COVID-19 Risk Categorization of Patients Attending Private Healthcare Facilities in Southwest Nigeria

Background: Understanding disease risk is important for prevention. Identifying high-risk COVID-19 patients helps healthcare professionals implement precautions. This study examined factors related to COVID-19 prevention in patients at private healthcare facilities in Southwest Nigeria, during the early stages of the pandemic. Methods: A survey was conducted in two hospitals using multi-stage sampling. 400 respondents were chosen from two out of 78 private healthcare facilities in Southwest Nigeria. Trained interviewers administered a questionnaire to collect information on risk profile, symptoms, perception of COVID-19 risk, and preventive practices. COVID-19 risk was assessed on a five-point scale. Data was analyzed using descriptive statistics, chi-square test, and binary logistic regression at a significance level of 0.05. Results: The average age of participants was 27.83 + 10.46 years. 52.8% of respondents were female. 70.5% were single, 75.8% belonged to the Yoruba ethnic group, and 72% identified as Christians. None had a history of international travel or contact with a confirmed COVID-19 case in the past 14 days, but 12.75% had been in contact with suspected cases. 47% reported having a fever. The majority had a low risk score for COVID-19. Most did not smoke (98.5%), consume alcohol (83.75%), or visit club houses (85.75%). Only 9.5% underwent COVID-19 testing, and 16.0% of those tested were positive. The main reason for test refusal was a lack of perception of susceptibility to COVID-19. Adherence to preventive practices was poor in all investigated circumstances. Conclusion: Patients presenting in hospitals during the early phase of the COVID-19 pandemic had a low risk of COVID-19. However, their poor compliance with preventive protocols and low testing uptake make them a potential source of transmission. Strategies to promote adoption of preventive measures are needed, especially among patients at private healthcare facilities.


Introduction
The coronavirus disease 2019 (COVID-19) pandemic, caused by a new strain of coronavirus, is a highly contagious respiratory illness [1].It spreads through respiratory droplets and can cause mild to severe symptoms such as fever, cough, and fatigue.The incubation period is around 5 to 14 days.The first case was reported in Wuhan, China on December 31, 2019, and Nigeria confirmed its first case in Lagos on February 27, 2020 [2,3].
Understanding the burden and distribution of risk factors is crucial in decision-making for implementing preventive measures [4][5][6][7].An individual's perception of their risk to COVID-19 is influenced by personal and social factors.Having an accurate perception of one's risk is vital in motivating individuals to take necessary completed tertiary education.17% of the population reported having medical conditions, with hypertension being the most prevalent at 38.8%.Other reported conditions include respiratory disease at 19%, diabetes mellitus at 3.5%, and hemoglobinopathy at 2.25%.None of the participants had contact with a confirmed case of COVID-19, while 12.75% had contact with a suspected case (Table 1 and Table 2).47% reported experiencing combinations of symptoms such as fever, body aches, runny nose or sore throat, and cough.Other reported symptoms included abdominal symptoms (13.8%), loss of smell (6%), loss of taste (4.5%), and shortness of breath (1.8%).The most common symptoms were fever, body ache, and cough, which align with findings from studies conducted in the USA and Lagos [11][12][13][14] (Table 3).The majority of respondents had low or moderate risk scores for COVID-19 screening (Table 4).
Individuals between the ages of 36 and 43 had the highest risk of COVID-19, three times higher than individuals at the extremes of age.This finding contradicts a study conducted in the United States.Older age groups may be more susceptible to severe forms of the disease (x 2 = 55.70;p < 0.05).This finding was dissimilar to a study conducted in USA which found that people of the extremes of age had higher risk of COVID-19 [15,16].Male respondents were twice as likely to be classified as high risk compared to females.However, this difference was not statistically significant (x 2 = 3.84, p = 0.146).These findings align with studies conducted in European Union member countries [17,18].Individuals of Northern Nigerian descent, specifically the Hausa ethnic group, were three times more likely to be classified as high risk compared to individuals from Eastern Nigeria (Ibo).Individuals of Yoruba descent were twice as likely.These differences in risk were statistically significant (x 2 = 15.35,p = 0.018).These findings are consistent with previous research on health disparities in the Hausa community.Sociocultural and environmental factors contribute to these disparities [19][20][21][22].
In terms of religious affiliation, Muslims were found to have a 2-fold higher likelihood (13, 11.7%) of being classified as high risk compared to Christians, but this difference was not statistically significant (x 2 = 8.24, p = 0.083).The relationship between religion and health outcomes has been studied, but the findings have been inconsistent.Some studies have found a significant link between religion and mental health, particularly in relation to depression, anxiety, substance abuse, and suicidal behavior [23].Other studies have explored the role of religious coping in moderating psychosocial factors and its potential protective effect on mental health outcomes [24][25][26][27].However, the influence of religious beliefs on health behaviors and outcomes is still a complex area of investigation.Tertiary education was associated with a significantly higher risk (13.0%) compared to secondary education for being classified protective actions.Adherence to preventive measures can effectively prevent and control the spread of the disease.Limited awareness of COVID-19 symptoms and risk factors may hinder willingness to adopt preventive measures.Identifying common risk factors can enhance preventive efforts (Otu, et al. 2018).Early identification of a patient's risk category can contribute to curtailing the spread of the disease [8].The objective of this study was to determine the factors associated with COVID-19 risk among patients attending private healthcare facilities in Southwest Nigeria.

Methods
This is a cross-sectional study among 400 outpatients in two private healthcare facilities, with the aim of investigating the factors associated with COVID-19 risk among patients in two private healthcare facilities in Southwest, Nigeria.A was a multi-stage random sampling technique was used to select participants for this study (simple random sampling to select the Local Government Area -stage 1,simple random sampling without replacement to select two hospitals-stage 2, systematic random sampling to select participants-stage 3) [9].Participants had to be willing, able to understand information, and adults aged 18-60 who had visited two hospitals.Exclusions included those taking antipyretics, severely ill individuals, and those who did not provide informed consent.
Data was collected through an intervieweradministered questionnaire, focusing on sociodemographic characteristics, COVID-19 risk profile scoring system adapted from WHO risk categorization tool was used (0-2: low risk, 3-4: moderate risk, 5-16: highrisk) [10], questionnaire was administered to respondents who met the inclusion criteria until the desired sample size was reached.Ethical approval was obtained from the Oyo State Ministry of Health and confidentiality was assured.
For data analysis, the questionnaires were counted, screened, coded, and entered into SPSS version 23.The respondents' occupations were categorized.The scoring guide in section C of the questionnaire had five sections, each assigned a specific point value.Risk categorization was determined based on the total points.Binary logistic regression was used to identify predictors of risk perception for having COVID-19.A p-value of less than 0.05 was considered statistically significant.

Results
The mean age was 27.83 ± 10.46 years.57.8% of the population below below 20-years-old, while 17.0% were between 20-29 years-old.52.8% of the population was female and 70.5% was unmarried.303 individuals identified as Yoruba, 8.5% as Igbo, and 4.3% as Hausa.72.0% of the population identified as Christian.56.8% of the population consisted of students.58.1% had completed secondary education and 42.3% had   Being single and living alone is associated with negative lifestyle changes and less psychological support [33][34][35].Hypertension increased the risk of COVID-19, while diabetes mellitus (x 2 = 48.81,p < 0.05) and respiratory diseases also increased the risk, but not significantly.A study found that individuals with diabetes mellitus had a higher risk compared to those with hypertension and respiratory diseases [11].

Strengths and Limitations
This study's strength lies in its robust statistical method for generating valid and reliable perception constructs.However, it faces limitations due to potential recall bias among participants, which may not necessarily indicate intentional actions based on voluntary and correct COVID-19 outcome statements.

Conclusion
The study analyzed the risk for COVID-19 infection in Nigeria, focusing on the age, gender, ethnicity, and religious affiliation of the population.The majority of respondents were students, with a high percentage of students and a high rate of completion of secondary education.The study found that individuals aged 36-43 had the highest risk of COVID-19, while male respondents were twice as likely to be classified as high risk.The study also found that Muslims had a higher likelihood of being classified as high risk compared to Christians.Higher education is linked to a higher risk of high-risk diseases.Government workers are at a higher risk due to stress and responsibility.Married individuals have a higher risk of COVID-19.Comorbidities like hypertension and diabetes mellitus also increase the risk.

Recommendation
The study suggests several public health recommendations to reduce the risk of COVID-19 infection.These include targeted campaigns, education programs, gender-specific interventions, community engagement, stress management, health screening, and policy interventions.These measures aim to raise awareness, promote preventive measures, and improve healthcare access for vulnerable populations.Collaboration between government agencies, healthcare providers, community organizations, and other stakeholders is crucial for effective implementation and mitigation of the virus's impact.

Table 1 :
Socio-demographics characteristics of the study population.

Table 2 :
Contact with suspected and confirmed cases.

Table 3 :
Symptoms of respondents.
[29]eing classified as high risk compared to students (4.8%).This difference was statistically significant (x 2 = 75.38,p<0.05).The higher risk among government workers can be attributed to stress from role overload and responsibility, as suggested by Mirmohammadi, et al.[30]and Sealey, et al.[31].Straub, Ronald Arthur Marsh and Whalen[32]found a high prevalence of as high risk (x 2 = 21.68,p=0.001).Larina, et al.[28]found a higher risk of breast cancer in medium and high education level groups compared to low education level group.Jiang, et al.[29]found that higher education was associated with more favorable cardiovascular disease risk factors.Government workers had a higher likelihood (16.7%)

Table 4 :
Factor associated with COVID-19 risk categorization of patients.