Challenges of implementing nonpharmaceutical- interventions to prevent COVID- 19 in an urban-slum in Lagos-Nigeria

ABSTRACT

Introduction/ Background: Non-pharmaceutical interventions are important public health measures targeted at behavioral changes to interrupt the transmission of coronavirus in humans. This study evaluated the challenges of implementing non-pharmaceuticalinterventions, assessed adherence, and identified requirements to the successful control of the spread of COVID-19 among individuals living in an urban-slum setting in Lagos-Nigeria. Methods: A cross-sectional study conducted among resident of an urban-slum in Makoko, Lagos-Nigeria. Adult members of households aged 18 years and above were selected via convenient sampling. An interviewer administered semi-structured questionnaire was used to obtain information on sociodemographic characteristics, living conditions and adherence to non-pharmaceutical interventions over a period of five-months from May to September 2020. Adherence to nonpharmaceutical intervention was determined by calculating an adherence index from 10 evidence based protective behaviors and a self-report of adhering to the measures. Descriptive-statistics and multiple-logistics regression model were used to determine challenges and factors associated with adherence to COVID-19 preventive measures. Results: A total of 357 participants with a mean-age of 45.8 ± 12.9 years were included in the analysis. Majority were males (62.2%) and married (83.8%). Most participants (93.8%) had no space for selfisolation as majority lived in a one-roomapartment (72.8%), shared toilets/kitchen-space (63.6%) with other families and had no constant source of water-supply (61.9%). About 98.8% are aware of the pandemic but only 33.9% adhered to the preventive-measures. The ability to afford facemasks/hand-sanitizers (aOR6.7;95% CI3.8-11.6), living-alone (aOR3.7;95%CI1.3-10.6), and ability to buy-water (aOR0.3;95% CI0.1-0.5) were found to be associated with adherence to the preventivemeasures after adjusting for covariates in a multilogistic- regression-model. Impact This study gives insight on the realities/challenges of implementing non-pharmaceutical-intervention against COVID-19 disease in a setting of economically disadvantaged individuals who are at a great risk of being a hub for circulating the virus. This will aid the government in addressing cogent factors that might fuel re-occurrence of the pandemic waves. Conclusion: Implementation of non-pharmaceutical interventions for COVID-19 prevention was a challenge as only a quarter of residents adhered to national guidelines. Government should prioritize vaccinating these cohort of individuals and address factors like poor housing, overcrowding and lack of public water supply that affects adherence to public health measures in this setting.