New research affirms the need of engaging communities during a pandemic

Early on in the COVID-19 pandemic, anecdotal reports in popular media suggested that there was low risk perception of the disease among communities and hesitancy to implement prevention and mitigation measures. The government of Uganda mostly employed a top-down approach in implementing COVID-19 prevention and mitigation measures, with limited meaningful community engagement as part of the response. Consequently, this left many people unconvinced about the existence of the pandemic and relevance of the mitigation measures. As such, there was negative perception of the mitigation measures and a reluctancy to implement them.

These observations were revealed in a new study titled: ‘Owning our future through community engagement: enhancing uptake of COVID-19 prevention and mitigation measures’ whose research findings were disseminated on August 3 2021 at Makerere University’s College of Health Sciences (MakCHS). The study was conducted between November 2020 and January 2021 by a team of researchers led by Prof. Nelson Sewankambo as Principal Investigator. Others were: Dr. David Kaawa-Mafigiri from Makerere University’s College of Humanities and Dr. Daniel Semakula from MakCHS. The study, conducted in Nakawa and Kawempe divisions of Kampala, aimed to assess the prevailing attitudes and perceptions towards COVID-19 mitigation measures; the likelihood of accepting a potential COVID-19 vaccine and the impact of the disease on livelihoods among vulnerable populations in Kampala. It was funded by the Government of the Republic of Uganda through the Makerere University Research and Innovations Fund (MakRIF). 

During the dissemination, Prof. Sewankambo told participants that since the onset of the COVID pandemic in Uganda, there has hardly been any community engagement to empower individuals, households and communities to take charge of their health and social wellbeing.

“We know that community engagement was a success feature in controlling the Ebola Virus Disease epidemics in Uganda, Democratic Republic of Congo and West Africa. However, the impact of community engagement in the COVID-19 pandemic is unknown for policy and action,” Prof Sewankambo said. 

Therefore, the study hypothesized that the success of any measures against the COVID-19 pandemic required community participation, ownership and sustainability of the efforts at grassroot levels.  

Key Findings 

Using survey questionnaires, household conversations, focus group discussions and in-depth interviews, over 1200 men, women and children aged above 12 in 858 households were examined. Survey results indicate that majority of the participants were aware of COVID-19 prevention measures with use of face masks being most renown (n=768 (90.57%)) followed by handwashing (n=743 (87.62%)). Others were: use of an alcohol-based sanitizer (n=537 (63.33%)), avoiding crowds (n= 491 (57.9%)), staying at home (n= 355 (41.86%)) and avoiding physical greetings (n=326 (38.44%)).

However, despite being aware of these prevention measures, Dr. Semakula reported that adherence substantially reduced by month eight of the pandemic. For example, majority (n= 675 (80%)) did not wear masks at all, or wore them inappropriately such as under their chins, or foreheads or partially covering the mouth by month eight of the pandemic. Similarly, only a small fraction (n=130 (15.6%)) of participants washed their hands (with or without soap) regularly when the opportunity presented, e.g., after greeting visitors, touching unhygienic objects, or visiting washrooms. 

“Several reasons might explain these findings: first, as the cases of COVID-19 reduced, the public probably became more complacent. Secondly, the top-down approach adopted by government at the beginning of the pandemic was no longer effective and required supplementary strategies such as community engagement,” Dr Semakula told participants while presenting results from the survey.

He added that the public increasingly lost trust in government amidst accusations of perceived misappropriation of resources, and failure to provide the public with the much-needed social protections. Notably, low adherence to the prevention measures was also reported among some of the enforcers of the social measures and was associated with ‘prevention fatigue’.

On the likelihood of accepting a COVID-19 vaccine, 63% of respondents mentioned that they were likely to accept it if it was found to be effective and safe. Differentially however, feedback from the in-depth interviews revealed that participants believed that traditional home remedies and religious practices could be effective for treating COVID-19 rather than vaccines.

“Whereas at a time of the interviews there was no authorized COVID-19 vaccine, some community members who believed in biomedical treatments thought that vaccines were not effective,” said while presenting qualitative results of the study

He also noted that majority of youth and young adults interviewed did not perceive themselves to be at high risk of contracting COVID-19 at the time that the study was conducted. Therefore, this led to poor adherence of the prevention measures.  

Recommendations

This study revealed the urgent need to supplement the current mitigation efforts with bottom-up approach that involves communities so that they may understand and own the response to the COVID-19 pandemic. This implies integrating community communication and participation into prevention and control measures and utilizing existing community social structures to support government programs during the pandemic. 

Furthermore, the study recommended the need for policy makers to address the low risk-perception of COVID-19, which could be a driver of the low adherence to the mitigation measures. It also highlighted the to need to rebuild the trust of the public in government mitigation efforts and programs including the recently introduced COVID vaccination program for the country to make substantial progress in controlling the pandemic.

Using these findings, the researchers plan to develop and implement a community engagement intervention for enhancing uptake of the recommended COVID-19 public health and social mitigation measures.  

As a wrap to the dissemination engagement, Dr. Zahara Nampewo, a Lecturer and Director Human Rights and Peace Center, School of Law-Makerere University told participants that there is a need to deal with people’s negative attitudes if the pandemic is to be dealt with. “A healthy human capital and population is important to have and this project fits within the Government of the Republic of Uganda Development objectives and Sustainable Development Goals” Dr. Nampewo added. Dr. Nampewo also noted the need to build Trust within the communities as an important aspect for project success, uptake and sustainability. She thanked the researchers for putting into use funding from the Government of the Republic of Uganda to conduct research which is positively informing work in the communities in which we live and serve. She was representing the Mak-RIF’s Grants Management Committee at the engagement. The dissemination was graced with participants from Gulu, Makerere, Clarke International and Kyambogo, Busitema, Universities, University of Cambridge, Infectious Diseases Institute, Informed Health Choices Project, Infectious Diseases Research Collaboration, Medical Research Council, Makerere University Joint Aids Program; journalists; social research scientists and public health experts among others. 

Compiled by: RACHEAL NINSIIMA