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

Publication date: Apr 03, 2024

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. 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 χ test were applied in this study following the conceptualization of Andersen’s healthcare utilization model. 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. 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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Concepts Keywords
Afghanistan Afghanistan
Bangladesh Bangladesh
Covid COVID-19
Healthcare Healthcare utilization
Rapidly India
Medication use


Type Source Name
disease MESH COVID-19
disease VO time
disease MESH non-communicable diseases
disease MESH Long Covid
pathway REACTOME Reproduction
drug DRUGBANK Coenzyme M
disease MESH emergency
disease MESH unemployment
disease IDO country
disease MESH chronic conditions
drug DRUGBANK Naproxen
disease VO immunization
disease VO effective
disease MESH acute stroke
disease IDO healthcare facility
disease VO population
disease IDO facility
disease VO LACK
disease VO dose
disease MESH infection
drug DRUGBANK Serine
drug DRUGBANK Fenamole
drug DRUGBANK Tropicamide
disease MESH Heart disease
disease MESH high blood pressure
disease MESH cancer
disease IDO blood
drug DRUGBANK Probucol
disease MESH asthma
pathway KEGG Asthma
drug DRUGBANK Ethanol
disease VO protocol
disease VO age
drug DRUGBANK Piroxicam
disease VO monthly
disease MESH communicable diseases
drug DRUGBANK Hexadecanal
disease VO Ply
drug DRUGBANK Indoleacetic acid
disease MESH pneumonia
disease MESH uncertainty
drug DRUGBANK Methylergometrine
disease VO injection
disease VO frequency
drug DRUGBANK Iron
disease MESH acute coronary syndrome
disease MESH complications
disease VO organization
disease VO Equity
drug DRUGBANK Ilex paraguariensis leaf
disease VO efficiency
disease VO volume
disease VO pregnant women
disease MESH tuberculosis
pathway KEGG Tuberculosis
disease IDO symptom
drug DRUGBANK Guanosine
disease MESH Seizure
disease MESH severe Mental disorders
disease MESH diabetes mellitus
disease MESH epilepsy
disease VO report
drug DRUGBANK Vorinostat

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