COVID-19 Related Knowledge, Attitudes, Practices and Needs of Households in Informal Settlements in Nairobi, Kenya

Background: Urban slums are at high risk of COVID-19 transmission due to the lack of basic housing, water, and sanitation facilities. Overcrowded conditions make quarantine measures near impossible. Methods: A mobile phone knowledge, attitudes, and practices survey was conducted March 30-31, 2020. Participants were sampled from two study cohorts across five urban slums in Nairobi, Kenya. Findings: 2,009 individuals (63% female) participated. Knowledge of fever and cough as COVID-19 symptoms was high, but only 42% listed difficulty breathing. Most (83%) knew anyone could be infected; younger participants had lower perceived risk. High risk groups were correctly identified (the elderly - 64%; those with weak immune systems - 40%) however, 20% incorrectly stated children. Handwashing and using hand sanitizer were known prevention methods, though not having a personal water source (37%) and hand sanitizer being too expensive (53%) were barriers. Social distancing measures were challenging as 61% said this would risk income. A third worried about losing income, only 26% were concerned about infecting others if themselves sick. Government TV ads and short message service (SMS) were the most common sources of COVID-19 information and considered trustworthy (by >95%) but were less likely to reach those with less education. Interpretation: Knowledge of COVID-19 is high; significant challenges for behavior change campaigns to reach everyone with contextually appropriate guidance remain. Government communication channels should continue with additional efforts to reach less educated households. A strategy is necessary to facilitate social distancing, self-quarantine, handwashing and targeted distributions of cash and food. Funding Statement: None. Declaration of Interests: The authors claim no conflict of interest. Ethics Approval Statement: The Population Council IRB had approved initial protocols for the AGI-K (p661) and NISITU (p829) cohorts, as well as the AMREF ESRC (P143/2014 and P407/2017). The Ministry of Health provided written approval to conduct the KAP surveys with these cohorts.