The coronavirus disease (COVID-19) pandemic, which began in China in December 2019, is still posing a global health risk (1). Over 304 million confirmed cases and 5.4 million deaths had been reported globally in the 2 years since its emergence, as of the first week of January 2022 (2). As of 2 January 2022, there were over 400 thousand COVID-19 confirmed cases in Ethiopia, and the virus was responsible for about 7,000 fatalities. Risk communication and awareness campaigns are being used to address worries about the alarming rise in COVID-19 cases and the widespread dissemination of flu-like symptoms among Ethiopians. Additionally, the COVID-19 vaccine has been given in doses totaling close to 11 million up to January 2022 (3).

The severity and mortality of COVID-19 infections are thought to be increased in patients with preexisting medical conditions like diabetes mellitus (DM), hypertension, and malignancies (4). The case-fatality ratio was higher in patients with cardiovascular diseases (10.5%), diabetes (7.3%), and hypertension (6%) compared to the general population (2.3%) (5). Aside from physical health, COVID-19 has had a negative impact on mental health, causing significant anxiety and depression in people (6), and interfering with daily lives, jobs, and relationships. People are afraid of infection, dying, and losing family members during the COVID-19 outbreak. At the same time, many people have lost or are in danger of losing their jobs, have become socially isolated and separated from loved ones, and have seen stay-at-home orders implemented in some countries in drastic ways (7).

As a result, whether infected or not, COVID-19 has had a significant impact on people’s quality of life (QOL) (8, 9). The COVID-19 outbreak is regarded as an unforeseen traumatic life event that has harmed individuals’ QOL in general and particularly their health-related quality of life (HRQOL). HRQOL is a multidimensional concept that describes how an individual assesses his or her mental, physical, emotional, and social wellbeing (10). Many studies have been conducted to investigate the QOL of recovered COVID-19 cases in the general population, hospitalized patients, and chronic illness patients (9, 11–13).

The COVID-19 pandemic has a significant negative impact on QOL, especially in terms of physical, mental, social, and spiritual wellbeing (9, 14–17). A recent study in Bangladesh found a link between chronic diseases such as hypertension (HTN), diabetes mellitus (DM), heart disease, asthma, kidney diseases, and cancer and significantly lower QOL in all domains (18). According to a recent Egyptian study, 64% and 62% of diabetic patients reported poor physical and mental QOL, respectively. (19). In a similar study conducted in the Netherlands, 43% of patients with chronic kidney disease reported that the COVID19 pandemic had reduced their QOL (20).

People with non-communicable chronic diseases (NCDs) found it challenging to see a doctor and have their prescriptions filled (21) during the COVID-19 pandemic. During the peak of the COVID-19 pandemic, movement restrictions and social isolation became the new normal, contributing to a substantial reduction in people’ activities, which is associated with a significant decline in overall QOL (22). As a result, it is essential to look into how the COVID-19 pandemic affected the QOL of individuals living with chronic NCDs.

The unbearable impact of the COVID-19 pandemic may have had a significant impact on the QOL of patients with chronic medical conditions. To the best of our knowledge, data on QOL assessment among chronic disease patients in response to the COVID-19 pandemic are scarce, particularly in low-income countries like Ethiopia. Furthermore, there is a scarcity of data on the relationship between COVID-19-related psychological complications (such as depression, anxiety, and stress) and QOL among chronic disease patients during the COVID-19 pandemic. Therefore, this study fills a research gap by (1) describing QOL among patients with chronic medical conditions and (2) identifying the association between various socio-demographic, clinical, and psychological factors and QOL to identify significant predictors of QOL among patients with chronic medical conditions during the era of COVID-19 pandemic.

This study included 633 participants. The majority of study participants (56.4%) were male, and 64.8% were married. About half (55.6%) were Protestant religious followers, followed by Orthodox Christians (25.9%), and about one-fourth (27.6%) were illiterate. More than one-fifth (22.7%) worked as a farmer, while 55.8% lived in urban. The mean age of the respondents was 46.49 ± 17.71 years as described in Table 1.

About half of the participants (53.1%) had diabetes mellitus, followed by hypertension (17.5%), and nearly one-third (31.6%) had a comorbid diagnosis. The majority of participants (57.5%) had been sick for 5 years, and 9.6% and 7.7% had used alcohol and khat in the previous 3 months, respectively. More than one-third (35.4%) of all participants had poor social support, while about half (52.4%) had moderate social support. The mean SRQ-20 and ISI scores were 6.06 ± 5.09 and 6.62 ± 6.89, respectively (Table 2).

The global COVID-19 outbreak has wreaked havoc. Millions of lives were lost, and billions of people suffered psychologically and economically as a result. This study was used to assess the QOL of people who had chronic medical illnesses, as well as factors that were found to be significantly associated with QOL during the COVID-19 pandemic.

When the total WHOQOL-BRIEF score was compared to the sample socio-demographic characteristics, age was found to be a significant predictor, with QOL decreasing as age increased. This result was consistent with recent follow-up studies that found out older age was a risk factor for poor QOL (11, 35). This association can be explained by the fact that older age is associated with lower levels of overall health and physical function (12). QOL is projected to decline as people age, as they are more likely to suffer from many health problems (36). Another explanation could be that when people become older, the risk of COVID-19 infection increases severely (37). This suggests that during the COVID-19 pandemic, aging had a detrimental impact on QOL scores among chronic medical ill individuals.

In our study, the QOL scores of female patients were significantly lower than that of male patients, indicating that their QOL was significantly worse. Similar associations have been discovered in earlier studies, which supports our conclusion (12, 35). During the COVID-19 outbreak, women were shown to be more vulnerable to a variety of psychological problems (such as anxiety and depression) as compared to men (38, 39). Moreover, it is a known fact that females are more likely to have a lower income, more hurdles to healthcare access, and more domestic task obligations. All of these reasons may have contributed to the poor QOL in females.

We found out that educational status is significantly associated with QOL, i.e., lower educational attainment has better QOL scores. This is supported by a recent study, which found that QOL scores were shown to be lower in patients with a higher degree of education (8), due to a higher level of awareness and concern about COVID-19 and its negative effect on QOL. In addition, according to Nguyen et al. those with a high level of education had a higher prevalence of depression during the pandemic, resulting in a stress burden that adversely affects their health-related QOL (40). On the contrary, previous studies also found that, with higher levels of education, there was a general increment in QOL scores (18, 41). Higher educational attainment is often associated with greater career prospects and higher earnings, hence improving an individual’s QOL (41). However, uneducated participants claimed that their QOL was barely adequate in terms of thinking capacity, perceived physical safety and security, and vitality (41). Another rationale is that highly educated people may have a lot of wants and requirements in their daily lives, which may be jeopardized by the COVID-19 pandemic.

In our study, rural resident participants had higher QOL scores as compared to their counterparts. This is in line with previous study conducted by Hawlader et al. in Bangladesh (18). In urban areas, high population density and pollution levels may also have a negative impact on subjective QOL (42).

Duration of illness is another significant predictor of QOL in our study. Those patients with ≤5 years duration of illness have lower QOL score as compared to those with ≥11 years. This may be because of the fact that QOL can improve over time as patients adjust to chronic illness, symptoms stabilize, and more effective treatment alternatives become available over the course of long-term illness (43–45).

Our study showed that the QOL score was found to be lower among alcohol users when compared to non-alcohol users. Similar findings were reported in previous studies such that alcoholism is related to a reduced QOL (46, 47). Alcohol use has been shown to rise during stressful times such as pandemics (48). Alcohol consumption has a variety of intangible negative consequences, such as suffering, loss of healthy living, and deterioration of social and familial bonding, all of which contribute to a decrease in the individual’s QOL (49). In addition, alcohol is related to an increased risk of weakening the immune system, making people more susceptible to infectious disorders such as COVID-19 (50). Individuals use alcohol to cope with COVID-19′s stressful adaptive challenges (51). Some studies have revealed that those who drink have a much lower QOL, particularly in terms of their mental health and social functioning (52, 53).

Our study also showed that participants who had CMD had a higher probability of having lower QOL scores. The findings were consistent with a prior study, which found lower QOL scores in those who reported higher levels of anxiety, depression, and stress (9). Depression and anxiety have been linked to cognitive dysfunction (54), physical distress (55), and poor social functioning (56), all of which have been associated with a reduction in patients’ QOL. Previous studies well established that there is an inverse association between QOL and mental health problems such as depression and anxiety (57). As a result, it is not surprising that having more perceived CMDs lowers the QOL of patients with chronic medical illness, as found by this study.

This study found a statistically significant negative association between the insomnia severity index scale and the QOL scale. Similarly, recent studies indicated that impaired QOL was found to be independently associated with lower sleep quality and insomnia (58, 59). Insomnia’s impact on QOL could be due to physical or mental health comorbidities, medications, and/or a variety of psychosocial issues, or it could be a symptom of a primary disease. Furthermore, insomnia causes significant impairments in occupational and social functioning, as evidenced by decreased productivity of work, recurrent absenteeism, decreased cognition and mood, and increased physical and psychological morbidity (60). These directly or indirectly affects QOL of individuals.

This study has some limitations. First, we recognize that a cross-sectional study could not detect the continuing impact of the COVID-19 pandemic on different dimensions of QOL; thus, future research could be done using data based on a longitudinal design. Second, we did not use preferred tools to assess QOL such as SF-6D that was primarily designed to measure QOL in clinical populations. Third, because only participants from south Ethiopia were included in the study, the results cannot be applied to all Ethiopians who have chronic NCDs. These results need to be verified by additional research using a larger sample size and perhaps even a qualitative assessment. Additionally, the use of the non-probability consecutive sampling method could be viewed as a limitation. Fourth, there is a potential for social desirability bias. For instance, when data were collected using an interviewer-administered method, participants may have over- or underreported their responses for a variety of reasons.

In general, increase in age, higher SRQ-20 score (having CMD), increased ISI score (insomnia), being female, shorter duration of illness (<5 years), and alcohol use have a significant negative association with high QOL in patients with chronic medical condition during COVID-19 pandemic, whereas being illiterate and living in rural residence have a positive association with high QOL. Overall, the findings confirmed that the COVID-19 pandemic had a negative impact on an individual’s QOL in a variety of ways. Thus, this study suggests that addressing insomnia, co-morbidities of mental disorders, and alcohol use has the potential effect to improve the QOL of patients with chronic medical illnesses.

The original contributions presented in this study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author/s.

The studies involving human participants were reviewed and approved by Hawassa University, College of Medicine and Health Sciences, Institutional Review Board (IRB) with reference number: IRB/076/13. The participants provided their written informed consent to participate in this study.

MA, BD, AG, and SH participated in the conception, designed the study, and were involved in the data collection. MA, BD, and SD performed the analysis of the study. MA and SD prepared the manuscript for publication. BD, AG, SH, and SD critically reviewed the manuscript. All authors read and approved the final manuscript.