An in-depth statistical analysis of the COVID-19 pandemic's initial spread in the WHO African region.

During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.

Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study.

BACKGROUND: Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. METHODS: A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. RESULTS: Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. CONCLUSIONS: Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.

Impact of COVID-19 on admission due to diarrhea to the emergency department of the largest specialized Pediatric Hospital, Kinshasa, the Democratic Republic of the Congo: A retrospective analysis

Context and objective. The COVID-19's lockdown effect on pediatric healthcare utilization has been demonstrated. However, little is known about this impact on the burden of diarrheal diseases among children in sub-Saharan Africa. This study aimed at studying the impact of the COVID-19 pandemic on admissions due to diarrhea into the largest specialized Pediatric Hospital in the city of Kinshasa. Methods. A retrospective study was conducted on diarrhea cases admitted into the emergency department of the Kalembe-Lembe Pediatric Hospital between January 1st and July 31st of 2019 and 2020. Variables were compared during the pandemic's lockdown period in 2020 to the equivalent period in 2019. Results. Overall, 422 medical records were examined. A 45% drop in diarrhea cases was observed in the pediatric emergency department between the study periods in 2019 and 2020. Daily admissions were significantly higher in 2019 than in 2020 (p < 0.001). The majority of patients were admitted with moderate dehydration in 2019 than in 2020 (p < 0.001) but an increase in proportion of patients with mild and severe dehydration was observed in 2020 than in 2019 (p < 0.001). The hospitalization rate was significantly higher in 2019 than in 2020 (p < 0.001). Conclusions; The COVID- 19's restrictions led to a substantial decrease in admissions due to diarrhea among children to the pediatric emergency department. Public health interventions are needed to promote an ambulatory healthcare system during future crises.

Contexte et objectif. L'effet de confinement dû à la COVID-19 sur l'utilisation des soins pédiatriques a été démontré sous d'autres cieux. Cependant, on en sait peu concernant cet impact sur le fardeau des maladies diarrhéiques chez les enfants en Afrique subsaharienne. Cette étude visait à rechercher l'impact de la pandémie à COVID-19 sur les admissions dues à la diarrhée dans un hôpital pédiatrique. Méthodes. Etude documentaire des cas de diarrhées recensés, au service des urgences de l'hôpital pédiatrique de Kalembe-Lembe, entre les 1er janvier et 31 juillet 2019 et 2020. Les variables ont été comparées, entre la période du confinement de la pandémie en 2020 et la période équivalente en 2019. Résultats. Au total 442 dossiers médicaux ont été colligés. Une baisse de 45 % d'admissions des cas de diarrhée a été observée, aux urgences pédiatriques pendant le confinement. Les admissions quotidiennes étaient significativement plus élevées en 2019 qu'en 2020 (p <0,001). La majorité des patients ont été admis avec une déshydratation modérée en 2019 qu'en 2020 (p <0,001) mais une augmentation de la proportion de patients avec une déshydratation légère et sévère a été observée en 2020 par rapport à 2019 (p <0,001). Le taux d'hospitalisation était significativement plus élevé en 2019 qu'en 2020 (p <0,001). Conclusion. Les restrictions dues à la COVID-19 ont conduit à une diminution substantielle des admissions dues à la diarrhée chez les enfants aux urgences pédiatriques. Des interventions de santé publique sont nécessaires pour promouvoir un système de santé ambulatoire lors d'une telle crise dans un proche avenir.