A comparative policy analysis of the early public health response to mitigate the spread of COVID-19 in Nigeria, Rwanda, and Zambia
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BACKGROUND: In the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide including sub-Saharan Africa to prevent and control transmission of SARS-CoV-2. This mixed methods study aims to examine adherence to and enforcement of NPIs implemented to curb COVID-19 in Nigeria, Rwanda, and Zambia, leading up to the 10,000th case of COVID-19 in each country. Additionally, we aim to broadly evaluate the relationship between levels and changes of NPIs over time and changes in COVID-19 cases and deaths. METHODS: This mixed methods analysis utilized semi-structured interviews and a quantitative dataset constructed using multiple open data sources, including the Oxford COVID-19 Government Response Tracker. Quantitative data were analyzed using four case windows (0 cases, 1-100 cases, 101-1,000 cases, and 1,001-10,000 cases). To understand potential barriers and facilitators in implementing and enforcing NPIs and how other epidemics within the countries may have affected compliance with NPIs, qualitative data were collected from those involved in the COVID-19 response and analyzed using NVivo. Quantitative results were analyzed using descriptive statistics, plots, ANOVA, post hoc Tukey, and correlation analyses. RESULTS: Individual indicator scores varied with the COVID-19 response in all three countries. Nigeria had sustained levels of strict measures for containment and closure NPIs, while in Rwanda there was a lot of variation in NPI score as it transitioned through the different case windows for the same measures. Zambia saw moderate stringency throughout the pandemic with gathering restrictions and business/school closure measures but maintained low levels of strictness for other containment and closure measures. Rwanda by far had the most consistent and stringent measures compared to Nigeria and Zambia. Their success in implementation was partly due to strong enforcement and having a population that generally obeys their government. CONCLUSION: Various forces either facilitated or hindered adherence and compliance to these measures. There were several lessons learned which highlight the need to engage communities early and create buy-in, as well as the need for preparation to ensure that response efforts are proactive rather than reactive when faced with an emergency.
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