Importance of Community-Level Interventions During the COVID-19 Pandemic: Lessons from Sub-Saharan Africa

Abstract

Community-level strategies are important in ensuring adequate control of disease outbreaks especially in sub-Saharan African countries. Learning from public health responses to previous infectious disease outbreaks is important in shaping these responses to COVID-19. This study aims to highlight and summarize the evidence from community-level interventions during infectious disease outbreaks in sub-Saharan Africa (SSA). We conducted a scoping review of published literature on community-level interventions and strategies adopted in different infectious disease outbreaks in SSA. To obtain relevant studies, we searched EMBASE, CINAHL, MEDLINE, and Google Scholar in August 2020. Our search was based on the combination of keywords such as coronavirus, flu, Ebola, community, rural, strategies, impact, effectiveness, feasibility, Africa, developing countries, and SSA. Studies that met the inclusion criteria were selected and synthesized under the following distinct themes: health education, sensitization, and communications; surveillance; and service delivery. Our review highlights community-based strategies that have been tried and tested with varying outcomes for different outbreaks in different sub-Saharan African communities, we believe they will inform the selection of strategies to adopt in managing the COVID-19 pandemic at the community level. The important aspects of these strategies were highlighted, requirements for successful implementation and the possible challenges that might be encountered were also discussed. Achieving control of the COVID-19 pandemic in sub-Saharan African communities, will require concerted community-based and community-led strategies, which in turn rely on the availability of necessary socioeconomic resources, and the contextual adaption of these interventions.

The effects of social isolation stress and discrimination on mental health

“…In this context, interventions had to be designed for remote implementation instead of face-to-face interactions at an individual as well as community level. The COVID-19 pandemic thus highlighted the importance of using digital interventions that reach a broad audience in order to prevent or reduce social isolation stress and discrimination [183][184][185][186][187]. Remote interventions can be achieved through self-guided programmes or delivered by community health workers or mental health professionals via online social media channels (e.g., direct message exchange) or traditional communication channels (e.g., telephone or video conversation, especially for older adults with limited digital literacy) [167].…”

Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study

“…Additionally, some religious organisations actively encouraged adherence to COVID-19 preventive measures 43. These findings highlight the dynamic process of classifying new diseases, as seen in the emergence of Ebola disease,44 and the need for sociocultural considerations and community participation in public health planning and communication, as well as active feedback and management of rumours and misinformation during the response 45 46…”

“…Moreover, intervention adaptation to suit local contexts is essential during emergency response to epidemics. 45 Early reported cases of COVID-19 in the country were among foreigners and high-profile politicians. Linking COVID-19 results to known public officers could have been responsible for the perception that COVID-19 is a disease of the elite.…”

“…Our findings support the need for inclusive risk communication for epidemic preparedness and control. Moreover, intervention adaptation to suit local contexts is essential during emergency response to epidemics 45. Early reported cases of COVID-19 in the country were among foreigners and high-profile politicians.…”

A Qualitative Evaluation of COVID-19 Preventative Response Activities in South Kivu, Democratic Republic of the Congo

“…Therefore, future COVID-19 response programs should promote this approach in our study setting when feasible and with proper PPE. While social media sites (e.g., WhatsApp and Facebook) can be sources of COVID-19 misinformation, they should also be leveraged to provide factual and context-specific health communication and have the benefit of reaching a larger audience at minimal cost [ 12 , 14 , 37 , 38 , 39 , 40 ]. A multi-prong approach that includes in-person visits, social media, and radio and television will likely be needed for COVID-19 preventative program delivery in our study setting.…”