The Effect of the COVID-19 Pandemic on Mental Health in Low and Middle Income Countries

We track the effects of the COVID-19 pandemic on mental health in eight Low and Middle Income Countries (LMICs) in Asia, Africa, and South America utilizing repeated surveys of 21,162 individuals. Many respondents were interviewed over multiple rounds pre- and post-pandemic, allowing us to control for time trends and within-year seasonal variation in mental health. We demonstrate how mental health fluctuates with agricultural crop cycles, deteriorating during pre-harvest "lean" periods. Ignoring this seasonal variation leads to unreliable inferences about the effects of the pandemic. Controlling for seasonality, we document a large, significant, negative impact of the pandemic on mental health, especially during the early months of lockdown. In a random effects aggregation across samples, depression symptoms increased by around 0.3 standard deviations in the four months following the onset of the pandemic. The pandemic could leave a lasting legacy of depression. Absent policy interventions, this could have adverse long-term consequences, particularly in settings with limited mental health support services, which is characteristic of many LMICs.

Self-Reported Mask Wearing Greatly Exceeds Directly Observed Use: Urgent Need for Policy Intervention in Kenya

BackgroundMany countries in sub-Saharan Africa have so far avoided large outbreaks of COVID-19, perhaps due to the strict lockdown measures that were imposed early in the pandemic. Yet the harsh socio-economic consequences of the lockdowns have led many governments to ease the restrictions in favor of less stringent mitigation strategies. In the absence of concrete plans for widespread vaccination, masks remain one of the few tools available to low-income populations to avoid the spread of SARS-CoV-2 for the foreseeable future. MethodsWe compare mask use data collected through self-reports from phone surveys and direct observations in public spaces from population-representative samples in Ugunja subcounty, a rural setting in Western Kenya. We examine mask use in different situations and compare mask use by gender, age, location, and the riskiness of the activity FindingsWe assess mask use data from 1,960 phone survey respondents and 9,549 direct observations. While only 12% of people admitted in phone interviews to not wearing a mask in public, 90% of people we observed did not have a mask visible (77.7% difference, 95% CI 0.742, 0.802). Self-reported mask use was significantly higher than observed mask use in all scenarios (i.e. in the village, in the market, on public transportation). InterpretationWe find limited compliance with the national government mask mandate in Kenya using directly observed data, but high rates of self-reported mask use. This vast gap suggests that people are aware that mask use is socially desirable, but in practice they do not adopt this behavior. Focusing public policy efforts on improving adoption of mask use via education and behavioral interventions may be needed to improve compliance. FundingWeiss Family Foundation, International Growth Centre