Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS

Abstract

Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disease. We fitted two-level random intercept logit models to explore independent relationships among the three indicators, while controlling for the selected explanatory variables. Handwashing capacity was highest in Tanzania (48.2%), and lowest in Chad (4.2%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77.4%), and lowest in Ethiopia (30.9%). Senegal had the largest proportion of households with an elderly person (42.1%), while Angola (16.4%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. In view of the age risk factors of COVID-19 transmission, and its dependence on handwashing and isolation capacities of households, each country needs to use the extant information on its risk status to shape communication and intervention strategies that will help limit the impact of the disease in its population across Africa.

SARS-CoV-2 infection in Africa: a systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021

“…These results may be due to increased intergenerational mixing at the household level, as prior research in Africa has shown that households sharing space with persons aged 60+ years may have increased transmission risk. 46 We also found lower seroprevalence was associated with rural geographical areas compared with urban areas, in line with other hypotheses and modelling associating rural areas with a potentially lower spread of infection due to decreased population density. 51 …”

“…The exact reasons for this heterogeneity remain unknown but could be related to mitigation strategy, health infrastructure and the effectiveness of PHSM implementation. The capacity to isolate has been shown to vary greatly in Africa, 46 and challenges have been reported with social distancing in the Western and Middle subregions, especially in high density areas. 47 48 This is also consistent with findings by Chisale et al , 8 who observed higher seroprevalence in studies conducted in Central Africa compared with other regions.…”

SARS-CoV-2 infection in Africa: A systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021

“…[48] In contrast to our global analysis,[9] we did not find lower seroprevalence in adults 60+ years compared to adults 20-29 years. These results may be due to increased intergenerational mixing at the household level, as prior research in Africa has shown that households sharing space with persons ages 60+ may have increased transmission risk [44]. We also found lower seroprevalence was associated with rural geographical areas compared to urban areas, in line with other hypotheses and modelling associating rural areas with a potentially lower spread of infection due to decreased population density.…”

“…The exact reasons for this heterogeneity remain unknown but could be related to mitigation strategy, health infrastructure, and the effectiveness of PHSM implementation. The capacity to isolate has been shown to vary greatly in Africa, [44] and challenges have been reported with social distancing in the Western and Middle sub-regions, especially in high density areas. [45,46] This is also consistent with findings by Chisale et al .…”

Contexts, beliefs and health behaviour: Are individuals who engage in risky sexual behaviour likely to wear facemasks against COVID-19?

“…Other notable factors implicated in the sustained transmission include access to sanitation facilities, age and underlying comorbidities. 1,2 While the literature is replete with evidence to show that attitude and behaviour, encapsulated in health beliefs, matter for the spread of infectious diseases, studies have further confirmed same to be valid with Covid-19. [3][4][5][6][7][8] Individuals, according to the health belief model (HBM), prevent or expose themselves from/to diseases based on their perception of their susceptibility, the severity of the disease, benefits accruable from engaging in protective behaviour, barriers to the protective behaviour, factors that could lead them to adopting the protective behaviour, and their perceived efficacy of the protective action.…”