The Impact of COVID-19 Control measures on NCD risk factors and Metabolic health: A comparison of 3 Caribbean countries
Lead Research Organisation:
University of the West Indies
Department Name: Caribbean Institute for Health Research
Abstract
Non communicable diseases (NCDs) such as diabetes, hypertension and heart disease are the leading causes of death in Low and Middle Income Countries (LMICs). Caribbean women, urban dwellers and the poor are more likely to have NCDs and a greater burden of NCD risk factors such as obesity, physical inactivity and unhealthy diet.
The recent control measures to limit the spread of COVID-19 in many LMICs interfered with daily routines and food systems. While some control measures such as limiting sale of alcohol and closure of fast food restaurants might have potential benefits on NCDs, these may be counterbalanced by limited access to fresh fruits and vegetables and a tendency to consume unhealthy stored/preserved foods. Additionally, stress, working from home, increased screen time (computer and TV) and boredom also create a change in sleep, physical activity and other NCD related lifestyle practices.
In this study we will examine how control measures used in 3 Caribbean islands affected the health and lifestyle practices of people living with NCDs, particularly women, the poor and those living in urban vs rural communities. By understanding the effects of COVID-19 control measures on NCD risk factors (lifestyle practices), mental health, metabolic health (blood sugar and cholesterol) and physical measurements (blood pressure and weight), LMIC governments can use their limited resources to better care for persons with NCDs during national crises and respond better to future COVID-19 and other infectious disease outbreaks.
The recent control measures to limit the spread of COVID-19 in many LMICs interfered with daily routines and food systems. While some control measures such as limiting sale of alcohol and closure of fast food restaurants might have potential benefits on NCDs, these may be counterbalanced by limited access to fresh fruits and vegetables and a tendency to consume unhealthy stored/preserved foods. Additionally, stress, working from home, increased screen time (computer and TV) and boredom also create a change in sleep, physical activity and other NCD related lifestyle practices.
In this study we will examine how control measures used in 3 Caribbean islands affected the health and lifestyle practices of people living with NCDs, particularly women, the poor and those living in urban vs rural communities. By understanding the effects of COVID-19 control measures on NCD risk factors (lifestyle practices), mental health, metabolic health (blood sugar and cholesterol) and physical measurements (blood pressure and weight), LMIC governments can use their limited resources to better care for persons with NCDs during national crises and respond better to future COVID-19 and other infectious disease outbreaks.
Technical Summary
Low and middle income countries (LMICs) have a disproportionate burden of noncommunicable diseases (NCDs) and limited resources for prevention and treatment. The COVID-19 pandemic has served to highlight and also exacerbate these disparities. With limited resources for tertiary level care and no evidence-based treatments or effective vaccines, LMIC governments employed a range of public health measures to control the spread of COVID-19, many of which interfered with daily routines and food systems. These control measure may have beneficial and detrimental effects on NCD risk factors, physical measurements (blood pressure and weight), mental & metabolic health.
The Caribbean's high NCD burden and heterogeneity in COVID-19 incidence & implementation of COVID-19 control measures provides a unique opportunity to investigate the effect of specific policies on NCD health practices and explore differential effects by gender, urban/rural residence and socioeconomic status. We plan to administer a telephone survey to hospital out-patients who had blood taken for metabolic studies (glucose and lipids) at tertiary hospitals prior to the outbreak in three island territories -Jamaica, Barbados and Trinidad & Tobago (n= 1460) to investigate the effect of COVID-19 control measures on NCD risk factor practices and mental health. Participants will be invited for repeat laboratory testing to evaluate the effect of COVID-19 control measures on metabolic health. Blood pressure and weight will be abstracted from outpatient visit records prior to and following the epidemic.
The effect of COVID-19 control measures on NCD risk factors, physical measures, mental and metabolic health has not been examined in the region. Through multi-island comparisons we can investigate the impact of specific government policies and help LMICs limit adverse outcomes in persons at risk of or living with NCDs while containing future COVID-19 outbreaks or other national disasters.
The Caribbean's high NCD burden and heterogeneity in COVID-19 incidence & implementation of COVID-19 control measures provides a unique opportunity to investigate the effect of specific policies on NCD health practices and explore differential effects by gender, urban/rural residence and socioeconomic status. We plan to administer a telephone survey to hospital out-patients who had blood taken for metabolic studies (glucose and lipids) at tertiary hospitals prior to the outbreak in three island territories -Jamaica, Barbados and Trinidad & Tobago (n= 1460) to investigate the effect of COVID-19 control measures on NCD risk factor practices and mental health. Participants will be invited for repeat laboratory testing to evaluate the effect of COVID-19 control measures on metabolic health. Blood pressure and weight will be abstracted from outpatient visit records prior to and following the epidemic.
The effect of COVID-19 control measures on NCD risk factors, physical measures, mental and metabolic health has not been examined in the region. Through multi-island comparisons we can investigate the impact of specific government policies and help LMICs limit adverse outcomes in persons at risk of or living with NCDs while containing future COVID-19 outbreaks or other national disasters.
Publications
Fisher L
(2023)
Food Security in Jamaicans with CKD Following the COVID-19 Pandemic: A Pilot Observational Study SA-PO060
in Journal of the American Society of Nephrology
| Description | To investigate the effect of COVID-19 control measures on NCD risk factors and metabolic health in 3 Caribbean islands patients were to be identified from the hospital Laboratory Information Systems. Patients with blood taken for fasting glucose and or lipids in the pre-pandemic period (prior to March 2020) would be identified from this database. After excluding patients who were hospitalized when these measurements were taken and selecting those attending hospital outpatient clinics with illnesses that were not likely to result in restrictions on eating and movements (such as Cancer, Kidney Disease) , a member of the hospital staff would make initial contact with these patients by telephone using contact information in the hospital registration systems. Research Assistants would then contact those persons who agreed to be contacted. Questionnaire data would be combined with laboratory data and weight and blood pressure readings from the patient chart. We experienced a number of challenges due to deficits in health information systems that resulted in delays and suboptimal recruitment. These were further exacerbated by restrictions that were in place due to the COVID-19 pandemic. Accessing the Hospital Laboratory Information Systems and Implications for sampling Only one hospital had dedicated Information Technology (IT) personnel that was able to access laboratory data systems and share these data with the study team. While other sites used commercial software for data collection, the end users had challenges accessing the clinical data for sharing with the research team. Notably several patients had multiple hospital record numbers. As a result we were only able to obtain a laboratory database for 2 sites and had to negotiate with a commercial provider to obtain these data. The lack of a unique identifier made it difficult to match participants with laboratory data. Additionally many hospital databases had outdated contact information for patients and no contact information for next of kin. To meet our project deliverables we had to hire persons to make initial calls and help track potential participants and instituted In-person recruitment on clinic days when COVID restrictions were lifted. Standards of Care and Implications for Data Abstraction Most sites did not have a clinic register to facilitate selection of persons for the study. Because paper-based records were being used at most institutions we had to manually search for data on key health outcomes. Poor recording of clinical data including weight and blood pressure at patient visits was noted from docket review. Conclusions and Recommendations for Health System Strengthening Our study highlights the need for strengthening Health Information Systems to improve quality of care in the region by facilitating use of routine data sources for research, evaluation of health outcomes and supporting evidence-based decision making. The final analysis of the data collected from this award is ongoing. |
| Exploitation Route | These data are being used to formulate a policy impact statement to guide the care of patients living with non-communicable diseases in the Caribbean in times of national disaster or other crises |
| Sectors | Agriculture Food and Drink Communities and Social Services/Policy Digital/Communication/Information Technologies (including Software) Healthcare |
| Description | Basic Research Skills Workshop Training for the South West Regional Health Authority, Trinidad |
| Organisation | Ministry of Health, Trinidad and Tobago |
| Country | Trinidad and Tobago |
| Sector | Public |
| PI Contribution | Co-investigators from the Trinidad and Tobago (T&T) site are preparing to host a Basic Research Skills workshop April 3 - 5, 2023 for the relevant staff at the South West Regional Health Authority (SWRHA), T&T. The SWRHA is responsible for the administration and management of the health facilities where data were collected for the project:. The General Manager of Policy, Planning and Research expressed a need to strengthen the capacity of staff to conduct research. The workshop would be the first in a series of initiatives to support staff at SWRHA. |
| Collaborator Contribution | Served as the source population for the sample used in this arm of the study. |
| Impact | To be executed in April 2023. This will help to strengthen research skills in the facility, enable members to conduct their own research activities and generate evidence for policy and decision making. They will also be better equipped to collaborate with other researchers. |
| Start Year | 2023 |
| Description | Stakeholder Engagement : Steering Committee |
| Organisation | Caribbean Public Health Agency |
| Country | Trinidad and Tobago |
| Sector | Hospitals |
| PI Contribution | We identified members of the steering committee from local health departments and a regional health agency. We have regular meetings of the steering committee |
| Collaborator Contribution | The Steering Committee: ?? Serves as liaisons between the Regional/National Health Institutions or Authorities and research team. ?? Reviews research activities, as well as provides feedback on study implementation strategies. ?? Provides advice to the research team to ensure strategic alignment with research objectives, activities, and the monitoring framework. ?? Increases the visibility of research activities to encourage participation. ?? Will guide the reporting of the data. ?? Will identify policy-relevant key messages and provide feedback on the final policy impact statement. ?? Will assist with packaging and dissemination of relevant research findings to critical stakeholder groups. ?? Will advocate for the interests of Official Development Assistance (ODA) countries not included in this study. |
| Impact | Disciplines include Health Professionals Public Health Specialists - Non Communicable Diseases Health Policy |
| Start Year | 2021 |
| Description | Dissemination Meeting "The Impact of COVID-19 Control Measures on NCD Risk Factors and Metabolic Health: A comparison of 3 Caribbean Countries." |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | The aim of this study was to examine the effect of COVID-19 control measures on NCD risk factors (specifically dietary intake, physical activity, smoking, sleep and other lifestyle practices) and metabolic health in Jamaica, Trinidad and Barbados, and whether these were related to country-specific COVID-19 control as well as by patients' socioeconomic status and demographic factors (age, sex and urban/rural status). The sample was to be comprised of patients living with an NCD, aged 18 to 74 years, who had blood taken for metabolic studies (glucose and or lipids) between January 2019 and March, 2020 (the onset of the pandemic in the Caribbean) identified using the laboratory information systems platform. Hospital staff would contacted eligible patients by telephone to determine interest in participation and those who agreed were to be enrolled remotely by project staff. The survey instrument consisted of a multicultural food frequency questionnaire on dietary intake during the pandemic. It also measured changes in dietary patterns and food security since the COVID-19 pandemic, physical activity, reported hours of sleep, work time, self-reported medical conditions, and demographic measurements. Weight, blood pressure and laboratory reports were to be abstracted from the records by medically trained personnel. Participants would then be invited to return for repeat laboratory testing, once restrictions on movement were relaxed, particularly where no post-pandemic lab reports were available. We excluded individuals who had to make a major change to their diet or physical activity in the 3 months preceding the pandemic because of a medical or health-related condition, those with chronic kidney disease on dialysis, cancer patients receiving active therapy, those with recent major surgical procedures affecting dietary intake and physical activity, a heart attack or stroke within three months of evaluation or hospitalization lasting 7 or more days for a severe illness (Sepsis, COVID-19, Neurosurgery, etc.) and persons residing in an institution (e.g. Nursing Home). Ethical approval was obtained from the University of the West Indies Campus Sites as well as relevant Ministry of Health and Institutional bodies in each island. Recruitment rates were slow and we eventually used a more blended approach to recruitment of participants with in-person recruitment and face to face delivery of questionnaires where appropriate as the COVID-19 restrictions were lifted. The target sample size was 1460 but at the end of the data collection period, 661 patients meeting the study inclusion criteria completed telephone interviews across all three sites. An additional supplement from the UKRI in July 2022 allowed us to pursue sub-studies to enhance the data collected from the quantitative survey including - ? Member checking on the findings of the study with a subset of patients who had participated in this study as well as members of the health team from two hospitals in Jamaica that delivered care to patients during the pandemic. ? Qualitative interviews with patients who reported food insecurity to understand the challenges they experienced with meal planning and how these were navigated using available resources during the COVID-19 pandemic. ? The effect of the pandemic on renal function in patients living with chronic kidney disease (a group not included in the main survey due to the more stringent dietary requirements) and ? Long COVID symptoms in patients from the University Hospital of the West Indies based on self-reported infection/ ICU admission - and compared these symptoms in persons without a history of infection. This dissemination meeting focused on the survey findings from the main questionnaire and preliminary findings from the qualitative interviews. We had appoximately 90 persons in attendance at the meeting. The event allowed us to interact with key stakeholders responsible for the goverment response to the COVID-19 pandemic. We were also able to discuss with health care workers their expereinces in executing clinical care activities during the pandemic and suggestions on how this could be improved. Researchers and policy makers were able to identity key areas of focus for future reserach on how we could build capacity to withstand future challenges. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Qualitative Exploration of Survey Findings & Public Patient Engagement and Involvement |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Study participants or study members |
| Results and Impact | We conducted focus group / key informant interviews with participants and staff from rural and urban hospitals in Jamaica to discuss their experiences with health maintenance during COVID and their suggestions on what the government and health care system could do to support them during this type of national and international crisis. Survey participants were purposely selected based on age, sex, and other demographic and social characteristics to attend these sessions in a comfortable, neutral and accessible setting outside of where they receive their health care or online using Zoom. We were particularly interested in the experiences of male patients as fewer men with chronic illnesses consistently access out-patient care and services compared to women and therefore would be at greater risk of being further marginalized by system interruptions. We had to conduct several one on one interviews with these men as a large enough sample was not available to meet at one time. Preliminary results of the survey were presented to them and their reactions to these findings elicited by a trained moderator. We also solicited their recommendations on how health and other systems could support them better as well as areas they would consider health research priorities coming out of their experience. |
| Year(s) Of Engagement Activity | 2022,2023 |