Healthcare access difficulty due to fear of COVID-19 infection among women of reproductive age: multilevel mixed-effects logistic regression analysis

Introduction The coronavirus disease of 2019 (COVID-19) pandemic left lasting effects in all sectors globally. Particularly among women of reproductive age, it has instilled difficulty of accessing healthcare, which has been linked to fear of being exposed to the virus at health facilities. However, most studies especially in East Africa have narrowed COVID-19 related research to qualitative reviews and descriptive analyses due to inadequacy of COVID-19 data. The purpose of this study was to determine the relationship between health facility visiting and healthcare access difficulty due to fear of COVID-19 at health facilities, while exploring both individual and contextual determinants. Methods The current study applied a multilevel logistic mixed-effects regression model to account for both individual and contextual dimensions in the study. Results Overall, 30.0% of the women reported difficulty in accessing healthcare. Women who had visited a health facility in the past 4 weeks of the survey and had health insurance were associated with less healthcare access difficulty; (AOR= 0.73; 95% CI, 0.57-0.95) and (AOR= 0.74; 95% CI, 0.59-0.94) respectively. On the contrary, women who watched television, in households that had partially and completely lost household income due to the virus were associated with more difficulty; (AOR= 1.38; 95% CI, 1.10-1.74), (AOR= 2.09, 95% CI, 1.51-2.88) and (AOR= 2.40, 95% CI, 1.65-3.47) respectively. About 72% of the total variance in healthcare access difficulty was attributable to differences in enumeration areas (ICC= 0.72; 95% CI, 0.66-0.76), with less significant individual level contribution. Conclusion Interventions that influence routine health facility visits can boost healthcare access among women. Enumeration area-specific interventions may be more effective.