Northwestern University Feinberg School of Medicine, IL, Chicago, USA.
Northwestern University Global Poverty Research Lab, Evanston, IL, USA.
BMC Health Serv Res. 2023 Jul 22;23(1):785. doi: 10.1186/s12913-023-09812-x.
The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers.
This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May-June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays.
Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8-46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1-36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso.
Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa.
COVID-19 大流行导致人们因担心感染而延迟就医，在全球范围内医疗服务的可及性也有所下降。在一些国家，这些延迟与 COVID-19 认知、收入下降和粮食不安全有关，但人们对 COVID-19 大流行初期西非患者层面导致就医延迟的因素知之甚少。了解这些因素对于确定高危人群和解决与医疗保健相关的障碍至关重要。
本研究使用了 2020 年 5 月至 6 月期间在布基纳法索（n=1352）、加纳（n=1621）和塞拉利昂（n=1301）进行的基于人群的电话调查中的自我报告数据。调查问题评估了就医延迟、社会人口学变量、COVID-19 认知和粮食不安全情况。使用卡方检验进行了单变量分析，使用 logistic 回归进行了多变量分析，以探讨各因素与各国之间就医延迟的关联。根据先前的研究选择了自变量，这些研究表明财务不安全、年龄较大、女性、农村地区和与 COVID-19 相关的担忧与延迟就医有关。
2020 年 3 月至 6 月期间，布基纳法索、加纳和塞拉利昂分别有 9.9%、10.6%和 5.7%的参与者延迟就医。粮食不安全情况普遍存在（21.8%-46.1%），在布基纳法索和加纳的单变量分析中与就医延迟有关。对家庭感染 COVID-19 风险的担忧很常见（18.1%-36.0%），在加纳和塞拉利昂的两变量和多变量分析中与就医延迟有关。在单变量分析中，布基纳法索的女性就医延迟更多，而 30 岁以上和城市地区与加纳的就医延迟有关。在多变量分析中，粮食不安全与布基纳法索的就医延迟增加有关。
多种因素与 COVID-19 大流行早期的就医延迟有关，粮食不安全和感染担忧在多个国家都有显著关联。这些发现强调需要投资于诊所的可及性、社区教育和财政援助，以解决医疗保健方面的障碍。虽然自 COVID-19 大流行的初始阶段以来，许多延迟已经缓解，但了解与患者和家庭层面早期医疗中断相关的因素，将为西非未来大流行期间维持医疗保健提供信息。
