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Article ; Online: Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa.

Babakazo, Pélagie / Bosonkie, Marc / Mafuta, Eric / Mvuama, Nono / Mapatano, Mala-Ali

2022 Volume 17, Issue 10, Page(s) e0275477

Abstract: Introduction: Breastfeeding has numerous advantages for infant, mother and society. However, many mothers discontinue breastfeeding due to problems they encounter. This study aimed to identify problems commonly experienced by breastfeeding mothers ... ...

Abstract	Introduction: Breastfeeding has numerous advantages for infant, mother and society. However, many mothers discontinue breastfeeding due to problems they encounter. This study aimed to identify problems commonly experienced by breastfeeding mothers during the first six months in Kinshasa. Methods: A prospective cohort study was carried out in Kinshasa from October 2012 to July 2013. A total of 422 mother-infant couples were recruited shortly after being discharged from twelve maternity facilities in Kinshasa and followed-up for six months. Interviews were conducted at the mother's house during the first week after birth, and thereafter at monthly intervals for six months. Data included mother's sociodemographic characteristics, the breastfeeding problems she experienced and information on child's feeding. Incidences of breastfeeding problems encountered during different periods were calculated as well as their confidence intervals. Results: Cracked or sore nipples, insufficient production of milk and breast engorgement were the most commonly experienced problems by lactating mothers. The problems occurred mainly during the first week (17.1%; CI95% 13.7-21.1) and the rest of the first month (16.2%; CI95% 12.8-20.3). Conclusions: The first month after birth presents the most risk for the occurrence of breastfeeding problems. Mothers should be supported as soon as possible after delivery, to improve their breastfeeding performance and to be informed on how to maintain breast milk supply.
MeSH term(s)	Breast Feeding ; Democratic Republic of the Congo ; Female ; Humans ; Infant ; Infant, Newborn ; Lactation ; Mothers ; Pregnancy ; Prospective Studies
Language	English
Publishing date	2022-10-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0275477
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Article ; Online: Health workforce incentives and dis-incentives during the COVID-19 pandemic: experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BMC health services research

2024 Volume 24, Issue 1, Page(s) 422

Abstract: Background: The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, ...

Abstract	Background: The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, incentivizing health workers motivates them and ensures continuity in the provision of health services. We describe health workforce experiences with incentives and dis-incentives during the COVID-19 response in the Democratic Republic of Congo (DRC), Senegal, Nigeria, and Uganda. Methods: This is a multi-country qualitative research study involving four African countries namely: DRC, Nigeria, Senegal, and Uganda which assessed the workplace incentives instituted in response to the COVID-19 pandemic. Key informant interviews (n = 60) were conducted with staff at ministries of health, policy makers and health workers. Interviews were virtual using the telephone or Zoom. They were audio recorded, transcribed verbatim, and analyzed thematically. Themes were identified and quotes were used to support findings. Results: Health worker incentives included (i) financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers' efforts during the COVID-19 response across the four countries. (ii) Non-financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives were common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives. Conclusion: Although important for worker motivation, financial and non-financial incentives generated some dis-incentives because of the perceived unfairness in their provision. Financial and non-financial incentives deployed during health emergencies should preferably be pre-determined, equitably and transparently provided because when arbitrarily applied, these same financial and non-financial incentives can potentially become dis-incentives. Moreover, financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential negative impacts of interventions such as service delivery re-organization and lockdown within already weakened systems need to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.
MeSH term(s)	Humans ; Motivation ; COVID-19/epidemiology ; Health Workforce ; Nigeria/epidemiology ; Democratic Republic of the Congo/epidemiology ; Senegal ; Uganda/epidemiology ; Pandemics ; Emergencies ; Communicable Disease Control
Language	English
Publishing date	2024-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10822-6
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Article ; Online: Heavy metals in children's blood from the rural region of Popokabaka, Democratic Republic of Congo: a cross-sectional study and spatial analysis.

Mbunga, Branly Kilola / Gjengedal, Elin L F / Bangelesa, Freddy / Langfjord, Mina M / Bosonkie, Marc M / Strand, Tor A / Mapatano, Mala Ali / Engebretsen, Ingunn M S

Scientific reports

2022 Volume 12, Issue 1, Page(s) 18576

Abstract: Exposure to heavy metals can affect cell differentiation, neurocognitive development, and growth during early life, even in low doses. Little is known about heavy metal exposure and its relationship with nutrition outcomes in non-mining rural ... ...

Abstract	Exposure to heavy metals can affect cell differentiation, neurocognitive development, and growth during early life, even in low doses. Little is known about heavy metal exposure and its relationship with nutrition outcomes in non-mining rural environments. We carried out a community-based cross-sectional study to describe the distribution of four heavy metal concentrations [arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg)] in the serum of a representative population of children aged 12 to 59 months old from the rural region of Popokabaka, Democratic Republic of Congo. The four metals were measured in 412 samples using inductively coupled plasma-mass spectrometry (ICP-MS). Limits of detection (LoD) and quantification (LoQ) were set. Percentiles were reported. Statistical and geospatial bivariate analyses were performed to identify relationships with other nutrition outcomes. Arsenic was quantified in 59.7%, while Cd, Hg, and Pb were quantified in less than 10%, all without toxicities. The arsenic level was negatively associated with the zinc level, while the Hg level was positively associated with the selenium level. This common detection of As in children of Popokabaka requires attention, and urgent drinking water exploration and intervention for the profit of the Popokabaka community should be considered.
MeSH term(s)	Child ; Humans ; Infant ; Child, Preschool ; Arsenic/analysis ; Cadmium/analysis ; Cross-Sectional Studies ; Democratic Republic of the Congo ; Lead/analysis ; Metals, Heavy/analysis ; Mercury/analysis ; Spatial Analysis
Chemical Substances	Arsenic (N712M78A8G) ; Cadmium (00BH33GNGH) ; Lead (2P299V784P) ; Metals, Heavy ; Mercury (FXS1BY2PGL)
Language	English
Publishing date	2022-11-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-23332-4
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Article ; Online: Spread and seasonality of COVID-19 pandemic confirmed cases in sub-Saharan Africa: experience from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BMC infectious diseases

2023 Volume 23, Issue 1, Page(s) 187

Abstract: 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 ... ...

Abstract	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 12 Results: Nigeria had the highest rate of spread (β) of COVID-19 (β = 381.2) while DRC had the least rate (β = 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 1 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.
MeSH term(s)	Humans ; Uganda/epidemiology ; COVID-19/epidemiology ; Nigeria/epidemiology ; Senegal/epidemiology ; Democratic Republic of the Congo/epidemiology ; Pandemics
Language	English
Publishing date	2023-03-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08168-1
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Article ; Online: Consequences of school closures due to COVID-19 in DRC, Nigeria, Senegal, and Uganda.

Ndejjo, Rawlance / Tusubiira, Andrew K / Kiwanuka, Suzanne N / Bosonkie, Marc / Bamgboye, Eniola A / Diallo, Issakha / Kabwama, Steven N / Egbende, Landry / Afolabi, Rotimi F / Leye, Mamadou Makhtar Mbacké / Namuhani, Noel / Kashiya, Yves / Bello, Segun / Babirye, Ziyada / Adebowale, Ayo Stephen / Sougou, Marieme / Monje, Fred / Kizito, Susan / Dairo, Magbagbeola David /

Bassoum, Omar / Namale, Alice / Seck, Ibrahima / Fawole, Olufunmilayo I / Mapatano, Mala Ali / Wanyenze, Rhoda K

PLOS global public health

2023 Volume 3, Issue 10, Page(s) e0002452

Abstract: 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 ... ...

Abstract	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.
Language	English
Publishing date	2023-10-16
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002452
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Article ; Online: Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda.

Kabwama, Steven N / Kiwanuka, Suzanne N / Mapatano, Mala Ali / Fawole, Olufunmilayo I / Seck, Ibrahima / Namale, Alice / Ndejjo, Rawlance / Kizito, Susan / Monje, Fred / Bosonkie, Marc / Egbende, Landry / Bello, Segun / Bamgboye, Eniola A / Dairo, Magbagbeola D / Adebowale, Ayo S / Salawu, Mobolaji M / Afolabi, Rotimi F / Diallo, Issakha / Leye, Mamadou M M /

Ndiaye, Youssou / Fall, Mane / Bassoum, Oumar / Alfvén, Tobias / Sambisa, William / Wanyenze, Rhoda K

Globalization and health

2022 Volume 18, Issue 1, Page(s) 60

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	COVID-19/epidemiology ; COVID-19 Testing ; Cross-Sectional Studies ; Democratic Republic of the Congo/epidemiology ; Humans ; Nigeria/epidemiology ; Pandemics ; Private Sector ; Senegal/epidemiology ; Uganda/epidemiology
Language	English
Publishing date	2022-06-15
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2185774-X
ISSN	1744-8603 ; 1744-8603
ISSN (online)	1744-8603
ISSN	1744-8603
DOI	10.1186/s12992-022-00853-1
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Article ; Online: Unintended consequences of implementing non-pharmaceutical interventions for the COVID-19 response in Africa: experiences from DRC, Nigeria, Senegal, and Uganda.

Diallo, Issakha / Ndejjo, Rawlance / Leye, Mamadou Makhtar Mbacké / Egbende, Landry / Tusubira, Andrew / Bamgboye, Eniola A / Fall, Manel / Namuhani, Noel / Bosonkie, Marc / Salawu, Mobolaji M / Ndiaye, Youssoupha / Kabwama, Steven Ndugwa / Sougou, Ndeye Mareme / Bello, Segun / Bassoum, Omar / Babirye, Ziyada / Afolabi, Rotimi Felix / Gueye, Thiané / Kizito, Susan /

Adebowale, Ayo S / Dairo, Magbagbeola David / Sambisa, William / Kiwanuka, Suzanne N / Fawole, Olufunmilayo I / Mapatano, Mala Ali / Wanyenze, Rhoda K / Seck, Ibrahima

Globalization and health

2023 Volume 19, Issue 1, Page(s) 36

Abstract: 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. ... ...

Abstract	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.
MeSH term(s)	Child ; Pregnancy ; Adolescent ; Female ; Humans ; Aged ; COVID-19/epidemiology ; COVID-19/prevention & control ; Uganda/epidemiology ; Nigeria/epidemiology ; Senegal/epidemiology ; Democratic Republic of the Congo/epidemiology ; Communicable Disease Control
Language	English
Publishing date	2023-06-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2185774-X
ISSN	1744-8603 ; 1744-8603
ISSN (online)	1744-8603
ISSN	1744-8603
DOI	10.1186/s12992-023-00937-6
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Article ; Online: COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

Fawole, Olufunmilayo Ibitola / Bello, Segun / Adebowale, Ayo Stephen / Bamgboye, Eniola Adetola / Salawu, Mobolaji Modinat / Afolabi, Rotimi Felix / Dairo, Magbagbeola David / Namale, Alice / Kiwanuka, Suzanne / Monje, Fred / Namuhani, Noel / Kabwama, Steven / Kizito, Susan / Ndejjo, Rawlance / Seck, Ibrahima / Diallo, Issakha / Makhtar, Mamadou / Leye, Mbacke / Ndiaye, Youssou /

Fall, Manel / Bassoum, Oumar / Mapatano, Mala Ali / Bosonkie, Marc / Egbende, Landry / Lazenby, Siobhan / Wang, William / Liu, Anne / Bartlein, Rebecca / Sambisa, William / Wanyenze, Rhoda

BMC public health

2023 Volume 23, Issue 1, Page(s) 835

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Humans ; Nigeria/epidemiology ; Senegal ; Uganda ; Democratic Republic of the Congo/epidemiology ; Pandemics ; COVID-19/epidemiology
Language	English
Publishing date	2023-05-08
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-15708-6
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Article ; Online: Improving testing capacity for COVID-19: experiences and lessons from Senegal, Uganda, Nigeria, and the Democratic Republic of Congo.

Bosonkie, Marc / Egbende, Landry / Namale, Alice / Fawole, Olufunmilayo I / Seck, Ibrahima / Kizito, Susan / Kaba, Didine / Kiwanuka, Suzanne N / Diallo, Issakha / Bello, Segun / Kabwama, Steven N / Kashiya, Yves / Monje, Fred / Dairo, M D / Bondo, Berthold / Namuhani, Noel / Leye, Mamadou M M / Adebowale, A S / Bassoum, Oumar /

Bamgboye, Eniola A / Fall, Manel / Salawu, Mobolaji / Afolabi, Rotimi / Ndejjo, Rawlance / Wanyenze, Rhoda K / Mapatano, Mala Ali

Frontiers in public health

2023 Volume 11, Page(s) 1202966

Abstract: Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 ... ...

Abstract	Background: African countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the Democratic Republic of the Congo (DRC). Methods: The four countries' testing strategies were studied using a mixed-methods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries. Results: The four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as PCR and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging. Case detection remains suboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder the demand for testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden. Conclusion: Although testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.
MeSH term(s)	Humans ; COVID-19/diagnosis ; COVID-19/epidemiology ; Democratic Republic of the Congo ; Nigeria ; Uganda/epidemiology ; Senegal ; COVID-19 Testing ; Pandemics
Language	English
Publishing date	2023-11-16
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1202966
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Article ; Online: Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa.

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Article ; Online: Health workforce incentives and dis-incentives during the COVID-19 pandemic: experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

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Article ; Online: Heavy metals in children's blood from the rural region of Popokabaka, Democratic Republic of Congo: a cross-sectional study and spatial analysis.

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

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

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

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

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

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Article ; Online: Improving testing capacity for COVID-19: experiences and lessons from Senegal, Uganda, Nigeria, and the Democratic Republic of Congo.

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