Written by: Laura Leavens, Kate Ambler, Sylvan Herskowitz, Mywish Maredia, and Jonathan Mockshell
In response to the pandemic, on March 20th, 2020, the Malawian government declared a state of disaster. Three days later, the government closed schools. The first cases were confirmed on April 2nd; a week later, the government announced several containment measures, including, but not limited to, bans on public events, take-away only at restaurants, and restrictions on gathering. Even before any cases were even confirmed, Malawi had begun a coordinated information campaign to warn its citizens about COVID-19 with public health messaging sent through radio, television, and social media platforms. Citizens could additionally use a mobile phone messaging system or a toll-free number to get information from health authorities (see Mzumara et al. 2021 for further details about Malawi’s COVID-19 strategy).
With higher incidence of poverty, and potentially less access to information and health services, the effects of the pandemic on the lives of rural Malawians demands attention as their response and relative vulnerability may differ substantially from the country’s urban population. To better understand the pandemic in this population as well as people’s perceptions of COVID-19, we modified an existing panel phone survey focused on the seasonality of rural labor to also include COVID-19-related questions. Households in eight rural districts of Malawi were surveyed, approximately every three months, between July 2020 and July 2021. The figure above displays daily case counts throughout the study period. Round 1 occurred during the first wave, round 2 took place before the second wave, round 3 occurred towards the end of the second wave, and round 4 took place at the beginning of the third wave. This blog post summarizes our findings from three previous project notes, which explored our results as the study progressed.
The first project note detailed findings from the first round of data collection in July 2020. It was clear that local public health messages and policies had been effective in raising awareness of the virus. There was near-universal awareness of COVID-19 in our sample, with 99.3% of respondents having heard of COVID-19. Over 90% of respondents listed frequent hand washing with soap and wearing masks as ways to reduce the risk of becoming infected with COVID-19. Even though COVID-19 infections were uncommon in rural areas at the time, 70% of respondents felt they were either “definitely” or “very likely” going to become infected with COVID-19. Respondents also voiced concerns over their livelihoods; only 65% of men and 52% of women reported working in the last three months. Of those who had not worked in the last three months, 7% cited government restrictions on work and movement as the reason for this lack of work.
After two rounds of data collection, we published further findings in a second project note. Awareness and concern about COVID-19 remained high, despite a decrease in cases in Malawi. All but two respondents had heard of COVID-19. There was a slight decrease in people’s perceived likelihood of infection. Yet, most respondents still reported they were taking preventative actions. Over 90% of respondents reported wearing face masks and washing hands with soap more frequently. However, local anecdotes suggested that consistent mask wearing was much lower. In contrast to round 1, in round 2, very few cited work or travel restrictions as a reason for being out of work. Nearly twice as many respondents said food prices had increased as in round 1 (82% vs 48%), although, given seasonal fluctuations in food prices, it was unclear how much was related to the pandemic.
Our third and final project note looked at the results from all four rounds of data collection. By round 3, COVID-19 had spread into rural areas during the second wave of the pandemic. Compared to 70% in round 1, 88% of respondents in round 4 thought they were either “very likely” or “definitely” going to become infected with COVID-19. In all previous rounds, on average, respondents perceived that others in Malawi, and to some extent their own communities, were more likely to catch COVID-19 than themselves. However, in round 4, the gap in perceived infection risk between self and the average person in Malawi substantially decreased, and the gap between self and community members approached zero. For economic impacts, COVID-19 was not perceived as the main reason for being out of work by any respondents in rounds 3 or 4 even while economic effects of the pandemic could still indirectly affect household income and employment. Respondents reported experiencing the most challenges (increases in food prices, unable to hire labor, etc.) in round 4.
Despite periods of decreased COVID-19 cases, rural Malawians continued to be highly aware of COVID-19, its risks, and its impacts on their lives. Over the course of the study, respondents increasingly reported economic challenges but decreasingly attributed lack of employment to COVID-19. Encouragingly, people remained highly aware of actions they can take to reduce their exposure; even if the level of compliance with public health guidance on the ground is outside the scope of this study. Given the uncertainty of the pandemic, continued public health messaging that is responsive to changing levels of risk, will be critical to reducing the impacts of the pandemic on rural livelihoods.
