Assessment of face mask use in peripartum women during the COVID-19 pandemic: an observational study

The new coronavirus disease 2019 (COVID-19) pandemic resulted in significant mortality, particularly in vulnerable groups, including pregnant women. Unavailability of a vaccine in South Africa until February 2021 and slow rollout made it important for the prevention of transmission to rely on non-pharmaceutical interventions such as face mask use. We aimed to assess the rate of face mask use in peripartum women in a secondary hospital in South Africa and to determine knowledge of and reasons for use and non-use of face masks.

This was a cross-sectional quantitative study using opportunistic sampling of women in the first and second stages of labour and the first six hours postpartum to assess the proportion of women who used face masks effectively between 1 and 31 October, 2020. A smaller sample of women answered a structured interviewer-administered questionnaire to assess their knowledge of face mask use and reasons for wearing or not wearing the face mask. The questionnaire was based on the Health Belief Model.

The study included 500 women. Of those who wore face masks, 81.7% wore them correctly and 18.3% ineffectively. 78% of respondents were aware of how to effectively use a face mask. Rates of effective face mask use were 83.1%, 64.3%, and 81.1% in the postpartum period, second and first stages of labour, respectively. 90% of participants had adequate knowledge of face mask use and this positively correlated with effective face mask wearing. More than half of the respondents, (53.2%), used face masks because they "felt susceptible to getting COVID-19 in the hospital". The majority felt that their reason for wearing a face mask was to prevent transmission to loved ones (90.8%) or to protect themselves (96%). More than half of the women, (54.0%), did not find face mask wearing troublesome. Face mask use was lowest in the second/third stages of labour (p = 0.016) and in women with secondary rather than tertiary education (p = 0.016).

Information on non-pharmaceutical interventions during the COVID-19 pandemic in a low- middle income country will be useful to inform educational and other strategies in future respiratory virus outbreaks.