The impact of COVID-19 pandemic on health service utilization among patients with chronic non-communicable diseases in Ghana

Background The COVID-19 pandemic significantly disrupted health systems globally and in sub-Saharan Africa (SSA) leading to reduction of health service utilization (HSU). Patients with non-communicable diseases (NCDs) had increased morbidity and mortality during the COVID-19 pandemic. We sought to determine the changes and impact of the COVID-19 pandemic on HSU among patients with NCDs comparing an epicentre to a non-epicentre region in Ghana. Methods We conducted a cross-sectional observational study of patients with NCD in the Ashanti and Northern regions in Ghana from February 2024 to July 2024. We distributed questionnaires to patients with NCD in selected facilities in the Northern and Ashanti regions of Ghana. The Andersens Behavioural Model was used as the conceptual framework to determine the factors affecting HSU. Multiple logistic regression was used to identify independent variables predicting reduction in HSU. P value of less than 0.05 was considered statistically significant. Results The study included 844 participants with NCDs equally sampled in the Ashanti and Northern regions of Ghana. The mean age of respondents was 61.4{+/-}11.6 years with 569(67%) females. Almost half 367 (43.5%) of all respondents reported COVID-19 led to a decrease in their HSU and over a third of respondents, 303(35.9%) missed their hospital appointments. The proportion of respondents reporting a decrease in HSU was significantly higher in the Northern region 276 (65.4%) than the Ashanti region 91 (21.6%), [p<0.001]. Reduction in HSU was associated with increasing age (aOR=0.97, 0.96 - 0.99, p<0.001), Northern region residence (aOR=9.60 CI 6.43 - 14.32, p<0.001), higher household income (aOR=1.36 CI 1.15-1.60, p<0.001), longer duration of NCD (aOR=1.03, CI 1.01 - 1.06, p=0.033) and possession of valid NHIS card (aOR=7.43, CI 2.44 - 22.57, p <0.001). Conclusion The COVID-19 pandemic led to reduction in HSU in Ghana. There was a significant reduction in NCDs in a non-epicentre region (Northern region) compared to the Ashanti region which was an epicenter region. Hence patients in non-epicentres should also be prioritized in pandemic situations.