Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2021 Mar 4;16(3):e0248055. doi: 10.1371/journal.pone.0248055. eCollection 2021.
With over 500 000 infections and nearly 12 000 deaths, South Africa (SA) is the African epicenter of the current Coronavirus (COVID-19) pandemic. SA has implemented a 5-stage Risk-Adjusted Strategy which includes a phased national lockdown, requiring social distancing, frequent hand washing and wearing face masks. Strict adherence to this strategy is crucial to reducing COVID-19 transmission, flattening the curve, and preventing resurgence. As part of the 22-country International Citizens Project COVID-19 (ICPcovid), this study aimed to describe the SA adherence to the Risk-Adjusted Strategy and identify determinants of adherence.
During 24 April-15 May 2020, people were electronically invited, through social media platforms and a text blast, to complete an online survey, accessible via www.icpcovid.com. The survey investigated COVID-19 testing and preventative adherence measures, then used logistic regression analysis to identify predictors of adherence.
There were 951 participants, with 731(76.9%) 25 to 54 years. Most (672;70.7%) were female, and 705(74.1%) had a university degree. Since the epidemic started, 529(55.6%) and 436(45.9%) participants stated they were eating healthier and taking more vitamins, respectively. Only 82(8.6%) had been COVID-19 tested, and 1(1.2%) tested positive. In public, 905(95.2%) socially distanced, however 99(10.4%) participants had recently attended meetings with over ten people. Regular hand washing was practiced by 907(95.4%) participants, 774(81.4%) wore face masks and 854(89.8%) stayed home when they experienced flu-like symptoms. The odds of adhering to the guidelines were lower among men versus women (AOR 0.72, 95% confidence interval [CI] = 0.528, 0.971) and those who had flu-like symptoms (AOR 0.42, 95% CI = 0.277, 0.628). In contrast, increased odds were reported for those who reported increased vitamin intake (AOR 1.37, 95% CI = 1.044,1.798), and were either cohabiting or married (AOR 1.39, 95% CI = 1.042,1.847).
Despite high reported adherence, face mask use and symptomatic individuals not self-isolating, were areas for improvement. However, these factors cannot solely account for SA's increasing COVID-19 cases. Larger general population studies are needed to identify other adherence predictors for a strengthened SA COVID-19 response. While the government must continue to educate the entire population on preventative measures, provide personal protective equipment and stress the importance of adherence, there also needs to be implementation of prioritised prevention strategies for men and single individuals to address their demonstrated lower adherence.
南非（SA）目前有超过 50 万例感染病例和近 12000 例死亡病例，是当前冠状病毒（COVID-19）大流行的非洲中心。SA 实施了 5 阶段风险调整策略，其中包括分阶段的全国封锁，要求保持社交距离、勤洗手和戴口罩。严格遵守这一策略对于减少 COVID-19 传播、平缓曲线和防止再次爆发至关重要。作为 22 个国家的国际公民项目 COVID-19（ICPcovid）的一部分，本研究旨在描述 SA 对风险调整策略的遵守情况，并确定遵守的决定因素。
在 2020 年 4 月 24 日至 5 月 15 日期间，通过社交媒体平台和短信通知人们在线填写问卷调查，可通过 www.icpcovid.com 进行访问。该调查研究了 COVID-19 的检测和预防措施的遵守情况，然后使用逻辑回归分析确定了遵守的预测因素。
共有 951 名参与者，其中 731 名（76.9%）年龄在 25 至 54 岁之间。大多数（672 人；70.7%）为女性，705 人（74.1%）拥有大学学位。自疫情开始以来，分别有 529（55.6%）和 436（45.9%）名参与者表示他们在饮食方面更加健康，服用更多的维生素。只有 82（8.6%）人接受过 COVID-19 检测，1 人（1.2%）检测呈阳性。在公共场所，905 人（95.2%）保持社交距离，但 99 名参与者（10.4%）最近参加了超过 10 人的会议。907 名参与者（95.4%）经常洗手，774 人（81.4%）戴口罩，854 人（89.8%）出现流感样症状时留在家中。与女性相比，男性遵守准则的可能性较低（优势比 0.72，95%置信区间 [CI] = 0.528，0.971），出现流感样症状的可能性也较低（优势比 0.42，95% CI = 0.277，0.628）。相反，报告增加维生素摄入量的参与者（优势比 1.37，95% CI = 1.044，1.798）和同居或已婚的参与者（优势比 1.39，95% CI = 1.042，1.847），其遵守的可能性更高。
尽管报告的遵守率很高，但仍有戴口罩和出现症状的人未自我隔离，这是需要改进的地方。然而，这些因素不能完全解释南非 COVID-19 病例的增加。需要进行更大规模的一般人群研究，以确定其他遵守预测因素，以加强南非 COVID-19 的应对措施。虽然政府必须继续向全体民众宣传预防措施，提供个人防护设备，并强调遵守的重要性，但也需要为男性和单身个人实施有针对性的预防策略，以解决他们表现出的较低遵守率问题。
