ABSTRACT
COVID-19-related knowledge and behaviors remain essential for controlling the spread of disease, especially among vulnerable patients with advanced, chronic diseases. We prospectively assessed changes over 11 months in COVID-19-related testing, knowledge, and behaviors among patients with non-communicable diseases in rural Malawi using four rounds of telephone interviews between November 2020 to October 2021. The most commonly reported COVID-19-related risks among patients included visiting health facilities (35-49%), attending mass gatherings (33-36%), and travelling outside the district (14-19%). Patients reporting having experienced COVID-like symptoms increased from 30% in December 2020 to 41% in October 2021. However, only 13% of patients had ever received a COVID-19 test by the end of the study period. Respondents answered 67-70% of the COVID-19 knowledge questions correctly, with no significant changes over time. Hand washing, wearing face masks and maintaining a safe distance were the most frequently reported strategies to prevent the spreading of COVID-19. Wearing face masks significantly improved over time (p < 0.001). Although the majority reported accurate knowledge about COVID-19 and enhanced adherence to infection prevention measures over time, patients commonly visited locations where they could be exposed to COVID-19. Government and other stakeholders should increase COVID-19 testing accessibility to primary and secondary facilities.
Subject(s)
COVID-19 , Noncommunicable Diseases , Humans , COVID-19/epidemiology , COVID-19 Testing , Malawi/epidemiology , Noncommunicable Diseases/epidemiology , Prospective StudiesABSTRACT
Background In the context of diminutive COVID-19 screening and testing, syndromic surveillance can be used to identify areas with higher-than-expected SARS-CoV-2 symptoms for targeted public health interventions. We used syndromic surveillance to monitor potential SARS-CoV-2 outbreaks in 14 health facilities in the Neno district of rural Malawi. Methods We monitored three indicators identified as potential symptoms of SARS-CoV-2 infection: the proportion of outpatient visits for fast-breathing cases in children under 5 years (FBC<5);the proportion of suspected malaria cases confirmed as non-malaria in children under 5 years (NMC<5);and the same indicator in individuals aged 5 years and older (NMC≥5). We extracted data aggregated by month and at the health facility-level from the District Health Information System. With data from January, 2016, to February, 2020, as a baseline, we used a linear model with a negative binomial distribution to estimate expected proportions for the indicators in absence of the COVID-19 pandemic with 95% prediction intervals (PI) for March, 2020, to July, 2021. We compared the observed proportions to the expected rates, focusing on the first two waves of infections (June to July, 2020, and January to March, 2021). Findings The proportion of FBC<5 was consistently higher than expected, with a peak in May, 2020, when 2·5% of outpatient visits were fast breathing cases in children younger than 5 years of age (compared with the expected rate of 0·8% [95% PI 0·4–1·5]). NMC<5 was as expected throughout the study period. The NMC≥5 indicator remained as expected, except for increases in suspected cases tested negative for malaria, to 31·3% (from the expected 18·6% [95% PI 12·3–28·7]) in November, 2020, and to 32·5% (from the expected 21·7% [95% PI 14·2–32·2]) in July, 2021. Interpretation An increase in FBC<5 and NMC≥5 before observed COVID-19 waves might indicate SARS-CoV-2 infections that were missed before robust testing. This tendency was not seen in NMC<5, which can represent differences in symptomatology leading to decreased health-seeking behaviours for this age group. Syndromic surveillance can allow for real-time responses at facilities, including increased and focused testing and screening to identify potential SARS-CoV-2 infections. Funding Supported by Canadian Institutes of Health Research.