Perceived Risk and Knowledge of COVID-2019 Community Transmission among Local Council Leaders in Rural Districts of Eastern Uganda
Authors: Walusansa Abdul , Iramiot Jacob Stanley , Kudamba Ali , Okurut Shaban Alemu , Mpagi Joseph , Namuli Aidah , Nabuuma Hawa , Godfrey Wasige , Kafeero Hussein M. , Ssenku Jamil 
Published: December 2020

Abstract
Background: Corona virus disease (COVID-19) is one of the topmost global hindrances to human existence. Rural settings have been reported to be more vulnerable in some parts of the world. In Uganda, local council (LC) leaders in rural districts are among the immediate personnel mandated to support compliance with preventive guidelines, and to identify and report/deliver COVID-19 cases to health units. We examined the potential risk of COVID-19 transmission, knowledge levels, perceptions & opinions of LC leaders in selected districts in Eastern Uganda, to support the design of risk-based COVID-19 control measures in rural settings, to protect lives better.Methods: A convenience sample was taken from village council leaders in the selected districts. Pretested questionnaires and in-depth interviews were used to assess the knowledge levels, perceptions, and opinions of respondents about COVID-19. An observational survey was also conducted to examine the barriers that might deter effective control of COVID-19, with reference to health guidelines set by the Ugandan government and the World Health Organization. Data was analyzed using HyperRESEARCH 2.8 software, and STATA version-15.0.Results and discussion: Eighty percent of local council leaders reported that they were formally engaged in the fight against COVID-19 in their communities, and the common means of engagement were; dissemination of COVID-19 information by word of mouth, regulation of public events, and monitoring of visitors that come from distant places. All clients reported having received some information about this pandemic, but there was generally low knowledge on some vital aspects: 70% of the respondents did not know the meaning of COVID-19; 100% were uninformed on these common symptoms; headache, sore throat, nausea, and loss of taste & smell; 10% did not know if willingness to conform to health guidelines may affect COVID-19 prevention, and they believed that domestic animals are viable vectors. Radio was the commonest source of COVID-19 information, but it was confounded by poor quality of radio-signals. Most respondents were of the view that in the communities they lead; inaccessibility to authentic health information, financial constraints, and belief that COVID-19 is a fallacy, were some of the leading obstacles to the fight against the pandemic. Low awareness and misconceptions on COVID-19 could be explained by; technological challenges, low literacy levels, and dissemination of wrong information about this pandemic. From the observational survey, the major factors which might intensify the risk of COVID-19 spread were: scarcity of requirements for hand hygiene, face protection, violation of health guidelines & directives, porous borders, terrain, and use of potentially polluted open water sources.Conclusion and recommendations: Rural communities in Eastern Uganda are vulnerable to the drastic spread of COVID-19, due to challenges related to: low awareness of COVID-19, reluctance in complying with preventive guidelines, finance, technology, terrain, porous borders, illiteracy and scarcity of protective wear and hygiene resources. Awareness creation, material aid, execution of preventive rules, and more research on COVID-19 are warranted.