SARS-CoV-2 infection, transmission dynamics and household impact in Malawi (SCATHIM)

Sub-Saharan African countries have adopted prevention measures similar to those used in developed countries to combat the SARS-CoV-2 virus (COVID-19) pandemic, although their social, cultural and economic contexts are markedly dissimilar. Limited empirical data exist on SARS-CoV-2 transmission dynamics and the feasibility of prevention measures in diverse African households, to guide the adaptation of the preventive measures. We aim to determine the transmission dynamics, determinants and socio-economic impact of SARS-CoV-2 infection in households located in urban medium-density, urban high-density and rural-high density locations in Malawi, Africa. Our specific objectives are to (1) measure the secondary attack rates of SARS-CoV-2 infection within households of symptomatic and asymptomatic index cases, (2) assess how SARS CoV-2 susceptibility and clinical outcomes among household contacts of index cases are influenced by socio-demographic, nutritional and anti-SARS CoV-2 immunological status; co-infections (HIV, TB, malaria) and their treatments, and household environment, (3) assess the acceptability, feasibility, adoption and effectiveness of personal protective equipment among household members of index cases, (4) describe lived experiences of caregivers of SARS-CoV-2 index cases, and (5) estimate the direct and indirect costs associated with SARS-CoV-2 prevention and care in households of index cases. Through this study, we will generate contextually-relevant empirical data for identifying high risk individuals; predicting the intensity of SARS-CoV-2 transmission and the impact of preventive measures; and designing appropriate social safety nets for households affected by SARS-CoV-2. Our research team's existing engagement with policy makers and local health department will facilitate knowledge translation and enhance their pandemic response capacity.