Incidence and Factors Associated With Experiencing Violence or Discrimination among Ugandans During the Covid-19 Lockdown, April 2020

Summary

Many countries in Sub-Saharan Africa, including Uganda, implemented nationwide lockdowns to minimize COVID-19 spread. Media reports suggested that violence and discrimination subsequently increased. We evaluated incidence and factors associated with experiencing violence or dis- crimination during the lockdown in April 2020 to inform prevention measures. We analyzed cross-sectional data collected through the International Citizen Project survey targeting all Ugandans via online platforms to assess social factors associated with the COVID-19 outbreak. Data collected included socio-demographic characteristics, home and work activities and key events during the epidemic, including experiences of any form of violence or discrimination. We performed descriptive statistics and created a single binary outcome variable for experiencing violence or discrimination and used logistic regression to identify associated factors. Among 1,726 participants, mean age was 36 years (range, 12-72 years); 1,051 (59%) were male, 145 (8%) had experienced violence or discrimination; of these, the largest proportion (32%) reported that it was perpetrated by a law enforcement officer. Associated factors included being male (Adjusted Odds Ratio (AOR)= 1.60 CI:1.10-2.33), attending work physically for >3 days in the past week (AOR=1.52 CI:1.03-2.23), and inability to access social or essential health services (AOR=3.10 CI:2.14-4.50). A substantial proportion of Ugandan residents experienced violence and/ or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. Being male, physically attending work, and difficulty accessing essential services were associated with experiencing violence or discrimination. Although results may not be generalizable due to the online nature of the questionnaire, we recommended that authorities develop strategies to address community safety and law enforcement violence during similar epidemics.

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Introduction

 In March 2020, the World Health Organization (WHO) declared COVID- 19 a pandemic. Of all the 46 countries in Sub Saharan Africa, 13 countries implemented lockdowns, Uganda inclusive, along with other recommended public health measures nationwide, while 10 more countries instigated partial lockdowns in hotspots.

The lockdown strategies required Uganda’s citizens to adjust and spent rather more time in their respective homesteads, communities or neighbor hoods. Media reports indicated that cases of domestic violence in- creased in Uganda’s communities following the institution of most of the lockdown directives that required citizens to stay at home. We estimated the incidence and identified factors associated with experiencing violence or discrimination among Ugandans during the COVID-19 epidemic to inform control and prevention measures.

Methods

 We conducted a cross-sectional study based on data collected by the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak. The ICP was initiated by an international group of researchers from Asian, African, South American, and Europe- an countries. The protocol and questionnaire for the ICP survey is largely based on the citizen science Corona survey first launched in Belgium by the university of Antwerp on march 17 2020, it was adopted by 21 countries globally including Uganda in April 2020 (1). The questionnaire was deployed on April 16, 2020, day 22 of Uganda’s total lockdown, and circulated widely via email, WhatsApp, Facebook, and Twitter platforms. The survey collected responses from Ugandans nationwide from 1,726 participants.

For this study, we abstracted data from the ICP study data- Uganda on key socio-demographics, professional life during the COVID-19 lock down (including ability to continue work, transportation means, and working conditions). We also considered data from participants’ responses on daily life during the COVID-19 lock down including access to food, talking to other people, experiencing violence or discrimination, being worried about their health, having underlying disease or condition, and access to essential medications. We performed multivariate logistic regression analysis using STATA 14 to identify the factors associated with experiencing violence or discrimination at a level of significance of 0.05.

Results

 Socio-demographic characteristics of study participants Our study considered all the 1,726 ICP study respondents whose mean age was 36 years ranging from 12 to 72 years. Forty one percent (706/1,726) belong to age-group- 29-39. Twenty two percent (376/1,726) had physically attended work for more than 3 days in the past week; 59% (1,015/1,726) were males, 97% (1679/1,726) were Ugandans; and 50% (864/1,726) had tertiary maximum level of education.

Forty four percent (754/1,726) were legally married and 49% (841/1,726) were currently living with a spouse or partner. Forty percent (688/1,726) resided in Kampala suburbs and 40% (697/1,726) resided in a house or apartment with a garden. Forty two percent (731/1,726) worked for a person, institution or company and 38% (663/1,726) were working from home. Twenty eight percent (481/1,726) belonged to the 4th wealth quintile. Forty one percent (708/1,726) were very satisfied with staying at home. Fifty seven percent (992/1,726) did not have any difficulty obtaining food.

Incidence of violence or discrimination among Ugandans during the COVID-19 lockdown, April 2020

A total of 167 events of violence/discrimination were reported in our study. Overall, only 8% (145/1,726) of the respondents experienced any form of violence or discrimination by any perpetrator during the COVID-19 epidemic in April 2020. One percent (21/1,726) had experienced physical violence at home, 2% (41/1,726) had experienced physical violence outside

of home, 5% (82/1,726) had experienced discrimination because of their social or economic status while 1% (23/1,726) had experienced discrimination because of their ethnicity, race or nationality. Thirty two percent (46/145) of the respondents who had experienced violence or discrimination reported that it was perpetrated by an enforcement officer, 11% (16/145) reported that it was perpetrated by other community members unknown to them, 20% (29/145) reported community members known to them, 18% (26/145) re- ported a family member within the household while 6% (9/145) reported a relative outside of the household, and 13% (19/145) reported more than one perpetrator.

Factors associated with experiencing violence or discrimination among Ugandans during the COVID-19 lockdown, April 2020

At multivariate analysis, after adjusting for covariates, the odds of experiencing domestic violence were 1.62 times higher for males compared to the females (Adjusted OR= 1.60 CI:1.10- 2.33). The odds of experiencing any form of violence or discrimination were 1.52 higher for participants who had physically attended work for more than 3 days in the past week compared to those who had spent less 3 days or were unemployed (Adjusted OR=1.52 CI:1.03-2.23).

Participants who reported that they had failed to access social or essential health services since the epidemic started were 3.10 times more likely to experience any form of violence or discrimination (Adjusted OR=3.10 CI:2.14-4.50). All other factors assessed including age, maximum education level, housing conditions, residence, marital status, occupation and wealth index were not statistically significant.

Discussion

 Overall, 8.4% experienced any form of violence and discrimination during the one-month period of the lockdown. While this figure is lower than the 20% reported in the UDHS, it represents a high incidence of violence since the UDHS includes reports over a one-year period compared to the 8% in a period of one month in this study. Although not assessed in this study, this high level of violence and discrimination could be attributed to stressors including long stay at home duration, frustration, boredom, inadequate supply of essential goods, and fear of infection due to the epidemic and the control measures with resultant job and income losses as well as law enforcement encounters (2).

This high incidence of violence and discrimination from this survey agrees with the patterns reported around the world. In China, it was reported that domestic violence more than tripled during the lockdown in February, and 90% was related to the COVID-19 epidemic. Brazil reported a 40-50% rise in domestic violence and a 30% increase was observed in Cyprus during their COVID-19 lockdowns (3)

Our findings show that law enforcement officers perpetrated more than one third of the reported violence and discrimination. To ensure compliance with COVID-19 preventive measures, strategies such as curfews, banning of gatherings, and unnecessary movements were backed by heavy deployment of law enforcement officers such as police and local defense forces country wide. Scuffles between the enforcement officers and the public more especially during the curfew hours were frequently cited in the local media reports during the COVID-19 epidemic.

The odds of experiencing any form of violence and discrimination were higher for those who were unable to access social or essential services compared to those who were able to access them. These findings are in agreement with findings from quarantine experiences during a SARS outbreak in Canada in 2003 which indicated that having inadequate essential supplies such as food, water, clothes, accommodation and medicines was a major source of agitation and frustration in the communities(4). The COVID-19 lockdown resulted in unanticipated and prolonged forced co-existence in the Ugandan homes and communities amidst the economic and financial frustration with struggles to access essential services and supplies which could have resulted in encounters with law enforcement in the curfew hours as well as disputes at household level.

Conclusion

 The incidence of violence and discrimination among Ugandan residents during the COVID-19 lockdown was high and mostly perpetrated by law enforcement officers due to the strict lockdown measures. Males, individuals who had attended to work physically for more than 3 days in the past week and those who had difficulties accessing social or essential health services were more likely to experience violence/ discrimination. Mitigation of violence should be integrated among the control measures in large-scale public health emergencies. More re- search is needed to explore alternative models of ensuring compliance to prevention measures in epidemics including models of risk communication and community mobilization.

References

1. Home | ICPCovid [Internet]. 2020 [cited 2020 Jun 11]. Available from: https://www.icpcovid.com/en/home
2. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Green- berg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The 2020 Mar 14;395(10227):912–20.
3. Graham-Harrison E, Athens AGHS in, Ford L. Lockdowns around the world bring rise in domestic The Guardian [Internet]. 2020 Mar 28 [cited 2020 Jun 29]; Available from: https://www.theguardian.com/society/2020/mar/28/lockdowns-world-rise -domestic-violence
4. Blendon RJ, Benson JM, DesRoches CM, Raleigh E, Taylor-Clark K. The Public’s Response to Severe Acute Respiratory Syndrome in Toronto and the United States. Clin Infect Dis. 2004 Apr 1;38 (7):925–31

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Elizabeth Katana¹, Bob Omoda Amodan¹, Lilian Bulage¹, Alex R. Ario¹, Joseph Nelson Siewe Fodjo², Robert Colebunders², Rhoda Wanyenze³ Incidence and Factors Associated With Experiencing Violence or Discrimination among Ugandans During the Covid-19 Lockdown in April 2020. Kampala, Uganda National Institute of Public Health. 2020 September 30th. Available from:https://uniph.go.ug/incidence-and-factors-associated-with-experiencing-violence-or-discrimination-among-ugandans-during-the-covid-19-lockdown-april-2020.