RESUMO
The COVID-19 crisis has rapidly increased the vulnerability of groups of population already facing precarious living conditions. The emergence of food and housing insecurity have forced health and social actors along with the local authorities to implement innovative responses in order to respond to these unmet needs. This article presents some of these responses, such as an interdisciplinary mobile COVID-19 screening team, an emergency housing program and a large-scale food assistance program. These examples highlight the need for an intersectoral, coordinated and collaborative response simultaneously targeting different domains of insecurity in parallel to actions on the underpinning social and political determinants of these vulnerabilities.
La crise liée au Covid-19 a fragilisé les populations en situation préalable de précarité. L'émergence de l'insécurité alimentaire et de logement a poussé les acteurs de la santé, du travail social et les autorités à mettre en place des mesures innovantes et intersectorielles permettant de répondre rapidement et efficacement aux besoins essentiels de ces populations. Cet article présente trois de ces mesures, à savoir une équipe mobile interprofessionnelle de dépistage, un dispositif d'hébergement et d'encadrement sanitaire pour les personnes sans-abri et un programme de distribution alimentaire à large échelle. Ces trois exemples illustrent la nécessité d'une approche transversale et collaborative et le besoin d'agir sur les déterminants sociaux et politiques sous-tendant ces vulnérabilités.
Assuntos
COVID-19 , Assistência Alimentar , Habitação , Humanos , SARS-CoV-2 , Populações VulneráveisRESUMO
BACKGROUND: Literature on the burden and management of atherosclerotic cardiovascular disease (ASCVD) in humanitarian settings is limited. This study aimed to describe patient characteristics and explore both service use and use of recommended secondary prevention drugs in Syrian refugee patients with ASCVD attending two Médecins Sans Frontières (MSF) clinics in Lebanon. METHODS: This study comprised a cross-sectional survey of ASCVD patients attending either MSF clinic over a four-week period in early 2017. Using descriptive statistics, we explored patient demographic characteristics, cardiovascular risk factors and assessed ASCVD secondary prevention medication prescription and patient adherence with a 7-day self-report scale. A retrospective study of routine clinical data explored workload and trends in patient loss to follow-up. We performed logistic regression modelling to explore risk factors for loss to follow-up. RESULTS: We included 514 patients with ASCVD in the cross-sectional study, performed in 2017. Most (61.9%) were male and mean age was 60.4 years (95% CI, 59.6-61.3). Over half (58.8%) underwent revascularization and 26.1% had known cerebrovascular disease. ASCVD risk factors included 51.8% with diabetes and 72.2% with hypertension. While prescription (75.7 to 98.2%) and self-reported adherence rates (78.4 to 93.9%) for individual ASCVD secondary prevention drugs (ACE-inhibitor, statin and antiplatelet) were high, the use of all three was low at 41.3% (CI95%: 37.0-45.6). The 5-year retrospective cohort study (ending April 2017) identified 1286 patients with ASCVD and 16,618 related consultations (comprising 24% of all NCD consultations). Over one third (39.7%) of patients were lost to follow-up, with lower risk among men. CONCLUSIONS: The burden of ASCVD within MSF clinics in Lebanon is substantial. Although prescription and adherence of individual secondary prevention drugs is acceptable, overall use of the three recommended drugs is suboptimal. Loss to follow-up rates were high. Further studies are needed to evaluate innovative strategies to increase the use of the multiple recommended drugs, and to increase the retention of patients with ASCVD in the care system.