Lockdown measures in response to COVID-19 in nine sub-Saharan African countries

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...

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Published inBMJ global health Vol. 5; no. 10; p. e003319
Main Authors Haider, Najmul, Osman, Abdinasir Yusuf, Gadzekpo, Audrey, Akipede, George O, Asogun, Danny, Ansumana, Rashid, Lessells, Richard John, Khan, Palwasha, Hamid, Muzamil Mahdi Abdel, Yeboah-Manu, Dorothy, Mboera, Leonard, Shayo, Elizabeth Henry, Mmbaga, Blandina T, Urassa, Mark, Musoke, David, Kapata, Nathan, Ferrand, Rashida Abbas, Kapata, Pascalina-Chanda, Stigler, Florian, Czypionka, Thomas, Zumla, Alimuddin, Kock, Richard, McCoy, David
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group Ltd 01.10.2020
BMJ Publishing Group LTD
BMJ Publishing Group
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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.
AbstractList 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.
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.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.
Author Yeboah-Manu, Dorothy
McCoy, David
Osman, Abdinasir Yusuf
Lessells, Richard John
Ferrand, Rashida Abbas
Haider, Najmul
Kapata, Nathan
Asogun, Danny
Mmbaga, Blandina T
Mboera, Leonard
Zumla, Alimuddin
Akipede, George O
Khan, Palwasha
Kock, Richard
Gadzekpo, Audrey
Kapata, Pascalina-Chanda
Czypionka, Thomas
Ansumana, Rashid
Shayo, Elizabeth Henry
Musoke, David
Urassa, Mark
Hamid, Muzamil Mahdi Abdel
Stigler, Florian
AuthorAffiliation 1 Pathobiology and Population Science , The Royal Veterinary College , London , UK
16 Ministry of Health , Lusaka , Zambia
10 SACIDS Foundation for One Health , Sokoine University of Agricultue , Morogoro , Tanzania
7 Department of Infectious Disease Epidemiology , London School of Hygiene & Tropical Medicine , London , UK
8 Department of Parasitology and Medical Entomology, Institute of Endemic Diseases , University of Khartoum , Khartoum , Sudan
23 Institute of Population Health Sciences, Barts and London Medical and Dental School , Queen Mary University of London , London , UK
17 Biomedical Research and Training Institute , Harare , Zimbabwe
2 Department of Communication Studies , University of Ghana , Legon , Ghana
22 Centre for Clinical Microbiology , University College London , London , UK
18 Department of Clinical Research , London School of Hygiene and Tropical Medicine , London , UK
5 Mercy Hospital Research Laboratory , Freetown , Sierra Leone
11 Department of Policy Analysis and Advoca
AuthorAffiliation_xml – name: 8 Department of Parasitology and Medical Entomology, Institute of Endemic Diseases , University of Khartoum , Khartoum , Sudan
– name: 10 SACIDS Foundation for One Health , Sokoine University of Agricultue , Morogoro , Tanzania
– name: 11 Department of Policy Analysis and Advocacy , National Institute for Medical Research , Dar es Salaam , Tanzania
– name: 21 Health Policy , London School of Economics and Political Science , London , UK
– name: 23 Institute of Population Health Sciences, Barts and London Medical and Dental School , Queen Mary University of London , London , UK
– name: 6 Department of Pubic Health , University of KwaZulu-Natal , Durban , South Africa
– name: 20 Health Economics and Health Policy , Institute for Advanced Studies , Vienna , Austria
– name: 5 Mercy Hospital Research Laboratory , Freetown , Sierra Leone
– name: 9 Noguchi Memorial Institute for Medical Research , University of Ghana , Legon , Ghana
– name: 15 School of Public Health , Makerere University College of Health Sciences , Kampala , Uganda
– name: 17 Biomedical Research and Training Institute , Harare , Zimbabwe
– name: 3 College of Medicine, Ambrose Alli University, Ekpoma, Nigeria and Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital , Irrua , Nigeria
– name: 4 Community Medicine , Irrua Specialist Teaching Hospital , Irrua , Edo , Nigeria
– name: 19 Austrian Sickness Fund , Vienna , Austria
– name: 12 Department of Paediatrics , Kilimanjaro Christian Medical University College , Moshi , Tanzania
– name: 14 National Institute for Medical Research Mwanza Research Centre , Mwanza , Tanzania
– name: 22 Centre for Clinical Microbiology , University College London , London , UK
– name: 2 Department of Communication Studies , University of Ghana , Legon , Ghana
– name: 13 Kilimanjaro Clinical Research Institute , Moshi , Tanzania
– name: 16 Ministry of Health , Lusaka , Zambia
– name: 1 Pathobiology and Population Science , The Royal Veterinary College , London , UK
– name: 7 Department of Infectious Disease Epidemiology , London School of Hygiene & Tropical Medicine , London , UK
– name: 18 Department of Clinical Research , London School of Hygiene and Tropical Medicine , London , UK
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  givenname: Najmul
  orcidid: 0000-0002-5980-3460
  surname: Haider
  fullname: Haider, Najmul
  organization: Pathobiology and Population Science, The Royal Veterinary College, London, UK
– sequence: 2
  givenname: Abdinasir Yusuf
  surname: Osman
  fullname: Osman, Abdinasir Yusuf
  organization: Pathobiology and Population Science, The Royal Veterinary College, London, UK
– sequence: 3
  givenname: Audrey
  surname: Gadzekpo
  fullname: Gadzekpo, Audrey
  organization: Department of Communication Studies, University of Ghana, Legon, Ghana
– sequence: 4
  givenname: George O
  surname: Akipede
  fullname: Akipede, George O
  organization: College of Medicine, Ambrose Alli University, Ekpoma, Nigeria and Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
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  organization: Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
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  fullname: Ansumana, Rashid
  organization: Mercy Hospital Research Laboratory, Freetown, Sierra Leone
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  givenname: Richard John
  surname: Lessells
  fullname: Lessells, Richard John
  organization: Department of Pubic Health, University of KwaZulu-Natal, Durban, South Africa
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  givenname: Palwasha
  surname: Khan
  fullname: Khan, Palwasha
  organization: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
– sequence: 9
  givenname: Muzamil Mahdi Abdel
  orcidid: 0000-0002-6157-4388
  surname: Hamid
  fullname: Hamid, Muzamil Mahdi Abdel
  organization: Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
– sequence: 10
  givenname: Dorothy
  surname: Yeboah-Manu
  fullname: Yeboah-Manu, Dorothy
  organization: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
– sequence: 11
  givenname: Leonard
  orcidid: 0000-0001-5746-3776
  surname: Mboera
  fullname: Mboera, Leonard
  organization: SACIDS Foundation for One Health, Sokoine University of Agricultue, Morogoro, Tanzania
– sequence: 12
  givenname: Elizabeth Henry
  surname: Shayo
  fullname: Shayo, Elizabeth Henry
  organization: Department of Policy Analysis and Advocacy, National Institute for Medical Research, Dar es Salaam, Tanzania
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  givenname: Blandina T
  surname: Mmbaga
  fullname: Mmbaga, Blandina T
  organization: Kilimanjaro Clinical Research Institute, Moshi, Tanzania
– sequence: 14
  givenname: Mark
  surname: Urassa
  fullname: Urassa, Mark
  organization: National Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania
– sequence: 15
  givenname: David
  orcidid: 0000-0003-3262-3918
  surname: Musoke
  fullname: Musoke, David
  organization: School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
– sequence: 16
  givenname: Nathan
  surname: Kapata
  fullname: Kapata, Nathan
  organization: Ministry of Health, Lusaka, Zambia
– sequence: 17
  givenname: Rashida Abbas
  surname: Ferrand
  fullname: Ferrand, Rashida Abbas
  organization: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
– sequence: 18
  givenname: Pascalina-Chanda
  surname: Kapata
  fullname: Kapata, Pascalina-Chanda
  organization: Ministry of Health, Lusaka, Zambia
– sequence: 19
  givenname: Florian
  surname: Stigler
  fullname: Stigler, Florian
  organization: Austrian Sickness Fund, Vienna, Austria
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  givenname: Thomas
  surname: Czypionka
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  organization: Health Policy, London School of Economics and Political Science, London, UK
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  givenname: Alimuddin
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  fullname: Kock, Richard
  organization: Pathobiology and Population Science, The Royal Veterinary College, London, UK
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  givenname: David
  surname: McCoy
  fullname: McCoy, David
  email: d.mccoy@qmul.ac.uk
  organization: Institute of Population Health Sciences, Barts and London Medical and Dental School, Queen Mary University of London, London, UK
BackLink https://www.ncbi.nlm.nih.gov/pubmed/33028699$$D View this record in MEDLINE/PubMed
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  start-page: 564
  year: 2020
  ident: 2025072913565700000_5.10.e003319.6
  article-title: Why is there low morbidity and mortality of COVID-19 in Africa?
  publication-title: Am J Trop Med Hyg
  doi: 10.4269/ajtmh.20-0474
– ident: 2025072913565700000_5.10.e003319.7
  doi: 10.1101/2020.04.17.20053157
– ident: 2025072913565700000_5.10.e003319.11
  doi: 10.1016/S0140-6736(20)30460-8
– ident: 2025072913565700000_5.10.e003319.24
– ident: 2025072913565700000_5.10.e003319.26
– ident: 2025072913565700000_5.10.e003319.12
– volume: 53
  start-page: 467
  year: 2020
  ident: 2025072913565700000_5.10.e003319.13
  article-title: The association between international and domestic air traffic and the coronavirus (COVID-19) outbreak
  publication-title: J Microbiol Immunol Infect
  doi: 10.1016/j.jmii.2020.03.026
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Snippet Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. However, the term ‘lockdown’ is not well-defined. Indeed, WHO’s...
Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. However, the term 'lockdown' is not well-defined. Indeed, WHO's...
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SubjectTerms Africa South of the Sahara
Analysis
Betacoronavirus
Clinical Laboratory Techniques - statistics & numerical data
Communicable Disease Control - methods
Communicable Disease Control - statistics & numerical data
Coronavirus Infections - diagnosis
Coronavirus Infections - epidemiology
Coronavirus Infections - prevention & control
Coronaviruses
COVID-19
COVID-19 Testing
Design
Disease control
Disease transmission
Economic life
Global health
Humans
Hygiene
Infections
Infectious diseases
Pandemics
Pandemics - prevention & control
Pneumonia, Viral - diagnosis
Pneumonia, Viral - epidemiology
Pneumonia, Viral - prevention & control
Population
Quarantine
SARS
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
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Title Lockdown measures in response to COVID-19 in nine sub-Saharan African countries
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