‘I exist because of we’: shielding as a communal ethic of maintaining social bonds during the COVID-19 response in Ethiopia

Estifanos, Abiy Seifu; Alemu, Getnet; Negussie, Solomon; Ero, Debebe; Mengistu, Yewondwossen; Gebrehiwot, Yirgu; Yifter, Helen; Melkie, Addisu; Gebrekiros, Damen Hailemariam; Kotecho, Messay Gebremariam; Soklaridis, Sophie; Cartmill, Carrie; Whitehead, Cynthia; Wondimagegn, Dawit

doi:10.1136/bmjgh-2020-003204

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…Consultations with crisis-affected communities in Yemen also reported acceptance of shielding within the context of strong cultural tendencies to protect older adults and the most vulnerable [ 28 ]. Similarly, a shielding intervention in Ethiopia leveraged a culture that values community solidarity and cohesion, where communities traditionally prioritise those most in need of protection [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

et al. 2021

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Background Shielding of high-risk groups from coronavirus disease (COVID-19) has been suggested as a realistic alternative to severe movement restrictions during the COVID-19 epidemic in low-income countries. The intervention entails the establishment of ‘green zones’ for high-risk persons to live in, either within their homes or in communal structures, in a safe and dignified manner, for extended periods of time during the epidemic. To our knowledge, this concept has not been tested or evaluated in resource-poor settings. This study aimed to explore the acceptability and feasibility of strategies to shield persons at higher risk of severe COVID-19 outcomes, during the COVID-19 epidemic in six communities in Sudan. Methods We purposively sampled participants from six communities, illustrative of urban, rural and forcibly-displaced settings. In-depth telephone interviews were held with 59 members of households with one or more members at higher risk of severe COVID-19 outcomes. Follow-up interviews were held with 30 community members after movement restrictions were eased across the country. All interviews were audio-recorded, transcribed verbatim, and analysed using a two-stage deductive and inductive thematic analysis. Results Most participants were aware that some people are at higher risk of severe COVID-19 outcomes but were unaware of the concept of shielding. Most participants found shielding acceptable and consistent with cultural inclinations to respect elders and protect the vulnerable. However, extra-household shielding arrangements were mostly seen as socially unacceptable. Participants reported feasibility concerns related to the reduced socialisation of shielded persons and loss of income for shielding families. The acceptability and feasibility of shielding strategies were reduced after movement restrictions were eased, as participants reported lower perception of risk in their communities and increased pressure to comply with social commitments outside the house. Conclusion Shielding is generally acceptable in the study communities. Acceptability is influenced by feasibility, and by contextual changes in the epidemic and associated policy response. The promotion of shielding should capitalise on the cultural and moral sense of duty towards elders and vulnerable groups. Communities and households should be provided with practical guidance to implement feasible shielding options. Households must be socially, psychologically and financially supported to adopt and sustain shielding effectively.

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Section: Discussionmentioning

confidence: 99%

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

et al. 2021

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“…Other potential responses to Covid-19 have included shielding, providing home care, or focusing on test, treat, and isolate (SSHAP 2020; Schmidt-Sane, Tulloch and Jones 2020; MacGregor and Hrynick 2020). Shielding (a measure to protect extremely vulnerable people from coming into contact with the virus, by minimising all interaction between them and others) has been used in settings to isolate the clinically vulnerable while allowing other members of a community to continue their daily activities Seifu Estifanos et al 2020;Smith and Spiegelhalter 2020;Butler and Tulloch 2020;Favas, Checchi and Waldman 2020). Shielding may be considered in LMIC contexts that are facing an uptick in Covid-19 cases as an alternative to a full lockdown.…”

Section: Building Syndemic Preparedness and Responsementioning

confidence: 99%

Local Covid-19 Syndemics and the Need for an Integrated Response

et al. 2021

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The Covid-19 pandemic is more than a health crisis. It has worse outcomes among individuals with co-morbidities, has exposed fault lines in our societies, and amplified existing inequalities. This article draws on emerging evidence from low- and middle-income contexts to highlight how Covid-19 becomes syndemic when it interacts with local vulnerabilities. A syndemic approach provides a frame for understanding how Covid-19 is amplified when clustered with other diseases and how this clustering is facilitated by contextual and social factors that create adverse conditions. Public health responses to Covid-19 have also exacerbated these adverse conditions as many face social and economic crises as a result of some policies. These multiple challenges generate major implications for both the public health response and for broader development action: first, one size does not fit all and we must attend to local vulnerabilities; second, short-term public health response and longer-term development approaches must be integrated for improved intersectoral coordination and synergy. A synergised public health and development response will allow us to better prepare for the next pandemic.

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“…Consultations with crisis-affected communities in Yemen also reported acceptance of shielding within the context of strong cultural tendencies to protect the elderly and most vulnerable [25]. Similarly, a shielding intervention in Ethiopia leveraged a culture that values community solidarity and cohesion, where communities traditionally prioritise those most in need of protection [26].…”

Section: Discussionmentioning

confidence: 99%

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

Abdelmagid

Ahmed²,

Nurelhuda

et al. 2020

Preprint

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BackgroundShielding of high-risk groups from coronavirus disease (COVID-19), either within their households or safe communal structures, has been suggested as a realistic alternative to severe movement restrictions in response to the COVID-19 epidemic in low-income countries. To our knowledge, this concept has not been tested or evaluated in resource-poor settings. This study aimed to explore the acceptability and feasibility of strategies to shield persons at higher risk of severe COVID-19 outcomes, during the COVID-19 epidemic in six communities in Sudan.MethodsWe purposively sampled participants from six communities, illustrative of urban, rural and forcibly-displaced settings. In-depth telephone interviews were held with 59 members of households with one or more members at higher risk of severe COVID-19 outcomes. Follow-up interviews were held with 30 community members after movement restrictions were eased across the country. All interviews were audio-recorded, transcribed verbatim, and analysed using a two-stage deductive and inductive thematic analysis.ResultsMost participants were aware that some people are at higher risk of severe COVID-19 outcomes but were unaware of the concept of shielding. Most participants found shielding acceptable and consistent with cultural inclinations to respect elders and protect the vulnerable. However, extra-household shielding arrangements were mostly seen as socially unacceptable. Participants reported feasibility concerns related to the social isolation of shielded persons and loss of income for shielding families. The acceptability and feasibility of shielding strategies were reduced after movement restrictions were eased, as participants reported lower perception of risk in their communities and increased pressure to comply with social commitments outside the house.ConclusionShielding is generally acceptable in the study communities. Acceptability is influenced by feasibility, and by contextual changes in the epidemic and associated policy response. The promotion of shielding should capitalise on the cultural and moral sense of duty towards elders and vulnerable groups. Communities and households should be provided with practical guidance to implement feasible shielding options. Households must be socially, psychologically and financially supported to adopt and sustain shielding effectively.

show abstract

‘I exist because of we’: shielding as a communal ethic of maintaining social bonds during the COVID-19 response in Ethiopia

Cited by 15 publications

References 10 publications

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

Local Covid-19 Syndemics and the Need for an Integrated Response

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

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