COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden
Abstract
:1. Introduction
2. Methods
2.1. Study Setting and Design
2.2. Survey Tool
2.3. Assessment of Adherence
2.4. Data Processing and Analysis
2.5. Ethical Considerations
3. Results
3.1. Participant Characteristics
3.2. COVID-19 Preventive Behaviors
3.3. Difficulties to Observe the COVID-19 Lockdown Measures
3.4. Flu-like Symptoms Reported by Participants
3.5. Factors Associated with Adherence to COVID-19 Preventive Measures
4. Discussion
5. Limitations of the Study
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Variable | Scoring | Interpretation | |
---|---|---|---|
I follow the 1.5–2m physical distance rule | Yes | 1 | 1 point for yes, 0 point for no |
No | 0 | ||
I wear a face mask when I go out | Yes | 1 | 1 point for yes, 0 point for no |
No | 0 | ||
I wash my hands regularly or I use hand sanitizer regularly | Yes | 1 | If any (or both) questions have answer yes, give just 1 point. Otherwise, give 0 point. |
No | 0 | ||
When I cough/sneeze, I cover my mouth and nose | Yes | 1 | 1 point for yes, 0 point for no |
No | 0 | ||
I avoid touching my face (eyes, nose, mouth) | Yes | 1 | 1 point for yes, 0 point for no |
No | 0 | ||
Total adherence score (maximum): 5 |
Characteristics | Survey 1 Participants n = 4124 | Survey 2 Participants n = 4703 | p-Value * |
---|---|---|---|
Age: Mean (SD) | 22.9 (5.5) | 23.7 (6.2) | <0.001 |
Gender: n (%) | |||
Male | 2490 (60.5%) | 2768 (59.1%) | 0.188 |
Female | 1626 (39.5%) | 1916 (40.9%) | |
Other/NA | 8 | 19 | |
Education level: n (%) | <0.001 | ||
Primary school | 20 (0.5%) | 133 (2.8%) | |
Secondary school | 285 (6.9%) | 562 (11.9%) | |
University: Undergraduate | 3429 (83.1%) | 3506 (74.5%) | |
University: Postgraduate | 390 (9.5%) | 502 (10.7%) | |
Residential setting: n (%) | <0.001 | ||
Rural | 47 (1.1%) | 129 (2.7%) | |
Sub-Urban | 202 (4.9%) | 371 (7.9%) | |
Urban | 3875 (94.0%) | 4203 (89.4%) | |
Live alone in household: n (%) | 246 (6.0%) | 282 (6.0%) | 0.987 |
Profession: n (%) | <0.001 | ||
Student | 2929 (71.0%) | 3064 (65.1%) | |
Unemployed | 360 (8.7%) | 598 (12.7%) | |
Self-employed | 197 (4.8%) | 366 (7.8%) | |
Private employee | 563 (13.7%) | 561 (11.9%) | |
Government employee | 75 (1.8%) | 114 (2.4%) | |
Working from home: n (%) a | 1527/2275 (67.1%) | 1467/2938 (49.9%) | |
Healthcare worker or student: n (%) | 1089 (26.4%) | 1589 (33.8%) | |
Source of COVID-19 information: n (%) b | |||
Radio, Television, or government | 3042 (73.8%) | 3225 (68.6%) | <0.001 |
Social Media | 3264 (79.1%) | 3045 (64.7%) | <0.001 |
Smoking: n (%) | 97 (2.4%) | 388 (8.3%) | <0.001 |
Underlying chronic disease: n (%) c | 246 (6.0%) | 492 (10.5%) | <0.001 |
Tested for COVID-19: n (%) | 208 (5.0%) | 867 (18.4%) | <0.001 |
Tested during the past 2 weeks: n (%) | NA | 215/867 (24.8%) | NA |
COVID-19 Test results: n (%) | |||
Positive | 49/182 (26.9%) | 206/776 (26.5%) | 0.992 |
Negative | 133/182 (73.1%) | 570/776 (73.5%) | |
..Not known/NA | 26 | 91 |
Survey 1 n = 4124 | Survey 2 n = 4703 | p-Value * | |
---|---|---|---|
Wear face masks: n (%) | 2112 (51.2%) | 2644 (56.2%) | <0.001 |
Observe 1.5m physical distancing: n (%) | 2634 (63.9%) | 2781 (59.1%) | <0.001 |
Regular handwashing: n (%) | 3334 (80.8%) | 3491 (74.2%) | <0.001 |
Regular use of alcohol-based gel: n (%) | 2352 (57.0%) | 2687 (57.1%) | 0.940 |
Cover mouth after coughing/sneezing: n (%) | 3606 (87.4%) | 3875 (82.4%) | <0.001 |
Avoid to touch face (eyes, nose, mouth): n (%) | 2819 (68.4%) | 2995 (63.7%) | <0.001 |
Staying home when I feel flu-like symptoms: n (%) | 3464 (84.0%) | 3418 (72.7%) | <0.001 |
Adherence score: n (%) | <0.001 | ||
0 | 168 (4.1%) | 249 (5.3%) | |
1 | 344 (8.3%) | 514 (10.9%) | |
2 | 484 (11.7%) | 641 (13.6%) | |
3 | 689 (16.7%) | 720 (15.3%) | |
4 | 983 (23.8%) | 869 (18.5%) | |
5 | 1456 (35.3%) | 1710 (36.4%) | |
Been to a bar/restaurant in the past 7 days: n (%) | 525 (12.7%) | 1837 (39.1%) | <0.001 |
Been to a market in the past 7 days: n (%) | 2153 (52.2%) | 2948 (62.7%) | <0.001 |
Been to a religious gathering in the past 7 days: n (%) | 984 (23.9%) | 1715 (36.5%) | <0.001 |
Travelled during the past 7 days: n (%) | <0.001 | ||
No | 3907 (94.7%) | 3876 (82.4%) | |
Yes, to another province | 155 (3.8%) | 535 (11.4%) | |
Yes, to another country | 62 (1.5%) | 292 (6.2%) |
Variable | Categories | Survey 1 | Survey 2 | ||
---|---|---|---|---|---|
Mean Likert Score (SD) | p-Value * | Mean Likert Score (SD) | p-Value * | ||
By gender | Male | 2.39 (1.6) | <0.001 | 2.48 (1.5) | <0.001 |
Female | 1.84 (1.5) | 2.46 (1.5) | |||
By residential setting | Rural | 2.87 (1.8) | 0.019 | 2.53 (1.4) | 0.037 |
Suburban | 2.18 (1.6) | 2.38 (1.5) | |||
Urban | 2.16 (1.6) | 2.32 (1.5) | |||
By professional status | Student | 2.03 (1.5) | <0.001 | 2.22 (1.5) | <0.001 |
Unemployed | 2.16 (1.6) | 2.33 (1.5) | |||
Self-employed | 2.81 (1.7) | 2.74 (1.5) | |||
Private employee | 2.62 (1.6) | 2.60 (1.6) | |||
Government employee | 2.61 (1.6) | 2.75 (1.5) |
Symptoms: n (%) | Survey 1 n = 4124 | Survey 2 n = 4703 | p-Value * |
---|---|---|---|
Fever | 360 (8.7%) | 658 (14.0%) | <0.001 |
Headaches | 442 (10.7%) | 918 (19.5%) | <0.001 |
Dry cough | 155 (3.8%) | 230 (4.9%) | 0.011 |
Productive cough | 146 (3.5%) | 194 (4.1%) | 0.171 |
Sore throat | 216 (5.2%) | 356 (7.6%) | <0.001 |
Coryza | 300 (7.3%) | 397 (8.4%) | 0.047 |
Loss of smell (anosmia) | 278 (6.7%) | 345 (7.3%) | 0.295 |
Loss of taste (ageusia) | 230 (5.6%) | 282 (6.0%) | 0.427 |
Shortness of breath | 86 (2.1%) | 150 (3.2%) | 0.002 |
Myalgia | 305 (7.4%) | 345 (7.3%) | 0.947 |
Fatigue | 254 (6.2%) | 251 (5.3%) | 0.107 |
Nausea | 119 (2.9%) | 182 (3.9%) | 0.013 |
Diarrhea | 70 (1.7%) | 126 (2.7%) | 0.002 |
Sub-Population: n (Mean Adherence Score) | Suspected COVID-19 Cases Based on WHO Definition [10] | Suspected COVID-19 Cases Based on Proposed Definition [6] | p-Value * |
---|---|---|---|
Adherence score and suspected COVID-19 prevalence by survey round: n (%) | |||
Survey 1: n = 4124 (3.54) | 259 (6.3%) | 334 (8.1%) | 0.001 |
Survey 2: n = 4703 (3.40) | 304 (6.5%) | 361 (7.7%) | 0.024 |
Differences across surveys * | 0.758 | 0.486 | |
Adherence score and suspected COVID-19 prevalence by region: n (%) ** | |||
Benadir: n = 3786 (3.43) | 248 (6.6%) | 296 (7.8%) | 0.043 |
Galmudug: n = 227 (3.54) | 12 (5.3%) | 13 (5.7%) | 0.852 |
Hirshabelle: n = 212 (3.41) | 14 (6.6%) | 16 (7.6%) | 0.689 |
Jubaland: n = 101 (2.71) | 6 (5.9%) | 7 (6.9%) | 0.772 |
Puntland: n = 92 (3.32) | 7 (7.6%) | 8 (8.7%) | 0.786 |
Somaliland: n = 117 (3.03) | 7 (6.0%) | 8 (6.8%) | 0.803 |
South West: n = 168 (3.07) | 10 (6.0%) | 13 (7.7%) | 0.538 |
Differences across regions * | 0.988 | 0.948 |
Covariate | Adjusted OR (95% CI) | p-Value |
---|---|---|
Age | 0.994 (0.987–1.00) | 0.126 |
Gender Male Female | Ref 1.715 (1.581–1.861) | <0.001 |
Profession Private employee Student Unemployed Self-employed Government employee | Ref 1.256 (1.109–1.423) 1.166 (0.994–1.369) 1.189 (0.989–1.430) 1.393 (1.058–1.839) | <0.001 0.059 0.066 0.019 |
Residential setting Rural Sub-Urban Urban | Ref 0.826 (0.602–1.131) 0.720 (0.541–0.956) | 0.235 0.024 |
Educational level Primary Secondary Undergraduate Postgraduate | Ref 1.099 (0.800–1.510) 1.211 (0.898–1.632) 1.679 (1.220–2.307) | 0.558 0.209 0.001 |
Healthcare student/worker | 2.180 (2.000–2.377) | <0.001 |
Living alone in house | 1.243 (1.056–1.463) | 0.009 |
Presence of flu symptoms | 0.678 (0.620–0.741) | <0.001 |
Presence of underlying disease | 0.868 (0.751–1.004) | 0.056 |
COVID-19 information from TV, radio, or government (Official source) No Yes | Ref 1.460 (1.341–1.589) | <0.001 |
COVID-19 information from social media No Yes | Ref 0.835 (0.764–0.913) | <0.001 |
Survey round Round 1 Round 2 | Ref 0.898 (0.829–0.972) | 0.008 |
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Ahmed, M.A.M.; Siewe Fodjo, J.N.; Gele, A.A.; Farah, A.A.; Osman, S.; Guled, I.A.; Ali, A.M.; Colebunders, R. COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden. Pathogens 2020, 9, 735. https://doi.org/10.3390/pathogens9090735
Ahmed MAM, Siewe Fodjo JN, Gele AA, Farah AA, Osman S, Guled IA, Ali AM, Colebunders R. COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden. Pathogens. 2020; 9(9):735. https://doi.org/10.3390/pathogens9090735
Chicago/Turabian StyleAhmed, Mohammed A. M., Joseph Nelson Siewe Fodjo, Abdi A. Gele, Abdiqani A. Farah, Shariff Osman, Ibraahim Abdullahi Guled, Abdiaziz Mohamed Ali, and Robert Colebunders. 2020. "COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden" Pathogens 9, no. 9: 735. https://doi.org/10.3390/pathogens9090735
APA StyleAhmed, M. A. M., Siewe Fodjo, J. N., Gele, A. A., Farah, A. A., Osman, S., Guled, I. A., Ali, A. M., & Colebunders, R. (2020). COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden. Pathogens, 9(9), 735. https://doi.org/10.3390/pathogens9090735