Assessing Sociodemographic Factors Associated with Household Hardships during the COVID-19 Pandemic in Manhica, Mozambique using Data Collected between April 2021 and February 2022 (preprint)

BackgroundCOVID-19 resulted in vast disruption to life in the 21st century. To quell the disease spread, national governments implemented several containment measures like state of emergency, curfews, and lockdowns that likely created hardships for households. To improve knowledge of the negative consequences of these lockdowns, we examine the extent to which the pandemic period was associated with hardships at the household level and assess factors associated with household vulnerability to these hardships. MethodsWe conducted a cross-sectional survey between April 2021 and February 2022 among households residing in the district of Manhica through a survey questionnaire fielded in the Health and Demographic Surveillance System (HDSS) operating in Manhica, Mozambique. Logistic regression was used to analyze associations between the head of household and household characteristics with specific household hardships (business closure, food price increase, household member detained, input inflation, job loss). ResultsHouseholds headed by individuals with lower education and employed in non-agricultural occupations as well as households that were larger in size or poorer in asset ownership compared to other households were generally at greater risk of experiencing a larger variety of hardships. Conversely, households that owned "distance demolishing technologies" such as motorcycles were less likely to experience these hardships, presumably as they were able to transcend local conditions. ConclusionsThese results identify at-risk groups according to a social determinants of vulnerability framework and will help inform future policies and practices that aim to mitigate the negative consequences of COVID-19 as well as future disease outbreaks.

Knowledge of COVID-19 prevention in Eastern Ethiopia (preprint)

Objectives: As of May 2023, over 500,000 COVID-19 cases and over 7,500 deaths have been reported in Ethiopia. Understanding community members' knowledge and perception of SARS-CoV-2 prevention is essential for directing public health interventions to reduce transmission and improve vaccination coverage. Here, we aimed to describe factors associated with knowledge of COVID-19 prevention among community residents in Eastern Ethiopia. Methods: We conducted a cross-sectional survey among a random sample of 880 participants in a Health and Demographic Surveillance System in the Harari Region, Ethiopia, from August to September 2021. Principal components analysis was used to create a score representing knowledge of COVID-19 prevention. Quasi-Poisson regression was used to examine associations between demographic characteristics and knowledge of COVID-19 prevention. Our survey also included information regarding knowledge of community or government measures to prevent COVID-19, healthcare services for children under five, and healthcare services for pregnant women. Results: The most cited individual measures to reduce the risk of contracting COVID-19 were washing hands with soap (91.5%) and wearing a facemask (89.2%), whereas least mentioned were avoiding domestic and international travel (22.2%) and wearing medical gloves (20.3%). The most recognized community or government measures to prevent SARS-CoV-2 transmission were closure of schools and universities (77.0%), advice to avoid gatherings (75.2%), and advice to stay home (62.3%). Adjusted analyses demonstrated that knowledge of COVID-19 prevention was higher among participants from rural areas than urban areas, those aged [≥]65 years (<25 years as reference), with secondary education (no formal education as reference), with monthly income of [≥]2,001 Birr (0-1,200 as reference), and were farmers or domestic/subsistence workers or government employees (unemployed as reference). Knowledge was lower among households with [≥]5 household members (1-2 as reference). Of households with children under five and pregnant women, 9.4% and 12.3% missed at least one medical care visit since mid-March 2020 consequent to the pandemic, respectively. Conclusions: Public health interventions to reduce infectious disease transmission depend on perceptions of risk and knowledge. The survey found that most adults had good knowledge of methods for reducing risks of COVID-19, although knowledge differed between groups. A substantial number of respondents reported missing important healthcare visits. Understanding these factors may help Ethiopian authorities plan effective health education programs to control community and household transmission of SARS-CoV-2.

Knowledge of COVID-19 Symptoms, Transmission, and Prevention: Evidence from Health and Demographic Surveillance in Southern Mozambique (preprint)

Background: Over 230,000 COVID-19 cases and over 2,200 deaths have been reported in Mozambique though March 2023. Understanding community members' knowledge and perception of SARS-CoV-2 transmission and prevention is essential for directing public health interventions to reduce disease spread and improve vaccination coverage. Here, we aimed to describe knowledge of COVID-19 transmission, prevention, and symptoms among community residents in Mozambique. Methods: We conducted a cross-sectional survey among 33,087 of 40,636 households (81.4%) in a Health and Demographic Surveillance System in Manhica, Mozambique, at the tail end of the Delta variant wave in September 2021 to the peak of Omicron cases in January 2022. Principal components analysis was used to create scores representing knowledge of COVID-19 symptoms, transmission, and prevention. Multiple imputation and quasi-Poisson regression were used to examine associations between demographic characteristics and sources of COVID-19 information, and knowledge of COVID-19 symptoms, transmission, and prevention. We examined whether sources of COVID-19 information mediated the relationship between educational attainment and knowledge of symptoms, transmission, and prevention. Results: Across this rural community, 98.2%, 97.0%, and 85.1% of household respondents reported knowing how COVID-19 could be prevented, that SARS-CoV-2 can cause disease, and how SARS-CoV-2 is transmitted, respectively. Most recognized symptoms were cough (51.2%), headaches (44.9%), and fever (44.5%). Most cited transmission mechanisms were droplets (50.5%) or aerosol (<5 micrometer diameter) (46.9%) from an infected person. Most cited prevention measures were handwashing (91.9%) and mask-wearing (91.8%). Characteristics associated with greater knowledge of symptoms, transmission, and prevention included having at least primary education, older age, employment, higher wealth, and Christian religion. Respondents who had had COVID-19 symptoms were also more likely to have knowledge of symptoms, transmission, and prevention. Gathering information from TV, WhatsApp, radio, and hospital mediated the relationship between educational attainment and knowledge scores. Conclusions: Community public health measures to reduce infectious disease transmission are contingent upon perceptions of risk and knowledge. These findings support the need for outreach and for community-engaged messaging to promote prevention measures, particularly among people with low education.

Food Insecurity amid COVID-19 Lockdowns: Assessing Sociodemographic Indicators of Vulnerability in Harar and Kersa, Ethiopia (preprint)

Objective The COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in lower-income countries, we examine food insecurity during the pandemic period. Design Cross-sectional study using logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. Setting The study is set in two communities in Eastern Ethiopia, one rural and one urban. Participants A random sample of 880 households residing in Kersa and Harar. Results Roughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income. Discussion After taking other characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings point to the need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households.

Household Hardships during the COVID-19 Pandemic: Examining Household Vulnerability and Responses to Pandemic Related Shocks in Eastern Ethiopia (preprint)

COVID-19 is associated with one of the largest disturbances to life in the 21st century. To quell disease spread, governments implemented lockdowns that likely created hardships for house-holds. To improve knowledge of consequences, we examine how the pandemic period was associ-ated with household hardships and assess factors associated with these hardships. We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with house-hold hardships. Data were collected between August and September of 2021 from a random sam-ple of 880 households living in a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Ethiopia. Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19 including lockdowns and travel restrictions were inde-pendently associated with experiencing household hardships. Our results identify characteristics of groups at-risk for food insecurity during the pan-demic; households that were already strug-gling prior to the onset of the pandemic were at greatest risk of adverse consequences during the pandemic period. These findings may inform future efforts to mitigate the consequences of COVID-19 and future disease out-breaks.