Factors Associated with Non-pharmaceutical Interventions Compliance (NPIs) During COVID-19 in Nigeria: Lessons for Future Infectious Diseases Pandemic

Abstract

To manage human-to-human transmission of COVID-19 during the initial outbreak of the pandemic, especially in the absence of effective  vaccines and amid the proliferation of various conspiracy theories regarding vaccination, the World Health Organization (WHO)  introduced non-medical interim guidelines. These guidelines emphasized non-pharmaceutical interventions (NPIs) as the primary  preventive measures to combat the disease. However, understanding levels of awareness and compliance is essential as a prerequisite  for designing appropriate interventions. The aim of this study was to assess NPIs awareness and compliance and the associated factors  in Nigeria. This was a cross-sectional study conducted between February and April 2021 using a structured online Google survey on a  sample of 1001 adult population of Nigeria. Chi-square test, t-test or one-way analysis of variance (ANOVA) were employed as required.  Amultinomial logistic regression analyses was used to identify factors associated with COVID-19 NPIs compliance. NPI compliance was  disaggregated into three: compliance with ALLthe NPIs, compliance with any two of the NPIs and compliance with only one (single) NPIs.  Atotal of 1001 participants across the six geopolitical zones participated in the survey; 46.4% (n= 465) were from the North-Central, 25.4%  (n= 254) from the South west and 28.2% from other geo-political zones. The majority (53.9%, n=540) of the respondents were male and an  average age of 34.1 more than half (57.4%) of the participants were single. 51.3% were employed and 59.9% had first degree. Almost  all the participants, 99.8% (n=999) and 98.3% (n=984) had good knowledge of COVID-19 and the NPIs as preventive measures respectively.  Although, there was high awareness of NPIs, compliance to all the NPIs was only 1.9%. However, there was high compliance  with a combination of two NPIs (91.2%), followed by compliance with a single NPIs (6.9%). Based on the multivariate  regression analysis, Gender and income showed a statistically significant increase in compliance with single and all NPIs relative to the  base category of two combinations of NPIs. Awareness of COVID-19 NPIs was negatively associated with compliance for both all NPIs and  single NPIs (Coeff: 1.99; p<0.001) and (Coeff: 3.23; p<0.001) respectively. The results highlight the necessity for customized health  messages that focus not only on awareness but, most importantly, on promoting compliance. Although, raising awareness plays a crucial  role, it often falls short in achieving the desired impact. Thus, to drive change and ensure preparedness for future pandemics, people  require actionable steps and clear understanding for adhering to health recommendations.