Preprint—COVID-19 related knowledge, attitudes, practices and needs of households in informal settlements in Nairobi, Kenya

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Objective: Urban slums are at high risk of COVID-19 transmission due to the lack of basic housing, water, and sanitation, and overcrowding. No systematic surveys of slum households’ experiences exist to date. Methods: A mobile phone knowledge, attitudes, and practices survey was conducted March 30-31, 2020. Participants were sampled from two study cohorts across five urban slums in Nairobi, Kenya. Findings: 2,009 individuals (63% female) participated. Knowledge of fever and cough as COVID-19 symptoms was high, but only 42% listed difficulty breathing. Most (83%) knew anyone could be infected; younger participants had lower perceived risk. High risk groups were correctly identified (the elderly - 64%; those with weak immune systems - 40%) however, 20% incorrectly stated children. Handwashing and using hand sanitizer were known prevention methods, though not having a personal water source (37%) and hand sanitizer being too expensive (53%) were barriers. Social distancing measures were challenging as 61% said this would risk income. A third worried about losing income, only 26% were concerned about infecting others if themselves sick. Government TV ads and short message service (SMS) were the most common sources of COVID-19 information and considered trustworthy (by > 95%) but were less likely to reach less educated households. Conclusion: Knowledge of COVID-19 is high; significant challenges for behavior change campaigns to reach everyone with contextually appropriate guidance remain. Government communication channels should continue with additional efforts to reach less educated households. A strategy is necessary to facilitate social distancing, handwashing and targeted distributions of cash and food.






Responding to the COVID-19 Pandemic