ABSTRACT
Introduction and Background. The extent to which refugee communities were aware of the COVID-19 pandemic and adhered to related preventive measures remained largely unknown at its onset. This research was conducted in two settings: among urban refugees in Kampala's informal settlements and refugees in established rural settlements. Objectives. The study assessed pre-post knowledge, attitudes, and practices (KAP) among refugees;explored local perception of risk or exposure;and analysed implementation of Uganda's national response to determine feasibility and adherence. Our study also identified existing systems in the COVID-19 response and determined their efficacy. Methodologically, this was a mixed-method cross-sectional study using both quantitative and qualitative approaches. It was conducted among 2093 participants in eleven (11) refugee settlements located within three (3) regions and hosting up to five (5) different nationalities. The urban study site was Kisenyi in Kampala, Central Uganda;the rural sites were Kyaka II in South Western Uganda and Adjumani in West Nile. Methods included a community and facility survey, interviews, focus group discussions, and observations. The study's quantitative arm used two-staged cluster sampling, and research instruments were checked for reliability using Cronbach's Alpha. T-test, analysis of variance (ANOVA), and multivariable linear regression were applied to analyse the data in SPSS version 22. Statistical significance was assumed at p < 0.05. Qualitative interviews were audio-recorded, transcribed, coded, and thematically analysed in line with study objectives. This chapter presents empirical data from the study's qualitative arm. Findings. Refugee communities were generally aware of COVID-19 and the related preventive measures. Adherence to preventive guidelines was high in the first 12 weeks of the pandemic outbreak in Uganda;however, this behaviour steadily declined after that, and high-risk behaviour was reported alongside heightened vulnerability and breakdown of support systems. Community leadership and the social work professions were largely underutilised in Uganda's mainstream COVID response although they could have helped increase and sustain adherence to preventive guidelines and in light of limited resources. Conclusion and Recommendations. Community adherence to a known threat is contingent on not only recognising but also addressing key social, economic, political, and other determinants. Resource-limited settings with increasing COVID-19 cases such as Uganda will need to leverage a holistic approach to emergency response that effectively engages local leadership and crucial professions such as social work to support those in the biomedical field. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.