Adapting to an aggregate shock: The impact of the Covid-19 crisis on rural households.

We examine the response of rural Ugandan households to a large aggregate shock, the Covid-19 pandemic, during and one year after the first lockdown in March 2020. Using 6 rounds of phone surveys from 558 households in western Uganda, we find that household income recovery from the lockdown differs by whether households had a business pre-pandemic. After an initial sharp fall, the incomes of those without a business have recovered to pre-pandemic levels. However, the relatively better-off households with a business before the pandemic still have one-third lower income, due to sustained closure of businesses even after the end of the first lockdown restrictions. Additionally, business-owning households have 30% lower wealth one-year into the pandemic, driven by 44% lower assets, 45% drop in savings, and a 15 fold increase in net-borrowing, suggesting long-term damage. Our findings point to the need to support households who face dwindling finances to fall back on.

Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study): protocol for a pilot randomised controlled trial.

INTRODUCTION: Scalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world's adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown. METHODS AND ANALYSIS: This study is a two-arm single-blind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial. ETHICS AND DISSEMINATION: This study has been approved by the University of the Witwatersrand Human Research Ethics Committee (MED20-05-011) and the Oxford Tropical Research Ethics Committee (OxTREC 34-20). Study findings will be published in scientific open access peer-reviewed journals, presented at scientific conferences and communicated to participants, their caregivers, public sector officials and other relevant stakeholders. TRIAL REGISTRATION NUMBERS: This trial was registered on 19 November 2020 with the South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).

Household response to an extreme shock: Evidence on the immediate impact of the Covid-19 lockdown on economic outcomes and well-being in rural Uganda.

We provide evidence on the economic and well-being impact of the Covid-19 lockdown on a sample of households in rural Uganda. Our sample consists of 1,277 households randomly drawn from 114 rural villages in western Uganda and surveyed in-person in early March 2020, just before the lockdown. We followed up with this sample in May 2020, reaching over 85% of them by phone. We find a large decline of 60% in household non-farm income due to household enterprise profits and labour income being almost wiped-out post the lockdown. Households respond to this loss of income in three key ways. One, there is a 40% decrease in food expenditure per adult equivalent. Two, they use up nearly 50% of their savings and borrow more, but have not yet liquidated their fixed assets or sold livestock. Three, they increase total household labour supply to household farm and livestock, more than making up for the decline in supply to enterprises and labour outside the household. We find a decrease in well-being as a result of this: there is an increase in the likelihood of missing a meal, a decline in reported satisfaction with quality of life, a higher likelihood of having a major argument with their spouse and an increase in perceived frequency of intimate partner violence against women in the village. The negative effects of the lockdown are greater for households that were wealthier at baseline, since these households were more reliant on enterprise and salaried income. These results were one of the first to show a large negative impact of the lockdown for a rural population. Our findings are important to policy makers in Uganda and other developing countries as they suggest income and consumption support is needed for rural households.

Migration, externalities, and the diffusion of COVID-19 in South Asia☆.

The initial spread of COVID-19 halted economic activity as countries around the world restricted the mobility of their citizens. As a result, many migrant workers returned home, spreading the virus across borders. We investigate the relationship between migrant movements and the spread of COVID-19 using district-day-level data from Bangladesh, India, and Pakistan (the 1st, 6th, and 7th largest sources of international migrant workers). We find that during the initial stage of the pandemic, a 1 SD increase in prior international out-migration relative to the district-wise average in India and Pakistan predicts a 48% increase in the number of cases per capita. In Bangladesh, however, the estimates are not statistically distinguishable from zero. Domestic out-migration predicts COVID-19 diffusion in India, but not in Bangladesh and Pakistan. In all three countries, the association of COVID-19 cases per capita and measures of international out-migration increases over time. The results show how migration data can be used to predict coronavirus hotspots. More broadly, the results are consistent with large cross-border negative externalities created by policies aimed at containing the spread of COVID-19 in migrant-receiving countries.