Covid‐19 in somalia: Adherence to preventive measures and evolution of the disease burden

Following the COVID‐19 outbreak in Somalia, strict preventive measures were implemented by the government. We assessed adherence to the government recommendations via two consecutive online cross‐sectional surveys between April and July 2020. A five‐point adherence score was constructed based on self‐reported observance of five preventive measures (physical distancing, face mask use, hand hygiene, mouth covering when coughing/sneezing, and avoidance of touching the face). 4124 and 4703 responses were analyzed during the first and second survey, respectively. The mean adherence score decreased from 3.54 ± 1.5 in the first survey to 3.40 ± 1.6 during the second survey; p < 0.001. More participants experienced at least one flu‐like symptom during the second survey (38.2%) compared to the first (16.2%); however, the proportion of positive COVID‐19 tests in the first (26.9%) and second survey (26.5%) was similar. The ordinal logistic regression model identified the following predictors for high adherence scores: female gender (odds ratio (OR) = 1.715 (1.581–1.861), p < 0.001); being a healthcare worker/student (OR = 2.180 (2.000– 2.377), p < 0.001); obtaining COVID‐19 information from official sources (OR = 1.460 (1.341–1.589), p < 0.001); and having postgraduate education (OR = 1.679 (1.220–2.307), p < 0.001). Conversely, obtaining COVID‐19 information from social media and residing in urban settings were associated with lower adherence. Targeted and context‐specific adaptations of the COVID‐19 response may be required in Somalia.