School closures help reduce the spread of COVID-19: A pre- and post-intervention analysis in Pakistan

Closing schools to control COVID-19 transmission has been globally debated, with concerns about children's education and well-being, and also because of the varied effectiveness of the intervention in studies across the world. This paper aims to determine the effect of school closure policy on the incidence of COVID-19 in Pakistan. A Difference-in-Differences (DiD) analysis compared changes in COVID-19 incidence across cities that completely (Islamabad) and partially (Peshawar) closed schools during the second wave of COVID-19 in Pakistan. Effects of closing (November 2020) and reopening schools (February 2021) were assessed in Islamabad and Peshawar 10 and 20 days after policy implementation. In Islamabad, there was a greater decline in cases than in Peshawar when schools closed. After 10-days, the average reduction of daily COVID-19 incidence in Islamabad was lower by 89 cases (95% CI: -196, 18), due to complete school closure, with a relative reduction of 125 cases (95% CI: -191, -59) compared to Peshawar. Similarly, the relative increase in Islamabad after schools re-opened was 107 cases (95% CI: 46, 167) compared to Peshawar. After 20-days, the average daily COVID-19 incidence in both cities declined after school were closed (Islamabad: -81 [95% CI: -150, -13] versus Peshawar: -80 [95% CI: -148, -12]). COVID-19 incidence appeared to decline after schools reopened as well (Islamabad: -116 [95% CI: -230, -3] versus Peshawar: -30 [95% CI: -124, 63]). However, Peshawar's decline is not statistically significant. These results control for changes in testing as well as a daily time trend. The magnitude and speed of reduction in cases with a complete school closure, and a similar but reverse trend of increasing cases upon reopening, suggests that closing schools reduces COVID-19 transmission in communities. However, there are learning-loss and well-being costs for children and their parents.

COVID-19 vaccination acceptance in underserved urban areas of Islamabad and Rawalpindi: results from a cross-sectional survey.

BACKGROUND: Urban slums are home to a significant number of marginalized individuals and are often excluded from public services. This study explores the determinants of willingness and uptake of COVID-19 vaccines in urban slums in Pakistan. METHODS: The study uses a cross-sectional survey of 1760 respondents from five urban slums in twin cities of Rawalpindi and Islamabad carried out between June 16 and 26, 2021. Pairwise means comparison tests and multivariate logistic regressions were applied to check the associations of socio-demographic factors and COVID-19 related factors with willingness to get vaccinated and vaccination uptake. RESULTS: Only 6% of the sample was fully vaccinated while 16% were partially vaccinated at the time of survey. Willingness to receive vaccination was associated with higher education (aOR: 1.583, CI: 1.031, 2.431), being employed (aOR: 1.916, CI: 1.423, 2.580), prior infection in the family (but not self) (aOR: 1.646, CI: 1.032, 2.625), family vaccination (aOR: 3.065, CI: 2.326, 4.038), knowing of and living close to a vaccination center (aOR: 2.851, CI: 1.646, 4.939), and being worried about COVID-19 (aOR: 2.117, CI: 1.662, 2.695). Vaccine uptake was influenced by the same factors as willingness, except worriedness about COVID-19. Both willingness and vaccination were the lowest in the two informal settlements that are the furthest from public facilities. CONCLUSIONS: We found low lived experience with COVID-19 infection in urban slums, with moderate willingness to vaccinate and low vaccination uptake. Interventions that seek to vaccinate individuals against COVID-19 must account for urban poor settlement populations and overcome structural barriers such as distance from vaccination services, perhaps by bringing such services to these communities.

Community engagement to increase vaccine uptake: Quasi-experimental evidence from Islamabad and Rawalpindi, Pakistan.

Developing countries have been facing difficulties in reaching out to low-income and underserved communities for COVID-19 vaccination coverage. The rapidity of vaccine development caused a mistrust among certain subgroups of the population, and hence innovative approaches were taken to reach out to such populations. Using a sample of 1760 respondents in five low-income, informal localities of Islamabad and Rawalpindi, Pakistan, we evaluated a set of interventions involving community engagement by addressing demand and access barriers. We used multi-level mixed effects models to estimate average treatment effects across treatment areas. We found that our interventions increased COVID-19 vaccine willingness in two treatment areas that are furthest from city centers by 7.6% and 6.6% respectively, while vaccine uptake increased in one of the treatment areas by 17.1%, compared to the control area. Our results suggest that personalized information campaigns such as community mobilization help to increase COVID-19 vaccine willingness. Increasing uptake however, requires improving access to the vaccination services. Both information and access may be different for various communities and therefore a "one-size-fits-all" approach may need to be better localized. Such underserved and marginalized communities are better served if vaccination efforts are contextualized.

School closures help reduce the spread of COVID-19: A pre- and post-intervention analysis in Pakistan.

Closing schools to control COVID-19 transmission has been globally debated, with concerns about children's education and well-being, and also because of the varied effectiveness of the intervention in studies across the world. This paper aims to determine the effect of school closure policy on the incidence of COVID-19 in Pakistan. A Difference-in-Differences (DiD) analysis compared changes in COVID-19 incidence across cities that completely (Islamabad) and partially (Peshawar) closed schools during the second wave of COVID-19 in Pakistan. Effects of closing (November 2020) and reopening schools (February 2021) were assessed in Islamabad and Peshawar 10 and 20 days after policy implementation. In Islamabad, there was a greater decline in cases than in Peshawar when schools closed. After 10-days, the average reduction of daily COVID-19 incidence in Islamabad was lower by 89 cases (95% CI: -196, 18), due to complete school closure, with a relative reduction of 125 cases (95% CI: -191, -59) compared to Peshawar. Similarly, the relative increase in Islamabad after schools re-opened was 107 cases (95% CI: 46, 167) compared to Peshawar. After 20-days, the average daily COVID-19 incidence in both cities declined after school were closed (Islamabad: -81 [95% CI: -150, -13] versus Peshawar: -80 [95% CI: -148, -12]). COVID-19 incidence appeared to decline after schools reopened as well (Islamabad: -116 [95% CI: -230, -3] versus Peshawar: -30 [95% CI: -124, 63]). However, Peshawar's decline is not statistically significant. These results control for changes in testing as well as a daily time trend. The magnitude and speed of reduction in cases with a complete school closure, and a similar but reverse trend of increasing cases upon reopening, suggests that closing schools reduces COVID-19 transmission in communities. However, there are learning-loss and well-being costs for children and their parents.