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SCHOOL OF PUBLIC HEALTH 
COLLEGE OF HEALTH SCIENCES 
UNIVERSITY OF GHANA 
    
ASSESSMENT OF THE QUALITY OF LIFE AND COPING STRATEGIES 
OF COVID-19 RECOVERED PATIENTS AT THE GHANA INFECTIOUS 
DISEASE CENTER  
BY 
ESINAM AKU AMEDEWONU  
(10221340) 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, 
LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE 
AWARD OF MASTER OF PUBLIC HEALTH (MPH) DEGREE 
MARCH 2021 
 
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DECLARATION 
I, Esinam Aku Amedewonu, hereby declare that apart from the references which were 
used and acknowledged duly, this dissertation is the product of my investigation, which 
was supervised and has not been submitted elsewhere in whole or in part for the 
attainment of any other degree. Where other people’s research have been used, these 
have been acknowledged accordingly.  
           
         
............................................... ..........................................  
Esinam Aku Amedewonu  Dr Genevieve C. Aryeetey 
          (Student)  (Supervisor) 
………23-09-202……. .... …….23-09-2022……. 
           (Date)  (Date) 
  
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DEDICATION 
This dissertation is dedicated to my loving mother. 
 
 
 
 
 
 
 
 
 
 
 
 
Glory be to God 
  
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ACKNOWLEDGEMENT 
I am very grateful for grace, favour, and countless mercies from God, our heavenly 
father.  
My sincere gratitude goes out to my academic supervisor, Dr. Genevieve C. Aryeetey, 
for offering me the needed guidance over the past year. 
I am also extremely grateful to my mother for her immense support and counsel over 
the past year. 
To Dr. Oliver-Commey and all the staff of Ghana Infectious Disease Centre (GIDC), I 
am eternally grateful. 
A special thanks goes out to Dr. (Rev.) Ndanu, Dr. Levi Ankrah, Tony Godi, Dr. Dai-
Kosi, Dr. Robert Djablettey, Dr. Jason Amponsah, and everyone who contributed in 
vast ways to enable me to complete this research. 
Finally, I am immensely grateful to all the patients of the post-Covid-19 review clinic 
who graciously agreed to partake in this study. It would not have been possible without 
you. 
God richly bless all of you.  
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ABSTRACT 
Background: Coronavirus Disease of 2019 (COVID-19) is the first global pandemic 
of the 21st century. Initially thought to be a respiratory disease, it is now known to affect 
multiple organ systems with variable presentation and devastating or fatal 
complications. Symptoms have been noted to persist after 30 days following recovery, 
resulting in what is known as “Long COVID”. Despite the large numbers of people who 
have suffered this disease globally and in Ghana, mid- to long-term impact of COVID-
19 on a person’s general well-being, physical function, and ability to return to work has 
not been fully investigated. This study sought to examine the self-rated quality of life, 
physical function, and general health in Ghanaian patients following clinical recovery 
from COVID-19 infection and the coping strategies used. 
Objective: To determine the Quality of Life (QoL) and coping strategies of Covid-19 
recovered patients at the Ghana Infectious Disease Centre.  
Methods: A descriptive cross-sectional and hospital-based study was carried out on 
150 recovered patients at the post-COVID-19 Review Clinic of the Ghana Infectious 
Disease Centre (GIDC). Quality of Life was estimated using the EuroQol Group 
Association five-domain, five level questionnaires (EQ-5D-5L). The Brief-COPE scale 
was used to assess the coping strategies of patients. Analysis of variance and linear 
regression was used to determine factors associated with QoL and coping strategies. 
Spearman correlation was used to establish the association between QoL and coping 
strategies.  
Results: The mean quality of life was slightly higher on the EQ-5D-5L percentage scale 
(81.5 ± 12.0) % compared to the self-reported EQ-VAS scale (75.6 ± 22.0) %. Scores 
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above 50% and approaching 100% depict an increasingly good quality of life. 
Persistence of symptoms after 30 days and the development of complications were 
significant predictors for both quality-of-life scales. Differences were not significantly 
observed for all other socio-demographic factors such as marital status, place of 
residence, and ethnicity as well as other COVID related factors such as access to 
rehabilitative centres on their quality of life. Problem-focused strategy was the most 
used coping strategy among respondents (2.71± 0.64). Age, persistence of symptoms, 
being a non-healthcare worker, and development of complications post-COVID-19 
were significant predictors of coping strategies. There were no significant differences 
observed for the other socio-demographic characteristics (sex, religion, ethnicity, 
marital status, place of residence and occupation) across all three coping strategy styles. 
Increasing quality of life was associated with decreasing coping mechanisms. 
Conclusion: Quality of life was relatively good post-infection. Persistence of 
symptoms and development of complications significantly predicted one’s quality of 
life. Participants generally adopted positive coping strategies during the COVID 
pandemic with a decreasing need to use a coping strategy as their QoL improved. 
Keywords: COVID-19, quality of life, recovered patients, coping strategies, Ghana 
 
  
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TABLE OF CONTENTS 
DECLARATION ...................................................................................................................................I 
DEDICATION ......................................................................................................................................II 
ACKNOWLEDGEMENT .................................................................................................................. III 
ABSTRACT ........................................................................................................................................ IV 
TABLE OF CONTENTS .................................................................................................................... VI 
LIST OF TABLES ............................................................................................................................... X 
LIST OF FIGURES ............................................................................................................................. XI 
LIST OF ABBREVIATIONS ............................................................................................................ XII 
1 INTRODUCTION .......................................................................................................................... 1 
1.0 BACKGROUND OF THE STUDY ................................................................................................. 1 
1.1 STATEMENT OF THE PROBLEM ................................................................................................ 3 
1.2 JUSTIFICATION OF THE STUDY ................................................................................................ 5 
1.3 OBJECTIVES OF THE STUDY .................................................................................................... 6 
1.3.1 General Objectives ............................................................................................................ 6 
1.3.2 Specific Objectives ............................................................................................................. 6 
1.3.3 Research Questions ........................................................................................................... 6 
1.4 SUMMARY OF CHAPTER .......................................................................................................... 7 
2 LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK .......................................... 8 
2.0 INTRODUCTION ........................................................................................................................ 8 
2.1 BACKGROUND ......................................................................................................................... 8 
2.2 DISEASE PROGRESSION OF SARS-COV-2 ............................................................................ 10 
2.3 EXTRAPULMONARY MANIFESTATIONS ................................................................................. 13 
2.3.1 Renal Manifestation ......................................................................................................... 14 
2.3.2 Cardiovascular Manifestation ......................................................................................... 14 
2.3.3 Gastrointestinal Manifestation ........................................................................................ 14 
2.3.4 Hepatobiliary Manifestation ............................................................................................ 14 
2.3.5 Endocrine Manifestation ................................................................................................. 15 
2.3.6 Neurological Manifestation ............................................................................................. 15 
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2.3.7 Ophthalmologic Manifestation ........................................................................................ 15 
2.3.8 Dermatological Manifestation ......................................................................................... 15 
2.3.9 Haematological Manifestation ........................................................................................ 16 
2.4 QUALITY OF LIFE (QOL) AND PERSISTENCE OF SYMPTOMS ................................................ 16 
2.5 COPING STRATEGIES ............................................................................................................. 19 
2.6 THEORETICAL FRAMEWORK.................................................................................................. 22 
2.7 CONCEPTUAL FRAMEWORK .................................................................................................. 25 
2.8 SUMMARY OF CHAPTER ........................................................................................................ 26 
3 METHODS ................................................................................................................................... 27 
3.0 INTRODUCTION ...................................................................................................................... 27 
3.1 STUDY DESIGN ...................................................................................................................... 27 
3.2 KNOWLEDGE PARADIGM ....................................................................................................... 27 
3.3 STUDY AREA ......................................................................................................................... 28 
3.4 STUDY POPULATION .............................................................................................................. 29 
3.4.1 Inclusion Criteria............................................................................................................. 30 
3.4.2 Exclusion Criteria ............................................................................................................ 30 
3.5 SAMPLE SIZE DETERMINATION ............................................................................................. 30 
3.6 SAMPLING ............................................................................................................................. 31 
3.7 VARIABLES ............................................................................................................................ 31 
3.7.1 Dependent Variables ....................................................................................................... 31 
3.7.2 Independent Variables ..................................................................................................... 32 
3.8 DATA COLLECTION AND TOOLS ............................................................................................ 33 
3.9 SAFETY CONSIDERATIONS..................................................................................................... 35 
3.10 DATA ANALYSIS ................................................................................................................... 35 
3.10.1 Estimating the Quality of life ...................................................................................... 35 
3.10.2 Assessment of Coping Strategies ................................................................................ 37 
3.10.3 Data Analysis .............................................................................................................. 37 
3.11 ETHICAL CONSIDERATION ..................................................................................................... 38 
3.11.1 Quality Assurance and Pretesting .............................................................................. 38 
3.11.2 Ethical Clearance ....................................................................................................... 39 
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3.11.3 Risks and Benefits ....................................................................................................... 39 
3.11.4 Compensation / Payment ............................................................................................ 39 
3.11.5 Right to Refuse ............................................................................................................ 39 
3.11.6 Anonymity and Confidentiality ................................................................................... 40 
3.11.7 Participant’s Consent ................................................................................................. 40 
3.11.8 Data Storage, Security and Usage .............................................................................. 40 
3.12 SUMMARY OF CHAPTER ........................................................................................................ 40 
4 RESULTS...................................................................................................................................... 42 
4.0 INTRODUCTION ...................................................................................................................... 42 
4.1 CHARACTERISTICS OF STUDY PARTICIPANTS ....................................................................... 42 
4.1.1 Socio-demographic Characteristics of Respondents ....................................................... 42 
4.1.2 Persistent Symptoms and Treatment Characteristics of Respondents ............................. 44 
4.1.3 Comorbidities and Complications of Respondents .......................................................... 45 
4.1.4 Rehabilitation Factors of Respondents ............................................................................ 47 
4.2 QUALITY OF LIFE OF STUDY PARTICIPANTS .......................................................................... 48 
4.3 PREDICTORS OF QUALITY OF LIFE ......................................................................................... 49 
4.3.1 Quality of Life and Socio-demographic Characteristics ................................................. 49 
4.3.2 Quality of Life and Symptoms, Comorbidities, Complications, and Treatment .............. 53 
4.3.3 Factors Influencing Quality of Life among respondents ................................................. 57 
4.4 COPING STRATEGIES USED BY STUDY PARTICIPANTS........................................................... 61 
4.4.1 Problem-focused Coping ................................................................................................. 61 
4.4.2 Emotional-focused Coping .............................................................................................. 62 
4.4.3 Avoidant Coping .............................................................................................................. 63 
4.5 PREDICTORS OF COPING STYLES USED BY STUDY PARTICIPANTS ........................................ 63 
4.5.1 Socio-demographic Characteristics and Coping Strategies............................................ 63 
4.5.2 COVID-19 Related Characteristics and Coping Strategies ............................................ 65 
4.6 ASSOCIATION BETWEEN QUALITY OF LIFE AND COPING STRATEGIES .................................. 66 
4.7 SUMMARY OF CHAPTER ........................................................................................................ 67 
5 DISCUSSION ............................................................................................................................... 68 
5.0 INTRODUCTION ...................................................................................................................... 68 
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5.1 QUALITY OF LIFE .................................................................................................................. 68 
5.2 PREDICTORS OF QUALITY OF LIFE ......................................................................................... 69 
5.3 COPING STRATEGIES ............................................................................................................. 75 
5.4 PREDICTORS OF COPING STRATEGIES.................................................................................... 77 
5.5 ASSOCIATION BETWEEN QUALITY OF LIFE AND COPING STRATEGIES .................................. 81 
6 CONCLUSION AND RECOMMENDATIONS ....................................................................... 83 
6.0 INTRODUCTION ...................................................................................................................... 83 
6.1 CONCLUSION ......................................................................................................................... 83 
6.2 LIMITATIONS ......................................................................................................................... 84 
6.3 RECOMMENDATIONS ............................................................................................................. 85 
7 REFERENCES ............................................................................................................................. 87 
8 APPENDICES ............................................................................................................................ 101 
8.0 APPENDIX 1: PARTICIPANTS INFORMATION SHEET ............................................................. 101 
8.1 APPENDIX 2: QUESTIONNAIRE ............................................................................................. 105 
8.2 CURRICULUM VITAE ........................................................................................................... 115 
8.3 ETHICAL CLEARANCE ......................................................................................................... 121 
  
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LIST OF TABLES 
Table 3.1: Details of dependent variables and Source of data ..................................... 32 
Table 3.2: Details of independent variables and Source of data .................................. 32 
Table 4.1: Socio-demographic characteristics of respondents (N = 150) .................... 43 
Table 4.2: Persistent symptoms and treatment characteristics of respondents (N = 150)
...................................................................................................................................... 44 
Table 4.3: Comorbidities and complications of respondents (N = 150) ...................... 46 
Table 4.4: Rehabilitation factors of respondents (N = 150 .......................................... 47 
Table 4.5: Reported problems (mild to extreme) from EQ-5D-5L Questionnaire ...... 48 
Table 4.6: Unadjusted linear regression of Quality of Life (EQ-5D-5L and EQ-VAS) 
% scores on socio-demographic characteristics ........................................................... 51 
Table 4.7: Unadjusted linear regression of Quality of Life (EQ-5D-5L and EQ-VAS) 
% scores on symptoms, comorbidities, complications, and treatment ........................ 55 
Table 4.8: Adjusted linear regression of factors influencing Quality of Life (EQ-5D-5L 
and EQ-VAS) % scores among respondents ............................................................... 59 
Table 4.9: Socio-demographic characteristics and Coping strategies ......................... 64 
Table 4.10: COVID-19 related characteristics and Coping strategies ......................... 65 
Table 4.11: Coping strategies and Quality of life ........................................................ 66 
  
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LIST OF FIGURES 
Figure 2.3:Theoretical framework of Quality of Life: An adaptation of the Precede-
Proceed Model ............................................................................................................. 24 
Figure 2.1: Conceptual Framework of Quality of Life ................................................ 26 
Figure 4.1: Quality of life ............................................................................................ 48 
Figure 4.2: Overall Coping Strategy ............................................................................ 61 
Figure 4.3: Problem-focused coping strategy .............................................................. 62 
Figure 4.4: Emotional-focused coping strategy ........................................................... 62 
Figure 4.5: Avoidant coping strategy........................................................................... 63 
  
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LIST OF ABBREVIATIONS 
COVID-19  – Coronavirus Disease 
GHS   – Ghana Health Service 
MERS   – Middle East Respiratory Syndrome 
OHRP  – Office for Human Research Protections 
PI   – Principal Investigators 
PPE   – Personal Protective Equipment 
SARS   – Severe Acute Respiratory Syndrome 
SARS-CoV-2  – Severe Acute Respiratory Syndrome Coronavirus 2 
 
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1 INTRODUCTION 
1.0 Background of the Study 
The Coronavirus disease 2019 (COVID-19) outbreak has significantly impacted the 
entire world (The Lancet, 2020). This novel disease was first noted on the 31st of 
December, 2019, when a report was made by Wuhan Municipal Health Commission to 
the World Health Organization on a cluster of an atypical pneumonia in Wuhan of the 
Hubei Province in China (Zhou et al., 2020).  The cause of this pneumonia was later 
identified as a virus of the coronaviridae family and was initially named 2019-nCoV 
(CDC, 2020; The Lancet, 2020). Subsequently, the WHO renamed this virus as the 
Severe Acute Respiratory Syndrome Coronavirus (SARS CoV-2) and the disease as 
Coronavirus Disease 2019 or simply COVID-19 (WHO, 2020d). Due to the rapid and 
highly contagious nature of spread, by the 29th of April 2020, COVID-19 had been 
confirmed in over 3 million people globally (Johns Hopkins University, 2020). On 11th 
March 2020, the WHO declared COVID-19 a pandemic, confirming the prevalence of 
the disease in a vast geographical area and affecting a remarkably high proportion of 
the world’s population (WHO, 2020d).  
Human-to-human spread is primarily a droplet-based transmission, but aerosol 
transmission is also believed to be a possible mode of spread (World Health 
Organization, 2020c). The incubation period averages 5-6 days, but reports by the 
WHO have suggested anything up to 14 days. The disease has a varying range of 
presentation from being asymptomatic, through presenting with symptoms similar to 
the common cold to more severe respiratory, enteric, hepatic and neurological 
symptoms (Adhikari et al., 2020). 
 
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Patients with mild to moderate disease often present with fever, cough, fatigue, 
dyspnoea, tachypnoea and decreased oxygen saturation requiring supplemental oxygen 
and necessitating hospitalization (Centers for Disease Control and Prevention, 2020; 
Huang et al., 2020; Richardson et al., 2020). According to these studies, within ten to 
fourteen days, quite a number of patients sufficiently recover and are discharged from 
the hospital. However, majority of patients may still not be void of symptoms. In fact, 
there is currently evidence to show some patients will experience a range of symptoms 
for weeks to months after clinical recovery or discharge from isolation with damage to 
varied internal organs in a phenomenon termed “Long COVID” (Centers for Disease 
Control and Prevention, 2020). 
Recent reports have suggested an oro-fecal transmission of the virus, in addition to the 
droplet-based and aerosol modes of transmission (CDC, 2019; Gao et al., 2020; 
Morawska & Milton, 2020; World Health Organization, 2020c). This may explain the 
other varying presentations of SARS-CoV-2 infection such as diarrhoea, loss of taste 
and smell, skin rash discolouration of fingers or toes, fatigue, hair loss, attention 
disorder, memory loss and sleep disorder. There is an overlap of the clinical 
manifestations of these conditions with those of respiratory illnesses which contribute 
to the symptom burden of the disease with the course and outcome of these signs and 
symptoms being largely unknown. There is also a general disorder of reduction of the 
innate immune response and progression from a pro-inflammatory status, to a 
hyperinflammatory state and then to adult respiratory distress syndrome (ARDS) 
(Huang et al., 2020; Potere et al., 2020), associated with increased mortality from heart 
failure or respiratory illness (Guan et al., 2020; Keeley et al., 2020). Many reports 
suggest COVID-19 infection is not limited to the respiratory system alone. Other 
systemic problems such as renal dysfunction, gastrointestinal complications, liver 
 
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dysfunction, cardiac manifestations such as arrhythmias and cardiomyopathies, 
mediastinal findings, neurological abnormalities and haematological manifestations 
such as venous thrombosis, myocardial infarction and stroke have also been noted 
(Behzad et al., 2020) 
Despite the large numbers of people locally and globally who have suffered and 
recovered from an infection, the clinical course of the respiratory illness post-recovery 
in terms of the persistence of signs and symptoms, prevalence of the disease, as well as 
the impact on the general wellbeing and function, has not fully been elucidated. One 
study in Italy showed the persistence of symptoms with reduced quality of life in 
COVID-19 survivors up to 60 days following the onset of symptoms (Docherty et al., 
2020). The mid- and long-term effects of an individual’s general health and well-being, 
as well as their physical function and ability to return to work post COVID-19 infection 
has also not been fully described. 
This study sought to examine the self-rated quality of life, physical function, and 
general health in Ghanaian patients following clinical recovery from COVID-19 
infection. 
1.1 Statement Of the Problem 
SARS-CoV-2 caused by a novel coronavirus, is a worldwide pandemic with 
unprecedented public health consequences, posing challenges to food systems and the 
world of work. It affects all manner of persons (children, adults, and elderly) and has 
major impacts on an individual’s medical, physical, economic, cognitive, social and 
mental health status (Lim et al., 2020; Simpson & Robinson, 2020), on their quality of 
life, health and well-being, with this impact being more pronounced in people with 
chronic health problems such as hypertension and diabetes (Samlani et al., 2020). As 
 
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of 15th May 2021, it had infected 162,561,793 people globally and resulted in a 
devastating 3,372,071 mortalities (Lucia et al., 2021). The dramatic loss of human lives 
worldwide as well as the devastating social and economic disruption caused by the 
pandemic has resulted in the potential for tens of millions of people becoming 
extremely poor and almost half of the entire world’s workforce losing their livelihoods 
because of jobs being decimated or the individual losing their capacity to work 
(Chriscaden Kimberly, 2020). 
Considering the fact that the disease has a multi-dimensional effect on various organs 
of the body and has also generated a plethora of psychiatric manifestations across the 
different strata of the society (Ijezie et al., 2021), the study seeks to explore the life 
conditions of patients i.e. their “Quality of life” after recovery from the illness as well 
as the coping strategies utilized over the period. The importance of disease outcomes 
in relation to the individual’s social integration has been known to interfere with a 
person’s quality of life (Behzad et al., 2020).  
While there are a myriad of studies currently exploring all levels of prevention and 
management of SARS-CoV-2 in Ghana there is not much evidence of inquiry into the 
“Quality of Life” after recovery from this novel virus. Hospitalised patients are only 
reviewed to assess their medical status after they are discharged from the treatment 
centres. Since the disease is known to affect most internal organs in the body, the 
disease is bound to have an impact on the life of patients after being infected. 
In Ghana there is a considerable gap in knowledge on the quality of life after Covid-19 
infection and how individuals are coping and dealing with their situation after isolation 
or discharge from the treatment centre to their respective homes. This study thus seeks 
to explore the life conditions of patients when they get back into the community. 
 
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1.2 Justification Of the Study 
COVID-19 is a novel disease. More is being discovered about this disease on a daily 
basis. There is sufficient evidence that COVID-19 is more than just a respiratory disease 
but also exhibits considerable systemic manifestations and effects. The medium to long 
term effects on the health and quality of life of post-COVID patients is still under 
investigation with very few studies being conducted globally.  
In Africa, the COVID-19 outbreak appeared to be less severe compared to the state of 
the outbreak in Europe and the Americas. Particularly in Ghana, despite a slightly more 
severe second wave, the mortality has been relatively low with 780 deaths reported as 
of 30 April 2021, from 92,740 infections and 90,376 recoveries (Ghana Health Service, 
2021). Negative long term health effects can result from the way individuals cope with 
stressors.  
How this disease has impacted Ghanaian survivors with regards to the mid- to long-
term effects on their health has not been reported and is yet to be investigated. In view 
of the scanty depth of knowledge with regards to the quality of life after COVID-19, it 
is necessary to explore this aspect of life of patients who were isolated or hospitalized 
in the COVID-19 treatment centre and their lives after recovery from the disease.  
This study thus investigated the impact of COVID-19 on the quality of life of Ghanaian 
patients who have recovered from the disease. It provides important information and 
data on the state of health of these individuals following recovery and discharge from 
isolation as well as provides an understanding of the patterns and predictors of coping 
strategies utilized. Ultimately, the findings of this study will provide vital information 
that should guide policy on post-discharge care and follow-up after COVID-19 
infection, rehabilitation, and social support systems, as well as inform guidelines on 
 
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Health Promotion to especially identify those individuals in most need of additional 
psychological support in pandemics. 
1.3 Objectives Of the Study 
1.3.1 General Objectives 
To determine the Quality of life (QoL) and coping strategies of Covid-19 recovered 
patients at the Ghana Infectious Disease Centre. 
1.3.2 Specific Objectives 
1. To estimate the quality of life of COVID-19 recovered patients. 
2. To determine the predictors of quality of life of COVID-19 recovered patients. 
3. To identify the coping strategies utilized by COVID-19 recovered patients in 
Ghana.  
4. To assess the association of socio-demographic characteristics on the coping 
strategies used by Covid-19 recovered patients. 
5. To determine the association between quality of life and coping strategies 
employed by COVID-19 recovered patients. 
1.3.3 Research Questions 
1. What are the effects of Covid-19 on the quality of life of recovered patients? 
2. What are the predictors of quality of life in COVID-19 recovered patients? 
3. What types of coping strategies are being used by Covid-19 recovered patients 
in Ghana? 
4. What are the associations of socio-demographic characteristics on the coping 
strategies used by COVID-19 recovered patients? 
 
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5. What is the relationship between quality of life and the coping strategies used 
by Covid-19 recovered patients? 
1.4 Summary of Chapter 
This chapter presented the background of the study, statement of the problem, 
justification of the study, the general and specific objectives of the study, and the 
research questions explored by this study.  
 
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2 LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK 
2.0 Introduction 
This chapter discusses the existing literature pertaining to the topic being studied. It is 
sub-divided into seven sections. The first section provides literature on the background 
of COVID-19. The second section describes the literature on the progression of the 
disease. Section three provides literature on the extrapulmonary manifestations of the 
disease. Section four provides literature on studies on the persistence of symptoms and 
its effects on the quality of life of COVID-19 recovered patients. Section five provides 
literature on the coping strategies utilized by patients. Section six outlines the 
theoretical framework that guides this research. The seventh section describes the 
conceptual framework for this study. 
2.1 Background 
The world was struck with a huge public health threat at the end of 2019, the COVID-
19 disease, which has since spread speedily and affected the lives of millions of people 
all over the globe. The novel virus is from the coronavirus family and was named Severe 
Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (CDC, 2020; ICM 
Anaesthesia COVID-19, 2020). It originated from Wuhan city, Hubei province, in 
China. On 30th January 2020, Covid-19 was declared by the World Health Organization 
as a public health emergency of international concern (PHEIC). Shortly afterwards on 
March 11th 2020, it was later declared a global pandemic, which has resulted in over 
3million mortalities worldwide till date (CDC, 2020; Jan et al., 2021; WHO, 2020a). 
This declaration is the first after many years since the declaration of the H1NI influenza 
as a pandemic in 2009. It’s capacity to spread to over 160 countries within a short time 
frame rendered it a highly contagious etiologic agent. 
 
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This viral disease is particularly of immense public health importance because it causes 
mortality in healthy adults, children, and the elderly with comorbidities (Gates, 2020). 
Although fewer cases have been reported in children as compared with adults, COVID-
19 does cause infection in children who can then transmit the virus to susceptible adults. 
Mortality from COVID-19 is relatively higher than the typical seasonal influenza with 
a case fatality risk of 1%. Furthermore, it is transmitted rather efficiently and 
exponentially, with the infected person spreading the disease to averagely two or three 
others. It is also rapidly spread by people who are only mildly ill or pre-symptomatic 
(Hoehl et al., 2020). The disease has therefore challenged healthcare systems and 
provisions globally. 
The first two confirmed cases in Ghana were recorded on 12th March 2020. Numbers 
of confirmed cases has since risen to 5,127 as of 13th May 2020 with 22 recorded deaths 
(Ghana Health Service, 2020). The worldwide figures however stood at 4.31 million 
infected people, with over 294,000 deaths. As of 3rd May 2021, Ghana had recorded a 
total of 92,683 positive cases with 779 deaths, whilst on the global front there had been 
153,989,880 positive cases with 3,222,447 mortalities (Lucia et al., 2021) affecting at 
least 40 countries. This pandemic has forced many local reactions and has challenged 
the healthcare system at several fronts. Ghana implemented nationwide measures such 
as closure of National borders via land, air, and sea, the quarantine of infected persons, 
contact tracing, testing, and a three-week lock-down in Accra and Kumasi, which were 
identified as the epicentres of the spread of the virus (Afrane, 2021). Emphasis was 
placed on ensuring social distancing in public places such as markets and rigorous 
handwashing facilities (Veronica buckets) were mandatory before entry into businesses 
and shops. The numbers of persons allowed in public transportation vehicles (trotro) 
was also drastically reduced to ensure social distancing and wearing of facemasks was 
 
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made mandatory by law. The government of Ghana further implemented several social 
interventions and programs, and many Non-Governmental Organizations, religious 
bodies, private entities, and individuals also contributed to the fight with several 
donations and aids. 
2.2 Disease Progression Of SARS-CoV-2 
The SARS-CoV-2 entity which is distributed broadly in humans and other mammals, 
is an enveloped, non-segmented positive-sense RNA virus that is part of the subgenus 
sarbecovirus, orthocoronavirinae subfamily and was initially named the 2019-novel 
coronavirus (2019-nCoV) on 12 January, 2020 by the World health Organization 
(WHO) (Guo et al., 2020; Huang et al., 2020; Tahir ul Qamar et al., 2020). It is roughly 
65-125nm in diameter with single stranded RNA and crown-like spikes on its outer 
surface. Being isolated from the respiratory epithelium from 3 bronchoalveolar lavage 
samples using a Polymerase Chain Reaction test (PCR), SARS-CoV-2 was noticed to 
share a homological sequence with two other members of the coronavirus family 
namely SARS-CoV and Middle-East Respiratory Syndrome Coronavirus (MERS-
CoV) with the development of similar pathogenesis and manifestations (Bai et al., 
2020; WHO, 2020c) but with a higher basic reproductive number than that of SARS-
CoV which affected only 26 countries and resulted in approximately 8,000 deaths in 
2003 (Bonful et al., 2020). SARS-CoV and MERS-CoV resulted in potentially fatal 
respiratory tract infections as well as pulmonary failure. Currently, it is reported that 
individuals who are infected produce copious amounts of the virus during the 
prodromal period in the upper respiratory airway tract, with subsequent affinity for the 
lower respiratory tract (Chan et al., 2020). As an infectious acute respiratory disease, it 
spreads primarily through the respiratory tract via respiratory droplets and secretions 
(Li et al., 2020).  
 
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According to the WHO, symptoms are non-specific and presentation ranges from 
asymptomatic to mild/ moderate disease to severe pneumonia or death (WHO, 2020c). 
There is a long prodromal stage with symptoms usually developing from 2 days to 14 
days after exposure to the virus (CDC, 2021) with a mean incubation period of 5-6 days 
(WHO, 2020c). The inflammatory signs and symptoms are a result of elevated levels 
of pro-inflammatory cytokines and leukocytes (Rothan & Byrareddy, 2020; WHO, 
2020c). Often referred to as a “cytokine storm”. Symptoms include fever, chills or 
rigors, headache, muscle aches, fatigue, dry cough, chest pain, difficulty in breathing 
or shortness of breath, sore throat, nasal congestion, anosmia, ageusia, hair loss, 
attention disorder/ inability to focus (brain fog), memory loss, insomnia, abdominal 
pains, nausea, and vomiting  (Garrigues et al., 2020). Most of these symptoms have 
been seen to persist weeks to months after the acute illness. COVID-19 has also been 
associated with several varying systematic manifestations (Cascella et al., 2020). In the 
elderly, and especially among those with comorbidities particularly diabetes and 
hypertension, the disease progresses into severe consequences or complications 
requiring hospitalization and later management in the Intensive Care Unit (ICU) usually 
from acute respiratory distress syndrome (ARDS), acute kidney and liver injury, cardiac 
injury, respiratory failure, stroke, and disseminated intravascular haemolysis (DIC) 
(Beeching & Fowler, 2020; CDC COVID-19 Response Team, 2020b; Rodriguez-
Morales et al., 2020). 
COVID-19 is highly transmissible, with human-to-human transmission of the virus 
occurring via small respiratory droplets when an individual comes into contact with an 
infected person’s secretions expelled from the nose and mouth through coughing, 
sneezing, shaking hands, or through contact with fomites and subsequently touching 
the eyes, nose or mouth (WHO, 2020c; World Health Organization, 2020b) . The 
 
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unique features and mode of transmission of the virus has informed several preventive 
measures promoted to reduce the rate of the spread. Since its declaration by the World 
Health Organization (WHO) as a pandemic on Wednesday March 11th, there have been 
remarkable efforts worldwide in response to the virus. These include intensified disease 
surveillance and mitigation of community spread. Other notable responses have been 
the development of serological tests and treatment modalities, continuous research and 
the development of vaccines (Heymann & Shindo, 2020). 
The virus has demonstrated to survive outside the host: up to 3 hours in air, for up to 4 
hours on copper surfaces, for up to 24 hours on cardboard surfaces, and up to 72 hours 
on plastics and stainless steel (van Doremalen et al., 2020). The WHO’s 
recommendation to reduce human-to-human transmission of the virus include regular 
washing of hands with soap under running water, limiting/avoiding physical contact 
between persons including handshakes, frequently rubbing hands using alcohol based 
hand sanitizers, coughing into the elbows or directly into tissue and immediately 
disposing it off, and limiting large gatherings (World Health Organization, 2020a). The 
COVID-19 virus has been shown in studies to be susceptible to extremely high 
temperatures of about 70 degrees Celsius hence warranting the use of steam inhalation 
in combating spread. 
Detection and confirmation of SARS-CoV-2 is via a positive real-time reverse-
transcriptase polymerase chain reaction (RT-PCR) test on nasopharyngeal or 
oropharyngeal swabs, and a radiological ground-glass opacification appearance on a 
chest computed tomography (chest CT) (Jan et al., 2021). Laboratory investigations 
usually reveal elevated inflammatory markers such as elevated d-dimers, C-reactive 
 
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proteins, lactate dehydrogenase, and ferritin levels. There may also be deranged liver 
function and renal function tests, leucocytosis, leukopenia, and lymphopenia. 
There is no specific treatment of COVID-19. Symptoms usually resolve spontaneously. 
There have however been several documented cases of re-infection with SARS-CoV-2 
worldwide with these cases exhibiting differing viral genomes, suggesting re-infection 
rather than a period of prolonged viral shedding (Goodman, 2021). 
Hydroxychloroquine, antiviral agents such as Remdisivir, as well as corticosteroids 
such as Methylprednisolone and Dexamethasone have been used in the management of 
COVID positive patients. 
Vaccines were also developed over the period to vaccinate over 70% of the populace 
worldwide in order to provide herd immunity against the very dangerous virus which 
was causing high mortality rates. Ghana was the first African country to receive the 
first historic shipment of the 600,000 COVAX vaccines by Astra Zeneca on the 24th of 
February, 2021(World Health Organization, 2021) . 
2.3 Extrapulmonary Manifestations 
Being primarily a respiratory disease, pulmonary manifestation and substantial 
respiratory pathology constitutes the main presentation of the illness (Behzad et al., 
2020). However, it is unfortunately not restricted to the respiratory system only. Many 
other organs are not spared and thus can be affected. Myocardial dysfunction, acute 
coronary syndrome, arrhythmias, acute kidney injury, renal dysfunction, 
gastrointestinal symptoms and complications, hepatocellular injury, liver dysfunction, 
endocrinological disorders, neurological abnormalities, ocular symptoms, dermatologic 
complications, and haematological manifestations are among the reported 
extrapulmonary features. 
 
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2.3.1 Renal Manifestation 
Signs of kidney damage is observed in a significant proportion of patients with COVID-
19 (Behzad et al., 2020). Clinical presentation includes proteinuria, haematuria, acute 
kidney injury (AKI), metabolic acidosis, clotting of extracorporeal circuits used for 
renal replacement therapy, and electrolyte abnormalities such as hyperkalaemia, 
hyponatremia, and hypernatremia. 
2.3.2 Cardiovascular Manifestation 
SARS-CoV-2 causes both direct and indirect cardiovascular sequelae (Behzad et al., 
2020). Several cardiovascular presentations have been reported which includes 
arrhythmias such as new onset atrial fibrillation and atrial flutter, sinus tachycardia, 
sinus bradycardia, QT prolongation, which is often drug induced, torsade’s de pointes, 
sudden cardiac arrest, pulseless electrical activity, myocarditis, myocardial ischaemia, 
myocardial infarction, acute cor-pulmonale, cardiomyopathy from biventricular, 
isolated right or left ventricular dysfunction and cardiogenic shock. 
2.3.3 Gastrointestinal Manifestation 
Gastrointestinal symptoms may be experienced by some patients with COVID-19. 
Symptoms may be linked to a longer duration of illness and an incidence of 12-16% 
(Cao et al., 2020; Mao et al., 2020; Pan et al., 2020; Redd et al., 2020; Wu et al., 2020). 
These include nausea, vomiting, diarrhoea, abdominal pain, anorexia, and rarely 
mesenteric ischaemia and gastrointestinal bleeding. 
2.3.4 Hepatobiliary Manifestation 
Patients with severe manifestations of COVID-19 may be observed to have signs of 
hepatobiliary damage (Behzad et al., 2020). Hepatocellular injury patterns are seen in 
 
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14-53% of critically ill patients (Arentz et al., 2020; Bhatraju et al., 2020; Eastin & 
Eastin, 2020; Wu et al., 2020; Zhou et al., 2020). This is associated with elevated levels 
of bilirubin, elevated hepatic transaminases/ aminotransferases, and low serum albumin 
levels. 
2.3.5 Endocrine Manifestation 
Patients suffering from pre-existing endocrine disease may be exposed to more severe 
clinical manifestations (CDC COVID-19 Response Team, 2020a). These include 
hyperglycaemia, diabetic ketoacidosis, and euglycemic ketosis. There is an increased 
risk of developing severe illness in patients with pre-existing diabetes or obesity. 
2.3.6 Neurological Manifestation 
Neurologic complications of COVID-19 include headache, dizziness, ageusia, 
anorexia, myalgia, and extreme fatigue. It has also been associated with cerebrovascular 
accidents/ stroke, encephalopathy, meningoencephalitis (Helms et al., 2020), Guillain-
Barré syndrome (an acute inflammatory demyelinating polyneuropathy) (Frye et al., 
2020; Zhao et al., 2020), acute haemorrhagic necrotizing encephalopathy, 
haemorrhagic posterior reversible encephalopathy syndrome (Franceschi et al., 2020), 
and psychosis. 
2.3.7 Ophthalmologic Manifestation 
Ocular manifestations such as conjunctivitis, conjunctival congestion and retinal 
changes have been reported in COVID-19 patients (Behzad et al., 2020). 
2.3.8 Dermatological Manifestation 
Cutaneous manifestations in COVID-19 include maculopapular rash, erythematous 
rashes, exanthematous rashes, vesicular lesions, urticaria, necrotic lesions, chickenpox-
 
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like vesicles, and petechiae (Chesser et al., 2017; Gianotti et al., 2020; Joob & 
Wiwanitkit, 2020) 
2.3.9 Haematological Manifestation 
Laboratory abnormalities and thromboembolic complications seen with COVID-19 
patients include thrombocytopaenia, neutrophilia, lymphopenia, leucocytosis, elevated 
erythrocyte sedimentation rate, elevated C-reactive protein, elevated ferritin, 
interteukin-6 and lactate dehydrogenase levels (Behzad et al., 2020). There are also 
elevated D-dimer and fibrinogen levels, prolonged prothrombin, and partial 
thromboplastin time. In terms of arterial thrombotic complications, there is an increase 
in myocardial infarction, ischaemic stroke, acute limb, and mesenteric ischaemia. For 
venous complications, there is an increased risk of deep venous thrombosis and 
pulmonary embolism. Another major complication is catheter related thrombosis in 
arterial and venous catheters as well as extracorporeal circuits. In a few instances 
Covid-19 patient’s manifest symptoms of cytokine-release syndrome which include 
high grade fevers, hypotension, and multi-organ dysfunction. 
2.4 Quality Of Life (QOL) And Persistence of Symptoms 
Quality of life (QoL) by definition is the subjective judgement and self-reporting 
constructed by patients on their individual feelings of well-being to their physical, and 
social functioning, as well as to their occupational, spiritual, marital and sexual 
functioning, requiring a degree of cognitive ability (Chaturvedi & Muliyala, 2016).  
Quality of life is a broad concept consisting of medical and psychological aspects which 
encompasses the standards of health, wealth, comfort, enjoyment, and happiness 
experienced by an individual or by groups of people including their daily activities, 
 
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psychological health, physical health status perception, instrumental activities, pain of 
perception, and their overall satisfaction with their lives (Chaturvedi & Muliyala, 
2016). It is a measure of general well-being, the positive and negative features of life, 
and also a measure of a good life expected by an individual or the society. Values, goals, 
norms, and the socio-cultural contexts surrounding an individual’s life guides these 
expectations. The World Health Organization (WHO) defines QoL as “an individual’s 
perception of their position in life in the context of culture and value systems in which 
they live (WHOQoL Group, 1993).”  
Recent focus has been on exploring the impact of physical and mental illness on quality 
of life (Bonomi et al., 2000). These psychosocial factors are now measured in addition 
to the usual biomedical factors to give a better outcome measure from both a clinician 
and patient perspective.  
Quality of life has been said to be a difficult concept to measure or define due to its 
relative subjectivity. It is a multidimensional concept that looks at an individual’s self-
perception and current state of mind. The challenge then arises as to which domains 
should be considered in defining an individual’s quality of life. Bonomi suggests that 
the most effective definition would include social, environmental, physical and 
psychological values. (Bonomi et al., 2000) 
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) mostly results in a 
favourable evolution of disease progression in patients (Taboada et al., 2021). However, 
a significant number of patients have poor outcomes, often progressing to Acute 
Respiratory Distress Syndrome (ARDS) thereby requiring management in an Intensive 
Care Unit (ICU).  There is an increased susceptibility to the persistence of symptoms 
 
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and the development of poor health-related quality of life (HRQoL) in patients who 
survive. 
A prospective study carried out by (Taboada et al., 2021) to evaluate the QoL, 
functional status and persistent symptoms of patients with COVID-19 induced Acute 
Respiratory Distress Syndrome (ARDS) at 6months post treatment in the ICU. A total 
of 91 survivors were used. At 6months after ICU discharge, a significant proportion of 
patients had worsened QoL (67%), persistent symptoms, reduction in the extent of 
functional status (63%), and persistent functional limitations (45%) compared to their 
pre-COVID status. Only 16% of the respondents had fully recovered. A limitation for 
the study was the use of critically ill patients in ICUs of hospitals in only one region. 
Another study carried out by (Garrigues et al., 2020) on post discharge persistent 
symptoms and health-related QoL after hospitalization for COVID-19 revealed that 
most patients who required hospitalization still had persistent symptoms even after 110 
days of discharge especially fatigue (55%) and dyspnoea (42%). Other symptoms noted 
were however loss of memory (34%), concentration disorder (28%), sleep disorder 
(30%), and hair loss (20%). Although the HRQoL was quite satisfactory, out of the 56 
active workers pre-infection, only 69.1% had resumed work and amongst the 39 
patients who had regular sports activity, only 71.8% had resumed physical activity with 
46% having a lower level of physical activity. 
(Lim et al., 2020) evaluated the impact of COVID-19 on HRQoL in a multi-ethnic 
Asian cohort with cardiovascular disease (CVD) in Singapore. Their study reported 
worsening of HRQoL during the COVID-19 outbreak. There was a significantly 
associated decline in the psychological health components especially anxiety and 
depression in patients with pre-existing CVD. A limitation to this study was the fact 
 
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that it was conducted in Asian patients with CVD hence may not be generalizable to 
other patient populations or ethnicities. 
Further studies conducted by (Jacobs et al., 2020) on the persistence of symptoms and 
QoL at 35days post hospitalization for COVID-19 infection reported that 72.7% of their 
patients had persistent symptoms at day 35. Out of the 183 participants recruited, 52% 
were employed. At the time the study was conducted, only 29.9% of these cohort had 
resumed work whiles 73.7% had not on account of persistent symptoms. This study 
thus revealed that symptoms often persist beyond 35days of onset of infection, and this 
usually impairs the individual’s ability to perform daily living activities, as well as 
impairs the QoL, health, mental social, and physical function. 
A cross-sectional survey of a geographical cohort carried out by (Garratt et al., 2021) 
on non-hospitalized patients concluded that several important dimensions of HRQoL, 
including general health, social functioning, with role-limitations due to emotional 
problems and well-being, and aspects of mental health were lower than the general 
uninfected population norms 1.5 – 6 months after onset of COVID-19. 
2.5 Coping Strategies 
The effects of COVID-19 on what was previously considered ‘normal life’ has been 
considerable. With disruptions in daily activities, work, education, social interactions, 
worship, food and job security, and access to healthcare, it has led to what is now known 
as the ‘new normal’ where wearing of facemasks, social distancing, and limiting of 
social interactions through the restriction of social gatherings is now considered 
standard practice (Arora et al., 2020; Mennechet & Dzomo, 2020; Mertens et al., 2020). 
It has led to drastic measures being instituted by countries all over the world in a bid to 
contain the spread of the virus.  
 
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Varying actions taken by each country has resulted in varying degrees of success. 
Measures taken by different governments included a total or partial lockdown of the 
country’s borders with restriction of movement within the country itself, closure of 
businesses, schools and churches, the mandatory washing of hands before entry into a 
public or private facility, as well as the compulsory wearing of facemasks and social 
distancing in public vehicles which were enforced with sanctions for culprits who 
disobeyed the orders. These control measures coupled with the rapid mortality rates has 
led to increasing emotions of fear and panic: fear of infection, fear of dying, and fear 
of losing a loved one. It has necessitated the development of certain strategies to cope 
with these stressors and this is bound to influence one’s quality of life. 
Psychologically, the COVID-19 pandemic has had immense negative impacts on our 
lives with consequences of stress, anxiety, and other mental health challenges 
(Asmundson & Taylor, 2020; Flesia et al., 2020; Kelvin & Rubino, 2020). This has 
been mostly due to the fear of the unknown, the rapid mode of transmission, the high 
morbidity and mortality rates, as well as the unavailability of a definitive mode of 
treatment. Necessary public health actions to reduce the spread of the disease such as 
social distancing and lockdown has led to loneliness and isolation with the propensity 
of increasing stress and anxiety.  
In March 2020, a web-based survey conducted in 41 countries yielded very high levels 
of stress perceived among the 1091 respondents recruited (Limcaoco et al., 2020). A 
study conducted in China reported a 16.5% prevalence of severe depression, a 28.8% 
prevalence of severe anxiety, and an 8.1% prevalence of severe stress due to the impact 
of the pandemic among the general population (Wang et al., 2020). Additionally, a 
study conducted among Italians, reported perceived high levels of depression, stress 
 
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and anxiety (Flesia et al., 2020; Rossi et al., 2020). This is of considerable importance 
because of the psychological vulnerability it imposes on the general population 
resulting in numerous suicides reported in several countries due to the untoward 
pressures from the pandemic (Gunnell et al., 2020; Thakur & Jain, 2020). A nationwide 
study conducted in Bangladesh among 10,067 participants reported a 5% prevalence of 
suicidal ideation during the pandemic (Mamun et al., 2021). 
Coping strategies have played an important role during the pandemic especially for 
people suffering from mental health issues as it may lead to either a positive or negative 
mental health outcome. Individuals use coping strategies consciously or unconsciously 
to solve problems through cognitive and behavioural efforts thereby reducing the 
stresses these problems cause (Algorani & Gupta, 2021). Utilizing coping strategies in 
a healthy way helps with the management of stressful situations, thereby reducing 
negative emotions and ultimately leading to resilience. Whereas unhealthy coping 
strategies results in severe stress and suicidal tendencies. There are 28 existing coping 
strategies (grouped into 14 paired subscales) which include denial, self-distraction, 
emotional support use, active coping, substance use, behavioural changes, planning, 
positive reframing, humour, acceptance, self-blame, religion, venting, and 
informational support use (Fluharty & Fancourt, 2021; Thai et al., 2021). These have 
been classified into two main categories: ‘approach coping’ strategies and ‘avoidant 
coping’ strategies.  
Approach coping is an effective adaptive coping strategy which focuses on one’s 
actions towards the stressor and is characterized by emotional support use, planning, 
informational support use, acceptance, positive reframing, and active coping to reduce 
stressors. Avoidant coping on the other hand manages stress less effectively with a 
 
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focus on efforts to avoid stressors and is characterized by denial, behavioural changes, 
self-blame, venting, and substance use. The remaining two strategies: religion and 
humour, do not belong in either category. Other categories that have been used to 
classify coping include ‘emotional-focused’ strategies, and ‘problem-focused’ 
strategies. 
Research conducted in China during the COVID-19 outbreak in nurses and nursing 
college students on the coping strategies and emotional responses revealed a greater use 
of problem-focused strategies in both groups than that of emotion-focused strategies 
(Lei et al., 2020). Females were also found to use more of problem-focused strategies 
than males in this same study. Other studies have identified a variety of other predictors 
for the choice of coping style strategies some of which include lower socio-economic 
position, personality types, psycho-social factors, and socio-demographic factors. 
The ways in which individuals deal with stressors can have long-term health 
implications (Busch et al., 2020). For instance, anxiety and depression typically result 
from avoidance coping strategies. Cognitive behavioural therapy has been shown to be 
the most effective therapy for targeting avoidance strategies and this focuses on 
cognitive reappraisal and problem-solving responses. Understanding the predictors and 
patterns of coping strategies used is therefore vital in the selection of treatment 
modalities and the identification of individuals in most need of additional psychological 
support. 
2.6 Theoretical Framework 
The Precede-Proceed model was used as the theoretical framework for this study. This 
model was proposed by Lawrence W. Green and Marshall W. Kreuter in 1974 to 
comprehensively assess health needs to design, implement, and evaluate health 
 
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promotion programs in meeting those needs (Crosby & Noar, 2011; Green & Kreuter, 
2005). The model was used in conceptualizing this work by identifying the possible 
factors affecting quality of life post COVID-19 infection in order to investigate 
problems and suggest possible interventions or recommendations for improvement.  
According to Green and Kreuter, the PRECEDE stands for predisposing, reinforcing, 
and enabling constructs in education/ecological diagnosis and evaluation and enables 
the planning of a focused and targeted public health program (Green & Kreuter, 2005). 
The PROCEED stands for policy, regulatory, and organizational constructs in 
educational and environmental development and enables the implementation and 
evaluation of public health programs. 
The model begins with Phase 1: ‘Social assessment’ characterized by identifying the 
desired outcome which is “Quality of life”. Phase 2 is ‘Epidemiological assessment’ 
which looks at the causes of poor quality of life which includes behavioural factors such 
as failure to comply with COVID-19 safety protocols, wearing of personal protective 
equipment’s (PPE’s), apathy towards the disease from failure to believe that the disease 
truly exists because they haven’t been sick or haven’t had a close friend or relative who 
has died from the disease, as well as using poor coping mechanisms. Phase 3 is the 
‘Educational and ecological assessment’ which looks at the predisposing factors which 
include age, sex, and comorbidities. Phase 4 looks at the ‘Administrative and policy 
assessment and intervention alignment’ where the already existing policies are 
reviewed, and interventions are designed to achieve the desired outcome. This includes 
setting up of rehabilitative centres for the rehabilitation of patients who have suffered 
from COVID-19, a functional referral system for the swift referral of severe and 
critically ill patients, the setting up of post-COVID clinics for the management of 
 
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patients to detect any sequelae of COVID early, and the formation of a rapid response 
team to be deployed in public health emergencies for the training of health workers and 
the containment of disease.  
Phase 5 is ‘Implementation’ which is done through advocacy and mass public education 
using social media such as TV, radio, billboards, and social platforms. Education will 
also be done at the hospitals for both staff and patients. Mass community campaigns 
will also be done using floats and vehicles. Phase 6 is ‘Process evaluation’ which is 
looking at the enabling and reinforcing factors which includes education of the public 
on the new measures that have been put in place, easy accessibility to treatment and 
rehabilitative centres, and affordability of services to encourage and increase patronage 
of services. Phase 7 is the ‘Impact evaluation’ which looks at the impact of the 
interventions that have been instituted. Then finally Phase 8 which looks at the 
‘Outcome evaluation’ which is the improved Quality of life. 
 
Figure 2.1:Theoretical framework of Quality of Life: An adaptation of the Precede-Proceed Model 
 
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2.7 Conceptual Framework 
The conceptual model was adapted from the EQ-5D (EuroQol Group, 2021) and was 
modified to incorporate the variables under study. Though limited studies have been 
conducted on the novel SARS-CoV-2 disease, studies have shown an association 
between socio-demographic factors and the incidence COVID-19 (Karmakar et al., 
2021; Peres et al., 2021). Significant evidence also exists in support of these socio-
demographic factors such as age, sex, socio-economic status and presence 
comorbidities being associated with severe and critical illness thereby drastically 
increasing morbidity and mortality (Sohrabi et al., 2021) which inadvertently has an 
effect on the quality of life of patients who recover from the disease. 
COVID-19 infection, persistence of symptoms and subsequent recovery has also been 
shown to be associated with the development of complications and the worsening of 
chronic comorbid states which has the propensity of affecting one’s quality of life 
(Garratt et al., 2021; Garrigues et al., 2020). Fear of the unknown, the unpredictability 
of the symptomatology, as well as the devastating and rapid degree of morbidity and 
mortality worldwide poses severe psychological stress, anxiety and depression on 
patients, often leading to the adoption of coping strategies to deal with the stressors 
(Thai et al., 2021). The coping strategies utilized by patients may have positive or 
negative long-term health effects consequently affecting quality of life (Busch et al., 
2020). 
Growing evidence of the long-term complications of COVID-19 has warranted the need 
for rehabilitative services especially for patients with severe disease (WHO, 2020b; Yu 
& Helwig, 2021). This is bound to have an impact on the overall recovery and quality 
of life of COVID-19 recovered patients. 
 
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Figure 2.2: Conceptual Framework of Quality of Life 
 
2.8 Summary of Chapter 
The chapter has extensively reviewed the present literature available on COVID-19 
with respect to its pathogenesis, clinical manifestation, disease progression and 
extrapulmonary manifestations. It also defined quality of life and described literature 
on the effects of COVID on health-related quality of life of survivors.  It further defined 
coping strategies and described from literature the various types of coping strategies 
used worldwide because of the pandemic. Finally, it introduced the theoretical 
framework guiding this study and presented the conceptual framework. 
  
 
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3 METHODS 
3.0 Introduction 
This chapter explains the methods which were applied to collect data for subsequent 
analysis on the quality of life and coping strategies of COVID-19 recovered patients in 
order to answer the research objectives. This chapter describes the study design, 
knowledge paradigm, and study area. It also states the study population and describes 
the sampling technique, the sample size determination, and data collection tools that 
were used. It then finally outlines the ethical considerations that were observed. 
3.1 Study Design 
A cross-sectional and facility-based quantitative study was designed to assess the 
quality of life of COVID-19 recovered patients who attended the Ghana Infectious 
Disease Centre (GIDC) post-COVID-19 review clinic between August to October 
2021. All COVID-19 recovered patients who attended the clinic during the study 
period, 18 years and above, were eligible to participate in the study. The clinical records 
of eligible participants were reviewed and data on patient’s first COVID positive test, 
negative test, length of stay in hospital or isolation centre, and comorbidities was 
collected. Data on patient’s sociodemographic characteristics, health status, persistence 
of symptoms, complications, and coping strategies were directly collected from the 
participants and a structured questionnaire was completed using both sources of data. 
A purposive non-probability sampling technique was used for sampling the 
participants. Data collected was analysed using STATA version 16. 
3.2 Knowledge Paradigm 
The knowledge paradigm utilized in this study was POSITIVISM.  
 
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The study sought to measure the impact of COVID-19 on the quality of life of patients 
who had recovered from the disease. It also sought to find out the single fact / reality 
out there utilizing a fixed design with a quantitative study approach. Knowledge was 
generated only by observation of facts and the data was analysed using these facts. In 
this study, the researcher had total control and influence over the subject of 
investigation and utilized impact evaluation as the research strategy which sought to 
identify the impact and effectiveness of existing policies on the participants quality of 
life. The research method was conducted through a survey and used a deductive 
research approach. Structured questionnaires with known variables were used as the 
research tool to collect the quantitative data on a large sample of participants. 
3.3 Study Area 
This research was carried out at the Ghana Infectious Disease Centre (GIDC) from 
August to October 2021. The Ghana Infectious Disease Centre is Ghana’s first 
infectious disease centre with a 100-bed capacity which was built in response to the 
COVID-19 pandemic. The hospital was built in a record time of 100 days to provide 
needed healthcare services. The GIDC was developed to improve the medical 
diagnostic and research capacity of Ghana with respect to infectious diseases. It was 
built by the Ghana COVID-19 Private Sector Fund, which is a private sector-led 
initiative committed to providing prompt response to hardship and suffering caused by 
the COVID-19 pandemic. 
A post-COVID clinic was set up in June 2020 but officially opened in January 2021. 
This is a follow up / review clinic for all patients who have had COVID and have been 
discharged to observe their progress after discharge from the facility. This clinic runs 
on weekdays (Mondays to Fridays) from 8am to 2pm. One consultation room is used, 
 
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and this is manned by 1 doctor and 2 nurses. An average of 5 patients are seen per day. 
Admission criteria for the clinic is any patient who has had a positive laboratory PCR 
test. Patients are booked for their first review two weeks after discharge from the 
COVID clinic. About 80% of patients who are hospitalized or isolated at Ga East 
Municipal Hospital or GIDC come back for review. Majority of patients have at least 2 
to 3 reviews before they are discharged from the clinic. These reviews are done 2 weeks 
apart with patients spending at least 6 weeks at the clinic. Some have however spent up 
to a year at the review clinic. Patients are reviewed for the persistence of COVID 
symptoms (cardiovascular, respiratory, neurological), and management of a previously 
well-controlled co-morbid state which due to COVID has now become uncontrolled 
such as diabetes, and hypertension. There are 3 clinical psychologists who assess 
patients at each visit (especially those with persistent neurological deficits).  
Discharge criteria from the clinic are when they are no longer symptomatic, when their 
blood pressure and glucose control is normalized, or when the proximity from their 
homes to the clinic is quite far hence regular visits is causing a financial burden in which 
case, they are transferred to a health facility or general clinic in closer proximity to 
them. As part of the patient’s management, those who had critical-COVID as part of 
their rehabilitation undergo chest physiotherapy, or other forms of physiotherapy either 
at GIDC or are referred to physiotherapy units closer to their homes. 
3.4 Study Population 
The study population were all recovered patients (18years and above) from January 
2021 to October 2021, attending the Ghana Infectious Disease Centre (GIDC) post-
COVID-19 review clinic and who were able and willing to give informed consent to 
participate in the study.  
 
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3.4.1 Inclusion Criteria 
1. Ghanaian adults (18years and above) with laboratory-confirmed diagnoses of 
COVID-19 who had recovered and were attending the review clinic. 
2. Persons who are at least one month in the recovery period. 
3. Persons who were willing and consented to be part of the study. 
3.4.2 Exclusion Criteria 
1. Presence of impairments to reasoning or mental disability such as dementia or 
Alzheimer’s. 
2. Immunocompromised individuals due to medical treatment such as cancer 
treatment patients. 
3. Persons with illnesses that prevented them from taking part in the study such as 
stroke or delirium. 
4. Persons who were not willing and did not consent to be part of the study. 
3.5 Sample Size Determination 
The GIDC post COVID clinic started officially operating from January 2021. Since its 
inception, it has averagely seen 5 patients per day from Mondays to Fridays. Over the 
period from January to June 2021, out of a total number of 782 patients that had been 
seen at the COVID clinic, 209 had been officially discharged to the post-COVID clinic 
following recovery. This was used to determine and calculate the minimum sample size 
using Yamane’s simplified formula. A confidence level of 95% and P=0.05 was 
selected. 
𝑁
𝑛 =  
[ 1 + 𝑁 (𝑒)2 ]
 
 
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Where: 
• n = Sample size 
• N = Population size 
• E = Precision level (Ajay & Micah, 2014) 
• With a population size of 209 and a precision level of 5%, using Yamane’s 
formula, the minimum sample size was estimated as 137 subjects. An attrition 
rate of 10% (13 patients) was considered and added making a total of 150 
patients. 
3.6 Sampling 
A purposive sampling technique was applied to select the study participants. All 
recovered adult patients who attended the Ghana Infectious Disease Centre post-
COVID-19 review clinic between January 2021 and October 2021 were recruited. Thus, 
data was collected at the review clinic from willing participants who were at least one 
month into the recovery period. 
3.7 Variables 
The variables of interest in this study were grouped into dependent and independent 
variables as explained below.  
3.7.1 Dependent Variables 
The dependent variables were quality of life and coping strategies as shown in Table 
3.1. 
 
 
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Table 3.1: Details of dependent variables and Source of data 
Type of variable Variable Operational definition Scale of measurement 
Dependent  Quality of Life A subjective perception / judgement Ratio  
of an individual’s general well-being.  
 Coping Strategies an individual consciously Ordinal  
strategies or unconsciously uses to solve 
problems through cognitive and 
behavioural efforts 
 
3.7.2 Independent Variables 
The independent variables of interest in the study were as follows: 
• Patients’ socio-demographic characteristics: such as age, sex, religion, 
ethnicity, level of education, marital status, occupation and area of residence. 
• Other independent factors were comorbidities, development of complications, 
financial costs, treatment modality, persistence of symptoms, and access to 
rehabilitative services as shown in Table 3.2. 
Table 3.2: Details of independent variables and Source of data 
Type of variable Variable Operational definition Scale of 
measurement 
Independent Age Age at last birthday of participant Ordinal 
variable in years 
 Sex  Gender of participant Binary (Nominal)  
 Occupation  Occupation of participant Nominal  
 Educational Highest level of education attained Ordinal  
level by participant 
 Religious Religious group of participants Nominal  
affiliation 
 Ethnicity Ethnic group affiliation of Nominal  
participants 
 Marital status Marital status of participant Nominal  
 
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Type of variable Variable Operational definition Scale of 
measurement 
 Area of Area of residence of participants Nominal  
residence 
 Comorbidities  The presence of one or more Nominal  
chronic disease conditions 
 Complication  Secondary disease or condition Nominal  
aggravating an already existing one 
 Financial cost Personal expenses incurred by Binary (Nominal) 
participants 
 Treatment Type of treatment offered to Binary (Nominal) 
modality participant 
 Persistence of Symptoms lasting more than Nominal  
symptoms 30days 
 Access to Access to functional rehabilitative Nominal  
rehabilitative services 
services 
 
3.8 Data Collection and Tools 
A structured questionnaire was developed and administered to study participants by the 
principal investigator with the assistance of one designated trained research assistant at 
the treatment centre. (See Appendix 2) 
Section A of the questionnaire included questions on the study participants socio- 
demographic characteristics such as age, sex, ethnicity, educational level, religion, 
occupation/employment status, marital status, and religion. 
Section B of the questionnaire included questions to ascertain the quality of life of study 
participants using the EuroQol Group Association five-domain, five level questionnaire 
(EQ-5D-5L), which is a widely used, worldwide validated questionnaire consisting of 
two sections: the descriptive system (EQ-5D-5L) and the visual analogue scale (EQ-
VAS) (Bekairy et al., 2018; Hunger et al., 2012; Luo et al., 2017; Pinto et al., 2011). 
 
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The descriptive system provides a standardized measure of one’s health status and 
assesses five domains (5D): mobility, self-care, usual activities, pain/discomfort, and 
anxiety/depression. Patients were asked to rate their health states in these 5 domains, 
with five possible response options which indicates the level of severity of the problem 
(no problems, slight problems, moderate problems, severe problems, or extreme 
problems). Value sets were then used to convert these five levels (5L) profile into a 
single index value. Ghana presently has no value sets available hence value sets for 
another African country, Zimbabwe, was used.  
Section C of the questionnaire will solicit answers on the persistence of symptoms, 
comorbidities, worsening of comorbidities, post-COVID complications, and access to 
rehabilitative services, and how these influenced the study participants recovery 
process and quality of life post-COVID-19 infection. Clinical information on the dates 
of participant’s positive COVID test and negative COVID test will be recorded from 
the patient’s medical records. 
Section D of the questionnaire will assess some of the coping strategies that were 
employed by participants during their recovery period from COVID using the Brief-
COPE questionnaire as developed by Carver (Carver et al., 1989). This consists of 14 
subscales comprising 2 items each, making a total of 28 coping strategies (28 different 
questions which depict a particular coping strategy). These are classified under three 
overarching styles of coping (Dias et al., 2012; Thai et al., 2021). The first strategy is 
‘Problem-Focused Coping’ (questions 2, 7, 10, 12, 14, 17, 23, 25) which includes 
Active Coping (2 & 7), Positive Reframing (12 & 17), Planning (14 
& 25), and the Use of Informational Support (10 & 23). This is a positive outcome 
strategy which aims at changing the stressful event. The second strategy is ‘Emotional-
 
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Focused Coping’ (questions 5, 9, 13, 15, 18, 20, 21, 22, 24, 26, 27, 28) which includes 
the Use of Emotional Support (5 & 15), Acceptance (20 & 24), Humour (18 & 28), 
Self-Blame (13 & 26), Religion (22 & 27), and Venting (9 & 21). This has both positive 
and negative outcomes and aims at regulating emotions associated with stressors. The 
third strategy is ‘Avoidant Coping’ (questions 1, 3, 4, 6, 8, 11, 16, 19) which includes 
Self-Distraction (1 & 19), Behavioural Disengagement (6 & 16), Substance Use (4 & 
11), and Denial (3 & 8). This is a negative outcome strategy and is generally 
maladaptive and harmful to one’s well-being. High scores are indicative of efforts to 
disengage physically or cognitively from the stressful situation whereas low scores 
indicate adaptive coping. Participants were asked to rate the degree to which they used 
each coping strategy to deal with the stressful event of COVID-19 during their 
recovery. 
3.9 Safety Considerations 
The questionnaires were administered in a quiet and secluded section of the GIDC 
affording the participant privacy. Informed consent was sought prior to filling the 
questionnaire and participants were reminded of the right to withdraw from the study 
at any point in time.  
3.10 Data Analysis 
3.10.1 Estimating the Quality of life 
EQ-5D-5L 
The EQ-5D-5L tool has 5 domains, each with 5 levels indicating quality of life in the 
respective domains (mobility, self-care, usual activities, pain/discomfort, and 
anxiety/depression). EQ-5D-5L scores are originally from Likert scale domains (an 
 
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ordinal scale) which are then converted to a continuous composite score scale pre-
determined by the developer of the tool (Euroqol Group, 1990; EuroQol Group, 2021). 
Each set of quality-of-life scores chosen constitute a value set that determines a person’s 
overall quality of life based on comparisons with the value sets defined for Zimbabwe, 
which was used as a proxy for Ghana since it was the only African country with value 
sets and there are no value sets for Ghana.  
A single index ranging from <0 to 1.00 was then calculated from the 5 levels using 
these value sets, with a value of 1.00 indicating “full health”, 0 representing “death” 
and values <0 indicating “states worse than death” (Euroqol Group, 1990; EuroQol 
Group, 2021). This was converted to the percentage scale where 1.00 = 100% for easy 
comparison with EQ-VAS which is also on a percentage scale. The use of the EQ-5D-
5L is meant to provide an objective measure of overall quality of life. In this study, the 
EQ-5D had good reliability with a Cronbach’s alpha of 0.79. 
 
EQ-VAS 
Participants also reported their overall health status from their own perspective on a 
visual analogue scale (EQ-VAS) which is a scale ranging from 0 to 100, where 0 
represented their “worst imaginable health” and 100 represented their “best imaginable 
health status”. The use of the EQ-VAS is meant to provide a subjective measure of 
overall quality of life. 
Scores from EQ-VAS (which is a subjective assessment) was used in comparison with 
scores from EQ-5D-5L (which is an objective measure) to determine if they were 
correlated. 
 
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3.10.2 Assessment of Coping Strategies 
The Brief-COPE used in this study to assess coping strategies has been validated in 
several populations, has different language translations and has a good Cronbach’s 
alpha of 0.87 (Garcia et al., 2018; Mohanraj et al., 2015; Peters et al., 2020) which was 
comparable to the Cronbach’s alpha reliability coefficient in this study which was 0.82. 
A 4-point Likert scale was used for rating coping strategies, and this ranged from 1 – 
“I haven’t been doing this at all” to 4 – “I have been doing this a lot”. The coping 
strategies were grouped into three broad themes and each theme further broken down 
into sub-themes made up of pairs of similar strategies (as described in section 3.8). The 
average scores for the paired coping strategies as well as for the three overarching sub-
themes were computed and presented to indicate the degree to which study participants 
utilized each coping style.  
3.10.3 Data Analysis 
Data was entered into Microsoft Excel 2016, cleaned, and exported to Stata version 16 
for statistical analysis. 
Descriptive statistics were provided for all variables and presented in tables using 
frequencies and percentages for categorical variables and using means and standard 
deviations for continuous variables. Worsening of comorbidities was assessed using 
patient’s clinical records where their first vitals recorded at the COVID clinic was taken 
as their baseline. Subsequent recordings that were taken at the post-COVID clinic were 
analysed to see trends / patterns using clinical judgement as a clinician. Worsening of 
comorbidities were reported as vital statistics which were abnormal and/or difficult to 
control (bring values to normal). 
 
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Analysis of variance was used to test for differences in means across categories of the 
socio-demographic factors, symptoms, comorbidities, complications, and treatment 
modalities. Linear regression was also used to determine factors associated with the 
outcome variables (Quality of life and Coping strategies). A level of significance was 
set at p<0.05. Factors that were statistically significant were fitted into an adjusted 
multiple linear regression model and presented in a table with 95% confidence intervals 
(CI). Spearman correlation was also used to establish the linear relationship between 
Quality of life and Coping strategies. 
Graphs indicating the means and standard deviations were used to describe Quality of 
life scores and types of Coping strategies used. 
Internal consistency of the tools used in measuring Quality of life and Coping strategies 
was assessed using the Cronbach’s alpha. 
3.11 Ethical Consideration 
The following activities were undertaken to ensure compliance with the ethical issues 
underlying the study.  
3.11.1 Quality Assurance and Pretesting 
Each questionnaire was coded with a unique identification number. Pre-testing was 
done at the Korle -Bu COVID-19 treatment unit to assess feasibility of the study. 
Questionnaires were modified based on pre-testing results before final administration 
to study participants. 
Questionnaires were checked manually to ascertain completeness and subsequently 
entered into Microsoft excel 2016. Data was cleaned and validated. Quality checks and 
 
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internal consistency checks were conducted to ensure validity and completeness of the 
data before analysis was done.  
A medical doctor and a registered nurse at the Ghana Infectious Disease Centre (GIDC) 
received training and were provided with Standard Operation Procedures (SOPs) to 
follow before the field work. They were fluent in English, Twi and Ga and were 
monitored to ensure compliance with SOPS. 
3.11.2 Ethical Clearance 
The research proposal was submitted to the Ghana Health Service Ethics Review 
Committee to attain ethical approval to undertake the study (Approval ID: GHS – ERC 
029/07/21). A permission letter was also provided by the School of Public Health to the 
Ghana Infectious Disease Centre (GIDC) for study site approval. 
3.11.3 Risks and Benefits 
Participants were not put at any physical risk. There were no immediate or direct 
benefits from participating in the study. Responses were however helpful in providing 
evidence for recommendations to appropriate authorities to help guide policies on post-
discharge care and follow-up after COVID-19 infection, rehabilitation, and social 
support systems, as well as providing evidence to inform guidelines on Health 
Promotion. 
3.11.4 Compensation / Payment 
Payments were not given to participants in this study.  
3.11.5 Right to Refuse 
Participation was strictly voluntary.  
 
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3.11.6 Anonymity and Confidentiality 
Participants provided information in privacy and were assured of confidentiality. 
Unique ID numbers were generated to identify participants of the study. 
3.11.7 Participant’s Consent 
The purpose for which the study was being conducted was extensively explained to all 
participants in languages that they understood. Attached to each questionnaire was a 
participants information sheet and consent form which was administered to all study 
participants who agreed to participate in the research. 
3.11.8 Data Storage, Security and Usage 
Completed questionnaires were stored in cabinets under lock and key. Electronic files 
were encrypted, stored in a folder with a password, backed-up and only accessible to 
the principal investigator. Data will be deleted after 2 years of completion of the study.  
3.12 Summary of Chapter 
This chapter outlined the methods applied for data collection and analysis. A fixed 
methods design using a quantitative approach was used to assess the quality of life of 
COVID-19 recovered patients (18 years and above) at the Ghana Infectious Disease 
Centre (GIDC). The knowledge paradigm applied was positivism and the disciplines 
outlined in the research included epidemiology, political science, welfare economics, 
and public health. Sample size was determined using Yamane’s formula and a 
purposive non-probability sampling technique was used to collect data. A survey was 
conducted using self-administered structured questionnaires. Data was entered into 
excel and exported to Stata for analysis. Internal consistency of the tools used in 
 
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measuring Quality of life and Coping strategies was assessed using the Cronbach’s 
alpha. All due ethical considerations were observed. 
  
 
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4 RESULTS 
4.0 Introduction 
This chapter shows the results obtained from the study which is based on the analysed 
data. It is divided into six sections. The first section presents the frequencies and 
percentages of all independent variables used in this study (socio-demographic 
characteristics, persistent symptoms, comorbidities, complications, rehabilitation, and 
treatment factors). Section two presents information on the Quality of life of 
participants (EQ-5D-5L and EQ-VAS). The third section presents information on the 
predictors of Quality of life. The fourth section presents information on the types of 
coping strategies used. The fifth section presents information on the predictors of the 
styles of coping used. Section six presents information on the association between 
Quality of life and the Coping strategies used.  
4.1 Characteristics Of Study Participants 
4.1.1 Socio-demographic Characteristics of Respondents 
The socio-demographic characteristics of participants are shown in Table 4.1. The mean 
age of respondents was 43.3 ± 14.8 years with most of them falling between the age 
group of 30-39years (35.3%). There were more females 82 (54.7%) than males, the 
dominant religion was Christianity (90%) and 46% were mostly Akan. Majority, (66%) 
of respondents were married, (94.7%) resided in urban areas, 83.3% had attained 
tertiary level education and 71.3% were formally employed. Although most of 
respondents were non – health workers (58.7%), out of the 41.3% who were health 
workers, doctors formed the majority constituting 72.6%. 
 
 
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Table 4.1: Socio-demographic characteristics of respondents (N = 150) 
 N % 
Age (years), Mean=43.3, SD=14.8   
<30 21 14.0 
30-39 53 35.3 
40-49 30 20.0 
50-59 23 15.3 
60+ 23 15.3 
Sex   
Male 68 45.3 
Female 82 54.7 
Religion   
Christian 135 90.0 
Muslim 8 5.3 
Other 7 4.7 
Ethnicity   
Ga-Dangme 32 21.3 
Akan 69 46.0 
Ewe 29 19.3 
Northern tribe 12 8.0 
Other 8 5.3 
Marital status   
Single 33 22.0 
Married 99 66.0 
Separated/ Divorced 3 2.0 
Widow(er) 15 10.0 
Place of residence   
Urban 142 94.7 
Non-urban 8 5.3 
Educational level   
Primary 5 3.3 
Secondary 11 7.3 
Tertiary 125 83.3 
Vocational/Technical 9 6.0 
Occupation   
Student 3 2.0 
Formally employed 107 71.3 
Informally employed 23 15.3 
Unemployed 8 5.3 
Retired  9 6.0 
Healthcare worker   
No 88 58.7 
Yes  62 41.3 
Specialty, if healthcare worker   
Doctor 45 72.6 
Nurse 14 22.6 
Other  3 4.8 
Total 150 100.0 
 
 
 
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4.1.2 Persistent Symptoms and Treatment Characteristics of Respondents 
Majority of respondents (52.7%) reported persistence of symptoms, with the most 
reported symptom being easy fatiguability constituting 63.3%, followed closely by 
headache (46.8%) then muscle ache (41.8%) as shown in Table 4.2. Abdominal pain, 
diarrhoea, nausea, and vomiting constituted only 2.5%. Sixty percent of respondents 
were not offered treatment or isolation services at their primary healthcare facility with 
three-quarters of respondents (75.3) undergoing self-isolation at home. Although 64.7% 
of medications were available at COVID-19 treatment facilities, 86% of respondents 
incurred personal financial costs with most of such costs resulting from medications 
(97.7%). 
Table 4.2: Persistent symptoms and treatment characteristics of respondents (N = 150) 
 N % 
Persistent symptoms (after 30 days)   
No 71 47.3 
Yes  79 52.7 
Symptoms (that persisted after 30 days) *   
Easy fatigue 50 63.3 
Headache 37 46.8 
Muscle ache 33 41.8 
Extreme fatigue 29 36.7 
Cough 24 30.4 
Dyspnoea 18 22.8 
Chest pain 17 21.5 
Ageusia 17 21.5 
Anosmia 15 19.0 
Sleep disorder 13 16.5 
Fever 6 7.6 
Attention Disorder 4 5.1 
Rigor 3 3.8 
Memory loss 3 3.8 
Abdominal pain 2 2.5 
Nausea & Vomiting 2 2.5 
Diarrhoea 2 2.5 
Treatment or isolation services at Primary healthcare facility   
Not offered 90 60.0 
Offered 60 40.0 
*Multiple responses were required 
 
 
 
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Table 4.2 (continued) 
 N % 
Medications available at COVID-19 treatment facility   
Not all available 53 35.3 
All available 97 64.7 
Personal financial costs incurred   
No 21 14.0 
Yes  129 86.0 
Reason for incurred cost*   
Length of stay 4 3.1 
Medications 126 97.7 
Ventilatory support 1 0.8 
Laboratory investigations 102 79.1 
Treatment modality   
Hospital admission 37 24.7 
Self-isolation at home 113 75.3 
Total 150 100.0 
*Multiple responses were required 
 
 
4.1.3 Comorbidities and Complications of Respondents 
Majority of respondents (58%) had no comorbidities. Out of those that had 
comorbidities, majority (65.1%) were hypertensives whiles only one person had 
chronic kidney disease. Twenty – three percent of respondents reported worsening of 
comorbidities with hypertension constituting the most worsened comorbidity (68.6%) 
as shown in Table 4.3. Almost a quarter of the respondents also reported the 
development of complications (23.3%), with 17.1% reporting post-traumatic stress 
disorder as the major complication and only one person reported cerebro-vascular 
accident and viral cystitis. 
  
 
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Table 4.3: Comorbidities and complications of respondents (N = 150) 
 N % 
Comorbidities prior to COVID-19 infection   
No 87 58.0 
Yes  63 42.0 
Comorbidities present (pre-COVID) *   
Diabetes 19 30.2 
Sickle cell disease 2 3.2 
Obesity 12 19.1 
Chronic kidney disease 1 1.6 
Hypertension 41 65.1 
Asthma 8 12.7 
Dyslipidaemia 10 15.9 
Comorbidities worsening post-COVID   
No 115 76.7 
Yes  35 23.3 
Comorbidities worsened (difficult to manage) *   
Diabetes 14 40.0 
Sickle cell disease 1 2.9 
Chronic kidney disease 1 2.9 
Dyslipidaemia 2 5.7 
Hypertension 24 68.6 
Asthma 3 8.6 
Migraine 1 2.9 
Complications post-COVID-19 infection   
No 115 76.7 
Yes  35 23.3 
Complications*   
Post-traumatic stress disorder 6 17.1 
Pulmonary embolism 2 5.7 
Difficulty mobilizing 4 11.4 
Cerebro-vascular accident / Stroke 1 2.9 
Deep vein thrombosis 3 8.6 
Acute kidney injury 3 8.6 
Total 150 100.0 
*Multiple responses were required 
 
  
 
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4.1.4 Rehabilitation Factors of Respondents 
Majority of respondents (88%) were not offered rehabilitative services. Out of those 
that were offered rehabilitative services, 66.7% benefited from chest physiotherapy. 
Only nine reported having access to a rehabilitative centre and seven of them required 
psychotherapy as shown in Table 4.4. 
Table 4.4: Rehabilitation factors of respondents (N = 150 
 N % 
Rehabilitative services post-COVID   
Not offered 132 88.0 
Offered 18 12.0 
Services offered*   
Chest physiotherapy 12 66.7 
Psychotherapy (Psychologist) 5 27.8 
Limb physiotherapy 7 38.9 
Access to rehabilitative centre   
No 141 94.0 
Yes  9 6.0 
Services rendered, if Yes*   
Chest physiotherapy 5 55.6 
Psychotherapy (Psychologist) 7 77.8 
Limb physiotherapy 6 66.7 
Reason for lack of access, if No   
Not required 104 73.8 
Not told 23 16.3 
None-available 9 6.4 
Too expensive 1 0.7 
Too far away 2 1.4 
Didn’t know where to assess services 2 1.4 
Total 150 100.0 
*Multiple responses were required 
  
 
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4.2 Quality of Life of Study Participants 
Overall mean Quality of life measured on the EQ-5D-5L percentage scale was slightly 
higher (81.5 ± 12.0) % than the self-reported EQ-VAS (75.6 ± 22.0) % as shown in 
Figure 4.1, with a wider range of scores observed from the EQ-VAS. 
 
Figure 4.1: Quality of life 
 
A larger proportion of participants suffered from mild to extreme symptoms of anxiety 
or depression (33.3%) followed closely by those who suffered varying degrees of pain 
or discomfort (32.7%) as shown in Table 4.5. 
Table 4.5: Reported problems (mild to extreme) from EQ-5D-5L Questionnaire 
 N = 150 % 
Mobility: problems with walking around 39 26.0 
Self-care: problems with washing or dishing 24 16.0 
Usual activity: problems with usual activity  40 26.7 
Pain or discomfort 49 32.7 
Anxiety or depression 50 33.3 
 
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4.3 Predictors of Quality of Life 
4.3.1 Quality of Life and Socio-demographic Characteristics  
4.3.1.1 EQ-5D-5L 
Unadjusted linear regression analysis of Quality of Life (EQ-5D-5L) % scores on socio-
demographic characteristics showed significant reduction in quality of life for older 
participants by 0.15% for each additional year (p=0.023). There were significant 
differences in mean quality-of-life score (p=0.033) where those who had up to 
secondary education had a mean score 6.62% lower compared to those with primary 
education and those with vocational/technical education had a mean quality-of-life 
score 7.05% lower compared to those with primary education as shown in Table 4.6. 
There were also significant differences in mean quality-of-life score (p=0.032) for the 
specialty of healthcare workers where nurses had a mean score 8.13% lower than 
doctors and other healthcare workers (pharmacists and healthcare assistants) had a 
mean score 5.68% lower than doctors.  
There were no significant differences in the mean quality-of-life EQ-5D-5L score 
across the other socio-demographic factors such sex, religion, ethnicity, marital status, 
place of residence, and occupation. 
4.3.1.2 EQ-VAS 
Unadjusted linear regression analysis of Quality of Life (EQ-VAS) % scores on socio-
demographic characteristics showed significant reduction in mean quality of life score 
(p=0.029) for sex where females had a mean score of 7.84% lower than males. There 
were also significant differences in mean quality-of-life score (p=0.015) where those 
who had up to secondary education had a mean score 2.00% lower compared to those 
with primary education as shown in Table 4.6. 
 
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Significant differences in mean quality-of-life score (p=0.002) were also reported for 
the specialty of healthcare workers where nurses had a mean score 22.30% lower than 
doctors and other healthcare workers (pharmacists and healthcare assistants) had a 
mean score 4.80% lower than doctors.  
There were no significant differences in the mean quality-of-life (EQ-VAS) score 
across the other socio-demographic factors such as age, religion, ethnicity, marital 
status, place of residence, and occupation. 
 
 
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Table 4.6: Unadjusted linear regression of Quality of Life (EQ-5D-5L and EQ-VAS) % scores on socio-demographic characteristics 
 EQ-5D-5L (% scale)  EQ-VAS (% scale) 
 Unadjusted  95% CI   Unadjusted 95% CI  
 Coeff**  Lower Upper P-value  Coeff** Lower Upper P-value 
Age (years) -0.15  -0.28 -0.02 0.023†  -0.18 -0.42 0.06 0.132 
Sex     0.127     0.029† 
Male Ref   Ref   
Female -3.00 -6.87 0.86 -7.84 -14.86 -0.81 
Religion     0.715     0.873 
Christian Ref   Ref   
Muslim 1.74 -6.91 10.39 -3.01 -18.90 12.87 
Other 3.44 -5.78 12.65 2.93 -13.99 19.86 
Ethnicity     0.807     0.355 
Ga-Dangme Ref   Ref   
Akan 0.80 -4.30 5.91 0.38 -8.89 9.65 
Ewe -2.00 -8.12 4.12 -3.52 -14.63 7.59 
Northern tribe -0.61 -8.69 7.47 -13.40 -28.07 1.28 
Other 2.97 -6.46 12.40 -2.31 -19.45 14.82 
Marital status     0.525     0.489 
Single Ref   Ref   
Married -0.11 -4.88 4.66 6.66 -2.08 15.40 
Separated/ Divorced 1.59 -12.72 15.90 9.33 -16.89 35.56 
Widow(er) -4.88 -12.26 2.51 3.67 -9.88 17.21 
Place of residence     0.571     0.193 
Urban Ref   Ref   
Non-urban -2.48 -11.10 6.14 -10.42 -26.15 5.31 
† Statistically significant. **Coefficients implies the mean differences of the dependent variable per unit change of the predictors. 
 
 
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Table 4.6 (continued) 
 EQ-5D-5L (% scale)  EQ-VAS (% scale) 
 Unadjusted  95% CI   Unadjusted 95% CI  
 Coeff**  Lower Upper P-value  Mean diff Lower Upper P-value 
Educational level     0.033†     0.015† 
Primary Ref   Ref   
Secondary -6.62 -19.13 5.90 -2.00 -24.82 20.82 
Tertiary 1.65 -8.94 12.23 16.10 -3.20 35.40 
Vocational/Technical -7.05 -19.99 5.90 5.78 -17.83 29.38 
Occupation     0.381     0.027† 
Student Ref   Ref   
Formally employed -4.67 -18.52 9.17 7.96 -16.85 32.77 
Informally employed -9.87 -24.39 4.65 -7.83 -33.84 18.19 
Unemployed -5.14 -21.15 10.87 8.75 -19.94 37.44 
Retired  -5.53 -21.30 10.23 11.11 -17.14 39.37 
Healthcare worker     0.484     0.066 
No Ref   Ref   
Yes  1.40 -2.54 5.33 6.68 -0.46 13.82 
Specialty, if healthcare worker     0.032†     0.002† 
Doctor Ref   Ref   
Nurse -8.13 -14.34 -1.93 -22.30 -34.01 -10.59 
Other  -5.68 -17.76 6.41 -4.80 -27.61 18.01 
† Statistically significant. **Coefficients implies the mean differences of the dependent variable per unit change of the predictors. 
 
 
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4.3.2 Quality of Life and Symptoms, Comorbidities, Complications, and Treatment 
4.3.2.1 EQ-5D-5L 
Unadjusted linear regression analysis of Quality of Life (EQ-5D-5L) % scores on 
symptoms showed significant differences in mean quality-of-life score (p<0.001) for 
participants who had persistent symptoms after 30days where their mean score was 
11.94% lower compared to those who did not have such symptoms. The lowest 
reduction was seen in those who experienced ageusia, followed by those who 
experienced dyspnoea as shown in Table 4.7. Those who had comorbidities prior to 
COVID-19 infection had mean quality-of-life score 3.88% lower than those who did 
not have any comorbidities (p=0.050). There were significant differences in the mean 
score (p=0.031) where those who had worsening comorbidities post-COVID-19 
infection had a mean score 4.99% lower compared to those whose comorbidities did 
not worsen. There were also significant differences (p<0.001) where those who had 
complications post-COVID had a mean quality-of-life score 11.43% lower than those 
who had no complications. Significant differences (p=0.031) were also seen in those 
who were offered rehabilitative services post-COVID, where the mean score was 6.49% 
lower for those who were offered rehabilitative services as compared to those who were 
not offered.  
There were no significant differences seen in the mean quality-of-life EQ-5D-5L score 
for the type of treatment modality used, access to rehabilitative centres, and for 
participants who incurred personal financial costs. 
 
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4.3.2.2 EQ-VAS 
Unadjusted linear regression analysis of Quality of Life (EQ-VAS) % scores on 
symptoms showed significant differences in mean quality-of-life score (p<0.001) for 
participants who had persistent symptoms after 30days where their mean score was 
16.83% lower compared to those who did not have such symptoms. The lowest 
reduction was seen in those who experienced sleep disorder, followed by those who 
experienced chest pain and dyspnoea as shown in Table 4.7. Those who had 
comorbidities prior to COVID-19 infection had mean quality-of-life score 10.88% 
lower than those who did not have any comorbidities (p=0.003). There were significant 
differences (p<0.001) where those who had worsening comorbidities post-COVID-19 
infection had a mean score 17.57% lower compared to those whose comorbidities did 
not worsen.  
There were also significant differences (p<0.001) for participants who had 
complications post-COVID with a mean quality-of-life score 18.54% lower than those 
who had no complications. Respondents who had access to rehabilitative centres 
reported significant differences (p=0.007) with a mean score 20.16% lower compared 
to those who did not. Additionally, significant differences (p=0.004 and p=0.001) were 
reported for the treatment modality and being offered rehabilitative services 
respectively where those who were self-isolated at home had a 11.94% higher mean 
quality-of-life score than those on hospital admission, and those who were offered 
rehabilitative services post-COVID had a 6.83% higher mean score than those who 
were not offered such services.  
There were no significant differences seen in the mean quality-of-life EQ-VAS score 
for participants who incurred personal financial costs.
 
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Table 4.7: Unadjusted linear regression of Quality of Life (EQ-5D-5L and EQ-VAS) % scores on symptoms, comorbidities, complications, and treatment 
 EQ-5D-5L (% scale)  EQ-VAS (% scale) 
 Unadjusted  95% CI   Unadjusted 95% CI  
 Coeff.  Lower Upper P-value  Coeff. Lower Upper P-value 
Persistent symptoms (after 30 days)     <0.001†     <0.001† 
No Ref    Ref    
Yes  -11.94 -15.30 -8.57 -16.83 -23.41 -23.41 
Symptoms (that persisted after 30 days) *           
Headache         
Muscle ache -13.67 -17.58 -9.76 <0.001† -19.43 -27.05 -11.81 <0.001† 
Cough -13.54 -17.67 -9.41 <0.001† -21.96 -29.77 -14.15 <0.001† 
Chest pain -10.31 -15.32 -5.29 <0.001† -24.29 -33.15 -15.43 <0.001† 
Ageusia -9.84 -15.74 -3.93 <0.001† -28.89 -39.07 -18.70 <0.001† 
Anosmia -16.90 -22.37 -11.44 <0.001† -18.27 -29.09 -7.46 0.001† 
Extreme fatigue -13.54 -19.62 -7.46 <0.001† -16.90 -28.43 -5.37 0.004† 
Dyspnoea -13.72 -18.09 -9.34 <0.001† -9.63 -20.97 1.72 <0.001† 
Easy fatigue -15.21 -20.64 -9.78 <0.001† -26.27 -36.34 -16.19 <0.001† 
Sleep disorder -11.61 -15.26 -7.96 <0.001† -17.75 -24.72 -10.78 <0.001† 
-12.07 -18.67 -5.46 <0.001† -33.10 -44.53 -21.66 <0.001† 
Comorbidities prior to COVID-19 infection     0.050     0.003† 
No Ref    Ref    
Yes  -3.88 -7.75 0.00 -10.88 -17.87 -3.90 
Comorbidities worsening post-COVID     0.031†     <0.001† 
No Ref    Ref    
Yes  -4.99 -9.50 -0.48 -17.57 -25.48 -9.66 
Complications post-COVID-19 infection     <0.001†     <0.001† 
No Ref    Ref    
Yes  -11.43 -15.62 -7.24 -18.54 -26.39 -10.69 
*Multiple responses were required. †Statistically significant. **Coefficients implies the mean differences of the dependent variable per unit change of the predictors 
 
 
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Table 4.7 (continued) 
 EQ-5D-5L (% scale)  EQ-VAS (% scale) 
 Unadjusted  95% CI   Unadjusted 95% CI  
 Coeff.  Lower Upper P-value  Coeff. Lower Upper P-value 
Personal financial costs incurred     0.721     0.266 
No Ref   Ref   
Yes  -1.01 -6.59 4.58 -5.77 -15.97 4.44 
Treatment modality     0.054     0.004† 
Hospital admission Ref   Ref   
Self-isolation at home 4.36 -0.08 8.80 11.94 3.92 19.95 
Rehabilitative services post-COVID     0.031†     0.001† 
Not offered Ref   Ref   
Offered -6.49 -12.36 -0.62 6.83 -2.02 15.68 
Access to rehabilitative centre     0.057     0.007† 
No Ref    Ref    
Yes  -7.84 -15.90 0.22 -20.16 -34.77 -5.55 
*Multiple responses were required. †Statistically significant. **Coefficients implies the mean differences of the dependent variable per unit change of the predictors 
 
 
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4.3.3 Factors Influencing Quality of Life among respondents  
4.3.3.1 EQ-5D-5L. 
Adjusted linear regression analysis of factors influencing Quality of Life (EQ-5D-5L) 
% scores among respondents showed significant differences in mean quality-of-life 
score (p<0.001) for participants who had persistent symptoms after 30days where their 
mean score was 9.18% lower compared to those who did not have such symptoms. 
Significant differences (p=0.008) were seen in participants who had complications with 
a mean score of 6.62 lower compared to those who didn’t have after controlling for the 
other factors in the model shown in Table 4.8. 
There were no significant differences in adjusted mean quality-of-life EQ-5D-5L scores 
across age, educational level, comorbidities, treatment modality, offering of- and access 
to- rehabilitative services. 
After the multivariate analysis only persistent symptoms after 30 days and 
complications post-COVID-19 infection remained significant independent predictors 
of quality of life, thereby confounding other factors previously thought significant 
predictors. 
4.3.3.2 EQ-VAS 
Adjusted linear regression analysis of factors influencing Quality of Life (EQ-VAS) % 
scores among respondents showed significant differences in mean quality-of-life score 
(p=0.047) for sex, where females reported a mean quality-of-life score 6.50% lower 
than males. There were also significant differences (p=0.020) for participants who had 
persistent symptoms after 30days where their mean score was 8.62% lower compared 
 
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to those who did not have such symptoms after controlling for the other factors in the 
model shown in Table 4.8. Respondents who reported having worsening comorbidities 
also showed significant differences (p=0.035) with a mean quality-of-life score 11.55% 
lower than those who did not have worsening comorbidities. Participants who reported 
complications post-COVID had significant differences (p=0.026) with a mean score of 
10.50% lower compared to those who didn’t have complications.  
There were no significant differences in adjusted mean quality-of-life EQ-VAS scores 
across age, educational level, occupation, comorbidities prior to COVID-19 infection, 
for the treatment modality, being offered and having access to rehabilitative services. 
After the multivariate analysis only sex, persistent symptoms after 30 days, 
complications post-COVID-19 infection, and comorbidities worsening post-COVID 
remained significant independent predictors of quality of life, thereby confounding 
other factors previously thought significant predictors. 
 
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Table 4.8: Adjusted linear regression of factors influencing Quality of Life (EQ-5D-5L and EQ-VAS) % scores among respondents 
 EQ-5D-5L (% scale)  EQ-VAS (% scale) 
 Adjusted  95% CI   Adjusted 95% CI  
 Coeff.  Lower Upper P-value  Coeff. Lower Upper P-value 
Age (years) -0.02  -0.17 0.12 0.759  0.14 -0.19 0.47 0.403 
Sex          0.047† 
Male -- -- -- Ref   
Female -- -- -- -6.50 -12.90 -0.10 
Educational level     0.309     0.543 
Primary Ref   Ref   
Secondary -6.04 -17.34 5.25 -2.35 -24.09 19.39 
Tertiary -0.79 -10.53 8.95 7.47 -12.64 27.59 
Vocational/Technical -5.28 -17.01 6.45 2.23 -20.18 24.63 
Occupation          0.444 
Student -- -- -- Ref   
Formally employed -- -- -- 6.50 -16.73 29.72 
Informally employed -- -- -- 0.66 -23.98 25.31 
Unemployed -- -- -- 10.21 -17.97 38.40 
Retired -- -- -- 17.02 -12.53 46.57 
Persistent symptoms (after 30 days)     <0.001†     0.020† 
No Ref   Ref   
Yes -9.18 -13.03 -5.33 -8.62 -15.85 -1.38 
Comorbidities prior to COVID-19 infection     0.917     0.904 
No Ref   Ref   
Yes -0.24 -4.70 4.23 -0.52 -9.09 8.04 
Comorbidities worsening post-COVID     0.726     0.035† 
No Ref   Ref   
Yes -0.99 -6.58 4.60 -11.55 -22.24 -0.85 
Complications post-COVID-19 infection     0.008†     0.026† 
No Ref   Ref   
Yes -6.62 -11.52 -1.73 -10.50 -19.70 -1.30 
† Statistically significant. Variables with blanks were excluded from the model. **Coeff. implies the mean differences of the dependent variable per unit change of the predictors 
 
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Table 4.8 (continued)  
 EQ-5D-5L (% scale)  EQ-VAS (% scale) 
 Adjusted  95% CI   Adjusted 95% CI  
 Coeff.  Lower Upper P-value  Coeff Lower Upper P-value 
Treatment modality     0.331     0.808 
Hospital admission Ref   Ref   
Self-isolation at home -2.45 -7.41 2.52 1.14 -8.07 10.34 
Rehabilitative services post-COVID     0.914     0.285 
Not offered Ref   Ref   
Offered -0.40 -7.75 6.94 -7.41 -21.07 6.24 
Access to rehabilitative centre     0.982     0.705 
No Ref   Ref   
Yes 0.11 -9.88 10.10 3.55 -15.00 22.11 
† Statistically significant. Variables with blanks were excluded from the model. **Coefficients implies the mean differences of the dependent variable per unit change of the 
predictors 
 
 
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4.4 Coping Strategies Used by Study Participants 
The highest coping strategy used by participants was problem-focused coping with a 
mean of 2.71 ± 0.64 SD on a scale 1 (no use at all) to 4 (used a lot). This was followed 
by emotional-focused coping with a mean of 2.32 ± 0.43 SD and lastly avoidant coping 
with a mean of 1.57 ± 0.39 SD as seen in Figure 4.2. 
 
Figure 4.2: Overall Coping Strategy 
 
4.4.1 Problem-focused Coping 
With Problem-focused coping, majority of respondents reported the use of 
informational support as their predominant coping style with a mean of 3.07 ± 0.98 SD. 
The least used was positive reframing with a mean of 2.23 ± 1.00 SD as shown in Figure 
4.3. 
 
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Figure 4.3: Problem-focused coping strategy 
 
4.4.2 Emotional-focused Coping 
With Emotional-focused coping strategy, majority of respondents utilised emotional 
support as their main coping style with a mean of 3.20 ± 0.89 SD. the least used style 
of coping was self-blame with a mean of 1.41 ± 0.67 SD as shown in Figure 4.4. 
 
Figure 4.4: Emotional-focused coping strategy 
 
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4.4.3 Avoidant Coping 
With Avoidant coping, the most used coping style was self-distraction with a mean of 
2.57 ± 1.03 SD and the least reported style of coping was substance use with a mean of 
1.05 ± 0.20 SD as shown in Figure 4.5. 
 
Figure 4.5: Avoidant coping strategy 
 
4.5 Predictors of Coping Styles Used by Study Participants 
4.5.1 Socio-demographic Characteristics and Coping Strategies 
Significant differences in mean avoidant coping scores were observed across age 
categories (p=0.011) where the highest score was observed among those aged 40-49 
years and the least among those aged 30-39 years as seen in Table 4.9. There were also 
significant differences in avoidant coping scores (P=0.004) as well as problem-focused 
coping scores (P=0.013) among healthcare worker profession where higher scores were 
observed for non-healthcare workers for both types of coping styles. There were no 
 
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significant differences observed for the other socio-demographic characteristics (sex, 
religion, ethnicity, marital status, place of residence and occupation) across all three 
coping strategy styles. 
Table 4.9: Socio-demographic characteristics and Coping strategies 
 Avoidant coping  Problem-focused  Emotional-focused 
 Mean SD P-value  Mean SD P-value  Mean SD P-value 
Age (years)   0.011†   0.618   0.623 
<30 1.63 0.39 2.55 0.56 2.33 0.35 
30-39 1.43 0.28 2.69 0.67 2.33 0.41 
  
40-49 1.70 0.43 2.76 0.63 2.37 0.47 
50-59 1.68 0.39 2.85 0.69 2.35 0.50 
60+ 1.55 0.44 2.70 0.63 2.19 0.46 
Sex   0.117   0.394   0.094 
Male 1.52 0.39  2.66 0.65  2.25 0.39 
Female 1.62 0.38 2.75 0.64 2.37 0.46 
Religion   0.750   0.815   0.208 
Christian 1.56 0.38 2.70 0.65 2.32 0.44 
  
Muslim 1.67 0.55 2.84 0.64 2.48 0.29 
Other 1.57 0.26 2.75 0.49 2.08 0.35 
Ethnicity   0.337   0.717   0.233 
Ga-Dangme 1.50 0.27 2.81 0.67 2.26 0.51 
Akan 1.61 0.39 2.73 0.64 2.38 0.40 
  
Ewe 1.49 0.33 2.58 0.62 2.18 0.46 
Northern tribe 1.67 0.64 2.69 0.58 2.40 0.34 
Other 1.69 0.41 2.64 0.81 2.40 0.41 
Marital status   0.560   0.183   0.324 
Single 1.57 0.35 2.75 0.61 2.37 0.31 
Married 1.57 0.39  2.69 0.64  2.31 0.46 
Separated/ Divorced 1.88 0.76 3.46 0.52 2.64 0.57 
Widow(er) 1.53 0.36 2.59 0.71 2.19 0.43 
Place of residence   0.956   0.337   0.917 
Urban 1.57 0.38  2.70 0.65  2.32 0.44 
Non-urban 1.58 0.45 2.92 0.53 2.30 0.27 
Educational level   0.136   0.689   0.424 
Primary 1.85 0.32 2.93 0.83 2.22 0.73 
Secondary 1.50 0.46  2.83 0.80  2.42 0.42 
Tertiary 1.55 0.36 2.70 0.64 2.30 0.43 
Vocational/Technical 1.76 0.61 2.56 0.43 2.51 0.34 
Occupation   0.213   0.469   0.478 
Student 1.75 0.13 2.58 0.63 2.28 0.32 
Formally employed 1.53 0.34 2.68 0.63 2.32 0.45 
  
Informally employed 1.67 0.53 2.92 0.68 2.43 0.38 
Unemployed 1.78 0.34 2.50 0.65 2.14 0.53 
Retired  1.58 0.47 2.71 0.75 2.21 0.36 
Healthcare worker   0.004†   0.013†   0.648 
No 1.65 0.39  2.82 0.61  2.33 0.42 
Yes  1.46 0.36 2.55 0.66 2.30 0.46 
Overall 1.57 0.39   2.71 0.64   2.32 0.43  
† Statistically significant 
 
 
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4.5.2 COVID-19 Related Characteristics and Coping Strategies 
Significant differences were observed in both avoidant coping (P<0.000) and problem-
focused coping (P=0.037) scores for participants who developed complications post-
COVID-19 infection where they scored higher than those who did not develop any 
complications as seen in Table 4.10. Participants who had persistent symptoms after 30 
days were also observed to have higher scores than those who didn’t have with 
significant differences being observed for emotional-focused coping scores (P=0.031). 
No significant differences were observed for the other COVID-19 related 
characteristics (prior comorbidities and worsening comorbidities) across all three 
coping styles. 
Table 4.10: COVID-19 related characteristics and Coping strategies 
 Avoidant coping  Problem-focused  Emotional-focused 
 Mean SD P-value  Mean SD P-value  Mean SD P-value 
Persistent symptoms 0.135 0.242 0.031† 
(after 30 days)       
No 1.52 0.30  2.64 0.68  2.24 0.47 
Yes  1.62 0.45 2.77 0.61 2.39 0.39 
Comorbidities prior to   0.233   0.710   0.869 
COVID-19 infection       
  
No 1.54 0.34 2.69 0.64 2.32 0.43 
Yes 1.62 0.43 2.73 0.64 2.31 0.44 
Comorbidities worsening   0.051   0.589   0.840 
post-COVID       
  
No 1.54 0.34 2.69 0.66 2.32 0.42 
Yes 1.68 0.49 2.76 0.60 2.30 0.47 
Complications post-   <0.000†   0.037†   0.061 
COVID-19 infection       
  
No 1.51 0.33 2.65 0.63 2.28 0.44 
Yes 1.78 0.47 2.91 0.63 2.44 0.41 
Overall 1.57 0.39   2.71 0.64   2.32 0.43  
† Statistically significant 
 
 
 
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4.6 Association Between Quality of Life and Coping Strategies 
From the Spearman correlation analysis, higher quality of life EQ-5D-5L scores were 
significantly associated with lower use of positive reframing, venting, religion, and 
behavioural disengagement coping strategies as seen in Table 4.11. Higher quality of 
life EQ-VAS scores was also significantly associated with lower use of informational 
support, venting, and behavioural disengagement coping strategies. Overall, lower use 
of emotional-focused coping strategies was significantly associated with higher EQ-
5D-5L quality of life whiles higher EQ-VAS quality of life was significantly associated 
with lower use of both problem-focused and avoidant coping strategies. An increase in 
the use of active coping, humour, self-distraction, and substance use were however 
associated with higher EQ-5D-5L quality of life whiles an increase in the use of humour 
and acceptance was associated with higher EQ-VAS quality of life but these were all 
not statistically significant. 
Table 4.11: Coping strategies and Quality of life 
 EQ-5D-5L  EQ-VAS 
 Rho P-value  Rho P-value 
Problem-focused -0.154 0.059  -0.167 0.042† 
Active coping 0.098 0.235 -0.021 0.802 
Use of informational support -0.062 0.455 -0.203 0.013† 
Positive reframing -0.279 0.001† -0.102 0.214 
Planning -0.151 0.065 -0.134 0.101 
      
Emotional-focused -0.243 0.003†  -0.100 0.223 
Emotional support -0.024 0.771 -0.100 0.224 
Venting -0.419 0.000† -0.245 0.003† 
Self-blame -0.074 0.371 -0.115 0.162 
Humour 0.008 0.921 0.123 0.134 
Acceptance -0.049 0.552 0.067 0.415 
Religion  -0.166 0.042† -0.091 0.268 
      
Avoidant coping -0.042 0.606  -0.228 0.005† 
Self-distraction 0.108 0.188 -0.060 0.466 
Denial -0.038 0.645 -0.142 0.083 
Substance use 0.105 0.199 -0.063 0.446 
Behavioural disengagement -0.428 0.000† -0.302 0.000† 
† Statistically significant 
 
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4.7 Summary of Chapter 
This chapter showed the results of the analysed data from the study. Overall mean 
Quality of life measured on the EQ-5D-5L percentage scale was slightly higher than 
the self-reported EQ-VAS percentage scale. Significant predictors of EQ-5D-5L 
Quality of life after controlling for other factors were persistence of symptoms after 30 
days and development of complications post-COVID-19 infection. Significant 
predictors of EQ-VAS Quality of life after controlling for other factors were sex, 
persistence of symptoms after 30 days, worsening of comorbidities, and development 
of complications post-COVID-19 infection.  
The most used coping strategy by respondents during the pandemic was problem-
focused coping. Significant predictors of the various styles of coping were observed 
across the different age groups for avoidant coping strategies and among non-healthcare 
workers for both avoidant and problem-focused coping strategies. 
Generally, as overall quality of life improved, the need for using a coping strategy 
reduced. Internal consistency of the tools used in measuring Quality of life and Coping 
strategies was assessed using Cronbach’s alpha.  
  
 
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5 DISCUSSION 
5.0 Introduction 
This chapter discusses the findings from the analysed data with respect to existing 
literature and is sub-divided into five sections.  
5.1 Quality of Life  
In this study, 33.33% reported having anxiety or depression whilst 32.67% reported 
symptoms of pain or discomfort. The mean EQ-5D index value and mean EQ-VAS for 
COVID-19 recovered patients was (81.5 ± 12.0) % and (75.6 ± 22.0) % respectively. 
This corresponded to values obtained in a study by (Garratt et al., 2021) on the quality 
of life after COVID-19 without hospitalisation which also reported a mean EQ-5D 
index value of (82.0 ± 17) %.  
It also corresponded to results obtained in a study by (Garrigues et al., 2020) on post-
discharge persistent symptoms and health-related quality of life after hospitalization for 
COVID-19 which reported an overall mean EQ-5D index value of (86.0 ± 20) % overall 
mean EQ-VAS score of (70.3 ± 21.5) %. This same study also reported similar mean 
EQ-5D index value of (82.0 ± 21) % and mean EQ-VAS score of (71.7 ± 22.2) % for 
patients who were admitted to the ICU.  
A multi-ethnic Asian study by (Lim et al., 2020) on the impact of COVID-19 on health-
related quality of life in patients with cardiovascular disease also reported similar 
findings with mean EQ-VAS and mean EQ-5D index values of (78.6 ± 12.6) % and 
(89.8 ± 20.0) % respectively. 
 
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This may possibly be explained by a rapid global response by local governments and 
international bodies such as WHO, UNICEF, and IMF to provide support, financial 
relief, and public health assistance to curb the devasting nature of the disease. 
5.2 Predictors of Quality of Life  
This study found four main predictors of quality of life. These were sex, persistent 
symptoms, worsening comorbidities, and development of complications post-COVID-
19 infection. All other factors (sex, educational level, occupation, comorbidities, 
treatment modality, rehabilitative services, and access to rehabilitative centres) were 
not significant predictors. 
As age increased for participants in this study, their quality of life decreased by 0.15% 
for each additional year. This showed a significant association between age and quality 
of life. However, when other factors were adjusted for, age seized to be a significant 
independent predictor of quality of life. This concurs with literature that age is 
associated with health-related quality of life. This can probably be explained by ageing 
having a direct relationship with the increasing incidence of comorbidities and 
problems in patients. A study by (Arab-Zozani et al., 2020) also reported older patients 
having lower health-related QoL scores compared with younger patients confirming 
that COVID-19 impacts older patients more. Other studies also reported similar 
findings in patients >60 years of age having severer disease thereby necessitating ICU 
admission (Sommer et al., 2020) confirming poorer quality of life as age increases.  
Women in this study had mean Quality of Life (EQ-VAS) scores 6.50% lower than that 
of males. Studies by (Arab-Zozani et al., 2020; Jacobs et al., 2020) have revealed 
similar findings. While reported prevalence of the disease is same between men and 
women and sometimes higher in men (Gebhard et al., 2020; Jin et al., 2020; Richardson 
 
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et al., 2020), it seems the disease severely affected women compared to men.  This 
finding may probably be due to differences in physical activity levels between both 
sexes with women having lower physical activity levels compared with men (Sharara 
et al., 2018). Literature also suggests women being more susceptible to experiencing 
more somatic symptoms due to physiological and socialization factors (Barsky et al., 
2001). Women may also be more worried when it comes to disease with a decreased 
ability of coping. In contrast to this study, other studies have reported an equal 
prevalence of COVID-19 in both sexes with males experiencing a greater severity of 
disease (Gebhard et al., 2020; Jin et al., 2020) probably due to behaviour, intrinsic risk, 
and exposure (Richardson et al., 2020). 
Majority of respondents (83.3%) had obtained tertiary education in this study. 
Educational level was noticed to be significantly associated with differences in HRQoL 
scores where those attaining tertiary education had higher mean (EQ-5D-5L) % scores. 
This relationship was however confounded when other factors were considered. This 
differed from some reports which showed higher levels of education being associated 
with lower mean health related QoL scores as a result of higher education being 
associated with higher levels of concern about the novel virus as well as greater levels 
of awareness about the COVID-19 pandemic and its impact on life (Arab-Zozani et al., 
2020). Another study by (Nguyen et al., 2020) also observed high prevalence of 
depression among patients with university/college education as a result of the stress 
from the COVID pandemic which affected their health related quality of life. 
This study had majority of respondents being formally employed. This was noticed to 
be significantly associated with higher mean Quality of Life (EQ-VAS) % scores of 
7.96. This relationship was however confounded when other factors were considered. 
 
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It corresponded to findings from literature reporting higher scores for employed 
patients. This could be due to employed patients having the opportunity to obtain better 
healthcare from their regular source of income which they had not lost during the 
pandemic (Tran et al., 2020). In this study respondents who were informally employed 
had the least rise in mean scores. This may probably be due to the fear people had for 
contracting the virus hence the restricted movements across the country as well as the 
greater proportion of people working from home and only going out when essentially 
necessary. This therefore affected their businesses resulting in lack of ready income 
with consequent anxiety and depression, lowering their quality of life.  
All participants who had persistent symptoms after 30 days had significantly lower 
quality of life compared to those who did not have persistent symptoms beyond 30 days 
with the lowest reduction seen in those who had ageusia, dyspnoea, extreme fatigue, 
and headache (using the mean EQ-5D-5L % scores) and sleep disorder, chest pains, 
dyspnoea, and cough (using the mean EQ-VAS % scores). All persistent symptoms 
were significantly associated with markedly reduced mean QoL % scores (ranging from 
-9.63 to -26.27) and this corresponded with findings from literature reporting the 
presence of symptoms such as fatigue, muscle weakness, anxiety, depression and sleep 
difficulties as long as 6 months after onset of symptoms thereby affecting health related 
quality of life (Huang et al., 2021). (Garrigues et al., 2020) reported on persistent 
symptoms (fatigue, dyspnoea, memory loss, concentration and sleep disorders) 110 
days after hospital discharge affecting patients quality of life in their study on post-
discharge persistent symptoms and health-related quality of life after hospitalization for 
COVID-19. 
 
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Garratt et al., 2021 also reported in their study on the quality of life after COVID-19 
without hospitalization, prolonged fatigue being a symptom for non-hospitalised 
patients several months after their diagnosis affecting their HRQoL. A study by Jacobs 
et al., 2020 on the persistence of symptoms and quality of life 35 days after 
hospitalization for COVID-19 infection also reported fatigue and dyspnoea as the most 
persistent symptom at day 35, greatly impacting the quality of life of patients with 
difficulty walking, lifting, and walking up stairs. 
Majority of respondents had hypertension (65.1%) or diabetes (30.2%) before 
contracting COVID. Having comorbidities prior to COVID-19 infection was found to 
be statistically significant with participants reporting lower mean quality of life (EQ-
VAS) % scores. This was consistent with findings from literature. Studies conducted 
by Lim et al., 2020 in Asians with pre-existing cardiovascular disease during the 
COVID-19 pandemic reported significant decline in the health-related quality of life 
(HRQoL) and psychological components of patients. Arab-Zozani et al., 2020 also 
reported lower HRQoL scores in patients with diabetes. This may probably be due to 
the fact that COVID exacerbates symptoms especially diabetes symptoms resulting in 
severer disease (Zhou & Tan, 2020). Additionally, patients with comorbidities 
constitute the vulnerable groups with lower mean quality of life scores during the 
pandemic (Nguyen et al., 2020). 
Diabetes and hypertension were observed to be the comorbidities which worsened most 
among respondents in the study. Respondents with worsening comorbidities were 
significantly associated with lower mean quality of life (EQ-VAS) % scores which 
concurs with findings in literature. Research by (Zhou & Tan, 2020) on diabetic patients 
with COVID-19 reported abnormal pre- and post-prandial blood glucose levels in these 
 
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patients leading to higher risk of secondary infection and mortality. Poor glycaemic 
control has been associated with poorer outcomes in diabetic patients (Rao et al., 2020). 
These findings are also consistent with research conducted in the US on COVID-19 
patients in critical care reporting patients with comorbidities such as hypertension, 
diabetes and cardiovascular disease being admitted more into intensive care units (ICU) 
as a result of severer disease leading to lower quality of life scores (Sommer et al., 
2020). 
About a quarter (23%) of respondents suffered complications due to COVID-19 
infection. Such complications included post-traumatic stress disorder, difficulty 
mobilizing, deep vein thrombosis, acute kidney injury, pulmonary embolism, newly 
diagnosed diabetes and hypertension, migraine, and stroke. They were significantly 
associated with lower mean quality of life scores. Some researchers have investigated 
the long-term sequelae of extrapulmonary manifestations during follow-up. They 
reported complications such as persistent renal dysfunction, newly diagnosed diabetes, 
venous thrombo-embolism, cardiovascular events, and cerebrovascular events (Huang 
et al., 2021) and also revealed the mental health of those participants as poor or fair. 
The development of complications post-COVID-19 infection affects the mental and 
psychological health and wellbeing of patients consequently affecting their health-
related quality of life. 
Several respondents (33.33%) suffered from mild to extreme symptoms of anxiety or 
depression, whiles 32.67% had mild to extreme pain or discomfort. Despite this, 
majority (88.0%) were not offered rehabilitative services (psychotherapy, chest, and 
limb physiotherapy) during or after recovery from COVID-19. Unadjusted linear 
regression of Quality of Life (EQ-VAS) % scores showed significantly higher scores 
 
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for those offered rehabilitation but when other factors were considered, this relationship 
was no longer significant. Hence rehabilitation was not an independent predictor of the 
improved QoL. This observation was because rehabilitative services were offered only 
to few hospitalized patients who had severe to critical manifestations of COVID hence 
their report of a lower QoL during the study. Majority of the participants who had mild 
to moderate disease were not offered rehabilitative services. Some patients who were 
not offered such services commented on their desire for it. Some also reported seeking 
personal physiotherapists and psychologist services at their homes to help them through 
the recovery process.  
Nine out of ten respondents (94%) had no access to rehabilitative centres. A few reasons 
for this being that they were not told, such centres were not available where they lived, 
some complained it was too expensive, too far away, or didn’t know where to assess 
such services. Out of those that had access to rehabilitative centres over three-quarters 
(77.8%) benefited from psychotherapy (psychologist review).  
A study conducted by (Lemhöfer et al., 2021) assessing the rehabilitation needs of 
patients during and after COVID-19 reported the disease causing a wide range of 
problems affecting several organ systems and persisting for long periods of time, 
requiring long-term rehabilitation needs. Many other studies (Chen et al., 2020; Nguyen 
et al., 2020) have also researched into the health-related quality of life of COVID 
patients and reported on the need for multi-disciplinary rehabilitative therapies to treat 
the wide range of symptoms and functional deficits, especially in the acute phase of the 
disease (Reisshauer et al., 2020; Stierli et al., 2020). 
According to literature, rehabilitation is an extremely important and essential 
component of the treatment and recovery process of COVID patients and needs to be 
 
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initiated during all phases of the disease process to enable patients return to normal 
functionality early (Gutenbrunner et al., 2020). Due to the increasingly high numbers 
affected by the disease globally, psychiatrists and physiotherapists need to be 
increasingly involved in the rehabilitation of patients, to restore and improve quality of 
life by improving physical function, pulmonary function, and psychological efficiency 
(Demeco et al., 2020).  
5.3 Coping Strategies  
The coping strategy utilized most by study participants was Problem-focused coping 
with a mean score of 2.71 ± 0.64 SD, followed by Emotional-focused coping with a 
mean score of 2.32 ± 0.43 SD. The least used strategy was Avoidant coping with a 
mean score of 1.57 ± 0.39 SD. Problem-focused coping is a positive coping strategy 
aimed at changing stressful events (Baker & Berenbaum, 2007). Emotional-focused 
coping has both positive and negative strategies, but generally more positive outcomes 
aimed at regulating emotions associated with stressors. Avoidant coping is generally a 
negative strategy with harmful effects to one’s physical well-being due to lack of 
actions to reduce stressors resulting in self-blame and helplessness (Fluharty & 
Fancourt, 2021). If used in the short-term period however avoidant coping may be 
considered positive in helping reduce acute stress.  
Findings from this study suggests that participants coped well during the COVID 
pandemic using mostly positive coping mechanisms. Being a novel disease and causing 
havoc on the global front, many media outlets both locally and internationally provided 
daily updates on the virus. This was consistent with this study’s findings where use of 
informational support was the most used problem-focused strategy with a mean score 
of 3.07 ± 0.98 SD.  
 
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A study conducted in Vietnam by (Thai et al., 2021) among public health and 
preventive medicine students on perceived stress and coping strategies during the 
COVID pandemic reported on the predominant use of approach coping strategies 
(active coping, acceptance, emotional support, planning, informational support, 
positive reframing, and planning) and this concurred with the strategies used by 
participants in this study. This may probably be due to the massive wealth of 
information that was being released daily about the virus leading to improved 
knowledge, awareness, and the necessary skills for coping although it was done in 
different target populations. 
Religion is a major aspect of the lives of many Ghanaians. A high number of 
respondents used religion as a coping strategy with a mean score of 2.87 ± 0.95 SD. 
According to literature, many studies conducted in participants in several countries 
including Columbia reported on religion having a potential impact on coping (Bentzen, 
2020; Meza, 2020). The reason for this could be from fear and panic which was evident 
in the early stages of the disease when not much was known about the virus. Many 
churches made use of online platforms to organize religious services and activities 
forming a psychosocial support system aiding coping mechanisms (Iddi et al., 2021).   
Self-distraction was the most used form of avoidant coping mechanism with a mean 
score of 2.57 ± 1.03 SD. The acute use of strategies such as watching T.V, reading, 
listening to music, and sleeping as ways of distracting oneself during a crisis has been 
reported as helpful (Fullana et al., 2020). A possible explanation could probably be due 
to the fact that the mind is taken off the stressor acutely, thereby reducing the stress. 
Substance use was the least used coping mechanism with a mean score of 1.05 ± 0.20 
SD. Participants reported resorting to the use of alcoholic beverages as a means of 
 
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reducing the stressor and this was confirmed in studies done in Ghana by (Asiamah et 
al., 2021) who reported a rise in risky health behaviours during the pandemic. Contrary 
to these findings were studies conducted in Spain reporting reductions in such 
behaviours as a result of a stricter and relatively longer lockdown period (López-Bueno 
et al., 2020). 
5.4 Predictors of Coping Strategies 
Middle aged adults (40 – 49 years) were found to use more of avoidant coping 
strategies, and this was found to be statistically significant. They were also found to use 
more emotional-focused strategies whilst older adults aged 50 – 59 years used more of 
problem-focused coping mechanisms. This was similar to findings  from (Fluharty & 
Fancourt, 2021) who reported older adults (30 – 59 years) and the elderly (60+ years) 
using more of problem-focused and emotional-focused coping. In our study, the coping 
strategy for those aged 40 – 49 years was more focused on avoidant and emotional 
coping mechanisms whiles those aged 50 – 59 years was more focused on problem 
coping mechanisms. It however differed from findings in that same study where 
avoidant coping was found to rather be used more by younger adults aged 18 – 29 years. 
From literature, older adults are more likely to use approach coping strategies and less 
likely to adopt avoidant coping strategies as a result of years of experience dealing with 
stressors (Chen et al., 2018; Hamarat et al., 2002). 
Females were noticed to have used more of all three coping mechanisms than men in 
this study. Although this was not found to be statistically significant, it concurred with 
findings from (Fluharty & Fancourt, 2021) who also reported women significantly 
using more of problem-focused, emotional-focused, and avoidant coping strategies than 
men. Several studies have also confirmed sex being a demographic predictor of coping 
 
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strategies with women scoring higher than men across all ranges of styles of coping 
(Frydenberg & Lewis, 1993; Panayiotou et al., 2014). A study conducted in Spain 
concluded on men being psychologically more affected during the lockdown (Ozamiz-
Etxebarria et al., 2020). Men being mostly bread winners, and the lack of income as the 
result of the lockdown may increase the depression and anxiety, resulting in their ability 
to cope. These could be possible reasons why they coped less. 
This study recorded participants with the least level of education using more of avoidant 
coping which corresponded to other researches which also found avoidance coping 
being used more in people with lower educational levels (Fluharty & Fancourt, 2021). 
Also similar to other studies was emotional-focused coping which was more common 
among those with a higher degree of education. In other studies, participants with a 
higher level of education used more of problem-focused mechanisms. In this study 
however, it was the participants with lower educational levels who mostly used 
problem-focused coping mechanisms. A possible reason for people with higher 
educational levels using more active coping mechanisms may be because they may be 
exposed to better problem-focused strategies during their years of studies. 
Problem-focused and emotional-focused coping mechanisms was common among 
people who were informally employed whilst avoidant coping was common among 
those unemployed. This was consistent with reports from other studies which also found 
active coping mechanisms being more commonly used among those who were 
employed (Fluharty & Fancourt, 2021). In contrast to these findings, other studies have 
reported individuals on self-employment (informally employed) as less likely to cope 
well during the pandemic (Iddi et al., 2021). This is probably because they do not earn 
 
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monthly salary therefore the lockdown affected their businesses and income. (Adom et 
al., 2020; Bennett et al., 2020). 
This current study showed that participants who were separated/divorced used all three 
coping strategies more although this finding was not statistically significant. This was 
consistent with literature reporting positive coping strategies being more commonly 
used among those separated/divorced (Iddi et al., 2021). An explanation for this may 
be because due to the divorce, there is likely to be more social support from family 
members to cope with the COVID. The divorce could also have been a stressor they 
had dealt with prior to the COVID resulting in a better likelihood of coping better during 
the pandemic. 
Participants living in non-urban places were recorded to use more of avoidant and 
problem-focused coping strategies whilst those living in urban areas used more of 
emotional-focused coping mechanisms. Studies by (Fluharty & Fancourt, 2021) 
similarly reported their respondents living in urban areas of using more of supportive 
coping strategies. This may be because urban areas are more densely populated (Id et 
al., 2020). The pandemic hit harder the urban populations than the non-urban 
populations. Urban lifestyle is more stressful hence people may have already developed 
certain coping strategies for survival. They may therefore be better suited to cope with 
the COVID than those living in the non-urban areas. 
Not being a healthcare worker was reported to cope better using all three coping 
strategies than being a healthcare worker. This was found to be statistically significant. 
A possible reason for healthcare workers coping less effectively could be because of 
the large scale of morbidity and mortality they had to observe physically and deal with 
 
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daily at the workplace which could have been a huge stressor during the pandemic. 
Literature suggests that healthcare workers are faced with higher levels of both 
psychological and physical stress resulting from their working environment (Id et al., 
2020). Hence the pandemic imposed extra stress on health workers which affected their 
ability to cope well. 
People who developed complications due to COVID-19 was observed to be associated 
with greater use of all three coping strategies than those who did not get any 
complications with significant associations observed for both avoidant and problem-
focused coping styles. These findings were consistent with studies conducted by 
(Fluharty & Fancourt, 2021) who also reported people suffering from adversities as a 
result of COVID-19 using more of avoidant coping. It however differed from that same 
study which reported participants with complications using less of emotional-focused 
and problem-focused coping mechanisms than those who didn’t have complications. 
Having comorbidities prior to getting COVID and having comorbidities worsening 
during the infection seemed to be associated with more use of avoidant coping and 
problem-focused strategies but less use of emotional-focused coping. These were 
however not statistically significant in this study. Other studies have also reported 
similar findings where having comorbidities prior to COVID was shown to decrease 
one’s chances of coping well (Iddi et al., 2021). 
Participants with persistent symptoms lasting more than 30 days commonly used all 
three coping strategies more than those who didn’t have persistent symptoms, and this 
was found to be significant for only the emotional-focused strategy. 
 
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5.5 Association Between Quality of Life and Coping Strategies 
When people are faced with stressful situations, they use a coping strategy to help them 
overcome the stress. Many studies have reported adaptive or approach coping 
mechanisms being associated with better quality of life (Chabowski et al., 2018; Ulusoy 
& Kal, 2020). A reduction in the stressor from effective coping results in the 
improvement in quality of life with a subsequent resultant decrease in the coping 
mechanisms being used for the stressor. 
In general, the need for the use of coping skills occurs more when QoL is low. In this 
study, an increase in the EQ-5D-5L Quality of life of participants was generally 
associated with a decrease in the overall need to use a coping strategy and this was 
statistically significant for emotional-focused coping strategies. A possible reason for 
this finding could be because as the stressors in the lives of participants reduced, their 
quality-of-life improved leading to a gradual decrease in their need to use a coping 
mechanism as the magnitude of stressors reduced. With more information being 
discovered on the novel virus, better and more effective treatment modalities are being 
instituted, resulting in a decrease in the fear and stigma surrounding the disease. The 
increased knowledge and understanding of the stressor (COVID-19) has resulted in a 
reduction in morbidity and mortality globally, with more people learning to cope better. 
People may only find the necessity to cope when there are ongoing stressors.  
This study also detected a positive association between improvement in quality of life 
of respondents and their use of humour for coping. They generally laughed more and 
made more jokes as their condition improved. They also used more active coping 
techniques as their quality of life improved allowing them to cope better during the 
pandemic. This was corroborated by other studies which also found a positive 
 
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association between quality of life and positive coping strategies (Holubova & Prasko, 
2017). 
Participants in this study also acutely used more self-distraction methods like watching 
more TV and reading as their quality of life improved. An explanation for this may be 
due to these habits being nurtured during the lockdown period hence becoming a part 
and parcel of their new lifestyle. They however developed some negative coping 
mechanisms of using substances like alcohol more during the period as life got better 
probably to enable them to forget about the difficulties they faced, the trauma they 
experienced or to celebrate surviving the disease. 
   
 
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6 CONCLUSION AND RECOMMENDATIONS 
6.0 Introduction 
This chapter presents the conclusions, recommendations, and limitations of the study. 
6.1 Conclusion 
This study was done to estimate the quality of life of COVID-19 recovered patients as 
well as determine the predictors of quality of life. It also sought to identify the coping 
strategies utilized during the pandemic, to determine the predictors of coping, and 
finally determine the association between quality of life and coping strategies employed 
by COVID-19 recovered patients. 
Overall, this study shows that majority of respondents maintained a relatively good 
quality of life after surviving COVID-19. Persistence of symptoms, development of 
complications and worsening of comorbidities were found to significantly affect quality 
of life negatively. Several respondents suffered from anxiety or depression as well as 
pain or discomfort which negatively affected their quality of life. Although 
rehabilitation was associated with higher quality of life scores, majority of respondents 
were not offered rehabilitation services during and after recovery. Those who received 
rehabilitation services at the centre and were advised to continue elsewhere upon 
discharge, did not have access to rehabilitation centres due to various reasons such as 
distance, expense, and lack of accessibility. 
During the pandemic, COVID patients generally coped very well using mostly positive 
coping strategies. Socio-demographic factors such as age and being a non-healthcare 
worker significantly predicted some of the coping strategies that were used. Other 
 
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significant predictors included persistent symptoms after 30 days and developing 
complications associated with the COVID.  
An increasing EQ-5D-5L Quality of life was associated with a decreasing need to use 
majority of the coping strategies. It was however positively associated with active 
coping, humour, and substance use. 
These findings have shown that persistence of symptoms, comorbidities, and 
complications negatively affect one’s quality of life. Rehabilitation (especially 
psychotherapy / clinical psychology) has been shown to considerably improve these 
factors. Improvement of these factors together with the adaptation of positive coping 
mechanisms results in an overall improvement in quality of life.   
There aren’t any well-established facilities or services in Ghana that offer care to 
patients post-COVID-19 infection. This may have possibly affected their recovery and 
QoL. Further research is needed to assess feasibility of establishing such services. This 
should help in guiding public health policies and rehabilitation interventions for the 
ongoing pandemic and other public health crisis. 
6.2 Limitations 
1. Responses to questions on quality of life and coping strategies in this study were 
based on the patient’s recall and these may be subject to possible recall bias. 
2. This study was a cross-sectional study which cannot establish true causality. It 
does not assess the “before” scenario. It is therefore not possible to know 
whether decreases in quality of life existed before the patients contracted 
COVID. 
 
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3. This study was conducted in only one treatment centre. It may therefore not 
reflect the experiences of patients in other treatment centres especially regarding 
access to rehabilitation services and clinical psychologists. 
4. COVID-19 is a novel disease and the knowledge on its pathology, management 
and complications is now evolving. It is possible that findings of this study may 
change (such as the level of quality of life and coping style choices) as there is 
better understanding of the disease. 
6.3 Recommendations 
1. The need to include rehabilitation and referral to clinical psychologists as part 
of the standard treatment protocol for patients. From the study, rehabilitation 
was found to be associated with an increase in quality of life. It was however 
noted that majority of respondents in this study suffered from mild to extreme 
symptoms of depression and pain but were not offered rehabilitation or 
psychological therapy during or after recovery from COVID-19. 
2. To set up rehabilitation centres for all survivors of COVID with particular 
emphasis on psychotherapy as the few respondents of this study who were 
prescribed rehabilitation complained of not having access to such facilities 
because none was available in their area of residence, or such facilities were 
very far away from where they live. 
3. The need to set up more post-COVID-19 clinics for follow-up to characterize 
the sequelae of the disease (persistence of symptoms and complications) since 
these factors were shown to affect a person’s quality of life. These clinics would 
help to increase accessibility to care and mitigate or treat these sequelae. 
 
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4. Patients can also be trained and motivated to employ positive coping 
mechanisms in situations such as COVID to overcome stressors during their 
infections. 
RESEARCH 
• Further research is needed to assess the feasibility of establishing facilities or 
services that offer post-COVID care in Ghana. 
• Further research is needed to evaluate the long-term effect of COVID and 
coping mechanisms on the quality of life of these patients. 
  
 
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8 APPENDICES 
8.0 Appendix 1: Participants Information Sheet 
Title: Assessment of the Quality of Life of COVID-19-Recovered Patients in a 
Major Treatment Centre in Accra. 
Institution Affiliation: Department of Health Policy, Planning and Management: 
School of Public Health, College of Health Sciences, University of Ghana, Legon.  
Introduction: Dear participant, my name is ESINAM AKU AMEDEWONU, a post-
graduate student from the school of Public Health, University of Ghana. My phone 
number is 0208174787 and I can be reached via email at eamedewonu@yahoo.com. 
Background and Purpose of research: I am conducting a study in this department to 
assess the Quality of Life of COVID-19 recovered patients at the Ghana Infectious 
Disease Centre (GIDC).  
Nature of Research: This study will look at the standard of your health, comfort and 
well-being in the period following your recovery from COVID-19. It shall also 
investigate your coping strategies in that period as well as the influence of the 
healthcare system on your recovery. Hopefully, the information you give me will help 
in policy and planning for further management of COVID patients in Ghana especially 
with respect to post-recovery care, rehabilitation, and social integration. 
Requirements: You will be required to fill out a simple questionnaire. This should take 
about 10-15 minutes of your time. This is purely academic research and the information 
given will be treated as confidential.  
Benefits: You may not have any immediate or direct benefits from my interview, but 
your responses would be helpful in recommendations to appropriate authorities to help 
guide policy on post-discharge care and follow-up after COVID-19 infection, 
rehabilitation, and social support systems, as well as inform guidelines on Health 
Promotion. 
Risks: The only inconvenience, if any that you would face by accepting to take part in 
this study perhaps is your time.  
 
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Compensation / Payment: There are no incentives/ payment for participating in this 
study.  
Voluntary withdrawal: Participation in this study is voluntary. If you indeed decide 
to take part, you are at liberty to withdraw whenever you wish to and are also allowed 
to skip answering any of the questions that you are not very comfortable with.  
Anonymity and Confidentiality: The information you would provide is going to be 
treated with strict confidentiality. Apart from my research team and members of the 
Ethics Committee, no body shall have access to the information since it shall be under 
lock and key. We also assure you that your name shall not appear or be mentioned in 
any report that will come out from this study.  
Ethical approval: As part of our duty to conform with standard practice and to ensure 
your safety, ethical approval has been sought from the Ghana Health Service Ethics 
Review Committee in order to carry out this study. 
Before taking Consent  
Do you have any questions you wish to ask about the study?    Yes   No  
If yes, please, indicate the questions below 
………………………………………………………………………………………… 
………………………………………………………………………………………… 
In case you have any questions later please, do not hesitate to contact: 
1. ESINAM AKU AMEDEWONU Department of Health Policy Planning and 
Management, School of Public Health, University of Ghana. (Tel: 0208174787, 
Email: eamedewonu@yahoo.com)  
2. NANA ABENA APATU Ghana Health Service Ethics Review Committee 
Administrator (Tel: 0503539896, Email: ethics.reseach@ghsmail.org) to make 
further clarification on ethical issues and your rights as participants if need be. 
  
 
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CONSENT FORM 
STUDY TITLE: ASSESSMENT OF THE QUALITY OF LIFE OF COVID-19 
RECOVERED PATIENTS IN A MAJOR TREATMENT CENTER IN ACCRA 
 
PARTICIPANTS’ STATEMENT 
I acknowledge that I have read or have had the purpose and contents of the Participants’ 
Information Sheet read and all questions satisfactorily explained to me in a language I 
understand English language / Ga / Twi. I fully understand the contents and any 
potential implications as well as my right to change my mind (i.e., withdraw from the 
research) even after I have signed this form. 
I voluntarily agree to be part of this research. 
 
Name of Participant: ………………………….    
Participants’ Signature: ……………………...OR Thumb Print……………………… 
Date: …………………………………. 
 
 
INTERPRETERS’ STATEMENT 
I interpreted the purpose and contents of the Participants’ Information Sheet to the afore 
named participant to the best of my ability in the English language / Ga / Twi language 
to his proper understanding. 
All questions, appropriate clarifications sort by the participant and answers were also 
duly interpreted to his/her satisfaction. 
 
Name of Interpreter: …………………………… 
Signature of Interpreter: ………………………. OR Thumb Print ………..............  
Date: ……………………… 
Contact Details: ……………………………………………………………………. 
 
 
 
 
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STATEMENT OF WITNESS 
 
I was present when the purpose and contents of the Participant Information Sheet was 
read and explained satisfactorily to the participant in the language, he/she understood 
English language / Ga / Twi. 
I confirm that he/she was given the opportunity to ask questions/seek clarifications and 
same were duly answered to his/her satisfaction before voluntarily agreeing to be part 
of the research. 
 
Name: ………………………… 
Signature: …………………………... OR Thumb Print ………............................  
Date: …………………………… 
 
 
INVESTIGATOR STATEMENT AND SIGNATURE 
 
I certify that the participant has been given ample time to read and learn about the study. 
All questions and clarifications raised by the participant have been addressed.  
 
Researcher’s name: ………………………………………. 
Signature: …………………………………………………. 
Date: …………………………………………………………. 
  
 
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8.1 Appendix 2: Questionnaire 
ASSESSMENT OF THE QUALITY OF LIFE OF COVID-19 
RECOVERED PATIENTS IN A MAJOR TREATMENT CENTER 
IN ACCRA 
Dear Respondent, 
COVID-19 disease has ravaged the world globally since it was first detected in 
December 2019. It has greatly affected the lives of millions of people and led to 
devastating deaths worldwide affecting both the young and old. It has been shown to 
affect multiple organ systems but it’s effects on health after recovery has not been fully 
investigated. This research is being carried out to thus assess the Quality of Life of 
COVID-19 Recovered Patients in a major treatment centre in Accra.  
Hopefully, it will provide important information and data on the state of health of these 
individuals following recovery and discharge from isolation which will guide policies 
on post-discharge care and follow-up after COVID-19 infection, rehabilitation, and 
social support systems, as well as inform guidelines on Health Promotion. 
You are assured that the answers you give will remain strictly confidential and your 
name will not be mentioned in our research reports.  
Thank you. 
 
Unique ID for Respondent ……………………………… 
Date of interview ……………………………………… 
  
 
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SECTION A: SOCIODEMOGRAPHIC FACTORS 
Please answer each item by filling in as required or marking the appropriate box with 
a tick. 
I. What is your age? …………………. (at last birthday in years). 
II. What is your sex?   
 Male   Female 
III. What is your religion?  
 Christian         Muslim  
 Traditionalist     Other(specify): ………………… 
IV. What is your ethnicity? 
 Ga-Dangme        Ewe  
 Akan       Northern tribe 
 Other (specify): ………………………. 
V. What is your marital status?  
 Single       Divorced  
 Married      Separated 
 Co-habiting     Widow/Widower  
VI. Where is your place of residence? (specify the name) ......................................  
 Rural     Urban    Peri-urban  
VII. What is the highest level of education you have attained?  
 Primary       Vocational/Technical  
 Secondary      None 
 Tertiary     Other (specify)………………… 
VIII. What is your occupation?  
 Student      Unemployed 
 Formally employed     Retired 
 Informally employed    Other (specify): ………………… 
IX. Are you a healthcare worker?  
 Yes      No 
If YES what specialty? 
 Doctor      Nurse 
 Physician assistant      Pharmacist 
 Physiotherapist     Other (specify): …………………  
 
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SECTION B: QUALITY OF LIFE [EQ-5D-5L QUESTIONNAIRE] 
Under each heading, please tick the ONE box that best describes your health over the 
period (from 2weeks after your first positive COVID result until now).  
MOBILITY  
  I have had no problems in walking about    
  I have had slight problems in walking about   
  I have had moderate problems in walking about  
  I have had severe problems in waling about  
  I have been unable to walk about   
SELF-CARE  
  I have had no problems washing or dressing myself  
  I have had slight problems washing or dressing myself   
  I have had moderate problems washing or dressing myself  
  I have had severe problems washing or dressing myself  
  I have been unable to wash or dress myself   
USUAL ACTIVITIES (e.g., work, study, housework, family, or leisure activities)  
  I have had no problems doing my usual activities  
  I have had slight problems doing my usual activities  
  I have had moderate problems doing my usual activities  
  I have had severe problems doing my usual activities  
  I have been unable to do my usual activities   
PAIN / DISCOMFORT  
  I have had no pain or discomfort  
  I have had slight pain or discomfort  
  I have had moderate pain or discomfort  
  I have had severe pain or discomfort  
  I have been in extreme pain or discomfort   
ANXIETY / DEPRESSION  
  I was not anxious or depressed  
  I was slightly anxious or depressed  
  I was moderately anxious or depressed   
  I was severely anxious or depressed  
  I was extremely anxious or depressed    
 
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(II) EQ VAS  
• We would like to know how good or bad your health OVER THE PERIOD 
has been 
THE BEST HEALTH 
• This scale is numbered from 0 to 100. YOU CAN IMAGINE 
• 100 means the best health you can imagine. 
 0 means the worst health you can imagine. 
• Please mark an X on the scale to indicate how your health has been 
• Now, write the number you marked on the scale in the box below 
 
 
YOUR HEALTH OVER THE PERIOD HAS BEEN =  
 
 
THE WORST HEALTH 
YOU CAN IMAGINE 
 
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SECTION C: HEALTH CARE SYSTEM, PERSISTENCE OF SYMPTOMS 
AND ACCESS TO REHABILITATIVE SERVICES 
Please answer each item by filling in as required or marking the appropriate box with 
a tick. 
1. Does your primary health care facility offer COVID-19 treatment/isolation 
services? 
 Yes      No 
 
If YES which facility? 
…………………………………………………………………………………… 
If NO which facility, were you referred to for COVID-19 management? 
…………………………………………………………………………………… 
 
2. Where you able to receive all covid 19 treatment medications from your 
treatment centre? 
 Yes      No 
If NO, which medications did you have to go and buy? 
.................................................................................................... 
.................................................................................................... 
.................................................................................................... 
 
3. Did you incur any financial costs during your COVID-19 management 
period? 
 Yes      No 
 
If YES, what accounted for it? 
 Length of stay in hospital     Required ventilatory support  
 Cost of medications     Cost of laboratory 
investigations 
 Others (please specify): .................................................................................................... 
4. Which mode of treatment did you require? 
 
 Hospital admission      Self-isolation at home  
 
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5. Did you have any persistent symptoms after 30 days following the initial 
diagnosis of COVID? 
 Yes      No 
 
If YES, which symptoms did you have? (Tick as many as apply) 
 Headache   Memory loss 
 Muscle aches   Hair loss 
 Cough  
 Chest pain   
 Ageusia (loss of taste) 
 Anosmia (loss of smell)   
 Attention disorder (inability to focus)   
 Abdominal pains    
 Extreme fatigue (tiredness)  
 Dyspnoea (difficulty breathing / shortness of breath)  
 Easy fatiguability (tiredness on minimal exertion) 
 Rigors – feeling cold with shivers and sudden rise in temperature 
 Fever 
 Sleep disorders (e.g., insomnia) 
 Nausea & vomiting 
 Diarrhoea 
 Others (please specify):  
 
6. Do you have any comorbid conditions (chronic diseases present prior to 
suffering COVID)?  
 Yes      No 
 
If YES which condition? 
 Diabetes     Hypertension 
 Sickle cell disease    Asthma  
 Obesity     Chronic lung disease (Emphysema, 
bronchitis) 
 Kidney disease    Dyslipidaemia 
 Other (specify): …………………………  
 
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7. Did you have any comorbidities which worsened or was difficult to manage 
following your COVID-19 infection? 
 Yes     No 
 
If YES, which conditions? 
 Diabetes     Hypertension 
 Sickle cell disease    Asthma  
 Kidney disease    Chronic lung disease (Emphysema, 
bronchitis) 
 Dyslipidaemia    Migraine 
 Other (specify): ………………………… 
 
8. Did you have any complications following your COVID-19 infection? 
 Yes      No 
 
If YES, which complications? 
 Post-traumatic stress disorder (PTSD)  Stroke/CVA  
 Pulmonary embolism  DVT  
 Neurological deficit   Myocardial infarction (heart 
attack) 
 Difficulty mobilizing/walking   Acute kidney injury  
 Others (specify): ................................................................................................................. 
 ....................................................................................................................................................... 
 
9. Did you require rehabilitative services post discharge? 
 Yes      No 
 
If YES, which services did you require? 
 Chest Physiotherapy     Limb physiotherapy  
 Psychiatry/Psychologist     Neurology (speech, stroke)  
 Others (please specify): .................................................................................................... 
 .......................................................................................................................................................  
 
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10. Did you have access to a rehabilitative centre? 
 Yes      No 
 
If YES, which services were rendered? 
 Chest Physiotherapy     Limb physiotherapy  
 Psychiatry/Psychologist     Neurology (speech, stroke)  
 Others (please specify): .................................................................................................... 
 ....................................................................................................................................................... 
 
If NO, why? 
  Did not require it 
  Was not told 
 No rehabilitation facility available 
  It was too expensive to afford 
  It was too far away to assess 
  I did not know where to assess such services 
 Others (please specify): .................................................................................................... 
 .......................................................................................................................................................  
 
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SECTION D: COPING STRATEGIES IN THE POST-COVID PERIOD [Brief-
COPE] 
The following questions ask how you sought to cope after recovery from COVID-19 
infection (2weeks after your first positive COVID result). Read the statements and 
indicate by ticking the appropriate box how much you used each coping style 
 
   I didn’t do this at all         I did this a lot 
       A little bit A medium amount 
 I turned to work or other activities to try 
  1 to take my mind off my current 1 2 3 4 
 challenges / getting COVID. 
 I concentrated my efforts on doing 
     2 something about the situation I am in 1 2 3 4 
 / getting COVID. 
     
     3 I kept saying to myself "this isn't 1 2 3 4 
 real". 
     
     4 I used alcohol or other drugs to 1 2 3 4 
 make myself feel better 
     
I got emotional support and advice 
     5 1 2 3 4 
 from others (e.g. family, friends, 
     therapist, etc.). 
     6 I gave up trying to deal with the 
1 2 3 4 
 challenges / the fact that I had 
 COVID. 
 
 I took action to try to make the 1 2 3 4 
 7 situation better / try to recover 
 from COVID. 
 I refused to believe that I had gotten 
  8 1 2 3 4 COVID. 
 
 I said things to myself to let my 
1 2 3 4 
   9 unpleasant feelings / emotions 
 escape (self-motivation). 
 
 I got help and advice from other 1 2 3 4 
    10 people (e.g., family, friends, 
 therapist, etc.) 
 I used alcohol or other drugs to 
    11 1 2 3 4 help me get through it. 
 
    I tried to see the challenges /situation in 
1 2 3 4 
    12 a different light, to make it seem more 
 positive. 
    
    13 I criticized myself. 1 2 3 4 
 
    
I tried to come up with a strategy 
    14 1 2 3 4 
 about what to do. 
   
I got comfort and understanding 
    15 1 2 3 4 
from someone. 
 
 I gave up the attempt to cope. 
 16 1 2 3 4 
 
 
  
 
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 I didn’t do this at all     I did this a lot 
A little bit A medium amount 
 I looked for something good in 
 17 1 2 3 4 
what had happened. 
 
  
 18 I made jokes about COVID. 1 2 3 4 
 
 I engaged in activities to think about 
it less, such as going to the movies, 1 2 3 4  19 
 watching TV, reading, daydreaming, 
 sleeping, or shopping. 
 20 I accepted the reality of the fact that I 
 1 2 3 4 got infected with COVID. 
 
 I expressed my negative feelings by 
 21 1 2 3 4 letting my emotions out e.g., crying. 
 
 I tried to find comfort in my religion or 
1 2 3 4 
   22 spiritual belief’s 
 
 I tried to get advice or help from 1 2 3 4 
   23 other people (e.g., family, friends, 
 therapist, etc.). 
  
   24 I learnt to live with the challenges / fact 1 2 3 4 
 that I got infected with COVID. 
 
I thought hard about the steps to take 
 25 1 2 3 4 
 during my recovery. 
 
I blamed myself for getting COVID 
 26 1 2 3 4 
 
  
 27 I prayed or meditated 1 2 3 4 
 
   28 I made fun of COVID. 
1 2 3 4 
 
 
 
 
THANK YOU FOR TAKING TIME TO FILL THE QUESTIONNNAIRE  
  
 
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8.2 Curriculum Vitae 
Esinam Aku Amedewonu 
MB ChB, DAWACS, MGCS, MWACS 
Department of Anaesthesia, Korle Bu Teaching Hospital, P. O Box KB 20, Korle Bu, Accra 
+233 (0)20 8174787  anastasia_4eva@yahoo.com | eamedewonu@yahoo.com 
PERSONAL STATEMENT 
Talented certified anaesthesiologist who is versatile, hardworking, and meticulous with an 
exceptional attitude towards work. Offering over 10 years of experience in the hospital setting 
with a broad level of expertise and a primary focus in pain and regional anaesthesia. Skilled 
leader, critical thinker, a team player with outstanding interpersonal skills and ability to relate 
with people from diverse backgrounds. Demonstrate success in providing basic anaesthesic 
care to elective and emergency surgeries to a wide range of patients from healthy individuals 
to critically ill patients as well as sedation procedures for adults and children requiring 
radiological intervention. Skilful in administering anaesthesia to various specialties: general 
surgery, neurosurgery, paediatric surgery, obstetrics and gynaecology, plastics, urology, 
otorhinolaryngology, maxillofacial surgery, ophthalmology, and orthopaedics surgery. 
Excellent skills in managing critically ill patients in the intensive care unit. Well-organised, 
enthusiastic, motivated to learn and excel in leadership opportunities with a long-standing 
record of success and safety. 
PROFESSIONAL QUALIFICATIONS 
2020 Membership (MWACS) West African College of Surgeons 
2019 Membership (MGCS) Ghana College of Physicians and 
Surgeons 
2017 Diploma in Anaesthesia (DAWACS) West African College of Surgeons 
2015 Full Accreditation with license to Medical and Dental Council of Ghana 
practise [MDC/RN/08190] 
2013 Bachelor of Medicine and Surgery (MB University of Ghana Medical School 
ChB) 
EDUCATION 
Date Institution Qualification obtained (or in pursuit of) 
2020 to date School of Public Health, University of Ghana, Master of Public Health (in progress) 
Legon 
2020 to date Ghana College of Physicians and Surgeons Fellowship in Anaesthesia (in progress) 
2017 – 2019 West African College of Surgeons Membership 
2017 – 2019 Ghana College of Physicians and Surgeons Membership 
2015 – 2017 West African College of Surgeons Diploma in Anaesthesia 
2009 – 2013 University of Ghana Medical School Bachelor of Medicine and Surgery 
2007 – 2010 University of Ghana, Legon Bachelor of Medical Sciences 
2002 – 2005 Achimota School, Accra West African Examinations Council 
(WAEC) Senior Secondary Certificate 
Examination (SSSCE) 
1991 – 2001 Christ The King International School, Accra WAEC Basic Education Certificate 
Examination (BECE) 
 
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EMPLOYMENT HISTORY 
Date Position Institution 
Sep 2019 to date Specialist Department of Anaesthesia, Korle Bu Teaching Hospital 
Sep 2017 – Aug 2019 Senior Medical Officer Department of Anaesthesia, Korle Bu Teaching Hospital 
Sep 2015 – Aug 2017 Medical Officer Department of Anaesthesia, Korle Bu Teaching Hospital 
 Job Roles Undertaken at the Department of Anaesthesia: 
• Administration and assisting in anaesthetic care 
• Management of Intensive Care Unit 
• Training of junior residents and medical officers 
• Pre-operative assessment of patient for surgery 
• Peri-operative preparation of patients for surgery 
• Morbidity and mortality report 
• Participation in weekly departmental presentation and scientific 
seminars 
• Management of severe and critically ill COVID-19 patients at the UGMC, 
GIDC, and Ga East Municipal Hospital 
Nov 2014 – Apr 2015 Senior House Officer        Department of Surgery, Tema General Hospital 
Job Roles Undertaken: 
• In-patient and outpatient care 
• Assist in surgical procedures in theatre 
• Provide emergency surgical care to patients at the surgical emergency 
• Monthly morbidity and mortality reports 
May 2014 – Oct 2014 Senior House Officer       Department of Child Health, Tema General Hospital 
Job Roles Undertaken: 
• In-patient and outpatient care 
• Parents counselling sessions 
• Presentation at weekly clinical meetings 
Nov 2013 – Apr 2014 House Officer                    Department of Obstetrics and Gynaecology, Korle Bu  
                                             Teaching Hospital 
Job Roles Undertaken: 
• In-patient and outpatient care 
• Operative and non-operative deliveries 
• Assist in gynaecological procedures and surgeries 
• Weekly review writing reports 
• Monthly morbidity and mortality reports 
May 2013 – Oct 2013 House Officer                    Department of Medicine and Therapeutics, Korle Bu  
                                              Teaching Hospital 
Job Roles Undertaken: 
• In-patient and outpatient care 
• Preparing weekly review summaries 
• Morbidity and mortality reports 
 
  
 
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KEY COMPETENCIES 
General Anaesthesia Well versed in general anaesthesia for major general surgical cases 
 
Plastics & Reconstructive Specialised competencies in anaesthesia for Plastics & 
surgery Reconstructive surgeries 
Obstetrics & Gynaecological Specialised competencies in anaesthesia for Obstetrics & 
Gynaecological surgeries 
Orthopaedics Specialised competencies in anaesthesia for Orthopaedic surgeries 
 
Ophthalmology Specialised competencies in anaesthesia for Ophthalmic surgeries 
 
Paediatric surgery Specialised competencies in anaesthesia for Paediatric surgery 
 
Maxillofacial Specialised competencies in anaesthesia for Maxillofacial surgeries 
 
Urological Specialised competencies in anaesthesia for Urological surgeries 
 
ENT Specialised competencies in anaesthesia for otorhinolaryngology 
surgeries 
Neuro Anaesthesia Specialised competencies in anaesthesia for major neurosurgical 
cases 
Pain Knowledge in regional anaesthesia and analgesia. Ability to 
perform regional anaesthetic techniques/blocks for pain control  
ICU Experienced in intensive care management of severely/critically ill 
patients 
Knowledge in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) 
 
Knowledge in Difficult Airway management 
 
Knowledge in Intensive Care Unit Management of Critically ill patients 
 
 
 
SELECTED WORKSHOPS, CONFERENCES, SEMINARS 
Dec 2020 Paediatric Advanced Life Support, MSSI, Accra 
Completed a course requirement for certification in Paediatric Advanced Life Support 
28 – 30 Nov Euroanaesthesia Virtual Congress, Brussels, Begium (Online) 
2020 Awarded a full bursary to attend Euroanaesthesia Virtual Congress held on 28-30th 
November in Brussels (Belgium) and organised by the World Federation of Societies of 
Anaesthesiologists and the European Society of Anaesthesiology and Intensive Care 
Sep 2019 Advanced Cardiovascular Life Support, MSSI Accra 
Completed the course requirement for certification in Advanced Cardiovascular Life 
Support (ACLS) 
Jul 2019 Evidence-Based Medicine Course, Ghana College of Physicians and Surgeons, Accra 
Participant of an evidence-based course by the Ghana College of Physicians and 
surgeons. This program sensitized participants to the value, concept and practice of 
evidence-based medicine, while enriching capacity in the application of Systematic 
reviews 
 
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May 2019 International Intensive Care Symposium, Istanbul, Turkey 
The 22nd Annual International Intensive Care Symposium held in Istanbul provided 
participants with an up-to-date review of the most recent developments in research 
and management of the critically ill, of which I was a beneficiary 
Sep 2017 – Sep Presenter/Moderator, Department of Anaesthesia, KBTH, Accra 
2019 Moderated and led several seminars and presentations at the Department of 
Anaesthesia, which included: Temperature control and monitoring in anaesthesia; 
Nursing for the critically ill patient; Sedation for minor procedures; Anaesthesia for 
Phaeochromocytoma, among others. 
 
 
CONTINUING MEDICAL EDUCATION (CME) PROGRAMMES ATTENDED  
Date TOPIC RESOURCE(S) TEAM / PERSONS 
 
August 2022 Pelvic pain The European Society of Regional 
Anaesthesia and Pain Therapy 
July 2022 Pain Webinar Ghana Anaesthetists Society  
October 2020  Pain Webinar  Ghana Anaesthetists Society  
February 2020 Basic Sciences Instrumentation & Clinical WACS (Anaesthesia)  
Measurements  
February 2020  Perioperative Ethical Dilemmas  Ghana Anaesthetists Society  
February 2019  Principles & Practice of Anaesthesia WACS (Anaesthesia)  
(Revision) 
Feb – March Basic Sciences, Instrumentation & Clinical WACS (Anaesthesia) 
2018  Measurements 
Feb 2017  Principles & Practice of Anaesthesia WACS (Anaesthesia) 
(Revision) 
April 2016 Essentials of Airway Management  Dept. of Anaesthesia, KBTH  
Feb – March Basic Sciences, Instrumentation & Clinical WACS (Anaesthesia)  
2016 Measurements  
  
 
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VOLUNTEER WORK/EXTRA-CURRICULAR ACTIVITIES 
Mar – Dec 2020 National COVID-19 ICU Team 
Part of the National Covid-19 ICU team responsible for the management 
of severely and critically ill Covid-19 patients in Ghana. This was at the 
early stage of the COVID-19 outbreak in Ghana and the world when very 
little was known about the disease and the earliest cases in Ghana were 
making it into the healthcare facilities 
Dec 2018 to Member, Ripples ARP 
date Ripples ARP is a local based organisation which is involved in advocacy 
programs, research and health promotion. Through this organisation, I 
have participated in several peer group counselling sessions, and 
collaborated in some ongoing studies 
2018 to date Member, Ghana Hepatobiliary Association 
2019 to date Member, Operation SMILE Ghana Anaesthetists Team 
Apr 2017 to date Member, Ghana Anaesthetist’s Society 
Dec 2012 to Health Advocate 
date I have rendered many pro-bono talks and screening sessions in the form of 
outreaches to at least 20 churches, schools and communities 
May 2012 – Volunteer, Global Brigades Ghana 
May 2013 Global Brigades are groups of passionate volunteers who mobilize toward 
positive social change. For one year I was part of its medical team offering 
free medical services to deprived villages. Global Brigades is the world’s 
largest student-led global health and sustainable development organization. 
Since 2004, Global Brigades has mobilized thousands of university 
students and professionals through skill-based service programs to 
improve quality of life in under resourced communities 
May 2010 Member of the Organizing Committee 
Member of the organizing committee and participant in the Annual 
Congress of the Federation of Ghana Catholic Health Trainees. This 
congress saw the adoption of more institutions into the Federation and held 
an outreach at Mayera (one of the six communities in the Amasaman sub 
district in the Greater Accra region). Statistics and reports from informants 
working there prior to the Congress, indicated that most of the pregnant 
women in the community were at high risk of maternal mortality. From the 
Congress, Mayerah benefited from massive educative campaigns on 
Maternal Mortality, Clinic sessions with over 2000 people screened, some 
treated, and others referred to Health centres 
2006 – 2012 Member, University of Ghana Medical Students’ Association 
2006 – 2012 Member, International Movement of Catholic Students- Pax Romana 
 
 
HOBBIES 
Reading 
Swimming 
Watching medical and scientific movies 
Dancing Ballet Jazz, Tap, Contemporary and HipHop 
  
 
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REFEREES 
Dr Fred Osei  
Consultant Anaesthesiologist 
Korle-Bu Teaching Hospital 
tcbl50@gmail.com 
+233 26 370 7083 
 
Dr Kofi- Mensah 
Consultant Anaesthesiologist 
Korle-Bu Teaching Hospital 
nanakofimensah4@gmail.com 
+233 20 253 6097 
 
Dr Daniel Sottie 
Consultant Anaesthesiologist 
Korle-Bu Teaching Hospital 
dsottie@gmail.com 
+233 24 213 7396 
 
Dr James Amoyaw Quashie-Sam 
Senior Specialist Anaesthesiologist 
Korle-Bu Teaching Hospital 
amoyaw23@gmail.com 
+233 20 815 0173 
 
Dr Jonas Afari 
Senior Specialist Anaesthesiologist 
Korle-Bu Teaching Hospital 
jawuku100@yahoo.com 
+233 54 677 7700 
  
 
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8.3 Ethical Clearance 
 
 
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