Department of Public Health and Health Sciences, Department of Economics, Northeastern University, Boston, United States of America.
Department of Economics, University of Oxford, Oxford, England.
PLoS One. 2024 Jul 11;19(7):e0305574. doi: 10.1371/journal.pone.0305574. eCollection 2024.
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.
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.
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.
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.
COVID-19 对世界各国构成了重大威胁，但撒哈拉以南非洲的许多国家避免了大规模疫情爆发。在乌干达，政府最初实施了严格的封锁措施，但后来侧重于戴口罩和保持社交距离等公共卫生政策。政府还开展了一项雄心勃勃的运动，向所有乌干达公民（约 3000 万只口罩）免费发放口罩。我们测试了口罩的分发情况，以及社区卫生志愿者对口罩使用的公共教育和鼓励是否会影响口罩的使用行为。
我们在乌干达姆巴莱区收集了分发口罩前后口罩使用行为的数据。经过培训的普查员在公共场所直接观察口罩佩戴情况，并通过电话调查询问口罩使用情况。我们比较了分发口罩前后观察到的和自我报告的口罩使用情况。我们还测试了随机选择村庄的志愿者接受有关 COVID-19 和口罩的培训，以教育公众，这是否会影响口罩接受者的行为、态度和知识。
我们在基线（2021 年 2 月）收集了 6381 次口罩使用的直接观察结果，在终线（2021 年 4 月）收集了 19855 次观察结果。我们对 9410 户有资格进行电话调查的家庭进行了清查，并在基线时随机选择了 399 人（4.2%），在终线时选择了 640 人（6.8%）。观察到的戴口罩的人数不到 1%：有 0.9%的人戴着口罩，0.5%的人戴口罩遮住口鼻。口罩佩戴在终线时明显增加，但仍然很低：有 1.8%的人被观察到戴口罩，分发运动后有 1.1%的人正确佩戴口罩。与此同时，很大一部分人报告说戴口罩：有 63.0%的人在基线时报告戴口罩，65.3%的人在终线时报告在村庄周围走动时戴口罩。当被问及在公共场所戴口罩时，94.7%的人在基线时报告戴口罩，97.4%的人在终线时报告戴口罩。我们没有发现分发期间志愿者负责传达有关 COVID-19 和口罩的信息的村庄中，口罩接受者在知识、行为或态度方面存在差异。
即使在分发免费口罩后，乌干达姆巴莱区的口罩使用仍然很低。鼓励新的健康行为可能需要更密集的干预措施，包括提醒和解决社会规范。
