COVID-19, psychological health, and Presenteeism: Longitudinal Evidence from Healthcare Workers in Greater Accra, Ghana

Background Healthcare workers (HCWs) in sub-Saharan Africa face high occupational risks due to workforce shortages and heavy disease burdens, which were intensified during the COVID-19 pandemic. Presenteeism—working while unwell—emerged as a critical concern, yet its prevalence and determinants among African HCWs are poorly understood. Methods We conducted a six-month longitudinal study (October 2021–April 2022) among 756 HCWs in four major COVID-19 treatment centers in Ghana, including 252 with confirmed COVID-19 and 504 unexposed controls. Presenteeism was measured using the Stanford Presenteeism Scale (SPS-6) at baseline, three months, and six months. Multivariable logistic regression assessed socio-demographic, occupational, and health-related predictors. Results Presenteeism was consistently higher among exposed HCWs, peaking at 91.7% at month 3 and declining to 76.2% at month 6, compared with lower rates in unexposed peers (p < 0.01). Laboratory scientists (AOR = 1.61, 95% CI: 1.01–2.59), nurses (AOR = 1.51, 95% CI: 1.05–2.17), HCWs with ≥ 2 part-time jobs (AOR = 1.74, 95% CI: 1.31–2.32), and those with ≥ 5 dependents (AOR = 1.31, 95% CI: 1.00–1.74) had increased odds of presenteeism. Severe anxiety elevated risk (AOR = 3.24, 95% CI: 1.22–8.64), whereas severe depression reduced it (AOR = 0.44, 95% CI: 0.25–0.76). Family and workplace support showed no protective effect. Conclusion Presenteeism was widespread among Ghanaian HCWs after COVID-19, driven by infection exposure, mental health challenges, multiple employment, and household responsibilities. Policies promoting adequate staffing, fair compensation, mental health support, and protective workplace cultures are urgently needed to safeguard HCW well-being and strengthen health system resilience in future health crises.