| dc.description.abstract | ABSTRACT
The COVID-19 pandemic has highlighted the disparities in access to water, sanitation, and hygiene (WASH) resources and health among various populations and regions, with sub-Saharan Africa (SSA) being affected more than most other regions. Older adults are particularly vulnerable to the consequences of WASH insecurity and COVID-19. Several researchers have investigated the impacts of national government responses on people's behaviour toward COVID-19 prevention and access to essential resources. However, there has been limited research exploring how these factors affect health and wellbeing, particularly among the elderly population, who are considered most vulnerable during the pandemic. The thesis fills this gap by examining access to WASH services among older adults living in marginalized communities in Uganda during the COVID-19 pandemic with a particular emphasis on how social, economic, and demographic factors, as well as pandemic knowledge, attitudes and practices, influenced their psychosocial health and wellbeing. To this end, the objectives of this research are threefold: (1) to examine the barriers to WASH access among older adults during the COVID-19 pandemic; (2) to assess older adults' knowledge, attitudes, risk perceptions, and practices (KARP) regarding COVID-19 prevention and management; and (3) to investigate the impact of WASH-related barriers and experiences of COVID-19 on the psychosocial health and wellbeing of older adults. Using a cross-sectional survey, the data for this research was collected from older adults (n=288) living in social isolation in four rural communities within the Greater Mukono Region of central Uganda. The results indicate that older adults in the study area experienced limited access to safe WASH services, which hindered their ability to effectively engage in COVID-19 preventive practices, such as handwashing. Their efforts to adapt to this lack of access – including obtaining water from remote sources, waiting in queues at community water collection points, and borrowing water from neighbors – inadvertently exposed them to a heightened risk of COVID-19 infections. Furthermore, older adults demonstrated substantial knowledge, moderate levels of reported attitudes and practices, and low levels of risk perception toward COVID-19. These issues are influenced by various socio-economic and demographic factors, including the frequency of information received, education level, gender, trust in the Ugandan government, satisfaction with the government's response to COVID-19, food security, the availability of space for isolating COVID-19 patients, and the presence of children within the household. Ultimately, barriers to accessing WASH services not only inhibit older adults' COVID-19 prevention and management practices but also adversely impact their psychosocial health and wellbeing. Access to WASH services is essential, as are other resources for daily living, such as food, income, and housing. This thesis demonstrates that the inadequacy of these resources, exacerbated by the COVID-19 pandemic, affects older adults' ability to practice COVID-19 preventive measures, heightens their concern about COVID-19, and hinders their capacity to meet their basic needs, resulting in emotional distress and lower levels of wellbeing. The findings of the thesis contribute to the literature on WASH insecurity, COVID-19, and psychosocial health and wellbeing of older adults in SSA in three significant ways. First, by uncovering the role of trust in governments in shaping vulnerable people’s psychosocial health and wellbeing during the COVID-19 pandemic, this research advances the proposition that trust in political authority is a critical determinant of population health, especially during health emergencies. Secondly, this research highlights how emerging infectious diseases intersect with resource scarcities in low- and middle-income countries, affecting the health and wellbeing of vulnerable populations. Lastly, by revealing the unique WASH vulnerabilities confronting older adults in LMICs during health emergencies, this research provides valuable insights for policymakers and practitioners on how to address the WASH and health needs of elderly people in resource-limited contexts during health emergencies. | en |
