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Fisher DA, Miller TR, Grube JW, Ringwalt CL, Achoki T, Ngwato TP, Shilakoe L, Mkhondo P. Locked Down: Economic and Health Effects of COVID-19 Response on Residents of a South African Township. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022:1-13. [PMID: 35967248 PMCID: PMC9361952 DOI: 10.1007/s40609-022-00230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Background Little research has examined how pandemics affect residents in under-resourced communities. This study investigated how COVID-19 and lockdown policies affected residents of Alexandra, one of Johannesburg, South Africa's lowest-income townships. Methods We conducted a telephone survey May 11-22, 2020, while the lockdown and alcohol ban were in effect, of a spatially stratified sample of 353 adult Alexandra residents drawn randomly from voter registration, credit card application, and prior studies' sampling frames. We examined economic consequences; health experiences, including COVID-19 exposure and mental health symptoms; alcohol use; and personal experiences with violence. Results Respondents were aged 18 to 89 and 47% female. About 70% of those employed before the lockdown were no longer working. Over half of households lost at least one source of income. About 50% of respondents reported stockpiling food. A majority reported price rises and declines in availability of food. Smaller percentages reported such changes for other items. Over 80% reported stress or anxiety, or depression due to the pandemic. The prevalence of past-week alcohol use fell from over 50% before the lockdown to less than 10% during the lockdown. Self-reported physical violence victimization increased. Discussion COVID-19 and the lockdown disrupted Alexandra residents' lives through unemployment, lost income, mental health problems, and increased violence. The differences between these outcomes and those in more advantaged communities deserve investigation. Research should also seek to identify tailored responses to effectively address the challenges of marginalized communities that often have limited resources to deal with pandemics and policies to contain them.
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Affiliation(s)
- Deborah A. Fisher
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD 20705-3113 USA
| | - Ted R. Miller
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD 20705-3113 USA
- Curtin University School of Public Health, Curtin University, Kent St, Bentley, WA 400 Australia
| | - Joel W. Grube
- Pacific Institute for Research and Evaluation, 2150 Shattuck Ave., Suite 601, Berkeley, CA 94704 USA
| | - Christopher L. Ringwalt
- Pacific Institute for Research and Evaluation, 101 Conner Drive, Suite 200, Chapel Hill, NC 27514-7038 USA
| | - Tom Achoki
- AB InBev Foundation, 1440 G Street NW, DC Washington, DC, 20005 United States
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Tara Polzer Ngwato
- Social Surveys Africa, 2 Upper Park Drive, Forest Town, Johannesburg, 2193 South Africa
| | - Lebogang Shilakoe
- Social Surveys Africa, 2 Upper Park Drive, Forest Town, Johannesburg, 2193 South Africa
| | - Penelope Mkhondo
- Social Surveys Africa, 2 Upper Park Drive, Forest Town, Johannesburg, 2193 South Africa
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McCreesh N, Dlamini V, Edwards A, Olivier S, Dayi N, Dikgale K, Nxumalo S, Dreyer J, Baisley K, Siedner MJ, White RG, Herbst K, Grant AD, Harling G. Impact of social distancing regulations and epidemic risk perception on social contact and SARS-CoV-2 transmission potential in rural South Africa: analysis of repeated cross-sectional surveys. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.12.01.20241877. [PMID: 33300009 PMCID: PMC7724677 DOI: 10.1101/2020.12.01.20241877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background South Africa implemented rapid and strict physical distancing regulations to minimize SARS-CoV-2 epidemic spread. Evidence on the impact of such measures on interpersonal contact in rural and lower-income settings is limited. Methods We compared population-representative social contact surveys conducted in the same rural KwaZulu-Natal location once in 2019 and twice in mid-2020. Respondents reported characteristics of physical and conversational ('close interaction') contacts over 24 hours. We built age-mixing matrices and estimated the proportional change in the SARS-CoV-2 reproduction number (R0). Respondents also reported counts of others present at locations visited and transport used, from which we evaluated change in potential exposure to airborne infection due to shared indoor space ('shared air'). Results Respondents in March-December 2019 (n=1704) reported a mean of 7.4 close interaction contacts and 196 shared air person-hours beyond their homes. Respondents in June-July 2020 (n=216), as the epidemic peaked locally, reported 4.1 close interaction contacts and 21 shared air person-hours outside their home, with significant declines in others' homes and public spaces. Adults aged over 50 had fewer close contacts with others over 50, but little change in contact with 15-29 year olds, reflecting ongoing contact within multigenerational households. We estimate potential R0 fell by 42% (95% plausible range 14-59%) between 2019 and June-July 2020. Discussion Extra-household social contact fell substantially following imposition of Covid-19 distancing regulations in rural South Africa. Ongoing contact within intergenerational households highlighted the limitation of social distancing measures in protecting older adults. Funding Wellcome Trust, UKRI, DFID, European Union.
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Affiliation(s)
- Nicky McCreesh
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vuyiswa Dlamini
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Anita Edwards
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Njabulo Dayi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Richard G. White
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- DSI-MRC South African Population Research Infrastructure Network, South Africa
| | - Alison D. Grant
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Laboratory and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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