Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study

Figures & data

Table 1 Socioeconomic Characteristics of the Respondents by Disease

	Diabetes/Hypertension (n= 51) n (%)	TB (n= 51) n (%)	HIV (n= 50) n (%)	Mental Health (n= 50) n (%)	Total
					(n= 202) n (%)	P-value
Age (years)
≤30	6 (11.8)	22 (43.1)	12 (24.0)	23 (46.0)	63 (31.2)	<0.001
31–49	18 (35.3)	25 (49.0)	31 (62.0)	19 (38.0)	93 (46.0)
≥50	27 (52.9)	4 (7.8)	7 (14.0)	8 (16.0)	46 (22.8)
Sex
Male	18 (35.3)	17 (33.3)	15 (30.0)	21 (42.0)	71 (35.2)	0.640
Female	33 (64.7)	34 (66.7)	35 (70.0)	29 (58.0)	131 (64.9)
Education
None/Primary	15 (29.4)	28 (54.9)	19 (38.0)	20 (40.0)	82 (40.6)	0.022
Secondary	21 (41.2)	16 (31.4)	27 (54.0)	22 (44.0)	86 (42.6)
Tertiary and above	15 (29.4)	7 (13.7)	4 (8.0)	8 (16.0)	34 (16.8)
Marital status
Single/others	22 (43.1)	30 (58.8)	24 (48.0)	35 (70.0)	111 (55.0)	0.033
Married/cohabit	29 (56.9)	21 (41.2)	26 (52.0)	15 (30.0)	91 (45.0)
Employment
With job	39 (76.5)	39 (76.5)	37 (74.0)	24 (48.0)	139 (68.8)	0.004
Without job	12 (23.5)	12 (23.5)	13 (26.0)	26 (52.0)	63 (31.2)
Decreased income due to COVID-19
Yes	50 (98.0)	42 (82.4)	43 (86.0)	41 (82.0)	176 (87.1)	0.053
No	1 (2.0)	9 (17.6)	7 (14.0)	9 (18.0)	26 (12.9)
Food security
Yes	10 (19.6)	2 (3.9)	9 (18.0)	8 (16.0)	29 (14.4)	0.097
No	41 (80.4)	49 (96.1)	41 (82.0)	42 (84.0)	173 (85.6)

Abbreviations: TB, tuberculosis; HIV, human immunodeficiency virus.

Table 2 Access to ERRH by Disease

	Diabetes/Hypertension (n= 51) n (%)	TB (n= 51) n (%)	HIV (n= 50) n (%)	Mental Health (n= 50) n (%)	Total
					(n= 202) n (%)	P-value
Time to reach ERRH
≤30 min	18 (35.3)	16 (31.4)	15 (30.0)	21 (42.0)	70 (34.7)	0.436
31–60 min	20 (39.2)	26 (51.0)	27 (54.0)	17 (34.0)	90 (44.6)
≥61 min	13 (25.5)	9 (17.6)	8 (16.0)	12 (24.0)	42 (20.8)
Means to travel to ERRH
Private car	1 (2.0)	0 (0.0)	0 (0.0)	1 (0.0)	2 (1.0)	0.105
Mini-bus	36 (70.6)	36 (70.6)	41 (82.0)	29 (58.0)	142 (70.3)
Bike taxi	7 (13.7)	13 (25.5)	6 (12.0)	9 (18.0)	35 (17.3)
Walking	4 (7.8)	0 (0.0)	1 (2.0)	7 (14.0)	12 (5.9)
Others	3 (5.9)	2 (3.9)	2 (4.0)	4 (8.0)	11 (5.5)

Abbreviations: TB, tuberculosis; HIV, human immunodeficiency virus; ERRH, Entebbe Regional Referral Hospital.

Table 3 Perception and Impacts of the ERRH Closure by Disease

	Diabetes/Hypertension (n= 51) n (%)	TB (n= 51) n (%)	HIV (n= 50) n (%)	Mental Health (n= 50) n (%)	Total
					(n= 202) n (%)	P-value
Aware of the ERRH service disruption
No	5 (9.8)	1 (2.0)	0 (0.0)	3 (6.0)	9 (4.5)	0.079
Yes	46 (90.2)	50 (98.0)	50 (100.0)	47 (94.0)	193 (95.5)
Acceptance of ERRH service disruption
Cannot accept	10 (19.6)	7 (13.7)	2 (4.0)	2 (4.0)	21 (10.4)	<0.001
Should accept as COVID19 measures	7 (13.7)	2 (3.9)	16 (32.0)	3 (6.0)	28 (13.9)
Assign alternative health facility	34 (66.7)	42 (82.4)	32 (64.0)	45 (90.0)	153 (75.7)
Difficulty in accessing health services
Transportation unavailable	36 (70.6)	36 (70.6)	40 (80.0)	36 (72.0)	148 (73.3)	0.666
Transportation cost	21 (41.2)	9 (17.6)	39 (78.0)	34 (68.0)	103 (51.0)	<0.001
Fear of catching COVID-19 at health facility	38 (74.5)	18 (35.3)	26 (52.0)	25 (50.0)	107 (53.0)	0.001
Health care expenditure
Not increased	1 (2.0)	3 (5.9)	3 (6.0)	0 (0.0)	7 (3.5)	<0.001
Somehow increased	1 (2.0)	13 (25.5)	17 (34.0)	4 (8.0)	35 (17.3)
More than doubled	49 (96.1)	35 (68.6)	30 (60.0)	46 (92.0)	160 (79.2)
Alternative health care
Health center IV	2 (3.9)	5 (9.8)	6 (12.0)	8 (16.0)	21 (10.4)	0.247
Health center III	0 (0.0)	9 (17.7)	4 (8.0)	12 (24.0)	25 (12.4)	0.001
Health center II	1 (2.0)	0 (0.0)	1 (2.0)	6 (12.0)	8 (4.0)	0.009
ERRH outreach services	8 (15.7)	0 (0.0)	9 (18.0)	0 (0.0)	17 (8.4)	<0.001
Private hospital in Entebbe	3 (5.9)	2 (3.9)	1 (2.0)	9 (18.0)	15 (7.4)	0.010
Hospital in Kampala	1 (2.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (0.5)	0.395
Private clinic	21 (41.2)	0 (0.0)	2 (4.0)	11 (22.0)	34 (16.8)	<0.001
Visiting healthcare worker	2 (3.9)	4 (7.8)	15 (30.0)	9 (18.0)	30 (14.8)	0.001
Buying drug at store	19 (37.2)	0 (0.0)	0 (0.0)	36 (72.0)	55 (27.2)	<0.001
Discontinued health care	4 (7.8)	22 (48.1)	8 (16.0)	2 (4.0)	36 (17.8)	<0.001
Health condition
No change/getting better	7 (13.7)	1 (2.0)	6 (12.0)	7 (14.0)	21 (10.4)	0.535
Worse	27 (52.9)	30 (58.8)	25 (50.0)	23 (46.0)	105 (52.0)
Extremely worse	17 (33.3)	19 (37.3)	19 (38.0)	20 (40.0)	75 (37.1)
Do not know	0 (0.0)	1 (2.0)	0 (0.0)	0 (0.0)	1 (0.5)

Abbreviations: TB, tuberculosis; HIV, human immunodeficiency virus; ERRH, Entebbe Regional Referral Hospital.

Table 4 Factors Associated with Discontinuation of Healthcare During the Closure of ERRH

	Univariate Analysis		Multivariate Analysis^a
	Odds Ratio (95% CI)	P-value	Adjusted Odds Ratio (95% CI)	P-value
Diseases
Mental health	1		1
Diabetes/hypertension	8.91 (2.79–28.48)	<0.001	3.68 (0.54–25.05)	0.184
TB	2.24 (0.63–7.97)	0.214	12.66 (2.57–62.52)	0.002
HIV	0.49 (0.09–2.80)	0.422	7.52 (1.37–41.27)	0.020
Age (years)
≤30	5.73 (1.57–20.86)	0.008	4.88 (1.07–22.34)	0.036
31–49	2.76 (0.76–10.06)	0.125	1.80 (0.42–7.73)	0.430
≤50	1		1
Health expenditure
Not increased	1
Somehow increased	2.75 (0.29–25.68)	0.375
More than doubled	1.06 (0.12–9.19)	0.959
Acceptance of ERRH service disruption
Cannot accept	1
Should accept as COVID-19 measure	0.69 (0.17–2.80)	0.610
Assign alternative health facility	0.65 (0.22–1.94)	0.447
Transportation cost
Expensive	1		1
Inexpensive	4.68 (2.01–10.89)	<0.001	3.15 (1.13–8.75)	<0.028
Fear of catching COVID-19 at health facilities
No	1		1
Yes	0.32 (0.15–0.70)	0.004	0.44 (0.18–1.08)	0.075

Note: ^a Logistic regression model (n=202).

Abbreviations: TB, tuberculosis; HIV, human immunodeficiency virus; ERRH, Entebbe Regional Referral Hospital.

Table 5 Characteristics of the Focus Group Discussion (FGD) Participants

Age	Sex	Primary Disease	Occupation
22	Female	Mental health	Business
50	Female	HIV/AIDS, COVID-19	Business
50	Female	HIV/AIDS	Business
27	Female	Mental health	Business
48	Male	HIV/AIDS, TB	Business
35	Female	HIV/AIDS	Bar attendant
49	Male	HIV/AIDS, TB	Fish monger
50	Male	HIV/AIDS	Fish monger

Abbreviations: TB, tuberculosis; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome.

Table 6 Summary of Emergent Themes and Relative Frequency (n=8)

Topic	Theme	Relative Frequency^a
Difficulties due to the lockdown	Ban of movement	***
	Downturned economic situations	***
	No food security	***
Impacts by the ERRH closure	Negative: Increased mortality in community	*
	Negative: Shortage of medicine at ERRH	***
	Positive: Functioned outreach services	*
	Positive: Changing health facility usage behavior	**
Fear of stigma	Hesitate to access to health services	*
Opinions toward the ERRH closure and suggestions for future pandemics	Not full closure and setting isolation centers	***
	Early announcement and assignment to other facilities	**

Note: ^aRelative frequency of responses is denoted by: *Mentioned only by a few participants, **Mentioned by around half of the participants, and ***Mentioned by all of the participants.

Abbreviation: ERRH, Entebbe Regional Referral Hospital.