LHCHF Research

Awareness, Actions, and Support Related to COVID-19 Among Orphanages in the Federal Capital Territory – Abuja at onset of Restricted Movement in March – April 2020.

 

 A Questionnaire based study administered by telephone over a 4 day period by the lady Helen Child Health Foundation Research Team.

Dr Benjamin Odeka MB DCH MA (law) FRCP(London)FRCPCH Director of Research

   Mr Remi Akejelu Data collator Lady Helen Child Health Foundation

 

ABSTRACT

 Background; The importation of COVID 19 to Nigeria with attendant need for hand hygiene and social distancing, has generated mixed public reaction and prompted government actions which on occasion is seen as confused, unclear and unfocused. Decision on restricted movement was generalized without clear consideration on the status of vulnerable children in different social settings.

Objective; To determine COVID 19 awareness, knowledge, and related behaviours among staff and children in the orphanages located in the Federal Capital territory of Abuja. To record the impact of government message on prevention and management of Corona Virus disease and social support promised under the social intervention project.

 Design; Direct questionnaire administered to residential orphanages in the federal capital territory of Abuja.

 Setting; 34 orphanages located within the federal capital territory of Abuja, Nigeria.

 Institutions; Administrators and carers in 34 residential orphanages with a population of 521 at the time of the survey.

 Measurements; Self reported knowledge, attitudes and behaviours in line with government provided information and support in relation to COVID 19 measures.

 Results; 67% response rate was recorded in the study from participants of which all the respondents (100%) were aware of the Covid 19 pandemic.  Almost all participants have put in place measures to prevent the virus infection (95%)

Most respondents 19 of the 20 (95%) were not contacted by any government agency nor able to access the government support of palliatives as promised when the lock down was announced.

 Conclusion:  Many orphanages in the federal capital territory have clear awareness of the symptoms, preventive measures and actions required to stop the spread of Covid 19. Most of the respondents (95%) have not received government palliation as required prior to the lock down.

The deficiency of lack of palliation will need to be rectified to enable these vulnerable children to survive the impact of the pandemic.

 Funding source; funded by Lady Helen Child Health Foundation (LHCHF).

 

Background

The introduction of the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) has caused upheaval across the world with the resultant evolution to a pandemic certified by the world health organization (1, 2). The Corona Virus infections led the WHO to declare a state of world Pandemic as a result of the high attack rate and ease of spread to many countries. This has resulted in increased mortality figures in many countries. Individual countries therefore designed bespoke public health measures to stem the spread of the Virus in their localities.

This development now requires the need for effective messaging on how to reduce the spread in the form of effective and reliable messaging in a changing world in need of public health related information. The messaging is confused at times and the effect on compliance directly related (3)

The disease is worse with Old members of the population and those with long standing medical condition with compromised immune status. Children are not severely affected by COVID 19 but could be effective carriers and spreaders of the disease. The factors that are associated with vulnerability are also noted to be relevant factors that reduce the ability to access and understand health information, make well informed  or take optimal health promoting actions (‘’health literacy’’)(4)

In these uncertain times, the interpretation and understanding of critical changing public health messages is important, many vulnerable groups may be further marginalized by inadequate health related communications, posing substantial risks to them and their communities.

We carried out a time sensitive study among orphanages in the Federal Capital territory to determine their current awareness of COVID 19, government awareness messages, satisfaction and confidence with government material support during restricted movement. This took place from 1^st to the 4^th of April 2020 during the first period of restricted movement in the Federal Capital territory of Abuja.

The common approach is the use of social isolation in addition to individual self hygiene measures implemented to enhance public health.

In a bid to curtail the spread of Coronavirus in Nigeria, the Federal Government by presidential order under the quarantine Act ordered the lock down of 2 states and the Federal Capital City for 2 weeks. The 14-day lockdown which was enforced in Lagos state, Ogun state and Abuja the FCT kicked in at 11pm on Monday 30^th march 2020. The order meant that all non essential services were suspended, with all schools, Bars, Courts, Mosques, Churches closed.

During this lockdown, everyone were to stay at home while offices and businesses within the affected areas were ordered to be closed and the Government announced that conditional cash transfer would be immediately paid to the most vulnerable members of the society and the poor as a palliative for restricting social liberty, movement and enforcing the staying at home directive which was bound to affect the livelihood of the individual worker, companies and orphanages.

It is against this background that the lady Helen Child Health Foundation conducted a survey on COVID-19 awareness and support for the Orphans and Vulnerable Children in Abuja during the period of the lockdown.

The questionnaire focuses on the awareness of the respondents to covid 19 issues, and the precaution in place at their respective orphanages to protect and prevent the children from contracting the virus and qualifying the level of education and support received from government or its agencies to combat COVID-19 during the lock down.

 METHODS

• Measurement( see tables)

This was a questionnaire based study sponsored by the lady Helen Child Health foundation, administered by telephone over a 4 day period from 1^st to 4^th of April 2020 during the lock down of Abuja FCT of Nigeria.

Study was approved for the research group to carry out the survey by the Lady Helen management team.

34 Orphanages were identified from searches of available database of the Ministries of Health, Women Affairs, NGO interest groups and self referred group. 30 orphanages with 521 resident children were contacted and 20 questionnaires were recorded.

The questionnaire study was designed to determine if there was awareness of the hygiene and safety measures advised by WHO and by proxy the government of Nigeria to stem the spread of the Corona virus. It was also designed to find out if the government promised support was received by the children.

• Sample and Procedure

In the inclusion criteria eligible orphanages listed on the database of Federal ministry of women affairs, and Federal Capital territory (FCT) Abuja, Nigeria were identified and selected.

Once identified the orphanages were contacted by telephone to introduce the study and screened for eligibility. The simple sample questionnaire (Table 1) was administered by our trained interviewer and responses were recorded for each responder on behalf of the orphanages. The average interview time was about 8 minutes.

34 orphanages were identified from the database of which 30 were eligible for enrollment to the survey. The total number of children in the 30 orphanages is 510. In all 20 orphanages out of 30 completed the survey with 10 either declining inviation to take part or were not contactable.

Overall response rate for the survey was 67%

Table 1

Question prototype

Are you aware of the corona virus pandemic?

Are the children aware of the corona virus?

Are the children aware of coughing and sneezing etiquette?

Are you aware of the need to keep safe social distance?

Are the children aware of the need to keep safe social distance?

Has there been any teaching on hand washing?

Do you have facility for hand washing in your premises?

Do you have hand sanitizers in your facility?

How often do you and the children wash their hands?

How often do you or the children use sanitizer?

What are the precautions put in place to keep the children and staff safe from corona virus

  

RESULTS

A total of 34 orphanages were identified from databases and 30 contacted of which 20 questionnaires was completed by telephone call from the 1^st – 4^th April 2020 in the first week of the lockdown period in Abuja. Out of the 20 orphanages that participated in the survey, 18 of them operate as private orphanage homes while 2 of the homes operate as faith based NGO/Foundation. In terms of their location within Abuja, 5 of the orphanage homes are located in urban area, 14 in semi urban area and 1 in a rural setting.

Table 2

Awareness of COVID-19.

Questions	Number  of Respondent
	Yes	No
Are you aware of the corona virus pandemic?	20	0
Are the children aware of the corona virus?	20	0
Are the children aware of coughing and sneezing etiquette?	20	0
Are you aware of the need to keep safe social distance?	20	0
Are the children aware of the need to keep safe social distance?	20	0

 As can be seen from the above table 2, all of the 20 respondents and the children in their homes are aware of the corona virus, as well as the sneezing/coughing etiquette and the need to keep safe social distance. This shows that there is a very high level of awareness of COVID-19 among adults/care giver and children, especially the orphans and vulnerable children. This is as a result widespread media coverage and sensitization (print , electronic and verbal face to face) within the community.  This is reassuring public health measure to stem this pandemic which has spread to most countries of the world, with more than 2,064815 people infected, and over 137,078 deaths in 185 countries. 407 confirmed corona virus cases and 12 deaths have been recorded in Nigeria with some recovering after contracting COVID-19. (John Hopkins University dash board @ https://coronavirus.jhu.edu  & Nigeria CDC reports assessed on 16^th April 2020)1

Table 3

Measures put in place against contracting and spreading corona virus

 

Questions	Numb. Of Respondent
	Yes	No
Has there been any teaching on hand washing?	20	0
Do you have facility for hand washing in your premises?	20	0
Do you have hand sanitizers in your facility?	19	1
How often do you and the children wash their hands?	20 (always)	0
How often do you or the children use sanitizer?	19 (always)	1
What are the precautions put in place to keep the children and staff safe from corona virus	Hand washing, use of sanitizers, staying at home, no visitors, keep safe social distance.

Finding from the survey ( table 3) shows that all of the orphanage homes that participated in the survey have trained their children on hand washing, they all have facility for hand washing on their premises and they engage in hand washing at most times. 19 out of the 20 orphanages also have sanitizer which they use regularly except one of the orphanages which did not have sanitizer hence do not use sanitizer.  Furthermore, the response to the question; “What are the precautions put in place to keep the children and staff of the orphanage safe from coronavirus” shows that all the respondents adhere to the advice and recommendations from WHO and health experts from notable sources on ways to protect and prevent the spread of the virus by listing hand washing with soap and water, the use of hand sanitizer, keeping safe social distance, staying at home, and not receiving visitor as some of the precautions they have in place at their various homes of orphans and vulnerable children during the COVID-19 lockdown.

Table 4

Support and Needs of orphanages during COVID-19 lockdown

 

Questions	Numb. Of Respondent
	Yes	No
Has any Government Agency been in touch to provide support and education on Corona Virus?	1	19
If yes, what have you been given?	Food	0
Is there any item you need to ensure that the children are protected against corona virus?	Food items, sanitizers, face mask, soap and Drugs.

The survey also shows that(table 4), the undertaking to support the vulnerable group of people (orphanages) by the government with immediate payment of a sum of money or materials as palliative for the lockdown at the time of enforcement of the stay at home directive, did not materialize. 19 out of the 20 respondent did not receive any visit or support from any Government Agency prior to or after the COVID-19 lockdown and stay at home directive of the government.  The respondents’ have listed Food items, Sanitizers, face mask, soap and drugs as their primary needs for the period of the lockdown and stay at home enforcement.

 

DISCUSSION

The data analyzed from the 20 respondent shows that there is a high level of awareness about the corona virus as well as a high level of compliance with the recommendation and advice from World Health Organization and health experts on ways to protect and prevent the spread of the Virus.  The data from the survey on the other hand also established that the Orphans and Vulnerable Children in the orphanages surveyed in Abuja where not provided any form of support to help them fight against contracting and spreading the virus especially during the period of the lockdown and enforcement of the stay at home directives which they complied with(4, 6). There was the conspicuous absence of government support especially with the provision of food, disinfectants, hand gels and face masks which are essential materials needed as first line in the management of the Corona virus pandemic especially during the lock down. This is an important study that highlights the omission of support to vulnerable group of children at the time of need and also points the search light of needs that  the humanitarian ministry need to be aware of and address so that  their presence is visible and their support felt.

The inaction or poverty of support only exposes the gap between government policy pronouncements and the absence of visible implementation (7, 8). One would have expected that vulnerable children in this dispensation would be factored in for protection in this time of need which unfortunately has not been considered.

We have been able to understand how the vulnerable children in orphanages are processing and adapting to current events and also highlighting their immediate needs. Our sample is small and snapshot limited by time which means that a larger study is needed and we will revisit this cohort with more validation of questions. Questions used were simple and easily understood and recording response unambiguous.

This snap shot study which is time sensitive highlights the dynamics of changing public information dissemination and consumption. New and evolving policies are here to stay, with restriction of movements and frequent media messages about Covid 19. However there is need for proactive advocacy to address the shortfall in the care and needs of vulnerable children especially those in orphanages in Nigeria. That is a reason for this research group to follow up this cohort in future detailed study (3, 5).

 A follow up study to review the quality of hygiene compliance to the prevention of the spread of Covid 19 will be carried out by visiting the 20 orphanages and interviewing the children and observing their behavior in relation to their compliance with the standard directive in this questionnaire study.

 Corresponding Author: Dr Benjamin Odeka MBBS DCH MA(healthcare law) FRCP FRCPCH, Research Director, Lady Helen Child Health Foundation, Suite 9 wing B, City Plaza, Area 11 Garki, Abuja, Nigeria. Email, ben@ladyhelenchildfoundation.com

  References

1. John Hopkins University Database: . https://coronavirus.jhu.edu
2. COVID 19 coronavirus outbreak. Assessed at www.worldometer.info/coronavirus on 10thApril 2020-04-19
3. Ioannidis JPA. Coronavirus disease 2019: the harms of exaggerated information and non-evidence based measures. Eur J Clin Invest. 2020:e13223. [PMID: 32202659] doi:10.1111/eci13223
4. Kelly B, Squires L, Bann C, et al. Perceptions and plans for prevention of Ebola: results rom national survey. BMC Public Health. 2015;15;1136.[PMID: 265726190]doi:10.1186/s12889.015-2441-7
5. Odeka BE: Covid 19 An impact on the world: An Appraisal of the News Media output, WHO pronouncements and people’s perception of the pandemic, Dec 2019- March 2020: Research Publication of Lady Helen Child health Foundation: https://ladyhelenchildfoundation.com/research-and-publication/
6. Lin L, Savoia E, Agboola F, et al. What we have learnt about communication inequalities during H1N1 pandemic: a systematic reviewof the literature. BMC Public Health. 2014; 14:484.[PMID: 24884634]doi:10.1186/1471-2458-14-484
7. Centre for Disease Control of Nigeria; https://ncdc.gov.ng
8. Presidential order federal republic of Nigeria: Regulation 1, 2020.