Sickness absenteeism among primary health care workers in Qatar before and during the COVID-19 pandemic

Sociodemographic characteristics of HCWs who availed sick leaves during the studied period

The study included 6,960 HCWs working with PHCC between January 1, 2019, and August 31, 2021. We found that 41,132 sick leaves were taken during that period. Among the 6,960 HCWs who availed at least one sick leave during the studied period, majority were between 30–39 years (45.9%), females (65.1%) with female to male ratio of 1.9:1. Expatriates accounted for 65.1% of HCWs availing sick leaves, with 1,240 (17.8%) were Indians, and 989 (14.2%) were Filipino. Clinical HCWs accounted for 59.8% of those who availed at least one sick leave, of whom, 2198 (31.6%) were nurses, and 923 (13.3%) were physicians. Upon analyzing the data based on the total sick leaves availed to reflect the frequency of requesting sick leaves per age, gender, nationality, and profession, we found that 42.8% of the 41,132 sick leaves were availed by those 30–39 years old, about three quarters (74.6%) were availed by females, 58%, and 42% were availed by expatriates, and locals respectively, and 52.8% by non-clinical staff (Table 1). The number of sick leaves availed in each month of years 2019–2021 and in different stages of the pandemic by sociodemographic characteristics and reason for sick leave are shown in Supplementary Tables 14.

Table 1 Number of sick leaves availed in years (2019–2021) by the sociodemographic characteristics and reasons for sick leaveTrend analysis of the availed sick leaves

In 2019, 12,945 sick leaves were availed by HCWs, October had the maximum number of leaves per month (1,417; 10.9%). A total of 13,557 sick leaves were availed in 2020, with 1563 (11.5%) of them were availed in March 2020. The remaining sick leaves (14,630) were availed up to August 31, 2021, with about one fifth (19.3%) of them being availed in March 2021. As shown in Fig. 1 and Supplementary Table 5, before COVID-19 (from January 2019), a total of 15,898 (38.6%) sick leaves were availed, with an average of 1,135 sick leaves per month, and an average of 1.34 days per sick leave. During the first wave of COVID-19 (March-Sep 2020), 7,157 (17.4%) sick leaves were availed with an average of 1,022 sick leaves per month, and an average of 2.47 days per sick leave (1.83 days/sick leave if we excluded COVID-19 related causes). On the other hand, during the second wave of COVID-19 (Feb-April 2021), 7,124 (17.3%) sick leaves were availed with an average of 2,375 sick leaves per month, and an average of 2.14 days per sick leave (1.54 days/sick leave if we excluded COVID-19 related causes).

Fig. 1figure 1

Sick leaves rate (average sick leaves per month) in different stages of the COVID-19 pandemic

Compared with pre-COVID-19 (Jan 2019-Feb 2020), as shown in Table 2, wave 1 had significantly lower incidence of sick leaves per day per 1000 HCWs (IRR 0.77, 95%CI 0.67–0.89, p < 0.001). On the other hand, wave 2 had significantly higher incidence of sick leaves compared to both pre-COVID-19 (IRR 1.55, 95%CI 1.27–1.90, p < 0.001), and Wave 1 (IRR 2.03, 95%CI 1.63–2.51, p < 0.001).

Table 2 Differences in the incidence of sick leaves per day per 1000 HCWs between different stages of the COVID-19 pandemic

Comparing the incidence of sick leaves per day per 1000 HCWs between the same months of each year, we found a significant difference between (March–April 2021, June 2021, and August 2021) and the same months in year 2019 (Table 3). Additionally, we found a significantly higher incidence in each of April (IRR 1.82, 95%CI 1.23–2.69, p < 0.003), May (IRR 1.61, 95%CI 1.01–2.60, p = 0.049), June (IRR 1.83, 95%CI 1.18–2.84, p = 0.007), and August (IRR 2.43, 95%CI 1.51–3.92, p < 0.001) in 2021 compared to the same months in year 2020. Figure 2 illustrates the rate of leaves per day per 1000 HCWs in different months across years 2019–2021.

Table 3 Differences in the incidence of sick leaves per day per 1000 HMCs between the same months of each year (2019, 2020, 2021)Fig. 2figure 2

The rate of sick leaves per day per 1000 HCWs in different months in years 2019, 2020, 2021

Predictors of healthcare worker’s sick leave rate

Using multivariable negative binomial regression analysis, and after adjusting to other variables we found that gender, nationality and profession were significantly associated with the number of sick leaves availed per HCW during the studied period. The number of sick leaves per person among female HCWs was significantly higher than that of male HCWs (IRR 1.47, 95%CI 1.40–1.54, p < 0.001). Moreover, the number of sick leaves per person among locals were about two times the number among expatriate HCWs (IRR 2.02, 95%CI 1.91–2.13, p < 0.001). On the other hand, physicians (IRR 0.81, 95%CI 0.75–0.87, p < 0.001), and nurses (IRR 0.88, 95%CI 0.84–0.93, p < 0.001) had significantly lower number sick leave per person compared to other professions (Table 4).

Table 4 Predictors of number of leaves availed by HCWs during 2019–2021 using multivariable negative binomial regressionCauses of the availed sick leaves

As shown in Table 5, upon analyzing the causes behind sick leaves in different time periods, we found overall that the most common reasons for requesting sick leaves before COVID-19 were respiratory related symptoms (33.6%), back and/or neck pain (10.9%), and gastroenteritis (7%). During the first wave, suspected or confirmed COVID-19 infection, respiratory symptoms/diagnoses (not labelled as suspected or confirmed COVID-19 infection), and back/neck pain were among the top three causes accounting for 20.6%, 18.4%, and 10.6% of the sick leaves availed during the first wave. Similarly, during the second wave of COVID-19, the top three causes were suspected or confirmed COVID-19 (19.4%), back and/or neck pain (12.5%), and respiratory symptoms (not labelled as suspected or confirmed COVID-19) (10.6%). On the other hand, after the second wave of COVID-19, back and/or neck pain came at the top of the list (16.7%), followed by respiratory symptoms (not labelled as suspected or confirmed COVID-19) (10.6%),

Table 5 Number of sick leaves availed in different stages of COVID-19 pandemic by reasons for sick leave

Further analysis on the most common reasons for sick leaves during different COVID-19 stages showed that the rates of respiratory-related sick leaves per day per 1000 HCWs (that are not labelled as suspected or confirmed COVID-19 infection) were higher during the Pre-COVID-19 stage compared to the other stages (as shown in Table 6). There was no significant difference in the rates between wave 1 and wave 2. Additionally, we observed that the rates of sick leaves due to back/neck pain were significantly higher during wave 2 and post wave 2 stages compared to the Pre-COVID-19 stage. Furthermore, the rates during wave 2 were higher compared to those in wave 1 (IRR 2.35, 95%CI 1.51–3.68, p < 0.001). In terms of gastroenteritis-related causes, we found that the rates of sick leaves were significantly lower during wave 1 and the post wave 1 stages compared to the Pre-COVID-19 stage. However, the rate was significantly higher during wave 2 compared to wave 1 (IRR 1.97, 95%CI 1.18–3.29, p = 0.009). Finally, we discovered that wave 2 had significantly higher rates of sick leaves due to suspected or confirmed COVID-19 infection compared to wave 1 (IRR 1.88, 95%CI 1.34–2.66, p < 0.001).

Table 6 Differences in the rates of cause specific sick leaves per day per 1000 HCWs between different stages of the COVID-19 pandemic

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