Contact tracing and the COVID-19 response in Africa: best practices, key challenges, and lessons learned from Nigeria, Rwanda, South Africa, and Uganda
Open accessAbstract
Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.
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References 17 · Cited by 104
Research works printed but not linked: 2
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- Authors
- Nachega, J. B., Atteh, R., Ihekweazu, C., Sam-Agudu, N. A., Adejumo, P., Nsanzimana, S., Rwagasore, E., Condo, J., Paleker, M., Mahomed, H., Suleman, F., Ario, A. R., Kiguli-Malwadde, E., Omaswa, F. G., Sewankambo, N. K., Viboud, C., Reid, M. J. A., Zumla, A., & Kilmarx, P. H.
- Affiliations
- Johns Hopkins University (US)
- Nigeria Centre for Disease Control (NG)
- University of Maryland, Baltimore (US)
- University of Ibadan (NG)
- Rwanda Biomedical Center (RW)
- Tulane University (US)
- Western Cape Department of Health (ZA)
- 16Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa;
- Ministry of Health (UG)
- African Centre for Global Health and Social Transformation (UG)
- Makerere University (UG)
- National Institutes of Health (US)
- University of California, San Francisco (US)
- UCL Biomedical Research Centre (GB)
- Corresponding author
- Nachega, Jean B.
- Kilmarx, Peter H.
- ORCID
- Venue
- The American Journal of Tropical Medicine and Hygiene
- Published
- 2021-04-07
- Volume
- 104
- Issue
- 4
- Pages
- 1179-1187
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC8045625
- OpenAlex
- W3127790195
- Cited by
- 104
- References
- 17
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 21 · 2023: 30 · 2022: 25 · 2021: 12
- FWCI
- 19.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- American Society of Tropical Medicine and Hygiene (1R21TW011706-01, 1D43TW010937-01A1, 1R25TW011217-01, R01HD089866)
- University of Pittsburgh
- National Institutes of Health (COVID-19)
- Centers for Disease Control and Prevention
- Fogarty International Center (D43TW010937, R25TW011217, R21TW011706)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD089866)
- European and Developing Countries Clinical Trials Partnership (1D43TW010937-01A1, 1R21TW011706-01, R01HD089866, 1R25TW011217-01)
- Topics
- Physical Sciences › Computer Science › Information Systems › COVID-19 Digital Contact Tracing
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Keywords
- COVID-19 pandemic, contact tracing, Africa, Nigeria, Rwanda, South Africa, Uganda, community health workers, community participation, public health communication, digital contact tracing, political commitment, cross-immunity
- MeSH terms
- COVID-19, SARS-CoV-2, Communicable Disease Control, Humans, Nigeria, Rwanda, South Africa, Uganda, Contact Tracing, Practice Guidelines as Topic
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