Papy Ansobi’s research while affiliated with University of Kinshasa and other places

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.

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.

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 to search the impact of pandemic COVID-19 on admissions due to diarrhea into the largest specialized Pediatric Hospital in the city of Kinshasa, Kalembe-Lembe Hospital. A retrospective analysis was conducted on medical records (n = 442) of 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. We found a 45% drop in admissions due to diarrhea to the pediatric emergency department during lockdown. 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 hospitalisation rate was higher in 2019 than in 2020 (p < 0.001). 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 such a crisis in the near future.

Background: Globally, 1.8 million children failed to receive the 3-dose diphtheria, tetanus and pertussis (DTP) series every year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces, including the capital of Kinshasa, is launched to reinforce routine immunization. The Mont Ngafula II health district (HD) was the only one to report high vaccination dropout rates over almost five consecutive years. This study aimed to assess issues within the local dynamic system of vaccination services and identify associated risk factors among children aged 12-23 months. 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 local authority of HD and mapped. Chi-square test and multivariate logistic regression were used to identify predictors of high vaccination dropout. Statistical significance was defined as p < 0.05. Results: Of 14 health areas included in the Mont Ngafula II HD, four reported high vaccine coverage, only one recorded low vaccine coverage and three registered both low vaccine coverage and high dropout rate. Multivariate logistic regression showed the predictors of immunization dropout as follows: no possession of immunization card (aOR = 2.49; 95% CI = 1.25-4.93; p = 0.010), living in rural areas (aOR = 1.53; 95% CI = 1.02-2.32; p = 0.042), unavailability of seating places (aOR = 7.10; 95% CI = 1.39-36.27; p = 0.019), no respect of the order of arrival (aOR = 3.88; 95% CI = 1.48-10.16; p = 0.006) during vaccination in health facilities, and the lack of a reminder system on days before the scheduled vaccination (aOR = 2.17; 95% CI = 1.43-3.32; p < 0.001). Conclusion: The poor utilization of immunization services seemed as the main health concern followed by the poor access. Residing in rural areas, no immunization card possession, absence of seating places, no respect of the order of arrival, and the lack of a reminder system were the predictors of vaccination dropout rates. These results advocate for prioritizing targeted interventions and programs that will strengthen interpersonal communication between vaccination service providers and users during vaccination in health facilities as well as implement and extend a reminder system using SMS reminders on days before the scheduled vaccination.