Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study

Background: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. Methods: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. Results: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p < 0.001), fewer antibiotics (p < 0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.

Psychosocial impact of the implementation of COVID-19 protocols

BACKGROUND: The COVID-19 pandemic has spread globally since the first case was diagnosed in Wuhan, China in December 2019 and we are now experiencing the fourth wave. Several measures are being taken to care for the infected and to curtail the spread of this novel infectious virus. The psychosocial impact of these measures on patients, relatives, caregivers, and medical personnel also needs to be assessed and catered for. METHODS: This is a review article on the psychosocial impact of the implementation of COVID-19 protocols. The literature search was done using Google Scholar, PubMed, and Medline. DISCUSSION: Modalities of transportation of the patient to isolation and quarantine centres have led to stigma and negative attitudes towards such individuals. When diagnosed with the infection, fear of dying from COVID-19, fear of infecting family members and close associates, fear of stigmatization, and loneliness are common among COVID-19 patients. Isolation and quarantine procedures also cause loneliness and depression, and the person is at risk of post-traumatic stress disorder. Caregivers are continually stressed out and have the constant fear of contracting SARS-CoV-2. Despite clear guidelines to help with closure for family members of people dying from COVID-19, inadequate resources make this unrealistic. CONCLUSION: Mental and emotional distress resulting from fear of SARS-Cov-2 infection, the mode of transmission, and consequences have a tremendous negative impact on the psychosocial well-being of those affected, their caregivers, and relatives. There is a need for the government, health institutions, and NGOs to establish platforms to cater to these concerns

Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD). Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank. Results: The majority of the participants were between ages 31­40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02­10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7­9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6­9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2­13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family. Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

Associations between COVID-19 vaccine hesitancy and the experience of violence among women and girls living with and at risk of HIV in Nigeria

Aim: Women and girls living with and at high risk of HIV (WGL&RHIV) had an increased risk for gender-based violence (GBV) during COVID-19. The study aimed to assess the associations between vaccine hesitancy and GBV, HIV status and psychological distress among these vulnerable women and girls in Nigeria. Methods: This cross-sectional study collected data from WGL&RHIV in 10 states in Nigeria between June and October 2021. The dependent variable was vaccine hesitancy. The independent variables were the experience of physical, sexual, economic and emotional GBV, HIV status and psychological distress during the COVID-19 pandemic. We conducted a multivariable logistics regression analysis to test the associations between vaccine hesitancy and the independent variables and covariates. Results: Among the 3 431 participants, 1 015 (22.8%) were not willing to be vaccinated against COVID-19. Not knowing or willing to disclose HIV status (aOR 1.40) and having mild (aOR 1.36) and moderate (aOR 1.38) symptoms of anxiety and depression were significantly associated with higher odds of vaccine hesitancy. Being a survivor of intimate partner physical violence (aOR 5.76), non-intimate partner sexual violence (aOR 3.41), as well as emotional abuse (aOR 1.55) were significantly associated with respectively more than five, three and one and half times higher odds of vaccine hesitancy. One positive outcome is that HIV-positive women and girls appeared to be more likely to get the COVID-19 vaccine when available. Conclusions: Sexual and gender-based violence, low socio-economic status, psychological distress and an unknown HIV status are essential determinants of COVID-19 vaccine hesitancy among vulnerable women and girls in Nigeria. National authorities and civil society organisations need to better integrate COVID-19 mitigation activities with HIV and gender-based violence interventions through a more feminist approach that promotes gender equality and the empowerment of women and girls in all their diversity for better access to health services.

A qualitative synthesis of the impact of infertility on the mental health of African women

Infertility is a reproductive problem that affects all gender, race, or social class. In many African countries, the burden of infertility is usually associated with economic, psychological, and socio-cultural factors. This review aimed to explore the factors that impact the mental health of African women with primary infertility. A qualitative evidence synthesis was used to summarise and analyse primary qualitative studies focused on the impact of primary infertility on African women. Seventeen studies met the eligibility criteria and were included in the review. The review found that social pressure, stigma from family and community members, and financial constraints led to psychological distress. In addition, social stigma also led to marital problems which led to significant psychological distress and low self-worth, especially on the wife. Recommendations to reduce stigma among African infertile women were as follows: advocacy and community mobilisation, education by health professionals, and holistic person-centred care. An intersectional approach to inform public health and social policy was also suggested.

Mental health distress during the COVID-19 pandemic in Nigeria: Need for psychological intervention

Background: The world began to realise the impact of the coronavirus disease 2019 (COVID-19) in January 2020, and since then the number of people infected has exceeded 1 million globally. In less than 1 month following the first reported case in Nigeria, over 180 people had tested positive to the disease. Studies have shown that such rapidly spreading infectious diseases have the potential to create widespread fear, apprehension, panic and anxiety amongst the general public. Aim: This study aimed at evaluating the impact of information dissemination and public mental healthcare needs during the COVID-19 pandemic in Nigeria. It also hopes to determine if there is an unmet need for telepsychiatry in Nigeria. Setting: Community-based study covering the North, South and West of Nigeria. Methods: This was a descriptive cross-sectional study using an on-line survey form via the snowballing sampling method. Results: Social media was identified as the main source of information concerning COVID-19, and half of the respondents opined that information dissemination was inadequate. Psychological distress was present in 90.5% of the participants and 61.8% admitted that this distress was worsened by fake news and myths concerning COVID-19. However, 53.8% of the participants were willing to access mental healthcare services, with telepsychiatry being the preferred choice. Conclusion: There is a need to implement a national public mental health service during this emergency. Telepsychiatry has numerous advantages in this context and maybe an opportunity to roll out a novel means of delivering mental healthcare.

Prevalence and correlates of psychological distress amongst healthcare workers during the COVID-19 pandemic: An online survey

Background: Understanding the mental health needs of healthcare workers during coronavirus disease 2019 (COVID-19) pandemic with a view of mitigating its impact on occupational functioning is vital. Aim: To determine the prevalence and correlates of psychological distress amongst healthcare workers. Setting: The study was carried out in Nigeria during COVID-19 pandemic. Methods: A cross-sectional quantitative study using a convenience sample was conducted amongst healthcare workers. The survey comprised of two Google formatted self-report questionnaires, a 12-item General Health Questionnaire and a questionnaire containing socio-demographic, work related and knowledge of COVID-19 variables. Questionnaires were distributed via closed professional WhatsApp platforms. Data were analysed using descriptive statistics, chi-square test and logistic regression. Results: There were 313 respondents and prevalence of psychological distress was 47.0%. Females were almost twice as likely to have psychological distress as males (OR = 1.92, 95% CI: 1.21­3.04, p = 0.006). Healthcare workers who had no contact with COVID-19 positive patients had an 87% reduced risk of psychological distress (OR = 0.13, 95%CI: 0.23­0.25, p = 0.018) compared with those who had contact with COVID-19 positive patients. Healthcare workers with poor knowledge of COVID-19 had a 44% reduced risk of psychological distress compared with those with good knowledge (OR = 0.56, 95% CI: 0.34­0.93, p = 0.025). Conclusion: Findings revealed that healthcare workers in Nigeria reported psychological distress during COVID-19 pandemic. Greater risk was amongst females and those who had contact with COVID-19 positive patients whilst poor knowledge was protective.