Knowledge, attitudes, practices, and perception of COVID-19 preventive measures among adult residents of Matadi (Democratic Republic of the Congo) after the third epidemic wave.

Background: Several governments from African countries, including the Democratic Republic of the Congo (DRC), implemented stringent public health measures to curb COVID-19 transmission in the early phases of the pandemic. While these restrictive measures are believed to have contributed to lowering case incidence and related mortality in DRC, data on the population's knowledge and adherence are limited. This study aimed to assess the knowledge, perception, attitudes, and practices of COVID-19 preventive measures and associated factors among adult residents of Matadi, thereby generating evidence for a strategy adjustment as the COVID-19 response is transitioning from emergency to control status. Methods: We used data from a population-based cross-sectional study conducted in October 2021. Consenting participants were enrolled through a multi-stage cluster sampling approach and administered a pre-tested structured questionnaire using a mobile application (Epicollect 5). We analyzed adult participants' data using STATA 15.1. Univariable and multivariable analyses were applied to identify factors associated with good knowledge, good perception, positive attitude and good practice. Results: We included 1,269 adult respondents for the secondary analysis. One respondent in six was female. The median age was 36 years (IQR 24-50). Most respondents (76.5%) had good knowledge. Respondents aged 40-49 years and those with vocational education level were 1.7 time (AOR 1.75, 95% CI 1.07-2.87) and twice as likely (AOR 2.06, 95% CI 1.01-4.21) to have good knowledge. Preventive measures were perceived as efficient by 45% of respondents. Good perception was associated with education level, profession, average household monthly income and good knowledge. Only 40% of respondents had a positive attitude. A positive attitude was associated with age, education level, and good knowledge. Respondents having good practice represented 5.8%. Good practice was associated with good knowledge, attitude and perception. Conclusion: Most respondents were knowledgeable, had a good perception of government-related COVID-19 preventive measures, a moderately positive attitude and an extremely low level of good practice. Current COVID-19 preventive strategies, including vaccination rollout, need adjustment into high-efficiency, context-based and risk group-specific interventions. Evidence generated by this study will improve preparedness and response to future outbreaks.

High Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Prevalence After the Third Epidemic Wave (May-October 2021) in Matadi, Democratic Republic of the Congo.

Background: By the end of the third wave of the coronavirus disease 2019 (COVID-19) epidemic (May-October 2021), only 3130 of the 57 268 confirmed cases of coronavirus disease 2019 (COVID-19) in the Democratic Republic of the Congo (DRC) were reported in Kongo Central. This province, and especially its capital city, Matadi, has essential trade and exchanges with Kinshasa, the epicenter of the COVID-19 epidemic in DRC. Kinshasa accounted for 60.0% of all cases during the same period. The true burden of COVID-19 in Matadi is likely underestimated. In this study, we aimed to determine the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and associated risk factors after the third wave in Matadi. Methods: We conducted a population-based cross-sectional study in October 2021. Consenting participants were interviewed and tested using an enzyme-linked immunosorbent assay commercial kit. We applied univariable and multivariable analysis to evaluate factors associated with seropositivity and adjusted the seroprevalence for the test kit performance. Results: We included 2210 participants from 489 households. Female participants represented 59.1%. The median age was 27 years (interquartile range, 16-45 years). The crude SARS-CoV-2 seroprevalence was 82.3%. Age was identified as the main risk factor as younger age decreased the seropositivity odds. Accounting for clustering at the household level increased the seroprevalence to 83.2%. The seroprevalence increased further to 88.1% (95% confidence interval, 86.2%-90.1%) after correcting for the laboratory test kit performance. Conclusions: The SARS-CoV-2 seroprevalence was very high, contrasting with reported cases. Evidence generated from this population-based survey remains relevant in guiding the local COVID-19 response, especially vaccination strategies.