Dramatic increases in knowledge, attitudes and practices of COVID-19 observed among low-income households in the Philippines: A repeated cross-sectional study in 2020.

Background: The COVID-19 pandemic has severely impacted populations globally, and knowledge, attitudes and practices (KAPs) surrounding the virus have necessarily evolved. This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization that runs the "Transform" poverty alleviation program. The main objective of this study was to describe the changes in COVID-19 KAPs among households experiencing extreme poverty in the Philippines over an 8-month period. Methods: A KAP questionnaire was integrated into the household survey collected as part of ICM's regular monitoring and evaluation of "Transform". Data collection for the first survey was conducted between February 20 and March 13, 2020, and the second survey was conducted between November 12 and December 12, 2020. Frequencies and proportions were calculated to describe the respondents' responses and the Kruskal-Wallis test was used to assess if there were significant differences in KAP identification between the two time points. Results: We observed a distinct increase across all KAP domains. Over 90% of study participants were able to correctly identify COVID-19 transmission modes and preventive measures, and an even higher percentage reported adopting these measures. However, the intention to seek care from public hospitals for COVID-19 symptoms dropped from 43.6% to 28.4%, while reports of self-treatment using stored medicines or antibiotics increased. Trust in community members and local health authorities was correlated with higher knowledge and practice scores. Conclusions: Our study results reflect the extraordinary speed of information dissemination and behaviour change globally over the course of the pandemic, but they also highlight the changes in KAP that show the additional challenges faced by populations experiencing poverty in the Philippines. Prioritization of reducing inequities in the implementation and adoption of the evolving public health measures will be integral as the pandemic continues.

Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the 'SPRINT' principles.

INTRODUCTION: The COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs). METHODS: We used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt. RESULTS: We describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency. CONCLUSIONS: Guideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the 'SPRINT principles' for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.

Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: A cross-sectional study.

BACKGROUND: The presence of COVID-19 in low- and middle-income countries (LMICs) is raising important concerns about effective pandemic response and preparedness in the context of fragile health systems and the pervasiveness of misinformation. The objective of this study was to gain an understanding of how COVID-19 was perceived by households experiencing extreme poverty in the Philippines. METHODS: This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO) that runs a poverty-alleviation program called Transform targeted towards extreme low-income households. We integrated knowledge, attitudes, and practices (KAP) questions into ICM's cross-sectional program monitoring and evaluation systems from February 20 through March 13, 2020. Frequencies and proportions were calculated to describe the respondents' responses, and the Kruskal-Wallis test and binomial logistic regression were undertaken to determine the socio-demographic characteristics associated with COVID-19 KAPs. RESULTS: In total, 2224 respondents from 166 communities in rural, urban and coastal settings were surveyed. Although the survey was administered during the earlier stages of the pandemic, 94.0% of respondents had already heard of COVID-19. Traditional media sources such as television (85.5%) and radio (56.1%) were reported as the main sources of information about the virus. Coughing and sneezing were identified as a transmission route by 89.5% of respondents, while indirect hand contact was the least commonly identified transmission route, recognized by 72.6% of respondents. Handwashing was identified by 82.2% of respondents as a preventive measure against the virus, but social distancing and avoiding crowds were only identified by 32.4% and 40.6%, respectively. Handwashing was the most common preventive practice in response to COVID-19, adopted by 89.9% of respondents. A greater number of preventive measures were taken by those with more knowledge of potential transmission routes. CONCLUSIONS: There is a need for targeted health education as a response strategy to COVID-19 in low-income settings, and it is important that strategies are contextually relevant. Understanding KAPs among populations experiencing extreme poverty will be important as tailored guidance for public health response and communication strategies are developed for LMICs.