Infected and Affected: The Indirect Consequences of COVID-19 in Central America

Posted September 18, 2020

By Jennifer Wheeler, PSI Deputy Director, Research, Paola Letona, PSI Evidence Regional Director, LAC, and Sussy Lungo, Regional Executive Director, Asociación PASMO

“When you are thinking about a pandemic, you have to differentiate between what comes from being infected and what comes from being affected.” —Clare Wenham, London School of Economics and Political Science.

The first confirmed case of COVID-19 in Central America was identified in Costa Rica on March 6, and as of September 11, the number of reported cases continues to rise, ranging between 4,818 in Nicaragua to and 99,715 in Panama. Many governments in Central America responded quickly to the pandemic by imposing shutdowns and curfews. These necessary prevention measures have reverberated across peoples’ lives with implications for employment, schooling, safety, mental health, and social attitudes.

Under the USAID–funded HIV/AIDS Combination Prevention Program for Central America, from May to June 2020 PSI Guatemala and the Pan American Social Marketing Organization (PASMO) collected data on key COVID-19 indicators through a national survey (Public Opinion Poll, CID Gallup) in five Central American countries—Guatemala, El Salvador, Honduras, Nicaragua and Panama—to inform a behavior change communication campaign designed to address attitudes and behaviors related to COVID-19 prevention, mental health effects, stigma and discrimination.

The telephone survey included 6,050 adults (approximately 1,200 per country). Across all five countries, many households reported a recent lack of water (ranging between 19-38%), soap (7-22%) and facemasks (17-40%) necessary for COVID-19 prevention. These results highlight significant barriers to the consistent practice of prevention behaviors, namely handwashing and wearing masks. Many households also deliberately postponed (17-36%) or were unable to access healthcare (21-26%) for conditions unrelated to COVID-19 during the month before they took the survey. Psychosocial effects of the pandemic were already being felt: participants reported feelings of depression and hopelessness, disruptions in sleep and changes in appetite (graph 1). These effects are significantly greater among women: for example, in Panama, 27% of women (vs. 16% of men) reported daily feelings of depression and hopelessness. These patterns are generally consistent across all countries surveyed.

Graph 1. Psychosocial effects due to COVID-19, per country.

The survey also confirmed stigma and negative attitudes towards individuals who are infected with or at risk of contracting COVID-19. Many participants agreed with statements that expressed negative attitudes towards recently returned migrants, health workers and community members affected by COVID-19 (graph 2).

Graph 2. Negative attitudes towards individuals infected or at risk of COVID-19, per country.

Results from this study were used to develop a COVID-19 communication campaign that focuses on how life has changed and how people can adjust together as a community. Along with reinforcing prevention messages, the campaign also raises awareness about mental health and addresses issues of stigma toward groups most at risk for COVID-19. To date, the campaign has been launched in four countries, with tailored adaptations for specific indigenous populations. Several Ministries of Health have embraced the campaign by including their own logos and have launched the campaign nationwide.

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

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In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

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Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

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Infected and Affected: The Indirect Consequences of COVID-19 in Central America

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

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