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.

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.

[Knowledge, attitudes and practices of the population of Dakar region on the COVID-19]. / 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.

Facteurs associés à l'autonomie de décision des femmes pour leur santé au Sénégal.

INTRODUCTION: In Senegal, the issue of access to maternal, reproductive and sexual health services remains a health priority. Although there have been many health interventions, women’s access to health services remains limited due to women’s limited autonomy in making decisions about their health.Purpose of research: The objective of this study was to study the factors associated with women’s decision-making autonomy in relation to their own health in Senegal in 2017. RESULTS: Six-point twenty-six percent (6.26%) of women were autonomous in making decisions about their health. For 80.33% of women, it was their husband or partner who decided for them.The factors associated with women’s decision-making autonomy were the 20-24 and 45-49 age groups with AOR of 0.28 [0.10-0.77] and 2.99 [1.25-7.17], rural housing environment (AOR = 0.52 [0.34-0.80]), higher women’s level of education (AOR = 4.10 [1.54-10.93]), the level of education of the husband/primary partner (AOR = 1.98 [1.08-3.61]), the marital status of the married woman (AOR = 0.09 [0.02-0.38]) and the fact that the woman is engaged in an income-generating activity (AOR = 3.70 [2.52-5.44]). CONCLUSIONS: This study highlights a low rate of decision-making autonomy among Senegalese women. It also made it possible to identify the factors on which action should be taken to improve women’s decision-making autonomy for their health. These factors include women’s access to education and the promotion of income-generating activities among women.

[Overweight, obesity and associated factors among public secondary school students in Dakar]. / Surpoids, obésité et facteurs associés chez les élèves du 2nd cycle d’enseignement public de Dakar.

These results support outreach activities for students, and the involvement of parents and teachers in strategies focused on food hygiene and sport..

[Determinants of modern contraceptive use in the Mbacké health district (Senegal)]. / Determinants de l'utilisation de la contraception moderne dans le district sanitaire de Mbacké (Séngal).

INTRODUCTION: Contraceptive prevalence is low in Senegal, particularly in the Mbacké health district. The objective of this study was to identify the determinants of use of modern contraception by women of reproductive age in this district. METHODOLOGY: A quantitative and qualitative analytical study was conducted. The quantitative survey was conducted from 1st to 20 July 2011. The study population consisted of women of childbearing age living in the district. A two-stage survey was conducted. Data were entered and bivariate analysis was performed using Epi Info 3.3.5software. Multivariate analysiswas performed by R 2.2.9 software. The adjusted odds ratios were calculatedfor variables with significant p values. The qualitative study was conducted from 25 to 31 July2011. Grouped interviews were used to collect women's perceptions of modern contraception. Content analysis was performed. CONCLUSION: Improving the socio-economic characteristics of women and raising public awareness about modern contraception would contribute to a better use of modern contraceptives in the Mbacké health district.

[Study of determinants of rape in minors in the Kolda region of Senegal]. / Etude des déterminants de viols chez les mineurs dans la région de Kolda au Sénégal.

INTRODUCTION: The objective of this study was to investigate the determinants of rape among minors in the Kolda region. METHODOLOGY: A retrospective, cross-sectional, descriptive and analytical was conducted from 23 December 1992 to 31 December 2011, based on the charts of rape victims under the age of 18 years. Sampling was complete. Bivariate and multivariate analyses were performed using Epi Info 3.3.2 and R 2.9.2 software, respectively. RESULTS: The study included 162 cases of sexual assault. The mean age of victims was 12.3 +/- 3 years (range: 4-17 years). The mean age of perpetrators of sexual assault was 26.4 +/- 9.5 years and minors accounted for 13% of perpetrators. 54.9% of victims, were raped. Victims of sexual assault knew the perpetrator in 66% of cases and were attacked in broad daylight in 53.4% of cases. The perpetrators were drunk at the time of sexual assault in 15.3% of cases. The assault took place in the bush (14.8%). Twenty eight percent (28%) of rapists were jailed and 38.6% of them were jailed for between 5 and 10 years. Sexual assault in the bush [adjusted OR = 3.46 (1.02-11.77)] and intoxication of the perpetrator at the time of sexual assault [adjusted OR = 3.47 (1.04-11.61)] were associated with a high risk of rape. In contrast, victims who knew their assailants were at a lower risk of rape [adjusted OR = 0.09 (0.03 to 0.24)]. CONCLUSION: Extension of this study to the national scale would provide health and judicial authorities with an overview of sexual assault among minors, to allow more effective prevention at the national level.

Sex and COVID-19 vaccination uptake and intention in the Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

The introduction of vaccines marked a game changer in the fight against COVID-19. In sub-Saharan Africa, studies have documented the intention to vaccinate and the uptake of COVID-19 vaccines. However, little is documented about how sex differences could have impacted COVID-19 vaccination. We conducted a multi-country cross-sectional study to assess the sex differences in COVID-19 vaccine uptake and intention to vaccinate in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This study involved analysis of data from mobile surveys conducted between March and June 2022 among nationally constituted samples of adults in each country. Bivariate and multivariable logistic regression models were run. The self-reported uptake of COVID-19 vaccines was not significantly different between males and females (p = 0.47), while the intention to vaccinate was significantly higher among males (p = 0.008). Among males, obtaining COVID-19 information from health workers, testing for COVID-19, and having high trust in the Ministry of Health were associated with higher vaccination uptake. Among females, having high trust in the government was associated with higher vaccination uptake. For intention to vaccinate, males who resided in semi-urban areas and females who resided in rural areas had significantly higher vaccination intention compared to their counterparts in urban areas. Other factors positively associated with vaccination intention among males were trust in the World Health Organization and perceived truthfulness of institutions, while males from households with a higher socio-economic index and those who had declined a vaccine before had a lower vaccine intention. Overall, the factors differentiating vaccine uptake and intention to vaccinate among males and females were mostly related to trust in government institutions, perceived truthfulness of institutions, and respondent's residence. These factors are key in guiding the tailoring of interventions to increase COVID-19 vaccine uptake in sub-Saharan Africa and similar contexts.

[Analysis of free health care for the elderly in the context of the "Plan Sésame" in Senegal]. / Analyse du fonctionnement du plan de prise en charge gratuite des soins chez les personnes âgées "Plan Sesame" au Senegal.

INTRODUCTION: Access to health care remains a major problem in Senegal, particularly among vulnerable groups such as the elderly. In 2006, the Senegalese government introduced a national plan for the provision of free health care known as "Plan Sésame" to improve access to care. The purpose of this study was to examine the current state of the "Plan Sésame" in national hospitals four years after its implementation (2006-2009). METHODS: A qualitative study using individual interviews was conducted between 15 March and 14 May 2010 among five target populations: hospital directors, health care providers, managers of the "Plan Sésame" in hospital admission services, management accountants, and beneficiaries. Content analysis was used. RESULTS: Between 2006 and 2008, hospital attendance rates increased every year. However, attendance rates began to decrease in 2009, except in the main hospital. The state has been left with a growing debt because of issues surrounding the reimbursement of expenses related to the "Plan Sésame'. As a result, national hospitals have been forced to restrict certain services included in the "Plan Sésame" and even to withdraw free health care for the elderly. These difficulties are likely to undermine the sustainability of the "Plan Sésame" CONCLUSION: The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

Consequences of school closures due to COVID-19 in DRC, Nigeria, Senegal, and Uganda.

In 2020 and 2021, Governments across the globe instituted school closures to reduce social interaction and interrupt COVID-19 transmission. We examined the consequences of school closures due to COVID-19 across four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. We conducted a qualitative study among key informants including policymakers, school heads, students, parents, civil society representatives, and local leaders. The assessment of the consequences of school closures was informed by the Diffusion of Innovations theory which informed the interview guide and analysis. Interview transcripts were thematically analysed. Across the four countries, schools were totally closed for 120 weeks and partially closed for 48 weeks. School closures led to: i) Desirable and anticipated consequences: enhanced adoption of online platforms and mass media for learning and increased involvement of parents in their children's education. ii) Desirable and unanticipated consequences: improvement in information, communication, and technology (ICT) infrastructure in schools, development and improvement of computer skills, and created an opportunity to take leave from hectic schedules. iii) Undesirable anticipated consequences: inadequate education continuity among students, an adjustment in academic schedules and programmes, and disrupted student progress and grades. iv) Undesirable unanticipated: increase in sexual violence including engaging in transactional sex, a rise in teenage pregnancy, and school dropouts, demotivation of teachers due to reduced incomes, and reduced school revenues. v) Neutral consequences: engagement in revenue-generating activities, increased access to phones and computers among learners, and promoted less structured learning. The consequences of school closures for COVID-19 control were largely negative with the potential for both short-term and far-reaching longer-term consequences. In future pandemics, careful consideration of the type and duration of education closure measures and examination of their potential consequences in the short and long term is important before deploying them.

[Socio-demographic factors and the treatment of obstetric fistula in southeastern Senegal]. / Facteurs sociodémographiques et prise en charge des fistules obstétricales au Sud-Est du Sénégal.

The objective of this study was to examine the socio-demographic profile and treatment of women suffering from obstetric fistula (OF) in southeastern Senegal. Conducted between August 2007 and January 2008, the study focused on women treated in regional hospitals in Tambacounda and Kolda. The data were collected using questionnaire-based interviews and analyzed using the Epi Info 3.3.1 software package. The patients (mean age of occurrence of OF: 24) were mostly from rural areas (86%), illiterate (89%), and excised (93%). The main cause of the condition cited by the participants was long working hours (42%). The study found that the participants were more likely to have no income-generating activity (84% compared to 22%) and to be divorced (19% compared to 2%) after (as opposed to before) the OF. The study also highlighted the prevalence of psychological disorders (62%), withdrawal (22%), abandonment by friends and/or family (16%) or by the husband (7%), and decreased effectiveness in household chores (4%). The average time between the occurrence of OF and the first consultation was 50.7 (± 55.3) months. The study found that 44% of the participants were waiting for an operation, 35% had undergone unsuccessful surgery, 14% had been treated and cured, 6% had recently undergone surgery, and 1% had suffered a recurrence. Good access to services was found to be necessary for effective treatment, although high-quality obstetric care and increased awareness were identified as the most important factors for the prevention of OF in southeastern Senegal.

[Factors associated with scale-up human papillomavirus (HPV) vaccine in Senegal: a case-control survey of parents]. / Facteurs associés à la vaccination contre le virus du papillome humain dans un contexte de passage à l´échelle au Sénégal: enquête cas-témoins auprès des parents.

INTRODUCTION: after a pilot phase, Senegal is the first country in West Africa to introduce cervical cancer vaccine into its Expanded Program on Immunization. Despite the gratuity and availability of the vaccination, coverage was low. The purpose of this study was to identify factors associated with HPV vaccination coverage in girls . METHODS: we conducted a case-control analytical study from 4th to 20th January 2020 in Dakar. The study population consisted of parents or guardians of girls aged 9 to 10. We performed cluster sampling, direct structured interviews and a literature review. Socio-demographic features, parents/guardians' knowledges and information about vaccination procedure were collected using a standardized questionnaire. Logistic regression was used to estimate the odds ratio. RESULTS: during this study, 510 cases and 510 controls and 1020 parents/guardians were interviewed. Significant factors associated with vaccination of girls were: parents/guardians' education (OR=1,97; [1,81-2,25]), knowledge of the disease (OR=3,05; [2,75-4,53], high household income (OR=1,21; [1,13-1,85]), fear of side effects (OR=0,35;[ 0,27-0,44]), reception of messages via internet/social networks (OR=0,54; [0,41-0,92]) and vaccination schedules for the community (OR= 2,12 [1,59-2,64]). CONCLUSION: vaccination of girls can be improved by strengthening parents' knowledge through appropriate channels and a better organization of health services.

What community-based public health approaches in West Africa for COVID-19 epidemic? A reflection based on the African socio-cultural context.

The social and cultural dimensions of health influence the course of disease and condition the success of health interventions. In Africa, previous epidemics such as Ebola have shown the importance of contextualizing health interventions. This literature review contributes to the reflection on the analysis of community-based interventions in the context of the particularities of West Africa in the fight against the pandemic in COVID-19.

Assessment of General Public's Knowledge and Opinions towards Antibiotic Use and Bacterial Resistance: A Cross-Sectional Study in an Urban Setting, Rufisque, Senegal.

Background: Bacterial resistance is a major public health problem worldwide. One solution to this scourge is to sensitize the general public on rational use of antibiotics. Our goal was to assess people's knowledge and opinions about antibiotic use and bacterial resistance in an urban setting. Method: We performed a cross-sectional study. A convenience sampling was done. A questionnaire was administered to 400 persons during face-to-face interviews. Results: Most respondents thought that antibiotics are effective against colds/flu (69.8%), cough (72.3%) and sore throat (64.4%). At the same time, 42.8% stated that antibiotic therapy can be stopped as soon as the symptoms disappear. Only 8.8% and 41.8% of people knew that handwashing and vaccination prevented bacterial resistance. Globally, 7% of people had a good knowledge. Socio-demographic variables were not associated with the level of knowledge. The main sources of information were entourage and pharmacy staff. Regarding the opinions, 78.3% of surveyed participants the people thought that that people overuse antibiotics. Additionally, 28% said that they have no role to play against bacterial resistance. Conclusion: People living in an urban setting had a low knowledge about antibiotic use and bacterial resistance. There is a need to implement awareness campaigns. Further studies on population practices toward antibiotic use are necessary.