Factors associated with students' adherence to COVID-19 standard operating procedures after the second wave peak of 2021 in secondary schools in Malaba, Tororo district

Abstract

Background In June 2020, standard operating procedures (SOPs) for COVID-19 were released by Ministry of Health. Understanding how schools in Malaba Town Council, Tororo district handled preventative measures was essential given the likelihood that Malaba border served as a significant entry point for new COVID-19 cases entering Uganda.

Objective To determine the factors associated with students’ adherence to COVID-19 SOPs after the second wave of 2021 in secondary schools in Malaba town council, Tororo district with an aim of providing feasible recommendations for improving adherence to the SOPs among students.

Methodology A cross-sectional mixed methods study design was conducted in Malaba town council, Tororo district, with 386 participants chosen through simple random sampling. Adherence to COVID-19 SOPs was the outcome variable categorized into good and poor adherence. Quantitative data were analyzed in STATA version 14.0 to obtain school factors associated with adherence to COVID-19 SOPs. Stakeholders were chosen for one-on-one interviews where purposive sampling was used to select key informants. Thematic analysis was performed on the qualitative data collected in ATLAS.ti.

Results Adherence to COVID-19 SOPs was 73.8% overall. Students were 2.36 times more likely to follow the SOPs if there were hand washing facilities at the entrances, exits, within classrooms, and within 5 meters of toilets/latrines (aPR = 2.36; 95% CI 1.28-4.38). The significance of clear communication and guidance from school leadership about COVID-19 SOPs was stressed by key informants in ensuring smooth implementation of COVID-19 SOPs in schools. They emphasized that with more COVID-19 information given to students, there was better adherence to SOPs and to supervise implementation, active observation of behaviors, practices and routine inspections were required. The fear of infection was found to be an important factor in adherence coupled with peer pressure and social norms. Additionally, insufficient resources were a great setback in implementation of COVID-19 SOPs as observed by stakeholders.

Conclusion After the second wave peak in 2021, the study discovered that the majority of students followed COVID-19 SOPs. This was mostly so because of the availability of hand washing facilities at entrances and exits, supervision through active observations of student behaviors and continuously giving COVID-19 related information to students. The fear to get infected with COVID-19 among students also further contributed to adherence to COVID-19 SOPs. From the findings, resource unavailability in form of money, personnel and equipment played a big role in limiting students from adhering to COVID-19 SOPs.