In the opening stages of the COVID-19 pandemic, it was widely predicted that sub-Saharan African populations would be the hardest hit by the virus. Among the reasons for this thinking were limited medical infrastructure, underdeveloped communications networks, low literacy rates, overcrowded living conditions, high prevalence of other infectious diseases, and economies largely based on manual labor of the sort that precluded easy social distancing.
But as the first wave of the pandemic peaked in 2020, news stories and scientific journals were heralding a surprising story about the apparent low rates of COVID-19 transmission and mortality in Africa. For instance, a Malawi–Liverpool Wellcome Trust Clinical Research Programme study found the COVID-19 death rate in Malawi’s second largest city to be eight times lower than expected.
One of the teams of researchers working to understand why is headed by Iliana and Hans-Peter Kohler. Iliana V. Kohler, is a Penn LDI senior fellow and associate director of the Penn Population Studies Center (PSC), and a research assistant professor at the School of Arts & Sciences. Hans-Peter Kohler is a Penn LDI senior fellow, professor of demography at the School of Arts & Sciences, and co-director of the Penn Population Aging Research Center (PARC).
The team’s paper—Curtailing COVID-19 on a Dollar-a-Day in Malawi: Role of Community Leadership for Shaping Public Health and Economic Responses to the Pandemic—is published online for the March, 2022 issue of the World Development journal. The title’s “dollar a day” references the fact that half the impoverished country’s population lives on less than a dollar-a-day.”
In Malawi, the government established its own COVID task force and public safety campaign in February. Then, after the first Malawi COVID case was detected in early April, the government announced plans for a strict national lock-down to start two weeks later.
“We had to move very quickly,” says Iliana Kohler. “We assembled and trained phone survey teams in Malawi as fast as possible with the idea that we had to train them, provide them with equipment for the survey, and get them back to their homes across the country before the lockdown started.”
The survey’s essential findings were that widespread trust in national government and, particularly, in local village heads, played a major role in shaping the population’s attitudes and behavior related to COVID-19 safety measures. Researchers found that the respondents’ response to COVID was also influenced by their previous struggles against epidemics of HIV/AIDS, tuberculosis, malaria and neglected tropical diseases. In this latest case, there was quick, widespread consensus that the newly emerged COVID-19 posed a mortal threat.
As the pandemic descended on the country, village heads provided their residents with education about the symptoms of COVID-19 and instructions on the required preventive measures, and cancelled group events like village meetings, public works projects and playgrounds. Some also created funds and redistributed foods, money and medical supplies to their most vulnerable residents.
The key study finding was the importance of how this local community leadership shaped their residents’ attitudes and behaviors about COVID-19 preventive measures.
Read more at Penn LDI.