PLoS One. 2022 May 19;17(5):e0266421. doi: 10.1371/journal.pone.0266421. eCollection 2022.
BACKGROUND: Diabetes and hypertension have become important clinical and public health problems in Ethiopia. The need for long-term sustainable health services for patients with diabetes and hypertension is essential to improve good control of treatment in these patients and subsequently delay or prevent complications. A collective shift to acute care for COVID-19 patients combined with different measures to contain the pandemic had disrupted outpatient care. Therefore, it is expected to have a significant impact on the treatment control of hypertensive and diabetic patients. However, there is limited evidence on the effect of the pandemic on treatment control and its determinants. Therefore, this study aimed to assess the effect of COVID-19 pandemic on treatment control of outpatient hypertensive and diabetic patients and to identify factors of poor treatment control in northwestern Ethiopia.
METHODS: A retrospective chart review and cross-sectional survey design was conducted between December 2020 and February 2021. Using a stratified systematic random sampling technique, 836 diabetic and/or hypertensive patients were included in the study. Web-based data collection was done using Kobo collect. Changes in the proportion of poor treatment control in hypertensive and/or diabetic outpatients during the COVID-19 pandemic period were assessed. A multivariate binary logistic regression mixed model was fitted to identify determinants of poor treatment control. Odds ratios were reported in raw and adjusted form, with their 95% confidence intervals and p-values.
RESULT: Poor treatment control increased significantly from 24.81% (21.95, 27.92) before the COVID-19 pandemic to 30.33% (27.01, 33.88), 35.66% (32.26, 39.20), 36.69% (33.40, 40.12) and 34.18% (3102, 37.49) during the first, second, third and fourth months following the date of first detection of COVID-19 cases in Ethiopia, respectively. Marital status (AOR=0.56, 95% CI; 0.41, 0.74), medication regimen (AOR=1.30, 95% CI; 1.02, 166), daily ( AOR = 0.12, 95% CI; 0.08, 0.20), twice (AOR = 0.42, 95% CI; 0.30, 0.59) and three times (AOR = 0, 31, 95% CI; 0.21, 0.47) medication frequency, number of medications taken per day (AOR=0.79, 95% CI; 0.73, 0.87), patient habits such as hazardous alcohol consumption (AOR=1.29, 95% CI; 1.02, 1.65) and sedentary lifestyle (AOR=1.72, 95% CI; 1.46, 2 .02), missed appointments during the COVID-19 pandemic (AOR = 2.09, 95% CI; 1.79, 2.45) and the presence of complications related to the disease (AOR = 1, 11, 95% CI; 0.93, 1.34) were significantly associated with poor treatment control in diabetic and/or hypertensive patients during the COVID-19 pandemic.
CONCLUSION: The COVID-19 pandemic has had a substantial impact on the treatment control of outpatients with diabetes and/or hypertension. Being married, as well as the frequency and types of medications taken per day were all found to be negatively associated with poor treatment control. During the COVID -19 pandemic, patient habits such as hazardous alcohol consumption and sedentary lifestyle, longer follow-up time, disease-related complications, patients taking injection medications, number of medications per day and missed appointments were positively associated with poor treatment control in ambulatory diabetic and hypertensive patients. Therefore, it is best to consider risk factors for poor treatment control when designing and implementing chronic disease control policies and strategies.