COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021.

Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings.

Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data.

BACKGROUND: Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS: We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS: Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS: The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.

Potential threats of cholera amidst COVID pandemic in the Democratic Republic of Congo; bridging the gaps: a review.

Cholera, being a global health issue has remarkably affected the wellness of the people, especially in the Democratic Republic of Congo (DRC). This has worsened during the COVID-19 pandemic, and it could be more if no concrete Intervention is done to curtail the outbreak. The authors reviewed past and present literatures on cholera and COVID-19 from the year 2013-2023 in well renowned scientific journals such as PUBMED, ResearchGate, Google Scholar. Database servers of these journals were accessed based on their permissions. From this search the authors found that, cholera is at its peak amidst COVID in DRC. Between the 10 March 2020 to the 10 March 2022, DRC reported a total of 86 462 cases of COVID-19 in 314 health zones in all 26 provinces of the country, with 1335 deaths recorded. And since the beginning of 2022, 6692 suspected cholera cases including 107 deaths have been reported in 54 health zones in 11 provinces of DRC, compared with 3681 suspected cases and 91 deaths reported during the same period in 2021 in 67 health zones in 14 provinces in the country. The authors realized that despite all efforts to mitigate the spread of cholera in DRC by the Congolese government and the non-governmental organizations in the country, there are still some gaps required to be filled, such as; limited community mobilizations and awareness campaigns about the signs and symptoms of cholera and COVID-19, unavailability of free cholera and COVID-19 vaccines to all the Congolese populations as well as association of witchcraft to diseases. etc. Hence, to mitigate this menace, the authors urge the Congolese government to utilize research implementation strategies such as increase mass awareness campaigns on cholera and COVID among the Congolese populations as well as training workshops for the religious and traditional leaders as well as the healthcare providers in the country for a better diagnosis and treatment of these diseases.

Contesting the crisis narrative: epidemic accounts in Sierra Leone, Tanzania, and Democratic Republic of the Congo.

Scientists and global commentators watched African countries closely in the early months of the COVID-19 pandemic, predicting an impending disaster: the virus was projected to overwhelm already weak health systems. These expectations were informed by imaginaries of Africa as an inevitable site of epidemic disaster. This paper draws on accounts from Sierra Leone, Tanzania, and Democratic Republic of the Congo to contrast global catastrophe framings with everyday imaginations and experiences of crisis and crisis management. Utilising ethnographic research, the paper initially explores how COVID-19 was understood in relation to previous epidemics, from HIV (human immunodeficiency virus) to Ebola, as well as political conflict. It then considers how global crisis narratives both inform and are in tension with everyday collective and personal experiences. The paper brings these empirical reflections into a conversation with theoretical debates on the discursive construction of crisis and its effects, and argues that these tensions matter because crisis framings have consequences.

High SARS-CoV-2 Seroprevalence after Second COVID-19 Wave (October 2020-April 2021), Democratic Republic of the Congo.

Serologic surveys are important tools for estimating the true burden of COVID-19 in a given population. After the first wave of SARS-CoV-2 infections, a household-based survey conducted in Kinshasa, Democratic Republic of the Congo, estimated >292 infections going undiagnosed for every laboratory-confirmed case. To ascertain the cumulative population exposure in Kinshasa after the second wave of COVID-19, we conducted a prospective population-based cross-sectional study using a highly sensitive and specific ELISA kit. The survey included 2,560 consenting persons from 585 households; 55% were female and 45% male. The overall population-weighted, test kit-adjusted SARS-CoV-2 seroprevalence was 76.5% (95% CI 74.5%-78.5%). The seroprevalence was 4-fold higher than during the first wave, and positivity was associated with age, household average monthly income, and level of education. Evidence generated from this population-based survey can inform COVID-19 response, especially vaccination campaign strategies in the context of vaccine shortages and hesitancy.

Using Population Mobility Patterns to Adapt COVID-19 Response Strategies in 3 East Africa Countries.

The COVID-19 pandemic spread between neighboring countries through land, water, and air travel. Since May 2020, ministries of health for the Democratic Republic of the Congo, Tanzania, and Uganda have sought to clarify population movement patterns to improve their disease surveillance and pandemic response efforts. Ministry of Health-led teams completed focus group discussions with participatory mapping using country-adapted Population Connectivity Across Borders toolkits. They analyzed the qualitative and spatial data to prioritize locations for enhanced COVID-19 surveillance, community outreach, and cross-border collaboration. Each country employed varying toolkit strategies, but all countries applied the results to adapt their national and binational communicable disease response strategies during the pandemic, although the Democratic Republic of the Congo used only the raw data rather than generating datasets and digitized products. This 3-country comparison highlights how governments create preparedness and response strategies adapted to their unique sociocultural and cross-border dynamics to strengthen global health security.

Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo.

BACKGROUND: From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. MAIN TEXT: Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. CONCLUSIONS: Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

COVID-19 outbreak and rural household food security in the Western Democratic Republic of the Congo.

Although global assessments of the initial impacts of the coronavirus disease (COVID-19) have focused on income, jobs, and health conditions, this study constitutes one of the first studies that assessed the impact of COVID-19 on food security in DRC and established the short-term implications of the COVID-19 outbreak on rural households' food security in DRC. In addition, the study recommendations contributed to shaping government interventions toward the pandemic in the Country. The study used data from four western provinces of the country on 1339 households. Our results show that 80 % of households experienced an increase in food prices, 61 % a noticeable decrease in the availability of food, and 54 % a decrease in their dietary diversity. Due to changes in food availability, dietary diversity, and food accessibility imposed by the COVID-19 outbreak, >70 % of households experienced either a decrease in the consumption of meat, milk, fish, and cereals or an increase in their consumption of traditional vegetables. In addition, COVID-19 significantly affected food security dimensions in larger households, households with a greater number of members aged 35 years and above, households headed by women, households where members participate in associations or cooperatives, households that depend on crop sales as the major source of income, and in poorer households. These findings highlight the significant implications of the COVID-19 outbreak on household food security in western DRC and underscore the need for emergency interventions to strengthen the resilience of rural people and accelerate their recovery and other long-term measures toward sustainable and inclusive development.

A Qualitative Evaluation of COVID-19 Preventative Response Activities in South Kivu, Democratic Republic of the Congo.

OBJECTIVE: In this evaluation of COVID-19 preventative response programs in South Kivu, Democratic Republic of the Congo (DRC), we aimed to explore community understandings of COVID-19, assess operational successes and challenges of COVID response activities, and identify barriers to practicing COVID-19 preventative behaviors. METHODS: Thirty-one semi-structured interviews were conducted from April to September 2021 in South Kivu, DRC, with community members (n = 16) and programmatic stakeholders (n = 15) (healthcare providers, government officials, and developmental and NGO staff engaged in COVID-19 response). FINDINGS: Most community members were aware of COVID-19 and its global burden, but few were aware of local transmission in their area. Some community members attributed COVID-19 to actions of malevolent neighbors, miasma ("bad air"), or spirits. Awareness of COVID-19 preventative measures was widespread, largely because of radio and TV health promotion programs. Community members and programmatic stakeholders both said community-level non-compliance to COVID-19 preventative measures was high despite high awareness of preventative methods. Community members expressed concern that face masks distributed as part of preventative programs contained the COVID-19 virus. Programmatic stakeholders emphasized the need for broader health system strengthening with improved coordination, provision of resources to health facilities at the provincial level, and prioritization of research. Lessons learned from addressing Ebola were leveraged for COVID-19 health promotion, rapid training of healthcare personnel, and surveillance. CONCLUSIONS: Community-informed approaches are needed for effective COVID-19 preventative response programs in South Kivu, DRC. Our study identified successes and challenges in COVID-19 response activities. Future research should assess the effectiveness of integrating preventive programs with COVID-19 vaccination efforts.

Malnutrition among under-five children in Democratic Republic of the Congo: A plague of the health system.

Malnutrition in children has been recognized as a major public health problem in the world and in particular in the Democratic Republic of Congo, which directly contributes to the increase in mortality and morbidity in this already fragile population. The Democratic Republic of Congo is a country plagued by repeated conflicts between different local armed groups and instability in the management of political affairs. There is a high prevalence of malnutrition in the eastern provinces of the country. Although it is a major public health problem, the inadequacy of the system in question plays an important role in the inequality of access to health care and therefore in the lack of growth monitoring of very young children under 5 years old. The rate of malnourished children has been observed in the country. Malnutrition in these children causes several alterations such as delayed physical and motor growth, a decrease in immune defenses which considerably increases the mortality rate and a decrease in cognitive and learning abilities. Malnutrition remains a serious public health problem in low-income countries and is reflected in various statistics from the World Health Organization. Children are more at risk of being at nutritional risk or suffering from malnutrition. This narrative review summarizes current data on the prevalence and determinants of malnutrition in children, including the difficulty of providing children with a consistent food intake due to mass displacement from conflict areas, the inability of nutritional centers to care of patients admitted for malnutrition due to lack of equipment and the many epidemics the country has had to deal with which have severely handicapped the already unstable health system.

Epidemiological Comparison of Four COVID-19 Waves in the Democratic Republic of the Congo, March 2020-January 2022.

PURPOSE: Nationwide analyses are required to optimise and tailor activities to control future COVID-19 waves of resurgence continent-wide. We compared epidemiological and clinical outcomes of the four COVID-19 waves in the Democratic Republic of Congo (DRC). METHODS: This retrospective descriptive epidemiological analysis included data from the national line list of confirmed COVID-19 cases in all provinces for all waves between 9 March 2020 and 2 January 2022. Descriptive statistical measures (frequencies, percentages, case fatality rates [CFR], test positivity rates [TPR], and characteristics) were compared using chi-squared or the Fisher-Irwin test. RESULTS: During the study period, 72,108/445,084 (16.2%) tests were positive, with 9,641/56,637 (17.0%), 16,643/66,560 (25.0%), 24,172/157,945 (15.3%), and 21,652/163,942 (13.2%) cases during the first, second, third, and fourth waves, respectively. TPR significantly decreased from 17.0% in the first wave to 13.2% in the fourth wave as did infection of frontline health workers (5.2% vs. 0.9%). CFR decreased from 5.1 to 0.9% from the first to fourth wave. No sex- or age-related differences in distributions across different waves were observed. The majority of cases were asymptomatic in the first (73.1%) and second (86.6%) waves, in contrast to that in the third (11.1%) and fourth (31.3%) waves. CONCLUSION: Despite fewer reported cases, the primary waves (first and second) of the COVID-19 pandemic in the DRC were more severe than the third and fourth waves, with each wave being associated with a new SARS-CoV-2 variant. Tailored public health and social measures, and resurgence monitoring are needed to control future waves of COVID-19.

Influence of the level of education on women's knowledge, attitude, and practices to control the transmission of COVID-19 in the Democratic Republic of the Congo.

Adequate knowledge, attitude, and practices (KAP) towards the novel coronavirus (COVID-19) can reduce its spread and may also be useful in preventing and controlling the transmission of severe acute respiratory syndrome coronavirus 2 (ARS-CoV-2) in the community. This study examines the influence of women's education level on COVID-19 KAP behaviour in the Democratic Republic of the Congo (DRC). This study uses COVID-19 data obtained from the Performance Monitoring for Action (PMA) in Kinshasa, the DRC's capital city. Data were collected through telephone interviews held in June 2020 with a representative sample of 1773 women aged 15-49 years. Data were then analysed using multiple probit regression and marginal effects techniques. To address possible sample selection bias due to the use of a telephone to recruit participants, the data were adjusted to account for the selectivity due to telephone number ownership through inverse probability weighting. In general, the results of this study indicate no statistically significant difference in the influence of the level of education on women's KAP to control the transmission of COVID-19 in the DRC, women with higher levels of education are not found to always exhibit improved knowledge, attitude, or practices of appropriate strategies for the prevention and control of COVID-19 in the DRC. The results also indicate that education can have both positive and negative influences in alleviating the burden of COVID-19.

Ebola virus disease outbreak in the Democratic Republic of the Congo: A mini-review.

Ebola virus disease is one of the most serious and deadliest infectious diseases in the world with a sufficient number of recorded deaths. Since its discovery in 1976 until its last epidemic (14th), recorded and declared on April 23, 2022 by the National Minister of Public Health of the Democratic Republic of Congo and we have observed a succession of simultaneous epidemics of the disease to Ebola virus. This disease escapes the control of the health system of the Democratic Republic of the Congo, a health system which is already destabilized by the corona virus disease 2019 pandemic. Since the World Health Organization has already classified the Ebola virus disease as a major public health problem at the global level, this epidemic remains an important issue to consider the possible and necessary means at all levels (political as well as health) to put an end to this disease. Despite the seriousness of this disease, the dangers, clinical manifestations and modes of transmission of which are well understood by healthcare personnel. The Congolese population should be informed of the risks of this Ebola virus disease. The World Health Organization, the disease control center in collaboration with the Congolese government are implementing preventive and curative measures to slow the progression of this disease in the affected areas and prevent the areas still spared from being affected. In this present work, we will talk about some characteristics of the Ebola virus disease and show the different efforts and recommendations to be taken to end this disease.

Effect of Recombinant Vesicular Stomatitis Virus-Zaire Ebola Virus Vaccination on Ebola Virus Disease Illness and Death, Democratic Republic of the Congo.

We conducted a retrospective cohort study to assess the effect vaccination with the live-attenuated recombinant vesicular stomatitis virus-Zaire Ebola virus vaccine had on deaths among patients who had laboratory-confirmed Ebola virus disease (EVD). We included EVD-positive patients coming to an Ebola Treatment Center in eastern Democratic Republic of the Congo during 2018-2020. Overall, 25% of patients vaccinated before symptom onset died compared with 63% of unvaccinated patients. Vaccinated patients reported fewer EVD-associated symptoms, had reduced time to clearance of viral load, and had reduced length of stay at the Ebola Treatment Center. After controlling for confounders, vaccination was strongly associated with decreased deaths. Reduction in deaths was not affected by timing of vaccination before or after EVD exposure. These findings support use of preexposure and postexposure recombinant vesicular stomatitis virus-Zaire Ebola virus vaccine as an intervention associated with improved death rates, illness, and recovery time among patients with EVD.

Health system resilience during COVID-19 understanding SRH service adaptation in North Kivu.

BACKGROUND: There is often collateral damage to health systems during epidemics, affecting women and girls the most, with reduced access to non-outbreak related services, particularly in humanitarian settings. This rapid case study examines sexual and reproductive health (SRH) services in the Democratic Republic of the Congo when the COVID-19 hit, towards the end of an Ebola Virus Disease (EVD) outbreak, and in a context of protracted insecurity. METHODS: This study draws on quantitative analysis of routine data from four health zones, a document review of policies and protocols, and 13 key-informant interviews with staff from the Ministry of Public Health, United Nations agencies, international and national non-governmental organizations, and civil society organizations. RESULTS: Utilization of SRH services decreased initially but recovered by August 2020. Significant fluctuations remained across areas, due to the end of free care once Ebola funding ceased, insecurity, number of COVID-19 cases, and funding levels. The response to COVID-19 was top-down, focused on infection and prevention control measures, with a lack of funding, technical expertise and overall momentum that characterized the EVD response. Communities and civil society did not play an active role for the planning of the COVID-19 response. While health zone and facility staff showed resilience, developing adaptations to maintain SRH provision, these adaptations were short-lived and inconsistent without external support and funding. CONCLUSION: The EVD outbreak was an opportunity for health system strengthening that was not sustained during COVID-19. This had consequences for access to SRH services, with limited-resources available and deprioritization of SRH.

Women and girls often face increased challenges to accessing healthcare during epidemics on top of pre-existing health disparities. There is emerging evidence that COVID-19 has had negative impacts on the health of women and girls in sub-Saharan Africa due to diverted funding, reduced services, negative socioeconomic impacts, and increased or new barriers to access. In the DRC, COVID-19 hit shortly after the end of an Ebola epidemic within a context of protracted insecurity. This study used mixed methods and drew upon 13 interviews to examine the effects of COVID-19 on SRH services in North Kivu and how the health system did or did not adapt to ensure continued access and utilization of SRH services. There was limited prioritization of SRH during COVID-19. Although the government issued policies on how to adapt SRH services, these were developed centrally, without much guidance on how to operationalize these policies in different contexts. Consequently, healthcare providers and civil society actors developed their own ways to continue activities at local levels, not necessarily in a systematic way. There was limited longer-term strengthening of the health system that could adapt to the subsequent COVID-19 pandemic aside from increased capacity of healthcare providers to manage infection prevention and control measures. However, this was hampered by the lack of personal protective equipment that received no external support. Therefore, donors need to consider how resources can be leveraged to support sustained strengthening of the health system to be able to adapt to shocks even when resources are limited.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo.

BACKGROUND: Associated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo. METHODS: Surveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes. RESULTS: Prevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distressT1= 57.04%, Mental distressT2= 40.29%, x2= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001). CONCLUSIONS: Although a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

Turning mobile big data insights into public health responses in times of pandemics: Lessons learnt from the Democratic Republic of the Congo

In low-income countries like the Democratic Republic of the Congo (DRC)—where data is scarce and national statistics offices often under-resourced—aggregated and anonymised mobile operators’ data can provide vital insights for decision-makers to promptly respond to both prevailing and new pandemics, such as COVID-19. Yet, while research on possible applications of mobile big data (MBD) analytics for COVID-19 is growing, there is still little evidence on how such use cases are actually being adopted by governmental authorities and how MBD insights can effectively be turned into informed public health actions in times of crises. This four-part commentary paper aims to bridge such literature gaps, by sharing lessons learnt from the DRC, whereby Congolese public health authorities, through a steep learning curve, have initiated a public–private sector dialogue with local mobile network operators (MNOs) and their ecosystem partners to leverage population mobility insights for COVID-19 policy-making. After having set the scene on the policy relevance of MBD analytics in the context of the DRC in the first section, the paper will then detail four key enablers that contributed, since March 2020, to accelerate Congolese authorities’ uptake of MBD, thus effectively increasing preparedness for future pandemics. Thirdly, we showcase concreate use-cases where “readiness-to-use” has actually translated into actual “usage” and “adoption” for decision-making, while introducing other use cases currently under development. Finally, we explore challenges when harnessing telco big data for decision-making with the ultimate aim to share lessons to replicate the successes and steer the development of MBD for social good in other low-income countries.

Containing COVID-19 in the Democratic Republic of the Congo: Government Measures and Women's Compliance

This article concerns the unfolding COVID-19 pandemic in the Democratic Republic of the Congo. It analyses the sanitary measures that the government has taken to respond to the pandemic since March 2020, the way these measures are enforced, and the extent to which women comply with the measures. The article draws from desk research and empirical data from the eastern city of Bukavu, where the research team conducted 134 structured interviews. The findings show widespread willingness to comply with some of the main measures because of fear of sanctions, fear of the pandemic and because of trust in the state or church. The article argues that many women hold the state accountable for the success in containing the virus, but also criticize the state for not providing livelihood assistance during the state of emergency. Further research is needed to assess the impact of COVID-19 on state legitimacy.

Crisis responses, opportunity, and public authority during Covid-19's first wave in Uganda, the Democratic Republic of Congo, and South Sudan.

Discussions on African responses to Covid-19 have focused on the state and its international backers. Far less is known about a wider range of public authorities, including chiefs, humanitarians, criminal gangs, and armed groups. This paper investigates how the pandemic provided opportunities for claims to and contests over power in Uganda, the Democratic Republic of the Congo, and South Sudan. Ethnographic research is used to contend that local forms of public authority can be akin to miniature sovereigns, able to interpret dictates, policies, and advice as required. Alongside coping with existing complex protracted emergencies, many try to advance their own agendas and secure benefits. Those they seek to govern, though, do not passively accept the new normal, instead often challenging those in positions of influence. This paper assesses which of these actions and reactions will have lasting effects on local notions of statehood and argues for a public authorities lens in times of crisis.