COVID-19 affects health services for non-communicable diseases

COVID-19 affects health services for non-communicable diseases

Jun 20, 2020 COLUMNS by admin

A doctor takes samples from a resident at Marycliff Primary School in Tudor Mombasa County during a Covid 19 Mass testing exercise. The County has recorded over 900 positive cases with more than 30 deaths. By Sherry Kui

Those suffering from NCD’s impacted by the pandemic in Kenya


 Prevention and treatment services for non-communicable diseases (NCDs) have been severely affected since the COVID-19 pandemic began, according to a recent World Health Organisation survey. 

The survey, which was completed by 155 countries during a three-week period recently, confirmed that the impact is global, but that low-income countries are most affected. 

This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death. 

In Kenya, for example, the Kenya STEPwise survey for NCDs risk factors (2015) report says they account for more than 50 per cent of total hospital admissions and over 55 per cent of hospital deaths in the country.

Health Cabinet Secretary Mutahi Kagwe says persons living with NCDs, such as high blood pressure, diabetes and cancer, are more at risk of becoming severely ill with Coronavirus disease.

“Deaths due to NCDs are projected to rise to 55 per cent by 2030 unless appropriate interventions or sustained attention to prevention and care are put in place. I advise all people with NCDSs to follow medical advice and observe all Covid-19 containment measures of hand-washing social distancing and proper wearing of face masks in public, among other measures,” he said.

The major NCDs are cardiovascular conditions, cancers, diabetes and chronic obstructive pulmonary diseases with their sequelae and their shared risk factors. Equally contributing to the huge burden are violence and injuries, haemoglobinopathies, mental disorders, oral, eye and dental diseases.

A leading kidney specialist, Dr Antony Were says chronic kidney disease (CKD) is the eighth leading cause of death in women causing more than 160,000 female deaths a year.

Currently, 195 million women worldwide are affected by CKD.

Experts say CKD is more likely to develop in women compared to men with an average 14 per cent prevalence in women and 12 per cent in men.

At the same time, some kidney diseases such as Lupus Nephropathy or kidney infection are common in women.

Women who have CKD during pregnancy are at increased risk for negative outcomes for the mother and baby.

Pregnancies in women with advanced CKD are most challenging.

Media personality Lorna Irung’u is among the first people  to publicly declare she was living with Lupus Nephrology.

Dr Were describes high blood pressure and diabetes as the “biggest drivers” fuelling the increased cases of kidney diseases in the country.

Other high-risk factors include having a family history of kidney disease, being overweight, smoking and those aged 50 years and above.

Experts say kidney diseases can affect people of all ages and races and one in every five men and one in four women between the ages of 65 and 74 have CKD. Early CKD often has no sign or symptoms.

Meanwhile, the Kenya Network of Cancer Organisations (KENCO) is urging the government to support cancer patients, their caregivers and survivors by providing them with social protection as the fight against the spread of COVID-19 is stepped-up.

Executive director, Christine Sitati said: “COVID-19 has caused other challenges such as high cost of transport and in some cases loss of livelihoods (among cancer patients and survivors) thus adversely affecting their access to treatment and nutritious immunity-boosting diets…

“As we celebrate life for survivors and give hope to newly diagnosed patients and their care-givers—we urge the government to support cancer patients, their caregivers and survivors at such (trying) times,”.

Kenya commemorated the National Cancer Survivors Day on June 7 whose theme was “A better quality life for cancer survivors is possible”.

The national umbrella body of over 35 cancer civil society organisations also challenges the government and all other stakeholders to consider undertaking concerted efforts on cancer control similar to the ongoing efforts against COVID-19.

“We need the urgency, great political will and effective policy changes to ensure we deal with the cancer epidemic in Kenya, right from prevention to survivorship,” Ms Sitati adds.

The World Health Organisation Director-General, Dr Tedros Ghebreyesus notes: “The results of this survey confirm what we have been hearing from countries for a number of weeks now…

 “Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19,”.

The main finding is that health services have been partially or completely disrupted in many countries. 

More than half (53 per cent) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49 per cent  for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.  

Rehabilitation services have been disrupted in almost two-thirds (63 per cent ) of countries, even though rehabilitation is key to a healthy recovery following severe illness from COVID-19.

According to the survey, a the majority (94  per cent ) of countries responding, ministry of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19. 

The postponement of public screening programmes (for example for breast and cervical cancer) was also widespread, reported by more than 50 per cent of countries. This was consistent with initial WHO recommendations to minimise non-urgent facility-based care whilst tackling the pandemic.

According to WHO, NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years; more than 85 per cent of these “premature” deaths occur in low- and middle-income countries. 

Experts say a person can lose up to 90 per cent of their kidney function before experiencing any signs.

The WHO has documented that people with pre-existing conditions such as cancer are among the those most-at-risk among COVID-19 mortalities due to a weakened immune system.

In Kenya, for example, cancer in the third  leading cause of death  with six people being diagnosed every hour.

A resident of Uthiru, Nairobi, washes her hands before buying from a shop. Hand washing is one of the most effective ways of preventing the spread of Covid-19 on June 17, 2020. Photo: Dorcas Moraa.

According to the WHO survey, in one in five countries (20 per cent) reporting disruptions, one of the main reasons for discontinuing services was a shortage of  medicines, diagnostics and other technologies. 

“Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country…  

“Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus,”. 

Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72 per cent of high-income countries reported inclusion compared to 42 per cent of low-income countries. 

Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. 

However, dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports. 

Seventeen percentof countries reporting, the survey shows, have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan. 

Encouraging findings of the survey were that alternative strategies have been established in most countries to support the people at highest risk to continue receiving treatment for NCDs. 

Among the countries reporting service disruptions, globally 58 per cent of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries this figure is 42 per cent. Triaging to determine priorities has also been widely used, in two-thirds of countries reporting.  

Also encouraging is that more than 70 per cent of countries reported collecting data on the number of COVID-19 patients who also have an NCD. 

The WHO’s director (department of NCDs) Dr Bente Mikkelsen observes: “It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with non-communicable diseases.

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