Prevalence and predictors of self-medication for COVID-19 among slum dwellers in Jinja City, Uganda (preprint)

Introduction: Self-medication is a serious public health concern globally and is more prevalent in underserved populations, especially in resource limited settings. The lack of effective treatment for COVID-19 and poor access to healthcare were drivers of self-medication. We investigated the prevalence and associated factors with self-medication for COVID-19 among slum dwellers in a Ugandan slum. Methods and materials: We conducted a cross-sectional study using randomly selected respondents from slums in Jinja city, Uganda. Households were proportionately selected from the slums and one participant with confirmed or self-reported COVID-19 during 2021 was recruited. Poisson regression with robust standard errors was used to determine the crude (CPR) and adjusted prevalence ratios (APR) (95% CI) of factors associated with self-medication. Variables were selected apriori and backward elimination approach used to fit the final multivariate model in which variables with a P[≤] 0.05 were included. Results: Overall, 517 respondents were recruited, median age (years) was 31 (26-40), and 59% were male. The prevalence of self-medication for COVID-19 was 87.23% (451/517), 95% CI: [84.00%-90.00%] and 56% knew that self-medication was dangerous. Age[≥]50 years, compared to 20-29 years [APR: 1.12, 95% CI:1.05, 1.20], being female [APR: 1.07, 95% CI: 1.02, 1.13], minor [APR: 1.62, 95% CI: 1.25, 2.11], and severe symptoms [APR: 1.51, 95% CI: 1.16, 1.96], access to internet [APR: 1.13, 95% CI: 1.07, 1.20]. Having medical insurance [APR: 0.63, 95% CI: 0.46, 0.87] and awareness about laws against self-medication [APR: 0.89, 95% CI: 0.81, 0.97] were associated with a lower risk of self-medication. Conclusion: The prevalence of self-medication in slum dwellers in Uganda was high despite high awareness about its dangers. Self-medication was common in those with severe symptoms and those access to internet. There is need to control infodemia and improve health insurance cover in informal settlements within Uganda.

Association between recent COVID-19 diagnosis on depression and anxiety symptoms among slum residents in Kampala, Uganda (preprint)

Background An increase in mental health problems has been reported since the beginning of the COVID-19 pandemic. However, little is known about the prevalence of depressive and anxiety disorders, and how recent COVID-19 diagnosis may influence risk of these conditions especially in low-income settings. In this study, we assessed the association between recent COVID-19 diagnosis and depressive and anxiety symptoms among residents in an urban slum setting in Uganda. Methods A cross-sectional study was conducted among 284 individuals in a slum settlement in Kampala, Uganda between April and May 2022. We assessed generalized anxiety and depression symptoms using two validated questionnaires. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. Results Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR= 1.60, 95% CI 1.09 - 2.34) and anxiety (PR = 2.83, 95% CI 1.50 - 5.31) . Conclusion This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.

Effect of COVID-19 on treatment of paediatric febrile illnesses among registered private drug sellers in East-Central Uganda: a qualitative study (preprint)

BackgroundPrivate drug sellers play a critical role in treating children with malaria, pneumonia and diarrhea which remain the leading causes of mortality in children less than five years in many low-and middle-income countries. The onset of COVID-19 led to intermittent lockdowns resulting in curtailed movement of people including for access of health services. This study qualitatively assessed the effect of COVID-19 on treatment of pediatric febrile illnesses among registered private drug sellers in East-Central Uganda.MethodsFour key informant interviews (KIIs) were held with drug inspectors and four focus group discussions (FGDs) were conducted with registered drug sellers at the end of the second lock down period following a nationwide reduction in COVID-19 cases. Interviews were audio recorded and transcribed verbatim. Transcripts were imported into Atlas.ti 7 software for management and thematic analysis.ResultsFour major themes arose from the study. These were; Treatment practices, Logistics, Living standards and collaboration between government and private sector. Accessing drugs used for treating children with febrile illnesses was difficult because of the lock down which restricted movement of people. As such, community members were not able to work resulting in poverty. This led to procuring incomplete doses for sick children from drug sellers hence inappropriate treatment. The curtailed movement also increased the cost of procuring drugs making them unaffordable by caregivers with febrile children. This in turn led to reduced income translating into reduced standards of living for drug sellers. Noteworthy, government and the private sector need to collaborate in order to make paediatric drugs easily accessible to the private drug sellers in future pandemics. This will lead to desired pediatric health outcomes.ConclusionCOVID-19 hampered the appropriate treatment of children because the instituted lock downs caused restricted movement hence a shortage of drugs and rampant poverty among community members. The hiked cost of procuring drugs for febrile children lowered the living standards of many drug sellers. It is important that in future, synergy be created between government and private health providers in order to benefit from the economies of scale.

Unintended Socio-Economic and Health Consequences of COVID-19 among Slum Dwellers in Kampala, Uganda (preprint)

Background: To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-economic and health consequences due to the COVID-19 pandemic and the mitigation measures in slums in Kampala to inform the on-going and future pandemic response strategies. Methods: This was a mixed methods cross-sectional study conducted in Bwaise I and Bwaise III slums of Kawempe division, Kampala Uganda from October to December 2020. We used systematic sampling to randomly select 425 household heads for the face-to-face quantitative interviews. We also conducted six focus group discussions (FGDs) with slum dwellers and used photovoice among eight Community Health Workers (CHWs) to document unintended socio-economic and health consequences. Quantitative data were imported into STATA version 14.0 for analysis, while qualitative data were analysed thematically using NVivo version 12. Modified Poisson regression analysis was conducted to establish factors associated with impact on access to food. Results: Most respondents reported limited access to food (71.1%; 302/425); disruption in education (77.1%; 270/350); drop in daily income and wages (86.1%; 329/382) and loss of employment (63.1; 125/198). Twenty five percent of the respondents (25.4%; 86/338) reported domestic violence as one of the challenges. Seven themes emerged from the qualitative findings on the impact of COVID-19 including: limited access to food; negative impact on children’s rights (child labour and early pregnancies) and education; poor housing and lack of accommodation; negative social behaviours; negative impact on family and child care; reduced income and employment; and negative impact on health and access to health care services. Conclusion: The slum dwellers of Bwaise I and Bwaise III experienced several negative socio-economic consequences of COVID-19 and its prevention measures that severely affected their wellbeing. Children experienced severe consequences such as child labour and early pregnancies among the girls. Response activities should be contextualised to different settings and protocols to protect the vulnerable groups in the community such as children and women should be developed and mainstreamed in response activities.

Face-masking, an acceptable protective measure against COVID-19: Findings of Ugandan high-risk groups (preprint)

Face-masking could reduce the risk of COVID-19 transmission. We assessed: knowledge, attitudes, perceptions, and practices towards COVID-19 and face-mask use among 644 high risk-individuals in Kampala, Uganda. In data analysis, descriptive, bivariate and multivariate logistic regression analyses, with a 95% confidence interval were considered. Adjusted-odds ratios were used to determine the magnitude of associations. P-values < 0.05 were considered statistically-significant. Majority: 99.7% and 87.3% of the participants respectively had heard and believed that face-masks were protective against COVID-19, while 67.9% reported having received information on face-mask use. Males, food market vendors, those with no formal education, and those aged 24-33, 44-53 and 54-63 years were 0.58, 0.47, 0.25, 1.9, 2.12, and 3.39 times less likely to have received information about face-mask use respectively. Majority, 67.8% owned locally-made, non-medical face-masks, while 77.0% of face-mask owners believed that they knew the right procedure of wearing them. Those who had received information on face-mask use were 2.85 and 1.83 times more likely to own face-masks and to perceive them as protective. Food market vendors were 3.92 times more likely to re-use their face-masks. Our findings suggest that Ugandan high-risk groups have good knowledge, optimistic attitudes and perceptions, and relatively appropriate practices towards COVID-19.

Lockdown measures in response to COVID-19 in Sub-Saharan Africa: A rapid study of nine countries (preprint)

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. This paper defines the term lockdown and describes the design, timing and implementation of lockdown in nine countries in Sub Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. It also discusses the manner in which lockdown is enforced, the need to mitigate the harms of lockdown, and the association between lockdown and the reported number of COVID-19 cases and deaths. While there are some commonalities in the implementation of lockdown, a more notable finding is the variation in the design, timing and implementation of lockdown measures across the nine countries. We found that the number of reported cases is heavily dependent on the number of tests done, and that testing rates ranged from 9 to 21,261 per million population. The reported number of COVID-19 deaths per million population also varies, but is generally low when compared to countries in Europe and North America. While lockdown measures may have helped inhibit some community transmission, the pattern and nature of the epidemic remains unclear. Of concern are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic harms. This paper highlights the need for inter-sectoral and trans-disciplinary research capable of providing a rigorous and holistic assessment of the harms and benefits of lockdown.