|
1
|
Jakubowski A, Egger D, Mulebeke R, Akankwasa P, Muruta A, Kiwanuka N, Wanyenze RK. Evaluation of a national program to distribute free face masks in Uganda: Evidence from Mbale District. PLoS One 2024; 19:e0305574. [PMID: 38990844 PMCID: PMC11238958 DOI: 10.1371/journal.pone.0305574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND COVID-19 posed a major threat to countries around the world, but many nations in sub-Saharan Africa avoided large-scale outbreaks. In Uganda, the government first enacted strict lockdowns but later focused on public health policies like masking and distancing. The government also embarked on an ambitious campaign to deliver a free face mask to all Ugandan citizens (approx. 30 million masks). We test whether mask distribution, and public education and encouragement of mask use by community health volunteers, affected mask behavior. METHODS We collected data about mask behavior before and after masks were distributed in the Mbale district of Uganda. Trained enumerators directly observed mask wearing in public places and asked about mask use via phone surveys. We compared observed and self-reported mask behavior before and after masks were distributed. We also tested whether training volunteers from randomly selected villages to educate the public about COVID-19 and masks affected behavior, attitudes, and knowledge among mask recipients. RESULTS We collected 6,381 direct observations of mask use at baseline (February 2021) and 19,855 observations at endline (April 2021). We conducted a listing of 9,410 households eligible for phone surveys and randomly selected 399 individuals (4.2%) at baseline and 640 (6.8%) at endline. Fewer than 1% of individuals were observed wearing masks at baseline: 0.9% were seen with a mask and 0.5% wore masks over mouth and nose. Mask wearing significantly increased at endline but remained low: 1.8% of people were observed with masks and 1.1% were seen wearing masks correctly after the distribution campaign. At the same time, a high proportion of people reported using masks: 63.0% of people reported using masks at baseline and 65.3% at endline when walking around their villages. When respondents were asked about mask use in public places, 94.7% reported using masks at baseline and 97.4% reported using masks at endline. We found no differences in knowledge, behavior, or attitudes among mask recipients in villages where volunteers were tasked with conveying information about COVID-19 and masks during distribution. CONCLUSION Mask use remained low in Mbale district of Uganda during study observation period even after free masks were distributed. Encouraging new health behaviors may need to involve more intensive interventions that include reminders and address social norms.
Collapse
Affiliation(s)
- Aleksandra Jakubowski
- Department of Public Health and Health Sciences, Department of Economics, Northeastern University, Boston, United States of America
| | - Dennis Egger
- Department of Economics, University of Oxford, Oxford, England
| | - Ronald Mulebeke
- School of Public Health, Makerere University, Kampala, Uganda
| | | | | | - Noah Kiwanuka
- School of Public Health, Makerere University, Kampala, Uganda
| | | |
Collapse
|
|
2
|
Wang CW, de Jong EP, Faure JA, Ellington JL, Chen CHS, Chan CC. Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study. Disaster Med Public Health Prep 2024; 18:e23. [PMID: 38351541 DOI: 10.1017/dmp.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. METHODS Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. RESULTS In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. CONCLUSIONS These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.
Collapse
Affiliation(s)
- Chia-Wen Wang
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore
| | - Erik Pieter de Jong
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Josemyrne Ashley Faure
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Chi-Hsin Sally Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
|
3
|
Lertsakulbunlue S, Kittisarapong P, Pikulkaew S, Pusayapaibul P, Tangtongsoonthorn A, Wichaiboon C, Amornchatchawankul F, Marsook S, Mahaisawariya S, Subwongcharoen N, Petcharat P, Luksanasup B, Lortharaprasert T, Tieantanyatip B, Kantiwong A, Jongcherdchootrakul K. What Sustains Mask-Wearing Behavior among Elders in a Rural Community in the Post-COVID-19 Era: An Exploratory Mixed-Methods Study. Behav Sci (Basel) 2023; 13:678. [PMID: 37622818 PMCID: PMC10451204 DOI: 10.3390/bs13080678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
The current study investigates the factors influencing face-mask-wearing practices among elderly individuals in rural Thailand. A mixed-methods approach was employed, involving qualitative interviews with 15 elderly participants and a subsequent survey of 201 elders. Seven subthemes were identified, including the perceived benefits of mask-wearing, the perceived threat of COVID-19, mask-wearing enhancing attractiveness and self-confidence, social norms, misconceptions about COVID-19 prevention tools, perceived barriers to mask-wearing, and resources to afford face masks. The developed themes, codes, and quotes were utilized for creating a questionnaire. The survey revealed the adherence of 81.1% of the participants to mask-wearing. Structural equation modeling (SEM) analysis demonstrated that motivation, comprising (1) the perceived threat of COVID-19, (2) alternative threats aside from COVID-19, and (3) the perceived benefits of a face mask strongly affected mask-wearing practices (β = 0.68, p < 0.001) and the willingness to wear a face mask (β = 0.61, p < 0.001). Social norms had a negative direct effect on the perceived barrier (β = -0.48, p < 0.001) and a positive direct effect on mask-wearing practices (β = 0.25, p = 0.001). This study highlights that motivation and social norms play pivotal roles in sustaining mask-wearing behavior among rural elderly populations. Encouraging local cooperative actions through community rules could initiate behavioral changes within the community. These findings contribute to the understanding of factors influencing mask-wearing and provide insights into designing effective interventions to promote mask-wearing among elderly individuals in rural areas.
Collapse
Affiliation(s)
- Sethapong Lertsakulbunlue
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (S.L.); (A.K.)
| | - Pinyada Kittisarapong
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Sirikorn Pikulkaew
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Pree Pusayapaibul
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Apisit Tangtongsoonthorn
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Chanunpisut Wichaiboon
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Fasai Amornchatchawankul
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Suranuch Marsook
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Supakrit Mahaisawariya
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Nattasit Subwongcharoen
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Phitchayut Petcharat
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Bannawit Luksanasup
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Thakornphong Lortharaprasert
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Bavorn Tieantanyatip
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Anupong Kantiwong
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (S.L.); (A.K.)
| | | |
Collapse
|
|
4
|
Takyiakwaa D, Tuoyire DA, Abraham SA, Agyare EA, Amoah JO, Owusu-Sarpong AA, Omona K, Obiri-Yeboah D, Doku DT. Culture and pandemic control at cross-roads: navigating the burial guidelines for COVID-19-related deaths in a Ghanaian setting. BMC Health Serv Res 2023; 23:519. [PMID: 37221506 PMCID: PMC10204008 DOI: 10.1186/s12913-023-09421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Despite the large volume of scientific evidence on the rapid spread of the COVID-19 pandemic and associated high morbidity and mortality, little is known about the sociocultural disruptions which ensued. The current study explored the nuanced navigation of the COVID-19-related death and burial protocols and its impact on traditional burial and funeral rites in Ghana. METHODS This qualitative study was based on the 'focused' ethnographic design. Data were collected using key informant interviews from nineteen COVID-19-related bereaved family members and public health officials involved in enforcing adherence to COVID-19-related death and burial protocols in the Cape Coast Metropolis of Central region of Ghana. Recursive analysis was conducted to generate the themes and sub-themes from the data. RESULTS The overarching theme was "Uncultural" connotations ascribed to the COVID-19-related death and burial protocols. The COVID-19-related death and burial protocols were ubiquitously deemed by participants to be 'uncultural' as they inhibited deep-rooted indigenous and eschatological rites of separation between the living and the dead. This was fueled by limited awareness and knowledge about the COVID-19 burial protocols, resulting in fierce resistance by bereaved family members who demanded that public health officials release the bodies of their deceased relatives. Such resistance in the midst of resource limitation led to negotiated compromises of the COVID-19-related death and burial protocols between family members and public health officials. CONCLUSIONS Insensitivity to socio-cultural practices compromised the implementation of the COVID-19 pandemic control interventions, particularly, the COVID-19-related death and burial protocols. Some compromises that were not sanctioned by the protocols were reached to allow health officials and families respectfully bury their dead. These findings call for the need to prioritize the incorporation of sociocultural practices in future pandemic prevention and management strategies.
Collapse
Affiliation(s)
- Dorothy Takyiakwaa
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana.
- Centre for Gender Research, Advocacy and Documentation, University of Cape Coast, Cape Coast, Ghana.
| | - Derek Anamaale Tuoyire
- Department of Community Medicine, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Susanna Aba Abraham
- Adult Health Department, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Ama Agyare
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Microbiology and Immunology Department, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - John Oti Amoah
- Centre for Gender Research, Advocacy and Documentation, University of Cape Coast, Cape Coast, Ghana
| | | | - Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Dorcas Obiri-Yeboah
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Microbiology and Immunology Department, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - David Teye Doku
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|