Submission ID 130480
| Issue/Objective | Equitable outbreak response in low-resource settings requires integrating epidemiological surveillance with behavioural insights; however, these systems are often implemented separately, limiting their ability to detect differential risk and behavioural vulnerability. Following the first confirmed COVID-19 case in Limmu Kossa District, Ethiopia, we implemented an integrated community-based surveillance (CBS) and behavioural risk assessment to identify inequities in exposure risk and risk perception and to inform targeted public health response. |
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| Methodology/Approach | A population-based cross-sectional study was conducted in March 2020 among 1,667 individuals (≥15 years) across three kebeles in Limmu Kossa District: two rural (Walake - index case location, and neighbouring Sunta) and one urban (Limmu-01). The CBS identified individuals with potential exposure and those at high-risk of severe disease (≥60 years of age or with chronic conditions) for follow-up. Structured questionnaires assessed knowledge, perceived susceptibility and severity, and preventive practices. Composite scores were derived from multiple items and analysed as continuous variables; internal consistency was assessed using Cronbach's alpha. Multivariable linear regression examined factors associated with KPP scores. Data were analysed using Stata 14, with p < 0.05 considered statistically significant. |
| Results | Among 1,667 respondents, surveillance identified 39 individuals with potential exposure and 518 at high-risk for severe disease, who were referred for follow-up. While knowledge (86%) and preventive practices (84.5%) were high, perceived susceptibility remained lower (61%). Knowledge was positively associated with preventive practices (β = 0.36, p<0.001). Residents in the index community had significantly lower knowledge (β = −0.18, p<0.001) and preventive practices (β = −0.09, p<0.01). Lower knowledge was also associated with being female, older age, and being a daily labourer, while higher knowledge was observed among those with elementary education and housewives. |
| Discussion/Conclusion | This integrated approach exposed structural and behavioural inequities masked by aggregate indicators, particularly the gap between high knowledge and low perceived susceptibility among vulnerable populations. Embedding behavioural risk assessment within community surveillance systems can strengthen equity-sensitive outbreak response by enabling targeted risk communication and prioritization of underserved groups. The model is feasible for integration into existing primary health care and surveillance platforms in resource-constrained settings. |
| Presenters and Affiliations | Gemechu Gudina Bulcha Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau Elias A. Yesuf Department of Public Health, Jimma University, Jimma, Ethiopia Gemechu Sh. Bejiga Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau Kemeredin Shifa Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau Bekele Desse Jimma Zone Health Department |
