abstract: 'Introduction With COVID-19, there is urgency for policymakers to

  understand and respond to the health needs of slum communities.

  Lockdowns for pandemic control have health, social and economic

  consequences. We consider access to healthcare before and during

  COVID-19 with those working and living in slum communities. Methods In

  seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored

  stakeholder perspectives and experiences of healthcare access for

  non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19

  lockdowns. Results Between March 2018 and May 2020, we engaged with 860

  community leaders, residents, health workers and local authority

  representatives. Perceived common illnesses in all sites included

  respiratory, gastric, waterborne and mosquitoborne illnesses and

  hypertension. Pre-COVID, stakeholders described various preventive,

  diagnostic and treatment services, including well-used antenatal and

  immunisation programmes and some screening for hypertension,

  tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and

  patent medicine vendors were key providers of treatment and advice for

  minor illnesses. Mental health services and those addressing

  gender-based violence were perceived to be limited or unavailable. With

  COVID-19, a reduction in access to healthcare services was reported in

  all sites, including preventive services. Cost of healthcare increased

  while household income reduced. Residents had difficulty reaching

  healthcare facilities. Fear of being diagnosed with COVID-19 discouraged

  healthcare seeking. Alleviators included provision of healthcare by

  phone, pharmacists/drug vendors extending credit and residents receiving

  philanthropic or government support; these were inconsistent and

  inadequate. Conclusion Slum residents'' ability to seek healthcare for

  non-COVID-19 conditions has been reduced during lockdowns. To encourage

  healthcare seeking, clear communication is needed about what is

  available and whether infection control is in place. Policymakers need

  to ensure that costs do not escalate and unfairly disadvantage slum

  communities. Remote consulting to reduce face-to-face contact and

  provision of mental health and gender-based violence services should be

  considered.'
affiliation: 'Griffiths, F (Corresponding Author), Univ Warwick, Warwick Med Sch,
  Div Hlth Sci, Coventry, W Midlands, England.

  Ahmed, Syed A. K. Shifat; Choudhury, Nazratun Nayeem; Yusuf, Rita, Independent Univ
  Bangladesh, Ctr Hlth Populat \& Dev, Dhaka, Bangladesh.

  Ajisola, Motunrayo, Univ Ibadan, Natl Inst Hlth Res Project, Ibadan, Oyo State,
  Nigeria.

  Azeem, Kehkashan; Rizvi, Narjis; Azam, Syed Iqbal; Iqbal, Romaina; Nazish, Ahsana;
  Tabani, Komal, Aga Khan Univ, Community Hlth Sci Dept, Karachi, Pakistan.

  Bakibinga, Pauline; Kibe, Peter; Kabaria, Caroline; Kisia, Lyagamula; Kyobutungi,
  Catherine; Mberu, Blessing; Mohamed, Shukri F., African Populat \& Hlth Res Ctr,
  Nairobi, Kenya.

  Chen, Yen-Fu; Griffiths, Frances; Harris, Bronwyn; Smith, Simon; Watson, Samuel,
  I; Wilson, Ria; Aujla, Navneet; Gill, Paramjit; Mohamed, Shukri F.; Oyebode, Oyinlola;
  Uthman, Olalekan A., Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry, W Midlands,
  England.

  Fayehun, Olufunke, Univ Ibadan, Fac Social Sci, Dept Sociol, Ibadan, Oyo State,
  Nigeria.

  Griffiths, Frances, Univ Witwatersrand, Sch Publ Hlth, Ctr Hlth Policy, Johannesburg,
  South Africa.

  Lilford, Richard J.; Sartori, Jo; Watson, Samuel, I, Univ Birmingham, Inst Appl
  Hlth Res, Coll Med \& Dent Sci, Birmingham, W Midlands, England.

  Omigbodun, Akinyinka, Univ Ibadan, Coll Med, Fac Clin Sci, Dept Obstet \& Gynaecol,
  Ibadan, Oyo State, Nigeria.

  Yeboah, Godwin; Porto de Albuquerque, Joao; Tregonning, Grant, Univ Warwick, Inst
  Global Sustainable Dev, Coventry, W Midlands, England.

  Diggle, Peter J., Univ Lancaster, Lancaster Med Sch, Lancaster, England.

  Madan, Jason J., Univ Warwick, Warwick Med Sch, Warwick Clin Trials Unit, Coventry,
  W Midlands, England.

  Odubanjo, Oladoyin, Nigerian Acad Sci, Lagos, Nigeria.

  Osuh, Mary E., Univ Ibadan, Coll Med, Dept Periodontol \& Community Dent, Fac Dent,
  Ibadan, Oyo State, Nigeria.

  Owoaje, Eme, Univ Ibadan, Fac Publ Hlth, Coll Med, Dept Community Med, Ibadan, Oyo
  State, Nigeria.

  Rahman, Omar, Univ Liberal Arts Bangladesh, Dhaka, Bangladesh.

  Taiwo, Olalekan John, Univ Ibadan, Dept Geog, Fac Social Sci, Ibadan, Oyo State,
  Nigeria.'
article-number: e003042
author: Ahmed, Syed A. K. Shifat and Ajisola, Motunrayo and Azeem, Kehkashan and Bakibinga,
  Pauline and Chen, Yen-Fu and Choudhury, Nazratun Nayeem and Fayehun, Olufunke and
  Griffiths, Frances and Harris, Bronwyn and Kibe, Peter and Lilford, Richard J. and
  Omigbodun, Akinyinka and Rizvi, Narjis and Sartori, Jo and Smith, Simon and Watson
  I, Samuel and Wilson, Ria and Yeboah, Godwin and Aujla, Navneet and Azam, Syed Iqbal
  and Diggle, Peter J. and Gill, Paramjit and Iqbal, Romaina and Kabaria, Caroline
  and Kisia, Lyagamula and Kyobutungi, Catherine and Madan, Jason J. and Mberu, Blessing
  and Mohamed, Shukri F. and Nazish, Ahsana and Odubanjo, Oladoyin and Osuh, Mary
  E. and Owoaje, Eme and Oyebode, Oyinlola and Porto de Albuquerque, Joao and Rahman,
  Omar and Tabani, Komal and Taiwo, Olalekan John and Tregonning, Grant and Uthman,
  Olalekan A. and Yusuf, Rita and Collaborative, Improving Hlth Slums
author-email: f.e.griffiths@warwick.ac.uk
author_list:
- family: Ahmed
  given: Syed A. K. Shifat
- family: Ajisola
  given: Motunrayo
- family: Azeem
  given: Kehkashan
- family: Bakibinga
  given: Pauline
- family: Chen
  given: Yen-Fu
- family: Choudhury
  given: Nazratun Nayeem
- family: Fayehun
  given: Olufunke
- family: Griffiths
  given: Frances
- family: Harris
  given: Bronwyn
- family: Kibe
  given: Peter
- family: Lilford
  given: Richard J.
- family: Omigbodun
  given: Akinyinka
- family: Rizvi
  given: Narjis
- family: Sartori
  given: Jo
- family: Smith
  given: Simon
- family: Watson I
  given: Samuel
- family: Wilson
  given: Ria
- family: Yeboah
  given: Godwin
- family: Aujla
  given: Navneet
- family: Azam
  given: Syed Iqbal
- family: Diggle
  given: Peter J.
- family: Gill
  given: Paramjit
- family: Iqbal
  given: Romaina
- family: Kabaria
  given: Caroline
- family: Kisia
  given: Lyagamula
- family: Kyobutungi
  given: Catherine
- family: Madan
  given: Jason J.
- family: Mberu
  given: Blessing
- family: Mohamed
  given: Shukri F.
- family: Nazish
  given: Ahsana
- family: Odubanjo
  given: Oladoyin
- family: Osuh
  given: Mary E.
- family: Owoaje
  given: Eme
- family: Oyebode
  given: Oyinlola
- family: Porto de Albuquerque
  given: Joao
- family: Rahman
  given: Omar
- family: Tabani
  given: Komal
- family: Taiwo
  given: Olalekan John
- family: Tregonning
  given: Grant
- family: Uthman
  given: Olalekan A.
- family: Yusuf
  given: Rita
- family: Collaborative
  given: Improving Hlth Slums
da: '2023-09-28'
doi: 10.1136/bmjgh-2020-003042
esi-highly-cited-paper: Y
esi-hot-paper: N
files: []
issn: 2059-7908
journal: BMJ GLOBAL HEALTH
keywords: 'health policy; health systems; public health; other infection; disease;

  disorder; or injury; qualitative study'
keywords-plus: DOMESTIC VIOLENCE; MODEL
language: English
month: AUG
number: '8'
number-of-cited-references: '54'
orcid-numbers: 'Yeboah, Godwin/0000-0003-4618-3175

  de Albuquerque, Joao Porto/0000-0002-3160-3168

  Kibe, Peter Mwangi/0000-0002-9027-9054

  Oyebode, Oyinlola/0000-0003-0925-9839

  Ajisola, Motunrayo/0000-0002-1704-0944

  Owoaje, Eme/0000-0002-0491-6732

  Griffiths, Frances/0000-0002-4173-1438

  Kisia, Lyagamula/0000-0002-2045-6158

  Madan, Jason/0000-0003-4316-1480

  Lilford, Richard/0000-0002-0634-984X

  Sartori, Jo/0000-0002-8681-9329

  Fayehun, Olufunke/0000-0002-3769-2130

  Watson, Sam/0000-0002-8972-769X

  OSUH PhD, Mary Ebelechukwu/0000-0003-2367-6487

  Kyobutungi, Catherine/0000-0002-5344-5631

  Harris, Bronwyn/0000-0003-4695-008X

  Bakibinga, Pauline/0000-0001-7097-5450

  Ahmed, Syed A K Shifat/0000-0001-8166-7971

  Chen, Yen-Fu/0000-0002-9446-2761'
papis_id: 24d71ff29ca6b86a56caeca5d49a5695
ref: Ahmed2020impactsocietal
researcherid-numbers: 'Yeboah, Godwin/D-5080-2015

  de Albuquerque, Joao Porto/O-2972-2019

  Kibe, Peter Mwangi/AAA-7500-2022

  Oyebode, Oyinlola/ABE-1256-2021

  Diggle, Peter J/A-3025-2009

  '
times-cited: '144'
title: 'Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19
  health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results
  of pre-COVID and COVID-19 lockdown stakeholder engagements'
type: article
unique-id: WOS:000564358100009
usage-count-last-180-days: '2'
usage-count-since-2013: '32'
volume: '5'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2020'