Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey

Supa Pengid; Karl Peltzer; Edlaine Faria de Moura Villela; Joseph Nelson Siewe Fodjo; Ching Sin Siau; Won Sun Chen; Suzanna A Bono; Isareethika Jayasvasti; M Tasdik Hasan; Rhoda K Wanyenze; Mina C Hosseinipour; Housseini Dolo; Philippe Sessou; John D Ditekemena; Robert Colebunders

doi:10.1186/s12913-022-07661-8

Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey

BMC Health Serv Res. 2022 Feb 28;22(1):265. doi: 10.1186/s12913-022-07661-8.

Authors

Supa Pengid^{1

2}, Karl Peltzer^{3

4}, Edlaine Faria de Moura Villela^{5

6}, Joseph Nelson Siewe Fodjo⁷, Ching Sin Siau⁸, Won Sun Chen⁹, Suzanna A Bono¹⁰, Isareethika Jayasvasti¹¹, M Tasdik Hasan^{12

13

14}, Rhoda K Wanyenze¹⁵, Mina C Hosseinipour¹⁶, Housseini Dolo^{17

18}, Philippe Sessou¹⁹, John D Ditekemena²⁰, Robert Colebunders⁷

Affiliations

¹ Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand.
² Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa.
³ Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa. kfpeltzer@gmail.com.
⁴ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan. kfpeltzer@gmail.com.
⁵ Disease Control Coordination, São Paulo State Health Department, São Paulo, 01246-000, Brazil.
⁶ Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, 74690-900, Brazil.
⁷ Global Health Institute, University of Antwerp, 2000, Antwerp, Belgium.
⁸ Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia.
⁹ Department of Health Science and Biostatistics, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
¹⁰ School of Social Science, Universiti Sains Malaysia, 11800, Gelugor, Malaysia.
¹¹ Institute of Nutrition, Mahidol University, Nakhon Pathom, 73170, Thailand.
¹² Jeeon Bangladesh Ltd., Dhaka, Bangladesh.
¹³ Department of Public Health, State University of Bangladesh (SUB), Dhaka, Bangladesh.
¹⁴ Department of Primary Care & Mental Health, University of Liverpool, Liverpool, L69 3BX, UK.
¹⁵ School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
¹⁶ University of North Carolina UNC Project Malawi, Lilongwe, Malawi.
¹⁷ International Center of Excellence in Research, Faculty of Medicine and OdontoStomatology, Bamako, Mali.
¹⁸ Lymphatic Filariasis Research Unit/International Center of Excellence in Research, Bamako, Mali.
¹⁹ Research Unit on Communicable Diseases, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou 01, BP, 526, Benin.
²⁰ Kinshasa School of Public Health, University of Kinshasa, Kinshasa, 7948, Democratic Republic of the Congo.

Abstract

Background: This study aimed to investigate, using Andersen's model of health care utilization, factors associated with COVID-19 testing among adults in nine low- and middle- income countries.

Methods: In between 10 December 2020 and 9 February 2021, an online survey was organized in nine low- and middle-income countries. In total 10,183 adults (median age 45 years, interquartile range 33-57 years, range 18-93 years), including 6470 from Brazil, 1738 Malaysia, 1124 Thailand, 230 Bangladesh, 219 DR Congo, 159 Benin, 107 Uganda, 81 Malawi and 55 from Mali participated in the study. COVID-19 testing/infection status was assessed by self-report.

Results: Of the 10,183 participants, 40.3% had ever tested for COVID-19, 7.3% tested positive, and 33.0% tested negative. In an adjusted logistic regression model, predisposing factors (residing in Brazil, postgraduate education), enabling/disabling factors (urban residence, higher perceived economic status, being a student or worker in the health care sector, and moderate or severe psychological distress), and need factors (having at least one chronic condition) increased the odds of COVID-19 testing. Among those who were tested, participants residing in Bangladesh, those who had moderate to severe psychological distress were positively associated with COVID-19 positive diagnosis. Participants who are residing in Malaysia and Thailand, and those who had higher education were negatively associated with a COVID-19 positive diagnosis. Considering all participants, higher perceived economic status, being a student or worker in the health sector, and moderate or severe psychological distress were positively associated with a COVID-19 positive diagnosis, and residing in Malaysia, Thailand or five African countries was negatively associated with a COVID-19 positive diagnosis.

Conclusion: A high rate of COVID-19 testing among adults was reported in nine low-and middle-income countries. However, access to testing needs to be increased in Africa. Moreover, COVID-19 testing programmes need to target persons of lower economic status and education level who are less tested but most at risk for COVID-19 infection.

Keywords: COVID-19; LMICs; adults; testing.

MeSH terms

Adult
Benin
COVID-19 Testing
COVID-19* / diagnosis
COVID-19* / epidemiology
Developing Countries*
Humans
Middle Aged
Patient Acceptance of Health Care
SARS-CoV-2