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.
| 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 | 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 |