Competing health risks associated with the COVID-19 pandemic and early response: A scoping review

  1. Stefan Baral
  2. Amrita Rao
  3. Jean Olivier Twahirwa Rwema
  4. Carrie Lyons
  5. Muge Cevik
  6. Anna E. Kågesten
  7. Daouda Diouf
  8. Annette H. Sohn
  9. Refilwe Nancy Phaswana-Mafuya
  10. Adeeba Kamarulzaman
  11. Gregorio Millett
  12. Julia L. Marcus
  13. Sharmistha Mishra

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Abstract

COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats.

Objectives

We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.

Methods

A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from November 1 st , 2019 to October 31 st , 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English.

Results

A total of 1604 published papers and 205 preprints were retrieved in the search. Overall, 8.0% (129/1604) of published studies and 10.2% (21/205) of preprints met the inclusion criteria and were included in this review: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (19/183) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.

Discussion

COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.

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  1. Version published to 10.1371/journal.pone.0273389
  2. Version published to 10.1101/2021.01.07.21249419v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.01.07.21249419: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategies (available in Appendix) were developed using MeSH and key terms were developed to focus on COVID-19 and its impact on one of the pre-specified key competing health risks: HIV, TB, malaria, SRH, and malnutrition.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    Abstracts and full-text articles were reviewed using Covidence[11],, an online systematic review management tool, and EndNote (version X8) [12].
    EndNote
    suggested: (EndNote, RRID:SCR_014001)
    For published papers, searches were implemented in PubMed.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    For preprints, we conducted a search of the COVID-19 Living Evidence Database, which includes published papers and preprints from both medRxiv and bioRxiv and is updated daily (https://zika.ispm.unibe.ch/assets/data/pub/search_beta/).
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations of this scoping review. Given the breadth of information reviewed, including over 1800 peer-reviewed and preprint articles, we did not conduct a formal population-intervention-control-outcome systematic review. Moreover, there were several areas not covered in this review, including vaccine-preventable diseases[161], non-communicable diseases[162, 163], specific health effects among migrant communities[164], violence[165], and mental health[166]. Preliminary data suggest effects across all these areas, including reports of increased domestic violence, decreases in childhood vaccinations, and increases in mortality and morbidity because of acute mental health stressors and substance use. In addition, publication bias may have affected the estimates reported here. Because we did not complete a quantitative meta-analysis, we were unable to assess the magnitude of publication bias. Finally, there may be limited generalizability of the indirect effects of COVID-19 across regions given significant variability in the underlying causes of morbidity and mortality and varying health systems and health infrastructure.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.01.07.21249419v1 on medRxiv