Background In the early months of 2020 as the COVID-19 pandemic took hold in Europe, there was much concern about how the pandemic would impact populations in Africa, both in terms of how the infection would interact with endemic diseases, and also with respect to the capacity for public health response. Initial case finding activities centred on urban travel hubs where the infection and transmission risk were highest. Rural communities were considered lower risk but were also given less access to diagnostics and other IPC measures. The aim of this study was to compare the knowledge, attitudes and practices of urban and rural communities regarding the government response to the pandemic.

Methods We used a mixed-methods design combining individual surveys with focus group discussions. The 240 participants included healthcare workers and lay members of the community (patient carers & relatives), recruited through participating health centres in both rural and urban locations in each country.

Results Preliminary analysis suggested that rural dwellers were less satisfied with the government response than those in urban settings. Proactive government management and logistical organisation prevented the spread of the COVID-19 pandemic but there were challenges with respect to communication crisis and financial management. Results from both the individual interviews and focus group discussions across 4 countries will be presented.

Conclusion There were clear gaps identified between the response to COVID-19 between rural and urban communities. The lessons learned should be incorporated into epidemic risk management plan in readiness for response to new and emerging threats. We will demonstrate how EDCTP networks of excellence can be used to implement impactful student-led multi-site research studies at low cost.