1
|
Altare C, Kostandova N, Basadia LM, Petry M, Gankpe GF, Crockett H, Morfin NH, Bruneau S, Antoine C, Spiegel PB. COVID-19 epidemiology, health services utilisation and health care seeking behaviour during the first year of the COVID-19 pandemic in Mweso health zone, Democratic Republic of Congo. J Glob Health 2024; 14:05016. [PMID: 38665056 PMCID: PMC11047223 DOI: 10.7189/jogh.14.05016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background Although the evidence about coronavirus disease 2019 (COVID-19) has increased exponentially since the beginning of the pandemic, less is known about the direct and indirect effects of the pandemic in humanitarian settings. In the Democratic Republic of the Congo (DRC), most studies occurred in Kinshasa and other cities. Limited research was conducted in remote conflict-affected settings. We investigated the COVID-19 epidemiology, health service utilisation, and health care-seeking behaviour during the first year of the pandemic (March 2020-March 2021) in the Mweso health zone, North Kivu, DRC. Methods This mixed-methods study includes a descriptive epidemiological analysis of reported COVID-19 cases data extracted from the provincial line list, interrupted time series analysis of health service utilisation using routine health service data, qualitative perceptions of health care workers about how health services were affected, and community members' health care seeking behaviour from a representative household survey and focus group discussions. Results The COVID-19 epidemiology in North Kivu aligns with evidence reported globally, yet case fatality rates were high due to underreporting. Testing capacity was limited and initially mainly available in the province's capital. Health service utilisation showed different patterns - child measles vaccinations experienced a decrease at the beginning of the pandemic, while outpatient consultations, malaria, and pneumonia showed an increase over time. Such increases might have been driven by insecurity and population displacements rather than COVID-19. Community members continued seeking care during the first months of the COVID-19 pandemic and visited the same health facilities as before COVID-19. Financial constraints, not COVID-19, were the main barrier reported to accessing health care. Conclusions The first year of the COVID-19 pandemic in the Mweso health zone was characterised by low testing capacity and an underestimation of reported COVID-19 infections. The increase in health care utilisation should be further explored to understand the role of factors unrelated to COVID-19, such as insecurity, population displacement, and poverty, which remain major challenges to successfully providing health services and improving the population's health. Measles vaccination coverage dropped, which exacerbated the ongoing measles outbreak. Improved decentralised testing capacity will be crucial for future epidemics and enhanced efforts to maintain child vaccination coverage.
Collapse
Affiliation(s)
- Chiara Altare
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, USA
| | - Natalya Kostandova
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Linda Matadi Basadia
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
| | - Marie Petry
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
| | - Gbètoho Fortuné Gankpe
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
| | - Hannah Crockett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Natalia Hernandez Morfin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophie Bruneau
- Operations Department, Action Contre la Faim, Paris, France
| | - Caroline Antoine
- Technical and Advocacy Department, Action Contre la Faim, Paris, France
| | - Paul B Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, USA
| | - IMPACT DRC TeamMullafirozeRoxanaLinkeJasperCecchiOlivierDasNayanaRickardKatieMushamalirwaJean-PaulRuhindaDestinLehmannNadiaAmandineMarieHenzlerElioraGallecierAudreyBesnardeauBenoitGerritsmaNoortje
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, USA
- Health and Nutrition Department, Action Contre la Faim, Kinshasa, Democratic Republic of Congo
- Operations Department, Action Contre la Faim, Paris, France
- Technical and Advocacy Department, Action Contre la Faim, Paris, France
| |
Collapse
|
2
|
Mylan S. Suspicious business: COVID-19 vaccination in Palabek refugee settlement, northern Uganda. Soc Sci Med 2024; 346:116695. [PMID: 38452488 DOI: 10.1016/j.socscimed.2024.116695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/09/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Dichotomised debates in public health discourse regarding COVID-19 vaccine supply and vaccine hesitancy do not capture the realities of vaccine uptake in Palabek refugee settlement, northern Uganda. Issues of supply, which analyse manufacture and distribution, foreground global inequalities and political influences. In contrast, vaccine hesitancy, emphasing rectifying deficiencies in knowledge and trust, leaves little room for the politics that shape vaccine uptake. The 'vaccine anxieties' framework problematises these dichotomised debates and proposes consideration of bodily, social and political dimensions. This article builds on the vaccine anxieties framework in relation to ethnographic research conducted in Palabek. Using the worldview of Acholi refugees from South Sudan, a focus on 'suspicious business' demonstrates that debates surrounding vaccine supply and hesitancy are intertwined, and, additionally, suggests spiritual elements should be paid greater attention. In Palabek, inconsistencies in distribution directly impacted vaccine uptake. Furthermore, vaccine interventions that built on deficiency models did not work. Vaccine uptake was inseparable from its biopolitical context that continued to perpetuate the same unequal dynamics of power and control that kept wealth circulating amongst certain powers, whilst others faced worsening precarity but remained perpetual recipients of humanitarian assistance and global health intervention, with little prospect of meaningful change. Suspicious business captures fluid dynamics that move between spiritual and physical realms, capturing wider geopolitical dynamics as they are revealed in everyday lives. In doing so, this flexible approach reveals the centrality of the politics of COVID-19, whilst constantly incorporating evolving dynamics. This flexibility provides potential for improving vaccine uptake, if wider geopolitical inequalities are addressed.
Collapse
Affiliation(s)
- Sophie Mylan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM) , London, WC1H 9SH, UK.
| |
Collapse
|
3
|
James M, Kasereka JG, Kasiwa B, Kavunga-Membo H, Kambale K, Grais R, Muyembe-Tamfum JJ, Bausch DG, Watson-Jones D, Lees S. Protection, health seeking, or a laissez-passer: Participants' decision-making in an EVD vaccine trial in the eastern Democratic Republic of the Congo. Soc Sci Med 2023; 323:115833. [PMID: 36934528 DOI: 10.1016/j.socscimed.2023.115833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
During the 10th Ebola virus disease (EVD) epidemic in the eastern Democratic Republic of the Congo (DRC) (2018-2020), two experimental EVD vaccines were deployed in North Kivu. This province has been at the centre of conflict in the region for the last 25 years. Amidst ambivalence towards protracted foreign intervention and controversy about introducing two experimental vaccines, the existing literature has focused on mistrust and 'resistance' towards the Ebola response and vaccines. In this article, we examine why people in the eastern DRC did decide to volunteer for a trial of a second EVD vaccine in North Kivu, despite the controversy. Drawing on ethnographic observation, interviews, and focus groups with trial participants conducted between September 2020 and April 2021, we analyse three motivations for participating: protection, health seeking, and expectations surrounding travel requirements. We make three points. First, participation in vaccine trials may be understood locally to have advantages which have not been considered by the trial, because they go beyond medical considerations and are specific to a particular social setting. Second, despite much of the literature focusing on a causal relationship between rumours and 'vaccine hesitancy', some rumours may in fact encourage participation. Third, material objects associated with trial participation - such as participant vaccine cards - can hold social and political meaning beyond the confines of the vaccine clinic, and influence decisions surrounding participation. Empirical investigation of how medical interventions become entangled in political economies is essential to understanding the perceived functions of participation, and thus the reasons why people volunteer in clinical trials. Participants' narratives about their decision-making provide an insight into how international bioethical debates interact with, but may also stand apart from, the situated social and economic realities driving decision-making around clinical trials on the ground. This highlights the need for ethical approaches that foreground the political, social, and economic context.
Collapse
Affiliation(s)
- Myfanwy James
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom; Department of International Development, University of Oxford, Oxford, United Kingdom.
| | | | - Benjamin Kasiwa
- Ebola Vaccine Deployment Acceptance and Compliance, Goma, Congo.
| | - Hugo Kavunga-Membo
- Laboratoire Rodolphe Mérieux Institut National de Recherche Biomédicale-Goma, Goma, North Kivu, Congo; Faculté de Médecine, Université de Goma, Goma, North Kivu, Congo.
| | - Kasonia Kambale
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Rebecca Grais
- Épicentre, Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France.
| | | | - Daniel G Bausch
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
| | - Shelley Lees
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| |
Collapse
|
4
|
James M, Mansaray A, Thige FO, Mafinda M, Kasonia KK, Paluku JK, Timbo AD, Karenzi L, Ntabala F, Tindanbil D, Leigh B, Kavunga-Membo H, Watson-Jones D, Gallagher K, Enria L. Continuity and Rupture in Crisis: from Ebola to COVID-19 in Sierra Leone and the eastern Democratic Republic of the Congo. Glob Public Health 2023; 18:2259959. [PMID: 37787158 DOI: 10.1080/17441692.2023.2259959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
This article examines the experience of healthcare professionals working in primary healthcare provision during the first wave of the COVID-19 pandemic in North Kivu, the Democratic Republic of the Congo, and in Kambia District, Sierra Leone. Drawing on ethnographic observation, interviews and focus groups, we explore everyday narratives of 'crisis' in these two regions which had recently seen Ebola epidemics. In describing the impact of COVID-19 on their life, work, and relationships with patients, healthcare workers made sense of the pandemic in relation to broader experiences of structural economic and political crisis, as well as differing experiences of recent Ebola epidemics. There were contradictory experiences of rupture and continuity: whilst COVID-19 disrupted routine health provision and exacerbated tensions with patients, the pandemic was also described as continuity, interacting with broader structural problems and longer-term experiences of 'crisis'. In effect, healthcare workers experienced the COVID-19 pandemic at the crossroads between the exceptional and the everyday, where states of exception brought by emergency measures shed new light on long-standing tensions and structural crisis.
Collapse
Affiliation(s)
- Myfanwy James
- London School of Economics and Political Science, London, UK
| | | | - Frederic Omega Thige
- Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | - Mabel Mafinda
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Joel Kahehero Paluku
- Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | - Alie D Timbo
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Lina Karenzi
- Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | - Ferdinand Ntabala
- Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | | | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Hugo Kavunga-Membo
- Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | | | | | - Luisa Enria
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
5
|
Zola Matuvanga T, Doshi RH, Muya A, Cikomola A, Milabyo A, Nasaka P, Mitashi P, Muhindo-Mavoko H, Ahuka S, Nzaji M, Hoff NA, Perry R, Mukamba Musenga E. Challenges to COVID-19 vaccine introduction in the Democratic Republic of the Congo - a commentary. Hum Vaccin Immunother 2022; 18:2127272. [PMID: 36165731 PMCID: PMC9746480 DOI: 10.1080/21645515.2022.2127272] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 vaccination in the Democratic Republic of the Congo (DRC) began in April 2021. A month later, most COVID-19 vaccine doses were reallocated to other African countries, due to low vaccine uptake and the realization that the doses would expire before use. Based on data available on 13 August 2022, 2.76% of the DRC population had been fully vaccinated with last dose of primary series of COVID-19 vaccine, placing the country second to last in Africa and in the last five in global COVID-19 vaccination coverage. The DRC's reliance on vaccine donations requires continuous adaptation of the vaccine deployment plan to match incoming COVID-19 vaccines shipments. Challenges in planning vaccine deployments, vaccinating priority populations, coordinating, and implementing the communications plan, disbursing funds, and conducting supervision of vaccination activities have contributed to low COVID-19 vaccine coverage. In addition, the spread of rumors through social media and by various community and religious leaders resulted in high levels of vaccine hesitancy. A strong risk communication and community engagement plan, coupled with innovative efforts to target the highest-risk populations are critical to increase vaccine uptake during the next phase of COVID-19 vaccine introduction.
Collapse
Affiliation(s)
| | - Reena H. Doshi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Albert Muya
- Infodemic management, World Health Organization, Kinshasa, DRC
| | - Aimé Cikomola
- Expanded Program on immunization, Democratic Republic of the Congo, Kinshasa, DRC
| | - Augustin Milabyo
- Expanded Program on immunization, Democratic Republic of the Congo, Kinshasa, DRC
| | - Pablito Nasaka
- Immunization and vaccination department, World Health Organization, Kinshasa, DRC
| | - Patrick Mitashi
- Department of tropical Medecine, University of Kinshasa, Kinshasa, DRC
| | | | - Steve Ahuka
- Department of Virology, National Institute for Biomedical Research (INRB), Kinshasa, DRC
| | - Michel Nzaji
- Expanded Program on immunization, Democratic Republic of the Congo, Kinshasa, DRC
| | - Nicole A. Hoff
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Robert Perry
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|