Knowledge, risk perceptions and behaviors related to the COVID-19 pandemic in Malawi
Authors: Banda Jethro , Dube Albert N. , Brumfield Sarah , Amoah Abena S. , Crampin Amelia C. , Reniers Georges , Helleringer Stéphane 
Published: June 2020

ABSTRACTBackgroundThere are limited data on knowledge and behaviors related to COVID-19 in African countries.MethodsBetween April 25th and May 23rd, we contacted 793 individuals aged 18 and older, who previously participated in studies conducted in the Karonga Health and Demographic Surveillance Site in Malawi. During an interview by mobile phone, we ascertained respondents’ sources of information about COVID-19 and we evaluated their knowledge of the transmission and course/severity of COVID-19. We also asked them to evaluate their own risks of infection and severe illness. Finally, we inquired about the preventive measures they had adopted in response to the pandemic. We described patterns of knowledge and behaviors by area of residence (rural vs. urban).ResultsWe interviewed 630 respondents (79.5% response rate). Four hundred and eighty-nine respondents resided in rural areas (77.6%) and 141 in urban areas (22.4%). Only one respondent had never heard of COVID-19. Misconceptions about the modes of transmission of SARS-CoV-2, and about the course and severity of COVID-19, were common. For example, 33.2% of respondents believed that the novel coronavirus is also waterborne and 50.6% believed that it is also bloodborne. A large percentage of respondents perceived that there was no risk, or only a small risk, that they would become infected (44.4%), but 72% of respondents expected to be severely ill if they became infected with SARS-CoV-2. Increased hand washing and avoiding crowds were the most reported strategies to prevent the spread of SARS-CoV-2. Use of face masks was more common among urban residents (22.5%) than among rural residents (5.0%).ConclusionDespite widespread access to information about the COVID-19 pandemic, gaps in knowledge about COVID-19 persist in this population. The adoption of preventive strategies remains limited, possibly due to low perceived risk of infection among a large fraction of the population.What is already known?SARS-CoV-2 is projected to spread widely in African countries.There is limited information about what affected populations know about this new health threat, and how they react to it.What are the new findings?In a study in Malawi, respondents lacked knowledge about several aspects of the transmission of SARS-CoV-2, and about the course and severity of COVID-19.These knowledge gaps were larger among residents of rural areas than among urban dwellers.Study respondents perceived themselves at low risk of infection with SARS-CoV-2, but they over-estimated the likely severity of the disease they would experience if they became infected.Most respondents reported increased frequency of handwashing, but the adoption of other protective behaviors (e.g., social distancing, use of masks) was limited, particularly in rural areas.What do the new findings imply?Additional information campaigns are needed to address knowledge gaps and misperceptions about SARS-CoV-2/COVID-19 in Malawi.