Subregional origins of emerging SARS-CoV-2 variants during the second pandemic wave in Côte d'Ivoire.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with increased transmissibility, virulence and immune escape abilities have heavily altered the COVID-19 pandemic's course. Deciphering local and global transmission patterns of those variants is thus key in building a profound understanding of the virus' spread around the globe. In the present study, we investigate SARS-CoV-2 variant epidemiology in Côte d'Ivoire, Western sub-Saharan Africa. We therefore generated 234 full SARS-CoV-2 genomes stemming from Central and Northern Côte d'Ivoire. Covering the first and second pandemic wave the country had been facing, we identified 20 viral lineages and showed that in Côte d'Ivoire the second pandemic wave in 2021 was driven by the spread of the Alpha (B.1.1.7) and Eta (B.1.525) variant. Our analyses are consistent with a limited number of international introductions of Alpha and Eta into Côte d'Ivoire, and those introduction events mostly stemmed from within the West African subregion. This suggests that subregional travel to Côte d'Ivoire had more impact on local pandemic waves than direct intercontinental travel.

Panel data evidence on the effects of the COVID-19 pandemic on livelihoods in urban Côte d'Ivoire.

In early March 2020, a few cases of COVID-19 were diagnosed in Abidjan, the capital city of Côte d'Ivoire. To combat the spread of the disease, large restrictions to mobility and gatherings were introduced between mid-March and late May 2020. We collected panel survey data on over 2,500 individuals from poorer neighborhoods of the Greater Abidjan area over the period immediately before and after the start of the pandemic. We document striking drops in employment, hours worked, income, and food consumption in the first months after the onset of COVID-19, when lockdown was in place. We also find that, in response, survey respondents received more private transfers from other parts of the country, at a time when remittances from abroad fell-and that some respondents moved either temporarily or permanently. In terms of recovery, we find that subjective well-being was lower on average in December 2020 than it was at baseline. Yet, despite schools being closed between mid-March and July 2020, school enrollment suffered little: by December 2020, enrollment rates had bounced back to their baseline level. Our results finally indicate that government policies aimed at alleviating the worst effects of lockdown only reached a few people, and not necessarily those most in need.

[Evolution of gender-based violence during the emergence of COVID-19 pandemic in Greater Abidjan (March 2020-May 2021)]. / Évolution des violences basées sur le genre lors de l'émergence de la pandémie de COVID-19 dans le Grand Abidjan (Mars 2020-Mai 2021).

In Côte d'Ivoire, a country of 28 million inhabitants in West Africa, a survey conducted by the Ministry of the Family in 2018 showed the extent of gender-based violence (GBV) in the Greater Abidjan area (5 million inhabitants), the country's economic capital. The social workers employed for this work were mobilized during the Covid-19 pandemic to raise awareness and help the population fight against SARS-CoV-2. The results collected by these workers during the first period (January 2019 - February 2020) and the second period (March 2020 - April 2021) are the subject of this article.From the first period to the second, the number of rapes increased from 41 to 77, sexual assaults from 4 to 7, physical assaults from 139 to 171, and forced marriages from 4 to 7. In total, the social workers helped 303 victims during the pre-pandemic period and 402 during the pandemic. This evolution varies from municipality to municipality in the Greater Abidjan area, and is not related to the number of inhabitants per municipality and without any link with the frequency of Covid-19 in each municipality. Despite possible biases, this study highlights a major health problem, GBV, and demonstrates the probable negative effects of the pandemic.

[Covid-19 in Côte d'Ivoire (March 2020 - April 2021) a year under the seal of the Coronavirus]. / La Covid-19 en Côte d'Ivoire (mars 2020 - avril 2021) une année sous le sceau du coronavirus.

After a year of coronavirus epidemic, Côte d'Ivoire is completing a third wave of Covid-19. Although the epidemic has been confined mainly to Greater Abidjan, thanks in particular to the isolation measures imposed on the Ivorian economic capital, the impact of the health crisis has nevertheless been marked. Like other West African countries, Côte d'Ivoire did not experience the epidemic tsunami that some predicted in March 2020, but more than 45 000 cases and nearly 300 deaths have been reported, although these figures underestimate the epidemiological reality. With the advent of vaccination, Côte d'Ivoire hopes to control the epidemic, but the possible circulation of variants, particularly South African variants, and the difficulties in obtaining vaccine doses are challenges that the Ivorian health authorities will have to overcome. The resilience of the population has been significant during this crisis, illustrating the ability of Ivorians to withstand the impact of this crisis.

[Effects of Covid-19 Pandemic on the Vaccine Activities on a Reference Immunization Center in Treichville, Côte D'ivoire]. / Effets de la Pandémie à Covid-19 sur les Activités Vaccinales D'un Centre de Vaccination de Référence de Treichville en Côte D'ivoire.

Introduction: Since March 11, 2020, Côte d'Ivoire has been affected by the coronavirus epidemic, declared that same day as pandemic by WHO. March 11, 2021, one year after the pandemic, Côte d'Ivoire has notified 36,824 cases of Covid-19 patients and among them 211 have died. As of May 31, 2020, Côte d'Ivoire had already notified 2,833 cases and 33 deaths. At that time, false rumors were circulating in Africa about the setting up of clinical trials on candidate vaccines. The impact of these rumors on the overall use of health services had to be measured and in particular on vaccination centers. Objectives: The objective of this study was to determine the effects of the pandemic on the activities of the immunization services of the National Institute of Public Hygiene in Abidjan, which comprises four departments: International Vaccination Center, Community Vaccination Service, Rabies Center, and Vaccination Unit of the Expanded Program on Immunization. The study was based on activity reports of the immunization services. Results: At the International Vaccination Center, activities fell by about 50% in March, 86% in April and 82% in May in comparison with 2018 and 2019. Activities of Community Vaccination Service decreased by about 26% in March and 99% in April and May. At the Rabies Control Center, this reduction was estimated at 38% in April and 45% in May. The highest losses were for yellow fever and meningitis vaccines. Conclusion: The drop in attendance at vaccination services could increase the risk of epidemics, especially yellow fever, which are recurrent in Abidjan. Intensive awareness and catch-up actions should be carried out and further studies performed to assess the impact of the pandemic on immunization activities.

Health Risk Assessment of Heavy Metals (Pb, Cd, Hg) in Hydroalcoholic Gels of Abidjan, Côte d'Ivoire.

Despite the high consumption of hydroalcoholic gels worldwide and particularly in Côte d'Ivoire since the outbreak of the COVID-19 pandemic, very few studies have measured the heavy metal content and human exposure in this product. Thus, 30 samples from supermarkets in Abidjan, Côte d'Ivoire, were collected for the study of risk assessment of exposure to heavy metals contained in hydroalcoholic gels. This study consists of the characterization of the danger by calculating the carcinogenic and non-carcinogenic risk by skin contact. Almost all samples analysed contain trace of lead, cadmium and mercury but at concentrations below the Canadian limit in cosmetic products applied to the skin and below the US FDA limit as an impurity in colour additives used in cosmetic products. The mean values of chronic daily intake via dermal absorption (CDIdermal) for adults were found in the order of mercury > lead > cadmium. The health risk estimation indicated that the mean total hazard quotient for dermal adsorption (HIdermal) obtained is 7.10 × 10-5 ± 5.52 × 10-5. This value was below 1, the acceptable limit, representing a non-carcinogenic risk for Abidjan residents through dermal adsorption. Moreover, the incremental lifetime cancer risk (ILCR) evaluation for lead and cadmium was insignificant, and the cancer risk can be neglected, but in case of their overusing, they can cause long-term health problems for consumers.

Effectiveness and sustainability of the WHO multimodal hand hygiene improvement strategy in the University Hospital Bouaké, Republic of Côte d'Ivoire in the context of the COVID-19 pandemic.

INTRODUCTION: The most frequent adverse events in healthcare are healthcare-associated infections, whose burden is highest in resource-limited settings. In addition, low resource settings often lack Hand Hygiene (HH) knowledge and reliable supply to disinfectant, a necessity emphasized by the past West African Ebola Epidemic and the ongoing COVID-19 pandemic. PASQUALE aims to increase patient safety by introducing the WHO multimodal HH strategy in the University Hospital Bouaké, Côte d'Ivoire. METHODS: Assessment of HH knowledge, perception and compliance was performed 12 months before, right after the intervention and at a ten months interval using questionnaires for knowledge and perception and direct observation for compliance. The intervention consisted of a HH training and the introduction of local production of alcohol-based hand-rub. In the absence of a control group, the effectiveness of the intervention was assessed by a before-and-after study. RESULTS: Baseline knowledge score was 14/25, increased significantly to 17/25 (p < 0.001) upon first and decreased to 13/25 in second follow-up. Compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. Alcohol-based hand-rub production and consumption almost doubled after first confirmed COVID-19 case in Côte d'Ivoire. CONCLUSION: The WHO HH improvement strategy is an effective and pandemic-adaptable method to increase long-term HH compliance. This study emphasizes that the implementation of the strategy to build a robust system is of utmost importance.

Introducing and Implementing HIV Self-Testing in Côte d'Ivoire, Mali, and Senegal: What Can We Learn From ATLAS Project Activity Reports in the Context of the COVID-19 Crisis?

Background: The ATLAS program promotes and implements HIVST in Côte d'Ivoire, Mali, and Senegal. Priority groups include members of key populations-female sex workers (FSW), men having sex with men (MSM), and people who use drugs (PWUD)-and their partners and relatives. HIVST distribution activities, which began in mid-2019, were impacted in early 2020 by the COVID-19 pandemic. Methods: This article, focusing only on outreach activities among key populations, analyzes quantitative, and qualitative program data collected during implementation to examine temporal trends in HIVST distribution and their evolution in the context of the COVID-19 health crisis. Specifically, we investigated the impact on, the adaptation of and the disruption of field activities. Results: In all three countries, the pre-COVID-19 period was marked by a gradual increase in HIVST distribution. The period corresponding to the initial emergency response (March-May 2020) witnessed an important disruption of activities: a total suspension in Senegal, a significant decline in Côte d'Ivoire, and a less pronounced decrease in Mali. Secondary distribution was also negatively impacted. Peer educators showed resilience and adapted by relocating from public to private areas, reducing group sizes, moving night activities to the daytime, increasing the use of social networks, integrating hygiene measures, and promoting assisted HIVST as an alternative to conventional rapid testing. From June 2020 onward, with the routine management of the COVID-19 pandemic, a catch-up phenomenon was observed with the resumption of activities in Senegal, the opening of new distribution sites, a rebound in the number of distributed HIVST kits, a resurgence in larger group activities, and a rebound in the average number of distributed HIVST kits per primary contact. Conclusions: Although imperfect, the program data provide useful information to describe changes in the implementation of HIVST outreach activities over time. The impact of the COVID-19 pandemic on HIVST distribution among key populations was visible in the monthly activity reports. Focus groups and individual interviews allowed us to document the adaptations made by peer educators, with variations across countries and populations. These adaptations demonstrate the resilience and learning capacities of peer educators and key populations.

Costs and Scale-Up Costs of Integrating HIV Self-Testing Into Civil Society Organisation-Led Programmes for Key Populations in Côte d'Ivoire, Senegal, and Mali.

Despite significant progress on the proportion of individuals who know their HIV status in 2020, Côte d'Ivoire (76%), Senegal (78%), and Mali (48%) remain far below, and key populations (KP) including female sex workers (FSW), men who have sex with men (MSM), and people who use drugs (PWUD) are the most vulnerable groups with a HIV prevalence at 5-30%. HIV self-testing (HIVST), a process where a person collects his/her own specimen, performs a test, and interprets the result, was introduced in 2019 as a new testing modality through the ATLAS project coordinated by the international partner organisation Solthis (IPO). We estimate the costs of implementing HIVST through 23 civil society organisations (CSO)-led models for KP in Côte d'Ivoire (N = 7), Senegal (N = 11), and Mali (N = 5). We modelled costs for programme transition (2021) and early scale-up (2022-2023). Between July 2019 and September 2020, a total of 51,028, 14,472, and 34,353 HIVST kits were distributed in Côte d'Ivoire, Senegal, and Mali, respectively. Across countries, 64-80% of HIVST kits were distributed to FSW, 20-31% to MSM, and 5-8% to PWUD. Average costs per HIVST kit distributed were $15 for FSW (Côte d'Ivoire: $13, Senegal: $17, Mali: $16), $23 for MSM (Côte d'Ivoire: $15, Senegal: $27, Mali: $28), and $80 for PWUD (Côte d'Ivoire: $16, Senegal: $144), driven by personnel costs (47-78% of total costs), and HIVST kits costs (2-20%). Average costs at scale-up were $11 for FSW (Côte d'Ivoire: $9, Senegal: $13, Mali: $10), $16 for MSM (Côte d'Ivoire: $9, Senegal: $23, Mali: $17), and $32 for PWUD (Côte d'Ivoire: $14, Senegal: $50). Cost reductions were mainly explained by the spreading of IPO costs over higher HIVST distribution volumes and progressive IPO withdrawal at scale-up. In all countries, CSO-led HIVST kit provision to KP showed relatively high costs during the study period related to the progressive integration of the programme to CSO activities and contextual challenges (COVID-19 pandemic, country safety concerns). In transition to scale-up and integration of the HIVST programme into CSO activities, this model shows large potential for substantial economies of scale. Further research will assess the overall cost-effectiveness of this model.

Knowledge, Attitudes, and Practices (KAP) Regarding the COVID-19 Outbreak in Côte d'Ivoire: Understanding the Non-Compliance of Populations with Non-Pharmaceutical Interventions.

At the beginning of the COVID-19 outbreak, preventive measures seemed the most appropriate method to control its spread. We assessed the knowledge, attitudes, and practices of the Ivorian public regarding preventive measures, conducting a hybrid survey across the country. Participants were invited to complete a questionnaire online, by phone, or face-to-face. Chi-squared, Fisher's exact, and Kruskal-Wallis tests were used to compare the frequency of responses regarding compliance with preventive measures. Data were validated for 564 individuals. Over one-third of respondents believed that COVID-19 was related to non-natural causes. Though the disease was perceived as severe, respondents did not consider it to be highly infectious. Overall, 35.6% of respondents fully trust health officials in the management of the pandemic, and 34.6% trusted them moderately. Individuals who believed COVID-19 was a disease caused by a pathogen and the well-educated were likely to comply with preventive measures. About 70% of respondents stated that their daily expenses had increased due to preventive measures. The study concludes that beyond unfavorable socioeconomic conditions, the level of knowledge regarding COVID-19 and trust in the government/health system are more likely to influence compliance with preventive measures such as self-reporting, physical distancing, the use of face masks, and eventually the acceptability of vaccines.