Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study

Abstract

Background In March 2020, South Africa implemented strict nonpharmaceutical interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 months, NPI policies were eased in stages according to a national strategy. COVID-19 spread throughout the country heterogeneously; the disease reached rural areas by July and case numbers peaked from July to August. A second COVID-19 wave began in late 2020. Data on the impact of NPI policies on social and economic well-being and access to health care are limited. Objective We aimed to determine how rural residents in three South African provinces changed their behaviors during the first COVID-19 epidemic wave. Methods The South African Population Research Infrastructure Network nodes in the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of longitudinal telephone surveys among randomly sampled households from rural and periurban surveillance populations every 2-3 weeks. Interviews included questions on the following topics: COVID-19–related knowledge and behaviors, the health and economic impacts of NPIs, and mental health. We analyzed how responses varied based on NPI stringency and household sociodemographics. Results In total, 5120 households completed 23,095 interviews between April and December 2020. Respondents’ self-reported satisfaction with their COVID-19–related knowledge and face mask use rapidly rose to 85% and 95%, respectively, by August. As selected NPIs were eased, the amount of travel increased, economic losses were reduced, and the prevalence of anxiety and depression symptoms fell. When the number of COVID-19 cases spiked at one node in July, the amount of travel dropped rapidly and the rate of missed daily medications doubled. Households where more adults received government-funded old-age pensions reported concerns about economic matters and medication access less often. Conclusions South Africans complied with stringent, COVID-19–related NPIs despite the threat of substantial social, economic, and health repercussions. Government-supported social welfare programs appeared to buffer interruptions in income and health care access during local outbreaks. Epidemic control policies must be balanced against the broader well-being of people in resource-limited settings and designed with parallel support systems when such policies threaten peoples’ income and access to basic services.

Impact of the Covid-19 epidemic and related social distancing regulations on social contact and SARS-CoV-2 transmission potential in rural South Africa: analysis of repeated cross-sectional surveys

“…Unsurprisingly, we found that time spent at home rose, while shared person-time spent in other homes dropped by 89% and at ‘other locations’ (largely school, work and shops) by 94%. This reduced potential for exposure in both public and private suggests that people are following rules both when they can and cannot be seen; these data are also consistent with other evidence from this area of reduced mobility in July and August compared even to earlier in 2020 [ 31 ]. Our respondents reported similar time spent attending health clinics in the two years, but reported that fewer others were present when they attended in 2020, perhaps reflecting improved social distancing policies within clinics.…”

“…Under the assumptions that close interaction contacts are the most important for infection transmission, and qualitatively the same in both years, we estimate a 42–45% reduction in the likely basic reproduction number between the two surveys. Given the substantial level of use of face coverings outside the home required and observed in South Africa [ 31 ], this reduction is likely to be an underestimate.…”

The impact of COVID-19 on a cohort of origin residents and internal migrants from South Africa's rural northeast

“…While there appeared to be some hesitancy in accessing care due to the pandemic, health care service avoidance as a result of COVID-19 was not widely reported in the cohort. The South African Population Research Infrastructure Network (SAPRIN) observed stable levels of chronic medication use within the Agincourt and DIMAMO (Limpopo) HDSS during the first wave of the pandemic; however, in the Africa Health Research Institute HDSS site in KwaZulu Natal, the extent of missed medication was significant ( Harling et al, 2021 ). This suggests local variations in interruptions in health service use.…”

Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019

“…Further, elevated blood pressure is increasing mortality for men and women. At present, the Agincourt HDSS is collecting data on COVID-19 in its surveillance site [ 44 ]. Future studies need to take into consideration the impacts of this third epidemic and its interactions with the advanced HIV and hypertension epidemics that continue to affect the lives of rural South Africans.…”