A complete data was obtained from 1,708 study participants above the age of 18 years who experienced clinical symptoms of COVID-19 (between 16 March – 31 December 2020) in Mogadishu districts and Garowe. Out of the total respondents (1,708), only 113 (6.6%) indicated that they had tested their COVID-19 status voluntarily whereas out of the total voluntarily tested individuals, 50 (44.2%) of them were tested positive. This indicates that the voluntary testing practice of COVID-19 in Somalia is far below the recommended practice by WHO and government of Somalia for individuals with clinical symptom of the virus to check their status voluntarily. This could also discourage the confidence of early case identification and the overall national and global efforts to promote preventive behaviors and mitigate the community transmission of the virus. According to [Table 1], almost one half, 842 (49.3%) of the respondents were female. Majority of the study participants 727 (42.6%) were in the age category between the age 26 and 33 years. more than one half, 1,012 (59.3%) of the respondents were at secondary level and above whereas 375 (22%) had no formal education. 1,023 (59.9%) of the study participants were married, followed by 447 (26.2) single. Out of the total respondents, only 230 (13.5%) had access to mass medias including the radios/TVs, however, 95.6% of the respondents had personal phones. 507 (29.7%) respondents indicated that their peers had an influence on their decisions to either attend or not attend for voluntary testing of COVID-19 at the public facilities. 339 (19.9%) of respondents indicated that the health workers discouraged them to attend for COVID-19 tests while they were clinically symptomatic. Majority of the respondents 790 (46.3%) were from households with 2-3 members whereas 578 (33.8%) respondents’ household members were 5 and above. Almost half, 822 (48.1%) of the respondents mentioned that COVID-19 positive individuals are stigmatized in their respective communities.
Table 1: Background Characteristics of the study participants (n = 1,708) Mogadishu and Garowe, Somalia March 2021
Characteristics
|
Frequency
|
Percentage (%)
|
Gender of the respondents
|
Female
|
842
|
49.3
|
Male
|
866
|
50.7
|
Age of the respondents
|
18 – 25 years
|
409
|
23.9
|
26 – 33 years
|
727
|
42.6
|
34 – 41 years
|
391
|
22.9
|
42 years and above
|
181
|
10.6
|
Education level of the respondents
|
No Formal Education
|
375
|
22.0
|
Primary Education
|
321
|
18.8
|
Secondary /and above
|
1012
|
59.3
|
Marital status of the respondents
|
Divorced
|
154
|
9.0
|
Married
|
1023
|
59.9
|
Separated
|
7
|
0.4
|
Single
|
447
|
26.2
|
Widowed
|
77
|
4.5
|
Telephone ownership (Personal)
|
No
|
76
|
4.4
|
Yes
|
1632
|
95.6
|
Household characteristics/composition
|
1 -2 individuals
|
340
|
19.9
|
3-4 individuals
|
790
|
46.3
|
5 and or above
|
578
|
33.8
|
Place of residence
|
Rural
|
34
|
2.0
|
Urban
|
1674
|
98.0
|
Insurance status of the respondents
|
Ensured
|
112
|
7%
|
Not insured
|
1596
|
93%
|
Majority of the study participants 1,674 (98%) were from urban. 804 (47.1%) of the total respondents lived less than 5 kilometers from the public testing centers, followed by 677 (39.6%) lived between 5 – 10 kilometers away from the public testing centers [see Table 1]. Majority of the respondents 1,328 (77.8%) indicated that only one member contributes to the monthly household income whereas only 62 (3.6%) indicated more than three sources of income for the monthly household income. Almost one half, 794 (46.5%) of the study participants indicated low monthly household income (Less than 1.9 USD per person per day). Majority of the households visited, 1435 (84%) were male headed households, whereas 882 (51.6%) of the respondents indicated that the husband was the household expense decision maker. Majority of the participants 1596 (93.4%) were not under health insurance coverage (not insured) [see Table 1]. Out of 113 respondents who attended for COVID-19 test at the testing facilities, majority 42 (37%) indicated waiting time for getting COVID-19 test of less than 15 minutes, however, 36 (32%) indicated waiting time of more than 30 minutes to get tested. Out 113 participants indicated to have gone for COVID-19 tests, 88 (77.9%) experienced overcrowd at the service facilities. Almost two-third of the respondents, 1,049 (61.4) had no access to outreach or health education programs. Majority of the study participants, 1,359 (79.6%) had awareness on the COVID-19 complications including the mortality and morbidities related to the virus. However, 511 (29.9%) of the respondents did not perceive the importance of COVID-19 tests for individuals with clinical symptoms. Equal number of respondents 571 (33.4%) perceived the severity of COVID-19 as moderate or severe whereas 567 (33.2%) of the respondents perceive the virus as a normal/ no more harm for the individuals. Majority of the study participants 1,344 (78.7%) of the respondents did not have chronic diseases. 184 (10.8%) out of the total study participants were disabled.
Anderson Behavioral Model Factors associated with Voluntary testing for COVID-19 Practice (VT4C-19)
In this study [see Table 2], we assessed the factors associated with voluntary testing practice among people with Clinical Symptoms of COVID-19 in Somalia. To control the possible confounder variables and identify the real predictor variables (Anderson’s Behavioral Model factors) associated with the dependent variable, the study used Multivariable Binary Logistic Regression model. The odds of Voluntary Testing for COVID-19 Practice (VT4C-19 practice) (p < 0.05) for men was 30% less (AOR 0.3; 95% CI: 0.2, 0.5, p<0.001) compared to its counterpart, 4.7-fold among the widowed compared to their counterparts of married and separated, AOR (95% CI): 2.1 (0.4, 9.9) and AOR (95% CI): 2.1 (0.5, 8.6) respectively. The Odds of VT4C-19 practice for those participants with available mass media was 2 times higher than those with no available mass media (AOR 2.0; 95% CI: 1.3, 3.2, p<0.05). the Odds of VT4C-19 practice was 2.5 times higher among the personal telephone owners than their counterparts without personal telephones (AOR 2.5; 95% CI: 1.3, 5.0, p < 0.05). The Odds of VT4C-19 practice was 42% less among those influenced by their peers than those with no peer influence (AOR 0.4; 95% CI: 0.3, 0.6, p<0.01). the study found that the Odds VT4C-19 practice was 40% less among those discouraged by the health workers compared to their counterparts (not discouraged by the health workers) (AOR 0.4; 95% CI: 0.3, 0.6, p<0.01). The Odds of VT4C-19 practice was 53% less among those participants with 5 and above household members (AOR 0.5; 95% CI: 0.3, 0.8, p< 0.05) than their counterpart with 3-4 household members AOR (95% CI): 0.9 (0.6, 1.5). The Odds of VT4C-19 practice was 38% less among those participants with those communities who stigmatize the COVID-19 cases (AOR 0.4; 95% CI: 0.3, 0.6, p<0.01) than those with no stigmatizing communities. Predisposing factors like the age of the respondents and education level did not reveal statistically significant association (p>0.05 with VT4C-19 practice of the study participants.
The Odds of VT4C-19 practice for urban resident participants was 7 times higher (AOR 7.4; 95 % CI: 3.5, 15.5, p<0.01) compared to Rural residents [Table 2]. The Odds VT4C-19 practice for Households (HH) with 2 sources of HH income was 33% less (AOR 0.3; 95 % CI: 0.2, 0.7, p<0.05) compared to participants with 3 or more HH sources of income AOR (95% CI): 0.7 (0.3, 1.6). The Odds of VT4C-19 practice for study participants from HHs with wife expense decision maker was 2.4 times higher (AOR 2.4; 95 % CI: 1.2, 4.9, p<0.05) compared to those with husbands or both. The Odds of VT4C-19 practice for insured study participants was 7.5 fold higher (AOR 7.5; 95 % CI: 4.7, 11.9, p<0.01) compared to non-insured study participants, however, the study found the Odds of VT4C-19 practice for study participants with access to outreach and/or health education programs was 50% less (AOR 0.5; 95 % CI: 0.4, 0.8, p< 0.05) compared to those with no access to outreach and/or health education programs. Enabling factors including distance from the testing centers and head of the households did not reveal statistically significant association (p>0.05 with VT4C-19 practice of the study participants.
The Odds of VT4C-19 practice for participants who perceived the importance of COVID-19 voluntary Test was 12.7-fold higher (AOR 12.7; 95 % CI: 4.7, 34.6), p<0.01) compared to those who did not perceive. The Odds of VT4C-19 practice for participants with chronic diseases 58% less (AOR 0.58; 95 % CI: 0.4, 0.9, p< 0.05) compared to those with chronic diseases. Need factors including awareness of the COVID-19 complications, illness severity and the disability did not reveal statistically significant association (p>0.05 with VT4C-19 practice of the study participants.
Table 2: Multivariate Logistic regression analysis of Anderson’s behavioral Modal and Voluntary Testing Practice Among People with Clinical Symptoms of COVID-19 in Somalia, April, 2021
|
Have you tested your C-19 status voluntarily?
|
|
Variable
|
No (%)
|
Yes (%)
|
COR (95 % CI)
|
AOR (95 % CI)
|
P - value
|
Gender of the respondents
|
Female
|
815 (97%)
|
27 (3%)
|
1
|
1
|
|
Male
|
780 (90%)
|
86 (10%)
|
0.291 (0.181, 0.467)
|
0.300 (.193, 0.468)
|
0.000
|
Age of the respondents
|
18 – 25 years
|
378 (92%)
|
31 (8%)
|
1
|
1
|
|
26 – 33 years
|
681 (94%)
|
46 (6%)
|
0.742 (0.287, 1.921)
|
1.402 (0.672, 2.926)
|
0.367
|
34 – 41 years
|
365 (93%)
|
26 (7%)
|
1.034 (0.441, 2.428)
|
1.155 (0.571, 2.336)
|
0.688
|
42 years and above
|
171 (94%)
|
10 (6%)
|
1.474 (0.628, 3.462)
|
1.218 (0.574, 2.583)
|
0.607
|
Education level
|
No Formal Education
|
353 (94%)
|
22 (6%)
|
1
|
1
|
|
Primary Education
|
305 (95%)
|
16 (5%)
|
0.558 (0.308, 1.010)
|
0.779 (0.477, 1.272)
|
0.318
|
Secondary /and above
|
937 (93%)
|
75 (7%)
|
0.959 (0.534, 1.720)
|
0.655 (0.376, 1.142)
|
0.136
|
Marital status
|
Divorced
|
146 (95%)
|
8 (5%)
|
1
|
1
|
|
Married
|
970 (95%)
|
53 (5%)
|
2.214 (0.420, 11.677)
|
2.055 (.426, 9.919)
|
0.370
|
Separated
|
7 (100%)
|
0 (0%)
|
1.876 (0.413, 8.524)
|
2.049 (0.490, 8.572
|
0.326
|
Single
|
397 (89%)
|
50 (11%)
|
0.000 (0.000 -)
|
0.000 (0.000, -)
|
0.999
|
Widowed
|
75 (97%)
|
2 (3%)
|
4.190 (0.860, 20.416)
|
4.723(1.125, 19.829)
|
0.034
|
Mass media availability
|
No
|
204 (89%)
|
26 (11%)
|
1
|
1
|
|
Yes
|
1391 (94%)
|
87 (6%)
|
2.403 (1.351, 4.276)
|
2.038 (1.284, 3.235)
|
0.003
|
Telephone ownership
|
No
|
65 (86%)
|
11(14%)
|
1
|
1
|
|
Yes
|
1530 (94%)
|
102 (6%)
|
2.403 (1.351, 4.276)
|
2.538 (1.299, 4.959)
|
0.006
|
Peer influence
|
No
|
1143 (95%)
|
58 (5%)
|
1
|
1
|
|
Yes
|
452 (89%)
|
55 (11%)
|
0.573 (0.375, 0.876)
|
0.417 (0.284, 0.613)
|
0.000
|
Discouragement from the Health Workers
|
No
|
1297 (95%)
|
72 (5%)
|
1
|
1
|
|
Yes
|
298 (885)
|
41 (12%)
|
0.591 (.375, .932)
|
0.403 (.269, 0.604)
|
0.000
|
Household characteristics/composition
|
1 -2 individuals
|
313 (92%)
|
27 (8%)
|
1
|
1
|
|
3-4 individuals
|
753 (95%)
|
37 (55)
|
0.795 (0.456, 1.385)
|
0.931 (0.570, 1.520)
|
0.776
|
5 and or above
|
529 (92%)
|
49 (8%)
|
0.528 (0.325, 0.859)
|
0.530 (0.341, 0.825)
|
0.005
|
In your community, is people with COVID-19 positive stigmatized?
|
No
|
852 (96%)
|
34 (4%)
|
1
|
1
|
|
Yes
|
743 (90%)
|
79 (105)
|
0.504 (0.317, 0.800)
|
0.375 (0.248, 0.568)
|
0.000
|
Place of residence of the respondents
|
Rural
|
23 (68%)
|
11 (32%)
|
1
|
1
|
|
Urban
|
1572 (94%)
|
102 (6%)
|
3.819 (1.532, 9.520)
|
7.371 (3.496, 15.540)
|
0.000
|
Distance from the public testing centers
|
Less than 5 KM
|
740 (92%)
|
64 (8%)
|
1
|
1
|
|
5 – 10 KM
|
647 (96%)
|
30 (4%)
|
0.664 (0.415, 1.062)
|
0.536 (0.343, 0.838)
|
0.006
|
Above 11 KM
|
208 (92%)
|
19 (8%)
|
1.585 (0.821, 3.062)
|
1.056 (0.619, 1.803)
|
0.841
|
Number of HH members contribute to monthly household income
|
1 source
|
1258 (95%)
|
70 (5%)
|
1
|
1
|
|
2 sources
|
284 (89%
|
34 (115)
|
0.943 (0.407, 2.184)
|
0.328 (0.155, 0.691)
|
0.003
|
3 or more
|
53 (85%)
|
9 (15%)
|
1.232 (0.517, 2.934)
|
0.705 (0.320, 1.555)
|
0.386
|
Head of the households
|
Child headed HH
|
16 (100%)
|
0 (0%)
|
1
|
1
|
|
Female headed HH
|
246 (96%)
|
11 (4%)
|
0.000 (0.000 -)
|
0.000 (0.000, -)
|
0.999
|
Male headed HH
|
1333 (93%)
|
102 (7%)
|
0.667 (0.310, 1.432)
|
0.584 (0.309, 1.105)
|
0.098
|
Expense decision maker at household level
|
Both Husband and wife
|
528 (94%)
|
35 (6%)
|
1
|
1
|
|
The husband
|
813 (92%)
|
69 (8%)
|
1.432 (0.607, 3.376)
|
1.871 (0.886, 3.951)
|
0.101
|
Wife
|
254 (97%)
|
9 (3%)
|
1.465 (0.634, 3.387)
|
2.395 (1.179, 4.866)
|
0.016
|
Insurance status of the respondents
|
Not insured
|
1515 (95%)
|
81 (5%)
|
1
|
1
|
|
Ensured
|
80 (71%)
|
32 (29%)
|
3.094 (1.781, 5.377)
|
7.481 (4.690, 11.934)
|
00.000
|
Outreach and health education programs
|
No
|
997 (95%)
|
52 (5%)
|
1
|
1
|
|
Yes
|
598 (91%)
|
61 (9%)
|
0.619 (0.415, 0.923)
|
0.511 (0.348, 0.750)
|
0.001
|
Awareness of C-19 complications
|
No
|
322 (92%)
|
27 (8%)
|
1
|
1
|
|
Yes
|
1273 (94%)
|
86 (6%)
|
1.954 (1.196, 3.191)
|
1.241 (0.792, 1.945)
|
0.346
|
Perceived importance of C-19 voluntary tests
|
Not important
|
507 (99%)
|
4 (1%)
|
1
|
1
|
|
Important
|
1088 (91%)
|
109 (9%)
|
22.59 (7.902, 64.588)
|
12.69 (4.656, 34.633)
|
0.000
|
Illness severity
|
|
|
|
|
|
Moderate
|
517 (91%)
|
54 (9%)
|
1
|
1
|
|
Normal
|
535 (94%)
|
32 (6%)
|
2.346 (1.450, 3.795)
|
2.101 (1.303, 3.386)
|
0.002
|
Severe
|
543 (95%)
|
27 (5%)
|
2.985 (1.701, 5.237)
|
1.203 (0.711, 2.035)
|
0.491
|
Chronic diseases (i.e. Diabetic and or hypertension)
|
No
|
1266 (94%)
|
78 (6%)
|
1
|
1
|
|
Yes
|
329 (90%)
|
35 (10%)
|
0.797 (0.514, 1.234)
|
0.579 (0.382, 0.879)
|
0.010
|
Disability among the respondents
|
No
|
1427 (94%)
|
97 (6%)
|
1
|
1
|
|
Yes
|
168 (91%)
|
16 (9%)
|
0.773 (0.432, 1.382)
|
0.714 (0.411, 1.240)
|
0.232
|