Out-of-pocket expenditure on non-communicable diseases during Covid-19. A cross-sectional study from a semi-urban area of Kannur, Kerala.

Introduction: Non-communicable disease (NCD) care was drastically affected during the COVID-19 pandemic. Therefore, this study aimed to estimate the cost incurred for NCD care during the pandemic and also to compare the cost of care of private and public facility utilizers. Methods: This community-based cross-sectional analytical study was conducted among 316 individuals aged 30 years and above from selected primary care facility service areas in Kannur district, Kerala. The total cost of illness for all NCDs was calculated from the patient's perspective and was estimated using a bottom-up approach. Direct, indirect, and total costs were summarized using the median with IQR. A median regression analysis was done to find the factors associated with total cost. Results: The total median direct medical cost was ₹400.0 (120-2360.0), and the total median direct non-medical cost was ₹720.0 (300.0-1200.0). The total median cost of NCD care was ₹1200.0.0 (200.0-3990.0). There was a significant association between the place of NCD service utilization and cost. The cost of availing care from private [₹2497.5 (455.0-6490.0)] was much higher compared to public facilities [₹120.0 (0-1000.0)]. Conclusion: The expenditure on NCD care during COVID-19 was high and for a private facility utilizer, it was much higher compared to a government facility utilizer. Strengthening the services through subcentres can reduce travel expenses, hence the non-medical cost of NCD care.

Prevalence and factors associated with utilization of ayurvedic drugs during COVID-19. A community-based cross-sectional study.

Background: COVID-19 pandemic emerged as a major public health emergency. Ayurvedic medicines are not generally considered as conventional medicine. Hence, we aimed to assess the prevalence of utilization of Ayurveda as prophylaxis for COVID-19 during the pandemic, factors associated with utilization, and willingness to use Ayurvedic medicines in future prospects. Methods: This cross-sectional analytical study was conducted in urban Bengaluru, India from April to May 2022. The sample size of the study was 427. Systematic random sampling was done and data were collected using a validated semi-structured questionnaire. Results: The mean (SD) age of the participants was 38.9 (±14.08) years. The proportion of utilization of ayurvedic medicines was 22.5% (n = 96, 95% CI 18.6-26.7) and social class was significantly associated with non-utilization (p = 0.042). Among the utilizers, 66% of them used Ayurvedic medicines for prevention/post-COVID ailments. More than half (55%, 95% CI 49.7-59.4) of the individuals were willing to use Ayurvedic medicines in the future and level of education was associated with unwillingness (p=0.010). Conclusion: Nearly three-fourth of the participants were not utilized Ayurvedic medicines during COVID-19 pandemic. Strengthening ayurvedic services and improving awareness may increase the utilization in the community. An integrated health system approach at the policy level is pivotal in mainstreaming Ayurvedic medicines.

'I was scared I will end up in another abortion': a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India.

BACKGROUND: As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. OBJECTIVE: To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. METHODS: A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. RESULTS: Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. CONCLUSIONS: Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.

Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India.

BACKGROUND AND AIMS: COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care. METHODS: This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity. RESULTS: A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress. CONCLUSIONS: Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.