The DHS Program

Modeling COVID-19 Related Indicators at the Second Subnational Administrative Level (English) 

Document Type

Spatial Analysis Reports

Publication Topic(s)

COVID-19

Country(s)

Rwanda, India

Language

English

Recommended Citation

Donohue, Rose E., Martha Medina, Bradley Janocha, Benjamin K. Mayala, and Trevor N. Croft. 2022. Modeling COVID-19 Related Indicators at the Second Subnational Administrative Level. DHS Spatial Analysis Reports No.22. Rockville, Maryland, USA: ICF.

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Publication Date

September 2022

Publication ID

SAR22

Abstract:

The COVID-19 pandemic has been a major burden to global public health in recent years, and has caused substantial morbidity and mortality. At the onset of the pandemic, handwashing was recognized as critically important to reducing the spread of COVID-19. Most countries implemented initiatives to improve access to handwashing during the pandemic. The COVID-19 pandemic also affected fieldwork in the Demographic and Health Surveys Program, and disrupted data collection in the Rwanda 2019–20 DHS and the India 2019–21 DHS. In this report, we use these unique datasets to explore the change in access to a basic handwashing facility using data collected before fieldwork was interrupted by the COVID-19 pandemic (pre) and after fieldwork resumed (post). We use a Bayesian geospatial modeling approach to estimate basic handwashing access at the second subnational administrative level (Admin 2), which is called a district in Rwanda and India. To assess the impact of systematic differences, we also compared the wealth and urban/rural distribution between the pre and post samples. We quantified the risk of COVID-19 transmission and mortality at the Admin 2 level by modeling the percentage of overcrowded households and the percentage of households with at least one member age 65 or older as proxy indicators. We evaluated the association between these risk factors and the percentage change in access to basic handwashing from the pre sample to the post sample at the Admin 2 level. The study found that basic handwashing access improved in 10 of the 13 districts evaluated in Rwanda, and 47 of the 49 districts evaluated in India. The average percentage increase in the 10 Rwandan districts was 27.7%, and the average percentage increase in the 47 Indian districts was 20.5%. We did not identify any systematic differences in wealth or the proportion of urban clusters between the pre and post samples. We did not identify a significant association between the percentage change in basic handwashing access experienced by districts and the districts’ COVID-19 risk, as measured by both the percentage of overcrowded households and the percentage of households with at least one member age 65 or older. Although this study was not designed to assess causative factors for any changes in basic handwashing access, we identified a positive trend in basic handwashing access. Further research and analysis could evaluate this trend and the causative factors underlying any changes in basic handwashing access. The improvement in handwashing has broader implications beyond COVID-19, because handwashing reduces the spread of respiratory and diarrheal diseases. By conducting this study at the policy- relevant Admin 2 level, the COVID-19-related factors modeled in this study could be used by policymakers and program planners to evaluate their COVID-19 response and adapt preventive measures in the future.