Sep 28

The urban poor and their battle against COVID-19

A recent survey conducted by the Urban Programs Team at SAJIDA Foundation, finds that the urban extreme poor in Bangladesh have key knowledge regarding COVID-19 prevention and symptoms. Whilst many social distancing and isolation recommended practices are challenging, this population is adopting several preventative practices where possible.

SAJIDA Foundation has been conducting a number of surveys with service users of their ‘Amrao Manush’ project to understand and respond to the realities and needs of the urban extreme poor population within their work. The Amrao Manush (we are people too) project is funded by Concern WorldWide and Irish Aid and aims to improve the lives and livelihoods of pavement, squatter and ‘under-developed’ slum dwellers.

The most recent survey aimed to explore the knowledge, perceptions and practices regarding COVID-19 amongst 515 of the urban extreme poor in Dhaka and Chittagong. 71.8% of the respondents were women and 28.2% were men. The survey covered a wide range of ages, with the majority (65.6%) aged between 21 to 40 years of age. Most respondents currently live in an ‘under-developed’ slums (68%), whilst 23.2% currently live on the pavement, and 8.8% in a squatter settlement.

Globally, the urban poor are facing many challenges and constraints to prevent COVID-19. The highly dense nature of slums, limited access to affordable water and shared water points and sanitation facilities pose key challenges in preventing the spread of the virus within slums. 54% of respondents live with five or more people – often in a single room1, and 64% share a water point with 10 or more people2.

Despite these challenges, the urban poor report they are engaging in a number of practices to prevent contracting COVID, and which build on their widespread understanding and knowledge of the virus.

Almost all respondents had heard of COVID-19 (99.4%), with their source of information coming from TV (85%), word of mouth (67%) and Government SMS/mobile audio announcement (36%)3. There was generally high knowledge regarding the risks the virus poses to the elderly, with 58% reporting that the elderly were most at risk from COVID-19. However, some mis-information persists, with 12% of participants reporting that they believed ‘inevitable death’ was a consequence of contracting COVID-19.

Most respondents could mention at least one key symptom of the virus. When asked ‘what are the symptoms of COVID-19?’ – 86% of respondents reported fever, 78% coughing, 56% sore throat, 34% difficulty breathing and 28% reported body aches. However, some rarer symptoms of COVID, such as sneezing (mentioned by 48% of participants) were also thought to be common symptoms. There was limited awareness that anosmia (loss of taste and smell) could be a symptom of COVID-19, reported by only 1.6% of respondents4.

An overwhelming majority (99%) of respondents reported being engaging in preventative practices against COVID-19. 94.9% of respondents are regularly washing their hands, with 82.3% of respondents report that they wash their hands at least four times a day with soap and water. Other preventative measures being utilized include drinking and gurgling hot water (39%), washing clothes immediately after returning home (32%) and prayer (5%)5. Whilst 84% of respondents report they are wearing masks, FGD’s with data-collectors revealed that respondents who engaged in a highly physically demanding job (such as a rickshaw puller or day-laborer) reported challenges in wearing a mask for the duration of the day, and would often wear a mask around the neck or the mask would be hanging from their ear in order to breathe.

The urban poor experience several barriers to access testing and health care for COVID-19. 12% of all respondents believe they may have had COVID-19, but had not been tested. Key barriers to testing included fear of having a confirmed diagnosis (45%) or not being sure if symptoms warranted a test (30%). Other key barriers included a lack of knowledge regarding the availability of testing (28%) and testing locations (27%) and a fear of contracting COVID if they visited a testing site (22%)10. Social pressures appeared to have some influence, with 8% of respondents stating that they had not gone for a test following a conversation with another family or community member.

However, 62% of the urban extreme poor believe they are at little to no risk of COVID-19 infection6. Respondents reported that they considered themselves to be at lower risk because they are ‘careful’ or diligently engage in preventative practices (73%), that their faith and prayers are keeping them from harm (42%) or that COVID is a ‘rich man’s disease’ (7%)7.

However, respondents are very concerned about what will happen if they contract COVID-19. A loss of income as a result of needing to isolate and being unable to work was a key concern discussed by 82% of respondents. Other concerns included the impact on their family (78%), fear of potential death (27%) as well as issues with complying to self-isolation measures (46%)8. Respondents also discussed a wide range of practices they would adopt to prevent the transmission of the disease including staying at home (47%), washing hands (33%), attempting to social distance (28%), self-isolation (28%) and wearing a mask inside (11%) or outside the home (19%)9.

This study highlights the need for NGOs, government actors and health service providers to work in collaboration with the urban poor to reduce the barriers to engaging in preventative practices and accessing health care. Public health information and programs should build on existing knowledge of populations and acknowledge the specific contextual constraints experienced by urban poor populations.

Recommendations include:

  • Ensure the urban poor are equipped with the tools and resources to engage in effective preventative practices and health-seeking behaviors to response to COVID-19. There is a need for a comprehensive, coordinated plan to address the testing and self-isolation constraints faced by the urban poor which places them at risk of poorer health and economic outcomes.
  • Develop targeted awareness-raising campaigns that harness the voices and perspectives of the urban poor to address misinformation and reduce stigma and unfounded beliefs regarding COVID-19.

Note on methods: This survey was conducted by nine Amrao Manush and SAJIDA call-center staff via mobile phone. Data collection occurred from the 16th June to the 2nd of July. Surveys took approximately 20 minutes to complete. Verbal informed consent was acquired from participants before proceeding with the survey.  Following the completion of the data collection period, the research team conducted two FGD’s with staff, to discuss their perceptions and observations throughout data collection and program recommendations.

The survey utilized a convenience quota to sample survey participants. The program has a database of approximately 2400 phone numbers of active service users. The survey aimed to capture a wide range of participants who access services, including a range of ages, genders and living locations (pavement, squatter and slum). Call lists were developed by paramedic/ para-councilor and call center staff, to try and capture this range of characteristics.  Calls were made to the listed database numbers, and data collectors talked to whoever answered the phone or who was available to talk.

This blog has been authored by Dr. Shoshannah Kate Williams & Saqeef Jameel ShahabuddinUrban Programs Team, SAJIDA Foundation

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