The wealth gradient and the effect of COVID-19 restrictions on income loss, food insecurity and health care access in four sub-Saharan African geographies

Introduction While there has been considerable analysis of the health and economic effects of COVID-19 in the Global North, representative data on the distribution and depth of social and economic impacts in Africa has been more limited. Methods We analyze household data collected prior to the COVID-19 pandemic and during the first wave of COVID in four African countries. We evaluate the short-term changes to household economic status and assess women's access to health care during the first wave of COVID-19 in nationally representative samples of women aged 15-49 in Kenya and Burkina Faso, and in sub-nationally representative samples of women aged 15-49 in Kinshasa, Democratic Republic of Congo and Lagos, Nigeria. We examine prevalence and distribution of household income loss, food insecurity, and access to health care during the COVID-19 lockdowns across residence and pre-pandemic wealth categories. We then regress pre-pandemic individual and household sociodemographic characteristics on the three outcomes. Results In three out of four samples, over 90% of women reported partial or complete loss of household income since the beginning of the coronavirus restrictions. Prevalence of food insecurity ranged from 17.0% (95% CI 13.6-20.9) to 39.8% (95% CI 36.0-43.7), and the majority of women in food insecure households reported increases in food insecurity during the COVID-19 restriction period. In contrast, we did not find significant barriers to accessing health care during COVID restrictions. Between 78.3% and 94.0% of women who needed health care were able successfully access it. When we examined pre-pandemic sociodemographic correlates of the outcomes, we found that the income shock of COVID-19 was substantial and distributed similarly across wealth groups, but food insecurity was concentrated among poorer households. Contrary to a-priori expectations, we find little evidence of women experiencing barriers to health care, but there is significant need for food support.