Non-communicable diseases (NCDs) are emerging as a major contributor to death and illness in Sierra Leone. Despite this, there is limited understanding of how NCD patients in Sierra Leone experience both direct COVID-19 exposure and the indirect consequences of the pandemic on socioeconomic determinants of health. We performed a cross-sectional telephone survey among adults (≥ 18 years) with hypertension, diabetes, or heart failure receiving care at the NCD clinic of Koidu Government Hospital (KGH) in rural Sierra Leone. We collected information on patient demographics, COVID-19 knowledge, and adherence to infection prevention measures. Wealth quintiles were assigned using an asset-based index to approximate national representation, and social vulnerability indicators were stratified by clinical program and wealth category. Among 400 participants, 80.5% were aged 40–69 years, and 46.1% were male. Over 90% were aware that wearing masks, maintaining physical distance, isolating from infected individuals, and avoiding handshakes were effective for COVID-19 prevention. Yet, only 27.3% had access to adequate handwashing facilities, 25.5% had attended crowded gatherings in the prior two weeks, and just 5.8% consistently used masks. Compared to national wealth distribution, 33.0% of participants were in the richest quintile, 34.8% in the second-richest, and 32.2% in the combined bottom three quintiles. Socioeconomic vulnerability was widespread with clear disparities across wealth levels. Within the 30 days prior to the survey, nearly 60% of individuals in the poorest-middle categories faced at least one barrier to essential health services, 87.4% resorted to at least one emergency coping strategy for food, housing, or health care, and 98.4% reported food-related worry. Corresponding figures for the richest quintile were 32.3%, 39.5%, and 81.6%.Patients demonstrated good awareness of COVID-19 preventive practices; however, there were notable gaps between knowledge and actual behaviors. Despite being wealthier than the national average, NCD patients still experienced high levels of socioeconomic vulnerability, highlighting the persistent issue of absolute poverty in Sierra Leone. Wealth-related inequities in access to essential resources remain a significant concern among this population.
