Braam Dorien H, Srinivasan Sharath, Church Luke, Sheikh Zakaria, Jephcott Freya L, Bukachi Salome
Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
Department of Politics and International Studies, University of Cambridge, Cambridge, UK.
Confl Health. 2021 Jun 12;15(1):47. doi: 10.1186/s13031-021-00382-5.
Authorities in Somalia responded with drastic measures after the first confirmed COVID-19 case in mid-March 2020, closing borders, schools, limiting travel and prohibiting most group functions. However, the impact of the pandemic in Somalia thereafter remained unclear. This study employs a novel remote qualitative research method in a conflict-affected setting to look at how some of the most at-risk internally displaced and host populations were impacted by COVID-19, what determined their responses, and how this affected their health and socio-economic vulnerability.
We conducted a remote qualitative study, using Katikati, a 1-to-1 conversation management and analysis platform using short message service (SMS) developed by Lark Systems with Africa's Voices Foundation (AVF), for semi-structured interviews over three months with participants in Mogadishu and Baidoa. We recruited a gender balanced cohort across age groups, and used an analytical framework on the social determinants of health for a narrative analysis on major themes discussed, triangulating data with existing peer-reviewed and grey literature.
The remote research approach demonstrated efficacy in sustaining trusted and meaningful conversations for gathering qualitative data from hard-to-reach conflict-affected communities. The major themes discussed by the 35 participants included health, livelihoods and education. Two participants contracted the disease, while others reported family or community members affected by COVID-19. Almost all participants faced a loss of income and/or education, primarily as a result of the strict public health measures. Some of those who were heavily affected economically but did not directly experienced disease, denied the pandemic. Religion played an important role in participants' beliefs in protection against and salvation from the disease. As lockdowns were lifted in August 2020, many believed the pandemic to be over.
While the official COVID-19 burden has remained relatively low in Somalia, the impact to people's daily lives, income and livelihoods due to public health responses, has been significant. Participants describe those 'secondary' outcomes as the main impact of the pandemic, serving as a stark reminder of the need to broaden the public health response beyond disease prevention to include social and economic interventions to decrease people's vulnerability to future shocks.
2020年3月中旬索马里出现首例新冠肺炎确诊病例后，当局采取了严厉措施，关闭边境、学校，限制出行并禁止大多数群体活动。然而，此后疫情在索马里的影响仍不明确。本研究在受冲突影响的地区采用一种新型的远程定性研究方法，以探讨一些风险最高的境内流离失所者和收容社区居民如何受到新冠肺炎的影响，是什么决定了他们的应对方式，以及这如何影响他们的健康和社会经济脆弱性。
我们进行了一项远程定性研究，使用Katikati，这是一个由Lark Systems与非洲之声基金会（AVF）开发的利用短信服务进行一对一对话管理和分析的平台，在三个月内对摩加迪沙和拜多阿的参与者进行半结构化访谈。我们招募了一个各年龄组性别均衡的队列，并使用一个关于健康社会决定因素的分析框架对所讨论的主要主题进行叙事分析，将数据与现有的同行评议和灰色文献进行三角互证。
远程研究方法在维持与难以接触到的受冲突影响社区进行可信且有意义的对话以收集定性数据方面显示出有效性。35名参与者讨论的主要主题包括健康、生计和教育。两名参与者感染了该疾病，而其他人报告有家庭成员或社区成员受到新冠肺炎影响。几乎所有参与者都面临收入和/或教育的损失，主要是由于严格的公共卫生措施。一些在经济上受到严重影响但未直接感染疾病的人否认疫情的存在。宗教在参与者对抗病和从疾病中得救的信念中发挥了重要作用。随着2020年8月封锁措施的解除，许多人认为疫情已经结束。
虽然索马里官方的新冠肺炎负担一直相对较低，但公共卫生应对措施对人们日常生活、收入和生计的影响却很大。参与者将这些“次要”结果描述为疫情的主要影响，这强烈提醒人们有必要将公共卫生应对措施从疾病预防扩大到包括社会和经济干预措施，以降低人们对未来冲击的脆弱性。
