COVID-19 risk behaviors in humanitarian settings: a cross-sectional study among conflict refugees in Uganda
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20211729Keywords:
COVID-19, Risk-behaviors, Predictors, Humanitarian populations, UgandaAbstract
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.
References
World Health Organization. Coronavirus disease (COVID-19): weekly epidemiological update (27th Dec. 2020). Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update---29-december-2020. Accessed on 1 February 2021.
Kaslow NJ, Friis-Healy EA, Cattie JE, Cook SC, Crowell AL, Cullum KA, et al. Flattening the emotional distress curve: A behavioral health pandemic response strategy for COVID-19. Am Psychol. 2020 Oct;75(7):875-86.
Jernigan DB; CDC COVID-19 Response Team. Update: Public Health Response to the Coronavirus Disease 2019 Outbreak - United States, February 24, 2020. MMWR Morb Mortal Wkly Rep. 2020 Feb 28;69(8):216-9.
Alwan NA, Bhopal R, Burgess RA, Colburn T, Cuevas LE, Smith GD, et al. Evidence informing the UK's COVID-19 public health response must be transparent. Lancet. 2020 Mar 28;395(10229):1036-7.
Lumu I. COVID-19 Response in Sub-Saharan Africa: Lessons From Uganda. Disaster Med Public Health Prep. 2020;14(3):46-8.
Dyer O. Covid-19: Many poor countries will see almost no vaccine next year, aid groups warn. BMJ. 2020;371:4809.
Ministry of Health Uganda: National Guidelines for management of COVID 19. Available at: https://www.health.go.ug/cause/national-guidelines-for-management-of-covid-19/. Accessed on 1 February 2021.
Favas C. Guidance for the prevention of COVID-19 infections among high-risk individuals in camps and camp-like settings. In: Abdelmagid N, Checchi F, Garry S, Jarrett P, Ratnayake R, Warsame A, eds. London School of Hygiene and Tropical Medicine; 2020: 1-15.
Hanafiah M, Khayriyyah W, Chang Da. Public knowledge, perception and communication behavior surrounding COVID-19 in Malaysia. Advance. Preprint. Available at: https://doi.org/10.31124 /advance.12102816.v1. Accessed on 1 February 2021.
Musinguzi G, Asamoah BO. The Science of Social Distancing and Total Lock Down: Does it Work? Whom does it Benefit?. Electron J Gen Med. 2020;17(6):230.
Tol WA, Patel V, Tomlinson M, Baingana F, Galappatti A, Panter-Brick C, et al. Research priorities for mental health and psychosocial support in humanitarian settings. PLoS Med. 2011 Sep;8(9):1001096.
Tol WA, Barbui C, Galappatti A, Silove D, Betancourt TS, Souza R, Golaz A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet. 2011 Oct 29;378(9802):1581-91.
Lau LS, Samari G, Moresky RT, Casey SE, Kachur SP, Roberts LF, et al. COVID-19 in humanitarian settings and lessons learned from past epidemics. Nat Med. 2020;26(5):647-8.
Blanchet K, Ramesh A, Frison S, Warren E, Hossain M, Smith J, et al. Evidence on public health interventions in humanitarian crises. Lancet. 2017;390(10109):2287-96.
Williams RE, Black CL, Kim HY, Andrews EB, Mangel AW, Buda JJ, et al. Determinants of healthcare-seeking behaviour among subjects with irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23(11):1667-75.
Barnes DM, Almasy N. Refugees' perceptions of healthy behaviors. J Immigr Health. 2005;7(3):185-93.
Turrini G, Purgato M, Acarturk C, Anttila M, Au T, Ballette F, et al. Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2019 Aug;28(4):376-88.
Tribe RH, Sendt KV, Tracy DK. A systematic review of psychosocial interventions for adult refugees and asylum seekers. J Ment Health. 2019;28(6):662-76.
Nwadiora E, McAdoo H. Acculturative stress among Amerasian refugees: gender and racial differences. Adolescence. 1996;31(122):477-87.
Ahimbisibwe F. Uganda and the refugee problem: Challenges and opportunities. Institute of Development Policy and Management. University of Antwerp. 2019;13(5):62-72.
Monteith W, Lwasa S. The participation of urban displaced populations in formal markets: contrasting experiences in Kampala, Uganda. Environment and Urbanization. 2019;29(2):383-402.
Peltzer K. Trauma and mental health problems of Sudanese refugees in Uganda. Cent Afr J Med. 1999;45(5):110-4.
Hovil L. Self-settled refugees in Uganda: An alternative approach to displacement?. J Refugee Studies. 2007;20(4):599-620.
Mathieu E, Sodahlon Y. Epidemic Investigation. International Encyclopedia of Public Health. 2008:401-13.
Woodward A, Kawachi I. Why reduce health inequalities? J Epidemiol Community Health. 2000 Dec;54(12):923-9.
Taber, K.S. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res Sci Educ. 2018:1273–96.
Briscese G, Lacetera N, Macis M, Tonin M. Compliance with covid-19 social-distancing measures in Italy: the role of expectations and duration. National Bureau of Economic Research; 2020 Mar 27.
Nivette A, Ribeaud D, Murray A, Steinhoff A, Bechtiger L, Hepp U, et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Soc Sci Med. 2021;268:113370.
Brouard S, Vasilopoulos P, Becher M. Sociodemographic and psychological correlates of compliance with the Covid-19 public health measures in France. Canadian Journal of Political Science/Revue canadienne de science politique. 2020:1-6.
Almutairi AF, BaniMustafa AA, Alessa YM, Almutairi SB, Almaleh Y. Public trust and compliance with the precautionary measures against COVID-19 employed by authorities in Saudi Arabia. Risk Management and Healthcare Policy. 2020;13:753.
Byrnes JP, Miller DC, Schafer WD. Gender differences in risk taking: a meta-analysis. Psychological bulletin. 1999;125(3):367.
Charness G, Gneezy U. Strong evidence for gender differences in risk taking. Journal of Economic Behavior & Organization. 2012;83(1):50-8.
Harris CR, Jenkins M. Gender differences in risk assessment: why do women take fewer risks than men?. Judgment and Decision Making. 2006;1:48-63.
Fry R. The increase in idleness of immigrant arrivals: The role of age at arrival, refugees and country of origin. The Quarterly Review of Economics and Finance. 1997;37:209-28.
Posselt M, Galletly C, Crespigny C, Procter N. Mental health and drug and alcohol comorbidity in young people of refugee background: a review of the literature. Mental Health and Substance Use. 2014;7(1):19-30.
Adler NE, Ostrove JM. Socioeconomic status and health: what we know and what we don't. Annals of the New York academy of Sciences. 1999 Dec;896(1):3-15.
Thomas SB, Fine MJ, Ibrahim SA. Health disparities: the importance of culture and health communication. Am J Public Health. 2004;94(12):2050.
Kreuter MW, McClure SM. The role of culture in health communication. Annu Rev Public Health. 2004;25:439-55.
Heaney CA, Israel BA. Social networks and social support. Health behavior and health education: Theory, research, and practice. 2008;4:189-210.
