Analysis of contact tracing data showed contribution of asymptomatic and non-severe infections to the maintenance of SARS-CoV-2 transmission in Senegal.

During the COVID-19 pandemic in Senegal, contact tracing was done to identify transmission clusters, their analysis allowed to understand their dynamics and evolution. In this study, we used information from the surveillance data and phone interviews to construct, represent and analyze COVID-19 transmission clusters from March 2, 2020, to May 31, 2021. In total, 114,040 samples were tested and 2153 transmission clusters identified. A maximum of 7 generations of secondary infections were noted. Clusters had an average of 29.58 members and 7.63 infected among them; their average duration was 27.95 days. Most of the clusters (77.3%) are concentrated in Dakar, capital city of Senegal. The 29 cases identified as super-spreaders, i.e., the indexes that had the most positive contacts, showed few symptoms or were asymptomatic. Deepest transmission clusters are those with the highest percentage of asymptomatic members. The correlation between proportion of asymptomatic and degree of transmission clusters showed that asymptomatic strongly contributed to the continuity of transmission within clusters. During this pandemic, all the efforts towards epidemiological investigations, active case-contact detection, allowed to identify in a short delay growing clusters and help response teams to mitigate the spread of the disease.

Unintended consequences of implementing non-pharmaceutical interventions for the COVID-19 response in Africa: experiences from DRC, Nigeria, Senegal, and Uganda.

INTRODUCTION: The coronavirus (COVID 19) pandemic is one of the most terrifying disasters of the twenty-first century. The non-pharmaceutical interventions (NPIs) implemented to control the spread of the disease had numerous positive consequences. However, there were also unintended consequences-positively or negatively related to the nature of the interventions, the target, the level and duration of implementation. This article describes the unintended economic, Psychosocial and environmental consequences of NPIs in four African countries. METHODS: We conducted a mixed-methods study in the Democratic Republic of Congo (DRC), Nigeria, Senegal and Uganda. A comprehensive conceptual framework, supported by a clear theory of change was adopted to encompass both systemic and non-systemic interventions. The data collection approaches included: (i) review of literature; (ii) analysis of secondary data for selected indicators; and (ii) key informant interviews with policy makers, civil society, local leaders, and law enforcement staff. The results were synthesized around thematic areas. RESULTS: Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. CONCLUSION: Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children. Noticeable efforts, including measures to avoid forced into marriage, increasing inequities, economic support to urban poor; those living with disabilities, migrant workers, and refugees, had been conducted to mitigate the negative effects of the NIPs.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

Epidemiology of Non-SARS-CoV2 Human Coronaviruses (HCoVs) in People Presenting with Influenza-like Illness (ILI) or Severe Acute Respiratory Infections (SARI) in Senegal from 2012 to 2020.

In addition to emerging coronaviruses (SARS-CoV, MERS, SARS-CoV-2), there are seasonal human coronaviruses (HCoVs): HCoV-OC43, HCoV-229E, HCoV-NL63 and HCoV-HKU1. With a wide distribution around the world, HCoVs are usually associated with mild respiratory disease. In the elderly, young children and immunocompromised patients, more severe or even fatal respiratory infections may be observed. In Africa, data on seasonal HCoV are scarce. This retrospective study investigated the epidemiology and genetic diversity of seasonal HCoVs during nine consecutive years of influenza-like illness surveillance in Senegal. Nasopharyngeal swabs were collected from ILI outpatients or from SARI hospitalized patients. HCoVs were diagnosed by qRT-PCR and the positive samples were selected for molecular characterization. Among 9337 samples tested for HCoV, 406 (4.3%) were positive: 235 (57.9%) OC43, 102 (25.1%) NL63, 58 (14.3%) 229E and 17 (4.2%) HKU1. The four types circulated during the study period and a peak was noted between November and January. Children under five were the most affected. Co-infections were observed between HCoV types (1.2%) or with other viruses (76.1%). Genetically, HCoVs types showed diversity. The results highlighted that the impact of HCoVs must be taken into account in public health; monitoring them is therefore particularly necessary both in the most sensitive populations and in animals.

Acceptability of contact management and care of simple cases of COVID-19 at home: a cross-sectional study in Senegal.

BACKGROUND: COVID-19 is a major public health problem. In mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The objective of the study was to determine the acceptability of contact and simple case management of COVID-19 at home and its associated factors in Senegal. METHODS: This was a descriptive and analytical cross-sectional study. We collected data from 11 June to 10 July 2020. We used a marginal quota sampling strategy. A total of 813 individuals took part in the survey. We collected data using a telephone interview. RESULTS: The care of simple cases of COVID-19 at home was well accepted (78.5%). The use of home contact management was less accepted (51.4%). Knowledge of the modes of transmission of the virus and confidence in institutional information were associated with the acceptability of home care for simple cases. Regularly searching for information on COVID-19 and confidence in the government's control of the epidemic were associated with the acceptability of managing contacts at home. CONCLUSIONS: Authorities should take these factors into account for better communication to improve the acceptability and confidence in home-based care for COVID-19 and future epidemics.

Time trends in infectious and chronic disease consultations in Dakar, Senegal: Impact of COVID-19 sanitary measures.

Background: The impact of COVID-19 sanitary measures on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. Methods: We conducted a cohort study on all emergency medical consultations from January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese or Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification ("infectious", "chronic", and "other"). We first investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Then, we examined any potential racial/ethnic disparities in COVID-19 consultation. Results: We obtained data on emergency medical consultations from 53 583 patients of all ethnic origins. The mean age of patients was 37.0 (standard deviation (SD) = 25.2) and 30.3 (SD = 21.7) in 2016-2019 and 45.5 (SD = 24.7) and 39.5 (SD = 23.3) in 2020 for Senegalese and Caucasian patients, respectively. The type of consultations between January and July were similar from 2016 to 2019; however, in 2020, there was a drop in the number of infectious disease consultations, particularly from April to May 2020, when sanitary measures for COVID-19 were applied (average of 366.5 and 358.2 in 2016-1019 and 133.0 and 125.0 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381.0 and 394.7 in 2016-2019 and 373.0 and 367.0 in 2020). In a multivariate analysis adjusted for age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (2016 odds ratio (OR) = 2.39, 2017 OR = 2.74, 2018 OR = 2.39, 2019 OR = 2.01). Furthermore, the trend in the number of infectious and chronic consultations was similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. Conclusions: During the implementation of COVID-19 sanitary measures, infectious disease rates dropped as chronic disease rates remained stagnant in Dakar. We observed no racial/ethnic disparities among the infectious and chronic consultations.

[Epidemiology and response strategies against COVID-19: the Senegalese experience from 2020 to 2021]. / Epidémiologie et stratégies de riposte contre la COVID-19: l´expérience sénégalaise de 2020 à 2021.

Introduction: in response to the SARS-CoV-2 pandemic that reached Senegal in March 2020, the country has put in place several strategies to contain its spread. The purpose of this study was to describe the epidemiology and the strategies adopted. Méthods: we conducted a descriptive cross-sectional study of confirmed cases of COVID-19 using RT-PCR test in Senegal from March 2, 2020 to September 30, 2021. Data were collected through a literature review and analyzed with R and QGIS software. Proportions and means with standard deviation were calculated. Results: Senegal has recorded a total of 73,782 confirmed cases and 1,859 deaths from SARS-CoV-2. The temporal evolution was marked by three epidemic waves. The epidemic was concentrated in high-density areas such as Dakar (48,656 cases or 66%), in men (sex-ratio 1:13) and in the age group 25-34 years (16.527 cases or 22.4%). The average age of patients was 43 ± 18 years; the national cumulative incidence was 428 per 100,000 population and the overall case fatality rate was 2.5% (1,859/73,782). Some strategies have been implemented, including staff training, restrictive measures, home-based case management and vaccination. Nine point two percent (840,154/9,128,453) of the target population received 2 doses of vaccine. Conclusion: the epidemic was spread more widely within some population groups. We recommend strengthening preventive measures in high-density cities and mobilizing community networks to encourage immunization.

Spread and seasonality of COVID-19 pandemic confirmed cases in sub-Saharan Africa: experience from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BACKGROUND: The COVID-19 pandemic has impacted the world negatively with huge health and socioeconomic consequences. This study estimated the seasonality, trajectory, and projection of COVID-19 cases to understand the dynamics of the disease spread and inform response interventions. METHOD: Descriptive analysis of daily confirmed COVID-19 cases from January 2020 to 12th March 2022 was conducted in four purposefully selected sub-Saharan African countries (Nigeria, Democratic Republic of Congo (DRC), Senegal, and Uganda). We extrapolated the COVID-19 data from (2020 to 2022) to 2023 using a trigonometric time series model. A decomposition time series method was used to examine the seasonality in the data. RESULTS: Nigeria had the highest rate of spread (ß) of COVID-19 (ß = 381.2) while DRC had the least rate (ß = 119.4). DRC, Uganda, and Senegal had a similar pattern of COVID-19 spread from the onset through December 2020. The average doubling time in COVID-19 case count was highest in Uganda (148 days) and least in Nigeria (83 days). A seasonal variation was found in the COVID-19 data for all four countries but the timing of the cases showed some variations across countries. More cases are expected in the 1st (January-March) and 3rd (July-September) quarters of the year in Nigeria and Senegal, and in the 2nd (April-June) and 3rd (October-December) quarters in DRC and Uganda. CONCLUSION: Our findings show a seasonality that may warrant consideration for COVID-19 periodic interventions in the peak seasons in the preparedness and response strategies.

Factors associated with COVID-19 vaccine hesitancy in Senegal: A mixed study.

This study was an explanatory, sequential, mixed-methods design conducted in Senegal. We collected quantitative data from December 24, 2020, to January 16, 2021, and qualitative data from February 19 to March 30, 2021. We conducted a telephone survey among a marginal quota sample of 607 people over 18 years old. We performed descriptive, bivariate, and multivariate analyses with R software for the quantitative phase; and performed manual content analyses for the qualitative phase. We surveyed 607 people for the quantitative phase and interviewed 30 people for the qualitative phase. Individuals who hesitated or refused to be vaccinated represented 12.9% and 32.8%, respectively. Vaccine hesitancy was related to gender, living in large cities, having a poor attitude toward the vaccine, thinking that the vaccine would not help protect them from the virus, being influenced by people important to them, and lacking information from health professionals. Vaccine refusal was related to living in large cities, having a poor attitude toward the vaccine, thinking that the vaccine would not help protect them from the virus, thinking that the vaccine could endanger their health, trusting opinions of people who were important to them, and lacking information from health professionals. The results of the study show that the factors associated with COVID-19 vaccine hesitancy and refusal are diverse and complex. Addressing these factors will help to ensure better vaccination coverage. Governments and health authorities should intensify their efforts to promote vaccine confidence and reduce misinformation.

Linear epitope mapping of the humoral response against SARS-CoV-2 in two independent African cohorts.

Profiling of the antibody responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) proteins in African populations is scarce. Here, we performed a detailed IgM and IgG epitope mapping study against 487 peptides covering SARS-CoV-2 wild-type structural proteins. A panel of 41 pre-pandemic and 82 COVID-19 RT-PCR confirmed sera from Madagascar and Senegal were used. We found that the main 36 immunodominant linear epitopes identified were (i) similar in both countries, (ii) distributed mainly in the Spike and the Nucleocapsid proteins, (iii) located outside the RBD and NTD regions where most of the reported SARS-CoV-2 variant mutations occur, and (iv) identical to those reported in European, North American, and Asian studies. Within the severe group, antibody levels were inversely correlated with the viral load. This first antibody epitope mapping study performed in patients from two African countries may be helpful to guide rational peptide-based diagnostic assays or vaccine development.

The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal.

BACKGROUND: In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers. METHODS: This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews. RESULTS: The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes. CONCLUSION: Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.

First wave COVID-19 pandemic in Senegal: Epidemiological and clinical characteristics.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has spread from China to the rest of the world. Africa seems less impacted with lower number of cases and deaths than other continents. Senegal recorded its first case on March 2, 2020. We present here data collected from March 2 to October 31, 2020 in Senegal. METHODS: Socio-demographic, epidemiological, clinical and virological information were collected on suspected cases. To determine factors associated with diagnosed infection, symptomatic disease and death, multivariable binary logistic regression and log binomial models were used. Epidemiological parameters such as the reproduction number and growth rate were estimated. RESULTS: 67,608 suspected cases were tested by the IPD laboratories (13,031 positive and 54,577 negative). All age categories were associated with SARS-CoV-2 infection, but also patients having diabetes or hypertension or other cardiovascular diseases. With diagnosed infection, patients over 65 years and those with hypertension and cardiovascular disease and diabetes were highly associated with death. Patients with co-morbidities were associated with symptomatic disease, but only the under 15 years were not associated with. Among infected, 27.67% were asymptomatic (40.9% when contacts were systematically tested; 12.11% when only symptomatic or high-risk contacts were tested). Less than 15 years-old were mostly asymptomatic (63.2%). Dakar accounted for 81.4% of confirmed cases. The estimated mean serial interval was 5.57 (± 5.14) days. The average reproduction number was estimated at 1.161 (95%CI: 1.159-1.162), the growth rate was 0.031 (95%CI: 0.028-0.034) per day. CONCLUSIONS: Our findings indicated that factors associated with symptomatic COVID-19 and death are advanced age (over 65 years-old) and comorbidities such as diabetes and hypertension and cardiovascular disease.

Hepatitis E Virus Seroprevalence and Associated Risk Factors in Pregnant Women Attending Antenatal Consultations in Senegal.

In West Africa, research on the hepatitis E virus (HEV) is barely covered, despite the recorded outbreaks. The low level of access to safe water and adequate sanitation is still one of the main factors of HEV spread in developing countries. HEV infection induces acute or sub-clinical liver diseases with a mortality rate ranging from 0.5 to 4%. The mortality rate is more alarming (15 to 25%) among pregnant women, especially in the last trimester of pregnancy. Herein, we conducted a multicentric socio-demographic and seroepidemiological survey of HEV in Senegal among pregnant women. A consecutive and non-redundant recruitment of participants was carried out over the period of 5 months, from March to July 2021. A total of 1227 consenting participants attending antenatal clinics responded to a standard questionnaire. Plasma samples were collected and tested for anti-HEV IgM and IgG by using the WANTAI HEV-IgM and IgG ELISA assay. The overall HEV seroprevalence was 7.8% (n = 96), with 0.5% (n = 6) and 7.4% (n = 91) for HEV IgM and HEV IgG, respectively. One of the participant samples was IgM/IgG-positive, while four were declared indeterminate to anti-HEV IgM as per the manufacturer's instructions. From one locality to another, the seroprevalence of HEV antibodies varied from 0 to 1% for HEV IgM and from 1.5 to 10.5% for HEV IgG. The data also showed that seroprevalence varied significantly by marital status (p < 0.0001), by the regularity of income (p = 0.0043), and by access to sanitation services (p = 0.0006). These data could serve as a basis to setup national prevention strategies focused on socio-cultural, environmental, and behavioral aspects for a better management of HEV infection in Senegal.

Cross-reactive immunity against SARS-CoV-2 N protein in Central and West Africa precedes the COVID-19 pandemic.

Early predictions forecasted large numbers of severe acute respiratory syndrome coronavirus (SARS-CoV-2) cases and associated deaths in Africa. To date, Africa has been relatively spared. Various hypotheses were postulated to explain the lower than anticipated impact on public health in Africa. However, the contribution of pre-existing immunity is yet to be investigated. In this study, the presence of antibodies against SARS-CoV-2 spike (S) and nucleocapsid (N) proteins in pre-pandemic samples from Africa, Europe, South and North America was examined by ELISA. The protective efficacy of N specific antibodies isolated from Central African donors was tested by in vitro neutralization and in a mouse model of SARS-CoV-2 infection. Antibodies against SARS-CoV-2 S and N proteins were rare in all populations except in Gabon and Senegal where N specific antibodies were prevalent. However, these antibodies failed to neutralize the virus either in vitro or in vivo. Overall, this study indicates that cross-reactive immunity against SARS-CoV-2 N protein was present in Africa prior to the pandemic. However, this pre-existing humoral immunity does not impact viral fitness in rodents suggesting that other human immune defense mechanisms could be involved. In Africa, seroprevalence studies using the N protein are over-estimating SARS-CoV-2 circulation.

A community edutainment intervention for gender-based violence, sexual and reproductive health, and maternal and child health in rural Senegal: a process evaluation.

BACKGROUND: Edutainment aims to spread educational messages in an entertaining way, and often reaches large audiences. While studies increasingly report the impacts of edutainment interventions, there is limited context-specific evidence on the underlying processes and barriers to effective delivery, especially in rural areas. This article presents results from a process evaluation of a community-based edutainment intervention designed to improve knowledge, attitudes, and practices on gender-based violence (GBV), sexual and reproductive health (SRH), and maternal and child health. The intervention focused on the television series, C'est la Vie!, screened through biweekly film clubs in rural Senegal and included post-screening discussions and thematic workshops, meant to reinforce messages, increase knowledge, and change social norms. The objectives of this study were to assess intervention adaptation, implementation fidelity, participants' responsiveness or engagement, and series appropriateness. METHODS: The intervention was implemented from December 2019 to March 2020 in 120 villages in Kaolack and Kolda regions of Senegal, and targeted adolescent girls and young women aged 14 to 34. The process evaluation was carried out in March 2020 in 14 villages using: i) individual semi-structured interviews with implementers (n = 3), village chiefs (n = 8), married women (n = 9), adolescent girls (n = 8), and men (n = 8); ii) focus groups with men (n = 7, 29 participants) and women (n = 10, 100 participants); and iii) observations of screening sessions (n = 4) and post-screening discussions (n = 2). Data were analyzed using thematic and content analysis. RESULTS: The results highlight that adaptation of the intervention helped reach the target population and improved participant attendance, but might have compromised fidelity to original design, as intervention components were shortened and modified for rural delivery and some facilitators made ad hoc modifications. The screenings coverage and frequency were adequate; however, their duration was shortened due to COVID-19 restrictions in Senegal. Participant responsiveness was excellent, as was the series appropriateness for most topics, including GBV. SRH remains a sensitive topic for youth, especially when the film clubs included non-peers, such as slightly older women. CONCLUSIONS: This study showed that using film clubs to deliver sensitive edutainment content in rural areas is feasible and has potential for scale-up.

Connaissances, attitudes et pratiques de la population de la région de Dakar sur la COVID-19.

INTRODUCTION: Faced with the increase in confirmed cases of COVID-19 in Senegal, particularly in the region of Dakar, epicenter of the disease, it is necessary to study the knowledge, attitudes and practices of the populations of the West and South districts on COVID-19. METHODS: A cross-sectional and analytical study was conducted from May 9 to 30, 2020. A four-stage cluster survey was carried out at the level of the West and South districts. Univariate and multivariate analyzes were carried out using R 3.4.4 software. RESULTS: In total, 400 people were surveyed. The mean age of those surveyed was 40.2 ± 14.7 years and extremes of 18 and 82 years. The male sex predominated in 66.5% of cases. People had good knowledge of the signs, transmission risks and prevention measures respectively in 4.7%; 3% and 47.8%. In total, 74% of the people surveyed respected the concept of "stay at home". Wearing a mask and systematic hand washing with soap and water were noted among the people surveyed in 53.6% and 34.8% of cases, respectively. People who had good knowledge of preventive measures against COVID-19 wore the mask more (ORaj = 2.1 [1.2-3.5]) and washed their hands more with soap and water (ORaj = 1.9 [1.1-3.4]). CONCLUSION: For an effective fight against this epidemic, it is important to strengthen risk communication with full community participation. This strategy must be coupled with actions aimed at making prevention means available to the benefit of the entire population.

[Ensuring continuity of care at the time of COVID-19: challenges for the Dakar Integrated Support Center for Addictions]. / Assurer la continuité des soins au temps de la COVID-19 : défis pour le centre de traitement des addictions à Dakar.

The COVID-19 pandemic has an impact on health systems, whose modes of adaptation and response on the ground are still poorly documented and are evolving. The Dakar Integrated Support Center for Addictions (CEPIAD) has been implementing risk reduction since 2014, particularly with drug users. The COVID-19 pandemic and related public health measures were an obstacle to its attendance by patients, in particular due to movement restriction. In addition to the implementation of individual and collective preventive measures in the center, CEPIAD has experimented "take-home" for methadon that is generally provided daily through directly observed treatment. The center has also taken care of amnestied incarcerated cannabis users. Several aspects of this experience, perceived positively, could be relevant outside the pandemic context.

Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda.

BACKGROUND: Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. METHODS: This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. RESULTS: Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. CONCLUSIONS: The private sector contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks for sustainable public-private engagements including regulation of pricing, quality assurance and alignment with national plans and priorities during response to epidemics.

Cross-sectional study of COVID-19 knowledge, beliefs and prevention behaviours among adults in Senegal.

OBJECTIVES: The aim of the study was to explore COVID-19 beliefs and prevention behaviours in a francophone West African nation, Senegal. DESIGN: This was a cross-sectional analysis of survey data collected via a multimodal observational study. PARTICIPANTS: Senegalese adults aged 18 years or older (n=1452). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were COVID-19 prevention behaviours. Secondary outcome measures included COVID-19 knowledge and beliefs. Univariate, bivariate and multivariate statistics were generated to describe the sample and explore potential correlations. SETTING: Participants from Senegal were recruited online and telephonically between June and August 2020. RESULTS: Mask wearing, hand washing and use of hand sanitiser were most frequently reported. Social distancing and staying at home were also reported although to a lower degree. Knowledge and perceived risk of COVID-19 were very high in general, but risk was a stronger and more influential predictor of COVID-19 prevention behaviours. Men, compared with women, had lower odds (adjusted OR (aOR)=0.59, 95% CI 0.46 to 0.75, p<0.001) of reporting prevention behaviours. Rural residents (vs urban; aOR=1.49, 95% CI 1.12 to 1.98, p=0.001) and participants with at least a high school education (vs less than high school education; aOR=1.33, 95% CI 1.01 to 1.76, p=0.006) were more likely to report COVID-19 prevention behaviours. CONCLUSIONS: In Senegal, we observed high compliance with recommended COVID-19 prevention behaviours among our sample of respondents, in particular for masking and personal hygiene practice. We also identified a range of psychosocial and demographic predictors for COVID-19 prevention behaviours such as knowledge and perceived risk. Stakeholders and decision makers in Senegal and across Africa can use place-based evidence like ours to address COVID-19 risk factors and intervene effectively with policies and programming. Use of both phone and online surveys enhances representation and study generalisability and should be considered in future research with hard-to-reach populations.