This study examines the impact of countermeasures, such as stay-at-home orders and school closures, on stress within households during the COVID-19 pandemic. In a phone survey carried out in Uganda, Tanzania, Sierra Leone, and Mozambique throughout 2021 (N = 22,497), 70% of respondents reported the presence of intra-household tension. On average, we document that the stringency of the countermeasures increases intra-household tensions. The duration of the countermeasures significantly increases tension but at a diminishing rate. The type of countermeasure (e.g. workplace closure, public transport restrictions) is less important, with all measures, apart from international travel restrictions, significantly increasing tension. Income shocks, frequently experienced during the pandemic, were compounded by the countermeasures. Thus, countermeasures have a strong impact on the psychological and economic wellbeing of households. Policymakers need to carefully consider the intersection of economic vulnerability and public health interventions during future crises, balancing the expected benefits of countermeasures with their costs.