Healthcare and Socio-economic Impacts of COVID-19 on Patients with Diabetes in Tanzania and Kenya
Lead Research Organisation:
Ifakara Health Institute (IHI)
Department Name: Research
Abstract
People with type 2 diabetes are known to be at increased risk of complications and death from COVID-19, and yet their healthcare has been disrupted by the pandemic. This could lead to more indirect COVID-19 related deaths. Tanzania and Kenya are experiencing increases in the numbers of people with type 2 diabetes, and their ability to manage their condition during COVID-19 may be hampered through lack of access to support, economic hardship and health system challenges. In addition, increased vulnerability may prevent patients seeking treatment, and experiences for people living in urban and rural areas and in the two countries may differ. There is therefore an urgent need to understand how COVID-19 has affected the healthcare and socio-economic welfare of people with type 2 diabetes in Tanzania and Kenya to inform policy recommendations and health education messages to improve health and welfare for this vulnerable population during the pandemic. This project will provide this evidence by administering questionnaires and interviews to people with type 2 diabetes and through interviews to healthcare providers in urban and rural settings in each country. It will also identify the cost of type 2 diabetes to each country during COVID-19 and gaps in national policy and emergency planning responses. The findings will be shared with relevant stakeholders to allow them to input into the development of context-specific policy recommendations and health messages for each country.
Technical Summary
This project will provide much-needed, timely and unique evidence from rural and urban areas of neighbouring East African Countries (Tanzania and Kenya) with different approaches to the control of COVID-19. The project aims to explore the experiences of people with type 2 diabetes (T2D) and healthcare providers on managing T2D during COVID-19. Guided by the World Health Organization Social Determinants of Health and Wellbeing Framework [1] , it will focus on how the pandemic has impacted patients' and healthcare providers' ability to manage T2D, the socio-economic burden of T2D, and patients' response to COVID-19 itself. It will also identify policy gaps in each country in relation to health and social care of T2D during COVID-19.
The study will foster multidisciplinary collaboration and capacity building by close working between scientists from Africa and UK throughout delivery of five interrelated workpackages
(WPs). WP1 will employ questionnaires (N=500 in each country) and in-depth interviews (N=30 in each country) to explore patients' experiences of healthcare access, and T2D self management, socio-economic challenges and knowledge, attitude and practices related to COVID-19 in rural and urban settings in each country. WP2 will use a desk review and field research to estimate the individual and societal economic burden of T2D. In WP3, IDIs with local healthcare providers (N=15 in each country) will explore their perspectives on T2D management during COVID-19. In WP4, a policy landscape analysis in each country will employ a desk review and key informant interviews to identify policy gaps, priority setting and action for T2D during COVID-19. WP5 will use a multi-stage participatory process involving key stakeholders in which evidence from WPs 1-4 will be synthesised to develop context-specific national policy recommendations and health education messages for T2D management during COVID-19.
The study will foster multidisciplinary collaboration and capacity building by close working between scientists from Africa and UK throughout delivery of five interrelated workpackages
(WPs). WP1 will employ questionnaires (N=500 in each country) and in-depth interviews (N=30 in each country) to explore patients' experiences of healthcare access, and T2D self management, socio-economic challenges and knowledge, attitude and practices related to COVID-19 in rural and urban settings in each country. WP2 will use a desk review and field research to estimate the individual and societal economic burden of T2D. In WP3, IDIs with local healthcare providers (N=15 in each country) will explore their perspectives on T2D management during COVID-19. In WP4, a policy landscape analysis in each country will employ a desk review and key informant interviews to identify policy gaps, priority setting and action for T2D during COVID-19. WP5 will use a multi-stage participatory process involving key stakeholders in which evidence from WPs 1-4 will be synthesised to develop context-specific national policy recommendations and health education messages for T2D management during COVID-19.
| Description | Patients with type 2 diabetes in Tanzania and Kenya (in rural and urban communities) reported similar health and socio-economic challenges in managing their illness during COVID-19. Mental health challenges were mostly expressed in Tanzania, not much in Kenya despite the lack of strict COVID-19 prevention measures such as lockdowns and curfews. Interestingly, patients were aware of their vulnerability of developing health complications if they contracted COVID-19. The outcome level challenges reported by participants in Tanzania and Kenya included: difficulty in accessing diabetic medicine, failure to comply with diabetic treatment, failure to get treatment on time, uncontrolled blood sugar, inability to attend health facilities for routine checks and consultations, and difficulties in accessing the recommended diet. Primary-level challenges which appear to have contributed to the outcome-level challenges in Tanzania included: the closure of diabetic clinics located in the health facilities which were chosen to manage COVID-19 patients and business instability. Primary-level outcomes reported in Kenya comprised: price inflation for diabetic testing kits, medicine and treatment, lockdown, and curfew. Outcome-level challenges reported in Kenya and Tanzania included the inability to afford health insurance and health insurance not being able to cover a wide range of diabetic services and mental stress. The project also managed to support a television program in which the diabetic experts spoke to the bigger audience about how to manage their illness during pandemic. The program also involved patients with type 2 diabetes who managed to express their experience and challenge faced during COVID-19. |
| Exploitation Route | The experience reported by patients with type 2 diabetes in Tanzania and Kenya can be a case study to help other countries around the world reflect on whether their healthcare systems and emergency preparedness actions/plans consider the needs of chronically ill people such as those with type 2 diabetes. Some measures employed in managing the COVID-19 vaccine in Tanzania, and Kenya seem to have contributed to multiple challenges for managing illness during COVID-19. Social protection schemes that target people with chronic illness, including those with type 2 diabetes in the community and at the health care port, would help to increase their resilience against shocks arising from emergencies such as COVID-19. |
| Sectors | Communities and Social Services/Policy,Healthcare |
| Description | The findings provided a basis for a national television program which involved experts on type 2 diabetes who were able to educate the audience about how important it is to change lifestyle (conducting physical exercise, adapt healthy dietary behaviors, avoid smoking and alcohol consumption). They also spoke about how well to manage diabetic illness during disease outbreak such as COVID-19. Our findings have been presented in a series of workshops targeting national, international, and local audiences. We have so far presented the factors that influence COVID-19 vaccine uptake, as well as the challenges reported by patients with type 2 diabetes in managing their illness during COVID-19 in Tanzania and Kenya. The findings supported the development of health promotion messages to improve illness management among patients with type 2 diabetes in Tanzania and Kenya. The messages will be reviewed by journalists from the respective Ministries to arrive at more effective health promotion messages. |
| Sector | Healthcare |
| Impact Types | Societal,Policy & public services |
| Description | Development of the HEALTH PROMOTION messages to improve COVID-19 VACCINE UPTAKE AMONG DIABETIC PATIENTS IN TANZANIA |
| Geographic Reach | Africa |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | PUBLIC AWARENESS ON HEALTH LIFESTYLE AND HOW DIABETIC PATIENTS COULD EFFECTIVELY MANAGE THEIR ILLNESS |
| Geographic Reach | National |
| Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
| Title | Engagement of Journal Editor in a Research team |
| Description | Through stakeholder consultation meetings, we were informed about the importance of engaging journal editors from the Ministry of Health and from the non-communicable Disease (NCD) alliance in Tanzania. These observations were shared by research partners in Kenya for harmonization. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | The health promotion messages to improve COVID-19 vaccine uptake are being reviewed and consolidated by an experienced team of journalists |
| Description | GECO stakeholder |
| Organisation | National Institute for Medical Research, Tanzania |
| Department | NIMR Dar Es Salaam |
| Country | Tanzania, United Republic of |
| Sector | Public |
| PI Contribution | We communicated the research design and were able to receive inputs on the tools. |
| Collaborator Contribution | A representative from NIMRI provided inputs into the research tool and we were able to integrate a few questions with regards to the cost of managing COVID-19 among people with type 2 diabetes. |
| Impact | Updated research tool with the ability to capture the cost of managing COVID-19 among patients with type 2 diabetes |
| Start Year | 2021 |
| Description | Dissemination of the findings through workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We conducted a meeting with patients living with type 2 diabetes in rural and urban Tanzania and Kenya to reflect on the key findings on the challenges of managing type 2 during COVID-19. Together, we developed actions to address the challenges in a way that during the discussions, patients were informed about the importance of complying with effective self-management of their illness consistently, including during disease outbreaks. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Local engagement |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | About 10 health professionals attended the meeting in Dar es Salam regional office. The intention of the meeting was to present the research study and receive comments on the study design, methods, and plans for dissemination and actions. The outcome of this meeting is that we were able to receive local permission to recruit patients with type 2 diabetes in the various health facilities here in Dar es Salaam. |
| Year(s) Of Engagement Activity | 2021,2022 |