Publication:
Estimating spatially disaggregated probability of severe COVID-19 and the impact of handwashing interventions: The case of Zimbabwe

Abstract
The severity of COVID-19 disease varies substantially between individuals, with some infections being asymptomatic while others are fatal. Several risk factors have been identified that affect the progression of SARS-CoV-2 to severe COVID-19. They include age, smoking and presence of underlying comorbidities such as respiratory illness, HIV, anemia and obesity. Given that respiratory illness is one such comorbidity and is affected by hand hygiene, it is plausible that improving access to handwashing could lower the risk of severe COVID-19 among a population. In this paper, we estimate the potential impact of improved access to handwashing on the risk of respiratory illness and its knock-on impact on the risk of developing severe COVID-19 disease across Zimbabwe. We use a geospatial model that allows us to estimate differential clinical risk at the district level. Results show that the current risk of severe disease is heterogeneous across the country, due to differences in individual characteristics and household conditions. This study demonstrates how household level improved access to handwashing could lead to reductions in the risk of severe COVID-19 of up to 16% from the estimated current levels across all districts. Taken alongside the likely impact on transmission of SARS-CoV-2 itself, as well as countless other pathogens, this result adds further support for the expansion of access to handwashing across the country. It also highlights the spatial differences in risk of severe COVID-19, and thus the opportunity for better planning to focus limited resources in high risk areas in order to potentially reduce the number of severe cases.
Link to Data Set
Citation
Joseph, George; Milusheva, Sveta; Sturrock, Hugh; Mapako, Tonderai; Ayling, Sophie Charlotte Emi; Hoo, Yi Rong. 2023. Estimating spatially disaggregated probability of severe COVID-19 and the impact of handwashing interventions: The case of Zimbabwe. Policy Research Working Papers; 10328. © World Bank. http://hdl.handle.net/10986/39636 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    The Importance of Maintenance
    (World Bank, Washington, DC, 2023-02) Joseph, George; Milusheva, Sveta; Sturrock, Hugh; Maidei Kashangura, Faith ; Ayling, Sophie Charlotte Amy; Hoo, Yi Rong
    Understanding the specific factors associated with cholera outbreaks is an integral part of designing better approaches to mitigate their impact. This paper uses georeferenced case data from the cholera epidemic that occurred in Harare, Zimbabwe, from September 2018 to January 2019. The paper applies spatio-temporal modeling to understand how the outbreak unfolded and the factors associated with higher risk of being a reported case. The study highlighted a number of findings. First, using call detail records to estimate weekly population movement throughout the city, the results suggest that human movement helps to explain the spatiotemporal patterns of the cases observed. In addition, the results highlight a number of sociodemographic risk factors and suggest that there is a relationship between cholera risk and water infrastructure, with populations living in close proximity to the sewer network with high access to piped water being at higher risk. A possible explanation for this surprising observation is that sewer bursts led to the contamination of the piped water network, turning access to piped water, usually assumed to be protective, into a risk factor. Although further studies are required to test this hypothesis, if it is true, it highlights the importance of maintenance for achieving the Sustainable Development Goals of improved water and sanitation infrastructure.
  • Publication
    Assessing Bias in Smartphone Mobility Estimates in Low Income Countries
    (Association for Computing Machinery, 2021-06-28) Milusheva, Sveta; Björkegren, Daniel; Viotti, Leonardo
    It has become common for governments and practitioners to measure mobility using data from smartphones, especially during the COVID-19 pandemic. Yet in countries where few people have smartphones, or use mobile internet, the movement of smartphones may not be a good indicator of the movement of the population. This paper develops a framework for approaching potential bias that can arise when measuring mobility with smartphones. Using mobile phone operator records in Uganda, we compare the mobility of smartphones and the basic and feature phones that are more common. Smartphones have different travel patterns, and decrease mobility substantially more in response to a COVID-19 lockdown. This suggests caution when interpreting smartphone mobility estimates in contexts with low adoption.
  • Publication
    COVID-19 Impact Monitoring
    (World Bank, Washington, DC, 2021-03) World Bank
    In May 2020, the National Statistical Office (NSO), with support from the World Bank, launched the High-Frequency Phone Survey on COVID-19, which tracks the socio-economic impacts of the pandemic on a monthly basis for a period of 12 months. The survey aimed to recontact the entire sample of households that had been interviewed during the Integrated Household Panel Survey (IHPS) 2019 round and that had a phone number for at least one household member or a reference individual. This report presents the findings from the Sixth round of the survey that was conducted during the period of December 10 - December 24, 2020.
  • Publication
    Why Do So Many Water Points Fail in Tanzania? An Empirical Analysis of Contributing Factors
    (World Bank, Washington, DC, 2019-02) Chellaraj, Gnanaraj; Joseph, George; Grabinsky Zabludovsky, Jonathan; Andres, Luis Alberto; Ayling, Sophie Charlotte Emi; Hoo, Yi Rong
    According to the 2015 Tanzania Water Point Mapping data, about 29 percent of all water points are non-functional, out of which 20 percent failed within the first year. This paper analyzes the various factors which impact water point failure and measures the relative contributions of these determinants. The results indicate that water points managed by village committees had a much higher likelihood of failure than those managed by private operators or water authority. Factors that cannot be modified such as hydrogeological factors play a major role in determining water points failure during the first year after installation. However, management type as well as the type of pump and technology matter considerably more in the short and medium term.
  • Publication
    Promoting Handwashing Behavior in Peru : The Effect of Large-Scale Mass-Media and Community Level Interventions
    (World Bank, Washington, DC, 2012-11) Galiani, Sebastian; Gertler, Paul; Orsola-Vidal, Alexandra
    This paper analyzes a randomized experiment that uses novel strategies to promote handwashing with soap at critical times in Peru. It evaluates a large-scale intervention that includes a mass media provincial campaign and a district-level community component. The analysis finds that the mass media intervention alone had no significant effect on exposure to the handwashing promotion campaign messages, and therefore no effect on handwashing knowledge or handwashing behavior. In contrast, the community-level intervention, a more comprehensive intervention that included several community and school activities in addition to the communications campaign, was successful in reaching the target audience with handwashing promotion messages and in improving the knowledge of the treated population on appropriate handwashing behavior. Those improvements translated into higher self-reported and observed handwashing with soap at critical junctures. However, no significant improvements in the health of children under the age of five were observed. The results are consistent with earlier literature, which indicates that substantively changing behavior to improve health is a complex task requiring intensive and more personalized interventions.

Users also downloaded

Showing related downloaded files

  • Publication
    Economic Recovery
    (World Bank, Washington, DC, 2021-04-06) Malpass, David; Georgieva, Kristalina; Yellen, Janet
    World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.
  • Publication
    South Asia Development Update, April 2024: Jobs for Resilience
    (Washington, DC: World Bank, 2024-04-02) World Bank
    South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the region’s below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workers’ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.
  • Publication
    Remarks at the United Nations Biodiversity Conference
    (World Bank, Washington, DC, 2021-10-12) Malpass, David
    World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.
  • Publication
    Media and Messages for Nutrition and Health
    (World Bank, Washington, DC, 2020-06) Calleja, Ramon V., Jr.; Mbuya, Nkosinathi V.N.; Morimoto, Tomo; Thitsy, Sophavanh
    The Lao People’s Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition–related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.
  • Publication
    The Journey Ahead
    (Washington, DC: World Bank, 2024-10-31) Bossavie, Laurent; Garrote Sánchez, Daniel; Makovec, Mattia
    The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.