Table 4 integrated findings from the qualitative and quantitative strands

Community knowledge about COVID-19

 Source of knowledge

Households mentioned multiple sources of health-related information (supplementary table 4, additional file 1) across the three states

Almost all participants mentioned to have heard of COVID-19, through different channels

“I heard about the disease of COVID-19 over the radio” (Adolescent community member, Western Equatoria)

“When I heard about Corona I was in the church.” (Adolescent Community member, Warrap)

“In the market and everywhere else. l hear a lot of things being said about Coronavirus.” (Adolescent community member, Central Equatoria)

 Awareness of COVID-19 symptoms

n/a

Participants were well-aware of COVID-19 symptoms

"It is a dangerous disease, it kills, people sneeze, it gives people difficulties in breathing, general rise of body temperature” (Person living with disability, Warrap)

“If it has affected you, you feel body weakness, you cannot breathe very well, headache” (Adult community member, Central Equatoria)

 Awareness of COVID-19 preventive measures

n/a

Participants were well-aware of COVID-19 preventive measures

“Then if it happens, you have to call the health worker, then call the number 666, then we have to protect ourselves by wearing the masks, then the hand sanitizers, washing” (Adult community member, Central Equatoria)

“Protection is needed, you must wash your hands clean, do not shake hands, and so you see a fellow and just wave to them” (Adolescent community member, Western Equatoria)

“People have to sit separate; one can sit there and another person there” (Adult community member, Warrap)

Perceived impact of COVID-19 on communities’ livelihoods

 Direct health

Of the total number of individuals seeking care for a perceived need (N = 3,286), a negligible proportion did so to get tested for coronavirus

Not reported by interview participants

n/a

 Non-health effects

In total, 79% of households (N = 1,223) perceived COVID-19 had affected their livelihoods in other ways than getting infected with the virus

Participants reported COVID-19 led to a lack of education due to school closures, teenage pregnancies, a lack of economic activities and church closures

“This Coronavirus has come to spoil all our things. There is nothing good, young men have resorted to doing useless things” (Adult community member, Western Equatoria)

“During the COVID-19, the people were not happy because it made life difficult” (Health facility worker, Western Equatoria)

‘It closed schools and markets; markets used to function but they wanted to close markets, it has been a great challenge to people” (Adult Community member, Western Equatoria)

 Indirect health effects

Of the households in Warrap and Western Equatoria who reported indirect effects of COVID-19, 29% and 23%, respectively, reported an effect of COVID-19 on their ability to access or utilise care [Table 2] while in Central Equatoria only 5% of households perceived such indirect effects

Some interview participants working in the South Sudanese health sector reported COVID-19 resulted in the reduced ability to access health services for local populations, due to reduced opening hours of health facilities, reduced availability of essential medicines and equipment, or reduced quality of care at facilities

“With the coming of coronavirus people [at the health facility] are working from Monday to Friday only and is not on full time, at 1:00 pm people have already left for home. Before that, people used to work from 7:00 am to 5:00 pm from Monday to Saturday” (Boma Health Committee member, Central Equatoria)

“The issue of Corona has scared people; it does not allow people to stay close to each other, it has created distancing. But that is not why people stopped going to the hospital, only that hospitals are not there” (Traditional Leader, Warrap)

Community response to COVID-19

 Adherence to governmental COVID-19 guidelines

The majority (92%, N = 1,223) of households reported to have taken precautions to protect themselves against COVID-19

Many participants working in the health sector felt that communities were generally adhering well to the governmental COVID-19 guidelines, whereas other participants felt the exact opposite

"I do not see them wearing mask, and people in the market are not wearing masks” (NGO employee, Western Equatoria)

“When we raise awareness, they do not accept what we are talking about, like actually COVID-19 is affecting many people, and it is the ignorance of the rules and regulations that are in the Ministry of Health” (Local Media employee, Warrap)

“For this COVID-19 from the beginning the community, when they come to the facility, we tell them to wear the mask, wash their hands. They did not want, but after health education, they are now wearing face mask, washing hands and measuring their temperature.” (Health Facility Worker, Central Equatoria)