COVID-19 and the fear of other unknowns: challenges and lessons learned from a digital contact tracing activity in the Rohingya camps in Cox's Bazar, Bangladesh

ABSTRACT

Contact tracing can play an important role in controlling infectious disease outbreaks such as the COVID-19 pandemic. Containing the spread of COVID-19 is crucial in humanitarian settings such as in the Rohingya camps in Cox's Bazar, Bangladesh. This manuscript describes the COVID-19 contact tracing activities undertaken by a group of researchers and implementers in Cox's Bazar, Bangladesh. The paper details the design and development of the Commcare 'Contact tracing and case monitoring app', subsequent implementation of the contact tracing activity, challenges faced during the implementation process, and the strategies adopted by the research team to overcome these challenges. The research team leveraged the suite of template applications for COVID-19 response developed by Dimagi in response to the COVID-19 pandemic. Research partners organized a series of brainstorming meetings and workshops with relevant stakeholders to finalize the 'COVID- 19 contact tracing and case monitoring app' for final implementation. This app was implemented in 10 Rohingya camps from Ukhiya and Teknaf sub-districts of Cox's Bazar for 4.5 months from 1st January 2021 to 15th May 2021. Due to a restriction on internet availability in the Rohingya camps by the government of the host country, the research team had to adopt a manual approach to implement the contact tracing activity. During these 4.5 months, 249,452 individuals from 10 Rohingya camps were screened for COVID-19 case registration. Of all the screened individuals, 431 were identified as COVID suspected cases, and 77 were identified as confirmed cases. The research team experienced several implementation challenges such as inexperience of contact tracers with the nature of the work, convincing the community to register in a digital system, obtaining information around COVID-19 symptoms, and many cultural, linguistic, gender, and other social barriers. The team adopted challenge-specific mitigation strategies for the effective implementation of the activity. The modalities of operation adopted by the team engaged with this present intervention to overcome the difficulties experienced in its conduction can hopefully provide some guidance to future parties attempting to conduct similar activities in complex humanitarian settings.