@Article{info:doi/10.2196/26073,
author="Harling, Guy
and G{\'o}mez-Oliv{\'e}, Francesc Xavier
and Tlouyamma, Joseph
and Mutevedzi, Tinofa
and Kabudula, Chodziwadziwa Whiteson
and Mahlako, Ruth
and Singh, Urisha
and Ohene-Kwofie, Daniel
and Buckland, Rose
and Ndagurwa, Pedzisai
and Gareta, Dickman
and Gunda, Resign
and Mngomezulu, Thobeka
and Nxumalo, Siyabonga
and Wong, Emily B
and Kahn, Kathleen
and Siedner, Mark J
and Maimela, Eric
and Tollman, Stephen
and Collinson, Mark
and Herbst, Kobus",
title="Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="13",
volume="7",
number="5",
pages="e26073",
keywords="behaviour change; COVID-19; economic well-being; health care access; health knowledge; mental health; South Africa; surveillance; nonpharmaceutical interventions",
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. ",
issn="2369-2960",
doi="10.2196/26073",
url="https://publichealth.jmir.org/2021/5/e26073",
url="https://doi.org/10.2196/26073",
url="http://www.ncbi.nlm.nih.gov/pubmed/33827046"
}