Characteristics, treatment outcomes, and experiences of covid-19 patients under home-based care management in Kapelebyong district; a cross-sectional study.

Abstract

Introduction: Uganda recorded the first case of COVID-19 virus in March 2020 and there was a rapid increase in community transmission across the country. The increased burden of COVID-19 in Uganda created a big challenge to Uganda’s health system. The Ministry of Health adopted the Home-Based Care strategy for confirmed COVID-19 cases that were asymptomatic or those with mild symptoms. However, since its adoption in Uganda, to the best of our knowledge, no study has been done to evaluate the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care particularly in rural settings. Objective: This study aimed at determining the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care in Kapelebyong District, Eastern region. Methods: We conducted a sequential explanatory mixed methods study. The quantitative part was a cross-sectional study that determined the treatment outcomes of COVID-19 patients under home-based care and the qualitative part borrowed upon the phenomenological strategy of inquiry to elicit lived experiences of these patients. Due to the limited number of patients that were under home-based care management in Kapelebyong district, we included all patients and this gave us a sample size of 303. Data were collected electronically using a questionnaire designed in Kobo Toolbox (Cambridge, Massachusetts, USA). The data submitted daily in Kobo Toolbox were checked for completeness and accuracy. Data were also collected using in-depth interviews to explore the experiences of COVID-19 patients managed under Home based care. We conducted multivariable logistic regression to determine factors associated with poor outcomes using Stata v.15.0 (Stata Corp LLC, College Station, Texas, USA) and thematic analysis using NVivo 12 (QRS International, Cambridge, MA) for qualitative data to explore lived experiences of COVID-19 patients managed at home. Results: Majority of the patients [96.0% (289/301)] cured at home, [3.3% (10/301)] were admitted to a health facility and [0.7% (2/301)] died. Cured at home was considered a good outcome [96.0% (289/301)] while being admitted to a health facility and/or dying were considered poor outcomes [4% (12/301)]. Patients above 60 years of age were 17.4 times as likely to have poor treatment outcomes as those below 60 years of age (AOR: 17.4; 95% CI: 2.2-137.6). Patients who spent more than one month under home care were 15.3 as likely to have poor treatment outcomes as those that spent less than one month under home care because most of them were elderly and they had associated comorbidities (AOR: 15.3; 95% CI: 1.6145.7). Participants identified stigma, fear, anxiety, rejection, not being followed upby health workers and economic loss as negative experiences encountered during home care. On the other hand; being close to family and friends, fear of contracting other diseases from hospital, easy access to food, being able to manage their family even when in isolation, and enjoying the freedom in their spacious home were identified as positive lived experiences during home care. Conclusion: Majority of COVID-19 patients managed under home-based care had good treatment outcomes. The determinants of poor treatment outcomes were advanced age (>60years) and comorbidities in those that had long stay in-home care (>1 month). We therefore, recommend that; home care for COVID-19 patients be done while sparing the elderly for hospital management, community sensitization on COVID-19 and home-based care to address stigma and rejection be prioritized and more systematic follow-up of patients under home care by health workers be done. Keywords: Home Based Care, COVID-19, Uganda, treatment outcome, stigma.