Assessment of the socioeconomic impact of COVID-19 in Rwanda: Findings from a country-wide community survey, preliminary analysis to inform further global research

Rationale: The COVID-19 pandemic along with its devastating impact on human lives has disrupted the socioeconomic situation worldwide. Rwanda has adopted lockdowns and other measures to prevent the spread of the COVID-19 pandemic. Recent studies documented the macro-level socio-economic pandemic impact but the impact on a household’s daily life has been scarcely documented especially in low-and-middle-income countries. Objective: This work describes the interplay between multiple factors to assess the socio-economic impact of COVID-19 on the Rwandan population at the micro-level (household). Methods: Data from a country-wide community survey conducted in Rwanda between December 2021 and March 2022 were used. A total of 26,412 response forms were received from around 4400 participants surveyed in 6 recurrent bi-weekly phases where participants were randomly selected. The Multivariable Logistic regression model was fitted to data with a backward stepwise elimination algorithm to assess the socioeconomic impact of COVID-19 on households’ income. Factors considered in this study are gender, age group, residence, level of education, occupation, change in employment status, socioeconomic status, and marital status. Results: The multivariable logistic regression model provided the factors associated with the decline in income due to COVID-19. The results show that people living without a partner are more likely to experience income decline due to COVID-19 than people living with their partner. It is seen that the higher the number of children in a household, the higher the risk of experiencing a decrease in income. Taking into consideration the education level and comparing people with post-secondary and university level vis-a-vis people who did not attend school, the latter are 27 times more likely to experience a decrease in their income, those who attended primary school are 5 times more likely to experience a decrease in income, and those who attended secondary school are almost 2 times more likely to experience a decrease in income. Conclusions: The findings from this research will be used by policymakers and other stakeholders to design and implement preventive and responsive measures for future pandemics that should be multifactorial and tailored to transversal parameters like gender and residence

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways