Authors: Alex Ndyabakira1, 2, Elizabeth Katana1, 2, Daniel A. Okello2, Aggrey Byaruhanga1, Geoffrey Amanya1, Richard Migisha1, Daniel Kadobera1, Julie Harris3, Alex A. Ario1
Affiliations; 1Uganda Public Health Fellowship program, Kampala, Uganda
2Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda
3Division of Global Health Protection, Center for Global Health, Centers for Disease control and prevention, Kampala, Uganda
Summary
On March 25, 2020, the government of Uganda instituted a total lock down and curfew in addition to other public health response measures in response to the COVID-19 pandemic. Six weeks later with little community transmission, the president gradually relaxed some of the COVID-19 lockdown restrictions. In light of an expected additional lifting of the lockdown measures we estimated the level of compliance to COVID-19 preventive measures to inform phased lifting of the lockdown. We conducted an online survey using a structured questionnaire designed using Google Docs and administered online to the general public from 8th to 15th May, 2020. We also purposively selected six sites in Kampala Metropolitan and observed practices of the general public on COVID-19 preventive measures from 10th to 13th May, 2020.
Out of the 965 respondents, only 23% were compliant with all the three key preventive measures (use of face mask in public, practicing social distance, and proper hand washing). Despite the 652 (68%) of the respondents having access to a face mask, only 293 (30%) regularly used it in public. Among the 965 respondents, 736 (83%) always practiced regular hand hygiene. However, only 496 (56%) always practiced social distancing outside of the home.
Compliance to the key COVID-19 preventive measures was low. Social distancing and consistent use of face masks in public were the least adhered to while hand washing was higly complied to. We recommend more enforcement and leveraging public access to face masks if compliance to COVID-19 preventive measures in public places is to be achieved.
Background
On March 18, 2020, the government of Uganda instituted several strategies such as halting mass gatherings, closure of learning institutions, and churches to reduce the risk of importation and spread of COVID-19 in the country. However, on March 21, 2020, Uganda detected the first case of COVD-19, a traveler who had returned from Middle East through mandatory screening of all travelers. Following this, the government instituted a number of control and prevention measures including total lock down and curfew on March 25, 2020.
Six weeks later (May 6, 2020), only 91 cases had been detected in the country, with little community transmission detected (8%). As a result, the President gradually relaxed some of the earlier restrictions. These included opening of large scale or whole sale trade, ware houses, garages, hard wares, and workshops in an attempt to spur economic growth. At the time, the Ministry was waiting for the results of the rapid assessment survey expected to establish the extent of community spread of the COVID-19 before the final position on easing the lock down could be reached. In light of an expected additional lifting of lockdown measures, it was important to understand the extent of adherence to the current recommended preventive measures. Information on adherence to the control and prevention measures was likely going to become increasingly important as human interactions would return to normal levels. We estimated the level of compliance to COVID-19 preventive measures to inform phased lifting of the lockdown.
Methods
We used a structured questionnaire designed using Google Docs and administered online to the general public from 8th to 15th May, 2020. The questionnaire was composed of questions on socio-demographics including age, sex, education level, employment status, daily life during the lock down lifting including ability to return to work and the means of transportation used, COVID-19 preventive practices including practicing social distancing outside the home, having access to a face mask, wearing a face mask in public, proper hand washing practices, shaking people’s hands, and hugging people.
We also purposively selected six sites in Kampala Metropolitan and observed practices of the general public on COVID-19 preventive measures from 10th to 13th May, 2020. We selected central business district (CBD) at Ben Kiwanuka Street, Kisenyi (downtown Kampala), Parliamentary Avenue (uptown Kampala), Kireka (Kampala suburb), Katanga (informal slum settlement), and Kalerwe daily food market.
Results
Online survey
Socio-demographic characteristics of the participants during early phase of easing the lockdown restrictions in Kampala metropolitan area, May 8-15, 2020
| Characteristic (N=965) | Frequency | Percentage |
| District of Residence*(n=948)
Kampala Wakiso Mbarara Mukono Others |
308 224 53 53 310 |
32.5 23.6 5.6 5.6 32.7 |
| Sex
Male Female |
640 325 |
66.3 33.7 |
| Highest level of education attained
None Primary school Secondary school Vocational or technical institution College/University Post-university education |
0 4 20 31 529 381 |
0 0.4 2.0 3.0 55 40 |
| Current employment status
Private sector/Self-employed/Business Non-government Organization (NGO) Public sector Unemployed |
450 158 280 77 |
47.0 16.0 29.0 8.0 |
| Able to return to regular work
Yes No I work from home Unemployed |
252 503 138 72 |
26.1 52.1 14.3 7.5 |
| Means of transportation to work
Unable to move Work from home Walk Boda Boda/Motorcycle/Bicycle Privately-owned car or other means Government/Company transport van/bus Unemployed |
427 116 107 46 108 90 71 |
44.3 12.0 11.0 4.8 11.2 9.3 7.4 |
A total of 965 persons responded to the online survey. The mean age of the participants was 39 years (13-79) and 66% (640/965) were males. More than a half, 56% (532/948) of the respondents were residents of Kampala and Wakiso. Fifty five percent (529/965) had college or university highest level of education, and 47% (450/965) were working with the private sector or self-employed or business. More than half 52% (503/965) had not yet returned to work and majority 44% (427/965) were unable to move (Table 1).
Table 1: Socio-demographic characteristics of the participants during early phase of easing the lockdown restrictions in Kampala metropolitan area, May 8-15, 2020
The level of compliance with COVID-19 preventive measures among participants during early phase of easing the lockdown restrictions in Kampala metropolitan area, May 8-15, 2020
Overall, only 23% (222/965) of the respondents always practiced all the three key preventive measures (use of face mask in public, practicing social distance and proper hand hygiene). Despite the (652/965) 68% of the respondents having access to a face mask, only (293/965) 30% regularly used it in public. Among the respondents, (736/965) 83% practiced regular hand hygiene. However, only (496/965) 56% practiced social distancing outside of home (Table 2).
Table 2:
| Characteristic (N=965) | Frequency (percentage) | Frequency(percentage) |
| Always compliant with the three preventive measures (uses facemask in public, hand washing and social distancing) | Yes
222 (23.0) |
No
743 (77.0) |
| Always wear a face mask in public | 293 (30.0) | 672 (70.0) |
| Always practices social distancing (at least one meter from closest person) | 540 (56.0) | 425 (44.0) |
| Always practices proper hand washing and hygiene | 802 (83.0) | 163 (17.0) |
Community Observations of public face mask use and hand washing practices in Kampala metropolitan area, May 10-13, 2020
The community observations revealed that face mask use was very low from all the Kampala sites. In all the six sites, the proportion of those wearing face masks correctly was less than 30% (table 3).
Table 3: Community observation of public face mask use among 1,167 persons at different locations in Kampala metropolitan area, May 10-13, 2020.
| Venue | Correctly wearing mask (n) | Incorrectly wearing mask (n) | Not wearing mask at all (n) | Percentage wearing mask correctly |
| Central Business District | 8 | 4 | 108 | 6.7 |
| Kisenyi (down town) | 30 | 9 | 270 | 9.7 |
| Parliamentary avenue (up town) | 35 | 27 | 93 | 22.5 |
| Kireka (Kampala suburb) | 5 | 0 | 200 | 2.0 |
| Kalerwe foodmarket | 10 | 5 | 250 | 3.8 |
| Katanga (informal slum settlement) | 0 | 0 | 113 | 0.0 |
Hand washing was fairly practiced compared to use of face masks with some sites such as commercial banks observed with 100% compliance (table 4).
Table 4: Community observations of hand hygiene practices before gaining access to a public place among 170 persons in Kampala city, May 10-13, 2020
| Location | Hand washing
(n) |
Not hand washing (n) | Percentage of hand washing (%) |
| Kalerwe food market | 75 | 5 | 94.2 |
| Commercial bank | 40 | 0 | 100.0 |
| Office block | 23 | 7 | 76.0 |
| Super market | 16 | 4 | 78.6 |
Discussion
In the online survey, out of the 965 respondents, only 23% were always compliant with all the three key preventive measures of COVID-19.
Conclusion
Compliance to the COVID-19 preventive measures was low. Social distancing and consistent use of face masks in public were the least adhered to; many people were seen wearing face masks incorrectly. Hand washing was higly complied to, possibly due to the fact that hand washing facilities were provided free of charge in most public and private places. More enforcement and leveraging public access to face masks is required if compliance to COVID-19 preventive measures in public places is to be achieved.
References
- UDHS. Uganda Demographic Health Survey project (UDHS) in 2016 [Internet]. Uganda Bureau of Statistics Kampala, Uganda The DHS Program ICF Rockville, Maryland, USA; 2016. Available from: https://dhsprogram.com/pubs/pdf/FR333/FR333.pdf
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