COVID-19 Preventive Practices, Psychological Distress, and Reported Barriers to Healthcare Access during the Pandemic among Adult Community Members in Sub-Saharan Africa: A Phone Survey

Abstract

The COVID-19 pandemic has had serious negative health and economic impacts in sub-Saharan Africa. Continuous monitoring of these impacts is crucial to formulate interventions to minimize the consequences of COVID-19. This study surveyed 2,829 adults in urban and rural sites among five sub-Saharan African countries: Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana. Participants completed a mobile phone survey that assessed self-reported sociodemographics, COVID-19 preventive practices, psychological distress, and barriers to healthcare access. A modified Poisson regression model was used to estimate adjusted prevalence ratios (aPRs) and 95% CIs to investigate potential factors related to psychological distress and barriers to reduced healthcare access. At least 15.6% of adults reported experiencing any psychological distress in the previous 2 weeks, and 10.5% reported that at least one essential healthcare service was difficult to access 2 years into the pandemic. The majority of participants reported using several COVID-19 preventive methods, with varying proportions across the sites. Participants in the urban site of Ouagadougou, Burkina Faso (aPR: 2.29; 95% CI: 1.74–3.03) and in the rural site of Kintampo, Ghana (aPR: 1.68; 95% CI: 1.21–2.34) had a higher likelihood of experiencing any psychological distress compared with those in the rural area of Nouna, Burkina Faso. Loss of employment due to COVID-19 (aPR: 1.77; 95% CI: 1.47–2.11) was also associated with an increased prevalence of psychological distress. The number of children under 5 years in the household (aPR: 1.23; 95% CI: 1.14–1.33) and participant self-reported psychological distress (aPR: 1.83; 95% CI: 1.48–2.27) were associated with an increased prevalence of reporting barriers to accessing health services, whereas wage employment (aPR: 0.67; 95% CI: 0.49–0.90) was associated with decreased prevalence of reporting barriers to accessing health services. Overall, we found a high prevalence of psychological distress and interruptions in access to healthcare services 2 years into the pandemic across five sub-Saharan African countries. Increased effort and attention should be given to addressing the negative impacts of COVID-19 on psychological distress. An equitable and collaborative approach to new and existing preventive measures for COVID-19 is crucial to limit the consequences of COVID-19 on the health of adults in sub-Saharan Africa.

Healthcare workers’ experiences with COVID-19-related prevention and control measures in Tanzania

“…This stress stems from concerns about contracting infections themselves or transmitting them to others, largely due to the inadequacies in pandemic preparedness within the healthcare system. These findings align with prior studies that have documented deficiencies in health system preparedness, interruptions in healthcare services, and the psychological distress experienced by HCWs [ 40 – 42 ]. Mitigating these fears and addressing other related concerns should be regarded as a pivotal component of an effective pandemic response [ 31 , 43 ].…”

Long-term impact of resilience and extraversion on psychological distress during the COVID-19 pandemic: a longitudinal investigation among individuals with and without mental health disorders

“…In the course of the pandemic, psychological distress did universally significantly increase among the general population ( 58 , 59 ), including residents of Austria ( 60 ) and Italy ( 61 ). It has been shown in this context that a person’s mental strain can be influenced by various factors like the country of residence ( 59 ), the condition of local healthcare and social security systems ( 62 ), as well as by gender, marital status, and family situation ( 33 ). In the United States, 12-15% of the general population have reported symptoms of serious psychological distress over an extended period ( 63 ), which is in line with our findings.…”

Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda

“…Available evidence suggests that psychological distress during the pandemic has been high in various parts of Africa, For example, in a phone-based study in urban areas of Burkina Faso, Ethiopia, and Egypt, 28% of participants had symptoms of mild, moderate, or severe psychological distress [ 11 ]. High prevenance of mental health disorders have been reported in East Africa [ 12 ], Mali [ 13 ], south Africa [ 14 , 15 ], Ghana [ 16 ] etc but most of these were conducted among health care workers or the general population.…”