Representativeness of individual-level data in COVID-19 phone surveys: Findings from Sub-Saharan Africa

Enhancing SARS-CoV-2 surveillance in Malawi using telephone syndromic surveillance from July 2020 to April 2022

INTRODUCTION

Monitoring the SARS-CoV-2 pandemic in low-resource countries such as Malawi requires cost-effective surveillance strategies. This study explored the potential utility of phone-based syndromic surveillance in terms of its reach, monitoring trends in reported SARS-CoV-2-like/influenza-like symptoms (CLS/ILS), SARS-CoV-2 testing and mortality.

METHODS

Mobile phone-based interviews were conducted between 1 July 2020 and 30 April 2022, using a structured questionnaire. Randomly digital dialled numbers were used to reach individuals aged ≥18 years who spoke Chichewa or English. Verbal consent was obtained, and trained research assistants with clinical and nursing backgrounds collected information on age, sex, region of residence, reported CLS/ILS in the preceding 2 weeks, SARS-CoV-2 testing and history of household illness and death. Data were captured on tablets using the Open Data Kit database. We performed a descriptive analysis and presented the frequencies and proportions with graphical representations over time.

FINDINGS

Among 356 525 active phone numbers, 138 751 (38.9%) answered calls, of which 104 360 (75.2%) were eligible, 101 617 (97.4%) consented to participate, and 100 160 (98.6%) completed the interview. Most survey respondents were aged 25-54 years (72.7%) and male (65.1%). The regional distribution of the respondents mirrored the regional population distribution, with 45% (44%) in the southern region, 41% (43%) in the central region and 14% (13%) in the northern region. The reported SARS-CoV2 positivity rate was 11.5% (107/934). Of the 7298 patients who reported CLS/ILS, 934 (12.8%) reported having undergone COVID-19 testing. Of the reported household deaths, 47.2% (982 individuals) experienced CLS/ILS 2 weeks before their death.

CONCLUSION

Telephonic surveillance indicated that the number of SARS-CoV-2 cases was at least twice as high as the number of confirmed cases in Malawi. Our findings also suggest a substantial under-reporting of SARS-CoV-2-related deaths. Telephonic surveillance has proven feasible in Malawi, achieving the ability to characterise SARS-CoV-2 morbidity and mortality trends in low-resource settings.

The evolution of household forgone essential care and its determinants during the COVID-19 pandemic in Nigeria: A longitudinal analysis

Apart from the morbidity and mortality, the Coronavirus disease 2019 (COVID-19) pandemic has increased the predisposition of households in Nigeria to forgone care, thereby increasing their vulnerability to adverse health consequences. Since there is no previous study in Nigeria on the evolution of pandemic-related forgone care and its drivers, our study assess the evolution of the problem using descriptive and nationally representative panel data analyses. We found about a 30% prevalence of forgone care during the lockdown, which declined progressively afterwards, dropping by 69.50 percentage points between April 2020 and April 2022. This decline produced a surge in households needing care from about 35.00% in the early pandemic to greater than 50%, beginning in early 2021. The forgone care was primarily due to financial hindrances, movement restrictions, and supply-side disruptions. Household socioeconomic factors such as income loss had 2.74 [95%CI: 1.45-5.17] times higher odds of forgone care, job loss, food insecurity, and poverty were 87% (OR: 1.87 [95%CI: 1.25-2.79]), 60% (OR: 1.60 [95%CI: 1.12-2.31]) and 76% (OR: 1.76 [95%CI: 1.12-2.75]) more likely to predispose households to forgone care, respectively. Also, geographical location, such as the South-South zone, induced 1.98 [95%CI: 1.09-3.58] times higher odds of forgone care than North-Central. A married female household head increased the odds by 6.07 [95%CI: 1.72-21.47] times compared with an unmarried female head. However, having a married household head, social assistance, and North-East or North-West zone compared with North-Central increased the chance of accessing care by 69% (OR 0.31 [95%CI: 0.16-0.59]), 59%,(OR 0.41 [95%CI: 0.21-0.77]), 72% (OR 0.28 [95%CI: 0.15-0.53]) and 64% (OR 0.36 [95%CI: 0.20-0.65]), respectively. Non-communicable diseases, disability, old age, large household size and rural-urban location did not affect the forgone care. Our study highlights the need to strengthen Nigeria's health system, create policies to promote healthcare accessibility and prepare the country for future pandemic challenges.

Can phone surveys be representative in low- and middle-income countries? An application to Myanmar

For decades, in-person data collection has been the standard modality for nationally and sub-nationally representative socio-economic survey data in low- and middle-income countries. As the COVID-19 pandemic rendered in-person surveys impossible and unethical, the urgent need for rapid monitoring necessitated researchers and statistical agencies to turn to phone surveys. However, apart from pandemic-related factors, a variety of other reasons can render large segments of a population inaccessible for in-person surveys, including political instability, climatic shocks, and remoteness. Such circumstances currently prevail in Myanmar, a country facing civil conflict and political instability since the February 2021 military takeover. Moreover, Myanmar routinely experiences extreme weather events and is characterized by numerous inaccessible and remote regions due to its mountainous geography. We describe a novel approach to sample design and statistical weighting that has been successfully applied in Myanmar to obtain nationally and sub-nationally representative phone survey data. We use quota sampling and entropy weighting to obtain a better geographical distribution compared to recent in-person survey efforts, including reaching respondents in areas of active conflict. Moreover, we minimize biases towards certain household and respondent characteristics that are usually present in phone surveys, for example towards well-educated or wealthy households, or towards men or household heads as respondents. Finally, due to the rapidly changing political and economic situation in Myanmar in 2022, the need for frequent and swift monitoring was critical. We carried out our phone survey over four quarters in 2022, interviewing more than 12,000 respondents in less than three months each survey. A survey of this scale and pace, though generally of much shorter duration than in-person interviews, could only be possible on the phone. Our study proves the feasibility of collecting nationally and sub nationally representative phone survey data using a non-representative sample frame, which is critical for rapid monitoring in any volatile economy.

How prevalent is COVID-19 vaccine hesitancy in low-income and middle-income countries and what are the key drivers of hesitancy? Results from 53 countries

OBJECTIVES

This study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine.

METHODS

This paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.

RESULTS

On average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.

CONCLUSIONS

Country estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.

Assessing COVID-19 vaccine hesitancy and barriers to uptake in Sub-Saharan Africa

BACKGROUND

Despite improved availability of COVID-19 vaccines in Sub-Saharan Africa, vaccination campaigns in the region have struggled to pick up pace and trail the rest of the world. Yet, a successful vaccination campaign in Sub-Saharan Africa will be critical to containing COVID-19 globally.

METHODS

Here, we present new descriptive evidence on vaccine hesitancy, uptake, last-mile delivery barriers, and potential strategies to reach those who remain unvaccinated. Our data comes from national high frequency phone surveys in six countries in East and West Africa with a total population of 415 million people. Samples were drawn from nationally representative samples of households interviewed in recent in-person surveys. Our estimates are based on a survey module harmonized across countries and are re-weighted to mitigate potential sample selection biases.

RESULTS

We show that vaccine acceptance remains generally high among respondents in Sub-Saharan Africa (between 95.1% and 63.3%) even though hesitancy is non-negligible among those pending vaccination. Many who are willing to get vaccinated are deterred by a lack of easy access to vaccines at the local level. Furthermore, social ties and perceptions as well as intra-household power relations matter for vaccine take-up. Among the unvaccinated population, radio broadcasts have widespread reach and medical professionals are highly trusted.

CONCLUSIONS

Our findings highlight that creating a positive social norm around COVID-19 vaccination, messaging that leverages trusted and accessible information sources and channels, and more easily accessible vaccination sites at the community level are promising policy options to boost vaccination campaigns in the region and end the pandemic everywhere.

Impacts of the COVID-19 Lockdown on Healthcare Inaccessibility and Unaffordability in Uganda

Several studies have reported adverse consequences of the COVID-19 lockdowns on the utilization of healthcare services across Africa. However, little is known about the channels through which lockdowns impacted healthcare utilization. This study focuses on unaffordability as a reason for not utilizing healthcare services. We estimate the causal impacts of the COVID-19 lockdown on healthcare inaccessibility and affordability in Uganda relative to the nonlockdown periods of the pandemic. We use nationally representative longitudinal household data and a household fixed-effects model to identify the impact of the lockdown on whether households could not access medical treatment and whether the reason for not getting care was the lack of money. We find that the lockdown in Uganda was associated with an 8.4% higher likelihood of respondents being unable to access healthcare when treatment was needed relative to the nonlockdown periods. This implies a 122% increase in the share of respondents unable to access healthcare. As lockdown restrictions eased, the likelihood of being unable to access medical treatment decreased. The main reason for the increase in inaccessibility was the lack of money, with a 71% increase in the likelihood of respondents being unable to afford treatment. We find little evidence that the effects of the lockdown differed by wealth status or area of residence. Our results indicate the need for policymakers to consider immediate social support for households as a strategy for balancing the disruptions caused by lockdowns.

Self-reported delays in care-seeking in West Africa during the first wave of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers.

METHODS

This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May-June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays.

RESULTS

Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8-46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1-36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso.

CONCLUSIONS

Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa.

The evolution of COVID-19 vaccine hesitancy in Sub-Saharan Africa: evidence from panel survey data

BACKGROUND

COVID-19 vaccination efforts are lagging in Sub-Saharan Africa, as just over 20 percent of the population has been fully vaccinated. COVID-19 vaccine hesitancy is considered important as a prerequisite for widespread vaccine take-up. Here, we study the dynamics of vaccine acceptance, its correlates, and reasons for hesitancy over time, drawing on two years of panel survey data.

METHODS

In this observational study, we use multiple rounds of data from national High Frequency Phone Surveys (HFPS) in five countries in East and West Africa (Burkina Faso, Ethiopia, Malawi, Nigeria, and Uganda), covering a period between 2020 and 2022. The surveys are cross-country comparable and draw their samples from nationally representative sampling frames. Based on this data source, the study presents population-weighted means and performs multivariate regression analysis.

RESULTS

COVID-19 vaccine acceptance was high throughout the study period (68% to 98%). However, acceptance levels were lower in 2022 than in 2020 in three countries (Burkina Faso, Malawi, Nigeria), and higher in one country (Uganda). Moreover, individuals are observed to change their stated vaccine attitudes between survey rounds, to a limited extent in some countries (Ethiopia) and more frequently in others (Burkina Faso, Malawi, Nigeria, Uganda). Vaccine hesitancy is higher in richer households, and those residing in urban areas; among women and those better educated. Hesitancy is lower in larger households and among heads of the household. The main reasons for hesitancy are concerns about side effects of the vaccine, its safety and efficacy, as well as assessments of COVID-19 risk, though these reasons fluctuate over time.

CONCLUSIONS

Reported COVID-19 vaccine acceptance levels remain far above vaccination rates in the study countries, suggesting that vaccine hesitancy is not the primary obstacle to reaching greater vaccine coverage, which may instead be related to access and delivery barriers as well as supply shortages. Nevertheless, vaccine attitudes appear malleable so that continued efforts are needed to retain high levels of vaccine acceptance.

How Did the COVID-19 Crisis Affect Different Types of Workers in the Developing World?

This paper examines how the COVID-19 pandemic affected the employment of different groups of workers across 40 mostly low and middle-income countries. Employment outcomes during the crisis are tracked through high-frequency phone surveys conducted by the World Bank and national statistics offices. Our results show that larger shares of female, young, less educated, and urban workers stopped working at the beginning of the pandemic. Gender gaps in work stoppage stemmed mainly from gender differences within sectors rather than differential employment patterns of men and women across sectors. Differences in work stoppage between urban and rural workers were markedly smaller than those across gender, age, and education groups. Preliminary results from 10 countries suggest that following the initial shock at the start of the pandemic, employment rates partially recovered between April and August 2020, with greater gains for those groups that had borne the brunt of the early jobs losses. Although the high-frequency phone surveys over-represent household heads and therefore overestimate employment rates, a validation exercise for five countries suggests that they provide a reasonably accurate measure of disparities in employment levels by gender, education, and urban/rural location following the onset of the crisis, although they perform less well in capturing disparities between age groups. These results shed new light on the distributional labor market consequences of the COVID-19 crisis in developing countries, and suggest that real-time phone surveys, despite their lack of representativeness, are a valuable source of information to measure differential employment impacts across groups during an unfolding crisis.

"Our interventions are still here to support communities during the pandemic": Resuming mass drug administration for neglected tropical diseases after COVID-19 implementation delays

The COVID-19 pandemic disrupted essential health services, including those provided by national neglected tropical disease (NTD) programs. Most mass drug administration (MDA) programs were postponed for 6-12 months following World Health Organization guidance released in April 2020 to temporarily halt NTD programs and launch necessary COVID-19 precautions. While NTD-endemic countries have since resumed MDA activities, it is critical to understand implementers' perspectives on the key challenges and opportunities for program relaunch, as these insights are critical for maximizing gains towards disease control and elimination during public health emergencies. Using data from using online surveys and focus group discussions, this mixed-methods study sought perspectives from Ministry of Health NTD Program Managers and implementing partners from non-governmental organizations working in sub-Saharan Africa. Data analysis revealed that findings converged around several main themes: disruptions for MDA programs included resource shortages due to prioritization of pandemic response, challenges adhering to COVID-19 safety protocols, and community hesitancy due to coronavirus transmission fears. Identified solutions for restarting MDA programs focused on adapting intervention delivery and packaging to minimize disease transmission, embracing technology to optimize intervention planning and delivery, and identifying opportunities to promote program integration between pandemic response strategies and NTD campaign delivery. Findings identifies key challenges due to disruptions to NTD program delivery and provide strategic recommendations for endemic countries to build resilient programs that can continue to perform during and beyond global pandemics.

On the forecastability of food insecurity

Food insecurity, defined as the lack of physical or economic access to safe, nutritious and sufficient food, remains one of the main challenges included in the 2030 Agenda for Sustainable Development. Near real-time data on the food insecurity situation collected by international organizations such as the World Food Programme can be crucial to monitor and forecast time trends of insufficient food consumption levels in countries at risk. Here, using food consumption observations in combination with secondary data on conflict, extreme weather events and economic shocks, we build a forecasting model based on gradient boosted regression trees to create predictions on the evolution of insufficient food consumption trends up to 30 days in to the future in 6 countries (Burkina Faso, Cameroon, Mali, Nigeria, Syria and Yemen). Results show that the number of available historical observations is a key element for the forecasting model performance. Among the 6 countries studied in this work, for those with the longest food insecurity time series, that is Syria and Yemen, the proposed forecasting model allows to forecast the prevalence of people with insufficient food consumption up to 30 days into the future with higher accuracy than a naive approach based on the last measured prevalence only. The framework developed in this work could provide decision makers with a tool to assess how the food insecurity situation will evolve in the near future in countries at risk. Results clearly point to the added value of continuous near real-time data collection at sub-national level.

Measuring consumption over the phone: Evidence from a survey experiment in urban Ethiopia

The paucity of reliable, timely household consumption data in many low- and middle-income countries have made it difficult to assess how global poverty has evolved during the COVID-19 pandemic. Standard poverty measurement requires collecting household consumption data, which is rarely collected by phone. To test the feasibility of collecting consumption data over the phone, we conducted a survey experiment in urban Ethiopia, randomly assigning households to either phone or in-person interviews. In the phone survey, average per capita consumption is 23 percent lower and the estimated poverty headcount is twice as high than in the in-person survey. We observe evidence of survey fatigue occurring early in phone interviews but not in in-person interviews; the bias is correlated with household characteristics. While the phone survey mode provides comparable estimates when measuring diet-based food security, it is not amenable to measuring consumption using the 'best practice' approach originally devised for in-person surveys.

Social media use and COVID-19 vaccine status among a nationally representative population sample in Uganda

Objectives

The effect of social media on COVID-19 vaccination behavior is sub-Saharan Africa is unclear. We conducted a study to determine social media use among a random nationally representative sample of adults in Uganda and assessed the association between recent social media use and COVID-19 vaccination uptake.

Methods

We used data from the 2020 general population survey in Uganda, the Population-based HIV Impact Assessment Survey, to identify a probability sample for a mobile phone survey and included nonphone owners in the phone survey by asking phone owners to pass the phone.

Results

In March 2022, of the 1022 survey participants, 213 (20%) did not own a mobile phone, 842 (80%) owned a mobile phone, of whom 199 (24%) indicated social media use, and 643 (76%) of whom did not use social media. Among all participants, the most frequent source of COVID-19 vaccine information was radio. Overall, 62% reported receiving the COVID-19 vaccination. The multivariable logistic regression model found that social media use was not associated with vaccination status.

Conclusion

Social media users in this population sample from Uganda-who were mainly young, urban residents with higher educational attainment-continue to utilize TV, radio and health care workers for public health messages, thus the Government of Uganda should continue to conduct public health communication through these mediums.

Adherence to COVID -19 protective practices in Ethiopia: Use and predictors of face mask-wearing

Introduction

The Ethiopian Ministry of Health strongly recommends that anyone, regardless of vaccination status, wears a standard face mask consistently when in public. This study aimed to assess the self-reported use and predictors of wearing face masks in the general population in Ethiopia.

Methods

This was a population-based cross-sectional study using a telephone survey. Adults living in Ethiopia were randomly selected from the Ethio Telecom list of mobile phone numbers and interviewed about their mask-wearing practice and individual and household-level factors that could impact on the use of face masking. Multivariable logistic regression was used to measure associations.

Results

A total of 614 participants were interviewed from September to November 2021. The prevalence of self-reported face mask use when in public was 81.1%. Living outside Addis Ababa, including Oromia [adjusted odds ratio [(AOR) 0.30, 95% confidence interval (CI) (0.14, 0.63)], Amhara [AOR 0.11, 95% CI (0.05, 0.23)], and Southern Nations, Nationalities and People's Region [AOR 0.31, 95% CI (0.12-0.79)] and being divorced or widowed [AOR 0.18, 95% CI (0.06, 0.62)] were found to be inversely associated with face mask use. Female gender [AOR 1.91, 95% CI (1.02, 3.58)] and older age [age ≥ 50, AOR 2.96, 95% CI (1.09-7.97)] were positively associated with the use of face masks. Attending social events [AOR 0.51, 95% CI (0.31-0.82)], was negatively associated with the use of face masks.

Conclusion

Self-reported use of face masks was relatively high nationally, but inconsistent among different regions and demographics. The findings imply that policies and messaging campaigns may need to focus on specific populations and behaviors in this ongoing pandemic.

Willingness to take COVID-19 vaccination in low-income countries: Evidence from Ethiopia

BACKGROUND

In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa's second most populous country.

METHODS

The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head's willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence.

RESULTS

Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income.

CONCLUSION

The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.

Acceptance of COVID-19 vaccines in sub-Saharan Africa: evidence from six national phone surveys

OBJECTIVES

To estimate the willingness to accept a COVID-19 vaccine in six sub-Saharan African countries and identify differences in acceptance across countries and population groups.

DESIGN

Cross-country comparable, descriptive study based on a longitudinal survey.

SETTING

Six national surveys from countries representing 38% of the sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria and Uganda).

PARTICIPANTS

Respondents of national high-frequency phone surveys, aged 15 years and older, drawn from a nationally representative sample of households.

MAIN OUTCOME MEASURES

Willingness to get vaccinated against COVID-19 if an approved vaccine is provided now and for free, disaggregated by demographic attributes and socioeconomic factors obtained from national household surveys. Correlates of and reasons for vaccine hesitancy.

RESULTS

Acceptance rates in the six sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 95% CI 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 95% CI 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects specifically emerge as the primary reservations toward a COVID-19 vaccine across countries.

CONCLUSIONS

Our findings suggest that inadequate demand is unlikely to represent the key bottleneck to reaching high COVID-19 vaccine coverage in sub-Saharan Africa. To turn intent into effective demand, targeted information, sensitisation and engagement campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.

Viewpoint: High-frequency phone surveys on COVID-19: Good practices, open questions

Following the onset of the COVID-19 pandemic, face-to-face survey data collection efforts came to a halt due to lockdowns, limitations on mobility and social distancing requirements. What followed was a surge in phone surveys to fulfill rapidly evolving needs for timely and policy-relevant microdata for understanding the socioeconomic impacts of and responses to the pandemic. Even as the face-to-face survey data collection efforts are resuming in different parts of the world with COVID-19 safety protocols, the rapidly-acquired experience with phone surveys on the part of national statistical offices and survey practitioners in low- and middle-income countries appears to have formed the foundation for phone surveys to be more commonly implemented in the post-pandemic era, in response to other shocks and as complementary efforts to face-to-face surveys. Informed by the practical experience with the high-frequency phone surveys that have been implemented with support from the World Bank Living Standards Measurement Study (LSMS) to monitor the socioeconomic impacts of the COVID-19 pandemic, this paper provides an overview of options for the design and implementation of phone surveys to collect representative data from households and individuals. Further, the discussion identifies the requirements for phone surveys to be a mainstay in the toolkits of national statistical offices and the directions for future research on the design and implementation of phone surveys.