RESUMEN
Many African countries have experienced a first wave of the COVID-19 pandemic between June and August of 2020. According to case counts reported daily by epidemiological surveillance systems, infection rates remained low in most countries. This defied early models of the potential impact of COVID-19 on the continent, that projected large outbreaks and massive strain on health systems. Theories proposed to explain the apparently limited spread of the novel coronavirus in most African countries have emphasized 1) early actions by health authorities (e.g., border closures) and 2) biological or environmental determinants of the transmissibility of SARS-CoV-2 (e.g., warm weather, cross-immunity). In this paper, we explored additional factors that might contribute to the low recorded burden of COVID-19 in Malawi, a low-income country in Southeastern Africa. To do so, we used 4 rounds of panel data collected among a sample of adults during the first 6 months of the pandemic in the country. Our analyses of survey data on SARS-CoV-2 testing and COVID-related symptoms indicate that the size of the outbreak that occurred in June-August 2020 might be larger than recorded by surveillance systems that rely on RT-PCR testing. Our data also document the widespread adoption of physical distancing and mask use in response to the outbreak, whereas most measured patterns of social contacts remained stable during the course of the panel study. These findings will help better project, and respond to, future waves of the pandemic in Malawi and similar settings.
RESUMEN
BackgroundThere are limited data on knowledge and behaviors related to COVID-19 in African countries. MethodsBetween April 25th and May 23rd, we contacted 793 individuals aged 18 and older, who previously participated in studies conducted in the Karonga Health and Demographic Surveillance Site in Malawi. During an interview by mobile phone, we ascertained respondents sources of information about COVID-19 and we evaluated their knowledge of the transmission and course/severity of COVID-19. We also asked them to evaluate their own risks of infection and severe illness. Finally, we inquired about the preventive measures they had adopted in response to the pandemic. We described patterns of knowledge and behaviors by area of residence (rural vs. urban). ResultsWe interviewed 630 respondents (79.5% response rate). Four hundred and eighty-nine respondents resided in rural areas (77.6%) and 141 in urban areas (22.4%). Only one respondent had never heard of COVID-19. Misconceptions about the modes of transmission of SARS-CoV-2, and about the course and severity of COVID-19, were common. For example, 33.2% of respondents believed that the novel coronavirus is also waterborne and 50.6% believed that it is also bloodborne. A large percentage of respondents perceived that there was no risk, or only a small risk, that they would become infected (44.4%), but 72% of respondents expected to be severely ill if they became infected with SARS-CoV-2. Increased hand washing and avoiding crowds were the most reported strategies to prevent the spread of SARS-CoV-2. Use of face masks was more common among urban residents (22.5%) than among rural residents (5.0%). ConclusionDespite widespread access to information about the COVID-19 pandemic, gaps in knowledge about COVID-19 persist in this population. The adoption of preventive strategies remains limited, possibly due to low perceived risk of infection among a large fraction of the population. What is already known?O_LISARS-CoV-2 is projected to spread widely in African countries. C_LIO_LIThere is limited information about what affected populations know about this new health threat, and how they react to it. C_LI What are the new findings?O_LIIn a study in Malawi, respondents lacked knowledge about several aspects of the transmission of SARS-CoV-2, and about the course and severity of COVID-19. C_LIO_LIThese knowledge gaps were larger among residents of rural areas than among urban dwellers. C_LIO_LIStudy respondents perceived themselves at low risk of infection with SARS-CoV-2, but they over-estimated the likely severity of the disease they would experience if they became infected. C_LIO_LIMost respondents reported increased frequency of handwashing, but the adoption of other protective behaviors (e.g., social distancing, use of masks) was limited, particularly in rural areas. C_LI What do the new findings imply?O_LIAdditional information campaigns are needed to address knowledge gaps and misperceptions about SARS-CoV-2/COVID-19 in Malawi. C_LI
