An assessment of the experiences, and perceptions of the collateral effects of the COVID-19 lockdown measures in Southeast Nigeria: implications for policy and action

¹African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria, ²Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria

^&Corresponding author
Ijeoma Nkem Okedo-Alex, African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria

Introduction    

The World Health Organization (WHO) categorized Nigeria as one of the 13 high-risk African countries with respect to the spread of COVID-19, largely because the country is among the vulnerable African nations, given her fragile health systems [1]. The control of COVID-19 has remained an enormous challenge for the Nigerian government and one of the broad approach to slow down the spread of the infection and prevent overwhelming the healthcare systems was by enforcing tight restrictions on population movements and a lockdown measure [2]. The lockdown in Nigeria started in March 2020 (Table 1) and was partially relaxed from early May 2020 to allow people to earn their living. This was initially restricted to high-risk areas such as Lagos and Ogun but later became total with the State governments enforcing this differentially at the State levels [3]. The lockdown involved national and interstate border closure, prohibition of public gatherings, and home confinements [3,4]. Following the full relaxation of lockdown measures by July 2020, some measures such as compulsory wearing of face masks when going outside the home, vaccination, and other WHO guidelines for preventing the further spread of COVID-19 have continued to be in place [3,5].

In spite of the role of the lockdown measures in halting community transmission in several climes, it has been associated with a variety of collateral effects. Studies have documented various effects of the COVID-19 lockdown on social life, mental health, and daily living. Some of the positive effects stated include reduced levels of mental health issues such as anxiety, depression, and loneliness, increased communal living and social connectedness, disruptions in routines, and more time for pastimes [6]. However, some other studies have reported increased suicidal tendencies, loneliness, nervousness as well as difficulty affording food and other basic needs during the lockdowns [7-9]. Other behavioral changes include increased food and alcohol consumption, sedentariness, and sporting activities [7,10]. Some studies also reported environmental effects such as improved air quality and reduced carbon footprint [11-13]. Most of these studies provide evidence from high-income countries. There is limited evidence from developing countries including Nigeria on the effects of the lockdown on the socioeconomic lives of its citizens. The aim of this study was to explore citizens´ experiences and perceptions of the impact of COVID-19 lockdown measures on daily living in Southeast Nigeria.

Methods     

Study area: the study was conducted in five states (Abia, Anambra, Ebonyi, Enugu and Imo) located in South-eastern Nigeria. Nigeria is divided into six geopolitical zones with each containing a variable number of States. The Southeast geopolitical zone is largely the trade and industrial hub of the country and is largely occupied by the Ibo ethnic group.

Study participants: the study participants were policymakers, researchers, non-governmental organizations (NGO) officials, and health practitioners.

Study design: the study design is cross-sectional descriptive in nature.

Sample size and sampling: one hundred and twenty (120) alumni of the African Institute for Health Policy & Health Systems (AIHPHS) of Ebonyi State University who were residing in the five south-eastern Nigeria states were purposively selected to participate in the survey. They were selected based on their role in research, policymaking and practice.

Data collection methods: data was collected in 2020 using emails, short message sending (SMS) requests and key informant interviews. This data collection method was used because of the ease and feasibility because the survey was conducted during the lockdown. The participants were requested to state how the lockdown has affected them negatively and positively and how the lockdown can be eased towards normalcy. The SMS and emails were pretested and corrections effected before final use. The key informant interviews were held with eight interviewees namely a policymaker, parliamentarian, teacher, doctor, traditional ruler, clergy, transporter and business operator. The interview guide assessed the impact of the COVID-19 and the lockdown measures on health and socio-economic well-being and recommended strategies to exit the lockdown. Each interview was done by phone calls and took approximately 40 minutes. The phone recording function was used to record the interviews after obtaining permissions from the key informants. Prior to the interview, the key informants´ willingness to participate and their preferred time and date were ascertained via phone calls. All interviews were conducted in English language. The research researchers who were trained in qualitative research data collection carried out the interviews.

Data analysis: of the 120 persons contacted, 95 (79.2%) responded (91 via SMS while 4 via e-mail). Their responses were collated and presented in tables using broad themes. For the key informant interviews, the Giorgi's phenomenological approach was used to analyse the transcriptions [14,15].

Ethical approval: the ethical approval for this study was received from the University Research Ethics Committee of Ebonyi State University, Abakaliki, Nigeria (Reference number: EBSU/DRIC/UREC/Vol.05/072).

Funding: this investigation received financial support from the Alliance for Health Policy and Systems Research, WHO (AHPSR/WHO No. 2020/1038213-0; PO No. 202568286).

Results     

The respondents were made up of 8(8.8%) policymakers, 31(32.6%) medical practitioners, 45(50.5%) health researchers and 8(8.8%) NGO officials. Table 1 shows the lockdown relaxation stages in Nigeria. There were four stages of easing of the lockdown. For workplaces, at stage 4, only essential workers (20%) were permitted to go to work with mandatory use of face masks and social distancing, at stage 3, approx. 75% of workers resumed work, at stage 2, approx. 95% of workers resumed work with the use of face masks encouraged, and at stage 1, no restrictions at all. There was a total shutdown of places of worship, sports facilities, educational institutions, and public gatherings in stages 3 and 4. Essential services such as banking with mandatory use of face mask, social distancing, and reduced daily banking hours to less than 6 hours; hospitals; food, drugs, and utilities were available throughout the lockdown.

Table 2 shows the positive and negative impacts of the COVID-19 lockdown. Positive impacts on social and family life include more quality time with family and improved family ties. In economic life, there was an additional source of income for some, such as the fashion designers who had to sew facemasks. Regarding work, career, and professional development; working from home made days less stressful and increased the opportunity to learn new skills at home due to fewer outdoor meetings and activities. It also gave more time for meditation, self-evaluation, and reflection. On health and well-being, there was a reduction in the chances of contracting diseases and an improvement in consciousness of personal hygiene. Concerning environmental health, there was a reduction in air pollution from reduced industrial work and reduced use of vehicles.

Negative impacts on social and family life include reduced or absence of social and religious interactions, and an increase in the rate of poverty, which led to aggressiveness and social vices among the people. In economic life, there was an increase in family expenditure and a reduction in economic activities such as the import and export of goods. Regarding work and career, it affected the academic calendar negatively. Concerning health and well-being, the pandemic affected mental health with increasing anxiety, loneliness, depression, and deviant behavior such as rape, assault, violence and stealing. There were also negative impacts on the health system including exposure to the weaknesses of the health systems, basic health care services implementation activities were slowed down due to restrictions in movement and banking services, and there was a reduction in regular patient hospital attendance with redundancy at health facilities.

Table 3 summarizes the responses of key informants and shows their suggestions on how lockdown can be managed by the government. Some of these include the provision of palliatives, ensuring access to food and other social amenities such as water supply, training of healthcare workers, improving service provision and primary healthcare facilities, engaging youths to do both skilled and unskilled work, provision of soft loans, removal of taxes, among others. Table 3.1 also shows feasible strategies for exiting lockdown towards normalcy such as enforcing the wearing of facemasks, handwashing and social distancing, continuous health education, and establishment of skill acquisition centers among others. There were also suggestions on measures to monitor the abatement of COVID-19 to prevent a second wave such as continuous testing for COVID-19 for suspected cases and isolation, monitoring of public places to ensure adherence to the use of face masks, social distancing and handwashing, continuous disease surveillance, upgrading of hospitals and maintenance of isolation centers, recruitment of more human resources in the hospitals, continuous screening especially at the borders, and provision of food for the masses.

Discussion     

This study explored the experiences and perceptions of the impact of COVID-19 lockdown measures on daily living in Southeast Nigeria. The COVID-19 lockdown in Nigeria had mixed effects on family and socioeconomic life, negatively impacting mental health but improving work-related life amongst others. During the lockdown, there was an opportunity for families to spend time together, and this helped to improve family ties. Family is an essential part of society and is the primary unit of socialization. The family serves the purpose of providing support for its members, however, busy schedules deprive a lot of families of this bonding, but the lockdown provided the quality time needed. Despite this positive impact on families, there were negative impacts as a result of reduced or absence of social and religious interactions, and also an increase in the rate of poverty leading to aggressiveness and social vices amongst the people. Social life and activities such as religious gatherings, group meetings, wedding ceremonies etc, have a way of distracting people from their worries and stressful days. Social ties can benefit health beyond target individuals by influencing the health of others through social networks [16].

During the lockdown, some businesses made extra income, such as the fashion designers who had to sew facemasks. These additional income opportunities could also contribute to reducing the financial stress that people face. On the other hand, there was an increase in family expenditure and a reduction in economic activities such as the import and export of goods. These negative impacts of the lockdown are areas that require attention so that during subsequent lockdowns, measures will be put in place to curtail such negative effects. Contrary to our findings, a study that analyzed the lockdown effect on economic activities in Nigeria revealed that most socioeconomic challenges including job loss, rise in poverty level, and fall in economic activities faced by individuals were not a result of the lockdown [17].

During the lockdown, working from home made work less stressful and gave more time for meditation, self-evaluation, and reflection, which can lead to better productivity and improved mental health. There was also an opportunity to learn new skills, which is essential in boosting the economic capacity of individuals. These positive impacts are necessary for career and professional development. Regarding health and well-being, the lockdown period reduced the chances of contracting diseases and improved the consciousness of personal hygiene. When people begin to take responsibility for their health, there´s a greater possibility of disease prevention [18]. The COVID-19 pandemic and lockdown instilled this consciousness of disease prevention in individuals, and this will go a long way to help in reducing the effect of further waves of COVID-19 and even other emerging diseases. On the other hand, there was a negative effect on mental health with increasing anxiety, loneliness, depression, and deviant behavior such as rape, assault, violence, stealing, etc. Other studies have also reported a negative effect on mental health [8]. Concerning environmental health, there was a reduction in air pollution from reduced industrial work and reduced use of vehicles. This is not surprising considering the amount of cars, aircraft, and industries that normally operate on a daily basis. The lockdown led to the shutting down of most of these activities. Other studies have also reported a reduction in air pollution as a result of the lockdown [11-13].

The effect of lockdown on the health system was also explored. This study showed that the weakness of the health system was exposed by the pandemic. Furthermore, Basic Health Care Services implementation activities were slowed down due to restrictions in movement and banking services, and there was redundancy at health facilities. The health system in low and middle-income countries (LMICs), including Nigeria, has been noted to be fragile and was further burdened by the COVID-19 pandemic [3]. This highlights the urgent need for strengthening the health systems in these LMICs. Some recommendations on how lockdown can be managed by the government as provided in this study include the provision of palliatives, ensuring access to food and other social amenities such as water supply, training of healthcare workers, improving service provision and primary healthcare facilities, engaging youths to do both skilled and unskilled work, provision of soft loans, removal of taxes, amongst others. Some of these measures have been demonstrated to be effective in reducing the effect of the lockdown [5].

Feasible strategies for exiting lockdown towards normalcy such as enforcing the wearing of facemasks, handwashing and social distancing, continuous health education, and establishment of skill acquisition centers amongst others were also suggested. There were also suggestions on measures to monitor the abatement of COVID-19 to prevent a second wave such as continuous testing for COVID-19 for suspected cases and isolation, monitoring of public places to ensure adherence to the use of face masks, social distancing and handwashing, continuous disease surveillance, upgrading of hospitals and maintenance of isolation centers, recruitment of more human resources in the hospitals, continuous screening especially at the borders, and provision of food for the masses. The possibility of subsequent waves of the pandemic must always be uppermost in the mind of decision-makers, and it is important to have a clear plan and preparation for such an eventuality. Decisions to ease lockdown in towns, cities, and countries should be based on a range of existing and emerging evidence.

Although the study involved a wide range of stakeholders and states, the study was carried out in only one geopolitical zone, and therefore findings may not be generalized to the other parts of the country. Findings may not fully represent all the impact of COVID-19 because of the nature of participants interviewed. Further studies should explore perspectives of the poor masses to get a clearer picture of the impact at the grassroots. The purposive selection of participants and reliance on self-reports could have introduced bias into the study.

Conclusion     

The COVID-19 pandemic had both positive and negative effects on different aspects of life in Nigeria including social and family life, economic life, health and wellbeing, and environmental health. There was a negative impact on the health care system. These findings are a call to policy action to mitigate the negative effects whilst sustaining the positive gains from the lockdown. There is also an urgent need to strengthen the health system of the country.

Competing interests     

The authors declare competing interests.

Authors' contributions     

All authors made a significant contribution to the work reported, including the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work. All the authors have read and agreed to the final manuscript.

Acknowledgments     

The authors appreciate the technical support received from the African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.

Tables     

Table 1: lockdown relaxation stages in Nigeria from March to October 2020

Table 2: negative and positive impacts of the COVID-19 lockdown from the survey

Table 3: summary of responses from key informant interviews

Table 3.1: summary of responses from key informant interviews

References