SARS-CoV-2 infection, transmission dynamics and household impact in Malawi (SCATHIM)

Sub-Saharan African countries have adopted COVID-19 prevention methods similar to those used in developed countries although their people live in a different context. The spread of COVID-19 in African households and people's adherence to preventive measures are not known, but this information is required to develop appropriate prevention measures. We aim to determine the intensity of COVID-19 spread in households located in urban medium-density, urban high-density and rural-high density areas in Malawi, Africa, factors that promote the spread of the disease and the impact of the disease on people's lives. Our specific objectives are to: (1) estimate the proportion of people living in the same household with infected people who become infected, (2) assess whether the risk of getting infected and developing severe symptoms are influenced by personal and nutritional characteristics and immunity to COVID-19; other infections (HIV, TB, malaria) or their treatments; and the household environment (3) assess whether the use of personal protective equipment is acceptable, feasible, and effective among people living with infected individuals (4) describe the experiences of caregivers of COVID-19 infected individuals (5) estimate the costs and lost income associated with home-based care for infected people. Study findings will help to identify high risk households/areas and design appropriate social safety nets for affected households. Our research team's existing collaboration with policy makers and local health department will facilitate the use of research findings to strengthen the fight against the disease.

Sub-Saharan African countries have adopted prevention measures similar to those used in developed countries to combat the SARS-CoV-2 virus (COVID-19) pandemic, although their social, cultural and economic contexts are markedly dissimilar. Limited empirical data exist on SARS-CoV-2 transmission dynamics and the feasibility of prevention measures in diverse African households, to guide the adaptation of the preventive measures. We aim to determine the transmission dynamics, determinants and socio-economic impact of SARS-CoV-2 infection in households located in urban medium-density, urban high-density and rural-high density locations in Malawi, Africa. Our specific objectives are to (1) measure the secondary attack rates of SARS-CoV-2 infection within households of symptomatic and asymptomatic index cases, (2) assess how SARS CoV-2 susceptibility and clinical outcomes among household contacts of index cases are influenced by socio-demographic, nutritional and anti-SARS CoV-2 immunological status; co-infections (HIV, TB, malaria) and their treatments, and household environment, (3) assess the acceptability, feasibility, adoption and effectiveness of personal protective equipment among household members of index cases, (4) describe lived experiences of caregivers of SARS-CoV-2 index cases, and (5) estimate the direct and indirect costs associated with SARS-CoV-2 prevention and care in households of index cases. Through this study, we will generate contextually-relevant empirical data for identifying high risk individuals; predicting the intensity of SARS-CoV-2 transmission and the impact of preventive measures; and designing appropriate social safety nets for households affected by SARS-CoV-2. Our research team's existing engagement with policy makers and local health department will facilitate knowledge translation and enhance their pandemic response capacity.