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BMC Medicine
Published in: BMC Medicine 1/2020

01-12-2020 | SARS-CoV-2 | Research article

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

Authors: Matthew Quaife, Kevin van Zandvoort, Amy Gimma, Kashvi Shah, Nicky McCreesh, Kiesha Prem, Edwine Barasa, Daniel Mwanga, Beth Kangwana, Jessie Pinchoff, W. John Edmunds, Christopher I. Jarvis, Karen Austrian, CMMID COVID-19 Working Group

Published in: BMC Medicine | Issue 1/2020

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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.
Appendix
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Footnotes
1
Fever, headache, cough, diarrhoea, difficulty breathing, loss of taste or smell, tiredness/fatigue, chest pain, chills, rash, dizziness, sneezing, sore throat, myalgia
 
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Metadata
Title
The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements
Authors
Matthew Quaife
Kevin van Zandvoort
Amy Gimma
Kashvi Shah
Nicky McCreesh
Kiesha Prem
Edwine Barasa
Daniel Mwanga
Beth Kangwana
Jessie Pinchoff
W. John Edmunds
Christopher I. Jarvis
Karen Austrian
CMMID COVID-19 Working Group
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-020-01779-4

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