Impact of COVID-19 lockdown on outpatient care for non-communicable diseases in Nepal

The implementation of restriction and mitigation measures to contain COVID-19 infection led to a significant disruption in the delivery of essential health services. However, the ramifications of the immediate COVID-19 containment policies on healthcare service utilization for major non-communicable diseases (NCDs)-related cases, particularly in low- and middle-income countries, remains unknown.

We used an interrupted time series study design, fitted with quasi-Poisson regression models, to assess the impacts of the nationwide lockdown on hospital visits for NCDs, namely cardiovascular disease (CVD), chronic respiratory disease (CRD), chronic kidney disease (CKD), cancer, and hypertension (HTN)-related cases, in Nepal. A total of 33 months of nationwide outpatient department visits data for NCD cases between July 2018 and April 2021, 20 months before and 13 months after the enforcement of the nationwide lockdown, were included in the final analysis.

Compared with the expected level, there was an estimated 73% [relative risk (RR) 0.269, 95% confidence interval (CI): 0.089-0.808] decrease in outpatient department visits for CVD and a 64% (RR 0.361, 95% CI: 0.175-0.745) decrease for cancer. Although an immediate reduction in outpatient department visits was observed, the evidence was not conclusive to determine the true effect of the COVID-19 pandemic on outpatient department visits for CRD (RR 0.89, 95% CI: 0.651-1.228), HTN (RR 1.004, 95% CI: 0.64-1.575), and kidney disease (RR 0.589, 95% CI: 0.231-1.501).

We estimated that the nationwide lockdown implemented in response to the COVID-19 pandemic affected hospital visits for patients with CVD and cancer. However, the available evidence was not conclusive enough to determine the impact of COVID-19 on outpatient department visits for the other NCDs analysed, namely HTN, CRD, and CKD.