COVID-19 pandemic has disrupted the continuity of care for chronic patients: evidence from a cross-sectional retrospective study in a developing country.

BACKGROUND: Any disruption in continuity of care for patients with chronic conditions can lead to poor outcomes for the patients as well as great damage for the community and the health system. This study aims to determine the continuity of care for patients with chronic conditions such as hypertension and diabetes during COVID-19 pandemic. METHODS: Through a cross-sectional retrospective study, data registered in six health centers in Yazd, Iran were analyzed. Data included the number of patients with chronic conditions (hypertension and diabetes) and average daily admission during a year before COVID-19 pandemic and the similar period after COVID-19 outbreak. The experience of continuity of care was assessed applying a validated questionnaire from a sample of 198 patients. Data analysis was done using SPSS version 25. Descriptive statistics, independent T-Test and Multivariable regression were used for analysis. FINDINGS: Results indicate that both visit load of the patients with chronic conditions (hypertension and diabetes) and their average daily admission were decreased significantly during a year after COVID-19 pandemic compared to the similar period before COVID-19 outbreak. The moderate average score of the patients` experience towards continuity of care during the pandemic was also reported. Regression analysis showed that age for the diabetes patients and insurance status for the hypertension patients affect the COC mean scores. CONCLUSION: COVID-19 pandemic causes serious decline in the continuity of care for patients with chronic conditions. Such a deterioration not only can lead to make these patients` condition worse in a long-term period but also it can make irreparable damages to the whole community and the health system. To make the health systems resilient particularly in disasters, serious attention should be taken into consideration among them, developing the tele-health technologies, improving the primary health care capacity, designing the applied responsive models of continuity of care, making multilateral participations and inter-sectoral collaborations, allocating sustainable resources, and enabling the patients with selfcare skills are more highlighted.

Water safety in drought: an indigenous knowledge-based qualitative study.

The indigenous knowledge of our ancestors provides valuable information on how to prevent negative health impacts on water hygiene in the event of drought. The present study aimed to explore the role of indigenous knowledge in maintaining water safety in drought conditions. A qualitative content analysis method using in-depth semi-structured interviews was used to collect and analyze the data. The current research was carried out from April 2017 to June 2018. A purposive sampling method was used to select 15 participants. Trustworthiness was applied with the Lincoln and Guba approach and data were analyzed using Graneheim and Lundman's method. Two categories including drinking water storage and water collection were extracted from the data. Each category includes different strategies to deal with water. Water storage includes water quantity and water quality. Water collection consists of collection methods and rules. Indigenous knowledge is an indispensable component of community disaster resilience. It can be transferred to other communities and employed to empower affected communities. But using the knowledge without scientific considerations cannot guarantee peoples' health throughout the drought periods.