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Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi.

Thindwa, Deus, Jambo, Kondwani ORCID:, Ojal, John, MacPherson, Peter ORCID:, Phiri, Mphatso, Pinsent, Amy, Khundi, McEwen, Chiume, Lingstone, Gallagher, Katherine E, Heyderman, Robert S, Corbett, Elizabeth L, French, Neil and Flasche, Stefan (2022) 'Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi.'. Epidemics, Vol 40, e100590.

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Understanding human mixing patterns relevant to infectious diseases spread through close contact is vital for modelling transmission dynamics and optimisation of disease control strategies. Mixing patterns in low-income countries like Malawi are not well known.

We conducted a social mixing survey in urban Blantyre, Malawi between April and July 2021 (between the 2nd and 3rd wave of COVID-19 infections). Participants living in densely-populated neighbourhoods were randomly sampled and, if they consented, reported their physical and non-physical contacts within and outside homes lasting at least 5 min during the previous day. Age-specific mixing rates were calculated, and a negative binomial mixed effects model was used to estimate determinants of contact behaviour.

Of 1201 individuals enroled, 702 (58.5%) were female, the median age was 15 years (interquartile range [IQR] 5–32) and 127 (10.6%) were HIV-positive. On average, participants reported 10.3 contacts per day (range: 1–25). Mixing patterns were highly age-assortative, particularly those within the community and with skin-to-skin contact. Adults aged 20–49 y reported the most contacts (median:11, IQR: 8–15) of all age groups; 38% (95%CI: 16–63) more than infants (median: 8, IQR: 5–10), who had the least contacts. Household contact frequency increased by 3% (95%CI: 2–5) per additional household member. Unemployed participants had 15% (95%CI: 9–21) fewer contacts than other adults. Among long range (>30 m away from home) contacts, secondary school children had the largest median contact distance from home (257 m, IQR 78–761). HIV-positive status in adults >=18 years-old was not associated with changed contact patterns (rate ratio: 1.01, 95%CI: (0.91–1.12)). During this period of relatively low COVID-19 incidence in Malawi, 301 (25.1%) individuals stated that they had limited their contact with others due to COVID-19 precautions; however, their reported contacts were 8% (95%CI: 1–13) higher.

In urban Malawi, contact rates, are high and age-assortative, with little reported behavioural change due to either HIV-status or COVID-19 circulation. This highlights the limits of contact-restriction-based mitigation strategies in such settings and the need for pandemic preparedness to better understand how contact reductions can be enabled and motivated.

Item Type: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > WC 20 Research (General)
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 22 Sep 2022 13:58
Last Modified: 06 Jun 2023 16:49


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