25 May, 2020

COVID 19 Chronicles: No matter where you look, there’s enough to make you worry

There is growing dread that attention/resources will be pulled back from other research activities, and COVID-19 will dominate. The question therefore remains: “How do we make a case for research activities to continue in terms of improving hypertension control at the community level?”

photo credit: mindful.com

“I hope that all of you are safe and healthy in this challenging COVID-19 times”. This sentence seems to be the common opening or closing salutation in most communications since the COVID-19 virus was detected in Wuhan, China, in late December 2019. Ghana, like most countries, has been affected by the pandemic with the first confirmed case reported on March 12, 2020.

Ghana’s total confirmed cases as of May 4, 2020, was 2,719. A total of 12 regions out of the 16 administrative regions had reported cases with the affected areas being Greater Accra (2,332), Central (30), Ashanti (124), Volta (30), Oti (23), Northern (13), Upper East (19), Upper West (19), North East (2), Western North (4),Western (21) and Eastern (94). There are 294 people reported to have recovered from the infection and 18 deaths (Ghana Health Service, 2020).

Figure 1 is a chart of the number of COVID-19 cases per region as of May 4, 2020

Prominent among the deaths reported in Ghana was that of Professor Jacob Plange-Rhule, a renowned physician and the Principal Investigator of our current Hypertension implementation research program. He will be sorely missed.

The Late Prof Jacob Plange-Rhule

Our current implementation program aims to build the capacity of 140 Community Health Nurses to diagnose accurately and refer individuals with high blood pressure to treatment centers across three contiguous districts in Ghana.
The present pandemic has had a profound impact on the implementation of our study in three main ways:

  • delays and setbacks for community interactions;
  • drop-in health-facility attendance; and
  • swing of the focus of attention/resources to address the pandemic.

On March 27, 2020, the President of Ghana, announced a partial lockdown in two out of the sixteen regions in Ghana as part of efforts to curb the spread of the virus. The partial lockdown in these two significant regions of Ghana, was enforced on March 30, 2020. Prior to the enforcement on March 30, a lot of individuals moved away from these two regions to the other regions (14 regions) for various reasons. This was to be expected as the ban was not implemented immediately it was pronounced. However, there were genuine concerns that this movements by various individuals could result in community spread. To protect its health workers, the Ghana Health Service in addition to enforcing safety measures such as washing of hands and wearing Personal Protective Equipment (PPE), also advised all health workers to limit interactions with community members. When this happened, community health nurses limited their home visits and focused primarily on the community members who visited their health facilities for their healthcare needs. The directive also meant that the community health nurses could not attend the household of community members and screen them for high blood pressure as well as follow up on the community members already identified as having high blood pressure.

The pandemic is also affecting outpatient department attendance across various facilities. In March 2020 OPD attendance dropped from 17455 to 15985. Thus, it is likely that some of the participants identified at the community level are not attending the referral centers due to the pandemic.

Figure 2 highlights data from DHIMS II on the OPD attendance from January 2020 to March 2020 across the various health facilities in the Kintampo North Municipality

Finally, there is growing dread that attention/resources will be pulled back from other research activities, and COVID-19 will dominate. The question therefore remains: ‘How do we make a case for research activities to continue in terms of improving hypertension control at the community level?’ There are certainly going to be some challenges in hypertension control should all resources be channeled towards COVID-19. It would be best if some of the health resources are also allocated to research activities involving NCDs such as hypertension. According to WHO, people with pre-existing non-communicable diseases (NCDs) also appear to be more vulnerable to becoming severely ill with the virus (WHO, 2020). Consequently, we cannot neglect the conduct of research to improve the outcomes of the major NCDs as a result of the emergence of COVID-19.

Given the urgency of this challenge, countries with limited resources, even as they battle with the COVID-19 pandemic, should still prioritize dealing with major NCDs like hypertension. At some point in the expectantly not too distant future, COVID-19 will be conquered and we will be able to return to our normal lives. Until then, we have to stay safe and continue practicing all the recommended safety measures.