Socio-demographic characteristics of the respondents
Out of the 425 respondents for the face-to-face interviews, most were females (66.4%; 282/425); aged 26 to 33 years (26.8%; 114/425); had attained secondary as their highest level of education (46.6%; 198/425); and were Muslims (32%; 136/425). Sixty three percent (268/425) of the respondents reported earning an average of between 50–300,000 Ugandan shillings (less than 100 dollars) per month (Table 1).
Table 1
Socio-demographic characteristics of the respondents
Variable
|
Frequency (n = 425)
|
Percentage (%)
|
Sex
|
|
|
Male
|
143
|
33.65
|
Female
|
282
|
66.35
|
Age (years)
|
|
|
18 to 25
|
78
|
18.35
|
26 to 33
|
114
|
26.82
|
34 to 41
|
96
|
22.59
|
42 to 49
|
65
|
15.29
|
≥ 50
|
72
|
16.94
|
Mean (SD)
|
37.22 ± 12.6
|
|
Highest level of education
|
|
|
No formal education
|
42
|
9.88
|
Primary
|
155
|
36.47
|
Secondary
|
198
|
46.59
|
Tertiary
|
30
|
7.06
|
Marital status
|
|
|
Married
|
166
|
39.06
|
Single
|
94
|
22.12
|
Co-habiting
|
76
|
17.88
|
Divorced / separated
|
59
|
13.88
|
Widowed
|
30
|
7.06
|
Religion
|
|
|
Anglican
|
131
|
30.82
|
Catholic
|
99
|
23.29
|
Muslim
|
136
|
32
|
Seventh Day Adventist
|
8
|
1.88
|
Pentecostal
|
41
|
9.65
|
Others
|
10
|
2.35
|
Occupation
|
|
|
Casual labourer
|
46
|
10.82
|
Employed
|
44
|
10.35
|
Self-employed
|
221
|
52
|
None
|
113
|
26.59
|
Others
|
1
|
0.24
|
Average income earned per month (Ugandan shilling)
|
|
50–300,000/=
|
268
|
63.06
|
300,001- 500,000/=
|
41
|
9.65
|
500,001–1,000,000/=
|
2
|
0.47
|
None
|
114
|
26.82
|
Socio-economic And Health Impact
Most respondents reported: limited access to food (71.1%; 302/425); disruption in education (77.1%; 270/350); a drop in daily income and wages (86.1%; 329/382); loss of employment, (63.1; 125/198); limited access to cooking energy (52.7%; 224/425); and limited access to transport (68.5%; 291/425). Most respondents mentioned no impact of COVID-19 on: access to water (65.9%; 280/425); sanitation and hygiene facilities (68.7%; 292/425); and access to health care services (71.5%; 304/425). Twenty five percent of the respondents 25.4%; 86/338) reported domestic violence. Almost half (40.2%; 171/425) of the respondents reported mental health challenges including reduced sleep, anxiety and urge to drug use (Table 2).
Table 2
Immediate socio-economic and health consequences due to COVID-19 in Bwaise I and Bwaise III, Kampala Uganda
Impact on:
|
High
|
Moderate
|
Low
|
No impact
|
Household access to food
|
302 (71.06)
|
41 (9.65)
|
20 (4.71)
|
62 (14.59)
|
Household access to water
|
96 (22.59)
|
28 (6.59)
|
21 (4.94)
|
280 (65.88)
|
Household access to sanitation and hygiene services
|
82 (19.29)
|
31 (7.29)
|
20 (4.71)
|
292 (68.71)
|
Education (n = 350)
|
270 (77.14)
|
9 (2.57)
|
4 (1.14)
|
67 (19.14)
|
Household daily wages and incomes (n = 382)
|
329 (86.13)
|
21 (5.50)
|
4 (1.05)
|
28 (7.33)
|
Employment (n = 198)
|
125 (63.13)
|
10 (5.05)
|
8 (4.04)
|
55 (27.78)
|
Domestic violence (n = 338)
|
86 (25.44)
|
22 (6.51)
|
21 (6.21)
|
209 (61.83)
|
Social behaviours
|
40 (9.41)
|
8 (1.88)
|
7 (1.65)
|
370 (87.06)
|
Family welfare
|
118 (27.76)
|
30 (7.06)
|
25 (5.88)
|
252 (59.29)
|
Household lighting
|
136 (32.00)
|
32 (7.53)
|
26 (6.12)
|
231 (54.35)
|
Household cooking energy
|
224 (52.71)
|
34 (8.0)
|
17 (4.00)
|
150 (35.29)
|
Transport
|
291 (68.47)
|
22 (5.18)
|
22 (5.18)
|
90 (21.18)
|
Health
|
87 (20.47)
|
43 (10.12)
|
17 (4.00)
|
278 (65.41)
|
Access to health care
|
89 (20.94)
|
19 (4.47)
|
13 (3.06)
|
304 (71.53)
|
Mental health
|
171 (40.24)
|
27 (6.35)
|
23 (5.41)
|
204 (48.00)
|
From the analysis of FGDs and photovoice findings, the following themes emerged under socio-economic and health consequences due to COVID-19 and response activities; limited access to food; negative impact on children rights and education; poor housing and lack of accommodation; negative social behaviours; negative impact on family and child care; reduced income and employment; and negative impact on health and access to health care services.
Factors associated with one of the highest reported impact on socio-economic and health vulnerabilities due to COVID-19 in Bwaise I and Bwaise III, in Kampala Uganda
Impact On Household Access To Food
After adjusting for potential confounders, respondents aged 25 to 33 years (adjusted PR = 1.19, 95% CI: 1.01–1.41); 42 to 49 years (adjusted PR = 1.22, 95% CI: 1.01–1.47); and ≥ 50 (adjusted PR = 1.22, 95% CI: 1.01–1.48) were more likely to have limited access to food. Respondents who reported earning an average monthly income of 300,001/= and above were 0.74 times less likely to have limited access to food (adjusted PR = 0.74, 95% CI: 0.55–0.98), see Table 3.
Table 3
Crude and adjusted factors associated with the impact of COVID-19 on household access to food and socio-demographic characteristics
Attributes
|
Impact of COVID-19 on household access to food
|
Unadjusted PR
(95% CI)
|
Adjusted PR
(95% CI)
|
P value
|
|
Low (n = 82)
|
High (n = 343)
|
|
|
P value
|
Sex
|
|
|
|
|
|
Male
|
29 (20.3)
|
114 (79.7)
|
0.98 (0.89–1.09)
|
1.03 (0.93–1.15)
|
0.542
|
Female
|
53 (18.8)
|
229 (81.2)
|
1
|
1
|
|
Age (years)
|
|
|
|
|
|
18 to 25
|
23 (29.5)
|
55 (70.5)
|
1
|
1
|
|
26 to 33
|
19 (16.7)
|
95 (83.3)
|
1.18 (1.01–1.39) *
|
1.19 (1.01–1.41)
|
0.044
|
34 to 41
|
17 (17.7)
|
79 (82.3)
|
1.16 (0.98–1.38)
|
1.18 (0.99–1.41)
|
0.063
|
42 to 49
|
10 (15.4)
|
55 (84.6)
|
1.20 (1.01–1.43) *
|
1.22 (1.01–1.47)
|
0.038
|
≥ 50
|
13 (18.1)
|
59 (81.9)
|
1.16 (0.97–1.39)
|
1.22 (1.01–1.48)
|
0.037
|
Highest level of education
|
|
|
|
|
|
No formal education
|
7 (16.7)
|
35 (83.3)
|
1
|
1
|
|
Primary
|
20 (12.9)
|
135 (87.1)
|
1.05 (0.90–1.21)
|
1.05 (0.91–1.21)
|
0.496
|
Secondary
|
45 (22.7)
|
153 (77.3)
|
0.93 (0.79–1.08)
|
0.96 (0.82–1.12)
|
0.596
|
Tertiary
|
10 (33.3)
|
20 (66.7)
|
0.80 (0.60–1.07)
|
0.84 (0.61–1.15)
|
0.270
|
Marital status
|
|
|
|
|
|
Married
|
42 (17.4)
|
200 (82.6)
|
1
|
1
|
|
Single
|
22 (23.4)
|
72 (76.6)
|
0.93 (0.82–1.05)
|
0.99 (0.87–1.12)
|
0.868
|
Divorced / separated
|
12 (20.3)
|
47 (79.7)
|
0.96 (0.84–1.11)
|
0.93 (0.81–1.07)
|
0.496
|
Widowed
|
6 (20.0)
|
24 (80.0)
|
0.97 (0.80–1.17)
|
0.89 (0.74–1.07)
|
0.225
|
Occupation before
pandemic
|
|
|
|
|
|
Casual labourer
|
7 (15.2)
|
39 (84.8)
|
1
|
1
|
|
Employed
|
13 (29.6)
|
31 (70.4)
|
0.83 (0.66–1.04)
|
0.88 (0.70–1.11)
|
0.277
|
Self-employed
|
44 (19.8)
|
178 (80.2)
|
0.95 (0.82–1.09)
|
0.97 (0.84–1.12)
|
0.700
|
None
|
18 (15.9)
|
95 (84.1)
|
0.99 (0.86–1.15)
|
0.88 (0.72–1.08)
|
0.225
|
Average monthly income
|
|
|
|
|
None
|
16 (14.0)
|
98 (86.0)
|
1
|
1
|
|
50–300,000/=
|
53 (19.8)
|
215 (80.2)
|
0.93 (0.85–1.03)
|
0.84 (0.69–1.01)
|
0.060
|
300,001- above
|
13 (30.2)
|
30 (69.8)
|
0.81 (0.66–1.00)
|
0.74 (0.55–0.98)
|
0.035
|
Unintended immediate social consequences due to COVID-19 and response activities
Negative Impact On Children Rights And Education
Closure of schools due to COVID-19 with no clear mechanism of continued learning at home exposed most children to several consequences. Photovoice participants noted that some children were exposed to forced labour either to provide extra income to the family or as their own initiative. Engagement of children in labour was mentioned by participants as likely to expose them to COVID-19, sexual violence, early pregnancies, undesirable behaviours and increase school dropout. A photographer explained the extent of the impact on children rights and education.
“Many children have become involved in petty trade and most of these are unwilling to return to school. I am sure a substantial percentage of these children will drop out of school when schools fully reopen. Sending children especially girls to sell merchandise is problematic because they may get molested or sexually assaulted by the men they find along the way” (Photographer 3, female, age 38)
Participants in both the FGDs and photovoice mentioned increased teenage pregnancies and early child marriages since the onset of COVID-19 (Photo 1). This was attributed to teenage girls being out of school and redundant at home with their parents and guardians focused on making income for survival. Unwanted pregnancies were also attributed to the girls lacking basic needs hence looking out to men for survival.
“My issue is that since schools were closed during COVID-19 outbreak, we saw many girls drop out of school. These girls have got unwanted pregnancies and as a mother, I can’t take care of the pregnant girl and the unborn baby because I have no money or a job. I could have taken care of the pregnant girl but the workplaces were closed. We have been affected so much by this situation.” (Female FGD, Participant 2, Bwaise III)
Limited access to food
Many study participants in the FGDs and photovoice mentioned reduced access to food given that most had their income reduced, lost jobs and some had their businesses shut down during the pandemic. Reduced access to food was expressed in terms of no money to buy the food, increased food prices and limited availability of certain foods. Patients suffering from chronic illnesses were affected more because they had to take their medication on an empty stomach. Most participants mentioned reduced: frequency of meals, eating of a balanced diet and portions (Photo 2) as a coping strategy.
“…COVID-19 affected me so much because I was used to eating two meals a day but I can no longer do that. We now have one meal a day and that is supper. We take a cup of tea a day at 4pm and prepare the little food we have. At 7pm, we have our supper and sleep. The earnings also reduced.” (Female FGD, Participant 8, Bwaise III)
Impact on family and child care
Cases of domestic violence in the slum communities were mentioned to have increased during the COVID-19 pandemic. Participants attributed this to no money to sustain homes, increased leisure time at home and loss of jobs by the bread winners. Relatedly, some families were said to have broken up due to the heightened violence and also increased demands for basic needs from the family.
“… I might even shed a tear while talking. First of all, i was beaten up during that time (lockdown). I was beaten up because I had no money. The child would ask me for food but I had nothing. My husband would ask for food and later beat me up. There is nothing I gained from the situation except being beaten up.” (Female FGD, Participant 4, Bwaise III)
Increased Drug Use And Abuse
Study participants in the photovoice also noted an increase in the number of people using drugs since the beginning of the lockdown (Photo 3). Most people are cited drinking alcohol from early morning hours to evening and others smoking cannabis and marijuana, with some developing mental illnesses. Some photovoice participants attributed the increase in drug use to increased stress in the population due to loss of jobs and income and others attributed it to several people having too much time and idleness, most of them having lost jobs and businesses.
“…the truth is we have had a rising number of such cases (cases of drug abusers) due to COVID-19 situation. Because, they (community members) searched for what to do and failed to get a job. They looked for money and what to eat and failed to get so they got frustrated and started drugs. That was a sensible person (photo 5) before COVID-19 situation but now, see what he has become.” (Photographer 7, male, age 32)
Unintended Immediate Economic Consequences Due To Covid-19
Reduced income and loss of employment
Most participants in photovoice and FGD mentioned loss of employment as one of the consequences of COVID-19. The loss of employment was largely a result of most companies laying off staff and others because of the shutdown of businesses during the lockdown. Loss of employment was said to have greatly impacted access to basic needs and family stability.
“…people lost jobs, curfew also affected food sellers because customers were limited, those with bars sent away many workers who are now jobless; those who have lodges aren’t functional yet it also employed many people; boda-boda riders were affected by curfew as well, schools were also affected so much.” (Male FGD, Participant 1, Bwaise III)
During the lockdown and after, several businesses in the community collapsed and others had reduced performance in terms of customers and income generation. Collapse of businesses was attributed to some people using up the capital for food to survive during the lockdown and reduced performance attributed to most people having no money to buy from the business vendors.
“COVID-19 situation affected me so much because I used to have a retail shop and the school going students would buy from me. I am a widow with many children but I had to close the shop. The little capital I had was used to buy and stock food during the COVID-19 lock down and every day would just pass by. I even lacked money to buy water and sugar.” (Mixed FGD, Participant 6, Bwaise III)
Inability To Afford Housing And Accommodation
Both photovoice and FGD participants mentioned several community members have since the start of COVID-19 accumulated rent arrears with some being evicted from the houses and shops (Photo 4). Accumulated rent arrears came because of unemployment and reduced income during the lockdown. Some community members were said to have resorted to residing in animal houses offered by neighbours.
“This photo shows the effect of COVID-19 on housing. The property in the photo belonged to a tenant who had been evicted. The tenant had rent arrears of four months and the landlord could not tolerate him any longer. Therefore, COVID has left many people homeless.” (Photographer 4, male, age 64)
Unintended Immediate Health Consequences Due To Covid-19
Reduced health and limited to access health care services
Due to limited movements during the lockdown, increased transport fares and no income, some slum dwellers resorted to not seeking health care when sick. They stayed indoors hoping to get better (Photo 5). More so, most said they were ignored and did not receive care when they visited the health centers as all attention was on COVID-19 patients. Those on chronic medication like people living with HIV, could not refill their medicines because of transport challenges.
“Some people who had chronic illnesses such as diabetes, HIV/AIDS and hypertension either worsened or died because there was very limited access to routine healthcare services. The limited access to health care services was due to absence of transport means to health facilities and change in priority of healthcare services to mainly focus on COVID-19 patients and neglecting other diseases.”(Photographer 5, female, age 60)
Respondents in the FGDs reported increased mental health conditions because of COVID-19 restrictions and related challenges. Most mentioned increased stress as a result of many needs against no money; others mentioned increased anxiety and disrupted sleep.
“We have all lost our minds during this situation. You find people walking while talking to themselves on the street. Others have tried sleeping but failed and others have got accidents because they walk without thinking. The landlords evict us and when you explain to them they also claim they built houses to make money. The children ask for food and when you talk to your husband, he just walks away. What I think is that the mental health issues will worsen in future because of this situation. People will only think 50% because of this stress.” (Female FGD, Participant 8, Bwaise III)