key: cord-355343-dtdsd8j2
authors: Buonsenso, Danilo; Cinicola, Bianca; Raffaelli, Francesca; Sollena, Pietro; Iodice, Francesco
title: Social consequences of COVID-19 in a low resource setting in Sierra Leone, West Africa
date: 2020-06-01
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.05.104
sha: 
doc_id: 355343
cord_uid: dtdsd8j2

Economical and psychological consequences of the lockdown in low-resource setting in rural Africa are unknown. We drafted a survey in order to address the social impact of COVID-19 lockdown on a rural village in Sierra Leone. The survey developed by the study group and translated in the local language, distributed to the householders of the village on April 13(th) and responses collected on April 14(th), when Sierra Leone was on day 11 of lockdown. The questions aimed to assess in the community the following items: age group, main activities before lockdown, change in income and ability to feed the family during lockdown, anxiety during lockdown. 78 householders (100% of Bureh Town) replied. All, expect one, declared a 51-80% (19.2%) to 81-100% (79.4%) reduction of weekly income compared with the pre-lockdown period, declaring difficulties in providing food for the family members (82%), and anxiety (60%). Our analyses showed that people lost their jobs and have difficulties in providing food for their families.

Liberia were closed; on April 3rd a three-day lockdown started and eventually on April 8th, due to the local escalation in reported cases, a 14-day lockdown was released, with the possibility of extension according to the epidemiological development. Despite these restrictions, on April 18th, 30 confirmed cases were reported, 532 people put in quarantine but still zero deaths related J o u r n a l P r e -p r o o f to COVID-19 were documented. Economical and psychological consequences of the lockdown in low resources setting in rural Africa are worrying the experts of global health (El-Sadr et al. 2020), but are still unknown and their early analysis will allow corrective interventions or preventive measures to support fragile areas to minimize the impact on the population.

We drafted a survey in order to urgently address the social impact of COVID-19 lockdown on the rural village of Bureh Town, Sierra Leone, West Africa (figure 1) and quickly implement corrective measures. It was developed in English by the lead author, reviewed by the research team and translated in the local language by the Headman and the authors of this study. The headman represent the chief of rural areas in sub-Saharan West Africa, being comparable as a mayor of city in high resource countries. The survey had been deliberately made simple so that everyone could respond regardless of schooling and included questions on age of the respondents, number of people and age groups of people living in the house, work situation and weekly income before and after the lockdown. The administered survey was composed with a descriptive purpose and composed of detailed questions aimed to assess the following items in the community: age group, main activities before lockdown, change in income and ability to feed the family during lockdown, anxiety during lockdown (supplementary material). The survey was a clinical/demographic one with descriptive aims. (table 1) , representing a total of 560 Bureh Town citizens (142 children under 5; 75 aged between 6 and 15; 80 aged between 16 and 25; 186 aged between 25 and 40, 75 aged between 40 and 60; 12 aged more than 60 years). All people were dependent from the local stream to collect water, where the younger groups of the family go every morning for this issue.

People were involved in local jobs such as: fishing (20, 25.7%), tourism (18, 23.1%), marketing (81 10.2%), schoolteacher (4, 4.1%), others (8, 10.2%) while 20 (25.7%) declared not to have a job before the lockdown. All householders, expect one, declared a 51-80% (15 householders, 19.2%) to 81-100% (62 householders, 79.4%) reduction of weekly income compared with the pre-lockdown period, declaring difficulties in providing food for the family members in 82% of respondents, due to lack of economic resources related to the reduced income and activities related to the lockdown; 76.9% of respondents declared to be very worried about economic fallout from the lockdown with 60% of householders declaring a mild-moderate anxiety.

Our analyses, even if just focused on a small village, showed a profound indirect impact of SARS-CoV-2 spread in Sierra Leone. Considering the rapid worldwide diffusion of COVID-

dramatic health impacts (of note only one ventilator is available for the whole population of Sierra Leone). Lockdown seemed to be the only measure to delay contagion but this decision was not without consequences for people, especially those living in fishing and touristic areas of the country. In our survey, all people but one declared a 51% to 100% reduction of weekly income with consequences in the ability to provide food for the family members, thus confirming results by other studies (Dyer 2020) . Most of the respondents considered themselves worried J o u r n a l P r e -p r o o f about the situation with a mild percentage of the population living in a mild-anxiety state. In fact, the households provided the response on day eleven since first lockdown was declared, meaning that local touristic activities, as well as minor markets, were already affected, with economic consequences for local workers, by more than seven days. These results are probably due to the fact that, differently from governments of high-income countries, community members were not supported by the administrations. For example, in the European Union and the United States, the government pushed the economy providing billions of euros/dollars to support those families that lost jobs or whose income was severely affected by the reduced business. The findings of our survey confirm the fear of severe consequences of the spread of SARS-CoV-2 in sub-Saharan Africa and the need for special surveillance tools(El Zowalaty and Järhult 2020). Although Kapata et al.(Kapata et al. 2020) gave a positive answer to the question "Is Africa prepared and equipped to deal with yet another outbreak of a highly infectious disease -COVID-19?", our data suggest that community members is economically and then psychologically suffering from this situation. Certainly, substantial progresses has been made in Africa since the 2014-16 Ebola outbreak (Delamou et al. 2017) , with lessons learned from previous and ongoing outbreaks (Largent 2016; Omoleke et al. 2016 

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We are thankful to the local operators of Bureh Village: Ismail Jaber, Matilda Yamba, Prince Williams, Memunatu N Kallon, Nee Turay. We are also grateful to all our colleagues that 

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