The impact of COVID-19 pandemic on health service utilization among patients with chronic non-communicable diseases in Ghana
This cross-sectional study of 844 Ghanaian patients with chronic non-communicable diseases reveals that the COVID-19 pandemic significantly reduced health service utilization, with a disproportionately higher impact observed in the non-epicentre Northern region compared to the epicentre Ashanti region, driven by factors such as age, income, disease duration, and health insurance status.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
When a global health crisis strikes, the most immediate fear is often the virus itself. Yet, for millions of people living with long-term conditions like high blood pressure or diabetes, the real danger can come from the silence that follows. These chronic illnesses require steady, regular care: check-ups, medication refills, and monitoring to keep the body in balance. When a pandemic disrupts the flow of daily life, these routine visits often stop. The question researchers face is not just whether people get sick, but whether they can still reach the doctors who keep them alive. This is the story of health service utilization, a term that simply means how often and how easily people are able to use the medical care they need. In places where resources are already stretched, a sudden halt in care can turn a manageable condition into a life-threatening one.
A team of researchers in Ghana set out to understand exactly how the COVID-19 pandemic changed this pattern for patients with chronic diseases. They focused on two very different parts of the country: the Ashanti Region, a bustling urban center that was heavily hit by the virus, and the Northern Region, a vast, mostly rural area where far fewer cases were reported. The logic seemed straightforward: one would expect the disruption to be worse where the virus was strongest. The researchers interviewed 844 patients with diabetes or high blood pressure, asking them about their experiences before and during the pandemic. They wanted to see who stopped going to the hospital, why they stopped, and what happened to their health as a result.
The findings turned the expected story on its head. While the Ashanti Region had thousands more confirmed cases of COVID-19 than the Northern Region, it was the patients in the North who stopped going to the hospital in much larger numbers. In the Northern Region, nearly two-thirds of the patients reported a drop in their visits to medical facilities, and more than half missed scheduled appointments entirely. In contrast, in the Ashanti Region, only about one-fifth of patients reported a decrease in visits. The researchers found that the fear of catching the virus in a hospital was a powerful force, but it seemed to hit the Northern Region harder. In one district hospital in the North, a high number of staff members had contracted the virus, creating a reputation that likely kept patients away, even though the virus itself was less common there than in the south.
The study also revealed that the reasons for staying home were not just about fear, but also about who the patients were and how long they had been sick. Older patients were actually more likely to keep coming for their care, perhaps because they had more complex needs or understood the risks of missing a visit. Surprisingly, patients with higher household incomes were more likely to reduce their visits, possibly because they could afford to wait or seek care elsewhere, or because they felt less urgency. Similarly, those who held valid national health insurance cards were more likely to stop coming to public clinics. This was a counterintuitive result, as insurance usually helps people access care. The researchers suggest that during the pandemic, having insurance might have made patients feel safer staying away from public facilities, perhaps fearing infection or assuming their appointments would be rescheduled anyway.
The consequences of these missed visits were real and measurable. About a third of all patients in the study missed their appointments, and for many, this led to acute illness. In the Northern Region, a quarter of the patients reported becoming seriously ill during the pandemic, a rate more than double that of the Ashanti Region. While the study did not track deaths directly, the link between missing appointments and worsening health was clear. Patients who stopped coming in were less able to control their blood sugar or blood pressure, leaving them vulnerable to severe complications. The researchers noted that this pattern suggests that during a crisis, the areas with the fewest virus cases might actually suffer the most from the breakdown of routine care.
This work highlights a difficult truth about health systems: a pandemic does not just spread a virus; it spreads fear and confusion, and these can be just as disruptive as the disease itself. The researchers concluded that in future health emergencies, officials cannot assume that the areas with the most cases are the only ones in danger. The quiet regions, where the virus is rare but the fear is high, may need just as much attention to ensure that people with chronic diseases can still get the care they need. The study serves as a reminder that keeping the doors of the clinic open is not just about fighting an infection, but about maintaining the trust and access that keeps millions of people healthy every day.
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