Original Research

Non-communicable disease care and management in two sites of the Cape Town Metro during the first wave of COVID-19: A rapid appraisal

Peter A. Delobelle, Mumtaz Abbas, Ishaaq Datay, Angela De Sa, Naomi Levitt, Darcelle Schouw, Steve Reid
African Journal of Primary Health Care & Family Medicine | Vol 14, No 1 | a3215 | DOI: https://doi.org/10.4102/phcfm.v14i1.3215 | © 2022 Peter A Delobelle, Mumtaz Abbas, Ishaaq Datay, Angela De Sa, Dinky Levitt, Darcelle Schouw, Steve Reid | This work is licensed under CC Attribution 4.0
Submitted: 27 August 2021 | Published: 18 January 2022

About the author(s)

Peter A. Delobelle, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
Mumtaz Abbas, Department of Health, Western Cape Government, Cape Town, South Africa
Ishaaq Datay, Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Angela De Sa, Department of Health, Western Cape Government, Cape Town, South Africa; and Division of Family Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Naomi Levitt, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Darcelle Schouw, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Steve Reid, Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa


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Abstract

Background: Non-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse.

Aim: This study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 wave.

Setting: Two public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning site.

Methods: A rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptively.

Results: Qualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetes.

Conclusion: This study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation.


Keywords

non-communicable diseases; community-orientated primary care; covid-19; service reorganisation; community health workers; type-2 diabetes; rapid appraisal

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