ArticlePLOS global public health2022
Adherence to and enforcement of non-pharmaceutical interventions (NPIs) for COVID-19 prevention in Nigeria, Rwanda, and Zambia: A mixed-methods analysis.
Article in PLOS global public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- Impact of Non-Pharmaceutical Interventions Targeted at COVID-19 Pandemic on Influenza Burden-A Systematic Review and Meta-Analysis.Influenza and other respiratory viruses · 2026Pooled it
- The impact of COVID-19 mitigation measures on neonatal health outcomes in sub-Saharan Africa: A systematic review and meta-analysis.Public health · 2025Pooled it
- Impacts of COVID-19 mobility-restricting policies and perceived COVID-19 risks on household unmet medical needs in Nigeria: a difference-in-differences analysis.BMC health services research · 2026Article
- Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis.JMIR public health and surveillance · 2024Article
- Assessing factors associated with compliance to preventive measures of COVID-19 in Rwanda: a cross-sectional community survey.BMJ open · 2024Article
- Impact of COVID-19 on food security and diet quality in Chilanga District, Zambia.Journal of health, population, and nutrition · 2024Article
- Quantified impacts of non-pharmaceutical interventions on influenza circulation during the COVID-19 pandemic in 13 African countries, 2020-2022.Influenza and other respiratory viruses · 2024Article
- Assessment of Factories on Adherence to COVID-19 Standard Operating Procedures: A Case Study of Wakiso, Mukono, Buikwe, and Jinja Districts, Uganda.Journal of tropical medicine · 2024Article
- An extended SEIRDV compartmental model: case studies of the spread of COVID-19 and vaccination in Tunisia and South Africa.Annals of medicine and surgery (2012) · 2023Article
- COVID-19 vaccine hesitancy: a systematic review of barriers to the uptake of COVID-19 vaccine among adults in Nigeria.Bulletin of the National Research Centre · 2023Review
- A general framework for optimising cost-effectiveness of pandemic response under partial intervention measures.Scientific reports · 2022Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn the early parts of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, including in sub-Saharan Africa, to prevent and control SARS-CoV-2 transmission. This mixed-methods study examines adherence to and enforcement of NPIs implemented to curb COVID-19 in Nigeria, Rwanda, and Zambia, leading up to the 10,000th case of laboratory-confirmed COVID-19 in each country. Additionally, we aim to evaluate the relationship between levels and changes of NPIs over time and changes in COVID-19 cases and deaths.
methodsThis 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. To understand potential barriers and facilitators in implementing and enforcing 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, and post hoc Tukey.
resultsIndividual 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 substantial variation in NPI score as it transitioned through the different case windows for the same measures. Zambia implemented moderate stringency throughout the pandemic using gathering restrictions and business/school closure measures but maintained low levels of strictness for other containment and closure measures. Rwanda had far more consistent and stringent measures compared to Nigeria and Zambia. Rwanda's success in implementing COVID-related measures was partly due to strong enforcement and having a population that generally follow the recommendations of their government.
conclusionVarious forces either facilitated or hindered adherence and compliance to COVID-19 control measures. The lessons learned and recommendations gleaned through interviews with experts involved in the COVID-19 pandemic and quantitative analysis of NPI implementation can be applied to future outbreaks, epidemics, and pandemics. Recommendations include engaging communities, using a risk-based approach to implement containment and closure NPIs, and providing social and economic support to citizens during periods of lockdowns and other measures that interrupt the ability to make a living.
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Registered trials
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