Challenges and coping strategies in non-communicable disease management during COVID-19 in Addis Ababa, Ethiopia: A qualitative study

Abstract

Background People with comorbidities are at higher risk of becoming severely ill with COVID-19. Evidence has shown that those with cardiovascular diseases, chronic respiratory diseases, diabetes and cancer had more severe illness and worse prognosis with COVID-19 compared to patients without comorbidities. Insufficient numbers of health workers, high financial barriers and lack of access to quality-assured medicines have been challenges for patients with non-communicable diseases (NCDs) in developing countries, even before COVID-19. Therefore, this study aimed to explore the challenges and coping strategies in NCD management during COVID-19 in Addis Ababa, Ethiopia.Methods This study followed a phenomenological study approach to explore challenges and coping strategies using the experience of healthcare professionals (HCPs) and people with NCDs. Twenty-two individuals (13 HCPs and nine people with NCDs) were recruited purposively and invited for in-depth interview. All interviews were made by telephone and data collected using interview guide. There was pre-interview telephonic conversation to ask participants for a convenient time and date for the actual interview. At the end of every interview, a summary of the interview notes was read to the participants to ensure the correct interpretation of participants’ original views. ATLAS.ti version 7 software was used to assist in the coding and categorisation. Thematic analysis was employed to understand the challenges and coping strategies in NCD management during COVID-19 in Addis Ababa, Ethiopia.Results Challenges posed by COVID-19 to people with NCD included postponement of NCD follow-up due to fear of COVID-19 infection, transportation problems and unwelcoming healthcare facilities; stress related to fear of death and absence of social support; and reduced physical activity in relation to staying at home. For the HCPs, a shortage of personal protective equipment and an absence of standards and guidelines were the common challenges. Telemedicine was the typical coping strategy used by HCPs, while people with NCDs were mostly expecting spiritual protection and safeguarding.Conclusions We concluded that the postponement of NCD follow-up, in addition to stress and reduced physical activity, may worsen the increasing mortality from preventable NCDs in the country. We recommend every COVID-19 response measures to target NCD health service independently.

Evidence Gaps and Challenges in the Fight Against COVID-19 in Africa: Scoping Review of the Ethiopian Experience

“… 81 There were also disruptions in the care of patients with chronic non-communicable diseases such as hypertension and diabetes. 78 Emergency medical services including emergency surgeries have also shown significant decline during the first three months of the outbreak. 41 …”

“…Fear of acquiring the infection, 78 , 79 service interruptions, and restrictions of movement 78 were mentioned as major reasons for disruption of essential healthcare services.…”

“…Instead, blanket restrictions were put in place for the whole nation even when essential healthcare services were reported to be extremely compromised at primary care facilities and regional hospitals. 40 , 41 , 78–81

Figure 2 COVID-19 outbreak timeline in Ethiopia and actions taken to curb the pandemic. The figure was constructed based on information released on different occasions by COVID-19 pandemic preparedness and response weekly bulletin (Ethiopia Public Health Institute) and Federal Ministry of Health of Ethiopia.

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“…81 There were also disruptions in the care of patients with chronic non-communicable diseases such as hypertension and diabetes. 78 Emergency medical services including emergency surgeries have also shown significant decline during the first three months of the outbreak. 41 Fear of acquiring the infection, 78,79 service interruptions, and restrictions of movement 78 were mentioned as major reasons for disruption of essential healthcare services.…”

“…nation even when essential healthcare services were reported to be extremely compromised at primary care facilities and regional hospitals. 40,41,[78][79][80][81]…”