{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T05:38:22Z","timestamp":1775281102065,"version":"3.50.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The implementation of restriction and mitigation measures to contain COVID-19 infection led to a significant disruption in the delivery of essential health services. However, the ramifications of the immediate COVID-19 containment policies on healthcare service utilization for major non-communicable diseases (NCDs)-related cases, particularly in low- and middle-income countries, remains unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used an interrupted time series study design, fitted with quasi-Poisson regression models, to assess the impacts of the nationwide lockdown on hospital visits for NCDs, namely cardiovascular disease (CVD), chronic respiratory disease (CRD), chronic kidney disease (CKD), cancer, and hypertension (HTN)-related cases, in Nepal. A total of 33\u2009months of nationwide outpatient department visits data for NCD cases between July 2018 and April 2021, 20\u2009months before and 13\u2009months after the enforcement of the nationwide lockdown, were included in the final analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared with the expected level, there was an estimated 73% [relative risk (RR) 0.269, 95% confidence interval (CI): 0.089\u20130.808] decrease in outpatient department visits for CVD and a 64% (RR 0.361, 95% CI: 0.175\u20130.745) decrease for cancer. Although an immediate reduction in outpatient department visits was observed, the evidence was not conclusive to determine the true effect of the COVID-19 pandemic on outpatient department visits for CRD (RR 0.89, 95% CI: 0.651\u20131.228), HTN (RR 1.004, 95% CI: 0.64\u20131.575), and kidney disease (RR 0.589, 95% CI: 0.231\u20131.501).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We estimated that the nationwide lockdown implemented in response to the COVID-19 pandemic affected hospital visits for patients with CVD and cancer. However, the available evidence was not conclusive enough to determine the impact of COVID-19 on outpatient department visits for the other NCDs analysed, namely HTN, CRD, and CKD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ije\/dyaf100","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T19:29:32Z","timestamp":1751398172000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of COVID-19 lockdown on outpatient care for non-communicable diseases in Nepal"],"prefix":"10.1093","volume":"54","author":[{"given":"Rajina","family":"Shakya","sequence":"first","affiliation":[{"name":"Nepal Health Research Council , Kathmandu,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghnath","family":"Dhimal","sequence":"additional","affiliation":[{"name":"Nepal Health Research Council , Kathmandu,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pramod","family":"Joshi","sequence":"additional","affiliation":[{"name":"Nepal Health Research Council , Kathmandu,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umesh Raj","family":"Aryal","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Health Sciences, Karnali Academy of Health Sciences , Jumla,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pradip","family":"Gynawali","sequence":"additional","affiliation":[{"name":"Nepal Health Research Council , Kathmandu,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-1406","authenticated-orcid":false,"given":"Dinesh","family":"Bhandari","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Monash University , Melbourne, Victoria,","place":["Australia"]},{"name":"School of Public Health, University of Adelaide , Adelaide,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"2025070115292898900_dyaf100-B1","author":"World Health Organization","year":"2023"},{"key":"2025070115292898900_dyaf100-B2","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.ijid.2020.01.009","article-title":"The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health\u2013the latest 2019 novel coronavirus outbreak in Wuhan, China","volume":"91","author":"Hui","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2025070115292898900_dyaf100-B3","author":"World Health Organization","year":"2020"},{"key":"2025070115292898900_dyaf100-B4","first-page":"1073","article-title":"The impact of COVID-19 on health and health systems","volume":"31","author":"Haileamlak","year":"2021","journal-title":"Ethiop J Health Sci"},{"key":"2025070115292898900_dyaf100-B5","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s40520-020-01601-4","article-title":"The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing","volume":"32","author":"Palmer","year":"2020","journal-title":"Aging Clin Exp Res"},{"key":"2025070115292898900_dyaf100-B6","volume-title":"Tackling NCDs: Best Buys and Other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases","author":"World Health Organization","year":"2024"},{"key":"2025070115292898900_dyaf100-B7","doi-asserted-by":"crossref","first-page":"5588","DOI":"10.3390\/ijerph17155588","article-title":"What happened to people with non-communicable diseases during COVID-19: implications of H-EDRM policies","volume":"17","author":"Chan","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025070115292898900_dyaf100-B8","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/ageing\/afaa260","article-title":"Effect of the COVID-19 lockdown on disease recognition and utilisation of healthcare services in the older population in Germany: a cross-sectional study","volume":"50","author":"Michalowsky","year":"2021","journal-title":"Age Ageing"},{"key":"2025070115292898900_dyaf100-B9","doi-asserted-by":"crossref","first-page":"e0256330","DOI":"10.1371\/journal.pone.0256330","article-title":"Impacts of COVID-19 on essential health services in Tigray, Northern Ethiopia: A pre-post study","volume":"16","author":"Desta","year":"2021","journal-title":"PLoS One"},{"key":"2025070115292898900_dyaf100-B10","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1177\/1010539520963626","article-title":"The impact of COVID-19 on the delivery of critical health care: experience from a non\u2013high-income country","volume":"32","author":"Kumanan","year":"2020","journal-title":"Asia Pac J Public Health"},{"key":"2025070115292898900_dyaf100-B11","doi-asserted-by":"crossref","first-page":"720948","DOI":"10.3389\/fpubh.2021.720948","article-title":"The impact of COVID-19 on hospital admissions in Croatia","volume":"9","author":"Kalanj","year":"2021","journal-title":"Front Public Health"},{"key":"2025070115292898900_dyaf100-B12","article-title":"The impact of the COVID-19 pandemic on health services utilization in China: time-series analyses for 2016\u20132020","volume":"9","author":"Xiao","year":"2021","journal-title":"Lancet Reg Health\u2013West Pac"},{"key":"2025070115292898900_dyaf100-B13","doi-asserted-by":"crossref","first-page":"e0243055","DOI":"10.1371\/journal.pone.0243055","article-title":"Mortality and risk factors of disease in Nepal: trend and projections from 1990 to 2040","volume":"15","author":"Pandey","year":"2020","journal-title":"PLoS One"},{"key":"2025070115292898900_dyaf100-B14","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1016\/S0140-6736(18)31668-4","article-title":"Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries","volume":"392","author":"Kruk","year":"2018","journal-title":"Lancet"},{"key":"2025070115292898900_dyaf100-B15","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1136\/bmj.327.7424.1129","article-title":"Measuring the health of nations: analysis of mortality amenable to health care","volume":"327","author":"Nolte","year":"2003","journal-title":"BMJ"},{"key":"2025070115292898900_dyaf100-B16","doi-asserted-by":"crossref","first-page":"h2750","DOI":"10.1136\/bmj.h2750","article-title":"Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis","volume":"350","author":"Kontopantelis","year":"2015","journal-title":"BMJ"},{"key":"2025070115292898900_dyaf100-B17","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025070115292898900_dyaf100-B18","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1186\/s12913-021-06681-0","article-title":"Health system gaps in cardiovascular disease prevention and management in Nepal","volume":"21","author":"Shrestha","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2025070115292898900_dyaf100-B19","volume-title":"Annual Health Report 2079\/80","author":"Department of Health Services","year":"2024"},{"key":"2025070115292898900_dyaf100-B20","first-page":"65","article-title":"Health system development in Nepal","volume":"58","author":"Marasini","year":"2020","journal-title":"JNMA J Nepal Med Assoc"},{"key":"2025070115292898900_dyaf100-B21","article-title":"The impact of COVID-19 on essential health service provision for noncommunicable diseases in the South-East Asia region: a systematic review","volume":"1","author":"Gadsden","year":"2022","journal-title":"Lancet Reg Health-Southeast Asia"},{"key":"2025070115292898900_dyaf100-B22","doi-asserted-by":"crossref","first-page":"102607","DOI":"10.1016\/j.dsx.2022.102607","article-title":"A rapid assessment of the impact of coronavirus disease (COVID-19) pandemic on health care & service delivery for noncommunicable diseases in India","volume":"16","author":"Nath","year":"2022","journal-title":"Diabetes Metab Syndr"},{"key":"2025070115292898900_dyaf100-B23","doi-asserted-by":"crossref","first-page":"mzab078","DOI":"10.1093\/intqhc\/mzab078","article-title":"Effect of COVID-19 on hospital visits in Ningbo, China: an interrupted time-series analysis","volume":"33","author":"Yang","year":"2021","journal-title":"Int J Qual Health Care"},{"key":"2025070115292898900_dyaf100-B24","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1017\/S146342362100030X","article-title":"The impact of COVID-19 on the care of people living with noncommunicable diseases in low-and middle-income countries: an online survey of physicians and pharmacists in nine countries","volume":"22","author":"Bullen","year":"2021","journal-title":"Prim Health Care Res Dev"}],"container-title":["International Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/54\/4\/dyaf100\/63638338\/dyaf100.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/54\/4\/dyaf100\/63638338\/dyaf100.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T19:29:36Z","timestamp":1751398176000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ije\/article\/doi\/10.1093\/ije\/dyaf100\/8180641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,11]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,6,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ije\/dyaf100","relation":{},"ISSN":["1464-3685"],"issn-type":[{"value":"1464-3685","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,6,11]]},"article-number":"dyaf100"}}