Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: a cross-sectional study in eastern Nepal

Saruna Ghimire; Aman Shrestha; Uday Narayan Yadav; Sabuj Kanti Mistry; Bunsi Chapadia; Om Prakash Yadav; Arm Mehrab Ali; Lal B Rawal; Priyanka Yadav; Suresh Mehata; Mark Harris

doi:10.1136/bmjopen-2021-056342

Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: a cross-sectional study in eastern Nepal

BMJ Open. 2022 Feb 3;12(2):e056342. doi: 10.1136/bmjopen-2021-056342.

Authors

Saruna Ghimire¹, Aman Shrestha¹, Uday Narayan Yadav^{2

3

4}, Sabuj Kanti Mistry^{3

5

6

7}, Bunsi Chapadia⁸, Om Prakash Yadav⁹, Arm Mehrab Ali⁵, Lal B Rawal¹⁰, Priyanka Yadav⁴, Suresh Mehata⁹, Mark Harris³

Affiliations

¹ Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA.
² National Centre for Epidemiology & Population Health, The Australian National University, Canberra, ACT, Australia unyadav1@gmail.com.
³ Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia.
⁴ Centre for Reserach Policy and Implementation, Biratnagar, Nepal.
⁵ ARCED Foundation, Dhaka, Bangladesh.
⁶ BRAC James P Grant School of Public Health, Dhaka, Bangaladesh.
⁷ Department of Public Health, Daffodil International University, Dhaka, Bangladesh.
⁸ Department of Microbiology, Miami University, Oxford, Ohio, USA.
⁹ Government of Nepal Ministry of Health and Population, Kathmandu, Nepal.
¹⁰ School of Health Medical and Applied Sciences, Central Queensland University, Sydney, New South Wales, Australia.

Abstract

Background: COVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic.

Methods: A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ² tests and binary logistic regressions determined inferences.

Results: Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds.

Conclusions: Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.

Keywords: COVID-19; epidemiology; health policy; public health.

MeSH terms

Aged
COVID-19*
Cross-Sectional Studies
Health Services Accessibility
Humans
Nepal / epidemiology
Pandemics
Preexisting Condition Coverage
SARS-CoV-2