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Background: As part of an international multi-country study on COVID-19 vaccine immunogenicity (InVITE, NCT05096091), we sought to characterize baseline anti-Nucleocapsid (N) and anti-Spike (S) seropositivity by country and by self-report of prior positive SARS-CoV-2 test result. Method(s): 3063 vaccine-naive individuals from the InVITE study cohort, who received a COVID-19 vaccine as part of their country's national immunization programs at participating sites in Democratic Republic of Congo (DRC), Guinea, Liberia and Mali, were enrolled between August 2021 and February 2022. Demographic and baseline characteristics were collected at study enrollment. Blood was collected at baseline prior to initiation of the vaccine regimen. SARS-CoV-2 anti-S antibody and anti-N antibody levels were measured using Quanterix anti-S IgG semi-quantitative antibody and BioRad Platelia SARSCoV- 2 anti-N Total Ab assays, respectively. Demographic characteristics were assessed for association with positive anti-S and anti-N serology. Result(s): Baseline demographics and serology results by country and overall are shown in the table. Conclusion(s): Despite low numbers of prior self-reported positive SARS-CoV-2 test, the serology results in this cohort indicate prior infection in a significant proportion of the InVITE study participants prior to receipt of a first dose of COVID-19 vaccination. These results suggest widespread previous SARS-CoV-2 infections that were unrecognized possibly due to mild-no symptoms, poor access to/availability of testing and/or limited monitoring through surveillance. Baseline Demographics and Serology Results.
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Four broad themes run through this year's N'Galy-Mann lecture: clinical medicine, HIV, health security, and global health. Three patterns of disease characterized medicine in East Africa at the time that AIDS was first described in the United States: diseases of poverty, mainly infectious;non-communicable diseases with differing international epidemiology;and classic tropical diseases restricted in distribution by ecologic needs of parasites and vectors. Limited resources did not prevent the practice of good medicine under adverse circumstances, nor application of basic principles of research. The recognition of a second AIDS virus (HIV-2) in West Africa in the mid-late 1980s required applied research to assess implications and potential global impact of this novel infection. CDC established a second collaborative research site in sub-Saharan Africa, Projet RETRO-CI, in Abidjan, Cote d'Ivoire (the first was Projet SIDA in the Democratic Republic of Congo, where N'Galy and Mann made seminal contributions). Controversy around HIV-2 diagnosis, transmission, and pathogenicity was slowly resolved through West African research showing HIV-2 was an AIDS-causing pathogen, slower than HIV-1 in its progression, and less transmissible until late in the course of infection. Mother-to-child transmission was exceptionally rare. Claims that HIV-2 protected against HIV-1 were not substantiated. Projet RETRO-CI clarified the spectrum of HIVassociated disease and the dominant role of tuberculosis. Placebo-controlled trials demonstrated efficacy of short-course zidovudine for prevention of perinatal transmission of HIV-1, and of cotrimoxazole prophylaxis in reducing hospitalization and mortality in persons with HIV. Global health today is dominated by discourse around health security. The West African and Congolese Ebola epidemics since 2014 aroused strong declarations, yet the world was poorly prepared to address the pandemic of COVID-19. Health in the world has changed substantially since AIDS emerged. As 2030, the year for delivery on the Sustainable Development Goals, approaches, development assistance for health remains essential to address traditional, unfinished commitments yet does not match today's global burden of disease. CROI attendees are encouraged to remember colleagues lost to COVID-19 and other challenges;to assess priorities in today's global health, including relating to HIV;and to reflect on what issues? N'Galy and Mann would focus on today.
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The COVID-19 pandemic has led communities, including Kinshasa peri-urban schools, to reinforce WASH-related practices as a key com-ponent in preventing the spread of COVID-19. This study aimed to determine the institutional and behavioural changes in adolescent girl students' handwashing practices before and during the COVID-19 pandemic. A cross-sectional study was performed, observing the hand hygiene of adolescent girl students, and assessing WASH facilities at schools, chosen from a sample previously selected in the study area. The results indicate significant increases in the prevalence of water points in schools from 10.9 to 22.5%, of handwashing facilities from 43 to 60.1% of schools with an average number of handwashing facilities from one to two, and the prevalence of school WASH brigades from 4.8 to 11.8% of schools. There was also a significant increase in schools receiving funds, and other support for WASH, respectively, from 24.9 to 70.3%, and from 17 to 45.9%, while the proportion of adolescent girl students washing their hands after using the toilet and before eating significantly increased from 6 to 28.4%. However, to improve the current WASH picture, and succeed in curtailing the spread of COVID-19 and related impacts, additional efforts to enhance handwashing practice and WASH items' coverage are expected. © 2023 The Authors.
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Purpose: Adolescence (ages 10-19) is a sensitive developmental period for the emergence of mental and behavioral health problems, but there is a lack of multi-country qualitative studies that explore how adolescents themselves understand these critical challenges. As part of UNICEF's 2021 State of the World's Children Report, the Global Early Adolescent Study collaborated with organizations in 13 countries to hold a series of focus group discussions (FGDs) with adolescents focused on mental health. These FGDs aimed to (1) understand adolescents' perspectives on significant mental health challenges in their age group, (2) understand adolescents' perspectives on the key risk and protective factors driving these challenges, and (3) understand the ways in which adolescents cope with these challenges, including barriers and facilitators to help-seeking. Methods: A total of 71 FGDs were conducted across 13 countries between February and June of 2021. Countries were selected to ensure geographic, economic, and cultural diversity, and included: Belgium, Chile, China, the Democratic Republic of Congo, Egypt, Indonesia, Jamaica, Jordan, Kenya, Malawi, Sweden, Switzerland, and the United States. Within each country, FGDs were stratified by sex and age such that there were at least two younger (ages 10-14) and two older (ages 15-19) focus groups. Depending on the COVID-19 restrictions at the time, FGDs were either held in-person or online. All FGDs were held in local languages and lasted between 60 and 90 minutes. FGDs were recorded, transcribed verbatim, and translated into English when necessary. These English translations were then coded and analyzed using an inductive thematic analysis approach. Results: Across diverse cross-cultural settings, a number of consistent findings emerged from the voices of adolescents. In particular, adolescents around the world emphasized the many contexts that drive mental health challenges, including family adversity, community violence, unsupportive school environments, poverty, social media culture, and restrictive gender norms. They also discussed significant barriers to seeking help for mental health challenges, such as community stigma, lack of social support, and fears of invalidation. These barriers frequently resulted in adolescents coping with these challenges without support, often using maladaptive strategies. Importantly, adolescents generally described and understood mental health in terms of distress (e.g., sadness, loneliness, shame, anger) rather than disorder (e.g., depression, anxiety). Conclusions: Above all, it was clear that adolescents around the world need much better formal and informal supports to adequately address mental and behavioral health problems, and that these responses must take into account the many contexts that contribute to these problems. Further, the non-clinical terminology frequently used by adolescents suggests that taking a purely diagnostic approach in addressing mental health challenges may exclude many adolescents in need of assistance. Sources of Support: Wellcome Trust.
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Background: COVID-19's restrictive measures have significantly affected our health, work and social relationships. As yet, less attention has been given to the changes in sex life. Aim(s): This study investigates people's satisfaction with sex life in Kinshasa in the Democratic Republic of Congo (DRC). Method(s): A cross-sectional survey of the general population (18 years and over) was conducted, from 1st to 18th July 2020, in 17 municipalities in Kinshasa and several measures were used: Quality of life MANSA, EQ-5D-3L, UCLA Loneliness;PHQ-9;GAD-7. Prior to conducting data analysis, diagnostic tests for our data were performed to assess distribution, variance and multicollinearity. Descriptive statistics, bivariate correlation and multiple regression analysis were used. Result(s): Sex life satisfaction increases from young adults aged 18-35 to those aged 36-55 and then there is a decrease from ages 56-69. After controlling for socio-demographic factors, sex life satisfaction was positively associated with the number and quality of people's friendships (B=0.30, p=0.01) and people's relationships with their families (B=0.32, p=0.03). People who feel lonely have lower sex life satisfaction (B=-0.15, p=0.01). Conclusion(s): People's quality of their friendships and family relationships are important for their sexual well-being. Healthcare providers and policymakers should consider people's quality of friendships and family relationships when planning to improve the sexual well-being of people in DRC. Copyright © 2022 The Authors.
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The earliest cases of COVID-19 disease in Africa were, in most cases, the result of imports from abroad. The Democratic republic of the Congo (DRC) identified the first case at the beginning of 2020. Two days after his return from France, the first patient was tested positively in the capital, Kinshasa. The travel restrictions and status of the state of emergency were announced on 24 March 2020. A lockdown followed. In June of the same year, 11 provinces were already affected by COVID-19 disease. The negative socio-economic impact has occurred and is similar to that in any other country. The DRC does not differ from other African countries or on the issue of infectious diseases such as HIV, malaria, cholera, measles or Ebola virus disease. Recurring Ebola epidemics are addressed by vaccination with Ervebo vaccine. Unlike Ebola, part of the population does not believe in the existence of SARS-CoV-2 and does not respect basic anti-epidemic measures. Medical capacities were very limited at the beginning of the SARS-CoV-2 epidemic, both in terms of diagnosis and testing and availability of treatment (60 ventilators to 83 million inhabitants). The situation is complicated as a result of 20 years continuing wars. Another African country, Guinea, is currently facing not only COVID-19, but also the zoonotic disease of Lassa fever, which has been detected in several patients. Copyright © 2021, Medakta s.r.o.. All rights reserved.
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Introduction/ Background: Health systems in sub-Saharan Africa are strained by communicable diseases, non-communicable diseases, and emerging diseases of pandemic potential. COVID-19 illustrated how shocks disrupt healthcare delivery. To understand factors of health systems resilience, we assessed maintenance of essential health services (EHS) in Uganda, Nigeria, Senegal, and the Democratic Republic of Congo. Methods: Mixed methods were used, including literature review, analysis of routine service data and key informant interviews (KIIs). Indicators including DPT3 coverage, general adult outpatient (OPD) attendance, and diabetes were assessed in 2020 (during the pandemic) and 2019 (baseline) using data from the DHIS2. KIIs were conducted to document EHS maintenance strategies and lessons learned. Key informants included national level policy makers (national task forces and EHS maintenance committee members), regional-level health service directors, district health officers, health facility staff and community health workers. Results: Monthly vaccine disruption ratios for DPT3 remained stable in DRC, but dropped in Uganda (0.7) and Nigeria (0.78), reverting to normal after 1 and 5 months respectively. In Senegal DPT3 dropped (0.65) moderate recovery starting May 2020. In Uganda, OPD visits decreased 10%-22% in three of four geographical regions and increased in one region, diabetes visits decreased by 23% in two regions. EHS maintenance strategies included telemedicine, multi-month drug dispensing, and expanded use of community health workers (CHW). Challenges to maintain EHS included poor dissemination of guidelines across health system levels, poor financing of interventions, and limited tracking of EHS. Impact: These findings highlight gaps in health system resilience with disruptions in essential health service delivery during the COVID-19 pandemic in Africa, and the strategies implemented by countries to mitigate the disruptions. These lessons are important for health systems strengthening and future pandemic preparedness and response. Conclusion: EHS maintenance can be improved through integration into pandemic preparedness and response policies and strengthened data analysis to detect service disruptions. Strategies to mitigate service disruptions such as telemedicine, multimonth drug refills, and community drug distribution via CHWs should be implemented and monitored at the national and subnational levels.
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Objective Making sure the right type of health workers are available in the right place is crucial to achieve universal health coverage. The Global Fund Strategic Initiative 2020- 2023 aims to improve the distribution of health workers at decentralized level in Chad, DRC, Mali, Niger and Nigeria. Within this project, technical support is provided to governments to strengthen priority setting processes for the selection of health workforce interventions. This study aims to share lessons learned on the contextualization of technical support across five different countries. Methods Between September 2021-February 2022, for each country, a document review was done to understand health worker issues and the policy context. An inventory was made of available health workforce data and evidence. About 15 stakeholder per country were interviewed on their roles, knowledge, interests and power related to health workforce issues. An institutional capacity assessment studied the capability of ministry of health to facilitate the priority setting process. The researchers collected lessons learned on the contextualization process using project update sheets. Results Contextual factors that played a role in the adaptation of technical support were decision space at decentralized level, covid-19 pandemic, travel security, fiscal space for health workforce interventions, stakeholders views on health workers issues, stakeholder's interest and political support for specific interventions, data and evidence base, timing of future policy processes, presence and potential synergy with other technical support projects and capacity of the government health workforce focal point in convening stakeholders. Discussion This is one of the first studies reporting on technical support for priority setting for health workforce interventions. In contextualizing technical support a broad range of factors need to be taken into account which may be relevant for other settings too. In contextualization a critical reflection is needed on the influence of the funder and provider of technical support.
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Purpose: Despite its critical role in containing outbreaks, the efficacy of contact tracing (CT), measured as the sensitivity of case detection, remains an elusive metric. We estimated the sensitivity of CT by applying unilist capture-recapture methods on data from the 2018-2020 outbreak of Ebola virus disease in the Democratic Republic of Congo. Methods & Materials: We applied different distributional assumptions to the zero-truncated count data to estimate the number of unobserved cases with a) any contacts and b) infected contacts, to compute CT sensitivity. Geometric distributions were the best fitting models. Results: Our results indicate that CT efforts identified almost all (n=792, 99%) of the cases with any contacts, but only half (n=207, 48%) of the cases with infected contacts, suggesting that CT efforts performed well at identifying contacts during the listing stage, but performed poorly during the contact follow-up stage. Conclusion: This novel approach can be applied to assess the effectiveness of CT. Importantly, the approach described is disease-agnostic, and can be extended to assess the sensitivity of CT for any disease, including COVID-19, for which CT has been identified as a crucial component of the response activities.
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The International Labour Organisation (ILO) estimates that approximately 2 billion people, about 61% of all globally employed people, are in the informal economy. This statistic is substantially higher for continental Africa (approximately 86%), and varies across the continent: 31.5% in South Africa, and exceeding 95% in Mozambique, Democratic Republic of Congo and Chad. The informal sector is characterised by vulnerabilities in income, job security, occupational risks and access to healthcare. The ILO, in addressing these challenges, developed Recommendation 204, the “Transition from the Informal to the Formal Economy Recommendation, 2015”. This provides a policy framework that requires a transition that provides adequate social and labour protection, extends legal coverage and protection and ensures compliance with laws. While this transition is necessary, its character particularly with regard to occupational health and safety, needs to be shaped in accordance with needs of workers, harnessing resources from the formal economy and structuring legal frameworks that prioritise health and social protection. Informal work environments vary from extractive, manufacturing, food preparation, commercial, social and retail. Hazardous exposures vary, with workers having little or no resources to introduce controls or to protect their health. Most lack the knowledge about the risks posed by their exposures. Access to medical surveillance is non-existent. While workplace exposures are important factors, social contexts further drive health outcomes: lack of health facilities close to working environments reduce primary health care access, lack of childcare facilities result in child exposures and precarious conditions increase gender and xenophobic violence. Numerous interventions have been piloted and proposed for protecting the health of workers in this sector, including the ILO initiatives such as Work Improvements in Small Enterprises (WISE). However, the success of any intervention is dependent on the multi-stakeholder context. The SARS-CoV-2 pandemic brought into sharp focus the vulnerability of the informal sector – both in terms of economic stability as well as health protection. In South Africa alone, approximately 1.5 million informal sector jobs were lost in the first quarter of 2020. The nature of work has meant that the risk for transmission of infection is extremely high, thus return to work is likely to have resulted in disproportionately higher rates of hospitalisation and death compared to formal workers – but few countries have collected data to better understand the epidemic-related risk of informal work. The growth in the informal economy is a direct result of neo-liberal economic policies championed by government and big-business. The policy infrastructure that encourages the growth in this sector excludes the protection of the health of these workers. All tiers of government should be obliged to commit to policy frameworks, local infrastructure for informal work activity and provision of resources for hazard control and medical surveillance. It is the responsibility of the state to ensure that these workers enjoy the rights to safe and healthy workplaces.