Africans lack basic facilities to curb COVID-19

An international study involving University of Cape Town (UCT) researchers reveals that hundreds of millions of Africans don’t have access to the most basic facilities to prevent the spread of the virus the causes COVID-19. The results show, for example, that almost 900 million live without on-site water and 283 million live in households where more than three people share a room.

When, early in 2020, it became clear that COVID-19 would soon reach pandemic proportions, the World Health Organization recommended a range of non-pharmacological public health interventions to curb the spread of the virus. Quickly implemented by governments across the globe, these included wearing masks, strict lockdown measures, physical distancing and widespread hygiene awareness campaigns focused on regular handwashing.

Although frustrating, these measures hardly pose a challenge for those living in homes with running water, refrigerators and the space to self-isolate.

For many people living in Africa, however, these seemingly simple measures have been all but impossible to implement and maintain.

“It’s quite terrifying when you start thinking about the people behind the data … how terrible to be locked-down in an informal settlement with the same strictures as everyone else.”

UCT’s Professor Murray Leibbrandt, director of the African Centre for Inequality Research (ACEIR), and postgraduate researcher Bongai Munguni were co-authors on the study. They collaborated with researchers from the University of Bristol’s Poverty Institute, the University of California, Los Angeles’ Fielding School of Public Health and other international research groups to investigate the feasibility of non-pharmacological public health interventions in low-resource settings in Africa.

Shocking statistics

Leibbrandt, who is also the South African Research Chair in Poverty and Inequality Research, explains that to determine people’s vulnerability to COVID-19, the team identified appropriate socio-economic measures from their already gathered survey data that corresponded to specific non-pharmacological public health interventions.

“Social distancing is crucial. So, looking at the survey work we do all the time, we established that good indicators of the ability or inability to social distance would be things like how many people live in a household and how many people share a bedroom,” he says.

“Similarly, if you don’t have running water in your home and make use of a communal tap, social distancing and washing your hands isn’t easy.”

Leibbrandt points out that this careful consideration of appropriate indicators is one of the paper’s greatest strengths.

Some of the team’s main findings from 54 countries across the continent include:

• approximately 718 million people live in households with more than six individuals at home
• approximately 283 million people live in households where more than three people sleep in a single room
• an estimated 890 million Africans lack on-site water, while 700 million people lack in-home soap or washing facilities
• 45% of people share toilet facilities with other households.

The median percentage of people without a refrigerator in their home was 79%. This has implications for social distancing, as having a refrigerator enables households to keep food fresh for longer, extending the time between necessary shopping excursions and making ‘shelter-in-place’ a more feasible option.

“If you don’t have running water in your home and make use of a communal tap, social distancing and washing your hands isn’t that easy.”

“It’s quite terrifying when you start thinking about the people behind the data and when you consider how terrible it must have been to be locked-down in an informal settlement with the same strictures as everyone else,” says Leibbrandt.

“You’re not supposed to leave your house except to buy food and so on, but the reality of your life makes that more or less impossible.”

A view from the ground  

As a member of the inaugural cohort of Researchers without Borders – a collaborative PhD programme between UCT and Bristol University – Munguni has been bridging the two institutions: her PhD is co-supervised by Leibbrandt, Professor David Gordon, director of the Bristol Poverty Institute (BPI) and lead author on the paper, and Professor Richard Harris, also from BPI.

Having spent hard lockdown in Mafuse village in rural Mozambique, where she grew up, Munguni was also able to make an invaluable contribution to the research by sharing her lived experience on the ground.

“In the village, we use a communal well located about 30 minutes’ walk away and it is shared by about 20 to 30 families,” she says. “Most of us also share bedrooms and gather firewood in the same forest, making social distancing unattainable from the start.”

Munguni adds that there are no COVID-19 testing stations close by and anyone who wants to get vaccinated must spend about two days travelling to the nearest district hospital.

A case for making vaccines more accessible

In many ways, this is the crux of the study: from the start of the pandemic, Africans living in low-resource settings have been on the back foot in the battle against COVID-19.

Despite their best intentions, many have been unable to implement non-pharmacological public health interventions or even get tested. Now, once again, as successful vaccine drives are bringing hope to a COVID-19 weary world, these communities are being left behind.

• Brewer T et al. (2021) Housing, sanitation and living conditions affecting SARS-CoV-2 prevention interventions in 54 African countries. Epidemiology and Infection, 149, E183. https://doi.org/10.1017/S0950268821001734