Food insecurity and level of depression among patients with chronic diseases, and associated factors during the COVID-19 lockdown: a cross-sectional study in rural Rwanda

Abstract

ObjectivesWe aimed to describe access to food and symptoms of depression among patients with chronic diseases or their caregivers, and assess associated factors during the COVID-19 lockdown in rural Rwanda.DesignA cross-sectional study.Setting and participantsA stratified random sampling technique was used to recruit 220 patients enrolled in the HIV, non-communicable diseases, mental health, paediatric development clinic and oncology programmes in three rural districts of Rwanda.Outcome measuresTelephone-based interviews were conducted to collect data on the number of daily meals before and during the COVID-19, and depression was assessed using the Patient Health Questionnaire-9. We used logistic regression analysis to investigate factors associated with households reporting a reduction in daily meals and with the survey respondent reporting symptoms of depression.ResultsOf the participants, 19.1% reported a reduction in daily number of meals for either adults or children in their households during lockdown and 24.6% had depression. Reporting a reduction in daily meals was associated with the district of residence and estimated household’s monthly income. Self-reported depression was significantly associated with negative experiences during lockdown, including reporting feeling depressed or fear (AOR 4.82; 95% CI 2.08 to 11.21), loneliness (AOR 4.33; 95% CI 1.32 to 14.13), reduction in daily meals (AOR 4.15; 95% CI 1.56 to 11.00) and lack of access to healthcare (OR 3.29; 95% CI 1.32 to 8.23).ConclusionsOur findings suggest that significant reduction in access to food affected rural Rwandans with chronic diseases during COVID-19 lockdown, and the lockdown effect varied by household’s pre-pandemic level of vulnerability to food insecurity. Reduction in household meals, as well as other self-reported effects of the lockdown, were associated with worse psychological status of survey respondents. Economic and food support should be considered by governments and non-governmental organisations to protect those most vulnerable including patients with chronic diseases against the effects of pandemics and their associated containment measures.

The impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries: systematic review

“…Among this, 14 studies focused on chronic disease patients, five focused on diabetes, three focused on hypertension, two focused on diseases and/ or hypertension, one focused on cancer, and one focused on cardiovascular disease. The review findings were organized into five frequently reported themes and subthemes: these are 1) disruption of follow-up care and poor health care utilization reported by 11 studies [10,11, 23,24,25,26,27,28,29,30,31]; 2) increased anxiety, stress, depression, and increased mental health problems reported by eight studies [15,32, 34,35,37,38,39,43]; 3) substance use reported by four studies [36,37,41,44]; 4) decreased physical activity and sedentary life reported by three studies [33,36,44]; and 5) increased food insecurity and poor dietary habits due to COVID-19 among NCDs patients, reported in five studies [36,40,42,43,44] Studies included in this review did not focus on the same subject matter. Some studies focused on one theme and others focus on more than two themes; for instance, (Andualem et al, 2020) examined adherence to lifestyle modifications and reported on diet, exercise, smoking, and alcohol, whereas (Abate et al, 2022) examined adherence to physical exercise recommendations and reported only on exercise compliance.…”

“…Five studies reported that the pandemic had a significant negative impact on food insecurity and dietary habits among noncommunicable diseases patients [36,40,42,43,44]. Two cross-sectional studies conducted among patients with diabetes, revealed that more than half of participants had poor dietary practices [40,42].…”

“…Another important impact of the COVID-19 pandemic was identified in seven studies that reported a negative impact of pandemic on the mental health and psychological well-being of noncommunicable disease patients [15,32,34,35,37,38,39,43]. Increased stress and anxiety can be a result of fear of contracting the virus, disruptions in healthcare services, social isolation, and economic hardships.…”

The impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries: A systematic review

“…The impact of COVID-19 on dietary habits among NCDs. Five studies reported that the pandemic had a significant negative impact on food insecurity and dietary habits among noncommunicable diseases patients [36,40,[42][43][44]. Two cross-sectional studies conducted among patients with diabetes, revealed that more than half of participants had poor dietary practices [40,42].…”

A positive association between food insecurity and the prevalence of overactive bladder in U.S. adults

“…Food insecurity is defined as the state of lacking social, economic, and physical access to sufficient and nutritious food for the purpose of maintaining an active and healthy lifestyle (8). Two cross-section analysis showed that people with food insecurity was likely to be accompanied by worse psychological status (depression and suicide ideation) and higher risk of metabolism disorders (9)(10)(11). In addition, a study with 3,632 people (≥60 years old) enrolled indicated that the people probably prefer to have sarcopenia (low grip strength) compared to those with full food security (12).…”