Risk perception, public health interventions, and Covid-19 pandemic control in sub-saharan Africa


Coronavirus disease 2019 (COVID 19) has had serious social, economic, and health effects globally. The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), which was first announced in December 2019 has resulted in more than 24 million infections. There is paucity of knowledge on the role of risk perception in the adoption of public health interventions needed to control the spread of COVID 19 infections within communities. This was a scoping review and documents how risk perception may be a major challenge for populations to adopt and implement different behavioral changes recommended to curtail the spread COVID- 19 pandemic in sub-Saharan Africa; and seeks to proffer solutions on how the identified challenges can be addressed drawing from lessons learnt from previous epidemics within the region. Database search of Google Scholar, PubMed, Research Gate among others were performed using related keywords to identify relevant journals and lists of primary articles. Culture, religious beliefs and poverty may influence how populations respond to infectious disease outbreaks. Risk strategies that focus only on biomedical approaches to control the COVID-19 pandemic may not mobilize the needed behavioral change. Lessons learnt from HIV and Ebola epidemics showed that involvement of communities could help transform weak adoption of public health measures when measures were framed in the relevant cultural context. An understanding of the factors influencing risk perception is needed to design appropriate risk communication strategies. Community engagement and reliance on local communication networks could promote mutual trust and increase the uptake of public-health interventions.



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Kakodkar P, Kaka N, Baig MN. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19). Cureus. 2020;12(4): e7560. DOI: https://doi.org/10.7759/cureus.7560

Keneda T, Ashford LS. Sub-Saharan Africa’s Demographic and Health Characteristics Will Influence the Course of the COVID-19 Pandemic. Available at: https://www.prb.org/sub-saharan-africas-demographic-and-health-characteristics-will-influence-the-course-of-the-covid-19-pandemic/. Accessed: 25 July 2020.

Diop BZ, Ngom M, Pougué Biyong C, et al. The relatively young and rural population may limit the spread and severity of COVID-19 in Africa: a modelling study. BMJ Global Health 2020; 5: e002699 DOI: https://doi.org/10.1136/bmjgh-2020-002699

Curtis N, Sparrow A, Ghebreyesus TA, Netea MG. Considering BCG vaccination to reduce the impact of COVID-19. Lancet. 2020;395(10236):1545-1546. DOI: https://doi.org/10.1016/S0140-6736(20)31025-4

O'Neill LAJ, Netea MG. BCG-induced trained immunity: can it offer protection against COVID-19? Nat Rev Immunol. 2020; 20(6):335-337. DOI: https://doi.org/10.1038/s41577-020-0337-y

Covián C, Retamal-Díaz A, Bueno SM, Kalergis AM. Could BCG Vaccination Induce Protective Trained Immunity for SARS-CoV-2? Front Immunol. 2020; 11:970. . DOI: https://doi.org/10.3389/fimmu.2020.00970

Grant WB, Lahore H, McDonnell SL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020;12(4):988. DOI: https://doi.org/10.3390/nu12040988

Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res. 2020;32(7):1195-1198. DOI: https://doi.org/10.1007/s40520-020-01570-8

Bi P, Wang J, Hiller J. Weather: driving force behind the transmission of severe acute respiratory syndrome in China? Intern. Med. J. 2007; 37: 550-554.

Twahirwa Rwema JO, Diouf D, Phaswana-Mafuya N, et al. COVID-19 Across Africa: Epidemiologic Heterogeneity and Necessity of Contextually Relevant Transmission Models and Intervention Strategies. Ann Intern Med. 2020;10.7326/M20-2628. DOI: https://doi.org/10.7326/M20-2628

Munjita SM, Samutela M, Ndashe K, Munsaka SM. Immunity, parasites, genetics and sex hormones: contributors to mild inflammatory responses in COVID-19? Pan African Medical Journal. 2020;35(2):36. DOI: https://doi.org/10.11604/pamj.supp.2020.35.2.23267

Lone SA, Ahmad A. COVID-19 pandemic - an African perspective. Emerg Microbes Infect. 2020;9(1):1300-1308. DOI: https://doi.org/10.1080/22221751.2020.1775132

EURACTIV.com. The last continent to face up COVID-19, Africa ‘needs to wake up. Available at: https://www.euractiv.com/section/botswana/news/the-last-continent-to-face-up-covid-19-africa-needs-to-wake-up/. Access: 25 July 2020.

ASSET. COVID-19 in Sub-Saharan Africa. July 2020. Available at: https://healthasset.org/daily-update-on-covid-19-in-sub-saharan-africa/. Accessed: 25 July 2020.

Mo Ibrahim Foundation. COVID-19 in Africa: A call for coordinated governance, improved health structures and better data. Africa: April 8, 2020. Available at: https://mo.ibrahim.foundation/sites/default/files/2020-03/2020%20COVID-19%20in%20Africa_1.pdf. Accessed: 25 July 2020.

OECD Development Matters. COVID-19 and beyond: How can Africa’s health systems cope? Available from: https://oecd-development-matters.org/2020/04/07/covid-19-and-beyond-how-can-africas-health-systems-cope/. Accessed: 25 July 2020.

Mudie K, Jin MM, Tan, et al. Non-communicable diseases in sub-Saharan Africa: a scoping review of large cohort studies. J Glob Health. 2019;9(2):020409. DOI: https://doi.org/10.7189/jogh.09.020409

Nkengasong J. Let Africa into the market for COVID-19 diagnostics. Nature. 2020; 580:565. DOI: https://doi.org/10.1038/d41586-020-01265-0

Bagcchi S. Stigma during the COVID-19 pandemic. Lancet Infect Dis. 2020;20(7):782. DOI: https://doi.org/10.1016/S1473-3099(20)30498-9

Molento MB. COVID-19 and the rush for self-medication and self-dosing with ivermectin: A word of caution. One Health. 2020; 10:100148. DOI: https://doi.org/10.1016/j.onehlt.2020.100148

Zhao Z, Li X, Liu F, Zhu G, Ma C, Wang L. Prediction of the COVID-19 spread in African countries and implications for prevention and control: A case study in South Africa, Egypt, Algeria, Nigeria, Senegal and Kenya. Sci Total Environ. 2020; 729:138959. DOI: https://doi.org/10.1016/j.scitotenv.2020.138959

Brug J, Aro AR, Richardus JH. Risk perceptions and behaviour: towards pandemic control of emerging infectious diseases: international research on risk perception in the control of emerging infectious diseases. Int J Behav Med. 2009;16(1):3-6. DOI: https://doi.org/10.1007/s12529-008-9000-x

Lee M, You M Safety Behaviors to Reduce Risk of Using Chemical Household Products: An Application of the Risk Perception Attitude Framework. Int. J. Environ. Res. Public Health 2020; 17: 1528

Böhret I. The Role of Culture in Response to Epidemics. 2018. Available at: https://www.researchgate.net/publication/328841925_The_Role_of_Culture_in_Response_to_Epidemics. Accessed 25 July 2020.

World Health Organization. Coronavirus disease (COVID-19) advice for the public. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Accessed: 25 July 2020.

To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020; 20(5):565-574. DOI: https://doi.org/10.1016/S1473-3099(20)30196-1

Nigeria Centre for Disease Control. Self-isolation and quarantine guidelines. Available at: https://covid19.ncdc.gov.ng/media/files/SelfIsolation_QuarantineGuide.pdf.pdf. Accessed: 25 July 2020.

Centor RM, Kim AH, Sparks JA. Web Exclusive. Annals On Call - COVID-19: Is Chloroquine the Answer?. Ann Intern Med. 2020;172(9):OC1. doi: 10.7326/A20-0003 DOI: https://doi.org/10.7326/A20-0003

Slovic P, Fischhoff B, Lichtenstein S. Why Study Risk Perception? Risk Analysis 1982; 2: 83–93. DOI: https://doi.org/10.1111/j.1539-6924.1982.tb01369.x

Warren EA, Paterson P, Schulz WS, et al. Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review. PLoS One. 2018;13(6):e0198680. DOI: https://doi.org/10.1371/journal.pone.0198680

Teasdale E, Santer M, Geraghty AW, Little P, Yardley L. Public perceptions of non-pharmaceutical interventions for reducing transmission of respiratory infection: systematic review and synthesis of qualitative studies. BMC Public Health. 2014;14:589. DOI: https://doi.org/10.1186/1471-2458-14-589

Yang S, Cho SI. Middle East respiratory syndrome risk perception among students at a university in South Korea, 2015. Am J Infect Control. 2017;45(6):e53-e60.. DOI: https://doi.org/10.1016/j.ajic.2017.02.013

Gierlach E, Belsher BE, Beutler LE. Cross-cultural differences in risk perceptions of disasters. Risk Anal. 2010;30(10):1539-1549. DOI: https://doi.org/10.1111/j.1539-6924.2010.01451.x

Hauck K. The Economics of Infectious Diseases. In: Oxford Research Encyclopedia of Economics and Finance [Internet]. 2018:1–34. Available from: http://economics.oxfordre.com/view/10.1093/acrefore/9780190625979.001.0001/acrefore-9780190625979-e-251 DOI: https://doi.org/10.1093/acrefore/9780190625979.013.251

Berthélemy JC, Gaudart J, Thuilliez J. Prevention or treatment? The case of malaria. Econ Lett. 2015:16–19. DOI: https://doi.org/10.1016/j.econlet.2015.03.022

Cori L, Bianchi F, Cadum E, Anthonj C. Risk Perception and COVID-19. Int J Environ Res Public Health. 2020;17(9): 3114. DOI: https://doi.org/10.3390/ijerph17093114

Pidgeon, N. Risk assessment, risk values and the social science programme: Why we do need risk perception research. Reliab. Eng. Syst. Saf. 1998; 59: 5–15.

Renn O. Three Decades of Risk Research: Accomplishments and New Challenges. Journal of Risk Research. 1998;1: 49–71. DOI: https://doi.org/10.1080/136698798377321

Aerts C, Revilla M, Duval L, et al. Understanding the role of disease knowledge and risk perception in shaping preventive behavior for selected vector-borne diseases in Guyana. PLoS Negl Trop Dis. 2020;14(4):e0008149.. DOI: https://doi.org/10.1371/journal.pntd.0008149

Foster M, Anderson B. Medical anthropology. New York: Wiley; 1978.

Liddell C, Barrett L, Bydawell M. Indigenous representations of illness and AIDS in Sub-Saharan Africa. Soc Sci Med. 2005; 60(4):691-700. DOI: https://doi.org/10.1016/j.socscimed.2004.06.020

Kirby B. Pentecostals are in a “spiritual war” against coronavirus in Africa—as are some political leaders. May 1 2020. Available at: https://qz.com/africa/1849315/pentecostal-churches-are-in-spiritual-war-vs-coronavirus-covid19/. Accessed: 25 July 2020.

United Nations. Policy brief. Impact of COVID-19 in Africa. 20 May 2020. Available at: https://unsdg.un.org/sites/default/files/2020-05/Policy-brief-Impact-of-COVID-19-in-Africa.pdf. Accessed: 25 July 2020.

Günther I. Why social distancing is a big challenge in many African countries. 20 April 2020. Available at: https://phys.org/news/2020-04-social-distancing-big-african-countries.html. Accessed: 25 July 2020.

Jaja IF, Anyanwu MU, Iwu Jaja CJ. Social distancing: how religion, culture and burial ceremony undermine the effort to curb COVID-19 in South Africa. Emerg Microbes Infect. 2020;9(1):1077-1079. DOI: https://doi.org/10.1080/22221751.2020.1769501

Lashitew A. Social distancing unlikely to hold up in Africa without a safety net for microentrepreneurs. 9 April 2020. Available at: https://www.brookings.edu/blog/africa-in-focus/2020/04/09/social-distancing-unlikely-to-hold-up-in-africa-without-a-safety-net-for-microentrepreneurs/. Accessed: 25 July 2020.

Nguyen LH, Drew DA, Joshi AD, et al. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. BMJ Yale. Preprint. doi: https://doi.org/10.1101/2020.04.29.20084111 DOI: https://doi.org/10.1101/2020.04.29.20084111

Bajunirwe F, Izudi J, Asiimwe S. Long distance truck drivers and the increasing risk of COVID-19 spread in Uganda. Int J Infect Dis. 2020;98:191-193. DOI: https://doi.org/10.1016/j.ijid.2020.06.085

ALNAP. Reducing the impact of the COVID-19 pandemic on internally displaced people (IDPs). 27 May 2020. Available at: https://www.alnap.org/help-library/reducing-the-impact-of-the-covid-19-pandemic-on-internally-displaced-people-idps. Accessed: 26 July 2020.

Makoni M. Africa prepares for coronavirus. Lancet. 2020; 395:483. DOI: https://doi.org/10.1016/S0140-6736(20)30355-X

Lucero-Prisno DE 3rd, Adebisi YA, Lin X. Current efforts and challenges facing responses to 2019-nCoV in Africa. Glob Health Res Policy. 2020;5:21. DOI: https://doi.org/10.1186/s41256-020-00148-1

Pennycook G, McPhetres J, Zhang Y, Lu JG, Rand DG. Fighting COVID-19 Misinformation on Social Media: Experimental Evidence for a Scalable Accuracy-Nudge Intervention. Psychol Sci. 2020;31(7):770-780. DOI: https://doi.org/10.1177/0956797620939054

Sharot T. The Optimism Bias. Current Biology 2011; 21(23): R941-R945 DOI: https://doi.org/10.1016/j.cub.2011.10.030

Dryhurst S, Schneider C, Kerr J, et al. Risk perceptions of COVID-19 around the world. Journal of Risk Research. 2020; https://doi.org/10.1080/13669877.2020.1758193. DOI: https://doi.org/10.1080/13669877.2020.1758193

Powe BD. Cancer fatalism among elderly Caucasians and African-Americans. Oncol Nurs Forum. 1995;22:1355–9.

Byrd T, Cohn LD, Gonzalez E, et al. Seatbelt use and belief in destiny among Hispanic and non-Hispanic drivers. Accid Anal Prev. 1998;31:63–65. DOI: https://doi.org/10.1016/S0001-4575(98)00045-1

Powe B, Finnie R. Cancer fatalism: the state of science. Cancer Nurs. 2003; 26(6):454–67. DOI: https://doi.org/10.1097/00002820-200312000-00005

Straughan PT, Seow A. Attitudes as barriers in breast screening: a prospective study among Singapore women. Soc Sci Med. 2000;51(11): 1695–703. DOI: https://doi.org/10.1016/S0277-9536(00)00086-1

Wallace JM, Brown TN, Bachman JG, et al. The influence of race and religion on abstinence from alcohol, cigarettes and marijuana among adolescents. J Stud Alcohol. 2003;64(6):843–848. DOI: https://doi.org/10.15288/jsa.2003.64.843

Franklin MD, Schlundt DG, McClellan LH, Kinebrew T, Sheats J, Belue R, et al. Religious fatalism and its association with health behaviors and outcomes.Am J Health Behav. 2007;31(6):563–72. DOI: https://doi.org/10.5993/AJHB.31.6.1

Hag Hamed D, Daniel M. The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims. Glob Health Promot. 2019;26(3):15–22. DOI: https://doi.org/10.1177/1757975917715884

Grund K, Goddon I, Schüler IM, Lehmann T, Heinrich-Weltzien R. Clinical consequences of untreated dental caries in German 5- and 8-year-olds. BMC Oral Health. 2015;15(1):140. DOI: https://doi.org/10.1186/s12903-015-0121-8

Bhatti A. Risk perception, culture and communication: South Asian Experience. Paper presented at the Fifth Conference of the European Sociological Association, Helsinki, 28 Aug.-1 Sept. 2001. Available at:https://scholar.google.com/scholar?cluster=6182744162003260061&hl=en&as_sdt=0,5&sciodt=0,5. Accessed: 25 July 20220.

Folayan MO, Haire B. History, culture and social norms: implications for ebola drug and vaccine clinical trials in affected region. In: Ebola’s Message: Public Health and Medicine in the 21st Century. MIT Press, Rogers Street in Cambridge, MA 02142.

Bavel JJV, Baicker K, Boggio PS, et al. Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav. 2020;4(5):460-471. DOI: https://doi.org/10.1038/s41562-020-0884-z

Lees S, Enria L. Context matters in fighting Ebola: lessons from West Africa for the DRC. Available at: https://reliefweb.int/report/democratic-republic-congo/context-matters-fighting-ebola-lessons-west-africa-drc. Accessed: 25 July 2020.

Carnaghi A, Trentin R, Cadinu M, Piccoli V. Recasting the HIV-risk perception in a social context: The interplay between group-based information and mood. Revue Internationale de Psychologie Sociale, Tome. 2011; 24(4): 59-71.

Adedimeji AA, Omololu FO, Odutolu O. HIV risk perception and constraints to protective behaviour among young slum dwellers in Ibadan, Nigeria. J Health Popul Nutr. 2007; 25(2):146-157.

Food and Agriculture Organisation. COVID-19: Our hungriest, most vulnerable communities face “a crisis within a crisis”. 2020. Available at: http://www.fao.org/news/story/en/item/1269721/icode/. Accessed: 25 July 2020.

Wasdani KP, Prasad A. The impossibility of social distancing among the urban poor: the case of an Indian slum in the times of COVID-19. The International Journal of Justice and Sustainability. 2020; 25(5): 414-418.

Islam T, Kibria MG, Challenges to the prevention of COVID-19 spread in slums of Bangladesh, Journal of Public Health. 2020; fdaa088. DOI: https://doi.org/10.1093/pubmed/fdaa088

The World Economic Forum. Why Sub-Saharan Africa needs a unique response to COVID-19. Available at: https://www.weforum.org/agenda/2020/03/why-sub-saharan-africa-needs-a-unique-response-to-covid-19/. Accessed 25 July 2020.

Afolabi MO, Folayan MO, Munung NS, et al. Lessons from the Ebola epidemics and their applications for COVID-19 pandemic response in sub-Saharan Africa. Dev World Bioeth. 2020; DOI: 10.1111/dewb.12275. DOI: https://doi.org/10.1111/dewb.12275

risk perception, COVID-19, Sub-saharan Africa, public health interventions
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Aduh, U., Folayan, M. O., Afe, A., Onyeaghala, A. A., Ajayi, I. O., Coker, M., Tebeje, Y. K., & Ndembi, N. (2020). Risk perception, public health interventions, and Covid-19 pandemic control in sub-saharan Africa. Journal of Public Health in Africa. https://doi.org/10.4081/jphia.2021.1622