The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements

Abstract

Background Many low- and middle-income countries have implemented control measures against coronavirus disease 2019 (COVID-19). However, it is not clear to what extent these measures explain the low numbers of recorded COVID-19 cases and deaths in Africa. One of the main aims of control measures is to reduce respiratory pathogen transmission through direct contact with others. In this study, we collect contact data from residents of informal settlements around Nairobi, Kenya, to assess if control measures have changed contact patterns, and estimate the impact of changes on the basic reproduction number (R0). Methods We conducted a social contact survey with 213 residents of five informal settlements around Nairobi in early May 2020, 4 weeks after the Kenyan government introduced enhanced physical distancing measures and a curfew between 7 pm and 5 am. Respondents were asked to report all direct physical and non-physical contacts made the previous day, alongside a questionnaire asking about the social and economic impact of COVID-19 and control measures. We examined contact patterns by demographic factors, including socioeconomic status. We described the impact of COVID-19 and control measures on income and food security. We compared contact patterns during control measures to patterns from non-pandemic periods to estimate the change in R0. Results We estimate that control measures reduced physical contacts by 62% and non-physical contacts by either 63% or 67%, depending on the pre-COVID-19 comparison matrix used. Masks were worn by at least one person in 92% of contacts. Respondents in the poorest socioeconomic quintile reported 1.5 times more contacts than those in the richest. Eighty-six percent of respondents reported a total or partial loss of income due to COVID-19, and 74% reported eating less or skipping meals due to having too little money for food. Conclusion COVID-19 control measures have had a large impact on direct contacts and therefore transmission, but have also caused considerable economic and food insecurity. Reductions in R0 are consistent with the comparatively low epidemic growth in Kenya and other sub-Saharan African countries that implemented similar, early control measures. However, negative and inequitable impacts on economic and food security may mean control measures are not sustainable in the longer term.

Rapid review of social contact patterns during the COVID-19 pandemic

“…The majority (8/12) of studies were based in high-income countries: European countries (n=6), the United States (n=1) or both (n=1). Eight studies surveyed participants with the intention of describing contact patterns representative of an entire country 33–40 and four studies aimed to describe sub-national areas such as cities (Shanghai and Wuhan in one study, Shenzhen and Changsha in a second) 41,42 , an informal settlement in Nairobi, Kenya 43 and a district in KwaZulu-Natal, South Africa 44 . Six studies included adults aged 18 years and above only 33,35–37,39,43 , four studies included participants of all ages 34,40–42 and two studies included teenagers and above 38,44 .…”

“…Eleven 33–43 studies collected data during the initial mitigation period between February and May 2020 with the most stringent physical distancing measures (Figure 2) with seven 33–35,37–40 collecting data during nationally-declared lockdown and four 36,41–43 during regional lockdown. Five 34–36,38,42 studies also collected additional data when interventions were relaxed (April and May for China and between May and September for other settings) and one 44 study collected data exclusively during the period of relaxation 44 .…”

Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements

“…Open access for rapid viral spread due to high population density, inadequate housing and sanitation facilities and intense levels of social mixing. 5 Coupled with the higher risks of disease transmission, residents of informal settlements face the concurrent shock of devastating impacts from physical distancing policies and lockdowns, including closing of businesses and schools and ban on large gatherings. Mitigation policies may slow the transmission of the virus, but they come with a heavy social and economic toll on poor urban populations, potentially higher for women.…”

Modeling the interplay between demography, social contact patterns, and SARS-CoV-2 transmission in the South West Shewa Zone of Oromia Region, Ethiopia

“…In line with observations from other settings [ 23 ], school closure was estimated to be insufficient to prevent the spread of the infection. Recently published studies have shown that the lockdown implemented in Kenya reduced individuals’ social interactions by 60–70% compared to the pre-pandemic period [ 15 ], but it is difficult to extrapolate these data to Ethiopia, where social distancing measures were comparatively milder. Data on how contacts outside school may have changed in Ethiopia during the COVID-19 epidemic are still lacking.…”