The spread of COVID-19 across the globe has led to several questions about how health systems in lower and middle-income countries will deal with the pandemic. Nigeria is the most populated country on the African continent and therefore a potential hotspot for COVID cases given the inherent difficulties of social distancing in its densely populated urban areas. As the recent coronavirus (COVID-19) spread to Nigeria, public attitudes and knowledge of the virus were unclear. Questions also remained about how health facilities would prepare and manage in this unprecedented time.
In late March 2020, Premise met with stakeholders to develop three inquiries to address risk communication and preparedness in Nigeria. In the span of two weeks, Premise was able to launch tasks and receive back results to elucidate perceptions and reactions to messaging about COVID-19, as well as clues about how health facilities were reacting to the pandemic.
In four urban areas in Nigeria—Kano, Maiduguri (Borno state), Oyo and Ibadan—Premise engaged its network to collect observations on precautions instituted at more than 500 primary care facilities.
These locations served as a sample representing different types of risk toward the prevention and mitigation of COVID-19 in Nigeria.
- Oyo and Ibadan – Proximity to Lagos, the epicenter of the pandemic in Nigeria, directly in the pathway of inter-state spread.*
- Kano – An international city with a heightened risk of travelers bringing the virus to the city from outside Nigeria (similar to Lagos or Abuja, which were already under lockdown).
- Maiduguri, Borno State – A more remote, hard to reach area to rapidly collect data due to geography and nearby threats of conflict.
Premise was careful to select locations that did not have any government enacted lockdown orders or movement restrictions. Contributors were required to go through training on social distancing best practices before collecting data from facilities.
Premise contributors identified a wide variety of signage about COVID-19 at health facilities, such as signs illustrating common symptoms and sharing guidance on how to prevent the spread of the virus. However, only 15% of all submissions shared outward facing signage on coronavirus. This represents a significant opportunity to improve risk communication at the primary health care level. Facilities can share precautionary information as well as provide guidance on whether samples can be submitted at the health facility for testing or if patients can receive treatment for COVID-19 symptoms.
While most locations visited did not have large crowds, Premise contributors observed a lack of social distancing at 5-10% of health facilities. About 35% of health facilities had hand washing stations outside the facility, a key method of preventing COVID-19 transmission.
As COVID-19 spreads rapidly throughout the world, especially in areas of fragile health systems, it is critical to support local teams to help health facilities best prepare to care for cases of COVID-19. The availability of personal protective equipment or PPE (e.g. facemasks) is a common concern globally for front-line health care workers. Premise contributors noticed that staff at nearly 50% of facilities wore face masks.
Combined, insights at the health facility level and across the community can be a valuable tool for local teams to address shortcomings or PPE shortages to ensure local health systems are best prepared to deal with the COVID-19 crisis.
Beyond resources at health facilities, public perceptions and knowledge of COVID-19 are critical to mitigating the spread of coronavirus. Premise launched two surveys on best practices (e.g. social distancing) as well as sources of information and trust in messaging. In about 10 days, Premise collected responses from over 800 individuals across four states—Oyo, Lagos, Kano and Borno.
A key finding from the survey is that a clear majority of people are hearing religious leaders oppose social distancing guidelines. 63% of respondents had personally heard a religious leader opposing this key prevention practice. Around 78% of individuals had also heard that Chloroquine could be an effective drug against COVID-19. Premise contributors also noted exposure to a wide variety of misinformation, including remedies, such as alcohol, garlic, palm oil and shea butter. Other misinformation included how to identify symptoms (e.g. pink eye) and transmission (e.g. sexually transmitted), as well as unequivocal denial of COVID-19’s presence in Africa or that black people could not be infected.
Only around 30% of respondents had high levels of confidence in the accuracy of information coming from both state and national government and health authorities. This coupled with the proliferation of misinformation contributors have encountered presents a challenge to ensure that citizens are equipped with the accurate and effective information needed to keep themselves, their families and their communities safe.
Beyond issues in messaging and understanding of the virus, the survey results highlighted issues with an understanding of social distancing. A quarter of people indicated that avoiding shaking hands is not part of social distancing practices.
About 75% of individuals said they were at least somewhat aware of “social distancing” as a method to reduce the chance of spreading coronavirus. However, more than 40% of individuals were “not at all concerned” or only “slightly concerned” about coronavirus spreading due to lack of social distancing in their own communities. This follows that about 40% of respondents said they did not follow social distancing. Of those individuals, most cited a lack of need to practice social distancing because they do not interact with vulnerable groups (e.g. the elderly or those with pre-existing conditions). Other factors included people who could not practice social distancing due to the fact that they were unable to avoid public transportation, unable to work from home, or unable to avoid being close to others while shopping for food or other necessities. This underscores a similar pattern emerging globally, where following best practices of social distancing may be a luxury reserved for those with higher socioeconomic status.
The ability for state and city level actors to stem the spread of COVID-19, whether in Borno, Nigeria or Seattle, Washington (USA) requires timely information and action. Premise continues to support these efforts by helping teams realize where intervention and support are most critical.
To learn more about the data Premise is capturing on COVID-19 visit www.premise.com/COVID-19.
*Besides Ogun state which was already under lockdown. Oyo only had a couple of cases.