Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India.
BMJ Open. 2021 Jan 19;11(1):e043590. doi: 10.1136/bmjopen-2020-043590.
The COVID-19 pandemic resulted in a national lockdown in India from midnight on 25 March 2020, with conditional relaxation by phases and zones from 20 April. We evaluated the impact of the lockdown in terms of healthcare provisions, physical health, mental health and social well-being within a multicentre cross-sectional study in India.
The SMART India study is an ongoing house-to-house survey conducted across 20 regions including 11 states and 1 union territory in India to study diabetes and its complications in the community. During the lockdown, we developed an online questionnaire and delivered it in English and seven popular Indian languages (Hindi, Tamil, Marathi, Telegu, Kannada, Bengali, Malayalam) to random samples of SMART-India participants in two rounds from 5 May 2020 to 24 May 2020. We used multivariable logistic regression to evaluate the overall impact on health and healthcare provision in phases 3 and 4 of lockdown in red and non-red zones and their interactions.
A total of 2003 participants completed this multicentre survey. The bivariate relationships between the outcomes and lockdown showed significant negative associations. In the multivariable analyses, the interactions between the red zones and lockdown showed that all five dimensions of healthcare provision were negatively affected (non-affordability: OR 1.917 (95% CI 1.126 to 3.264), non-accessibility: OR 2.458 (95% CI 1.549 to 3.902), inadequacy: OR 3.015 (95% CI 1.616 to 5.625), inappropriateness: OR 2.225 (95% CI 1.200 to 4.126) and discontinuity of care: OR 6.756 (95% CI 3.79 to 12.042)) and associated depression and social loneliness.
The impact of COVID-19 pandemic and lockdown on health and healthcare was negative. The exaggeration of income inequality during lockdown can be expected to extend the negative impacts beyond the lockdown.
2020 年 3 月 25 日午夜，印度实施了全国封锁，4 月 20 日开始分阶段和分区放宽限制。我们在印度进行了一项多中心横断面研究，评估了封锁对医疗服务、身体健康、心理健康和社会福利的影响。
SMART India 研究是一项正在进行的入户调查，在印度的 20 个地区进行，包括 11 个邦和 1 个联邦属地，旨在研究社区中的糖尿病及其并发症。在封锁期间，我们开发了一个在线问卷，并以英语和七种流行的印度语言（印地语、泰米尔语、马拉地语、泰卢固语、卡纳达语、孟加拉语、马拉雅拉姆语）向 SMART-India 参与者的随机样本发送了两轮问卷，时间是从 2020 年 5 月 5 日至 5 月 24 日。我们使用多变量逻辑回归来评估封锁的第三和第四阶段对红色和非红色区域内的健康和医疗服务提供的总体影响及其相互作用。
共有 2003 名参与者完成了这项多中心调查。结果与封锁之间的双变量关系显示出显著的负相关。在多变量分析中，红色区域和封锁之间的相互作用表明，医疗服务提供的五个方面都受到了负面影响（负担能力不足：OR 1.917（95%CI 1.126 至 3.264），可及性不足：OR 2.458（95%CI 1.549 至 3.902），不足：OR 3.015（95%CI 1.616 至 5.625），不适当：OR 2.225（95%CI 1.200 至 4.126），护理连续性中断：OR 6.756（95%CI 3.79 至 12.042）），以及相关的抑郁和社会孤独。
COVID-19 大流行和封锁对健康和医疗服务的影响是负面的。封锁期间收入不平等的加剧可能会使负面影响超出封锁期。
