Article Text

Protocol
COVID-19-related attitudes, risk perceptions, preventive behaviours and economic impact in sub-Saharan African countries: implementing a longitudinal phone-based survey protocol in rural Senegalese households
  1. Valerie Seror1,2,
  2. Gwenaëlle Maradan3,
  3. El-Hadj Ba4,
  4. Sebastien Cortaredona1,2,
  5. Cyril Berenger3,
  6. Olivier L’Haridon5,6,
  7. Cheikh Sokhna1,2,4
  8. CO3ELSER group
    1. 1Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
    2. 2IHU, Mediterranée Infection, Marseille, France
    3. 3ORS PACA, Southeastern Health Regional Observatory, Marseille, France
    4. 4VITROME, Campus Universitaire de l'IRD, Hann, Senegal
    5. 5Univ Rennes, CNRS, CREM UMR 6211, Rennes, France
    6. 6Faculty of Economics, University of Rennes 1, Rennes, France
    1. Correspondence to Valerie Seror; valerie.seror{at}inserm.fr

    Abstract

    Introduction Rural areas are considered safe havens against the increased spread of COVID-19 and associated restrictive measures, especially in contexts where public authorities are not in a position to systematically and substantially ease COVID-19-induced economic shocks. In the current sub-Saharan Africa context, still marked by uncertainty surrounding the spread of COVID-19, we present the protocol of an ongoing longitudinal study aimed at investigating COVID-19-related attitudes, risks perceptions, preventive behaviours and economic impact in rural areas in Senegal.

    Methods and analysis A prospective randomised longitudinal study of 600 households located in three semiurban villages and nine randomly selected rural villages in the Niakhar area (located 135 km East of Dakar). Three ad hoc phone surveys are administered to 600 heads of households, their housewives in charge of managing the household and a relative living temporarily in the household, respectively. In addition to sharing identical sets of questions on several topics (risks perceptions, attitudes to curfew, attitudes to vaccines, beliefs about COVID-19 infection), the three separate survey questionnaires also include other topics (economic impact, local preventive strategies) whose related questions differ between questionnaires. As analysing evolutions is the study’s primary focus, data on all the topics covered will be collected in three waves unless the spread of COVID-19 by mid-2021 justifies extending data collection. The present article presents the study protocol and details about the implementation of the first wave of data collection which started in July 2020. The decision to wait before presenting the protocol was based on the unprecedented context the COVID-19 pandemic.

    Ethics and dissemination The survey’s protocol was approved by the Senegalese National Ethical Committee for Research in Health (131/MSAS/CNERS/Sec) and received authorisation from both the Senegalese Ministry of Health (619/MSAS/DPRS/DR) and the French Commission on Information Technology and Liberties (CNIL 2220771).

    • COVID-19
    • public health
    • public health
    • tropical medicine
    • health economics
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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    Strengths and limitations of this study

    • The current sub-Saharan African context is still marked by uncertainty surrounding the spread of the COVID-19 pandemic and the scarce availability of individual data.

    • This ongoing longitudinal study aims to investigate COVID-19-related attitudes, risk perceptions, preventive behaviours and the economic impact in Senegalese rural areas.

    • Three waves of data collection are planned (the first wave started in July 2020). However, this number may increase if the spread of COVID-19 by mid-2021 justifies extending data collection over a longer period of time.

    • In the unprecedented context of the COVID-19 pandemic, the generalisability of the study’s results needs to be explored.

    Introduction

    After spreading from China to other Asian countries in late 2019, COVID-19 appeared in Western Europe in January 2020 where it rapidly led to overwhelmed hospitals and an exponential increase in deaths (COVID-19 data repository of the Johns Hopkins Centre for Systems Science and Engineering, Baltimore, MD, USA). While most European countries adopted lockdown measures only several weeks after the first COVID-19 cases were reported (eg, a 6-week delay in Italy and a 7-week delay in France), many sub-Saharan African (SSA) countries decided to act sooner before the outbreak spread.

    Spread of COVID-19 still limited in SSA, but uncertainties remain about how the pandemic will evolve

    The COVID-19 pandemic spread to SSA in February/March 2020. Senegal implemented restrictive measures (curfew, closing schools, banning of public gatherings and cancellation of major national and religious celebrations) 3 weeks after the first COVID-19 cases had been reported in the country, whereas in Nigeria, a street publicity awareness campaign on COVID-19 preventive measures was launched in the capital Lagos, 2 days after the first cases had been identified. Concerns were expressed, especially in Senegal and Burkina Faso, with respect to the sharp increases in both these countries in the number of COVID-19 cases soon after the first cases were confirmed there.1

    The announcements of restrictive measures led to mass movements of people from big cities to rural villages, both caused by fear of COVID-19 and the impact it could have in terms of economic losses. However, as time went by, it increasingly appeared that the outbreak was much less devastating than initially anticipated,2 and the mass movements of people mentioned above were gradually reversed. Apart from the early adoption of restrictive measures, the most widely proposed hypothesis for the much lower spread of COVID-19 in SSA than in most other world regions is that different demographic characteristics (younger average ages, lower population densities and lower urbanisation rates),3–6 and a higher immune response in relation with more highly solicited immune systems7 hamper the spread. Recently, another strong hypothesis has been put forward, suggesting that the extensive implementation of local preventive strategies may have played a crucial role in substantially lowering the spread of the disease.8 9

    Nevertheless, the possibility cannot be ruled out that the COVID-19 pandemic could spread throughout SSA countries,2 10 as it did (and still continues to do) in North African and European countries (ie, all the countries north of SSA (see the Johns Hopkins Coronavirus world map: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6). Such a development is of great concern because of the associated risk of overwhelming already fragile healthcare systems1 11 in a context where the pandemic has brought about a worldwide economic crisis whose consequences might be severe for SSA.12

    Few COVID-19 data are available from an individual perspective

    Most published analyses to date on the COVID-19 pandemic in SSA countries have not been supported by collected data, except for data on the numbers of confirmed cases and deaths. One study conducted in seven English-speaking countries (Ghana, Kenya, South Africa, Tanzania, Uganda and the English-speaking regions of Cameroon) assessed the extent to which these populations were exposed to COVID-19-related misinformation. Using an online survey (April–May 2020), it showed that false beliefs were shared by between 15% and 30% of the respondents, depending on the false statement assessed, with a higher likelihood of false beliefs in older and unemployed respondents.13 In addition, three studies assessed COVID-19-related knowledge, attitudes and practices in Nigeria, in Ghana/South Africa and in the Republic of Chad (April–May 2020, March–April 2020 and May–August 2020, respectively) using online surveys. All three showed that study participants were very familiar with personal preventive measures against COVID-19 and the disease’s main symptoms.14–16 However, the Nigerian study also showed that approximately half of the surveyed individuals believed that only elderly people with comorbidities were likely to develop severe COVID-19, and 85% were unaware of the risk of being infected by asymptomatic individuals. Consistent with this finding and given that the participants in the Nigerian study were relatively young (69% aged between 21 and 30 years old), only 22.5% of surveyed individuals reported wearing a face mask when they went out.14 Another Nigerian study involving assessing perceived risks pointed out that despite good knowledge of COVID-19, implementing preventive behaviours would not be likely if the virus was not considered a risk (online survey in April 2020).17 More generally, the study conducted in the Republic of Chad showed significantly lower uptake of preventive practices in individuals with lower educational levels and precarious employment.16 Furthermore, other published studies emphasised individuals’ fear of serious COVID-19-related economic repercussions (notably people living in urban Ghanaian neighbourhoods with their own business in the informal economy18 and farmers working in the Ethiopian vegetable sector).19

    Study objectives

    The present ongoing study was designed in a setting marked by both uncertainty about the spread of COVID-19 in SSA and the scarce availability of individual data. Given the continued risk that the spread of COVID-19 will increase substantially in SSA, the memory of mass movements of people from big cities in March 2020 highlights the role that rural areas could play if such an event were to reoccur. This role could be major in a context where public authorities may not be in a position to systematically and substantially ease the economic shock induced by the pandemic.20–22 While this role could evolve depending on rural populations’ attitudes to such mass movements and their perceptions of the associated risks, we hypothesised that evaluating the evolution of individuals’ perceived impact of COVID-19 pandemic could provide invaluable information about the potential pressure of the COVID-19 pandemic on these rural areas.

    Accordingly, the present ongoing longitudinal study was designed to investigate the attitudes, risk perceptions and preventive behaviours of people living in a Senegalese rural area in terms of COVID-19, as well as their perceptions of the related economic impact. As rural areas often have limited access to the internet and given the increased risk of COVID-19 transmission during close contact interactions, the only available option was to conduct a phone-based survey.

    Methods and analysis

    Population

    This study includes adults (18 years old and over) living in all 30 villages of the rural Niakhar area covered by the Niakhar Health and Demographic Surveillance System (HDSS).23 The Niakhar HDSS, which is the oldest HDSS in Senegal (created in 1962) and one of the oldest in Western Africa, gathers regular data for the population covered, including demographic and health data. The Niakhar area itself is located 135 km East of Dakar and covers 203 km2 with a population of 50 355 inhabitants (January 2018 census). More specifically, it is located in the ‘department’ (an administrative area) of Fatick (there are 45 departments in Senegal) which covers three different healthcare districts (including the Niakhar healthcare district). Most of the population (96.4%) living in this area belongs to the Serere ethnic group. The main economic activity is agriculture with food cultivation (millet) and a cash crop (peanuts), in addition to small-scale cattle breeding.

    Representativeness of Niakhar area with respect to COVID-19

    As the Niakhar area has been a site for research for several years, especially for infectology and epidemiology of infectious diseases, including malaria, meningitis and hepatitis,23 the question arises as to how much the people living in the area are still truly representative of other Senegalese rural populations, especially regarding their knowledge of diseases that have long been studied there. However, given that COVID-19 is a new disease, we hypothesised that the Niakhar healthcare district would likely be comparable with other such districts in the country with a similar population density, age distribution and poverty index.24

    To assess this hypothesis, we performed a multivariable Poisson regression on the numbers of confirmed COVID-19 cases at the district level (Senegalese Minister of Health: http://www.sante.gouv.sn/Pr%2525C3%2525A9sentation/coronavirus-informations-officielles-et-quotidiennes-du-msas). While standardised residuals represent variations in the data that cannot be explained by the model, residual plots enabled us to identify outliers (figure 1). As a result, the Niakhar healthcare district could not be considered an outlier in terms of the number of declared cases of COVID-19 (standardised residuals=−0.53). Furthermore, at the time the study began, the prevalence of COVID-19 in the department of Fatick was comparable with that in other Senegalese departments with similar population densities (figure 2).

    Figure 1

    Multivariable Poisson regression at the district level and residual dependence plot (n=79). Outcome: number of confirmed COVID-19 cases at the healthcare district level (data accessed on 26 November 2020: http://www.sante.gouv.sn/Pr%2525C3%2525A9sentation/coronavirus-informations-officielles-et-quotidiennes-du-msas). Offset: total population of the healthcare district. Covariates: urbanisation rates (%), poverty index (%) and rates of people aged 50 and older (%).

    Figure 2

    Number of COVID-19 confirmed cases at the department level (n=45). Source: http://www.sante.gouv.sn/Pr%2525C3%2525A9sentation/coronavirus-informations-officielles-et-quotidiennes-du-msas; data accessed on 26 November 2020. The administrative ‘department’ of Fatick covers several healthcare districts, including the Niakhar healthcare district.

    Study design and procedure

    Study participants were randomly selected using a two-stage stratified sampling design. All 30 villages in the Niakhar area were previously identified as rural (n=27) or semiurban villages (n=3), depending on their infrastructure and equipment.23 More specifically, unlike rural villages, the three semiurbanised villages have health facilities, a weekly market, daily buses to the Senegal’s capital Dakar and several shops. The participating villages selected in the first stage (n=12) of the present study comprised the three semiurban villages and a simple random sample of nine rural villages. In the second stage of sampling, 600 households from all the 1756 households in these 12 participating villages were selected, again using simple random sampling.

    This figure of 600 households was not arrived at from a calculation to determine the optimal number of households to be included, but was the result of a trade-off between the budgetary and logistic constraints of surveying up to three members in each household (ie, a potential maximum of 1800 individuals) in three successive waves of data collection (the first wave started on 27 July 2020). Taking into account the design of previous surveys conducted in the same area,25 we assumed a response rate of 90% for the first wave of data collection and an attrition rate of 15% over the data collection period, resulting in an estimated 500 surveyed households by the end of the third wave (scheduled for mid-2021). In the planned analyses, potential selection bias will be assessed and reduced by using sampling weights computed as reciprocals of the probabilities of selection of each household. Final weights will be calculated using an iterative process (ranking ratio estimation) involving sociodemographic data collected regularly by the Niakhar HDSS.

    Longitudinal phone survey in multi-adult households

    Data collection is expected to last at least until end-2021, unless the spread of COVID-19 at that time justifies extending data collection. The study started in March 2020 and it is funded until March 2022 (Inserm-ANRS, grant number ECTZ147735). Given that any application for funding for possible subsequent waves of data collection needs to occur well in advance, the decision about this issue has been postponed until mid-2021. For each wave, data are collected by surveying participants over their mobile phone. Participants’ telephone numbers were recorded by community health workers (locally called Badjanou Gokh) prior to the first survey. Phone interviews are conducted using computer-assisted telephone interviews (CATI) software. To achieve higher response rates, 15 calls (1 initial and 14 callbacks) are planned during the several weeks of data collection, at different times of the day and on different days, before discarding a non-responsive telephone number. While 12–15 calls and 6–10 calls are generally recommended for landline and mobile CATI surveys respectively,26 we opted for a maximum of 15 calls given the frequency of poor telephone connections in the area.

    The COVID-19 sanitary context makes the implementation of the survey at each wave and the collection of data more complex than usual. Although this study protocol was the result of a close collaboration between Senegalese and French researchers, travelling restrictions prevented some of the latter from being physically present for the training of the CATI interviewers, for data collection preparatory meetings, for field meetings and for feedback sessions. Accordingly, the Senegalese research team is in charge of coordinating data collection and organising CATI schedules, although regular internet-based meetings with the French research team ensure joint decision-making.

    The lack of the possibility to train interviewers up on CATI in Senegal because of the international travel restrictions meant that only experienced bilingual (French and Serer) interviewers already present in Senegal could administer the CATI surveys. As Serere is an oral only language, practice sessions to administer the questionnaires were performed by the interviewers in order to reach a consensus on the specific words to be used when performing the interviews in Serere. Consequently, the relevance and ease of understanding of each questionnaire item was assessed before the interviews took place in Serere. A total of seven interviewers collected data in the first wave. They were supervised by another senior interviewer whose specific role, in addition to supervision, was to share feedback on data collection with the two (Senegalese and French) research teams. In many aspects, the data collection process greatly benefits from long-term existing experience the interviewers have in administering research-based surveys.

    Data collection

    The first data collection wave began on 27 July 2020 and interviewing lasted 6 weeks. Furthermore, parallel data collection about local preventive strategies implemented in villages since July 2020 is about to be completed. Figure 3 summarises the major steps of data collection and presents the study sample to be followed in our longitudinal design.

    Figure 3

    Study flow diagram. Mobile phone numbers provided by community health workers (Badjanou Gokh). 500 surveyed households were expected to participate by the end of the third wave of data collection (scheduled for mid-2021), given a 90% response rate for the first wave and a 15% attrition rate at each subsequent wave.

    For the first wave, phone interviews took place with three different persons in each participating household as follows: the head of the household, his wife (for those who had more than one wife, the wife responsible for managing the household) and a relative from a city who had decided to come and live momentarily in the rural household because of the risk of COVID-19 and the fear of associated economic consequences. Specifically, heads of households had to decide which wife and which temporary visiting relative would be surveyed, and to provide their names and mobile phone numbers during the first phone interview. When interviewing heads of households, their designated wives and visiting relatives on their mobile phones, the interviewers first presented the study and informed them about its longitudinal design, obtained their consent to participate and then interviewed them. As a way of thanking households for their participation, the community health workers provided them with a personal protection kit including hydroalcoholic gel and a face mask at the end of the first wave of data collection.

    As regards relatives temporarily living in the household, those individuals interviewed in the first wave of data collection will be surveyed in successive waves. New visiting relatives identified between two different waves of data collection will also be included in the study design by interviewing them in all data collection waves subsequent to their inclusion. As we wanted to ensure that our study design and protocol were feasible given current national and international restrictive measures due to COVID-19, we chose to wait until the first wave of data collection neared completion before presenting the study design here.

    Questionnaires

    Three questionnaires were constructed (one each) for the heads of the selected households, their designated wives in charge of managing the household and their designated relative temporarily living with them (online supplemental files 1–3, respectively). In addition to sharing identical sets of questions on several topics (risks perceptions, attitudes to curfew, attitudes to vaccines, beliefs about COVID-19 infection), the three separate survey questionnaires also contain other questions on other topics (economic impact, local preventive strategies). These questions differ between questionnaires. For example, with regard to local preventive strategies, household heads are asked about the local COVID-19 prevention strategies implemented in their village, while their wives are asked about anti-COVID-19 private prevention measures in the household, and newcomers about personal preventive measures in the household and possibly asked to implement when they first arrived (eg, quarantine). While this study involves collecting data at different moments in time, the same topics and associated sets of questions presented below will be used throughout the study in order to evaluate evolutions.

    Measures

    Sociodemographic characteristics

    As the study’s framework provides for collected data to be matched with existing data in the Niakhar HDSS23 database, only individual sociodemographic data needs to be collected during the telephone interviews, including marital status, educational level, number of children, the latter’s ages and type of schooling (public or religious school), as well as the respondent’s level of access to the internet. With regard to employment at the time of the survey, participants are invited to answer open-ended questions whose responses are consequently recoded into nine different standard categories (Farmers, Craftsmen, Workers, Employees, Intermediate professions, Managers and higher intellectual professions, Students, Pensioners, Not engaged in active employment). While these categories are consistent with those adopted in some Northern countries, they will be grouped into broader categories if necessary (such as Employed, Seeking employment,and Other, inactive (Students, Pensioners)) and then considered in relation to educational level.27

    Risk perceptions

    Collecting data on the perceived risks of COVID-19 is of crucial importance in understanding individuals’ related attitudes and behaviours. In line with previous survey studies, the assessment of risk perceptions in the present study involves collecting information on introspective judgements.28 29 After asking surveyed individuals whether they have heard about COVID-19 pandemic before being surveyed, an assessment is performed using a scale from 0 (not at all) to 10 (extremely) to measure how worried they are about getting the disease, and how contagious and severe they perceive it to be.30 In addition, perceived mortality of COVID-19 is assessed based on a question about what the participant believes with be the number of deaths out of every 100 people with COVID-19. To provide greater insight into participants’ COVID-19 risk perceptions, all the questions mentioned above are asked again for malaria, a well-known and common viral infection in SSA countries which also starts with flu-like symptoms.

    Finally, respondents are invited to self-assess their perceived absolute and relative risks of COVID-19 infection31 by ranking their level of self-perceived risk (four-point Likert-type scale from ‘very low’ (=1) to ‘very high’ (=4)) and by positioning their own perceived risks with respect to others of the same age and gender (five-point Likert-type scale from ‘much lower’ (=1) to ‘much higher’ (=5)). The questionnaires also include items measuring the extent of the respondent’s fear that the visiting relative is unknowingly infected with COVID-19 and asymptomatic.

    Other questionnaire items assessing risk perceptions include asking heads of households (/their surveyed wife) to adopt their spouse’s perspective and to report the extent to which they believe their spouse is worried about COVID-19. Similarly, both individuals are asked to report the extent to which they believe their spouse perceives that she (/he) is at risk of COVID-19 and how she (/he) places this level of perceived risk in relation to that of other wives (/husbands) of the same age and gender. Accounting for the potential impact of respondents’ current health state on their perceived risks, respondents are asked how they feel in terms of their state of health at the time of the survey (11-point Likert-type scale from ‘very poor’ (=0) to ‘very well’ (=10)).

    Attitudes

    Given the unprecedented context of COVID-19 pandemic, assessing individual attitudes to the disease necessitates using ad-hoc questions. Considering the restrictive measures adopted in Senegal from March 2020 onward, attitudes to curfews in general, whether implemented in rural or urban areas are assessed in the present study. With regard to health issues, surveyed individuals are invited to report how worried they are about buying counterfeit drugs, their attitudes to vaccination in general and to (unavailable at the time of the first wave of data collection) the anti-COVID-19 vaccine. In addition, participants are asked whether they would consider having anti-COVID-19 vaccine for themselves and for their children if it were free of charge (four-point Likert-type scale from ‘certainly yes’ (=1) to ‘definitely not’ (=4) in all cases). Assessing knowledge of COVID-19 variants and their perceived risks in comparison with the risks of the original strain is planned for subsequent waves of data collection. Finally, individuals’ agreement (agree/disagree) is assessed regarding statements circulating on the internet and reflecting rumour-related fake information on COVID-19 transmission and cure.

    Preventive behaviours

    It has been recently suggested that locally implemented COVID-19 preventive strategies could potentially explain, at least in part, the as yet slow spread of COVID-19 in SSA.8 9 The present study collected data which could shed some more light on this issue. In our ongoing longitudinal study, preventive behaviours cover individual protection measures by the study’s participants and collective prevention strategies implemented by administrative, religious or medical authorities in the area covered by the survey. With regard to the former, the study’s questionnaires include items measuring how much the COVID-19 pandemic has led to changes in everyday life in the participating households, in changes in journeys to and from the local market or the closest city and in changes in the way relatives from cities are welcomed, especially in terms of possible quarantine on their arrival.

    In order to compare participant recall with objective data on locally implemented collective prevention strategies, specific data have been gathered from the outset of the study to document the dates, duration and nature of all collective actions implemented in the study’s 12 study villages. To do this, the interviewers who conduct the phone surveys have also been in charge of conducting face-to-face interviews in each village, with the village chief, the healthpost nurses, the community health workers (Badjanou Gokh) and representatives from both the town hall and the subprefecture, local associations involved in the fight against COVID-19 spread (eg, former military personnel, student and youth associations), and non-governmental organisations (eg, local branches of the Red Cross). At the regional level, interviews have also been conducted on a regular basis with representatives of the healthcare districts. The preventive measures identified mainly consist in the distribution of leaflets, antiseptic soap and face masks, as well as the installation of hand washing facilities in schools, markets, village entrances, households, churches and mosques. These data will continue to be collected over the whole data collection period.

    Economic impact on everyday life

    One primary concern about the spread of COVID-19 in SSA countries is a possible resulting economic shock.12 20–22 Supposing that urban areas would most likely be the first to be highly impacted by the COVID-19 pandemic, rural areas could indeed be in position to soften, at least in part, the economic consequences of COVID-19 pandemic. In this respect, our ongoing study assesses the pandemic’s impact with questions about the main sociodemographic characteristics of relatives from cities currently living in the household because of COVID-19, and questions about the perceived burden on the rural household (eg, having to provide food for more people) as well as the benefits (eg, larger labour force for agricultural work) associated with their arrival in the household. In addition, the study examines possible assistance from administrative authorities or neighbours locally implemented, as well as possible assistance given to neighbours because of the COVID-19 pandemic. Furthermore, possible COVID-19 pandemic-related financial difficulties are explored concerning everyday purchases and sales of crops in local markets. Finally, relatives from cities temporarily living in the household because of their fear of COVID-19 and induced economic losses are asked to self-assess the extent to which the pandemic has impacted their own life as well as everyday life in the household. In terms of financial support provided to the household, heads of households are asked about those relatives currently living with them and whether these relatives provided support before they arrived to temporarily stay. Similarly, they are asked about the extent to which relatives who left the household to go back to cities currently financially support the household.

    Main relationships to be tested

    In this unprecedented COVID-19 pandemic sanitary context, while the present study serves a descriptive purpose, its primary aim is to assess various relationships. In line with the economic-based approach recently published in the French context of COVID-19,32 our study should enable the calibration of individual risk perceptions to be assessed based on the consistency between perceived mortality of COVID-19 and epidemiological information available at the time of data collection. Furthermore, a greater understanding of calibration should be gained by the fact that we are taking perceived worry, severity and contagiousness of COVID-19 into account, and conducting comparisons with introspective judgements relating to malaria. In addition, taking participants’ sociodemographic characteristics into account should provide greater insight into the determinants of risk perceptions. Following on from Attema et al (2021), we will examine the calibration, heterogeneity and determinants of risk perceptions, accounting for the temporal dynamics of the COVID-19 pandemic in Senegal. Finally, by focusing on the extent to which interviewed persons (husbands, wives) assess their spouse’s perceived risk of getting COVID-19, this study could also help to estimate the potential impact of discrepancies in couples’ risk perceptions regarding the extent of preventive measures actually adopted in households.

    As regards the COVID-19 preventive strategies implemented at the village and household levels, it is possible that experience gained from the Ebola and HIV/AIDS pandemics has helped people manage the risk of COVID-19.10 In the present study, we hypothesise that accurate recall of local prevention strategies currently in place is higher in villages with more prevention strategies implemented. We also hypothesise that implementing preventive strategies at the village level might have a positive impact on adopting strategies at the household level. Exploring the relationship between collective and individual preventive behaviours will therefore enable us to evaluate the impact of locally implemented preventive measures on slowing the spread of COVID-19. Using the prospectively collected data will also allow us to analyse the dynamics of this relationship over time with respect to attitudes and risk perceptions.

    With regard to the economic impact of COVID-19 pandemic on everyday lives, adopting a descriptive approach will be useful given the scarce data available. In addition, accounting for the sociodemographic characteristics of both heads of households and relatives who temporarily left big cities will allow us to assess the size of any possible gradient in the economic pressure of the COVID-19 pandemic on rural areas and its evolution over time. In the unprecedented context of the COVID-19 pandemic, the generalisability of the study’s results will however remain to be explored.

    Patient and public involvement

    No patient involved. We plan to disseminate results to the study participants and all the villagers interested in the study in participating villages at the end of the study (currently March 2022). If restrictive measures against the gathering of people are no longer in place, dissemination is planned to be held in the open air and in the presence of each village chief, healthpost representatives and the Badjanou Gokh. In addition, restitution workshops are planned to be organised at the sanitary district and regional level and to involve administrative and sanitary authorities. Finally, the main findings from the study are planned to be complied in a document distributed at subnational and national levels to the administrative and sanitary authorities.

    Ethics and dissemination

    COVID-19 is currently (as of February 2021) spreading relatively slowly in SSA although a sharp increase in its spread cannot be excluded. Given the current context, the present ongoing longitudinal study protocol aims to provide data on the attitudinal, behavioural and economic consequences of the disease in a rural area in Senegal at a time when very few data are available. Since rural areas may likely be seen as safe refuges, our study collects data from heads of rural households, their wives (in charge of managing the household) and relatives who leave cities to temporarily live in these households, specifically because of the COVID-19 pandemic. The study protocol was approved by the Senegalese National Ethical Committee for Research in Health (131/MSAS/CNERS/Sec) and received authorisation from the Senegalese Ministry of Health (619/MSAS/DPRS/DR) and the French Commission on Information Technology and Liberties (CNIL 2220771).

    To conclude, this ongoing study benefits greatly from close previously established research relationships between the researchers and the interviewers involved. Now that data collection for the first wave is nearing completion, and that data collection has been proven to be feasible despite COVID-19 restrictions, we believe that the primary benefit of our longitudinal design will be to provide data which could help to analyse evolutions in risk perceptions, attitudes and preventive behaviours of the disease, as well as its economic impact on everyday lives. In the unprecedented context of the COVID-19 pandemic, the generalisability of the study’s results needs to be explored.

    Ethics statements

    Acknowledgments

    We would like to thank the interviewers involved in the study, that is, Modou DIOME, Cheikh DIOUF, Ndèye Selbé DIOUF, Moussa GUEYE, Fadiène NDIAYE, Mayé NDOUR, Coumba Sandiane SENE, Natalie TINE. Finally, our thanks to Jude Sweeney (Milan, Italy) for the English revision and editing of our manuscript.

    References

    Supplementary materials

    Footnotes

    • Collaborators Members of the CO3ELSER Study Group are Elhadji Ba; Assane Ndiaye; Cheikh Sokhna (UMR VITROME, IRD-Université Aix Marseille, AP-HM, SSA, IHU-Méditerranée Infection, Marseille, France, and Campus International, IRD-UCAD de l’IRD, Dakar, Sénégal) Cyril Berenger, Gwenaelle Maradan (ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France), Valerie Seror, Sebastien Cortaredona, Patrick Peretti-Watel (Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France, IHU-Méditerranée Infection, Marseille, France), Olivier L’Haridon (Faculty of Economics, University of Rennes 1, Univ Rennes, CNRS, CREM UMR 6211, Rennes, France), Jocelyn Raude (EHESP School of Public Health, Rennes, France).

    • Contributors VS and CS conceptualised the study and obtained funding. GM, E-HB, OLH and SC contributed to the development of the study design. GM, E-HB and CB were responsible for the development of the data collection platform, field testing of the study logistics and participant recruitment. VS, CS, GM, OLH and SC drafted the first version of the manuscript. All authors read, edited and approved the final version.

    • Funding This work is supported by the French National Institute for Health and Medical Research-French National Agency for Aids and Viral Hepatitis Research (Inserm-ANRS, grant number ECTZ147735).

    • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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