Entebbe Regional Referral Hospital (ERRH) for two years on the accessibility to necessary healthcare among non-COVID-19 patients. Methods: This mixed-methods study focused on ERRH patients with tuberculosis (TB), human immunodeficiency virus (HIV), diabetes/hypertension, and mental illness. A quantitative study used a structured-questionnaire with a primary outcome measure to assess the discontinuation of healthcare accessibility. A qualitative study with a focus group discussion (FGD) was conducted on eight patients. Results: Of the 202 quantitative survey participants, 17.8% discontinued necessary healthcare due to the ERRH closure, and the discontinuation rates differed by disease: 48.1% of TB patients, 16.0% of HIV patients, 7.8% of diabetes/hypertension patients, and 4.0% of mental health patients (P < 0.001). Almost 90% of the patients reported a worsened health condition, regardless of the disease. Multivariable logistic regression analysis showed that patients with diabetes/hypertension (adjusted odds ratio [AOR], 12.69; 95% confidence interval [CI], 2.57-62.52) and HIV (AOR, 7.52; 95% CI, 1.37-41.27) were more likely to discontinue healthcare than those with mental illness. The factors associated with discontinued healthcare included age ≥50 years vs ≤30 years (AOR, 4.88; 95% CI, 1.07-22.34), and high transportation cost vs low cost (AOR, 3.15; 95% CI, 1.13-8.75). The FGD also identified difficulties in obtaining medication, especially for TB, even though ERRH provided the outreach services. Conclusion:Our study revealed that the ERRH closure and lockdowns had an overall profound negative impact on access to healthcare and health conditions. Younger patients and those with TB were the most affected patients. This study provides practical suggestions from the field for policy makers to strengthen universal health access during health crises in Uganda and other sub-Saharan countries.Plain Language Summary: This study investigated the impact of service disruption in a tertiary hospital (ERRH) that was converted to a COVID-19-dedicated hospital for two years in Uganda. This mixed-methods study focused on the ERRH patients with tuberculosis (TB), human immunodeficiency virus (HIV), diabetes, hypertension, and mental illness. A quantitative study used a structured questionnaire with the primary outcome measure being the discontinuation of healthcare provision. A qualitative study with a focus group discussion (FGD) was conducted on eight patients. Of the 202 quantitative survey participants, 17.8% discontinued necessary healthcare due to ERRH closure, and the discontinuation rates differed by disease: 48.1% of tuberculosis patients, 16.0% of HIV patients, 7.8% of diabetes/hypertension patients, and 4.0% of mental health patients (P < 0.001). Almost 90% of the patients

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Section: Diabetes/hypertensionmentioning

confidence: 89%

Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study

Komasawa,

Aung,

Nsereko

et al. 2023

RMHP

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“…Multimorbidity and dual diagnosis have been extensively captured in the last two decades, and the syndemic approach to understanding either disease–behavioural conditions or disease–disease interaction have been documented in the previous literature [ 4 ]. Regarding disease–disease interactions, many articles discussed the syndemic interaction between HIV and tuberculosis [ 5 , 6 ], diabetes and depression [ 7 , 8 ], and COVID-19 and non-communicable diseases [ 9 , 10 ]. At the same time, disease–behavioural condition interactions were conceptualized by using lexicalized acronyms and multidimensional syndemic frameworks to understand the clustering of population-level/individual-level health, and its determinants across different dimensions [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

AlShurman

Butt

2023

IJERPH

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Background: Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. Methods: A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. Results: Our review revealed that the adherence to COVID-19 regulations—although they were effective in preventing COVID-19 transmission, cases, and deaths—created a dynamically unstable ‘vicious cycle’ between undesirable health, economic, and social outcomes. The “accumulation” of complex stressors decreased individuals’ cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals’ risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people’s vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. Conclusions: Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

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“…Coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and stroke have been occurring as double burden worldwide, interrelating to each other [1]. Although effective COVID-19 vaccines are available, the acceptance rate is quite low and vaccine hesitancy is high in some countries [2], [3], [4].…”

Section: Introductionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Coronavirus 2 Infection is Associated with Homocysteine Level and Clinical Outcomes in Ischemic Stroke Patients

Syahrul

Imran

Musadir

et al. 2022

Open Access Maced J Med Sci

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BACKGROUND: Since its emergence in December 2019 and declared as pandemic in March 2020, the drastic increase in cases of coronavirus disease 2019 (COVID-19) is alarming the importance of disease monitoring in order to prevent further complication, like ischemic stroke. One of the efforts is utilizing biomarker. For instance, elevated homocysteine level, already known risk factor of ischemic stroke, is currently identified in COVID-19 patients. AIM: To assess factor associated with homocysteine level and clinical outcomes of ischemic stroke patients. Methods: A cross-sectional study was conducted at Dr. Zainoel Abidin Hospital di Indonesia between March and August 2021. Ischemic stroke patients who had physical and neurology examinations, SARS-CoV-2 RT-PCR swab, chest x-ray, electrocardiography, head CT-scan and the total homocysteine level were included. To assess the factors associated with homocysteine level and the outcomes of ischemic stroke patients, the independent Student t-test or Anova and chi-squared were used, respectively. RESULTS: We included 62 ischemic stroke patients of which 32 (51.6%) were male and the age ranged between 30 and 80 years. Out of total, 60 patients (96.8%) were survived after the hospital admission. There was a significant association between gender and having COVID-19 with homocysteine level (p=0.012 and p=0.020, respectively). Having COVID-19 was the only variable significantly associated with the outcome of the ischemic stroke patient (p=0.035). CONCLUSION: COVID-19 is associated with homocysteine level and the clinical outcome in ischemic stroke patients. Therefore, SARS-CoV-2 infection in ischemic stroke or vice versa need to be monitored closely in hospital settings.

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COVID-19 and non-communicable diseases in the Eastern Mediterranean Region: the need for a syndemics approach to data reporting and healthcare delivery

Cited by 4 publications

References 16 publications

Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study

Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

Severe Acute Respiratory Syndrome Coronavirus 2 Infection is Associated with Homocysteine Level and Clinical Outcomes in Ischemic Stroke Patients

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