Journal Article

Economic and social determinants of health care utilization during the first wave of COVID-19 pandemic among adults in Ghana: a population-based cross-sectional study

Popoola, Bamidele Olubukola, Zuñiga, Roberto Ariel Abeldaño, Amuna, Paul, Gaffar, Balgis, Khan, Abeedha Tu-Allah, Yousaf, Muhammad Abrar, Adjuik, Martin, Uzochukwu, Benjamin, Ezechi, Oliver, Virtanen, Jorma I., Nguyen, Annie L., Foláyan, Moréniké Oluwátóyìn, Ellakany, Passent, Ayanore, Martin Amogre, Lawal, Folake Barakat, El Tantawi, Maha, Quadri, Mir Faeq Ali, Ishabiyi, Anthonia Omotola, Aly, Nourhan M., Ara, Eshrat, Brown, Brandon

2024

Overview

Background The COVID-19 pandemic had socioeconomic effects in Africa. This study assessed the social and economic determinants of healthcare utilization during the first wave of COVID-19 among adults in Ghana. Methods Information about individuals residing in Ghana was derived from a survey conducted across multiple countries, aiming to evaluate the impact of the COVID-19 pandemic on the mental health and overall well-being of adults aged 18 and above. The dependent variable for the study was healthcare utilization (categorized as low or high). The independent variables were economic (such as financial loss, job loss, diminished wages, investment/retirement setbacks, and non-refunded travel cancellations) and social (including food scarcity, loss of financial support sources, housing instability, challenges affording food, clothing, shelter, electricity, utilities, and increased caregiving responsibilities for partners) determinants of health. A multinomial logistic regression was conducted to identify factors associated with healthcare utilization after adjusting for confounders (age, gender, access to medical insurance, COVID-19 status, educational background, employment, and marital status of the participants). Results The analysis included 364 responses. Individuals who encountered a loss of financial support (AOR: 9.58; 95% CI: 3.44–26.73; p  < 0.001), a decrease or loss of wages (AOR: 7.44, 95% CI: 3.05–18.16, p  < 0.001), experienced investment or retirement setbacks (AOR: 10.69, 95% CI: 2.60-43.88, p  = 0.001), and expressed concerns about potential food shortages (AOR: 6.85, 95% CI: 2.49–18.84, p  < 0.001) exhibited significantly higher odds of low healthcare utilization during the initial phase of the pandemic. Contrastingly, participants facing challenges in paying for basic needs demonstrated lower odds of low healthcare utilization compared to those who found it easy to cover basic expenses (AOR: 0.19, 95% CI: 0.06–0.67, p  = 0.001). Conclusion Economic and social factors were associated with low healthcare utilization in Ghana during the first wave of the pandemic. Investment or retirement loss and financial support loss during the pandemic had the largest effect on healthcare utilization. Further research is needed to understand the connection between concerns about food shortages, welfare losses during pandemics and healthcare utilization during pandemics in Ghana.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Adults / Biostatistics / Caregiving / Child & adolescent mental health / COVID-19 / COVID-19 - epidemiology / Cross-Sectional Studies / Data analysis / Data collection / Dependent variables / Economic aspects / Economic determinants / Economic factors / Economics / Electric utilities / Electricity / Employment / Environmental Health / Epidemics / Epidemiology / Financial loss / Financial support / Food / Food security / Food supply / GDP / Ghana / Ghana - epidemiology / Gross Domestic Product / Health behavior / Health care / Health care access / Health care policy / Health care utilization / Health insurance / Health services utilization / Healthy food / Housing / Humans / Independent variables / Influence / Investments / Marital status / Maternal & child health / Medical care / Medicine / Medicine & Public Health / Mental health / Mental health services / Mortality / Pandemics / Patient Acceptance of Health Care / Pharmacists / Population studies / Public Health / Retirement / Scarcity / Setbacks / Shortages / Social aspects / Social determinants / Social Determinants of Health / Social factors / Social networks / Sociocultural factors / Sociodemographics / Socioeconomic Factors / Unemployment / Utilization / Vaccine / Variables / Wages & salaries / Welfare / Well being