Covid-19 outbreak in Ghana: Exploring the determinants, policy responses and long-term consequences

Abstract

Background: Ghana implemented several COVID-19 policy responses to address the burden of the outbreak, given its unprecedented nature and the urgent need for mitigating strategies. To date, there is limited evidence on whether these policies met their intended influence on the COVID-19 burden in Ghana. Adequate evidence is warranted to inform more data-driven and socio-culturally acceptable policy decisions in the event of another COVID-19 wave or similar infectious disease outbreak in the future. In addition to the limited evidence on the policies’ influence on the COVID-19 burden, there is also a limited understanding of whether the policies could mitigate any long-term consequences of the outbreak in Ghana. Such knowledge is critical to inform the policies’ continuation. Further, there is data scarcity on the factors that determined severe COVID-19 health outcomes, like mortality, during the onslaught of the outbreak to inform initial, immediate, and context-relevant mitigating interventions in the event of a similar attack in Ghana. Therefore, this thesis examined the determinants of COVID-19- related mortality, prolonged hospitalisations and long COVID in Ghana. It also evaluated the effectiveness of Ghana’s COVID-19 policies against their targeted COVID-19 burden and examined whether the policies could mitigate any long-term consequences of the COVID-19 outbreak in Ghana and, if so, the extent of the mitigation. Methods: Seventy-two studies were first reviewed to identify the knowledge gaps around the effectiveness and long-term influence of Ghana’s COVID-19 policies and the determinants of COVID-19 health outcomes in Ghana to provide the research questions and methodological directions for this study. After that, Dahlgren and Whitehead’s determinants of health framework, logistic regression and negative binomial model were fitted to examine factors that determined prolonged COVID-19-related hospitalisations, mortalities, and long COVID in Ghana. Secondary data from Ghana’s main COVID-19 treatment centre was used for the determinants analyses. Later, qualitative content analyses and experts’ perspectives on the effectiveness of Ghana’s COVID-19 policies were explored to provide evidence of the policies’ influence on the COVID-19 burden in Ghana. An agent-based mathematical model, the CALMS model, was then used to predict the long-term consequences of the COVID-19 outbreak and examine the influence of the COVID-19 policies on the predicted long-term consequences. Results: The determinants of COVID-19 health outcomes analyses showed that individuals with both hypertension and Diabetes Mellitus (DM) are 17 times more likely to die from ii COVID-19 infection and four times more likely to experience long COVID than those with no comorbidities. In addition, they are more likely to spend two additional days in hospitals due to COVID-19 than those with no comorbidities. The content analyses and experts’ evaluation also showed that public awareness campaigns and border closure policies are effective policies to educate and enhance adherence to COVID-19 prevention protocols and prevent COVID-19 case importation, respectively. In addition, the agent-based modelling demonstrated that the vaccination policy could reduce Ghana’s long-term COVID-19-related direct healthcare costs, mortalities, long COVID, and hospital and ICU admissions in the next ten years by nearly 90%. Conclusions: Ghana could consider persons with DM and hypertension when developing infectious disease policy guidelines for managing current and future outbreaks like COVID- 19. Policies like diabetes and hypertension clinics nationwide to enhance regular clinical observations of persons with DM and hypertension to reduce their risk of severe disease outcomes could be considered in the guidelines. Others could include regular clinical and community-based screening for the early detection and management of DM and hypertension. Further, Ghana could also consider public awareness campaigns as one of its immediate interventions in the event of similar outbreaks. Finally, it could enhance and promote its vaccination intervention uptake to address/reduce the number of COVID-19-related deaths, hospitalisations, long COVID and direct healthcare costs in the long term.