Public awareness and perception towards COVID-19 in Sub-Saharan African countries during the lockdown

Background: The coronavirus disease (COVID-19) outbreak has caused a universal health crisis resulting in significant morbidities and mortalities particularly among high-risk groups. This study sought to determine regional factors associated with knowledge and attitude towards COVID-19 mitigation practices and risk perception of contracting the disease in Sub-Saharan African (SSA) countries. Methods: A cross-sectional anonymous online study was conducted among 1970 participants between April and May 2020, during the lockdown in many SSA countries. Recruitment of participants was via WhatsApp, Facebook and emails using authors’ networks. The outcome variables were KAP (knowledge, attitudes and practice) of COVID-19 and analysis of variance (ANOVA) with post hoc test was run to assess the level of KAP by four regions in SSA. Simple and multiple linear regression (MLR) analyses were performed to examine factors associated with the outcome measures in the four SSA regions. Results: Mean knowledge (P=0.707) and risk perception (P=0.904) scores by four regions in SSA did not differ significantly. However, the mean attitude score was higher among West Africans compared with Southern (P=0.019) and Central Africans (P=0.003). MLR analysis revealed that among those living in West (adjusted coefficient β=-0.83 95% CI: -1.19, -0.48) and Southern Africa (β=-0.91 95% CI: -1.42, -0.40), having a primary or secondary education was associated with a decrease in knowledge scores while not being worried about COVID-19 decreased risk perception scores across the four SSA regions(West [β=-6.57, 95% CI: -7.53, -5.62], East [β=-6.24: 95% CI: -8.34,-4.15], Central [β=-6.51, 95% CI: -8.70, -4.31], and Southern Africa [β=-6.06: 95% CI: -7.51, -4.60]). Except among Southern Africans, participants who practiced self-isolation had positive attitude towards COVID-19. Conclusion: Future research on health education regarding COVID-19 or a future related pandemic in SSA should target people with lower education, those who do not self-isolate, those living in Southern and Western Africa and not worried about contracting COVID-19

Acceptance and Risk Perception of COVID-19 Vaccination among Pregnant and Non Pregnant Women in Sub-Saharan Africa: A Cross-Sectional Matched-Sample Study

This study aims to evaluate the acceptance and risk perception of pregnant and non pregnant women towards COVID-19 vaccines using a cross-sectional matched-sample study approach. A web-based questionnaire with closed- and open-ended questions was administered to adults older than 18 years in the sub–Saharan African (SSA) region. Respondents (n = 131) were grouped based on their pregnancy status (54 pregnant and 77 non pregnant women) and matched for comparison by age. The matched groups were compared using the chi-square test and the t-test where appropriate. Compared to non pregnant women, pregnant women reported significantly lower risk perception scores of COVID-19 infection (3.74 vs. 5.78, p < 0.001) and were less likely to take the COVID-19 vaccine (odds ratio = 0.12, 95% confidence interval (CI) 0.06–0.27, p < 0.001). A similar proportion of pregnant and non pregnant women believed in false information about the COVID-19 vaccine, and 40% of unvaccinated pregnant women (n = 40) were concerned about the safety of the vaccine. After adjustment, women’s education, marital status, belief in misconceptions and risk perception were associated with non-vaccination among pregnant women. The content analysis revealed that pregnant women refused the vaccine due to mistrust of their countries’ health systems, concerns about the country where the vaccines were manufactured and a lack of confidence in the production process of the vaccines. This study shows the poor acceptance of COVID-19 vaccines among pregnant women in SSA, who perceived a lower risk of COVID-19 infection. Understanding the reasons for non-acceptance and the motivation to accept the COVID-19 vaccine could guide the development of health education and promotion programmes, and aid governments and policymakers in implementing targeted policy changes

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa

Background: Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA). Methods: A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded ‘not sure’ or ‘no’ to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of ‘vaccine hesitancy’ and ‘vaccine resistance’, respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes. Results: The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper. Conclusion: We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health

Prevalence and factors associated with mental and emotional health outcomes among africans during the COVID-19 lockdown period—A web-based cross-sectional study

Mental health and emotional responses to the effects of COVID-19 lockdown in sub-Saharan Africa (SSA) are of serious public health concern and may negatively affect the mental health status of people. Hence, this study assessed the prevalence of mental health symptoms as well as emotional reactions among sub-Saharan Africans (SSAs) and associated factors among SSAs during the COVID19 lockdown period. This was a web-based cross-sectional study on mental health and emotional features from 2005 respondents in seven SSA countries. This study was conducted between 17 April and 17 May 2020 corresponding to the lockdown period in most SSA countries. Respondents aged 18 years and above and the self-reported symptoms were feeling anxious, being worried, angry, bored and frustrated. These were the main outcomes and were treated as dichotomous variables. Univariate and multivariate logistic regression analyses were used to identify the factors associated with these symptoms. We found that over half (52.2%) of the participants reported any of the mental health symptoms and the prevalence of feeling bored was 70.5% followed by feeling anxious (59.1%), being worried (57.5%), frustrated (51.5%) and angry (22.3%) during the COVID-19 pandemic. Multivariate analysis revealed that males, those aged >28 years, those who lived in Central and Southern Africa, those who were not married, the unemployed, those living with more than six persons in a household, had higher odds of mental health and emotional symptoms. Similarly, people who perceived low risk of contracting the infection, and those who thought the pandemic would not continue after the lockdown had higher odds of mental health and emotional symptoms. Health care workers had lower odds for feeling angry than non-healthcare workers. During the COVID-19 lockdown periods in SSA, about one in two participants reported mental health and emotional symptoms. Public health measures can be effectively used to identify target groups for prevention and treatment of mental health and emotional symptoms. Such interventions should be an integral component of SSA governments’ response and recovery strategies of any future pandemic

International Research Collaboration During the Pandemic: Team Formation, Challenges, Strategies and Achievements of the African Translational Research Group

This paper discusses multidisciplinary international research collaboration team formation during the COVID-19 pandemic, challenges faced, strategies adopted, achievements and dynamics in the implementation of research on Coronavirus disease-2019 (COVID-19), by the African Translational Research Group (ATReG). The paper also discusses the lessons learnt and future opportunities for global collaborative research. In-depth virtual interviews were conducted with consenting members of ATReG. Questions were designed to provide rich, deep, and insightful opinions, lived experiences and perspectives of ATReG group members on group formation, challenges, strategies and achievements. Interview data was transcribed and analysed thematically, and the results were presented with important quotations presented. The ATReG consisted of English (n = 13) and French (n = 1) speaking sub-Saharan African (SSA) researchers who specialise in public health, epidemiology, optometry, information technology, supply chain management, psychiatry, community health, general medical practice, nutrition and biostatistics. Most members of the group reported an informal but well-coordinated structure of the group. Formed during the pandemic, all group meetings were held online, and many members are yet to meet each other in person. The group collected data from Africans and published 10 peer reviewed journal articles on COVID-19 within two years. It presented in international conferences, engaged with the media and the public and was awarded a national competitive funding in Nigeria all of which which contributed to career progression and academic promotion of some members. There have been challenges in sustaining the research collaboration and maintaining productivity. Challenges include difficulties meeting deadlines and obtaining funding for research activities. However, these challenges have been addressed through a collaborative problem-solving approach. The study found the need for operational and methodological flexibility, centralised coordination, and established funding sources as being essential for long term sustainability and performance of the group. The ATReG’s objective of providing useful data on COVID-19 and generating useful knowledge about COVID-19 in SSA has been achieved. In such a multi-disciplinary international collaborative team relaiant on the online medium to operate, the experiences and challenges can be a model for learning for researchers intending to form international multidisciplinary collaborative groups. Nonetheless, there are still many important areas of research which ATReG will continue to pursue

Opinion and uptake of chloroquine for treatment of COVID-19 during the mandatory lockdown in the sub-Saharan African region

Background: As the search for effective treatment of coronavirus disease 2019 (COVID-19) infection continues, the public opinion around the potential use of chloroquine (CQ) in treating COVID-19 remains mixed. Aim: To examine opinion and uptake of CQ for treating COVID-19 in the sub-Saharan African (SSA) region. Setting: This study was conducted through an online survey software titled SurveyMonkey. Methods: Anonymous online survey of 1829 SSA countries was conducted during the lockdown period using Facebook, WhatsApp and authors' networks. Opinion and uptake of CQ for COVID-19 treatment were assessed using multivariate analyses. Results: About 14% of respondents believed that CQ could treat COVID-19 and of which, 3.2% took CQ for COVID-19 treatment. Multivariate analyses revealed that respondents from Central (adjusted odds ratios [aOR]: 2.54, 95% confidence interval [CI] 1.43, 4.43) and West Africa (aOR: 1.79, 95% CI 1.15, 2.88) had higher odds of believing that CQ could treat COVID-19. Respondents from East Africa reported higher odds for uptake of CQ for COVID-19 than Central, Western and Southern Africans. Knowledge of the disease and compliance with the public health advice were associated with both belief and uptake of CQ for COVID-19 treatment. Conclusion: Central and West African respondents were more likely to believe in CQ as a treatment for COVID-19 whilst the uptake of the medication during the pandemic was higher amongst East Africans. Future intervention discouraging the unsupervised use of CQ should target respondents from Central, West and East African regions

Factors affecting willingness to comply with public health measures during the pandemic among sub-Sahara Africans

Background: The unprecedented outbreak of coronavirus disease (COVID-19) drastically spread worldwide, resulting in extraordinary measures put in place in various countries including Sub Saharan Africa (SSA) countries. Objective: To assess the factors associated with compliance with the public health measures imposed by various SSA countries. Method: Cross sectional study using self-administered surveys distributed on social media platforms between April 18th and May 16th, 2020, corresponding with the mandatory lockdown period in most SSA countries. Multivariate analysis examined the associated factors. Results: The prevalence of hand hygiene, quarantine, self isolation practices, wearing of face mask and attending large gatherings during COVID-19 were 94%, 39%, 31%, 64% and 14%, respectively. In multivariate models, older age 49+ years: adjusted OR 2.13, 95%CI 1.22,3.71), females (OR 1.41,95%CI 1.03,1.93), Central African countries (OR 3.73,95%CI 2.02,6.87) were associated with wearing face mask. Living alone (aOR 1.52,95%CI 1.04,2.24) during the lockdown was associated with avoiding large gatherings including religious events. Female respondents (aOR 1.61, 95%CI 1.30, 2.00), married (aOR 1.71,95%CI 1.33,2.21) and unemployed (aOR 1.62,95%CI 1.25,2.09) SSAs were more likely to practice self-quarantine measures. Conclusion: The low prevalence of mitigation practices suggest the need for targeted education campaign programs to sensitise the population

Risk perception of COVID-19 among sub-Sahara Africans: a web-based comparative survey of local and diaspora residents

Abstract Background Perceived risk towards the coronavirus pandemic is key to improved compliance with public health measures to reduce the infection rates. This study investigated how Sub-Saharan Africans (SSA) living in their respective countries and those in the diaspora perceive their risk of getting infected by the COVID-19 virus as well as the associated factors. Methods A web-based cross-sectional survey on 1969 participants aged 18 years and above (55.1% male) was conducted between April 27th and May 17th 2020, corresponding to the mandatory lockdown in most SSA countries. The dependent variable was the perception of risk for contracting COVID-19 scores. Independent variables included demographic characteristics, and COVID-19 related knowledge and attitude scores. Univariate and multiple linear regression analyses identified the factors associated with risk perception towards COVID-19. Results Among the respondents, majority were living in SSA (n = 1855, 92.8%) and 143 (7.2%) in the diaspora. There was no significant difference in the mean risk perception scores between the two groups (p = 0.117), however, those aged 18–28 years had lower risk perception scores (p = 0.003) than the older respondents, while those who were employed (p = 0.040) and had higher levels of education (p &lt; 0.001) had significantly higher risk perception scores than other respondents. After adjusting for covariates, multivariable analyses revealed that SSA residents aged 39–48 years (adjusted coefficient, β = 0.06, 95% CI [0.01, 1.19]) and health care sector workers (β = 0.61, 95% CI [0.09, 1.14]) reported a higher perceived risk of COVID-19. Knowledge and attitude scores increased as perceived risk for COVID-19 increased for both SSAs in Africa (β = 1.19, 95% CI [1.05, 1.34] for knowledge; β = 0.63, 95% CI [0.58, 0.69] for attitude) and in Diaspora (β = 1.97, 95% CI [1.16, 2.41] for knowledge; β = 0.30, 95% CI [0.02, 0.58] for attitude). Conclusions There is a need to promote preventive measures focusing on increasing people’s knowledge about COVID-19 and encouraging positive attitudes towards the mitigation measures such as vaccines and education. Such interventions should target the younger population, less educated and non-healthcare workers. </jats:sec

Economic, health and physical impacts of covid-19 pandemic in sub-saharan african regions: A cross sectional survey

Purpose: The key preventive measures adopted to minimise the spread of the coronavirus disease (COVID-19) had significant health, economic and physical impacts mostly in developing countries. This study evaluated the health, economic and physical impacts of COVID-19 lockdown measures among sub-Saharan African (SSA) population and associated demographic variations. Methods: A total of 1970 respondents took part in this web-based cross-sectional survey during the mandatory lockdown period in most SSA. The dependent variables were health (COVID-19 infection, hospitalisation), socioeconomic (lost job, closed down business) and physical impacts (separated from family) of COVID-19. Univariate and bivariate logistic regression analyses were used to explore the factors associated with each of the dependent variables by the four sub-regions (Southern, Western, Central and East Africa). Results: The respondents were aged 34.1 ± 11.5 years (range: 18–75 years) and mostly men (1099, 55%). 25.9% (n = 511) reported an impact of COVID-19 pandemic with significant regional variations (p 0.05). Among Central African respondents, more men than women lost their businesses (45.7% versus 14.3%, p = 0.002) and contracted COVID-19 infections (40.0% versus 18.2%, p = 0.024) during the study period. Multivariable analysis revealed that respondents from East (adjusted odds ratio [AOR] 1.95, 95% confidence interval [CI]: 1.42–2.69), Southern (AOR 1.46, 95% CI: 1.09– 1.96) and Central Africa (AOR 1.47, 95% CI: 1.06–2.03) reported significantly higher impact of COVID-19. Those who reported family separation during the lockdown were more likely to be older participants (39–48 years, AOR 2.48, 95% CI: 1.11–5.57). Conclusion: One in four SSA respondents, mostly East and Southern Africans, were adversely affected by the COVID-19 pandemic during the lockdown. Interventions in high-risk populations are needed to reduce the health, socioeconomic and gender disparities in the impacts of COVID-19