The multi-level factors influencing the development and impact of COVID-19 response in a university community: A review of the experiences of Kabale University in southwestern Uganda.

Abstract

The index case of COVID-19 in Uganda was reported on 20^th March 2020.  The first confirmed imported case of COVID-19 in Kigezi sub- region South Western Uganda, where Kabale University is located, was reported on April 24^th 2020. On August 2^nd 2020 the first COVID-19 community case was recorded in the Kigezi Sub-region. Right from the early days of the threat of COVID-19 spread in Uganda, Kabale University put in place multiple mechanisms and interventions to contain the pandemic including:

• A COVID-19 Study Group: set up in February 2020 to study the disease, carry out risk assessment and advise the University on how to be prepared to handle cases if the disease were to reach the environment of the University.


• A multidisciplinary Kabale University COVID-19 Task Force: set up on 30^th March 2020 to advise the University on preparations to ensure safe continuity of business at the university during a possible outbreak of COVID-2019 by designing and implementing appropriate infection prevention and control (IPC) measures, the Standard Operating Procedures (SOPs), for the University community.


• COVID-19 Knowledge Attitudes & Practice (KAP) Study –to inform planning for safe maintenance of business continuity at the university in the face of the COVID-19 outbreak. Following a national lockdown, the purpose of the study was to guide development of necessary measures to be undertaken to minimize the spread of COVID-19 among students, staff and visitors when re-opening of the University became imminent. The study revealed high levels of knowledge (84% correct rate of response); an overall positive attitude (77% positive rate of response); but only moderate COVID-19 preventive practices (68.8% correct rate of preventive practice). Knowledge was higher among male students (p=0.033); students older than 20 years (p=0.000); and students taking health related courses such as Medicine or Nursing (p=0.019). Attitudes about COVID-19 were better among female students (p=0.034); and in students older than 20 years (p=0.000).  Age and sex are significant predictors of COVID-19 prevention practices (p=0.001, p=0.000 respectively).

These findings informed the need for:

• Effective behavioral change communication: to alert the university and the neighboring communities about COVID-19. The strategies to be used to achieve this were; Internal memos to the university community through e-mail, social media and written notices placed in strategic areas, Radio talk shows through several FM radio stations in Kabale town and, Branded health literacy print-outs in form of posters, leaflets and brochures.


• Promotion of good respiratory and oral and hand hygiene – to discourage; haphazard spitting, ejecting or smearing nasal mucus on public places, sneezing or coughing in public without protection, and promotion of frequent handwashing.


• Random COVID-19 testing – One such test in June 2021 revealed positivity rate of 17.8%


• Development of the Kabale University COVID-19 Standard Operating Procedures.

The order of personal prevention priorities emphasized in the SOPs were; face masking, hand washing with running water and soap or disinfectant, hand sanitizing with 70% alcohol and, keeping a physical distance of at least 2 meters from one another etc. With vaccination, this order has now been revised to give top priority to vaccination, although we still equally emphasize maintenance of the previous strategies.