COVID-19-related testing, knowledge and behaviors among severe and chronic non-communicable disease patients in Neno District, Malawi: A prospective cohort study.

ObjectiveTo assess changes over time in COVID-19 knowledge, risks, symptoms, testing, and infection prevention practices among patients with complex non-communicable disease (NCD) receiving care at Neno District and Lisungwi Community Hospitals, Malawi. Design and participantsWe conducted a prospective open cohort study using telephone-based data collection among patients enrolled in NCD clinics. We conducted four rounds of data collection between November 2020 and October 2021. SettingRural southwestern Malawi in Neno District which has a population of 150, 211 persons. Primary and secondary outcome measuresWe used descriptive statistics to characterize the population and assess COVID-19-related knowledge and behaviors. Linear and logistic regression models were used to assess significant changes over time. ResultsAcross four rounds of data collection, the most commonly reported COVID-19-related risks among patients included visiting health facilities (range: 35-49%), attending mass gatherings (range: 33-36%), and travelling outside the district (range: 14-19%). Patients reporting having ever experienced COVID-like symptoms increased from 30% in December 2020 to 41% in October 2021, however, as of the end of study period, only 13% of patients had ever received a COVID-19 test. Overall, respondents answered about two thirds (range: 67-70%) of the COVID-19 knowledge questions correctly with no significant changes over time. Hand washing, wearing of face masks and maintaining safe distance were the most frequently reported strategies used to prevent spreading of COVID-19. Wearing of facemask significantly improved from 63% to 96% over time (p<0.001). ConclusionsHouseholds of advanced chronic disease patients reported accurate knowledge about COVID-19 and improved adherence to wearing of face masks over time. However, patients commonly visit locations where they could be exposed to COVID-19 and often experience COVID-like symptoms but are rarely tested for COVID-19. We urge the government and other stakeholders to increase COVID-19 testing accessibility to primary facility and community levels. Strengths and limitations of this studyO_LIAssessed COVID-19-related outcomes among a highly vulnerable group of patients in a rural African setting C_LIO_LILongitudinal follow-up allowed us to assess changes over time from December 2020 to September 2021 C_LIO_LIData can inform COVID-19 infection preventive measures in a setting with persistently poor access to COVID-19 vaccines C_LIO_LIThe telephone survey was conducted among severe and chronic NCD patients in rural Malawi and is not generalizable to urban areas or rural populations without cellular service C_LIO_LIData was self-reported data and vulnerable to social desirability bias C_LI