"Kuteteza": A community-engaged COVID-19 Prevention and Protection Initiative in Southern Malawi.

Background

The COVID-19 epidemic in Malawi involved almost 90,000 recorded cases and 2,638 deaths. In response to early concerns about vulnerable older people in rural areas, we developed 'Kuteteza': a COVID-19 mitigation response project. Clinicians, public health professionals, and researchers collaborated with government and district-level staff in two Southern Malawi districts. Interventions included supported 'shielding' of older people - minimising social mixing whilst having their daily needs supported. Additional mitigation strategies included provision of masks, handwashing stations, and soap. Government partnerships allowed additional support for vulnerable groups. We present the findings of a realist project evaluation, assessing the feasibility of this approach.

Methods

We collated anonymised descriptive data on Kuteteza procedures and conducted qualitative structured observations in villages involved in the initiative. We carried out three focus groups involving community members, frontline health staff, and volunteers in each setting. These provided deeper insights into experiences of the pandemic and impacts of the intervention, including suggested opportunities during future outbreaks.

Results

The project involved 25 villages across two districts, with 1,087 people over the age of 60 voluntarily participating in 'shielding'. Supplies of food, water, and cooking fuel were mostly arranged within the family. In Kuteteza villages, the handwashing stations and soap were widely used, and there was awareness and some observance of COVID-19 prevention measures. The project, including the provision of supplies, was greatly appreciated by communities, but wider contextual constraints - namely widespread economic insecurity - presented persisting challenges. Suggestions for improvement largely concerned project enhancements and extensions.

Conclusions

Through effective stakeholder engagement and contribution to national response strategy, the Kuteteza project helped raise COVID-19 awareness and supported populations at a critical time in the pandemic. Kuteteza approaches were welcomed locally and may be incorporated in future epidemic responses. Supported 'shielding' should be paired with government-led measures to mitigate economic hardship.

During the COVID pandemic in Malawi, cases were seen first and most often in the cities. Serious concerns were raised about how the pandemic might affect more rural populations, with poorer access to healthcare, greater income insecurity, and higher numbers of older adults (aged over 60 years). In an effort to prevent the worst of the expected impacts for older adults living in the villages, we formed a partnership of health workers, researchers, and policymakers, setting up the 'Kuteteza' response project (meaning ‘to protect’ in the Chichewa language). The project worked with community members in 25 villages, supporting communities to enable 'shielding' of older adults: minimising their social mixing whilst also providing items such as handwashing stations, masks, food parcels and regular supplies of soap. Volunteers and health workers engaged with residents, spreading evidence-based information about COVID and feeding back community insights. This paper describes the results of a project evaluation – reporting numbers of villages and people involved, observations from participating villages, and insights from community members in focus groups. One of the mains strengths of the project was in how the team worked together and with communities themselves, making sure actions were in line with national and regional policy and guidance and that it could quickly adapt to evolving needs as the pandemic progressed. We recommend these approaches for future responsive health projects, and present the outcomes of our evaluation for learning and discussion.

Informations de copyright

Copyright: © 2024 Mategula D et al.

Déclaration de conflit d'intérêts

No competing interests were disclosed.