Search results and characteristics of included articles

The literature search yielded a total of 787 articles. After the removal of duplicates, 614 single entries were screened for eligibility. Out of the 614 articles, only 24 were found relevant and included in this scoping review after a two-stage screening process (see Table 1). Also, the reference lists of these 24 articles were manually searched to identify any other relevant articles, but none was found. Finally, this scoping review included a total of 24 articles (see Fig. 1).

Fig. 1

Sixteen of the 24 selected articles investigated issues related to COVID-19 prevention and control in Africa [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. Two assessed precautionary practices for Lassa fever [29, 30], while five were on Ebola virus disease control [31,32,33,34,35]. However, one article explored knowledge, preventive practices, and isolation precautions broadly, the authors’ focus was not on a particular infection.

Table 1 Publications reviewed on quarantine and isolation implementation in Africa

Seven studies were conducted in Nigeria [14, 22, 26, 28,29,30, 37], 5 in Ethiopia [17, 19, 20, 24, 27], 4 in Ghana [15, 31, 32], 2 in Liberia [33, 35], and 1 each in Sudan [21], Guinea [16], Sierra Leone [34], Uganda [25], Cameroon [36], and Tunisia [23]. One was a multicountry study conducted in 4 different locations—the Democratic Republic of Congo, Nigeria, Senegal and Uganda [18].

Units of analysis varied amongst the reviewed articles. The majority of the sampled individuals included healthcare personnel, persons who experienced or were in quarantine, migrants, community members, policymakers, epidemic focal persons, and some aimed at health managers (see Table 1). Furthermore, some articles included samples from primary schools, hospitals, community mobilizers, and contact tracers. In total, 5882 persons, 81 health facilities, and 146 primary schools were respondents. Only one of the 23 articles introduced intervention in their research [33].

Challenges with Q&I implementation during viral infection outbreaks in AfricaInadequate outbreak response preparation

Several African countries exhibited unpreparedness during the COVID-19 outbreak. For instance, in Nigeria, the overall level of preparedness among healthcare institutions was inconsistent [22, 26]. Many hospitals lacked isolation units until after the virus was confirmed in the country, with only 45% of hospitals establishing such facilities [26]. In a sample of 20 hospitals, only 15% were highly prepared, 75% were moderately prepared, and 10% were classified as not ready based on World Health Organization (WHO) standards [26]. In Ethiopia, over one-third of healthcare workers rated their facility’s preparedness as poor, citing a lack of isolation and triage protocols [19]. Similarly, preparedness at points of entry in Cameroon was inadequate, particularly in areas such as communication, resource evaluation, and sanitary inspection [36]. The lack of comprehensive plans for responding to outbreaks at both the community and state levels contributed to ineffective Q&I implementation.

Human resource challenges

A shortage of trained personnel hindered the management of viral outbreaks in several African countries. In Nigeria, for example, there was a limited availability of infectious disease specialists, with anesthesiologists being particularly scarce [26]. In Ghana and other countries such as Senegal, Uganda, and the Democratic Republic of Congo (DRC), the scarcity of trained personnel affected contact tracing and other public health activities essential for managing Ebola Virus Disease (EVD) and COVID-19 [15, 18, 32]. In Nigeria, nearly half of health workers had not been trained in general infection prevention and control (IPC) measures [37]. Similarly, in Cameroon, none of the healthcare workers had been trained in surveillance activities, and less than half of healthcare workers in Guinea received any formal training in COVID-19 prevention and management [16]. In Ethiopia, while many healthcare workers had undergone training, gaps in knowledge persisted, particularly in isolation techniques and procedures for reporting suspected COVID-19 cases [19].

The knowledge and application of IPC measures were found to be suboptimal across multiple African countries. In Nigeria, for instance, the knowledge of IPC practices among healthcare workers was poor, with 82% of personnel being unaware of proper isolation precautions, and only 7.6% understanding when personal protective equipment (PPE) should be used [37]. Similarly, in Ethiopia, nearly half of the healthcare personnel lacked skills in isolation techniques and methods for reporting suspected COVID-19 cases [19]. The overall understanding of EVD screening protocols and IPC measures was also low among health workers in Ghana, affecting their ability to screen migrant returnees effectively [32].

The welfare and protection of healthcare workers were inadequate in several African countries during viral outbreaks. For example, in Nigeria, many hospitals lacked provisions for staff accommodation, feeding, and life insurance for personnel managing COVID-19 patients [26]. In Ghana, contact tracers complained about poor remuneration and a lack of insurance coverage [15]. The shortage of PPE further compounded the challenges. In Nigeria, Ethiopia, and Guinea, many hospitals lacked sufficient PPE for their personnel [16, 19, 26]. In Guinea, 70% of healthcare workers had not received PPE for three months, raising concerns about their safety while managing COVID-19 patients [16]. Similarly, healthcare workers in Ghana expressed anxiety about their safety due to inadequate PPE when screening for EVD [32].

Noncompliance with IPC guidelines was another major issue affecting Q&I implementation. In Nigeria, some health workers failed to follow basic precautions such as handwashing, wearing facemasks, or using PPE when attending to patients [30]. Compliance with IPC measures was found to be better at designated Lassa fever treatment centers than at non-designated centers [22]. In Liberia, an intervention study revealed low baseline compliance with IPC practices, though some improvements were observed post-intervention [33]. In some countries, such as Guinea, hospitals had yet to receive necessary guidance documents for COVID-19 prevention, sample collection, and patient management, further impeding compliance with IPC measures [16].

Healthcare infrastructure shortages

The lack of adequate healthcare infrastructure was a persistent challenge in many African countries. In Nigeria, Lassa fever treatment centers were found to lack basic amenities such as perimeter fences, hand hygiene facilities, and separate toilets for infected patients [30]. In Ghana, health personnel relied solely on thermometers for screening EVD cases due to a lack of laboratory testing capacity [31]. The absence of dedicated spaces for Q&I was a significant problem in Guinea, Nigeria, Cameroon, and Ghana. In Guinea, 74% of health facilities lacked dedicated spaces for isolating confirmed COVID-19 cases [16]. Similarly, in Nigeria, 83.5% of healthcare institutions were found to be suboptimal for COVID-19 patient care due to a lack of isolation facilities, bed space, and oxygen support [14].

Screening for viral infections was hindered by a lack of resources and equipment in several African countries. In Guinea, 93% of hospitals had no equipment to screen for COVID-19 [16]. Similarly, in Nigeria, a significant number of hospitals lacked the resources to test for COVID-19 [22, 26]. The lack of laboratory support was also a problem in Ghana, where health personnel could not test suspected EVD cases, relying solely on thermometers for screening [31]. Testing shortages were also reported in the DRC, where insufficient test kits affected outbreak control efforts [18]. The inability to detect suspected cases of infection in a timely manner led to underreporting and a delay in referring confirmed cases to appropriate care centers in countries like Senegal and Uganda [18].

The shortage of health infrastructure is also a function of funding constraints. Hence, limited funding was a critical issue affecting Q&I implementation in Africa. The renovation of Lassa fever treatment centers in Nigeria, for example, was stalled due to a lack of financial resources [30]. Similarly, inadequate funding forced countries such as Nigeria to shift from institutional Q&I to self-quarantine and self-isolation measures during the COVID-19 pandemic. In the DRC, insufficient funding affected outbreak control efforts, while in Uganda, overreliance on donor funding disrupted surveillance and infection control measures [18]. The lack of sustainable funding models for public health infrastructure and personnel support remains a significant barrier to effective outbreak management in Africa.

Social factors affecting Q&I implementation

Social and cultural factors such as stigma and misinformation significantly hampered the effectiveness of Q&I in African nations. In Nigeria and Senegal, for instance, the stigma associated with being infected led to underreporting of cases, making it difficult to track and isolate the spread of infections. Nigeria’s vast landmass, negative perceptions of COVID-19, and the inaccessibility of certain conflict zones in northern regions compounded the challenges of effective outbreak control [18]. Similarly, in Sierra Leone, health personnel struggled to reach vulnerable populations in remote areas, which limited the country’s ability to contain the virus effectively [34].

Another significant issue was poor self-quarantine practices, where individuals exposed to the virus continued to interact with others to meet daily needs, potentially spreading the virus further [15, 18]. This was exacerbated by harassment of contact tracers, with quarantined individuals demanding their test results and food [15]. In countries like Ghana, porous borders, uncooperative travelers, stockouts of essential materials, and language barriers further complicated containment efforts during the EVD outbreak [32]. Political discourse around disease outbreaks was also politicized, further hindering cooperation between health workers and the public [15].

In Liberia, state-enforced quarantines heightened stigmatization and mistrust within communities. This led to panic, fear, and the disenfranchisement of vulnerable groups. The practice of mandatory cremation during the EVD outbreak, as well as the enforcement of quarantine measures, were perceived as degrading, resulting in secret burials and further distrust in the system [35]. Essential supplies, such as food and water, were often rationed, leading to non-compliance with quarantine rules in Liberia [35]. Sierra Leone faced additional challenges, including poor social mobilization, weak community engagement, and a lack of two-way communication between health officials and local communities. This lack of dialogue resulted in ineffective responses and a general distrust in health interventions [34].

Negative experiences with Q&I enforcement

Enforcement of Q&I measures often resulted in negative experiences for those affected. In many cases, quarantine conditions were substandard, with individuals facing boredom, poor hygiene, unhealthy meals, and limited access to drinking water. These poor conditions, combined with preferential treatment for certain individuals and the high cost of quarantine, led to widespread dissatisfaction [25]. Communication gaps regarding quarantine protocols, such as preparation, length of stay, and the collection of COVID-19 test results, created confusion and anxiety for those in quarantine [25]. In Uganda, quarantined individuals expressed concerns about stigma and the fear of being attacked post-discharge. A significant portion (43.7%) feared discrimination upon their release from isolation [17]. In Ethiopia, many quarantined individuals (85.2%) struggled with financial insecurity during and after their stay in quarantine, with 64% lacking any plans for life post-quarantine. This experience was exacerbated by the inability to engage in normal social interactions [20]. Quarantine hesitancy, contact denial, and mistreatment by law enforcement were additional negative experiences reported in Uganda, with some individuals being mistakenly quarantined due to errors in identity [27].

Healthcare personnel also faced significant challenges. In Sudan, nearly half of healthcare workers (48%) were concerned about contracting the virus, and many reported experiencing anxiety and an increased workload due to the pandemic [21]. Similarly, some quarantined patients in Uganda experienced heightened anxiety about the possibility of infection during their isolation [25].

Psychosocial burden of Q&I

The psychosocial burden of Q&I on individuals and healthcare workers was another major challenge. In Uganda, psychological distress was