COVID-19 risk behaviors in humanitarian settings: a cross-sectional study among conflict refugees in Uganda

Abstract

Background: Worldwide, behavioral change interventions are at the core of prevention efforts to contain the novel Corona Virus (COVID-19). While the evidence base to inform such interventions in the general population is growing, equivocal research in humanitarian populations is lacking. The current study describes the nature, extent and predictors of COVID-19 risk behaviors among conflict refugees in Uganda in a bid to inform prevention strategies for humanitarian settings.Methods: Cross-sectional survey data on COVID-19 risk-behaviors, demographic, socio-economic, behavioral and clinical variables was gathered from 1014 adult refugees drawn from 3 refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed using t-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression.Results: Many refugees (25-70%) were involved in hygiene, congestion and nutritional/physical activity related risk behaviors likely to contribute to community transmission of COVID-19. Refugees living in rural settlements, of male sex, young age and low socio-economic status were at heightened risk of exposure to COVID-19 risk behaviors. Physical activity and healthy nutritional practices reduced the likelihood of COVID-19 risk behavior. Indulgence in COVID-19 risk behaviors increased the risk of developing COVID-19 symptoms. Conclusions: COVID-19 risk behaviors among conflict refugees in Uganda are multifaceted in nature, widespread in extent and associated with symptom development, signaling for high risk for COVID-19 transmission in humanitarian settings. The data on predictors of COVID-19 risk behaviors have unmasked underlying inequalities, holding promise for development of evidence-based interventions to meet the needs of most vulnerable clusters in the refugee community.

Understanding the barriers and facilitators of COVID-19 risk mitigation strategy adoption and COVID-19 vaccination in refugee settlements in Uganda: a qualitative study

“…Some of our results on the other hand, diverge from findings described in previous studies. In contrast to our findings, the REFLECT study found low compliance with certain preventive measures including social distancing, facemask use, use of sanitizers and disinfectants, and healthy nutritional habits among refugee populations with investigators listing competing survival needs and structural factors in the refugee settlement context such as crowded communal spaces as key barriers [35]. High adoption of risk mitigation strategies found in our study, which was conducted later in the pandemic (April 2021 -April 2022 vs. August -November 2020) when exposure to COVID-19 in refugee settlements had increased and the COVID-19 response by UNHCR and implementing partners had been scaled up in refugee settlements, suggests, that risk perception and access to materials required for the adoption of risk mitigation strategies are key factors driving health behavior in this context.…”

Adherence to COVID-19 preventive measures and its association with intimate partner violence among women in informal settings of Kampala, Uganda

“…Knowledge and awareness of COVID-19 transmission and disease severity is generally high in different Ugandan population [25,26] despite misconceptions held about the risk of COVID-19 acquisition [27] and recently regarding hesitancy for COVID-19 vaccination [28]. Recent research from Uganda conducted by Lawoko and colleagues showed a high likelihood for COVID-19 risk behaviors among adult refugees with low socio-economic status and those living in rural settlements [29]. Although adherence to COVID-19 prevention measures was reported to be poor during the first phase of the COVID-19 pandemic in Uganda [30] some evidence suggests that women are more adherent to practicing COVID-19 preventive measures when compared to men [25].…”