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      The Decision to Wear a Face Mask as a Protective Behavioral Measure Against COVID-19: Survey Results From Greater Kampala Metropolitan Area, Uganda

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          Abstract

          The use of face masks is one of the behavioral measures used to prevent COVID-19 infection. Despite the positive contribution of face masks, there is uncertainty surrounding face mask wearing in low-income countries. Using data from 1,054 respondents in Greater Kampala Metropolitan area, we investigate the variation in face mask wearing inside and outside public spaces. Results indicate that more than three quarters of the respondents wore a face mask always outside public spaces and slightly more than half wore a face mask sometimes inside public spaces. Irrespective of location (inside or outside public spaces), respondents were more likely to wear facemasks sometimes or always to prevent COVID-19 infection. There is need to raise awareness about face mask wearing and its efficacy to prevent COVID-19 infection.

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          Respiratory virus shedding in exhaled breath and efficacy of face masks

          We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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            Comparison of Convenience Sampling and Purposive Sampling

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              Rational use of face masks in the COVID-19 pandemic

              Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that caused coronavirus disease 2019 (COVID-19), the use of face masks has become ubiquitous in China and other Asian countries such as South Korea and Japan. Some provinces and municipalities in China have enforced compulsory face mask policies in public areas; however, China's national guideline has adopted a risk-based approach in offering recommendations for using face masks among health-care workers and the general public. We compared face mask use recommendations by different health authorities (panel ). Despite the consistency in the recommendation that symptomatic individuals and those in health-care settings should use face masks, discrepancies were observed in the general public and community settings.1, 2, 3, 4, 5, 6, 7, 8 For example, the US Surgeon General advised against buying masks for use by healthy people. One important reason to discourage widespread use of face masks is to preserve limited supplies for professional use in health-care settings. Universal face mask use in the community has also been discouraged with the argument that face masks provide no effective protection against coronavirus infection. Panel Recommendations on face mask use in community settings WHO 1 • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected SARS-CoV-2 infection. China 2 • People at moderate risk* of infection: surgical or disposable mask for medical use. • People at low risk† of infection: disposable mask for medical use. • People at very low risk‡ of infection: do not have to wear a mask or can wear non-medical mask (such as cloth mask). Hong Kong 3 • Surgical masks can prevent transmission of respiratory viruses from people who are ill. It is essential for people who are symptomatic (even if they have mild symptoms) to wear a surgical mask. • Wear a surgical mask when taking public transport or staying in crowded places. It is important to wear a mask properly and practice good hand hygiene before wearing and after removing a mask. Singapore 4 • Wear a mask if you have respiratory symptoms, such as a cough or runny nose. Japan 5 • The effectiveness of wearing a face mask to protect yourself from contracting viruses is thought to be limited. If you wear a face mask in confined, badly ventilated spaces, it might help avoid catching droplets emitted from others but if you are in an open-air environment, the use of face mask is not very efficient. USA 6 • Centers for Disease Control and Prevention does not recommend that people who are well wear a face mask (including respirators) to protect themselves from respiratory diseases, including COVID-19. • US Surgeon General urged people on Twitter to stop buying face masks. UK 7 • Face masks play a very important role in places such as hospitals, but there is very little evidence of widespread benefit for members of the public. Germany 8 • There is not enough evidence to prove that wearing a surgical mask significantly reduces a healthy person's risk of becoming infected while wearing it. According to WHO, wearing a mask in situations where it is not recommended to do so can create a false sense of security because it might lead to neglecting fundamental hygiene measures, such as proper hand hygiene. However, there is an essential distinction between absence of evidence and evidence of absence. Evidence that face masks can provide effective protection against respiratory infections in the community is scarce, as acknowledged in recommendations from the UK and Germany.7, 8 However, face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas. As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks. Recommendations on face masks vary across countries and we have seen that the use of masks increases substantially once local epidemics begin, including the use of N95 respirators (without any other protective equipment) in community settings. This increase in use of face masks by the general public exacerbates the global supply shortage of face masks, with prices soaring, 9 and risks supply constraints to frontline health-care professionals. As a response, a few countries (eg, Germany and South Korea) banned exportation of face masks to prioritise local demand. 10 WHO called for a 40% increase in the production of protective equipment, including face masks. 9 Meanwhile, health authorities should optimise face mask distribution to prioritise the needs of frontline health-care workers and the most vulnerable populations in communities who are more susceptible to infection and mortality if infected, including older adults (particularly those older than 65 years) and people with underlying health conditions. People in some regions (eg, Thailand, China, and Japan) opted for makeshift alternatives or repeated usage of disposable surgical masks. Notably, improper use of face masks, such as not changing disposable masks, could jeopardise the protective effect and even increase the risk of infection. Consideration should also be given to variations in societal and cultural paradigms of mask usage. The contrast between face mask use as hygienic practice (ie, in many Asian countries) or as something only people who are unwell do (ie, in European and North American countries) has induced stigmatisation and racial aggravations, for which further public education is needed. One advantage of universal use of face masks is that it prevents discrimination of individuals who wear masks when unwell because everybody is wearing a mask. It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene. WHO currently recommends that people should wear face masks if they have respiratory symptoms or if they are caring for somebody with symptoms. Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit. In parallel, urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. Taiwan had the foresight to create a large stockpile of face masks; other countries or regions might now consider this as part of future pandemic plans. © 2020 Sputnik/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                21 October 2021
                2021
                21 October 2021
                : 9
                : 675734
                Affiliations
                [1] 1Department of Social Work and Social Administration, Makerere University , Kampala, Uganda
                [2] 2Department of Population Studies, Makerere University , Kampala, Uganda
                Author notes

                Edited by: Tracy Jackson, University of Edinburgh, United Kingdom

                Reviewed by: Gerald Mboowa, Makerere University, Uganda; Liz Steed, Queen Mary University of London, United Kingdom; Rosemary M. Caron, University of New Hampshire, United States

                *Correspondence: Peter Kisaakye pkisaakye@ 123456gmail.com

                This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2021.675734
                8566546
                34746072
                cc309182-8378-4645-913c-fb0ac23100a3
                Copyright © 2021 Bukuluki and Kisaakye.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 March 2021
                : 13 September 2021
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 47, Pages: 6, Words: 4518
                Categories
                Public Health
                Original Research

                covid-19,face masks,greater kampala metropolitan area,uganda perspectives,uganda

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