The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study

"We want our freedom back, that's our only need": a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania

Background

The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population.

Methods

In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor.

Findings

21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced.

Discussion

The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs.

Conclusion

There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

COVID-19 epidemiology, health services utilisation and health care seeking behaviour during the first year of the COVID-19 pandemic in Mweso health zone, Democratic Republic of Congo

Background

Although the evidence about coronavirus disease 2019 (COVID-19) has increased exponentially since the beginning of the pandemic, less is known about the direct and indirect effects of the pandemic in humanitarian settings. In the Democratic Republic of the Congo (DRC), most studies occurred in Kinshasa and other cities. Limited research was conducted in remote conflict-affected settings. We investigated the COVID-19 epidemiology, health service utilisation, and health care-seeking behaviour during the first year of the pandemic (March 2020-March 2021) in the Mweso health zone, North Kivu, DRC.

Methods

This mixed-methods study includes a descriptive epidemiological analysis of reported COVID-19 cases data extracted from the provincial line list, interrupted time series analysis of health service utilisation using routine health service data, qualitative perceptions of health care workers about how health services were affected, and community members' health care seeking behaviour from a representative household survey and focus group discussions.

Results

The COVID-19 epidemiology in North Kivu aligns with evidence reported globally, yet case fatality rates were high due to underreporting. Testing capacity was limited and initially mainly available in the province's capital. Health service utilisation showed different patterns - child measles vaccinations experienced a decrease at the beginning of the pandemic, while outpatient consultations, malaria, and pneumonia showed an increase over time. Such increases might have been driven by insecurity and population displacements rather than COVID-19. Community members continued seeking care during the first months of the COVID-19 pandemic and visited the same health facilities as before COVID-19. Financial constraints, not COVID-19, were the main barrier reported to accessing health care.

Conclusions

The first year of the COVID-19 pandemic in the Mweso health zone was characterised by low testing capacity and an underestimation of reported COVID-19 infections. The increase in health care utilisation should be further explored to understand the role of factors unrelated to COVID-19, such as insecurity, population displacement, and poverty, which remain major challenges to successfully providing health services and improving the population's health. Measles vaccination coverage dropped, which exacerbated the ongoing measles outbreak. Improved decentralised testing capacity will be crucial for future epidemics and enhanced efforts to maintain child vaccination coverage.

Experiences of teachers and students on school closures and its consequences during the COVID-19 pandemic in Nyarugusu refugee camp, Tanzania

Tanzania has experienced several waves of COVID-19 since it was first detected in the country. During the first wave, Tanzania took several measures to prevent wider virus transmission with school closures being one of them. All areas and institutions were targeted, including the refugee camps in Kigoma region. Despite the abundant evidence generated in relation to the effects of the pandemic and associated school closures globally, there has been a paucity of literature exploring the experiences of teachers and students in humanitarian settings. We conducted a qualitative study to explore COVID-19 related school closures in Nyarugusu refugee camp. We aimed to describe teachers' and students' experiences and perceived consequences of school closures. In-depth interviews with teachers and students were conducted in September 2020 in Burundian and Congolese schools in the context of a cluster randomised trial of EmpaTeach, a school-based violence prevention intervention. A total of 44 individuals (29 teachers and 15 students) were interviewed. A phenomenological theoretical framework was used to guide the content analysis. Findings indicated that the COVID-19 pandemic was generally seen as frightening by refugees. Study participants understood the importance of school closures to prevent transmission of the virus, but various negative consequences were reported by both teachers and students. These included perceived mental health difficulties such as stress, depression and anxiety associated with the worry of infection, idleness, and disruption of education. Participants also perceived an increase in occurrences of early marriages and unplanned pregnancies, which they thought contributed to increased school dropout. Participants identified the main causes of such outcomes as a lack of parental supervision, children's lack of restraint and poor character, and a lack of alternative teaching practices (such as online or remote learning) to keep the students busy while at home. Children were held accountable for their faults with little support from the adults. Our findings suggest that there is an urgent need to strengthen child protection programming to support children and their communities during emergencies and provides protective environments such as school and education. There is a critical need to develop preparedness plans for future pandemics to support child safety, academic development and wellbeing.

Assessment of Hygiene Practices, Awareness, and Water Consumption Regarding Covid-19 Among Children in a Refugee Camp

INTRODUCTION

At the outbreak of infectious diseases, the response of different communities to the disease varies, and children are most affected by the collective anxiety and grief that consequently arises. In this research, the behavior of children and their parents in terms of hygiene and precautions before and during the COVID-19 pandemic was investigated.

METHODOLOGY

The focus of the present research was on sanitation facilities, particularly access to end-use of water for hand washing. The research was conducted in Barika Camp, Kurdistan, Iraq and 311 parents and children were interviewed. A data collection team consisting of two females and one male was responsible for gathering data, primarily from women who served as the main respondents. Questionnaires consisted of three main parts: demography, COVID-19 pandemic effects, and sanitary shelter specifications.

RESULT

The results demonstrated that the behavior of refugees during the COVID-19 pandemic regarding the priority of child protection, type of disinfectants, and water consumption has significantly altered. These changes mainly depended on the women's age and education level.

DISCUSSION

Overall results showed that in 61.09% of the participants, the number of hand washes and in 58.58%, the washing time increased, leading to water shortage in the refugee camp.

Exploring the impact of preconception care and unintended pregnancy on access to antenatal healthcare services among Rohingya women: Insights from a cross-sectional survey

Background

The low utilization of antenatal healthcare services among Rohingya refugee women contributes to high maternal and child mortality rates. The objective of this study was to evaluate the prevalence of antenatal healthcare services utilization and the impacts of preconception care and pregnancy intention on accessing these services among Rohingya refugee women in Bangladesh.

Methods

We analyzed data from 708 women collected through a multistage cross-sectional survey conducted in April 2023. The outcome variable was the uptake of at least one antenatal healthcare services, while the exposure variables were preconception care uptake and unintended pregnancy. We used a multivariate logistic regression model to determine the effects of preconception care and unintended pregnancy on antenatal care utilization, adjusting for potential covariates.

Results

Approximately 47 % of women reported not accessing any antenatal healthcare services during their most recent pregnancy. Moreover, around 68 % of women did not receive any preconception care, and nearly one-third of pregnancies were unintended at conception. We observed lower likelihoods of antenatal care utilization among women without preconception care or with unintended pregnancy. The negative effects were even more pronounced when women reported no use of preconception care along with experiencing mistimed (aOR, 0.61, 95 % CI: 0.45-0.77) and unwanted (aOR, 0.43, 95 % CI: 0.34-0.52) pregnancy for their most recent pregnancy.

Conclusion

Maternal healthcare service utilization is alarmingly low among Rohingya refugees, with a significant lack of preconception care and a high prevalence of unintended pregnancies. This underscores the critical importance of implementing awareness-building programs to increase uptake of antenatal healthcare services.

COVID-19 and Mental Health: A "Pandemic Within a Pandemic"

The COVID-19 pandemic has brought significant changes in daily life for humanity and has had a profound impact on mental health. As widely acknowledged, the pandemic has led to notable increases in rates of anxiety, depression, distress, and other mental health-related issues, affecting both infected patients and non-infected individuals. COVID-19 patients and survivors face heightened risks for various neurological and psychiatric disorders and complications. Vulnerable populations, including those with pre-existing mental health conditions and individuals living in poverty or frailty, may encounter additional challenges. Tragically, suicide rates have also risen, particularly among young people, due to factors such as unemployment, financial crises, domestic violence, substance abuse, and social isolation. Efforts are underway to address these mental health issues, with healthcare professionals urged to regularly screen both COVID-19 and post-COVID-19 patients and survivors for psychological distress, ensuring rapid and appropriate interventions. Ongoing periodic follow-up and multidimensional, interdisciplinary approaches are essential for individuals experiencing long-term psychiatric sequelae. Preventive strategies must be developed to mitigate mental health problems during both the acute and recovery phases of COVID-19 infection. Vaccination efforts continue to prioritize vulnerable populations, including those with mental health conditions, to prevent future complications. Given the profound implications of mental health problems, including shorter life expectancy, diminished quality of life, heightened distress among caregivers, and substantial economic burden, it is imperative that political and health authorities prioritize the mental well-being of all individuals affected by COVID-19, including infected individuals, non-infected individuals, survivors, and caregivers.

Parity of esteem: A global COVID-19 vaccination approach for people with mental illnesses, based on facts from 34 countries; recommendations and solutions

Background

The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has detrimental effects on physical and mental health. Patients with severe mental illness are at higher risk of contracting the virus due to social determinants of health. Vulnerable populations include the elderly, people with pre-existing conditions, and those exposed to SARS-CoV-2. Unfortunately, only a few countries have updated vaccination strategies to prioritize patients with mental illnesses. Therefore, we aimed to explore whether individuals with mental disorders are prioritized in vaccine allocation strategies in different world regions. They are often neglected in policymaking but are highly vulnerable to the threatening complications of COVID-19.

Methods

A questionnaire was developed to record details regarding COVID-19 vaccination and prioritizations for groups of persons with non-communicable diseases (NCDs), mental disorders, and substance use disorders (SUDs). NCDs were defined according to the WHO as chronic diseases that are the result of a combination of genetic, physiological, environmental, and behavioral factors such as cardiovascular diseases, cancer, respiratory diseases, and diabetes.

Results

Most countries surveyed (80%) reported healthcare delivery via a nationalized health service. It was found that 82% of the countries had set up advisory groups, but only 26% included a mental health professional. Most frequently, malignancy (68%) was prioritized followed by diabetes type 2 (62%) and type 1 (59%). Only nine countries (26%) prioritized mental health conditions.

Conclusion

The spread of the coronavirus has exposed both the strengths and flaws of our healthcare systems. The most vulnerable groups suffered the most and were hit first and faced most challenges. These findings raise awareness that patients with mental illnesses have been overlooked in immunization campaigns. The range of their mortality, morbidity, and quality of life could have widened due to this delay.

Reflections on the multi-sectoral response to COVID-19 in Bangladesh’s Rohingya refugee camps

While the COVID-19 pandemic continues to impact people globally, refugees comprise a vulnerable population, particularly those living in densely populated areas. In Bangladesh, Cox’s Bazar is currently home to almost a million Rohingya refugees. Because of the lack of healthcare, sanitation and water, as well as overcrowding, refugees were at high risk of becoming ill during the early phases of the COVID-19 pandemic in 2020. Moreover, superstitions and lack of trust in the healthcare system threaten to put the community at further risk. To prevent tragic consequences, national and international attention and action are required to strengthen the health system for Rohingya refugees. The community will require surveillance and testing, infection prevention and control measures, adequate food supplies, and access to improved healthcare services. This paper calls for a multi-sectoral approach to developing an action plan and implementation strategy to minimize the impact of COVID-19 on this vulnerable population.

The consequences of the COVID-19 pandemic on the refugee population: a rapid review

AIMS

This is a rapid review examining the available evidence about the repercussions of the COVID-19 pandemic on the refugee population.

METHODS

A search in the databases such as PubMed, Scopus, CINAHL, PsycINFO, and Web of Science was conducted and all relevant original articles, letters, and editorial and policy papers were included.

RESULTS

From 208 publications matching the search criteria, 36 were included. These publications were categorized into three distinct domains: Public Health, Policies and Financing, and Technology. Our findings revealed that the situation of the refugee population has worsened during the pandemic. Difficulty accessing healthcare, violation of human rights, lack of access to technology devices, unfavorable government policies, and economic crisis were the most important aspects impacted by COVID-19.

CONCLUSION

Governments, health managers, health professionals, and policy makers should be aware of refugees' problems during the pandemic to provide immediate solutions.

Modelling COVID-19 pandemic control strategies in metropolitan and rural health districts in New South Wales, Australia

COVID-19 remains a significant public health problem in New South Wales, Australia. Although the NSW government is employing various control policies, more specific and compelling interventions are needed to control the spread of COVID-19. This paper presents a modified SEIR-X model based on a nonlinear ordinary differential equations system that considers the transmission routes from asymptomatic (Exposed) and symptomatic (Mild and Critical) individuals. The model is fitted to the corresponding cumulative number of cases in metropolitan and rural health districts of NSW reported by the Health Department and parameterised using the least-squares method. The basic reproduction number [Formula: see text], which measures the possible spread of COVID-19 in a population, is computed using the next generation operator method. Sensitivity analysis of the model parameters reveals that the transmission rate had an enormous influence on [Formula: see text], which may be an option for controlling this disease. Two time-dependent control strategies, namely preventive (it refers to effort at inhibiting the virus transmission and prevention of case development from Exposed, Mild, Critical, Non-hospitalised and Hospitalised population) and management (it refers to enhance the management of Non-hospitalised and Hospitalised individuals who are infected by COVID-19) measures, are considered to mitigate this disease's dynamics using Pontryagin's maximum principle. The most sensible control strategy is determined through the cost-effectiveness analysis for the metropolitan and rural health districts of NSW. Our findings suggest that of the single intervention strategies, enhanced preventive strategy is more cost-effective than management control strategy, as it promptly reduces COVID-19 cases in NSW. In addition, combining preventive and management interventions simultaneously is found to be the most cost-effective. Alternative policies can be implemented to control COVID-19 depending on the policymakers' decisions. Numerical simulations of the overall system are performed to demonstrate the theoretical outcomes.

Seropositivity and flight-associated risk factors for SARS-CoV-2 infection among asylum seekers arriving in Berlin, Germany - a cross-sectional study

Introduction

Refugees and asylum seekers might be at increased risk of SARS-CoV-2 infection due to precarious living conditions during flight.

Methods

Between March 24th and June 15th 2021, we conducted a cross-sectional study among adult asylum seekers arriving in Berlin. Each participant was tested for acute SARS-CoV-2 infection with a nasopharyngeal swab using reverse transcriptase PCR (rt-PCR), and for anti-SARS-CoV-2-S1 IgG antibodies using ELISA. Seropositivity, antibody avidity, and data on flight history were used to categorize individuals into two groups according to the estimated time of infection before or during flight. Sociodemographic characteristics, COVID-19 related symptoms, hygiene behaviors, and living conditions during transit were assessed using two self-report questionnaires.

Results

Among 1041 participants (34·5% female, mean age 32·6 years), most frequently reported countries of origin were Moldova (20·5%), Georgia (18·9%), Syria (13·0%), Afghanistan (11·3%), and Vietnam (9·1%). Seropositivity rate was 25·1% and incidence rate of acute SARS-CoV-2 infection was 2·8%. A higher likelihood for seropositivity was observed in women (OR [95%CI]=1·64 [1·05-2·57]) but reduced by frequent hygiene behaviors (OR [95%CI]=0·75 [0·59-0·96]) or traveling by plane (OR [95%CI]=0·58 [0·35-0·96]). Other associated factors were lower educational level, accommodation in refugee shelters, traveling with children or by foot, and COVID-19 information seeking.

Conclusion

Flight-associated risk factors such as accommodation in a refugee shelter and poor hygiene behaviors are associated with an elevated risk of infection, which should be addressed by public health interventions.

Clinical trial registration

[https://doi.org/10.1186/ISRCTN17401860], identifier [17401860].

"We are invisible to them"-Identifying the most vulnerable groups in humanitarian crises during the COVID-19 pandemic: The case of Rohingyas and the Host communities of Cox's Bazar

The COVID-19 pandemic has had an adverse impact on the Rohingya and the Bangladeshi host communities, which have been well documented in the literature. However, the specific groups of people rendered most vulnerable and marginalized during the pandemic have not been studied comprehensively. This paper draws on data to identify the most vulnerable groups of people within the Rohingya and the host communities of Cox's Bazar, Bangladesh, during the COVID-19 pandemic. This study employed a systematic sequential method to identify the most vulnerable groups in the context of Rohingya and Host communities of Cox's Bazar. We conducted a rapid literature review (n = 14 articles) to list down Most vulnerable groups (MVGs) in the studied contexts during the COVID-19 pandemic and conducted four (04) group sessions with humanitarian providers and relevant stakeholders in a research design workshop to refine the list. We also conducted field visits to both communities and interviewed community people using In-depth interviews (n = 16), Key-informant Interviews (n = 8), and several informal discussions to identify the most vulnerable groups within them and their social drivers of vulnerabilities. Based on the feedback received from the community, we finalized our MVGs criteria. The data collection commenced from November 2020 to March 2021. Informed consent was sought from all participants, and ethical clearance for this study was obtained from the IRB of BRAC JPGSPH. The most vulnerable groups identified in this study were: single female household heads, pregnant and lactating mothers, persons with disability, older adults, and adolescents. Our analysis also found some factors that may determine the different levels of vulnerabilities and risks faced by some groups more than others in the Rohingya and host communities during the pandemic. Some of these factors include economic constraints, gender norms, food security, social safety-security, psychosocial well-being, access to healthcare services, mobility, dependency, and a sudden halt in education. One of the most significant impacts of COVID-19 was the loss of earning sources, especially for the already economically vulnerable; this had far-reaching consequences on individuals' food security and food consumption. Across the communities, it was found that the economically most affected group was single female household heads. The elderly and pregnant and lactating mothers face challenges seeking health services due to their restricted mobility and dependency on other family members. Persons living with disabilities from both contexts reported feelings of inadequacy in their families, exacerbated during the pandemic. Additionally, the shutdown in the formal education, and informal learning centres in both communities had the most significant impact on the adolescents during the COVID-19 lockdown. This study identifies the most vulnerable groups and their vulnerabilities amid the COVID-19 pandemic in the Rohingya and Host communities of Cox's Bazar. The reasons behind their vulnerabilities are intersectional and represent deeply embedded patriarchal norms that exist in both communities. The findings are essential for the humanitarian aid agencies and policymakers for evidence-based decision-making and service provisions for addressing the vulnerabilities of the most vulnerable groups.

The first year of the COVID-19 pandemic in humanitarian settings: epidemiology, health service utilization, and health care seeking behavior in Bangui and surrounding areas, Central African Republic

BACKGROUND

Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas.

METHODS

This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions.

RESULTS

The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from - 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; - 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from - 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care.

CONCLUSIONS

A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed.

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review

Objectives

The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention.

Methods

The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach.

Results and Discussion

This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants' inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information.

Conclusion

This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

Covid-19 case management in a Greek migrant camp: The Hellenic Red Cross Mobile Health Unit intervention in Nea Malakasa temporary accommodation center

Introduction

Since the outbreak of the Covid-19 pandemic the scientific community had expressed its concerns about increased transmission of the virus within asylum seeker accommodation centers due to substandard living conditions and poor sanitation. Studies regarding management of Covid-19 cases in such facilities are urgently needed in order to guide international strategies on future pandemics within the humanitarian setting. Our study's paradigm of Covid-19 case management in a Greek migrant camp aims to add on existing data.

Data and Methods

A retrospective analysis of epidemiological and demographical data collected as part of a healthcare intervention in a Greek migrant camp during three Covid-19 epidemic waves is presented in this study. Descriptive statistics were generated using STATA 12.

Results

During the first wave, the camp's administration adopted a 2-month strict lockdown strategy and no positive cases were recorded. During the second wave, suspected coronavirus cases were referred for PCR testing and, in case of positivity were hospitalized. 3% (n=28) of the camp's population were referred for PCR, with 1% of the population (n=10) being tested positive for Covid-19 and admitted to hospital. Close contacts of positive cases were encouraged to comply with non-pharmaceutical interventions and were offered medical care if symptoms developed. During the third epidemic wave, in-camp management was decided by on-site operators, with rapid antigen testing of symptomatic individuals, daily monitoring of positive cases by the medical team and mass screening of their closed contacts. 4% (n=33) of the camp's residents were tested positive, while none was hospitalized. 19% (n=148) of the camp's population were considered close contacts, were advised to self-isolate and were offered mass screening with rapid antigen test, from which another 21 positive cases emerged. In total, 7% (n=54) of the camp population, (n=21) female adults, (n=24) male adults and (n=9) children, were infected with SARS-CoV-2 during the third epidemic wave, with no deaths being recorded. During the study period, only 50 residents had received one dose of Covid-19 vaccines.

Conclusion

We recommend an in-camp Covid-19 response featuring regular follow up of positive cases and prompt referral to tertiary centers based on clinical criteria, while overemphasizing the need for equitable access to primary healthcare for asylum seekers in Greece, primarily during the current pandemic. Prolonged camp lockdowns should be avoided as they pose substantial health risks for their vulnerable population.

Leveraging interactive voice response technology to mitigate COVID-19 risk in refugee settlements in Uganda: Lessons learned implementing "Dial-COVID" a toll-free mobile phone symptom surveillance and information dissemination tool

BACKGROUND

Persons living in refugee settlements in sub-Saharan Africa may be at increased risk for COVID-19 and experience barriers to accessing COVID-19 information. We aimed to evaluate the implementation of "Dial-COVID" a multi-lingual, toll free, telephone platform that uses interactive voice response (IVR) to track COVID-19 symptoms/exposure and disseminate COVID-19 health information in refugee settlements in Uganda. We hypothesized that IVR could provide an alternative way to screen for COVID-19 and communicate public health information to humanitarian populations when physical access and testing capacity were limited.

METHODS

The Dial-COVID IVR platform was created in ten languages and advertised by community health workers in refugee settlements for participants to call into toll free. In a recorded IVR symptom survey, participants were screened for COVID-19 symptoms/exposures and based on their responses, received tailored public health messages about COVID-19 risk mitigation in accordance with Uganda Ministry of Health guidelines. Here we report the challenges and lessons learned implementing this research during the pandemic.

RESULTS

Between February 2021 and March 2022, 15,465 calls were received by the Dial-COVID platform from all 31 refugee settlements in Uganda through which 6,913 symptom surveys were completed and 10,411 public health messages were disseminated in all study languages. Uptake of Dial-COVID fluctuated with the national COVID-19 caseload and was impacted by phone ownership and connectivity in refugee settlements. Intensified advertising efforts promoted Dial-COVID uptake. Flexibility to adapt IVR messages was contingent on translation capacity.

CONCLUSION

Refugees living in refugee settlements across Uganda accessed Dial-COVID to share and obtain COVID-19 information suggesting that IVR holds potential for rapid information dissemination and screening of humanitarian populations during future infectious disease outbreaks and may be a valuable tool for routine public health programs. IVR adaptation flexibility and reach are influenced by language constraints and by contextual factors related to platform access.

REGISTRATION DETAILS

World Pandemic Research Network- 490652.

Trend of expansion of SARS-CoV-2 infection and COVID-19 burden in Gabon (Central Africa) in mid-2021, based on a serological survey

•

There was a lower SARS-CoV-2 seroprevalence in Gabon than had been reported for other countries.

•

The low seroprevalence correlated with low rates of confirmed cases and deaths in Gabon.

•

An unusually high seroprevalence was found in the rural population.

•

The risk of infection increases with age, which should guide public-health policies.

Objective

Methods

Results

Conclusions

Seroprevalence of SARS-CoV-2 antibodies among Forcibly Displaced Myanmar Nationals in Cox's Bazar, Bangladesh 2020: a population-based cross-sectional study

OBJECTIVES

The study aimed to determine the seroprevalence, the fraction of asymptomatic infections, and risk factors of SARS-CoV-2 infections among the Forcibly Displaced Myanmar Nationals (FDMNs).

DESIGN

It was a population-based two-stage cross-sectional study at the level of households.

SETTING

The study was conducted in December 2020 among household members of the FDMN population living in the 34 camps of Ukhia and Teknaf Upazila of Cox's Bazar district in Bangladesh.

PARTICIPANTS

Among 860 697 FDMNs residing in 187 517 households, 3446 were recruited for the study. One individual aged 1 year or older was randomly selected from each targeted household.

PRIMARY AND SECONDARY OUTCOME MEASURES

Blood samples from respondents were tested for total antibodies for SARS-CoV-2 using Wantai ELISA kits, and later positive samples were validated by Kantaro kits.

RESULTS

More than half (55.3%) of the respondents were females, aged 23 median (IQR 14-35) years and more than half (58.4%) had no formal education. Overall, 2090 of 3446 study participants tested positive for SARS-CoV-2 antibody. The weighted and test adjusted seroprevalence (95% CI) was 48.3% (45.3% to 51.4%), which did not differ by the sexes. Children (aged 1-17 years) had a significantly lower seroprevalence 38.6% (95% CI 33.8% to 43.4%) compared with adults (58.1%, 95% CI 55.2% to 61.1%). Almost half (45.7%, 95% CI 41.9% to 49.5%) of seropositive individuals reported no relevant symptoms since March 2020. Antibody seroprevalence was higher in those with any comorbidity (57.8%, 95% CI 50.4% to 64.5%) than those without (47.2%, 95% CI 43.9% to 50.4%). Multivariate logistic regression analysis of all subjects identified increasing age and education as risk factors for seropositivity. In children (≤17 years), only age was significantly associated with the infection.

CONCLUSIONS

In December 2020, about half of the FDMNs had antibodies against SARS-CoV-2, including those who reported no history of symptoms. Periodic serosurveys are necessary to recommend appropriate public health measures to limit transmission.

Health-related quality of life and coping strategies adopted by COVID-19 survivors: A nationwide cross-sectional study in Bangladesh

INTRODUCTION

This study aims to investigate the health-related quality of life and coping strategies among COVID-19 survivors in Bangladesh.

METHODS

This is a cross-sectional study of 2198 adult, COVID-19 survivors living in Bangladesh. Data were collected from previously diagnosed COVID-19 participants (confirmed by an RT-PCR test) via door-to-door interviews in the eight different divisions in Bangladesh. For data collection, Bengali-translated Brief COPE inventory and WHO Brief Quality of Life (WHO-QoLBREF) questionnaires were used. The data collection period was from October 2020 to March 2021.

RESULTS

Males 72.38% (1591) were more affected by COVID-19 than females 27.62% (607). Age showed significant correlations (p<0.005) with physical, psychological and social relationships, whereas gender showed only a significant correlation with physical health (p<0.001). Marital status, occupation, living area, and co-morbidities showed significant co-relation with all four domains of QoL (p<0.001). Education and affected family members showed significant correlation with physical and social relationship (p<0.001). However, smoking habit showed a significant correlation with both social relationship and environment (p<0.001). Age and marital status showed a significant correlation with avoidant coping strategies (p<0.001); whereas gender and co-morbidities showed a significant correlation with problem-focused coping strategies (p<0.001). Educational qualification, occupation and living area showed significant correlation with all three coping strategies(p<0.001).

CONCLUSION

Survivors of COVID-19 showed mixed types of coping strategies; however, the predominant coping strategy was avoidant coping, followed by problem-focused coping, with emotion-focused coping reported as the least prevalent. Marital status, occupation, living area and co-morbidities showed a greater effect on QoL in all participants. This study represents the real scenario of nationwide health-associated quality of life and coping strategies during and beyond the Delta pandemic.

Transmission and Profile of COVID-19 in Children in North Sumatera, Indonesia

BACKGROUND

In December 2019, a cluster of viral pneumonia cases, later identified as coronavirus disease 2019 (COVID-19), was first reported in Wuhan, China, and then continued to spread to other parts of the world. COVID-19 is thought to be more prevalent in adults than children; therefore, information about COVID-19 burden and characteristics in children is lacking.

METHODS

We gathered data on the profile and transmission in children with COVID-19 from data collected by the North Sumatera Provincial Health Office team. Data were presented as mean±SD and percentage. Statistical analysis was performed using STATA version 15.0.

RESULTS

From April to October 2020, there were 1125 confirmed COVID-19 cases in children in North Sumatera, representing approximately 8.9% of all cases. Death occurred in 0.62% of the patients, and the children who died had underlying diseases. Four major clusters of COVID-19 infection in children were found in three Islamic boarding schools and one refugee shelter.

CONCLUSION

A high number of children in North Sumatera were affected by COVID-19, and mortality was found to be higher in children with underlying diseases. Major clusters were found in places with prolonged and repeated activities in close contact, such as boarding schools and a refugee shelter.

COVID-19 epidemiology and changes in health service utilization in Uganda's refugee settlements during the first year of the pandemic

BACKGROUND

The COVID-19 pandemic has been characterized by multiple waves with varying rates of transmission affecting countries at different times and magnitudes. Forced displacement settings were considered particularly at risk due to pre-existing vulnerabilities. Yet, the effects of COVID-19 in refugee settings are not well understood. In this study, we report on the epidemiology of COVID-19 cases in Uganda's refugee settlement regions of West Nile, Center and South, and evaluate how health service utilization changed during the first year of the pandemic.

METHODS

We calculate descriptive statistics, testing rates, and incidence rates of COVID-19 cases in UNHCR's line list and adjusted odds ratios for selected outcomes. We evaluate the changes in health services using monthly routine data from UNHCR's health information system (January 2017 to March 2021) and apply interrupted time series analysis with a generalized additive model and negative binomial distribution, accounting for long-term trends and seasonality, reporting results as incidence rate ratios.

FINDINGS

The first COVID-19 case was registered in Uganda on March 20, 2020, and among refugees two months later on May 22, 2020 in Adjumani settlement. Incidence rates were higher at national level for the general population compared to refugees by region and overall. Testing capacity in the settlements was lower compared to the national level. Characteristics of COVID-19 cases among refugees in Uganda seem to align with the global epidemiology of COVID-19. Only hospitalization rate was higher than globally reported. The indirect effects of COVID-19 on routine health services and outcomes appear quite consistent across regions. Maternal and child routine and preventative health services seem to have been less affected by COVID-19 than consultations for acute conditions. All regions reported a decrease in consultations for respiratory tract infections.

INTERPRETATION

COVID-19 transmission seemed lower in settlement regions than the national average, but so was testing capacity. Disruptions to health services were limited, and mainly affected consultations for acute conditions. This study, focusing on the first year of the pandemic, warrants follow-up research to investigate how susceptibility evolved over time, and how and whether health services could be maintained.

Exploring the Mental, Social, and Lifestyle Effects of a Positive COVID-19 Infection on Syrian Refugees in Jordan: A Qualitative Study

Migrants and refugees are among the vulnerable populations that suffered disproportionately from the COVID-19 crisis. However, their experiences with COVID-19 positivity status have not been investigated. This study explored the physical, mental, and psychosocial impacts of a positive COVID-19 diagnosis on Syrian refugees living in Jordan. Using a qualitative approach, twenty phone interviews were conducted with ten adult Syrian refugees living within the camp and ten refugees living in non-camp (host community) settings in Jordan. Follow-up interviews with five health care providers at a refugee camp were conducted to explore the services and support provided to the refugees with COVID-19 infection. The findings were thematically analyzed and grouped into major themes, subthemes, and emerging themes. Refugees living within camp settings had better access to testing, healthcare, and disease management and did not experience fear of being deported. Refugees in both settings suffered mental and psychosocial health impacts, social isolation, fear of death, and disease complications. COVID-19 infection has negatively impacted refugees' well-being with noticeable disparities across the different living conditions. Refugees living within host community settings may need more support for managing their condition, accessibility to free testing, as well as treatment and healthcare services.

Sociocultural Costs of the Long-term COVID-19 Outbreak in Bangladesh: A Systematic Review

Beyond the physical transmission of COVID-19, the pandemic has had far-reaching consequences in Bangladesh, including social and cultural implications. This review paper aimed at identifying and synthesizing the costs of COVID-19 on sociocultural issues in Bangladesh. For this purpose, we conducted a systematic search in MEDLINE, PubMed, ProQuest, Web of Science, Scopus and Google Scholar up to August 2021. Studies related to the costs of COVID-19 were identified, tabulated, analyzed, and synthesized by using a thematic approach. Our final synthesis of 19 studies resulted in five analytical themes: (i) disruption in education, (ii) loss of everyday social interaction, (iii) increase of "new poor" and suicide, (iv) rise of violence against women, and (v) worsening the life of refugees. Our findings showed that the costs of disruption in education, loss of everyday social interaction, and increase of "new poor" and suicide were more evident. Finally, we recommend the government and the community to adopt some integrated actions and policies to combat the problems in improving Bangladeshi sociocultural situations.

Modelling how face masks and symptoms-based quarantine synergistically and cost-effectively reduce SARS-CoV-2 transmission in Bangladesh

BACKGROUND

Non-pharmaceutical interventions (NPIs) used to limit SARS-CoV-2 transmission vary in their feasibility, appropriateness and effectiveness in different contexts. In Bangladesh a national lockdown implemented in March 2020 exacerbated poverty and was untenable long-term. A resurgence in 2021 warranted renewed NPIs. We sought to identify NPIs that were feasible in this context and explore potential synergies between interventions.

METHODS

We developed an SEIR model for Dhaka District, parameterised from literature values and calibrated to data from Bangladesh. We discussed scenarios and parameterisations with policymakers with the aid of an interactive app. These discussions guided modelling of lockdown and two post-lockdown measures considered feasible to deliver; symptoms-based household quarantining and compulsory mask-wearing. We compared NPI scenarios on deaths, hospitalisations relative to capacity, working days lost, and cost-effectiveness.

RESULTS

Lockdowns alone were predicted to delay the first epidemic peak but could not prevent overwhelming of the health service and were costly in lost working days. Impacts of post-lockdown interventions depended heavily on compliance. Assuming 80% compliance, symptoms-based household quarantining alone could not prevent hospitalisations exceeding capacity, whilst mask-wearing prevented overwhelming health services and was cost-effective given masks of high filtration efficiency. Combining masks with quarantine increased their impact. Recalibration to surging cases in 2021 suggested potential for a further wave in 2021, dependent on uncertainties in case reporting and immunity.

CONCLUSIONS

Masks and symptoms-based household quarantining synergistically prevent transmission, and are cost-effective in Bangladesh. Our interactive app was valuable in supporting decision-making, with mask-wearing being mandated early, and community teams being deployed to support quarantining across Dhaka. These measures likely contributed to averting the worst public health impacts, but delivering an effective response with consistent compliance across the population has been challenging. In the event of a further resurgence, concurrent messaging to increase compliance with both mask-wearing and quarantine is recommended.

Facilitating Safe Discharge Through Predicting Disease Progression in Moderate Coronavirus Disease 2019 (COVID-19): A Prospective Cohort Study to Develop and Validate a Clinical Prediction Model in Resource-Limited Settings

BACKGROUND

In locations where few people have received coronavirus disease 2019 (COVID-19) vaccines, health systems remain vulnerable to surges in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Tools to identify patients suitable for community-based management are urgently needed.

METHODS

We prospectively recruited adults presenting to 2 hospitals in India with moderate symptoms of laboratory-confirmed COVID-19 to develop and validate a clinical prediction model to rule out progression to supplemental oxygen requirement. The primary outcome was defined as any of the following: SpO2 < 94%; respiratory rate > 30 BPM; SpO2/FiO2 < 400; or death. We specified a priori that each model would contain three clinical parameters (age, sex, and SpO2) and 1 of 7 shortlisted biochemical biomarkers measurable using commercially available rapid tests (C-reactive protein [CRP], D-dimer, interleukin 6 [IL-6], neutrophil-to-lymphocyte ratio [NLR], procalcitonin [PCT], soluble triggering receptor expressed on myeloid cell-1 [sTREM-1], or soluble urokinase plasminogen activator receptor [suPAR]), to ensure the models would be suitable for resource-limited settings. We evaluated discrimination, calibration, and clinical utility of the models in a held-out temporal external validation cohort.

RESULTS

In total, 426 participants were recruited, of whom 89 (21.0%) met the primary outcome; 257 participants comprised the development cohort, and 166 comprised the validation cohort. The 3 models containing NLR, suPAR, or IL-6 demonstrated promising discrimination (c-statistics: 0.72-0.74) and calibration (calibration slopes: 1.01-1.05) in the validation cohort and provided greater utility than a model containing the clinical parameters alone.

CONCLUSIONS

We present 3 clinical prediction models that could help clinicians identify patients with moderate COVID-19 suitable for community-based management. The models are readily implementable and of particular relevance for locations with limited resources.

Evaluating Effects of Dynamic Interventions to Control COVID-19 Pandemic: A Case Study of Guangdong, China

The emergence of different virus variants, the rapidly changing epidemic, and demands for economic recovery all require continual adjustment and optimization of COVID-19 intervention policies. For the purpose, it is both important and necessary to evaluate the effectiveness of different policies already in-place, which is the basis for optimization. Although some scholars have used epidemiological models, such as susceptible-exposed-infected-removed (SEIR), to perform evaluation, they might be inaccurate because those models often ignore the time-varying nature of transmission rate. This study proposes a new scheme to evaluate the efficiency of dynamic COVID-19 interventions using a new model named as iLSEIR-DRAM. First, we improved the traditional LSEIR model by adopting a five-parameter logistic function β(t) to depict the key parameter of transmission rate. Then, we estimated the parameters by using an adaptive Markov Chain Monte Carlo (MCMC) algorithm, which combines delayed rejection and adaptive metropolis samplers (DRAM). Finally, we developed a new quantitative indicator to evaluate the efficiency of COVID-19 interventions, which is based on parameters in β(t) and considers both the decreasing degree of the transmission rate and the emerging time of the epidemic inflection point. This scheme was applied to seven cities in Guangdong Province. We found that the iLSEIR-DRAM model can retrace the COVID-19 transmission quite well, with the simulation accuracy being over 95% in all cities. The proposed indicator succeeds in evaluating the historical intervention efficiency and makes the efficiency comparable among different cities. The comparison results showed that the intervention policies implemented in Guangzhou is the most efficient, which is consistent with public awareness. The proposed scheme for efficiency evaluation in this study is easy to implement and may promote precise prevention and control of the COVID-19 epidemic.

COVID-19 & informal settlements: is 'Stay Home' safe?

The disproportional burden of coronavirus (COVID-19) and vulnerability to containment measures in informal settlements have been recognised; however, the role of poor housing conditions in propagating these remains neglected. Poor housing conditions makes it difficult to effectively implement social distancing measures. With increased time spent in cramped, dark and uncomfortable indoor environments, water and sanitation outside the home, and no outdoor space, higher exposure to existing health hazards and high levels of stress, with women and children being most vulnerable, are anticipated. Through this commentary paper, we reflect on these interconnections and recommend immediate measures and the long-term need for adequate housing for health and well-being.

Assessing the Dynamic Outcomes of Containment Strategies against COVID-19 under Different Public Health Governance Structures: A Comparison between Pakistan and Bangladesh

COVID-19 scenarios were run using an epidemiological mathematical model (system dynamics model) and counterfactual analysis to simulate the impacts of different control and containment measures on cumulative infections and deaths in Bangladesh and Pakistan. The simulations were based on national-level data concerning vaccination level, hospital capacity, and other factors, from the World Health Organization, the World Bank, and the Our World in Data web portal. These data were added to cumulative infections and death data from government agencies covering the period from 18 March 2020 to 28 February 2022. Baseline curves for Pakistan and Bangladesh were obtained using piecewise fitting with a consideration of different events against the reported data and allowing for less than 5% random errors in cumulative infections and deaths. The results indicate that Bangladesh could have achieved more reductions in each key outcome measure by shifting its initial lockdown at least five days backward, while Pakistan would have needed to extend its lockdown to achieve comparable improvements. Bangladesh's second lockdown appears to have been better timed than Pakistan's. There were potential benefits from starting the third lockdown two weeks earlier for Bangladesh and from combining this with the fourth lockdown or canceling the fourth lockdown altogether. Adding a two-week lockdown at the beginning of the upward slope of the second wave could have led to a more than 40 percent reduction in cumulative infections and a 35 percent reduction in cumulative deaths for both countries. However, Bangladesh's reductions were more sensitive to the duration of the lockdown. Pakistan's response was more constrained by medical resources, while Bangladesh's outcomes were more sensitive to both vaccination timing and capacities. More benefits were lost when combining multiple scenarios for Bangladesh compared to the same combinations in Pakistan. Clearly, cumulative infections and deaths could have been highly impacted by adjusting the control and containment measures in both national settings. However, COVID-19 outcomes were more sensitive to adjustment interventions for the Bangladesh context. Disaggregated analyses, using a wider range of factors, may reveal several sub-national dynamics. Nonetheless, the current research demonstrates the relevance of lockdown timing adjustments and discrete adjustments to several other control and containment measures.

Epidemiological characterization of COVID-19 in displaced populations of South Sudan

Introduction

South Sudan is facing a protracted humanitarian crisis with increasing population vulnerability. The study aimed to describe the epidemiology of COVID-19 in displaced populations in South Sudan.

Methods

the study involved the internally displaced populations (IDP) in Bentiu IDP camp, South Sudan. This was a descriptive cross-sectional study involving individuals that met the COVID-19 probable and confirmed case definitions from May 2020 to November 2021. Case data were managed using Microsoft Excel databases.

Results

the initial COVID-19 case in Bentiu IDP camp was reported on 2 May 2020. The overall cumulative attack rate (cases per million) was 3,230 for Bentiu IDP and 1,038 at the national level. The COVID-19 Case Fatality Ratio (CFR) among the IDPs was 19.08% among confirmed and 1.06% at the national level. There was one wave of COVID-19 transmission in the IDPs that coincided with the second COVID-19 wave in South Sudan for the period May 2020 to November 2021. Adult males aged 20-49 years were the most affected and constituted 47.1% of COVID-19 cases. Most severe cases were reported among adults 60-69 years (53%) and ≥ 70 years (80%). The risk of COVID-19 death (deaths per 10,000) increased with age and was highest in patients aged ≥ 60 years at 64.1. The commonest underlying illnesses among COVID-19 deaths was HIV-related illness, heart disease, and tuberculosis.

Conclusion

COVID-19 constitutes a significant impact on internally displaced populations of South Sudan. The COVID-19 response in displaced populations and the high-risk groups therein should be optimized.

Uses and gratifications approach: influence of COVID-19 media exposure on millennial generation in Makassar city, Indonesia

This study aims to analyze the effect of COVID-19 message exposure through the use of conventional media and new media based on indicators of frequency, duration, and consistency. Analysis of gratifications based on indicators seeking information, social interaction, and education. This study analyzes the uses and gratifications theory through conventional and new media exposure to COVID-19 pandemic information exposure. The quantitative research method tests the theory of uses and gratifications that is based on indicators of research variables. The determination of respondents is completed through probability sampling comprises of 384 respondents. Research data is analyzed with the inferential statistics with the ANOVA formula analysis. The results showed that the three indicators of satisfaction fulfillment testing indicators, namely seeking information, social interaction, and education are in middle satisfaction. The results of the regression analysis test showed that there was a positive influence on variable X (media exposure) on the level of respondent satisfaction (Y). The results of the coefficient of determination are 0.588 conventional media and the determination of new media of 0.553 is the level of satisfaction of respondents. The validity and accuracy of the uses and gratifications theory in the exposure to the COVID-19 message and respondent satisfaction are positively correlated. The research specifications of the uses and gratifications approach in the era of the COVID-19 pandemic prove that conventional media is still needed by millennials in the search for information after the development of new media.

COVID-19 knowledge, attitude, and practices among the Rohingya refugees in Cox's Bazar, Bangladesh

Objectives

Study design

Methods

Results

Conclusion

•

This is the first KAP study in Bangladesh on Rohingya refugees and COVID-19.

•

COVID-19 knowledge, attitude, and practices (KAP) of Rohingya refugees in eight refugee camps in Cox's Bazar, Bangladesh, were assessed.

•

The KAP scores of the respondents were not satisfactory.

•

Significant differences were found only in the knowledge scores based on education and gender.

•

This study emphasizes the importance of COVID-19 training with a focus on behavioral changes for the Rohingya people of Bangladesh.

Psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda: burden and associations

BACKGROUND

Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We studied the association between psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.

METHODS

Cross-sectional survey data on psychological distress, social support, demographics, socio-economic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed in SPSS-version 22, and statistical significance was assumed at p < 0.05.

RESULTS

Refugees resident in rural/semi-rural settlements exhibited higher levels of psychological distress [F(2, 1011) = 47.91; p < 0.001], higher availability of social interaction [F(2, 1011) = 82.24; p < 0.001], lower adequacy of social interaction [F(2, 1011) = 54.11; p < 0.001], higher availability of social attachment [F(2, 1011) = 47.95; p < 0.001], and lower adequacy of social attachment [F(2, 1011) = 50.54; p < 0.001] than peers in urban settlements. Adequacy of social interaction significantly explained variations in psychological distress levels overall and consistently across settlements, after controlling for plausible confounders. Additionally, adequacy of social attachment significantly explained variations in psychological distress levels among refugees in rural settlements, after controlling for plausible confounders.

CONCLUSION

There is a settlement-inequality (i.e. rural vs. urban) in psychological distress and social support among conflict refugees in Uganda. To address psychological distress, Mental Health and Psychosocial Support Services (MHPSS) should focus on strategies which strengthen the existing social networks among refugees. Variations in social support are a key predictor of distress which should guide tailored need-adapted interventions instead of duplicating similar and generic interventions across diverse refugee settlements.

COVID-19 epidemiology and changes in health service utilization in Azraq and Zaatari refugee camps in Jordan: A retrospective cohort study

BACKGROUND

The effects of the Coronavirus Disease 2019 (COVID-19) pandemic in humanitarian contexts are not well understood. Specific vulnerabilities in such settings raised concerns about the ability to respond and maintain essential health services. This study describes the epidemiology of COVID-19 in Azraq and Zaatari refugee camps in Jordan (population: 37,932 and 79,034, respectively) and evaluates changes in routine health services during the COVID-19 pandemic.

METHODS AND FINDINGS

We calculate the descriptive statistics of COVID-19 cases in the United Nations High Commissioner for Refugees (UNHCR)'s linelist and adjusted odds ratios (aORs) for selected outcomes. We evaluate the changes in health services using monthly routine data from UNHCR's health information system (HIS; January 2018 to March 2021) and apply interrupted time series analysis with a generalized additive model and negative binomial (NB) distribution, accounting for long-term trends and seasonality, reporting results as incidence rate ratios (IRRs). COVID-19 cases were first reported on September 8 and September 13, 2020 in Azraq and Zaatari camps, respectively, 6 months after the first case in Jordan. Incidence rates (IRs) were lower in camps than neighboring governorates (by 37.6% in Azraq (IRR: 0.624, 95% confidence interval [CI]: [0.584 to 0.666], p-value: <0.001) and 40.2% in Zaatari (IRR: 0.598, 95% CI: [0.570, 0.629], p-value: <0.001)) and lower than Jordan (by 59.7% in Azraq (IRR: 0.403, 95% CI: [0.378 to 0.430], p-value: <0.001) and by 63.3% in Zaatari (IRR: 0.367, 95% CI: [0.350 to 0.385], p-value: <0.001)). Characteristics of cases and risk factors for negative disease outcomes were consistent with increasing COVID-19 evidence. The following health services reported an immediate decline during the first year of COVID-19: healthcare utilization (by 32% in Azraq (IRR: 0.680, 95% CI [0.549 to 0.843], p-value < 0.001) and by 24.2% in Zaatari (IRR: 0.758, 95% CI [0.577 to 0.995], p-value = 0.046)); consultations for respiratory tract infections (RTIs; by 25.1% in Azraq (IRR: 0.749, 95% CI: [0.596 to 0.940], p-value = 0.013 and by 37.5% in Zaatari (IRR: 0.625, 95% CI: [0.461 to 0.849], p-value = 0.003)); and family planning (new and repeat family planning consultations decreased by 47.4% in Azraq (IRR: 0.526, 95% CI: [0.376 to 0.736], p-value = <0.001) and 47.6% in Zaatari (IRR: 0.524, 95% CI: [0.312 to 0.878], p-value = 0.014)). Maternal and child health services as well as noncommunicable diseases did not show major changes compared to pre-COVID-19 period. Conducting interrupted time series analyses in volatile settings such refugee camps can be challenging as it may be difficult to meet some analytical assumptions and to mitigate threats to validity. The main limitation of this study relates therefore to possible unmeasured confounding.

CONCLUSIONS

COVID-19 transmission was lower in camps than outside of camps. Refugees may have been affected from external transmission, rather than driving it. Various types of health services were affected differently, but disruptions appear to have been limited in the 2 camps compared to other noncamp settings. These insights into Jordan's refugee camps during the first year of the COVID-19 pandemic set the stage for follow-up research to investigate how infection susceptibility evolved over time, as well as which mitigation strategies were more successful and accepted.

CHALLENGES AND DIFFICULTIES IN IMPLEMENTING AND ADOPTING ISOLATION AND QUARANTINE MEASURES AMONG INTERNALLY DISPLACED PEOPLE DURING THE COVID-19 PANDEMIC IN MALI (161/250)

•

The lack of facilities for quarantine and isolation in the sites for internally displaced people (IDPs) was found to be a barrier to the adoption of isolation and quarantine measures by IDPs.

•

Changes in social behavior and practices to adopt isolation and quarantine were found to be difficult for IDPs.

•

Financial vulnerability and fear of stigma were identified as barriers to the adoption of isolation and quarantine measures by IDPs.

•

Endogen solutions to adopt isolation and quarantine measures include strengthening IDPs’ awareness on COVID-19 by IDPs.

Introduction

Isolation and quarantine are among the key measures that protect internally displaced people (IDPs) against COVID-19. This study aims to identify the challenges encountered by humanitarian actors, and health, political, and administrative stakeholders in implementing these measures. It also describes the difficulties faced by IDPs when adopting them, and the local initiatives developed to overcome those difficulties.

Method

We conducted a qualitative survey consisting of individual interviews and focus groups among IDPs, humanitarian actors, and health, political, and administrative stakeholders. The data was collected between November and December 2020 in the Bamako and Ségou Regions of Mali. Interviews were recorded with audio recorders, then transcribed and thematically analyzed using the NVivo 13 software.

Findings

The study involved 36 individual interviews and eight focus groups with 68 participants of whom IDPs represented 72.3%. The main challenges reported on IDP sites included difficulties in contacting positive cases, a lack of facilities for quarantine and isolation, a lack of physical space for building new facilities, and a lack of financial resources to support IDPs during isolation and quarantine. The difficulties reported included: changes in social behavior and practices, fear of stigma, a poor level of literacy, and language barriers. To address those difficulties, the local initiatives developed by IDPs included strengthening the awareness of IDPs on COVID-19, early warning of sites’ leaders about positive and suspected cases, and setting up a toll-free number to facilitate access to appropriate information on COVID-19.

Conclusion

The findings of this study could be used as evidence to guide policy, adjust current strategies and take into account with more focus IDPs, a group with increased vulnerability, in COVID-19 response, more precisely during the implementation of isolation and quarantine measures. By doing so, they will help improve the response to COVID-19, IDPs health, and population health.

Epidemiological modelling in refugee and internally displaced people settlements: challenges and ways forward

The spread of infectious diseases such as COVID-19 presents many challenges to healthcare systems and infrastructures across the world, exacerbating inequalities and leaving the world’s most vulnerable populations at risk. Epidemiological modelling is vital to guiding evidence-informed or data-driven decision making. In forced displacement contexts, and in particular refugee and internally displaced people (IDP) settlements, it meets several challenges including data availability and quality, the applicability of existing models to those contexts, the accurate modelling of cultural differences or specificities of those operational settings, the communication of results and uncertainties, as well as the alignment of strategic goals between diverse partners in complex situations. In this paper, we systematically review the limited epidemiological modelling work applied to refugee and IDP settlements so far, and discuss challenges and identify lessons learnt from the process. With the likelihood of disease outbreaks expected to increase in the future as more people are displaced due to conflict and climate change, we call for the development of more approaches and models specifically designed to include the unique features and populations of refugee and IDP settlements. To strengthen collaboration between the modelling and the humanitarian public health communities, we propose a roadmap to encourage the development of systems and frameworks to share needs, build tools and coordinate responses in an efficient and scalable manner, both for this pandemic and for future outbreaks.

SARS-CoV-2 attack rate in reception and accommodation centres for asylum seekers during the first wave: systematic review of outbreak media reports in Germany

•

Sars-CoV-2 attack rate in asylum reception centers in Germany during the first wave was 13%.

•

Mass quarantine was imposed in 75% of outbreaks, but was associated with higher attack rate.

•

Recommended standards of isolation of infected persons not always implemented.

•

Protective measures for vulnerable individuals reported for minority of outbreaks.

•

Implementation of adequate infection control measures is required despite vaccine availability.

•

Mass quarantine should be avoided.

Objectives

Despite concerns about the impact of the severe acute respiratory syndrome corona virus (SARS-CoV-2) in refugee camps, data on attack rates and effectiveness of containment measures are lacking. We aimed to (1) quantify the attack rate of SARS-CoV-2 during outbreaks in reception and accommodation centres in Germany during the first pandemic wave, (2) assess differences in the attack rate based on containment measures, and (3) provide an overview of testing strategies, communication, conflicts, and protection measures for refugees with special needs.

Methods

Systematic web-based review of outbreak media reports (until June 2020) on confirmed SARS-CoV-2 cases in reception centres for asylum seekers in Germany using the google search engine. Reports were screened for pre-defined inclusion criteria and complemented by snowball searches. Data on facility name, location, confirmed cases, containment measures, communication, protection strategies, and conflicts was extracted for each outbreak and reporting date. Evidence synthesis: meta-analysis and negative binomial regression.

Findings

We identified 337 media reports on 101 SARS-CoV-2 outbreaks in 99 reception and accommodation centres in Germany. The pooled SARS-CoV-2 attack rate was 13.1% (95% confidence interval, CI: 9.8–16.7). Outbreak sites implementing mass quarantine (n = 76) showed higher rates (15.7; 95% CI: 11.6–20.2) compared to sites using conventional strategies (6.6; 95% CI: 3.1–11.2), yielding a rate ratio of 0.44 (95% CI: 0.27–0.72) adjusted for testing strategies, type and size of accommodation. Conflicts occurred in at least 11.8% of all outbreaks. Few sites reported specific measures to protect refugees with special needs.

Conclusion

Mass quarantine is associated with higher attack rates, and appears to be a counter-productive containment measure in overcrowded camps, but further research with individual-level data is required to rule out residual confounding. Despite available vaccines, reception centres and refugee camps should follow the available guidelines on COVID-19 response and refrain from mass quarantine if physical distancing cannot be guaranteed.

Impact of COVID-19 on Women Who Are Refugees and Mothering: A Critical Ethnographic Study

Refugee women often experience trauma and social disconnection in a new country and are at risk of experiencing reduced physical, mental, and emotional well-being. Globally, COVID-19 has affected the health and well-being of the population at large. This critical ethnographic study aimed to explore the effects of COVID-19 on women who are refugees and mothering in Saskatchewan, Canada. In-depth interviews were undertaken with 27 women who are refugees and mothering young children aged 2 years and under. This study suggests that during COVID-19, refugee women are at high risk of experiencing add-on stressors due to isolation, difficulty in accessing health care, COVID-19-related restrictions in hospitals, limited follow-up care, limited social support, financial difficulties, and compromised nutrition. During COVID-19, collaborative efforts by nurses, other health-care professionals, and governmental and non-governmental organizations are essential to provide need-based mental health support, skills-building programs, nutritional counseling, and follow-up care to this vulnerable group.

Country differences in transmissibility, age distribution and case-fatality of SARS-CoV-2: a global ecological analysis

Objectives The first COVID-19 pandemic waves in many low-income countries appeared milder than initially forecasted. We conducted a country-level ecological study to describe patterns in key SARS-CoV-2 outcomes by country and region and explore associations with potential explanatory factors, including population age structure and prior exposure to endemic parasitic infections. Methods We collected publicly available data and compared them using standardisation techniques. We then explored the association between exposures and outcomes using random forest and linear regression. We adjusted for potential confounders and plausible effect modifications. Results While mean time-varying reproduction number was highest in the European and Americas regions, median age of death was lower in the Africa region, with a broadly similar case-fatality ratio. Population age was strongly associated with mean (β=0.01, 95% CI, 0.005, 0.011) and median age of cases (β=-0.40, 95% CI, -0.53, -0.26) and deaths (β= 0.40, 95% CI, 0.17, 0.62). Conclusions Population age seems an important country-level factor explaining both transmissibility and age distribution of observed cases and deaths. Endemic infections seem unlikely, from this analysis, to be key drivers of the variation in observed epidemic trends. Our study was limited by the availability of outcome data and its causally uncertain ecological design.

Toward the understanding of national culture in the success of non-pharmaceutical technological interventions in mitigating COVID-19 pandemic

This study conceptually explores the relationship between a nation's culture and the success of utilizing various digital technologies to mitigate the spread of a pandemic, such as novel coronavirus (COVID-19). In the absence of a cure or vaccine of COVID-19, the national governments and public health authorities have been aggressively utilizing digital technologies to mitigate the pandemic spread. Given the urgency caused by COVID-19, this study highlights the importance of considering a country's national culture in evaluating the efficacy of a given digital technology, despite how promising or groundbreaking it may sound, in combating the spread of an infectious disease. Relying on the two critical dimensions of national culture, power distance and individualism/collectivism, this study proposes a framework that describes how people from different countries, depending on their prevalent national cultural values, would be receptive (or intolerant) to using government-run technology solutions meant for curbing the pandemic spread.

Floods, landslides and COVID-19 in the Uttarakhand State, India: Impact of Ongoing Crises on Public Health

The Uttarakhand State, known for its Himalayan Mountains, is a territory in Northern India that is extremely vulnerable to earthquakes, landslides, and floods. Currently, due to the COVID-19 outbreak, India is facing the dual challenge of containing a pandemic and responding to natural disasters. This situation can have a negative impact on the health and the economic development of the region, leading to a long-lasting humanitarian crisis that can disrupt even more, the already overburdened health service. In addition, it can pose serious threats to the wellbeing of the population as it complicates physical distancing and other COVID-19 prevention measures. It is of utmost importance to analyse the impact of floods, landslides, and COVID-19 pandemic on the health system of the Uttarakhand State, and how these crises interact with each other.

'It is a disease which comes and kills directly': What refugees know about COVID-19 and key influences of compliance with preventive measures

BACKGROUND

Refugees are at increased risk for COVID-19 infection in part due to their living conditions, which make it harder to adopt and adhere to widely accepted preventive measures. Little empirical evidence exists about what refugees know about COVID-19 and what they do to prevent infection. This study explored what refugee women and their health care workers understand about COVID-19 prevention, the extent of their compliance to public health recommendations, and what influences the adoption of these measures.

METHODS

In October 2020, we conducted 25 in-depth interviews with facility and community health care staff (n = 10) and refugee women attending antenatal and postnatal care services (n = 15) in Eastleigh, Nairobi.

FINDINGS

While researchers found a high level of awareness about COVID-19 and related prevention and control measures among refugee women, various barriers affected compliance with such measures, due in part to poverty and in part to rampant misconceptions informed by religious beliefs and political narratives about the virus.

CONCLUSIONS

These findings indicated that Kenya's Ministry of Health needs to institute a concerted and continuous education program to bring refugee communities up to speed about COVID-19 and its prevention. In addition to disseminating information about the need to wear masks and repeatedly wash hands, supplies-masks, soap and access to water-need to be made available to poor refugee communities. Future research could explore which measures for disseminating factual information work best in refugee populations with different cultural norms and how best to target interventions to these groups.

Seroprevalence of SARS-CoV-2 antibodies and retrospective mortality in a refugee camp, Dagahaley, Kenya

BACKGROUND

Camps of forcibly displaced populations are considered to be at risk of large COVID-19 outbreaks. Low screening rates and limited surveillance led us to conduct a study in Dagahaley camp, located in the Dadaab refugee complex in Kenya to estimate SARS-COV-2 seroprevalence and, mortality and to identify changes in access to care during the pandemic.

METHODS

To estimate seroprevalence, a cross-sectional survey was conducted among a sample of individuals (n = 587) seeking care at the two main health centres and among all household members (n = 619) of community health workers and traditional birth attendants working in the camp. A rapid immunologic assay was used (BIOSYNEX® COVID-19 BSS [IgG/IgM]) and adjusted for test performance and mismatch between the sampled population and that of the general camp population. To estimate mortality, all households (n = 12860) were exhaustively interviewed in the camp about deaths occurring from January 2019 through March 2021.

RESULTS

In total 1206 participants were included in the seroprevalence study, 8% (95% CI: 6.6%-9.7%) had a positive serologic test. After adjusting for test performance and standardizing on age, a seroprevalence of 5.8% was estimated (95% CI: 1.6%-8.4%). The mortality rate for 10,000 persons per day was 0.05 (95% CI 0.05-0.06) prior to the pandemic and 0.07 (95% CI 0.06-0.08) during the pandemic, representing a significant 42% increase (p<0.001). Médecins Sans Frontières health centre consultations and hospital admissions decreased by 38% and 37% respectively.

CONCLUSION

The number of infected people was estimated 67 times higher than the number of reported cases. Participants aged 50 years or more were among the most affected. The mortality survey shows an increase in the mortality rate during the pandemic compared to before the pandemic. A decline in attendance at health facilities was observed and sustained despite the easing of restrictions.

Operational response simulation tool for epidemics within refugee and IDP settlements: A scenario-based case study of the Cox's Bazar settlement

The spread of infectious diseases such as COVID-19 presents many challenges to healthcare systems and infrastructures across the world, exacerbating inequalities and leaving the world's most vulnerable populations most affected. Given their density and available infrastructure, refugee and internally displaced person (IDP) settlements can be particularly susceptible to disease spread. In this paper we present an agent-based modeling approach to simulating the spread of disease in refugee and IDP settlements under various non-pharmaceutical intervention strategies. The model, based on the June open-source framework, is informed by data on geography, demographics, comorbidities, physical infrastructure and other parameters obtained from real-world observations and previous literature. The development and testing of this approach focuses on the Cox's Bazar refugee settlement in Bangladesh, although our model is designed to be generalizable to other informal settings. Our findings suggest the encouraging self-isolation at home of mild to severe symptomatic patients, as opposed to the isolation of all positive cases in purpose-built isolation and treatment centers, does not increase the risk of secondary infection meaning the centers can be used to provide hospital support to the most intense cases of COVID-19. Secondly we find that mask wearing in all indoor communal areas can be effective at dampening viral spread, even with low mask efficacy and compliance rates. Finally, we model the effects of reopening learning centers in the settlement under various mitigation strategies. For example, a combination of mask wearing in the classroom, halving attendance regularity to enable physical distancing, and better ventilation can almost completely mitigate the increased risk of infection which keeping the learning centers open may cause. These modeling efforts are being incorporated into decision making processes to inform future planning, and further exercises should be carried out in similar geographies to help protect those most vulnerable.

Exploring the impacts of COVID-19 on Rohingya adolescents in Cox's Bazar: A mixed-methods study

This article explores how intersecting vulnerabilities faced by Rohingya adolescents living in Cox's Bazar, Bangladesh, have been exacerbated during the COVID-19 pandemic. Both the direct health impacts and the indirect repercussions of COVID-19 mitigation strategies have served to heighten pre-existing risks, preventing adolescents from reaching their full capabilities. This article provides empirical mixed-methods data from the Gender and Adolescence: Global Evidence (GAGE) longitudinal study, drawing on phone surveys adolescents aged 10-14 and 15-19 (1,761), qualitative interviews with adolescents aged 15-19 years (30), and key informant interviews (7) conducted between March and August 2020 with both Rohingya and Bangladeshi adolescents residing in refugee camps and host communities, respectively. While this article focuses on displaced Rohingya adolescents' experiences during COVID-19, we contextualize our findings by drawing on data collected from Bangladeshi adolescents who serve as comparators. Findings highlight that the pandemic has lead to a decline in Rohingya adolescents' reported health status, exacerbated food insecurity, educational and economic marginalization and bodily integrity risks, amongst both girls and boys. This paper concludes by reflecting on the policy implications necessary to safeguard refugee adolescent trajectories in the context of COVID-19.

Psychological Impact of COVID-19 Pandemic in Bangladesh: Analysis of a Cross-Sectional Survey

The COVID-19 pandemic has generated fear, panic, distress, anxiety, and depression among many people in Bangladesh. In this cross-sectional study, we examined factors associated with different levels of psychological impact as a result of COVID-19 in Bangladesh. From April 1 to 30, 2020, we used a self-administered online questionnaire to collect data from 10,609 respondents. Using the Impact of Event Scale-Revised to assess the psychological impact of the COVID-19 pandemic on respondents, we categorized the levels of impact as normal, mild, moderate, or severe. Ordinal logistic regression was used to examine the associated factors. The prevalence of mild, moderate, and severe psychological impact was 10.2%, 4.8%, and 45.5%, respectively. Multivariate analysis revealed that the odds of reporting normal vs mild, moderate, or severe psychological impact were 5.9 times higher for people living in the Chittagong Division, 1.7 times higher for women with lower education levels, 3.0 times higher among those who were divorced or separated, 1.8 times higher for those working full time, and 2.4 times higher for those living in shared apartments. The odds of reporting a psychological impact were also higher among people who did not enforce protective measures inside the home, those in self-quarantine, those who did not wear face masks, and those who did not comply with World Health Organization precautionary measures. Increased psychological health risks due to COVID-19 were significantly higher among people who experienced chills, headache, cough, breathing difficulties, dizziness, and sore throat before data collection. Our results showed that 1 in 2 respondents experienced a significant psychological impact as a result of the COVID-19 pandemic. Public health researchers should consider these factors when targeting interventions that would have a protective effect on the individual's psychological health during a pandemic or future disease outbreak.

Empowering the crowd: feasible strategies for epidemic management in high-density informal settlements. The case of COVID-19 in Northwest Syria

More than 1 billion people live in informal settlements worldwide, where precarious living conditions pose unique challenges to managing a COVID-19 outbreak. Taking Northwest Syria as a case study, we simulated an outbreak in high-density informal Internally Displaced Persons (IDP) camps using a stochastic Susceptible-Exposed-Infectious-Recovered model. Expanding on previous studies, taking social conditions and population health/structure into account, we modelled several interventions feasible in these settings: moderate self-distancing, self-isolation of symptomatic cases and protection of the most vulnerable in 'safety zones'. We considered complementary measures to these interventions that can be implemented autonomously by these communities, such as buffer zones, health checks and carers for isolated individuals, quantifying their impact on the micro-dynamics of disease transmission. All interventions significantly reduce outbreak probability and some of them reduce mortality when an outbreak does occur. Self-distancing reduces mortality by up to 35% if contacts are reduced by 50%. A reduction in mortality by up to 18% can be achieved by providing one self-isolation tent per eight people. Protecting the most vulnerable in a safety zone reduces the outbreak probability in the vulnerable population and has synergistic effects with the other interventions. Our model predicts that a combination of all simulated interventions may reduce mortality by more than 90% and delay an outbreak's peak by almost 2 months. Our results highlight the potential for non-medical interventions to mitigate the effects of the pandemic. Similar measures may be applicable to controlling COVID-19 in other informal settlements, particularly IDP camps in conflict regions, around the world.