Assessing socioeconomic vulnerability and COVID-19 infection risk among NCD patients in rural Sierra Leone: a cross-sectional study

• Main Authors: Foday Boima (Author), Marta Patiño Rodriguez (Author), Stefanie A. Joseph (Author), Mohamed S. Kamara (Author), Alfred Gborie (Author), Lebbie Williams (Author), Daniel Lavalie (Author), Chiyembekezo Kachimanga (Author), Thierry Binde (Author), Jean Gregory Jerome (Author), Dale A. Barnhart (Author), the Cross-Site (Author)
• Format: Book
• Published: Springer, 2023-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1007/s44155-023-00047-z; 2731-0469
• Keywords: COVID-19; Non-communicable disease; Sierra Leone; Social inequalities; Health inequities; Public aspects of medicine; RA1-1270; Social Sciences; H
• Source: Discover Social Science and Health, Vol 3, Iss 1, Pp 1-14 (2023)

Abstract Background In Sierra Leone, non-communicable diseases (NCDs) are an increasingly important source of mortality and morbidity. However, Sierra Leonean NCD patients' experience of direct exposure to COVID-19-related risks and indirect effects of the COVID-19 pandemic on socioeconomic determinants of health has not been described. Methods We conducted a cross-sectional telephone survey among adult (≥ 18 years) hypertensive, diabetic, and heart failure patients receiving treatment at the NCD clinic at Koidu Government Hospital (KGH) in rural Sierra Leone. We described patient demographics, COVID-19 related knowledge, and practice of infection prevention measures. Patients were categorized into nationally representative wealth quintiles using an asset-based wealth index and measures of social vulnerability were reported by clinical program and wealth category. Result Of the 400 respondents, 80.5% were between 40 and 69 years old and 46.1% were male. The majority of patients (> 90%) knew utilizing masks, social distancing, isolation from positive cases, and avoiding hand shaking were effective COVID-19 prevention measures. However, only 27.3% of the population had access to adequate handwashing facilities, 25.5% had attended crowded events in the past two weeks, and only 5.8% always used face masks. Compared with the national distribution of wealth, 33.0% of our population belonged in the richest quintile, 34.8% in the second-richest quintile, and 32.2% in the bottom 3 poorest-middle quintiles. Socioeconomic vulnerability was high overall with significant disparities between wealth categories. In the 30 days before the interview, almost 60% of the poorest-middle categories experienced one barrier to essential health services, 87.4% used at least one emergency coping mechanism to cover food, housing, or health care, and 98.4% were worried about having food. In the richest category, the proportion of patients experiencing these challenges was 32.3%, 39.5% and 81.6%, respectively. Conclusion Our patients had good knowledge of COVID-19 prevention measures; however, we found substantial discrepancies between patients' self-reported knowledge and practices. Although our population was wealthier than the national average, the NCD patients were still exposed to unacceptable levels of socioeconomic vulnerability, reflecting a high absolute poverty in Sierra Leone. Furthermore, wealth-based disparities in access to essential resources persist among NCD patients.