Characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care in Kapelebyong district in Uganda: a mixed-methods study

Eudu James; Benon Wanume; Milton W Musaba; Ritah Nantale; Vivian Mutaki; Brendah Nambozo; David Okia; David Soita; Agnes Napyo; Joseph K B Matovu; Racheal Namulondo; Jovani Lubaale; Francis Okello; Ronald Mulebeke; Abel Kakuru; Nancy Amejje; David Emojong; Charles Okolimong; Simple Ouma; Sam Okware; Peter Olupot-Olupot; David Mukunya

doi:10.1186/s41182-022-00486-5

Characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care in Kapelebyong district in Uganda: a mixed-methods study

Trop Med Health. 2022 Dec 14;50(1):93. doi: 10.1186/s41182-022-00486-5.

Authors

Eudu James¹, Benon Wanume¹, Milton W Musaba², Ritah Nantale³, Vivian Mutaki¹, Brendah Nambozo¹, David Okia¹, David Soita¹, Agnes Napyo¹, Joseph K B Matovu^{1

4}, Racheal Namulondo¹, Jovani Lubaale¹, Francis Okello¹, Ronald Mulebeke¹, Abel Kakuru¹, Nancy Amejje¹, David Emojong¹, Charles Okolimong¹, Simple Ouma⁵, Sam Okware⁶, Peter Olupot-Olupot^{1

7}, David Mukunya^{1

8}

Affiliations

¹ Department of Community and Public Health, Busitema University, Mbale, Uganda.
² Department of Obstetrics and Gynecology, Busitema University, Mbale, Uganda.
³ Department of Nursing, Busitema University, Mbale, Uganda. ritahclaire24@gmail.com.
⁴ Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
⁵ Department of Research, The AIDs Support Organization, Mbale, Uganda.
⁶ Department of Research, Uganda National Health Research Organizations, Kampala, Uganda.
⁷ Department of Research, Mbale Clinical Research Institute, Mbale, Uganda.
⁸ Department of Research, Nikao Medical Center, Kampala, Uganda.

Abstract

Background: A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda's health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda.

Methods: We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0 RESULTS: A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2-137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6-145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food.

Conclusion: Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care.

Keywords: COVID-19; Home-based care; SARS-COV-2; Stigma; Treatment outcome; Uganda.