%0 Journal Article
%@ 2369-2960
%I JMIR Publications
%V 7
%N 5
%P e26073
%T Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study
%A Harling,Guy
%A Gómez-Olivé,Francesc Xavier
%A Tlouyamma,Joseph
%A Mutevedzi,Tinofa
%A Kabudula,Chodziwadziwa Whiteson
%A Mahlako,Ruth
%A Singh,Urisha
%A Ohene-Kwofie,Daniel
%A Buckland,Rose
%A Ndagurwa,Pedzisai
%A Gareta,Dickman
%A Gunda,Resign
%A Mngomezulu,Thobeka
%A Nxumalo,Siyabonga
%A Wong,Emily B
%A Kahn,Kathleen
%A Siedner,Mark J
%A Maimela,Eric
%A Tollman,Stephen
%A Collinson,Mark
%A Herbst,Kobus
%+ Africa Health Research Institute, P.O. Box 198, Mtubatuba 3935, KwaZulu-Natal, South Africa, 27 0355507500, guy.harling@ahri.org
%K behaviour change
%K COVID-19
%K economic well-being
%K health care access
%K health knowledge
%K mental health
%K South Africa
%K surveillance
%K nonpharmaceutical interventions
%D 2021
%7 13.5.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
%X 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. 
%M 33827046
%R 10.2196/26073
%U https://publichealth.jmir.org/2021/5/e26073
%U https://doi.org/10.2196/26073
%U http://www.ncbi.nlm.nih.gov/pubmed/33827046