Voluntary Testing Practice Among People with Clinical Symptoms of COVID-19 in Somalia: Using Andersen’s Behavioral Model

Abstract

Background: COVID-19, is a respiratory disease caused by a novel coronavirus. The virus is a global pandemic which threatens children and their rights in countries around the world. Epidemiologists have advocated for a robust testing and contact tracing as a potential solution to balance public health and economic priorities. Using Anderson Behavioral Model, our study aimed to analyze predisposing, Enabling and Need factors associated with VT4C-19 practice in Somalia. Methods: A cross sectional community-based survey were conducted at household level among adults above the age 18 years living in Mogadishu and Garowe cities. The study used multi-stage stratified-cluster sampling method. Out of the Four main towns in Somalia with a designated free National laboratory for COVID-19 testing by the government, the study randomly selected two cities (Mogadishu & Garowe) using Simple Random Sampling (SRS) Method. The study used univariate analysis and Multivariable Binary Logistic Regression model to control other possible confounders and to give the Andersen Behavioral Modal that were independently associated with voluntary testing for COVID-19 in Somalia. The statistical significance tests were accepted at <i>p<0.05</i>. Results: Only 113 (6.6%) out of (1,708) study participants who experienced clinical symptoms of COVID-19 (between 16 March – 31 December 2020) voluntarily tested their COVID-19 status. The study found Predisposing factors including gender (<I>P<0.001</I>), marital status (<i>p<0.05</i>), mass media availability (<i>p<0.05</i>), telephone ownership (<i>p<0.05</i>), peer influence (<I>P<0.001</I>) and stigma of COVID-19 positive individuals in the community (<I>P<0.001</I>), and Enabling factors including: place of residence (<i>p<0.001</i>), expense decision maker at household level (<i>p<0.05</i>), insurance status (<i>p<0.001</i>) and access to outreach and health education program (<i>p<0.05</i>), as well as the Need factors including: perceived importance of COVID-19 voluntary test (<i>p<0.001</i>) and chronic diseases status among the study participants (<i>p<0.05</i>) were among the factors associated with the practice of voluntary tests of COVID-19 among the clinically symptomatic individuals in Somalia. Conclusion: The uptake of Voluntary testing for COVID-19 is very low in Somalia. To promote this, health officials and policy makers need to focus on a consistent and culturally sensitive community sensitization programs and bringing the COVID-19 test closer to the communities including rural communities.