Evaluating The Implementation Of Wastewater-Based Surveillance For COVID-19 In Kisumu, Kenya

The World Health Organization (WHO) has recommended various COVID-19 surveillance tools, including wastewater-based surveillance (WBS), which has demonstrated promising results in high-income countries (HICs). However, its application in low- and middle-income countries (LMICs) remains limited. This study explores WBS's potential as a complementary surveillance tool in a resource-constrained environment, Kisumu, Kenya, where sewer infrastructure is inadequate. Conducted from March 2022 to March 2023by University of Illinois Chicago (UIC) researchers and the Kenyan non-profit Safe Water and AIDS Project, the research involved sporadic sampling of wastewater from centralized and decentralized sites, yielding 161 samples with 23 positive for SARS-CoV-2 and epidemiological data from 4 major hospitals in Kisumu. Time series analysis shows that by combining centralized and decentralized samples wastewater surveillance has the capacity to predict an upcoming wave 6 to 11 days prior to a positive case report. Additionally, wastewater testing in Kisumu has detected SARS-CoV-2, highlighting a chance to enhance COVID-19 surveillance among high-risk groups in resource limited settings. The study also addresses the barriers to utilizing WBS data for decision-making in Kisumu. Key barriers identified include the absence of a policy framework for use of WBS, financial limitations, and insufficient awareness among stakeholders. In-depth interviews with 14 stakeholders were conducted. Participants noted that although WBS has potential to support public health, it was rarely used in public health decisions in Kisumu due to above challenges. To address these challenges, we recommend establishing a comprehensive network that includes a broader range of stakeholders. This collaborative approach is crucial for successfully implementing WBS for COVID-19 in any setting. Effective health communication requires understanding the demographics, COVID-19 knowledge, attitudes, and information preferences of informal settlement residents compared to those in formal communities. We conducted intercept interviews at public toilets near informal settlements to evaluate these factors. Analysis of data from 752 study participants shows that informal settlement residents perceive a higher risk of contracting COVID-19 and struggle more with accessing and understanding related health information. These insights suggest the need for tailored health communication strategies to better address the specific needs of informal settlement residents.