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Article ; Online: A qualitative inquiry on drivers of COVID-19 vaccine hesitancy among adults in Kenya.

Orangi, Stacey / Mbuthia, Daniel / Chondo, Elwyn / Ngunu, Carol / Kabia, Evelyn / Ojal, John / Barasa, Edwine

PLOS global public health

2024 Volume 4, Issue 3, Page(s) e0002986

Abstract: COVID-19 vaccination rates have been low among adults in Kenya (36.7% as of late March 2023) with vaccine hesitancy posing a threat to the COVID-19 vaccination program. This study sought to examine facilitators and barriers to COVID-19 vaccinations in ... ...

Abstract	COVID-19 vaccination rates have been low among adults in Kenya (36.7% as of late March 2023) with vaccine hesitancy posing a threat to the COVID-19 vaccination program. This study sought to examine facilitators and barriers to COVID-19 vaccinations in Kenya. We conducted a qualitative cross-sectional study in two purposively selected counties in Kenya. We collected data through 8 focus group discussions with 80 community members and 8 in-depth interviews with health care managers and providers. The data was analyzed using a framework approach focusing on determinants of vaccine hesitancy and their influence on psychological constructs. Barriers to COVID-19 vaccine uptake were related to individual characteristics (males, younger age, perceived health status, belief in herbal medicine, and the lack of autonomy in decision making among women - especially in rural settings), contextual influences (lifting of bans, myths, medical mistrust, cultural and religious beliefs), and COVID-19 vaccine related factors (fear of unknown consequences, side-effects, lack of understanding on how vaccines work and rationale for boosters). However, community health volunteers, trusted leaders, mandates, financial and geographic access influenced COVID-19 vaccine uptake. These drivers of hesitancy mainly related to psychological constructs including confidence, complacency, and constraints. Vaccine hesitancy in Kenya is driven by multiple interconnected factors. These factors are likely to inform evidence-based targeted strategies that are built on trust to address vaccine hesitancy. These strategies could include gender responsive immunization programs, appropriate messaging and consistent communication that target fear, safety concerns, misconceptions and information gaps in line with community concerns. There is need to ensure that the strategies are tested in the local setting and incorporate a multisectoral approach including community health volunteers, religious leaders and community leaders.
Language	English
Publishing date	2024-03-28
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002986
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Article ; Online: Examining the unit costs of COVID-19 vaccine delivery in Kenya.

Orangi, Stacey / Kairu, Angela / Ngatia, Anthony / Ojal, John / Barasa, Edwine

BMC health services research

2022 Volume 22, Issue 1, Page(s) 439

Abstract: Background: Vaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We ... ...

Abstract	Background: Vaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. Methods: We used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews(n = 12) were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with 2-doses, and the vaccine delivery costs per person vaccinated with 2-doses were estimated and reported in 2021USD. Results: The financial costs of vaccine procurement per person vaccinated with 2-doses ranged from $2.89-$13.09 in the 30% and 100% coverage levels respectively, however, the economic cost was $17.34 across all strategies. Financial vaccine delivery costs per person vaccinated with 2-doses, ranged from $4.28-$3.29 in the 30% and 100% coverage strategies: While the economic delivery costs were two to three times higher than the financial costs. The total procurement and delivery costs per person vaccinated with 2-doses ranged from $7.34-$16.47 for the financial costs and $29.7-$24.68 for the economic costs for the 30% and 100% coverage respectively. With the exception of procurement costs, the main cost driver of financial and economic delivery costs was supply chain costs (47-59%) and advocacy, communication and social mobilization (29-35%) respectively. Conclusion: This analysis presents cost estimates that can be used to inform local policy and may further inform parameters used in cost-effectiveness models. The results could potentially be adapted and adjusted to country-specific assumptions to enhance applicability in similar low-and middle-income settings.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Humans ; Immunization Programs ; Kenya/epidemiology ; Pandemics
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-04-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07864-z
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Article ; Online: Estimating the contribution of different age strata to vaccine serotype pneumococcal transmission in the pre vaccine era: a modelling study.

Flasche, Stefan / Lipsitch, Marc / Ojal, John / Pinsent, Amy

BMC medicine

2020 Volume 18, Issue 1, Page(s) 129

Abstract: Background: Herd protection through interruption of transmission has contributed greatly to the impact of pneumococcal conjugate vaccines (PCVs) and may enable the use of cost-saving reduced dose schedules. To aid PCV age targeting to achieve herd ... ...

Abstract	Background: Herd protection through interruption of transmission has contributed greatly to the impact of pneumococcal conjugate vaccines (PCVs) and may enable the use of cost-saving reduced dose schedules. To aid PCV age targeting to achieve herd protection, we estimated which population age groups contribute most to vaccine serotype (VT) pneumococcal transmission. Methods: We used transmission dynamic models to mirror pre-PCV epidemiology in England and Wales, Finland, Kilifi in Kenya and Nha Trang in Vietnam where data on carriage prevalence in infants, pre-school and school-aged children and adults as well as social contact patterns was available. We used Markov Chain Monte Carlo methods to fit the models and then extracted the per capita and population-based contribution of different age groups to VT transmission. Results: We estimated that in all settings, < 1-year-old infants cause very frequent secondary vaccine type pneumococcal infections per capita. However, 1-5-year-old children have the much higher contribution to the force of infection at 51% (28, 73), 40% (27, 59), 37% (28, 48) and 67% (41, 86) of the total infection pressure in E&W, Finland, Kilifi and Nha Trang, respectively. Unlike the other settings, school-aged children in Kilifi were the dominant source for VT infections with 42% (29, 54) of all infections caused. Similarly, we estimated that the main source of VT infections in infants are pre-school children and that in Kilifi 39% (28, 51) of VT infant infections stem from school-aged children whereas this was below 15% in the other settings. Conclusion: Vaccine protection of pre-school children is key for PCV herd immunity. However, in high transmission settings, school-aged children may substantially contribute to transmission and likely have waned much of their PCV protection under currently recommended schedules.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Child ; Child, Preschool ; Female ; Humans ; Immunity, Herd/immunology ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Models, Theoretical ; Pneumococcal Infections/prevention & control ; Pneumococcal Vaccines/administration & dosage ; Pneumococcal Vaccines/therapeutic use ; Vaccines, Conjugate/administration & dosage ; Vaccines, Conjugate/therapeutic use ; Young Adult
Chemical Substances	Pneumococcal Vaccines ; Vaccines, Conjugate
Language	English
Publishing date	2020-06-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2131669-7
ISSN	1741-7015 ; 1741-7015
ISSN (online)	1741-7015
ISSN	1741-7015
DOI	10.1186/s12916-020-01601-1
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Article: The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria.

Adamu, Aishatu Lawal / Karia, Boniface / Bello, Musa M / Jahun, Mahmoud G / Gambo, Safiya / Ojal, John / Scott, Anthony / Jemutai, Julie / Adetifa, Ifedayo M

BMJ global health

2022 Volume 7, Issue 1

Abstract: Background: Pneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to ... ...

Abstract	Background: Pneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income. Methods: We recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary level hospital and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor). Results: Of 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14-22) for outpatients and US$272 (US$271-360) for inpatients. Median household cost was US$51 (US$40-69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE, respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs and caregiver having a non-salaried job. Conclusion: Provider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.
MeSH term(s)	Child ; Child, Preschool ; Cost of Illness ; Health Expenditures ; Humans ; Nigeria/epidemiology ; Pneumococcal Infections/prevention & control ; Pneumonia
Language	English
Publishing date	2022-01-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-007080
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Article ; Online: Examining the Unit Costs of COVID-19 Vaccine Delivery in Kenya

Orangi, Stacey / Kairu, Angela / Ngatia, Anthony / Ojal, John / Barasa, Edwine

medRxiv

Abstract	Background: Vaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. Methods: We used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews (n=12) with stakeholders involved in the vaccine delivery and administration at a national level and in two counties were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with two doses, and the vaccine delivery costs per person vaccinated with two doses were estimated and reported in 2021 USD. Results: The financial costs of vaccine procurement per person vaccinated with two doses ranged from $2.89 to $13.09 in the 30% and 100% coverage levels respectively. The economic costs of vaccine procurement per person vaccinated with two doses was $17.34 across all strategies. With regard to unit vaccine delivery costs per person vaccinated with two doses, the financial costs ranged from $4.28 to $3.29 in the 30% and 100% coverage strategies: While the economic delivery costs were two to three times higher than the financial costs. The total procurement and delivery costs per person vaccinated with 2-doses ranged from $7.34 to $16.47 for the financial costs and $29.7 to $24.68 for the economic costs for the 30% and 100% coverage respectively. With the exception of procurement costs, the main cost driver of financial and economic delivery costs was supply chain costs (47-59%) and advocacy, communication and social mobilization (29-35%) respectively. Conclusion: This analysis presents cost estimates that can be used to inform local policy and may further inform parameters used in cost-effectiveness models. The results could potentially be adapted and adjusted to country-specific assumptions to enhance applicability in similar low-and middle-income settings.
Keywords	covid19
Language	English
Publishing date	2021-11-02
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.11.01.21265742
Database	COVID19

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Article ; Online: Vaccine strategies to reduce the burden of pneumococcal disease in HIV-infected adults in Africa.

Thindwa, Deus / Pinsent, Amy / Ojal, John / Gallagher, Katherine E / French, Neil / Flasche, Stefan

Expert review of vaccines

2020 Volume 19, Issue 11, Page(s) 1085–1092

Abstract: Introduction: Streptococcus pneumoniae: Areas covered: Nonsystematic review on the pneumococcal burden in HIV-infected adults and vaccine strategies to reduce this burden.: Expert opinion: We propose and discuss the relative merit of changing the ... ...

Abstract	Introduction: Streptococcus pneumoniae Areas covered: Nonsystematic review on the pneumococcal burden in HIV-infected adults and vaccine strategies to reduce this burden. Expert opinion: We propose and discuss the relative merit of changing the infant PCV program to use (1a) a two prime plus booster dose schedule, (1b) a two prime plus booster dose schedule with an additional booster dose at school entry, to directly vaccinate (2a) HIV-infected adults or vaccinating (2b) HIV-infected pregnant women for direct protection, with added indirect protection to the high-risk neonates. We identify key knowledge gaps for such an evaluation and propose strategies to overcome them.
MeSH term(s)	Adult ; Africa ; Anti-HIV Agents/administration & dosage ; HIV Infections/complications ; HIV Infections/drug therapy ; Humans ; Immunization Schedule ; Infant ; Pneumococcal Infections/prevention & control ; Pneumococcal Vaccines/administration & dosage ; Streptococcus pneumoniae/isolation & purification ; Vaccines, Conjugate/administration & dosage
Chemical Substances	Anti-HIV Agents ; Pneumococcal Vaccines ; Vaccines, Conjugate
Language	English
Publishing date	2020-12-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2181284-6
ISSN	1744-8395 ; 1476-0584
ISSN (online)	1744-8395
ISSN	1476-0584
DOI	10.1080/14760584.2020.1843435
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Article ; Online: Effect of Maternally Derived Anti-protein and Anticapsular IgG Antibodies on the Rate of Acquisition of Nasopharyngeal Carriage of Pneumococcus in Newborns.

Ojal, John / Goldblatt, David / Tigoi, Caroline / Scott, J Anthony G

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2017 Volume 66, Issue 1, Page(s) 121–130

Abstract: Background: In developing countries, introduction of pneumococcal conjugate vaccine has not eliminated circulation of vaccine serotypes. Vaccinating pregnant mothers to increase antibody concentrations in their newborn infants may reduce the acquisition ...

Abstract	Background: In developing countries, introduction of pneumococcal conjugate vaccine has not eliminated circulation of vaccine serotypes. Vaccinating pregnant mothers to increase antibody concentrations in their newborn infants may reduce the acquisition of pneumococcal carriage and subsequent risk of disease. We explored the efficacy of passive immunity, attributable to anti-protein and anticapsular pneumococcal antibodies, against acquisition of carriage. Methods: We examined the rate of nasopharyngeal acquisition of pneumococci in the first 90 days of life associated with varying anticapsular and anti-protein antibody concentrations in infant cord/maternal venous blood in Kilifi, Kenya. We used multivariable Cox proportional hazard models to estimate continuous functions relating acquisition of nasopharyngeal carriage to the concentration of maternally derived antibody. Results: Cord blood or maternal venous samples were collected from 976 mother-infant pairs. Pneumococci were acquired 561 times during 33,905 person-days of follow-up. Increasing concentrations of anti-protein antibodies were associated with either a reduction (PhtD1, PspAFam2, Spr0096, StkP) or, paradoxically, an increase (CbpA, LytC, PcpA, PiaA, PspAFam1, RrgBT4) in acquisition rate. We observed a nonsignificant reduction in the incidence of homologous carriage acquisition with high concentrations of maternally derived anticapsular antibodies to 5 serotypes (6A, 6B, 14, 19F, and 23F). Conclusion: The protective efficacy of several anti-protein antibodies supports the strategy of maternal vaccination to protect young infants from carriage and invasive disease. We were not able to demonstrate that passive anticapsular antibodies were protective against carriage acquisition at naturally occurring concentrations though it remains possible they may do so at the higher concentrations elicited by vaccination.
MeSH term(s)	Antibodies, Bacterial/blood ; Antigens, Bacterial/immunology ; Bacterial Proteins/immunology ; Carrier State/epidemiology ; Female ; Humans ; Immunity, Maternally-Acquired ; Immunoglobulin G/blood ; Incidence ; Infant ; Infant, Newborn ; Kenya/epidemiology ; Male ; Nasopharynx/microbiology ; Pneumococcal Infections/epidemiology ; Pneumococcal Infections/prevention & control ; Pneumococcal Vaccines/administration & dosage ; Pneumococcal Vaccines/immunology ; Polysaccharides, Bacterial/immunology ; Streptococcus pneumoniae/immunology
Chemical Substances	Antibodies, Bacterial ; Antigens, Bacterial ; Bacterial Proteins ; Immunoglobulin G ; Pneumococcal Vaccines ; Polysaccharides, Bacterial
Language	English
Publishing date	2017-09-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/cix742
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Article ; Online: A computational framework for modelling infectious disease policy based on age and household structure with applications to the COVID-19 pandemic.

Hilton, Joe / Riley, Heather / Pellis, Lorenzo / Aziza, Rabia / Brand, Samuel P C / K Kombe, Ivy / Ojal, John / Parisi, Andrea / Keeling, Matt J / Nokes, D James / Manson-Sawko, Robert / House, Thomas

PLoS computational biology

2022 Volume 18, Issue 9, Page(s) e1010390

Abstract: The widespread, and in many countries unprecedented, use of non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic has highlighted the need for mathematical models which can estimate the impact of these measures while accounting for the ... ...

Abstract	The widespread, and in many countries unprecedented, use of non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic has highlighted the need for mathematical models which can estimate the impact of these measures while accounting for the highly heterogeneous risk profile of COVID-19. Models accounting either for age structure or the household structure necessary to explicitly model many NPIs are commonly used in infectious disease modelling, but models incorporating both levels of structure present substantial computational and mathematical challenges due to their high dimensionality. Here we present a modelling framework for the spread of an epidemic that includes explicit representation of age structure and household structure. Our model is formulated in terms of tractable systems of ordinary differential equations for which we provide an open-source Python implementation. Such tractability leads to significant benefits for model calibration, exhaustive evaluation of possible parameter values, and interpretability of results. We demonstrate the flexibility of our model through four policy case studies, where we quantify the likely benefits of the following measures which were either considered or implemented in the UK during the current COVID-19 pandemic: control of within- and between-household mixing through NPIs; formation of support bubbles during lockdown periods; out-of-household isolation (OOHI); and temporary relaxation of NPIs during holiday periods. Our ordinary differential equation formulation and associated analysis demonstrate that multiple dimensions of risk stratification and social structure can be incorporated into infectious disease models without sacrificing mathematical tractability. This model and its software implementation expand the range of tools available to infectious disease policy analysts.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; Communicable Disease Control/methods ; Communicable Diseases ; Humans ; Pandemics/prevention & control ; Policy ; SARS-CoV-2
Language	English
Publishing date	2022-09-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2193340-6
ISSN	1553-7358 ; 1553-734X
ISSN (online)	1553-7358
ISSN	1553-734X
DOI	10.1371/journal.pcbi.1010390
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Article ; Online: Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi.

Thindwa, Deus / Mwalukomo, Thandie S / Msefula, Jacquline / Jambo, Kondwani C / Brown, Comfort / Kamng'ona, Arox / Mwansambo, Charles / Ojal, John / Flasche, Stefan / French, Neil / Heyderman, Robert S / Swarthout, Todd D

AIDS (London, England)

2022 Volume 36, Issue 14, Page(s) 2045–2055

Abstract: Objective: Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination ... ...

Abstract	Objective: Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors. Methods: Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage. Results: Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004-17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex. Conclusion: Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.
MeSH term(s)	Adult ; Female ; Humans ; Infant ; Male ; Carrier State/epidemiology ; Cross-Sectional Studies ; HIV Infections/complications ; HIV Infections/drug therapy ; Malawi/epidemiology ; Nasopharynx ; Pneumococcal Infections/epidemiology ; Pneumococcal Infections/prevention & control ; Pneumococcal Vaccines ; Prevalence ; Risk Factors ; Streptococcus pneumoniae ; Infant, Newborn ; Child, Preschool
Chemical Substances	Pneumococcal Vaccines
Language	English
Publishing date	2022-08-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639076-6
ISSN	1473-5571 ; 0269-9370 ; 1350-2840
ISSN (online)	1473-5571
ISSN	0269-9370 ; 1350-2840
DOI	10.1097/QAD.0000000000003365
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Article ; Online: Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi.

Thindwa, Deus / Jambo, Kondwani C / Ojal, John / MacPherson, Peter / Dennis Phiri, Mphatso / Pinsent, Amy / Khundi, McEwen / Chiume, Lingstone / Gallagher, Katherine E / Heyderman, Robert S / Corbett, Elizabeth L / French, Neil / Flasche, Stefan

Epidemics

2022 Volume 40, Page(s) 100590

Abstract: Introduction: Understanding human mixing patterns relevant to infectious diseases spread through close contact is vital for modelling transmission dynamics and optimisation of disease control strategies. Mixing patterns in low-income countries like ... ...

Abstract	Introduction: Understanding human mixing patterns relevant to infectious diseases spread through close contact is vital for modelling transmission dynamics and optimisation of disease control strategies. Mixing patterns in low-income countries like Malawi are not well known. Methodology: We conducted a social mixing survey in urban Blantyre, Malawi between April and July 2021 (between the 2nd and 3rd wave of COVID-19 infections). Participants living in densely-populated neighbourhoods were randomly sampled and, if they consented, reported their physical and non-physical contacts within and outside homes lasting at least 5 min during the previous day. Age-specific mixing rates were calculated, and a negative binomial mixed effects model was used to estimate determinants of contact behaviour. Results: Of 1201 individuals enroled, 702 (58.5%) were female, the median age was 15 years (interquartile range [IQR] 5-32) and 127 (10.6%) were HIV-positive. On average, participants reported 10.3 contacts per day (range: 1-25). Mixing patterns were highly age-assortative, particularly those within the community and with skin-to-skin contact. Adults aged 20-49 y reported the most contacts (median:11, IQR: 8-15) of all age groups; 38% (95%CI: 16-63) more than infants (median: 8, IQR: 5-10), who had the least contacts. Household contact frequency increased by 3% (95%CI: 2-5) per additional household member. Unemployed participants had 15% (95%CI: 9-21) fewer contacts than other adults. Among long range (>30 m away from home) contacts, secondary school children had the largest median contact distance from home (257 m, IQR 78-761). HIV-positive status in adults >=18 years-old was not associated with changed contact patterns (rate ratio: 1.01, 95%CI: (0.91-1.12)). During this period of relatively low COVID-19 incidence in Malawi, 301 (25.1%) individuals stated that they had limited their contact with others due to COVID-19 precautions; however, their reported contacts were 8% (95%CI: 1-13) higher. Conclusion: In urban Malawi, contact rates, are high and age-assortative, with little reported behavioural change due to either HIV-status or COVID-19 circulation. This highlights the limits of contact-restriction-based mitigation strategies in such settings and the need for pandemic preparedness to better understand how contact reductions can be enabled and motivated.
MeSH term(s)	Adolescent ; Adult ; COVID-19/epidemiology ; Child ; Communicable Diseases/epidemiology ; Female ; HIV Infections/epidemiology ; Humans ; Infant ; Malawi/epidemiology ; Male ; Schools
Language	English
Publishing date	2022-06-08
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2467993-8
ISSN	1878-0067 ; 1755-4365
ISSN (online)	1878-0067
ISSN	1755-4365
DOI	10.1016/j.epidem.2022.100590
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