Perceptions and compliance with COVID-19 preventive measures in Southern and Central regions of Mozambique: a quantitative in-person household survey in the districts of Manhiça and Quelimane

Abstract

Background The COVID-19 pandemic has led countries into urgent implementation of stringent preventive measures at the population level. However, implementing these measures in low-income countries like Mozambique was incredibly difficult, coupled with lack of scientific evidence on the community understanding and compliance with these measures. This study assessed the perceptions and implementation of COVID-19 preventive measures recommended by Mozambican authorities in Manhiça and Quelimane districts, taking confinement, social distancing, frequent handwashing, mask wearing, and quarantine as the key practices to evaluate. Methods A quantitative survey interviewing households’ heads in-person was conducted in October 2020 and February 2021; collecting data on perceptions of COVID-19, symptoms, means of transmission/prevention; including self-evaluation of compliance with the key measures, existence of handwashing facilities, and the ratio of face-masks per person. The analysis presents descriptive statistics on perceptions and compliance with anti-COVID-19 measures at individual and household levels, comparing by district and other variables. T-test was performed to assess the differences on proportions between the districts or categories of respondents in the same district. Results The study interviewed 770 individuals of which 62.3% were heads of households, 18.6% their spouses, and 11.0% sons/daughters. Most participants (98.7%) had heard of COVID-19 disease. The most difficult measure to comply with was staying at home (35.8% of respondents said they could not comply with it at all); followed by avoiding touching the month/nose/eyes (28.7%), and social distancing at home (27.3%). Mask wearing in public places was the measure that more respondents (48.8%) thought they complied 100% with it, followed by avoiding unnecessary traveling (40.0%), avoiding crowed places (34.0%), and social distancing outside home (29.0%). Only 30.4% of households had handwashing devices or disinfectant (36.7% in Manhiça and 24.1% in Quelimane); and of those with devices, only 41.0% had water in the device, 37.6% had soap, and 22.6% had other disinfectant. The ratio of masks per person was only 1, which suggests that people may have used the same mask for longer periods than recommended. Conclusions Community members in Manhiça and Quelimane were aware of COVID-19 but they lacked understanding for implementing the preventive measures. This, together with socio-economic constraints, led to lower levels of compliance with the key measures. Understanding and addressing the factors affecting proper implementation of these measures is crucial for informing decision-makers about ways to improve community knowledge and practices to prevent infectious diseases with epidemic potential.

Knowledge of COVID-19 symptoms, transmission, and prevention: Evidence from health and demographic surveillance in Southern Mozambique

“…This study is part of a broader examination within the Child Health and Mortality Prevention Surveillance (CHAMPS) network to analyze the consequences of COVID-19 lockdowns for child health and mortality [14][15][16][17]. Leveraging the established platform of the CHAMPS Network of Health and Demographic Surveillance Systems (HDSSs) [18], we administered a short questionnaire to all households in a rural district [19]. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for cross-sectional studies were followed.…”

“…A survey instrument was developed to collect information about households' experiences during the COVID-19 lockdown, which included information on knowledge regarding COVID-19 symptoms, transmission, and prevention [22]. Questions were based on guidelines issued by the Ministry of Health for COVID-19 prevention in Mozambique [23].…”

“…In adjusted analyses, higher knowledge of symptoms, transmission, and prevention scores were among participants who were 18-64 years (0.07 ~0. 19) with �65 as reference; were Catholic, Protestant, or Evangelical (0.05 ~0.22) with Zion church members as reference; were PLOS GLOBAL PUBLIC HEALTH merchants (0.08 ~0.15), retired/pensioners (0.17 ~0.18), or professionals (0.07 ~0.12) with unemployed as reference; and were in the poorer to richest wealth index quintiles (0.11 ~0.25) with poorest as reference (Fig 2). Knowledge scores for all three COVID-19 knowledge indices were significantly lower for widowed (-0.10 ~-0.09) compared to married participants.…”

“…Coronavirus disease 2019 (COVID- 19) was first reported in Mozambique in March 2020. Since then, there have been over 230,000 confirmed cases and over 2,200 deaths reported in Mozambique through May 2023 [1], though the death toll could be much higher than official figures due to the challenges experienced in the country's surveillance capacities and underreporting [2].…”

Assessing Sociodemographic Factors Associated with Household Hardships during the COVID-19 Pandemic in Manhiça, Mozambique using Data Collected between April 2021 and February 2022

“…The COVID-19 lockdown dataset analyzed for this study can be found in the CHAMPS Population Surveillance Dataverse [link]. [54] The Manhiça HDSS data that was used in combination with the COVID-19 lockdown dataset are available from the authors upon reasonable request.…”