Bangladesh reported the first confirmed Covid-19 case on March 08, 2020, and ever since, the number of cases and the death count have been increasing steadily. In this context, the study titled "Covid-19 in Bangladesh: Prevalence, KAP and Heterogeneous Shocks under 'General Holiday' - An Exploratory Study Based on an Online Survey" generated data online covering all socio-economic groups and all districts of the country. It was conducted during the period of the 'general holiday' in Bangladesh which is euphemistically a reference to lockdown.
Netizens of Bangladesh, who had completed the Secondary School Certificate Examination (SSC) were eligible for the survey with respondents drawn from all 64 administrative districts, over the period May 5-29, 2020. There are around 36 million Facebook users in Bangladesh but at any given period, active numbers are much lower, perhaps as low as 12.5 million. The survey was advertised widely through Facebook. A total of 30,741 persons responded to fill up the questionnaire, from which 832 observations were dropped due to duplication, leaving a total of 29,909 responses for analysis.
The socio-economic and demographic data collected include: age in years, marital status, gender, education level, household size, household income, administrative divisions, and location of household. The employment status of the respondents during the Covid-19 pandemic situation was also captured. In light of earlier studies, the relevant behavioural factors (social distancing, using hand sanitiser, mask, hand wash, go out of the house etc.) as well as information on associated Covid-19 symptoms and comorbidities, were also captured in the survey. Most of the study participants were aged were between 31-49 years (71.3 per cent). The majority were male (66 per cent), married (77.54 per cent), had tertiary education (65 per cent), were employed (60 per cent), and engaged in private sector salaried work (48 per cent). The participants were from all administrative divisions of Bangladesh although an absolute majority were from Dhaka and Chattagram divisions (52 per cent). During the Covid-19 pandemic situation, more than half of the respondents (53 per cent) worked from home.
The survey captured the illness history of the respondents preceding one month from the period of the survey. All information collected during the survey was self-reported. It found that 10.34 per cent of respondents suffered from some type of illness during the reference period while 7.34 per cent of respondents reported that they had at least two symptoms of Covid-19 (e.g., fever, dry cough, lost sense of smell, diarrhoea, wet cough, headache, tiredness, and breathing problem). Further, 2.6 perc ent respondents reported displaying three or more COVID-like symptoms. Survey respondents also reported that 2.27 per cent of family members displayed Covid-19 type symptoms whereas 0.61 per cent had a single comorbidity (e.g., asthma, blood pressure, diabetes, heart disease, lung disease, kidney disease, liver disease) and 0.57 per cent had two or more comorbidities, making them especially vulnerable.
The study also obtained information related to precautionary measures adopted by study participants. Over 30 per cent reported practising social distance completely, and nearly 95 per cent reported using masks when going out. Around 34 per cent of respondents used hand gloves regularly while 37 per cent reported they used gloves sometimes. The study found that about 83 per cent of respondents used hand sanitizer/hand rub whereas approximately 73 per cent of respondents reported they washed their hands at least 4 times in a day.
It was found that widowed, divorced and unmarried individuals had a higher risk of being symptomatic. It was also found that those who were living in small towns were less likely to display Covid-19 symptoms compared to those living in villages.
It was also seen that larger households, especially those with more than 6 members, were more prone to Covid-19. On the other hand, Individuals who used hand gloves, sanitiser/hand rubs, and who rarely went outside of their homes were significantly much less likely to develop Covid-19 symptoms compared to those who ignored these. Those aged 19-30 and 31-49 were found to be at higher risk, compared to those aged less than 19 years.
People living in big towns or City Corporation areas were more likely to be exposed to Covid-19 infections compared to the people who live in village areas. Further, higher-income households were relatively less prone to COVID-related mortality than the low-income household, as they had fewer comorbidities. It was found that individuals living in larger households (4 to 6 members) were also at higher risk as they had a 1.61 times higher risk of comorbidity than small households.
Since 85 per cent of the workforce in the country is engaged in informal employment, the lockdown may have had farreaching implications for the economy. The impact of the lockdown is not symmetric across socio-economic groups. Effective policymaking during a crisis like the current pandemic necessitates exploring this asymmetry.
From figure 1 it can be seen that 13 per cent of the respondents became unemployed. The worst affected were the self-employed, followed by freelancers, and daily contract-workers. Around 44 per cent of the self-employed and 38 per cent of the freelancers reported that their earnings had actually come to a halt.
As the income sources of the unemployed group are irregular and informal, they faced the biggest income shock. Almost all of them reported either reduction of income or stoppage of income flows. Even for those employed, half reported some negative impacts with those in the lower-income groups suffering disproportionately.
Compared to the unemployed group, employed respondents are 42.4 per cent more likely to report that their income has remained unchanged and 36 per cent less likely to report that their income has completely stopped during the lockdown. Further, the higher the household income level, the higher is the likelihood that its income has remained unchanged, compared to the pre-lockdown period. A significant neighbourhood effect is also observed: if a case of death due to corona is reported in the locality, there is a 4.2 per cent greater chance that income flows have stopped compared to unaffected localities. Reduction or stoppage of income flows is more likely for respondents in Dhaka.
Older respondents had higher food expenditures compared to younger ones. The study found that younger people tended to suffer relatively greater income loss, translating into lower food consumption. As far as food expenditures are concerned, there was not much difference between rural and urban areas. In fact, rural areas report a slightly higher percentage of respondents whose expenditures increased.
Socio-economic characteristics such as age, education, location of residence, and knowledge influence the adoption of preventive practices. While lack of knowledge prevents people from adopting good hygiene practices, pressure from employers and the government appears to play a useful role in encouraging behavioural change. Also, urban residents are expected to have higher odds of wearing masks than the rural areas. The adoption of preventive practices also depends on how other people in society are behaving. People feel more encouraged and comfortable when other people in the community also adopt good practices. The study found that women are more likely to adapt to new hygiene and preventive practices than men but the study didn't find age to have any influence.
The survey data shows that most of the participants used masks (94 per cent). The percentage of those washing their hands 4-6 times was over 41 per cent and those washing 7-10 times was over 48 per cent. The study also found that 70 per cent were able to maintain social distance, while 29 per cent reported that they were unable to maintain social distance although they wanted to. Gender is not significant in this case, rather the level of education including the mother's education was significant. The use masks increases with the awareness of how the infection spreads. Relatively lower mask usage is found in villages (87 per cent) compared to Metropolitan areas (97 per cent). A stricter lockdown also improves mask use frequency.
The association between education level and status of social distance maintained is interesting. The higher the level of education, the higher the percentage of individuals who are unable to maintain social distance. The likelihood of a person wearing masks is 81 per cent higher for those who know how the virus spreads. Similarly, villagers are less likely to wear masks as are those who live in areas where lockdown observance is less strict.
People who frequently go out have higher odds of being unable to observe social distance. For those going out once a week, once or twice a week, and once a day, the odds are respectively 53 per cent, 34 per cent, and 50 per cent lower compared to those who stay home. Those who have knowledge of social distance, have a 2.37 times higher likelihood of preserving social distance while location appears to have no significant effect. If a lockdown is maintained properly in the respondent's area, it improves the likelihood of social distancing by 4 times.
The results of the study suggest that the mother's education, knowledge of Covid-19 and monthly income have a positive impact on safe practices. Gender and age had no statistically significant association with the use of masks or social distancing although age was found to be negatively associated with hand-washing.
A concern that is being increasingly raised in the context of Covid-19 is the effect that it appears to be having on domestic violence, especially during lockdown in conditions when people are forced to be confined indoors for prolonged periods. Around 25 per cent of respondents living with families stated that arguments and quarrels, including physical violence, have increased under lockdown. The study found that 16.2 per cent of respondents, in fact, indicated that they quarreled frequently or very frequently while at the lower end of the scale, 60 per cent reported little or no quarrels. In the middle ranges the response rate was 26 per cent which indicates quite a large number of people reporting domestic unhappiness, arguments, quarrels and even physical violence even under 'soft' lockdown.
Ordinary people were trying hard to fight back to regain their livelihoods but their means were limited. The impact on the labour market was severe - clearly indicating that for a poor country, a longer-term lockdown would be untenable. Therefore, the government's decision to avoid a hard lockdown and withdraw the 'general holiday' sooner, rather than later, was by far the better option. If public resources and government capacity to distribute food and cash were much better, a different strategy may have been feasible.
[This article provides a summary of the key findings of the paper titled "Covid-19 in Bangladesh: Prevalence, KAP and Heterogeneous Shocks under 'General Holiday' - An Exploratory Study Based on an Online Survey". The funding for the study was provided by the Planning Ministry under the "Special Research Program" of BIDS.]
K A S Murshid, Director General, Bangladesh Institute of Development [email protected] Tanveer Mahmood, Research Associate, Bangladesh Institute of Development [email protected] Nahian Azad, Research Associate, Bangladesh Institute of Development Studies. [email protected]
A R Sarker, Research Fellow, Bangladesh Institute of Development Studies