{"doi":"10.2196/26073","title":"Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study","abstract":"BACKGROUND: In March 2020, South Africa implemented strict nonpharmaceutical interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 months, NPI policies were eased in stages according to a national strategy. COVID-19 spread throughout the country heterogeneously; the disease reached rural areas by July and case numbers peaked from July to August. A second COVID-19 wave began in late 2020. Data on the impact of NPI policies on social and economic well-being and access to health care are limited. OBJECTIVE: We aimed to determine how rural residents in three South African provinces changed their behaviors during the first COVID-19 epidemic wave. METHODS: The South African Population Research Infrastructure Network nodes in the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of longitudinal telephone surveys among randomly sampled households from rural and periurban surveillance populations every 2-3 weeks. Interviews included questions on the following topics: COVID-19-related knowledge and behaviors, the health and economic impacts of NPIs, and mental health. We analyzed how responses varied based on NPI stringency and household sociodemographics. RESULTS: In total, 5120 households completed 23,095 interviews between April and December 2020. Respondents' self-reported satisfaction with their COVID-19-related knowledge and face mask use rapidly rose to 85% and 95%, respectively, by August. As selected NPIs were eased, the amount of travel increased, economic losses were reduced, and the prevalence of anxiety and depression symptoms fell. When the number of COVID-19 cases spiked at one node in July, the amount of travel dropped rapidly and the rate of missed daily medications doubled. Households where more adults received government-funded old-age pensions reported concerns about economic matters and medication access less often. CONCLUSIONS: South Africans complied with stringent, COVID-19-related NPIs despite the threat of substantial social, economic, and health repercussions. Government-supported social welfare programs appeared to buffer interruptions in income and health care access during local outbreaks. Epidemic control policies must be balanced against the broader well-being of people in resource-limited settings and designed with parallel support systems when such policies threaten peoples' income and access to basic services.","journal":"JMIR Public Health and Surveillance","year":2021,"id":167804,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":31,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9615,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":277339,"name":"F. Xavier Gómez‐Olivé","orcid":"0000-0002-4876-0848","position":1,"is_corresponding":false},{"id":559581,"name":"Joseph Tlouyamma","orcid":"0000-0003-4635-3234","position":2,"is_corresponding":false},{"id":559582,"name":"Tinofa Mutevedzi","orcid":"0000-0002-1749-3089","position":3,"is_corresponding":false},{"id":443436,"name":"Chodziwadziwa Kabudula","orcid":"0000-0002-5867-0336","position":4,"is_corresponding":false},{"id":559583,"name":"Ruth Mahlako","orcid":"0000-0002-2406-9294","position":5,"is_corresponding":false},{"id":559584,"name":"Urisha Singh","orcid":"0000-0001-6905-7599","position":6,"is_corresponding":false},{"id":559585,"name":"Daniel Ohene‐Kwofie","orcid":"0000-0001-7107-9498","position":7,"is_corresponding":false},{"id":559586,"name":"Rose Buckland","orcid":"0000-0002-3947-6685","position":8,"is_corresponding":false},{"id":559587,"name":"Pedzisai Ndagurwa","orcid":"0000-0001-5628-4901","position":9,"is_corresponding":false},{"id":250370,"name":"Dickman Gareta","orcid":"0000-0002-4004-5655","position":10,"is_corresponding":false},{"id":371607,"name":"Resign Gunda","orcid":"0000-0003-1404-9879","position":11,"is_corresponding":false},{"id":250368,"name":"Thobeka Mngomezulu","orcid":"0000-0002-4142-2432","position":12,"is_corresponding":false},{"id":371609,"name":"Siyabonga Nxumalo","orcid":"0000-0001-5931-1784","position":13,"is_corresponding":false},{"id":250374,"name":"Emily Wong","orcid":"0000-0003-4755-5380","position":14,"is_corresponding":false},{"id":277340,"name":"Kathleen Kahn","orcid":"0000-0003-3339-3931","position":15,"is_corresponding":false},{"id":69650,"name":"Mark J. Siedner","orcid":"0000-0003-3506-842X","position":16,"is_corresponding":false},{"id":559588,"name":"Eric Maimela","orcid":"0000-0003-2843-4663","position":17,"is_corresponding":false},{"id":443314,"name":"Stephen Tollman","orcid":"0000-0003-0744-7588","position":18,"is_corresponding":false},{"id":500925,"name":"Mark Collinson","orcid":"0000-0002-8205-7099","position":19,"is_corresponding":false},{"id":250378,"name":"Kobus Herbst","orcid":"0000-0002-5436-9386","position":20,"is_corresponding":false},{"id":250367,"name":"Guy Harling","orcid":"0000-0001-6604-491X","position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":null,"created_at":"2026-07-18T23:45:58.359801Z","pmid":"33827046","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}