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Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi.
Thindwa, Deus; Jambo, Kondwani C; Ojal, John; MacPherson, Peter; Dennis Phiri, Mphatso; Pinsent, Amy; Khundi, McEwen; Chiume, Lingstone; Gallagher, Katherine E; Heyderman, Robert S; Corbett, Elizabeth L; French, Neil; Flasche, Stefan.
  • Thindwa D; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Malawi-Liverpool-Wellcome Clinical Research Programme, B
  • Jambo KC; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
  • Ojal J; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; KEMRI-Wellcome Research Programme, Geographic Medicine C
  • MacPherson P; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
  • Dennis Phiri M; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
  • Pinsent A; Aquarius Population Health, London, UK.
  • Khundi M; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Chiume L; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Gallagher KE; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; KEMRI-Wellcome Research Programme, Geographic Medicine Centre, Kilifi, Kenya.
  • Heyderman RS; NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK.
  • Corbett EL; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
  • French N; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK.
  • Flasche S; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Epidemics ; 40: 100590, 2022 09.
Article in English | MEDLINE | ID: covidwho-1881988
ABSTRACT

INTRODUCTION:

Understanding human mixing patterns relevant to infectious diseases spread through close contact is vital for modelling transmission dynamics and optimisation of disease control strategies. Mixing patterns in low-income countries like Malawi are not well known.

METHODOLOGY:

We conducted a social mixing survey in urban Blantyre, Malawi between April and July 2021 (between the 2nd and 3rd wave of COVID-19 infections). Participants living in densely-populated neighbourhoods were randomly sampled and, if they consented, reported their physical and non-physical contacts within and outside homes lasting at least 5 min during the previous day. Age-specific mixing rates were calculated, and a negative binomial mixed effects model was used to estimate determinants of contact behaviour.

RESULTS:

Of 1201 individuals enroled, 702 (58.5%) were female, the median age was 15 years (interquartile range [IQR] 5-32) and 127 (10.6%) were HIV-positive. On average, participants reported 10.3 contacts per day (range 1-25). Mixing patterns were highly age-assortative, particularly those within the community and with skin-to-skin contact. Adults aged 20-49 y reported the most contacts (median11, IQR 8-15) of all age groups; 38% (95%CI 16-63) more than infants (median 8, IQR 5-10), who had the least contacts. Household contact frequency increased by 3% (95%CI 2-5) per additional household member. Unemployed participants had 15% (95%CI 9-21) fewer contacts than other adults. Among long range (>30 m away from home) contacts, secondary school children had the largest median contact distance from home (257 m, IQR 78-761). HIV-positive status in adults >=18 years-old was not associated with changed contact patterns (rate ratio 1.01, 95%CI (0.91-1.12)). During this period of relatively low COVID-19 incidence in Malawi, 301 (25.1%) individuals stated that they had limited their contact with others due to COVID-19 precautions; however, their reported contacts were 8% (95%CI 1-13) higher.

CONCLUSION:

In urban Malawi, contact rates, are high and age-assortative, with little reported behavioural change due to either HIV-status or COVID-19 circulation. This highlights the limits of contact-restriction-based mitigation strategies in such settings and the need for pandemic preparedness to better understand how contact reductions can be enabled and motivated.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: HIV Infections / Communicable Diseases / COVID-19 Type of study: Experimental Studies / Observational study / Randomized controlled trials Limits: Adolescent / Adult / Child / Female / Humans / Infant / Male Country/Region as subject: Africa Language: English Journal: Epidemics Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: HIV Infections / Communicable Diseases / COVID-19 Type of study: Experimental Studies / Observational study / Randomized controlled trials Limits: Adolescent / Adult / Child / Female / Humans / Infant / Male Country/Region as subject: Africa Language: English Journal: Epidemics Year: 2022 Document Type: Article