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Lockdown measures in response to COVID-19 in nine sub-Saharan African countries
  1. Najmul Haider1,
  2. Abdinasir Yusuf Osman1,
  3. Audrey Gadzekpo2,
  4. George O Akipede3,
  5. Danny Asogun4,
  6. Rashid Ansumana5,
  7. Richard John Lessells6,
  8. Palwasha Khan7,
  9. Muzamil Mahdi Abdel Hamid8,
  10. Dorothy Yeboah-Manu9,
  11. Leonard Mboera10,
  12. Elizabeth Henry Shayo11,
  13. Blandina T Mmbaga12,13,
  14. Mark Urassa14,
  15. David Musoke15,
  16. Nathan Kapata16,
  17. Rashida Abbas Ferrand17,18,
  18. Pascalina-Chanda Kapata16,
  19. Florian Stigler19,
  20. Thomas Czypionka20,21,
  21. Alimuddin Zumla22,
  22. Richard Kock1,
  23. David McCoy23
  1. 1Pathobiology and Population Science, The Royal Veterinary College, London, UK
  2. 2Department of Communication Studies, University of Ghana, Legon, Ghana
  3. 3College of Medicine, Ambrose Alli University, Ekpoma, Nigeria and Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
  4. 4Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
  5. 5Mercy Hospital Research Laboratory, Freetown, Sierra Leone
  6. 6Department of Pubic Health, University of KwaZulu-Natal, Durban, South Africa
  7. 7Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  8. 8Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
  9. 9Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
  10. 10SACIDS Foundation for One Health, Sokoine University of Agricultue, Morogoro, Tanzania
  11. 11Department of Policy Analysis and Advocacy, National Institute for Medical Research, Dar es Salaam, Tanzania
  12. 12Department of Paediatrics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
  13. 13Kilimanjaro Clinical Research Institute, Moshi, Tanzania
  14. 14National Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania
  15. 15School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
  16. 16Ministry of Health, Lusaka, Zambia
  17. 17Biomedical Research and Training Institute, Harare, Zimbabwe
  18. 18Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  19. 19Austrian Sickness Fund, Vienna, Austria
  20. 20Health Economics and Health Policy, Institute for Advanced Studies, Vienna, Austria
  21. 21Health Policy, London School of Economics and Political Science, London, UK
  22. 22Centre for Clinical Microbiology, University College London, London, UK
  23. 23Institute of Population Health Sciences, Barts and London Medical and Dental School, Queen Mary University of London, London, UK
  1. Correspondence to Dr David McCoy; d.mccoy{at}qmul.ac.uk

Abstract

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. However, the term ‘lockdown’ is not well-defined. Indeed, WHO’s reference to ‘so-called lockdown measures’ indicates the absence of a clear and universally accepted definition of the term ‘lockdown’. We propose a definition of ‘lockdown’ based on a two-by-two matrix that categorises different communicable disease measures based on whether they are compulsory or voluntary; and whether they are targeted at identifiable individuals or facilities, or whether they are applied indiscriminately to a general population or area. Using this definition, we describe the design, timing and implementation of lockdown measures in nine countries in sub-Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. While there were some commonalities in the implementation of lockdown across these countries, a more notable finding was the variation in the design, timing and implementation of lockdown measures. We also found that the number of reported cases is heavily dependent on the number of tests carried out, and that testing rates ranged from 2031 to 63 928 per million population up until 7 September 2020. The reported number of COVID-19 deaths per million population also varies (0.4 to 250 up until 7 September 2020), but is generally low when compared with countries in Europe and North America. While lockdown measures may have helped inhibit community transmission, the pattern and nature of the epidemic remains unclear. However, there are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic disruption.

  • SARS
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-003319

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @HaiderNajmul, @ansumanaR, @DorothyYeboahM1, @DavidMusoke14

    • Contributors DM and RK conceptualised the study. DM, NH and AY coordinated data collection and analysis. DM and NH prepared the first draft manuscript. All coauthors reviewed the manuscript, provided critical comments and gave their concurrence before its submission to the journal for publication.

    • Funding NH, AYO, AG, DA, RA, MMAH, DY-M, LM, NK, PCK, AZ and RK are part of PANDORA-ID-NET Consortium (EDCTP Reg/Grant RIA2016E-1609) funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2) programme, which is supported under Horizon 2020, the European Union’s Framework Programme for Research and Innovation.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.