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Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, Singh U, Ohene-Kwofie D, Buckland R, Ndagurwa P, Gareta D, Gunda R, Mngomezulu T, Nxumalo S, Wong EB, Kahn K, Siedner MJ, Maimela E, Tollman S, Collinson M, Herbst K
Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study
Protective behaviours and secondary harms from non-pharmaceutical interventions during the COVID-19 epidemic in South Africa: a multisite prospective longitudinal study
Guy Harling;
Francesc Xavier Gómez-Olivé;
Joseph Tlouyamma;
Tinofa Mutevedzi;
Chodziwadziwa Whiteson Kabudula;
Ruth Mahlako;
Urisha Singh;
Daniel Ohene-Kwofie;
Rose Buckland;
Pedzisai Ndagurwa;
Dickman Gareta;
Resign Gunda;
Thobeka Mngomezulu;
Siyabonga Nxumalo;
Emily B Wong;
Kathleen Kahn;
Mark J Siedner;
Eric Maimela;
Stephen Tollman;
Mark Collinson;
Kobus Herbst
ABSTRACT
Background:
In March 2020 South Africa implemented strict non-pharmaceutical interventions (NPIs) to contain Covid-19. Over the subsequent five months NPIs were eased in stages according to national strategy. Covid-19 spread throughout the country heterogeneously, reaching rural areas by July and peaking in July-August. Data on the impact of NPI policies on social and economic wellbeing and access to healthcare is limited.
Objective:
To determine how rural residents of three South African provinces changed their behaviour during the first Covid-19 epidemic wave.
Methods:
The South African Population Research Infrastructure Network (SAPRIN) nodes in Mpumalanga (Agincourt), KwaZulu-Natal (AHRI) and Limpopo (DIMAMO) provinces conducted longitudinal telephone surveys among randomly sampled households from rural and peri-urban surveillance populations every 2-3 weeks. Interviews included questions on: Covid-19 knowledge and behaviours; health and economic impact of NPIs; and mental health.
Results:
2262 households completed 10,966 interviews between April and August 2020. By August, self-reported satisfaction with Covid-19 knowledge had risen from 48% to 85% and facemask use to over 95%. As selected NPIs were eased mobility increased, and economic losses and anxiety and depression symptoms fell. When Covid-19 cases spiked at one node in July, movement dropped rapidly, and missed daily medication rates doubled. Economic concerns and mental health symptoms were lower in households receiving a greater number of government-funded old-age pensions.
Conclusions:
South Africans reported complying with stringent Covid-19 NPIs despite the threat of substantial social, economic and health repercussions. Government-supported social welfare programmes appeared to buffer interruptions in income and healthcare access during local outbreaks. Epidemic control policies must be balanced against impacts on wellbeing in resource-limited settings and designed with parallel support systems where they threaten income and basic service access.
Citation
Please cite as:
Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, Singh U, Ohene-Kwofie D, Buckland R, Ndagurwa P, Gareta D, Gunda R, Mngomezulu T, Nxumalo S, Wong EB, Kahn K, Siedner MJ, Maimela E, Tollman S, Collinson M, Herbst K
Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study