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BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | COVID-19 | Research

Patterns and determinants of healthcare utilization and medication use before and during the COVID-19 crisis in Afghanistan, Bangladesh, and India

Authors: Md Tauhidul Islam, Mieghan Bruce, Khurshid Alam

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

COVID-19 rapidly spread through South Asian countries and overwhelmed the health systems that were unprepared for such an outbreak. Evidence from high-income countries showed that COVID-19 impacted healthcare utilization, including medication use, but empirical evidence is lacking in South Asia. This study aimed to investigate the effect of COVID-19 on healthcare utilization and medication use in South Asia.

Method

The current study used longitudinal data from the ‘Premise Health Service Disruption Survey’ 2020 and 2021. The countries of interest were limited to Afghanistan, Bangladesh, and India. In these surveys, data related to healthcare utilization and medication use were collected for three-time points; ‘Pre-COVID phase’, ‘Initial phase of COVID-19 outbreak’, and ‘One year of COVID-19 outbreak’. Generalized estimating equation (GEE) along with McNemar’s test, Kruskal–Wallis test and χ2 test were applied in this study following the conceptualization of Andersen’s healthcare utilization model.

Result

The use of healthcare and medication was unevenly impacted by the COVID-19 epidemic in Afghanistan, Bangladesh, and India. Immediately after the COVID-19 outbreak, respondents in Bangladesh reported around four times higher incomplete healthcare utilization compared to pre-COVID phase. In contrast, respondents in Afghanistan reported lower incomplete utilization of healthcare in a similar context. In the post COVID-19 outbreak, non-adherence to medication use was significantly higher in Afghanistan (OR:1.7; 95%CI:1.6,1.9) and India (OR:1.3; 95%CI:1.1,1.7) compared to pre-COVID phase. Respondents of all three countries who sought assistance to manage non-communicable diseases (NCDs) had higher odds (Afghanistan: OR:1.5; 95%CI:1.3,1.8; Bangladesh: OR: 3.7; 95%CI:1.9,7.3; India: OR: 2.3; 95% CI: 1.4,3.6) of non-adherence to medication use after the COVID-19 outbreak compared to pre-COVID phase.

Conclusion

The present study documented important evidence of the influence of COVID-19 epidemic on healthcare utilization and medication use in three countries of South Asia. Lessons learned from this study can feed into policy responses to the crisis and preparedness for future pandemics.
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Literature
1.
2.
Fischer R, Karl JA. Predicting behavioral intentions to prevent or mitigate COVID-19: a cross-cultural meta-analysis of attitudes, norms, and perceived behavioral control effects. Social Psychol Personality Sci. 2022;13(1):264–76.CrossRef
3.
Maital S, Barzani E. The global economic impact of COVID-19: a summary of research. Samuel Neaman Inst Natl Policy Res. 2020;2020:1–12.
4.
Martínez-Córdoba P-J, Benito B, García-Sánchez I-M. Efficiency in the governance of the Covid-19 pandemic: political and territorial factors. Globalization Health. 2021;17:1–13.CrossRef
5.
Haldane V, Morgan GT. From resilient to transilient health systems: the deep transformation of health systems in response to the COVID-19 pandemic. Health Policy Plann. 2021;36(1):134–5.CrossRef
6.
Aljuboori ZS, Young CC, Srinivasan VM, Kellogg RT, Quon JL, Alshareef MA, Chen SH, Ivan M, Grant GA, McEvoy SD. Early effects of COVID-19 pandemic on neurosurgical training in the United States: a case volume analysis of 8 programs. World Neurosurg. 2021;145:e202–8.PubMedCrossRef
7.
Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19—implications for the health care system. In., vol. 383: Mass Medical Soc; 2020: 1483–1488.
8.
Bong C-L, Brasher C, Chikumba E, McDougall R, Mellin-Olsen J, Enright A. The COVID-19 pandemic: effects on low-and middle-income countries. Anesth Analg 2020.
9.
Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, Sann KK, Shrestha BR, Hashmi M, Palo JEM. Critical care bed capacity in Asian countries and regions. Crit Care Med. 2020;48(5):654–62.PubMedCrossRef
10.
Moynihan R, Sanders S, Michaleff ZA, Scott AM, Clark J, To EJ, Jones M, Kitchener E, Fox M, Johansson M. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ open. 2021;11(3):e045343.PubMedCrossRef
11.
Aranda Z, Binde T, Tashman K, Tadikonda A, Mawindo B, Maweu D, Boley EJ, Mphande I, Dumbuya I, Montaño M. Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. BMJ Global Health. 2022;7(1):e007247.PubMedCrossRef
12.
Shapira G, Ahmed T, Drouard SHP, Amor Fernandez P, Kandpal E, Nzelu C, Wesseh CS, Mohamud NA, Smart F, Mwansambo C. Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-saharan African countries. Health Policy Plann. 2021;36(7):1140–51.CrossRef
13.
Dema E, Gibbs J, Clifton S, Copas AJ, Tanton C, Riddell J, Pérez RB, Reid D, Bonell C, Unemo M. Initial impacts of the COVID-19 pandemic on sexual and reproductive health service use and unmet need in Britain: findings from a quasi-representative survey (Natsal-COVID). Lancet Public Health. 2022;7(1):e36–e47.PubMedPubMedCentralCrossRef
14.
Byrne A, Barber R, Lim CH. Impact of the COVID-19 pandemic–a mental health service perspective. Progress Neurol Psychiatry. 2021;25(2):27–33b.CrossRef
15.
Saso A, Skirrow H, Kampmann B. Impact of COVID-19 on immunization services for maternal and infant vaccines: results of a survey conducted by imprint—the immunising pregnant women and infants network. Vaccines. 2020;8(3):556.PubMedPubMedCentralCrossRef
16.
Kluge HHP, Wickramasinghe K, Rippin HL, Mendes R, Peters DH, Kontsevaya A, Breda J. Prevention and control of non-communicable diseases in the COVID-19 response. Lancet. 2020;395(10238):1678–80.PubMedPubMedCentralCrossRef
17.
Mirzazada S, Padhani ZA, Jabeen S, Fatima M, Rizvi A, Ansari U, Das JK, Bhutta ZA. Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan. Confl Health. 2020;14(1):1–13.CrossRef
18.
Hassanain SA, Edwards JK, Venables E, Ali E, Adam K, Hussien H, Elsony A. Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004–2014. Confl Health. 2018;12(1):1–9.CrossRef
19.
Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC. Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. Am J Psychiatry. 2008;165(1):34–41.PubMedCrossRef
20.
21.
Ganguly S, Mistree D. The COVID-19 Crisis in South Asia: coping with the pandemic. New York: Routledge; 2022.CrossRef
22.
Babu GR, Khetrapal S, John DA, Deepa R, Narayan KV. Pandemic preparedness and response to COVID-19 in south Asian countries. Int J Infect Dis. 2021;104:169–74.PubMedCrossRef
23.
Sarkar A, Liu G, Jin Y, Xie Z, Zheng Z-J. Public health preparedness and responses to the coronavirus disease 2019 (COVID-19) pandemic in South Asia: a situation and policy analysis. Global Health J. 2020;4(4):121–32.CrossRef
24.
Bitar H, Alismail S. The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: a rapid systematic review. Digit Health. 2021;7:20552076211009396.PubMedPubMedCentral
25.
Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020;20:1–9.CrossRef
26.
27.
Hasan AH, Das SC, Islam MS, Mansur M, Shawon MSR, Hassan R, Chowdhury MSJH, Mondal MBA, Mohammad QD. Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh. PLoS ONE. 2021;16(1):e0240385.PubMedPubMedCentralCrossRef
28.
29.
Downey LE, Gadsden T, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for endemic infectious diseases in the South-East Asia region: a systematic review. Lancet Reg Health-Southeast Asia 2022.
30.
Gadsden T, Downey LE, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for noncommunicable diseases in the South-East Asia region: a systematic review. Lancet Reg Health-Southeast Asia 2022.
31.
Ahmed T, Roberton T, Vergeer P, Hansen PM, Peters MA, Ofosu AA, Mwansambo C, Nzelu C, Wesseh CS, Smart F. Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low-and middle-income countries: an interrupted time-series analysis with mathematical modeling of administrative data. PLoS Med. 2022;19(8):e1004070.PubMedPubMedCentralCrossRef
32.
Soares P, Leite A, Esteves S, Gama A, Laires PA, Moniz M, Pedro AR, Santos CM, Goes AR, Nunes C. Factors Associated with the patient’s decision to avoid Healthcare during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(24):13239.PubMedPubMedCentralCrossRef
33.
Herrera CA, Kerr AC, Dayton JM, Kakietek JJ. Healthcare service disruption in 14 latin American and Caribbean countries during the COVID-19 pandemic: analysis of household phone surveys, 2020–2021. J Global Health 2023, 13.
34.
Hwang J, Kim W-H, Heo J. An association between individual’s risk perceptions and delayed or foregone healthcare services during the COVID-19 pandemic in Korea. BMC Health Serv Res. 2023;23(1):850.PubMedPubMedCentralCrossRef
35.
Dapke K, Phadke R, Rocha I, dos Santos Costa A, Ahmad S, Essar M, Menon V, Bassey E, Malhotra K, Shah J. Drug supply shortage in India during COVID-19 pandemic: efforts and challenges. Harv Public Health Rev 2021, 31.
36.
The World Bank.: South Asia Vaccinates: South Asia Economic Focus. In.; 2021.
37.
38.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995:1–10.
39.
Dey DK, Mishra V. Determinants of choice of healthcare services utilization: empirical evidence from India. Indian J Community Health. 2014;26(4):356–63.
40.
Wilcox R. Trimming and winsorization. Encyclopedia of biostatistics 2005, 8.
41.
42.
Pescaroli G, Galbusera L, Cardarilli M, Giannopoulos G, Alexander D. Linking healthcare and societal resilience during the Covid-19 pandemic. Saf Sci. 2021;140:105291.PubMedPubMedCentralCrossRef
43.
44.
Ritchie H, Mathieu E, Rodés-Guirao L, Appel C, Giattino C, Ortiz-Ospina E, Hasell J, Macdonald B, Beltekian D, Roser M. Coronavirus pandemic (COVID-19). Our world in data 2020.
45.
Khanijahani A, Iezadi S, Gholipour K, Azami-Aghdash S, Naghibi D. A systematic review of racial/ethnic and socioeconomic disparities in COVID-19. Int J Equity Health. 2021;20(1):1–30.CrossRef
46.
Trivedi R, Lorenz KA. Supporting Indian and other South asians facing COVID-19 and other Serious illnesses. J Pain Symptom Manag. 2021;62(4):e1–e3.CrossRef
47.
Nafees N, Khan D. Health information seeking among general public in India during COVID 19 outbreak: exploring healthcare practices, information needs, preferred information sources and problems. Libr Philos Pract 2020:1–15.
48.
Noh J-W, Im Y-M, Kim K-B, Kim MH, Kwon YD, Cha J. Digital and Economic Determinants of Healthcare in the Crisis-affected Population in Afghanistan: Access to Mobile phone and socioeconomic barriers. Healthcare: 2021. MDPI; 2021. p. 506.
49.
Xiao H, Dai X, Wagenaar BH, Liu F, Augusto O, Guo Y, Unger JM. The impact of the COVID-19 pandemic on health services utilization in China: time-series analyses for 2016–2020. Lancet Reg Health-Western Pac. 2021;9:100122.CrossRef
50.
Haque M, Islam S, Iqbal S, Urmi UL, Kamal ZM, Rahman A, Kamal M, Haque M, Jahan I, Islam Z. Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications. Bangladesh J Med Sci 2020:36–S50.
51.
Haque M, Kumar S, Charan J, Bhatt R, Islam S, Dutta S, Abhayanand JP, Sharma Y, Sefah I, Kurdi A. Utilisation, availability and price changes of medicines and protection equipment for COVID-19 among selected regions in India: findings and implications. Front Pharmacol. 2021;11:582154.PubMedPubMedCentralCrossRef
52.
Degli Esposti L, Buda S, Nappi C, Paoli D, Perrone V. Implications of covid-19 infection on medication adherence with chronic therapies in Italy: a proposed observational investigation by the fail-to-refill project. Risk Manage Healthc Policy. 2020;13:3179.CrossRef
53.
Midão L, Almada M, Carrilho J, Sampaio R, Costa E. Pharmacological adherence behavior changes during COVID-19 outbreak in a Portugal Patient Cohort. Int J Environ Res Public Health. 2022;19(3):1135.PubMedPubMedCentralCrossRef
54.
Jaiswal S, Sharma H, Joshi U, Agrawal M, Sheohare R. Non-adherence to anti-tubercular treatment during COVID-19 pandemic in Raipur district Central India. Indian J Tuberculosis 2021.
55.
Menon S, Sander JW. Effects of the COVID-19 pandemic on medication adherence: in the case of antiseizure medications, a scoping review. Seizure. 2021;93:81–7.PubMedPubMedCentralCrossRef
56.
Wang H, Yao F, Wang H, Wang C, Guo Z. Medication adherence and influencing factors among patients with severe Mental disorders in low-income families during COVID-19 outbreak. Front Psychiatry 2021, 12.
57.
Ruksakulpiwat S, Zhou W, Niyomyart A, Wang T, Kudlowitz A. How does the COVID-19 pandemic impact medication adherence of patients with chronic disease? A systematic review. Chronic Illn 2022:17423953221110151.
58.
59.
Asheq A, Ashames A, Al-Tabakha M, Hassan N, Jairoun A. Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates. F1000Research 2021, 10.
60.
Zhang H-Q, Lin J-Y, Guo Y, Pang S, Jiang R, Cheng Q-J. Medication adherence among patients with chronic obstructive pulmonary disease treated in a primary general hospital during the COVID-19 pandemic. Annals Translational Med 2020, 8(18).
61.
Gul ZB, Atakli HD. Effect of the COVID-19 pandemic on drug compliance and stigmatization in patients with epilepsy. Epilepsy Behav. 2021;114:107610.PubMedCrossRef
62.
Curry P, Chinoy H, Jani M, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Morris A, Barton A. POS1229 THE IMPACT OF COVID-19 ON MEDICATION NON-ADHERENCE IN a RHEUMATOID AND PSORIATIC ARTHRITIS UK COHORT. In. BMJ Publishing Group Ltd; 2022.
63.
Venema V. Coronavirus: should I worry about my lockdown eating. BBC News 2020, 25.
64.
Mafham MM, Spata E, Goldacre R, Gair D, Curnow P, Bray M, Hollings S, Roebuck C, Gale CP, Mamas MA. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381–9.PubMedPubMedCentralCrossRef
65.
World Health Organization. Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020. In.: World Health Organization; 2020.
66.
Shah J, Essar MY, Qaderi S, Rackimuthu S, Nawaz FA, Qaderi F, Shah A. Respiratory health and critical care concerns in Afghanistan. Lancet Respiratory Med. 2022;10(3):229–31.CrossRef
67.
68.
Ahmed NU, Rahman M, Roy SS, Sharmin S, Chowdhury SA, Chowdhury R, Saha D. Impact of TeleHealth Services through Shastho Batayon 16263 for tackling the COVID-19 pandemic in Bangladesh. East J Healthc. 2022;2(1):13–7.CrossRef
69.
Venkatesh U, Aravind GP, Velmurugan AA. Telemedicine practice guidelines in India: global implications in the wake of the COVID-19 pandemic. World Medical & Health Policy; 2022.
70.
Press Trust Of India. Home health care services on rise in India due to Covid-19 pandemic: experts. In: ndtv. India: Pune; 2021.
71.
72.
Kretchy IA, Asiedu-Danso M, Kretchy J-P. Medication management and adherence during the COVID-19 pandemic: perspectives and experiences from low-and middle-income countries. Res Social Administrative Pharm. 2021;17(1):2023–6.CrossRef
73.
Snoswell CL, Taylor ML, Comans TA, Smith AC, Gray LC, Caffery LJ. Determining if telehealth can reduce health system costs: scoping review. J Med Internet Res. 2020;22(10):e17298.PubMedPubMedCentralCrossRef
74.
75.
Choi BC, Pak AW. Understanding and minimizing epidemiologic bias in public health research. Can J Public Health. 2005;96:284–6.PubMedCrossRef
76.
Zhang Y-N, Chen Y, Wang Y, Li F, Pender M, Wang N, Yan F, Ying X-H, Tang S-L, Fu C-W. Reduction in healthcare services during the COVID-19 pandemic in China. BMJ Global Health. 2020;5(11):e003421.PubMedCrossRef
77.
Worthington RP, Gogne A. Cultural aspects of primary healthcare in India: a case-based analysis. Asia Pac Family Med. 2011;10(1):1–5.
78.
Ahmed SM, Adams AM, Chowdhury M, Bhuiya A. Gender, socioeconomic development and health-seeking behaviour in Bangladesh. Soc Sci Med. 2000;51(3):361–71.PubMedCrossRef
Metadata
Title
Patterns and determinants of healthcare utilization and medication use before and during the COVID-19 crisis in Afghanistan, Bangladesh, and India
Authors
Md Tauhidul Islam
Mieghan Bruce
Khurshid Alam
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
COVID-19
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-10789-4

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