The Impact of Covid-19 on Essential Health Service Provision for Noncommunicable Diseases in the South-East Asia Region: A Systematic Review

Background: The COVID-19 pandemic has had a profound impact on the 11 countries of the WHO South East Asia Region with substantial stress to health systems. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the COVID-19 pandemic on the service provision of four NCDs (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the South East Asia region.Methods: A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2020. The quality of included studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the ‘synthesis without meta-analysis’ reporting guidelines. The review was registered with PROSPERO (CRD42020187629) and reported according to PRISMA guidelines.Findings: Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional in nature. The majority of studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. 11/15 cancer studies examined disruptions to outpatient services, of which ten found a >40% reduction in service delivery post the onset of COVID-19 as compared to a pre-pandemic period. 10/12 cardiovascular disease studies examined disruptions to inpatient admissions, of which 9 found a reduction of 30% or greater compared to a pre-pandemic period. Two studies reported on disruption to respiratory disease services, finding a 78.9% reduction in diagnoses, and an 83% reduction in surgical management, respectively.Interpretation: This review provides evidence that the COVID-19 pandemic has substantially disrupted the provision of health services for multiple NCDs, and in particular - cancer and cardiovascular disease, across numerous countries in the region. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region.Registration Details: The review was registered with PROSPERO (CRD42020187629) and reported according to PRISMA guidelines.Funding Information: This work was supported by the WHO Sri Lanka Country Office. TG is supported by a university post graduate award from the University of New South Wales. SJ and DP are both supported by NHMRC Principal Research fellowships. Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: Ethical approval was not required for this review as all information collected was available in the public domain.