Barriers to Adherence to Covid-19 Prevention Measures in Harare in 2021

Abstract

Harare, the epicentre of COVID-19 infection in Zimbabwe has witnessed unprecedented morbidity and mortality due to the disease. However, although the government adopted the WHO endorsed prevention measures, the number of cases continues to rise and yet there still is no proven cure for COVID -19 to date only prevention measures are used to curb the pandemic. Non-adherence can be pervasive and detrimental. An analytical cross-sectional study was conducted, with mixed methods study design, in Harare in 2021 to evaluate adherence to practice of prevention measures and the barriers to adherence. A survey and interviews of key informants were used to collect data from three hundred and eighty-five (385) participants from households’ selected using multistage cluster sampling procedure and twelve (12) key informants selected through convenience sampling. The key informant’s interview data facilitated for an in-depth analysis of community adherence and the barriers encountered. Data on knowledge, attitude (perceived severity, perceived susceptibility and efficacy belief), adherence (regular practice) with preventive measures and barriers was gathered. Logistic regression, descriptive statistics and Chi-square were used to identify variables associated with the community’s adherence with COVID-19 preventive measures and the barriers to adherence. There was an 89.5% response rate and the mean age of the study participants was 36 years; SD=12.0 and 217 (56.4%) participants were females. All the participants were aware of COVID-19 disease although 211(54.8%) of them did not know all the set prevention measures. The knowledge level was found out to be average (M = 5.5; SD = 1.2) 61.1% and the sociodemographic factors which influenced knowledge, were, gender, place of residence, level of education and health status at p<0.050. Neutral attitude with a mean score on attitude questions was (35.6; SD= 4.8; range 0-45). Efficacy belief (M=39.2; SD 7.3) showed the neutral attitude towards how prevention measures were beneficial and effective. The study found that knowledge was associated with attitudes, perceived susceptibility and efficacy belief, (OR=3.5; 95% CI :( 2.9-6.5); p=0.012 and (OR=3.0; 95% CI: (2.7-6.1); p=0.014 respectively at p<0.050. The study showed an overall poor level of adherences of (39.7%) to the set prevention measures, 153 participants always practiced the set prevention measures. Regression analysis showed that the independent variables knowledge (OR=2.6; 95% CI: 1.9-4.6) and attitudes (OR=4.6; 95% CI: 2.9- 6.9; p=0.001) were positive predictors of adherence to preventive measures at p<0.050. Adherence varied with socio-demographic factors, such as age, religion, place of residence and health status, comorbidity at p<0.050. The study concluded that knowledge, attitudes, religion and culture, lack of protective clothing, overcrowded spaces, lack of information and low-income levels were barriers to adherence to COVID -19 prevention measures. Recommendations were made to Harare City health to forge multisectoral collaboration with local clinics and private health institutions to enhance public awareness, training and adherence and to the Ministry of Finance to work with the Ministry of Health and Child Care (MoHCC) in subsidizing facial masks and hand sanitizers to cater for the under-privileged.