A study on the health and socioeconomic impact of COVID-19 pandemic and barriers to self-management of diabetes during the lockdown among rural residents of South India

Aim: To study the health and socioeconomic impact of the COVID-19 pandemic and to assess the barriers to self-management of diabetes during the lockdown, in rural South India. Materials and Methods: Details of demographic, social, economic, migration and health status were collected using a structured questionnaire from participants aged ≥18 years belonging to the 21 villages of Chengalpattu and Kancheepuram districts of Tamil Nadu state in south India as part of the Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND) study. From the 11,249 TREND participants, a random list of 25% (n = 2812) was system-generated using random numbers and 2812 participants were contacted for the study, of whom 2511 individuals participated. Telephonic interviews were conducted during the lockdown from June to August 2020. Further, qualitative interviews(Focus group discussions) were conducted among 27 individuals with diabetes between September and December 2020. Data were analyzed using thematic analysis. Results: The mean age of the study population was 43 ± 14 years and 50.4% were women. Diabetes was present in 14.7%, hypertension in 31.9%, generalized and abdominal obesity in 33.3% and 46.5% respectively. When the lockdown was implemented in March 2020, 37% had migrated from urban to rural areas. Lack of daily wage jobs (68%), price of essential commodities (41.7%), social distancing/curfew (34.8%), mental fatigue/depression (14.7%), and loss of job (7.1%) were some reasons stated for their adverse social and financial circumstances. People with diabetes stated that they had to avoid or cut down their regular hospital visits due to travel restrictions. Many of the patients took the same medications for almost a year. Conclusion: Unemployment, poor mental health, and reduced household income were the most significant negative impacts faced by rural residents during the lockdown due to COVID-19. People with diabetes experienced disruptions in diabetes management due to the pandemic.