Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme

Abstract

Background South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. Results Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. Conclusions Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor.

Intention-Based Critical Factors Affecting Willingness to Adopt Novel Coronavirus Prevention in Pakistan: Implications for Future Pandemics

“…We found that ease of pandemic prevention adoption promoted the individuals’ WAPP. Consistent with our results, Kusuma et al [ 50 ] revealed that the unavailability of protective gears (mainly hand sanitizers and face masks) adversely impacted the COVID-19 prevention adoption in four South Asian countries (India, Bangladesh, Sri Lanka, and Pakistan). It means that the easier the adoption of pandemic prevention, the more that individuals will be willing to adopt it.…”

“…Clipper [ 49 ] also argued that tech solutions strengthened the healthcare systems and made prevention adoption easier through information communication. Further, Kusuma et al [ 50 ] conducted a survey-based analysis in four South Asian countries (India, Pakistan, Bangladesh, and Sri Lanka) by recruiting 29,809 respondents to evaluate the feasibility of COVID-19 prevention adoption. The individuals were found less likely to adopt pandemic prevention due to the unavailability of protective gears.…”

Government responses and COVID-19 deaths: Global evidence across multiple pandemic waves

“…On the one hand, we might expect effectiveness to improve over time as governments learn how to better calibrate and target policies [32,33]. On the other hand, we may expect the opposite to the extent individuals grow tired of COVID-19 restrictions, as responses become politicized, or as economic disruption grows more severe [34][35][36][37][38][39].…”

Factors Associated with Financial Security, Food Security and Quality of Daily Lives of Residents in Nigeria during the First Wave of the COVID-19 Pandemic

“…As a result, staff were laid off, work hours were reduced, salaries were cut, and furloughs were enacted in a bid to meet organisations' operating costs [4,5]. These types of market shocks have unequal consequences on the financial well-being of populations as a whole [6] with the impact varying between populations in-country thereby worsening the existing inequalities [7,8]. Women, young people, and adults aged 65 and older were more likely to be financially vulnerable during the pandemic while household heads with at least a tertiary education have a lower probability of being affected [9].…”

“…It is likely that the impact of the economic shock caused by the pandemic will differ between populations [7]. For example, people living with HIV (PLHIV) may be more vulnerable to the COVID-19 pandemic's economic impact compared to those not living with HIV.…”