At the time of the interview, participants ranged in age from 21 to 64 years. A total of 27 women and 25 men were included in the study. Table 1 provides sociodemographic characteristics of the study participants.
Table 1
Social-demographic characteristics of study participants (n = 52)
Variables
|
|
n
|
%
|
Number of women interviewed
|
27
|
52
|
Number of men interviewed
|
25
|
48
|
Age
|
|
|
|
|
18-30
|
17
|
33
|
|
31-60
|
28
|
54
|
|
60+
|
7
|
13
|
Marital status
|
|
|
|
|
Single
|
18
|
35
|
|
Married
|
34
|
65
|
Education
|
|
|
|
|
Primary
|
13
|
25
|
|
Secondary
|
23
|
48
|
|
Tertiary
|
16
|
31
|
Professional
|
|
|
|
|
Business
|
31
|
60
|
|
Academics
|
4
|
8
|
|
Health related field
|
17
|
33
|
City
|
|
|
|
|
Blantyre
|
17
|
33
|
|
Lilongwe
|
17
|
33
|
|
Mzuzu
|
17
|
33
|
Religion
|
|
|
|
|
Christian
|
31
|
60
|
|
Moslem
|
14
|
27
|
|
Others
|
7
|
13
|
The results of our study include quotations, to illustrate how participants attached meaning to each emerging theme. We selected the quotations using the criteria suggested by (39) in Malawian context that include: (1) the ability to represent divergent perspectives; (2) typical views expressed by many respondents; and (3) the depth or clarity with which the ideas are conveyed. Pseudonyms have been used to protect confidentiality of the research participants. Our study identified four overarching themes that appear to undermine participants’ risk perception of COVID-19 epidemic. In this paper, we employed the health belief model to understand people’s perception of risk and their action to prevent the disease.
Our results revealed that several beliefs influenced perception of COVID-19 risks among the research participants. The following paragraphs present the common themes that are related to low and high-risk perception of COVID-19 among urban dwellers in Malawi.
Religious beliefs
Our study releveled a number of risk factors related to religious beliefs that influenced risk perception of COVID-19 in urban Malawi. One of the low risk factors was linked to the belief of coming of Christ. Some Christian participants understand that Jesus, the son of God, warned the world about his return to judge humanity and one signal of his return is a global pandemic. Therefore, some respondents ascribe to this prophecy and maintain that COVID-19 is fulfilling the Christian Holy Scriptures marking the end of days. The following excerpt from a pastor in Mzuzu city illustrates this view.
“This is not a real virus like HIV; rather, it is a disease from the darkness. The evil spirits have brought this disease to attack only those who are not righteous. This is a sign of the coming of Jesus to redeem righteous people in the world and the police are accomplices of this prophecy” [Leah, Businesswoman, 47 years, Mzuzu].
Consistent across faiths, multiple participants reporting those who do not pray and have little or no faith in God are more likely to be infected by COVID-19, unlike believers. One local leader reported, the only way to avoid COVID-19 is to repent, which is a perception in sharp contrast to scientific preventative measures. Some participants ascribed to the theory that COVID-19 has emanated from the wrath of God. They claimed that the sins of the world have angered God. Furthermore, most of the respondents reported that God wants to wipe out humankind from the earth through the epidemic. They substantiated their line of narrative regarding the biblical stories of Noah and the fate of Sodom and Gomorrah. In all these given scenarios, they claimed God used heavy rain and fire to destroy the sinful people. These religious participants perceived that COVID-19 is an act of God. One key respondent from Islamic faith explained this view while showing a photo of destruction of Sodom and Gomorrah:
“This pandemic is Kiamah (punishment) from Allah to humankind for their sins. Allah has been tolerating the sins that people have been committing, such as stealing of government funds, prostitution, and murdering of albinos in this country. God has seen that people are not repenting, and he wants to punish them” [Chejuma, 36, businessman, Blantyre].
Religious ideologies undermined perceived risk of contracting COVID-19 among the participants. According to half the participants, the onset of COVID-19 fulfills the biblical prophecy in the book of Revelations. One participant shared, the book outlines in the days prior to the return of Jesus, people will experience many horrible things. One further potential sign is the number 666, which is considered the number of the beast. They purport that “antichrist people” will force this number upon Christians. The accompanying excerpt illustrates a purported connection between 666 and COVID-19 pandemic.
“The government last year told us we should get the national identity cards so that everyone should have a number. They said that without that number we cannot access social services. This year they say there is COVID-19, which is claiming the lives of people. To avoid it, the government has shut down churches. This is strange, as God commands us to pray all the time. This government wants us to stop praying; perhaps the numbers on the national cards will work now. I cannot follow their advice, as I do not want to get the 666 number” [Chisomo, 21, businesswoman, Lilongwe].
Some religious participants voiced their doubts about COVID-19 vaccination research. Sharing that God’s followers should not take part in the trials. One participant suggested that the COVID-19 vaccine would induce a mark of triple six, a negative omen among devout Christians. Another respondent assumed that COVID-19 is a disguised Roman numeral number 666 that has come through this epidemic. He suggested that antichrists have mixed the roman numerals C=100, VI = 6, D = 500, and minus 19 to prevent people from understanding that it is the number 666. Therefore, religious beliefs influence some participants and ultimately counter public health information and initiatives. Although participants showed knowledge of risk factors and mitigation methods, they did not consider themselves at risk because of religious beliefs and political affiliations. Many reported that, if they remained devout, they could not contract the disease.
Political beliefs
Two polarizing views emerged from Malawians based on their political affiliation concerning their risk perception associated with contracting COVID-19. Respondents’ views were linked to the principle of cost and benefits within the broader HBM framework. Our findings shows that a high-risk perception of COVID-19 was seen as beneficial to the then-ruling party, as its leadership would remain in power if they cancelled the presidential elections in June 2020. However, compliance with isolation strategies was perceived to undermine the capacity of opposition parties to challenge ruling party through the democratic election. Participants who supported the then-ruling party claimed that COVID-19 is real and the prevention measures that the government planned were in the best interest of Malawians. In this example, the participant held the view that they were at high risk of contracting the disease and justified lockdown measures. The following scenario exemplifies this line of reasoning as a participant showed the pictures of opposition party political rallies.
“The opposition parties are reducing concerted government efforts towards combating COVID-19. If you can see, they challenged the presidential order of lockdown and they have started their public political campaigns. Our president is leading by example as he is on self-quarantine. Our presidential running mate is distributing facemasks whenever he is conducting political rallies” [Christopher, 25, Businessman, Blantyre].
We observed that the participants that self-identified with political opposition parties claimed that there were no COVID-19 cases in Malawi as they argued that the then-government wanted to capitalize on the crisis. Yet, the issue that the illness is fake or exaggerated created genuine concern for some of our participants. In Malawi, there have been no public declarations of COVID-19 infections. Lack of COVID-19 disclosure undermines the perceived risk of contracting the disease by some participants. The following excerpt illustrates this point of view as supported by a newspaper photograph.
“There is no COVID-19 in Malawi. Look in Britain, the Prime Minister Boris Johnson disclosed that he was suffering from coronavirus. We could see on television how his condition was deteriorating. What is so special with Malawi that even a single person has come to the open to say he or she is suffering from it? This is just government propaganda to shun away from the presidential election” [Phiri, Businessman, 26, Mzuzu].
The excerpt suggests that some opposition political leaders encouraged people to patronize their political rallies. Six participants added that top official of the then-coalition opposition parties encouraged political patrons to hug each other as a proof that there is no COVID-19.
This approach undermined risk perception among supporters of the opposition parties. The interviews with health professionals show a higher risk perception attributed to COVID-19 regardless of their political party affiliation. The following excerpt illustrates the risk perception in one of the health care workers:
“We had a COVID-19 orientation, and we were told that the disease is dangerous and deadly, hence the need to observe and follow all the precaution measures. For example, we need to practice social distancing -thus sitting 3 meters apart from each other, and no handshakes. People should always put masks on their face, and they should frequently wash their hands”. [Neri, 31, Healthcare, Lilongwe].
Neri’s statement suggests that some health professionals in Malawi accepted public health recommendations and ascribed to COVID-19 preventative measures.
The final theme that emerged is lack of trust in the government. Rampant corruption reduced public trust in the government in Malawi, which undermined citizens’ perceived risk of contracting COVID-19. Some participants claimed that some donor organizations remitted COVID-19 funds to countries that registered the disease in Africa. Reporting that, in Malawi, there was no case of the epidemic before April 2, 2020, and that the government colluded with health workers to claim that some people were tested positive for COVID-19. These participants felt politicians would use COVID-19 funds for self-enrichment. One participant recounted a record of two government Ministers caught on camera on national television discussing ways of concealing evidence that they are collecting COVID-19 allowances.
“My suspicion that this government fabricated that there is COVID-19 in Malawi for them to get rich out of this pandemic was verified yesterday on MBC TV. The minister of health, Jappie Mhango and information minister, Mark Botomani were not aware that microphones were turned on during COVID-19 briefing session. Believing they were speaking confidentially, Botomani warned Mhango that their tactic of withdrawing funds is about to be revealed to the public. I encourage you to access this link to understand more. https://www.nyasatimes.com/hrdc-gives-cabinet-ministers-botomani-and-mhango-7- days-to-resign/” [Thandizo, businessman, 34, Blantyre].
Thandizo’s sentiments about the behavior of the two ministers undermined her risk perception of contracting the disease. The two ministers were discussing how they can manipulate the COVID-19 funds as part of their allowances. Yet, the then-ruling party denied that ministers were not being getting the allowances drawn from the COVID-19 funds.