Coordination and Management of COVID-19 in Africa through Health Operations and Technical Expertise Pillar: A Case Study from WHO AFRO One Year into Response

Abstract: Background: following the importation of the first Coronavirus disease 2019 (COVID-19) case into Africa on 14 February 2020 in Egypt, the World Health Organisation (WHO) regional office for Africa (AFRO) activated a three-level incident management support team (IMST), with technical pillars, to coordinate planning, implementing, supervision, and monitoring of the situation and progress of implementation as well as response to the pandemic in the region. At WHO AFRO, one of the pillars was the health operations and technical expertise (HOTE) pillar with five sub-pillars: case management, infection prevention and control, risk communication and community engagement, laboratory, and emergency medical team (EMT). This paper documents the learnings (both positive and negative for consideration of change) from the activities of the HOTE pillar and recommends future actions for improving its coordination for future emergencies, especially for multi-country outbreaks or pandemic emergency responses. Method: we conducted a document review of the HOTE pillar coordination meetings’ minutes, reports, policy and strategy documents of the activities, and outcomes and feedback on updates on the HOTE pillar given at regular intervals to the Regional IMST. In addition, key informant interviews were conducted with 14 members of the HOTE sub pillar. Key Learnings: the pandemic response revealed that shared decision making, collaborative coordination, and planning have been significant in the COVID-19 response in Africa. The HOTE pillar’s response structure contributed to attaining the IMST objectives in the African region and translated to timely support for the WHO AFRO and the member states. However, while the coordination mechanism appeared robust, some challenges included duplication of coordination efforts, communication, documentation, and information management. Recommendations: we recommend streamlining the flow of information to better understand the challenges that countries face. There is a need to define the role and responsibilities of sub-pillar team members and provide new team members with information briefs to guide them on where and how to access internal information and work under the pillar. A unified documentation system is important and could help to strengthen intra-pillar collaboration and communication. Various indicators should be developed to constantly monitor the HOTE team’s deliverables, performance and its members

Transitioning the COVID-19 response in the WHO African region: a proposed framework for rethinking and rebuilding health systems

The onset of the pandemic revealed the health system inequities and inadequate preparedness, especially in the African continent. Over the past months, African countries have ensured optimum pandemic response. However, there is still a need to build further resilient health systems that enhance response and transition from the acute phase of the pandemic to the recovery interpandemic/preparedness phase. Guided by the lessons learnt in the response and plausible pandemic scenarios, the WHO Regional Office for Africa has envisioned a transition framework that will optimise the response and enhance preparedness for future public health emergencies. The framework encompasses maintaining and consolidating the current response capacity but with a view to learning and reshaping them by harnessing the power of science, data and digital technologies, and research innovations. In addition, the framework reorients the health system towards primary healthcare and integrates response into routine care based on best practices/health system interventions. These elements are significant in building a resilient health system capable of addressing more effectively and more effectively future public health crises, all while maintaining an optimal level of essential public health functions. The key elements of the framework are possible with countries following three principles: equity (the protection of all vulnerable populations with no one left behind), inclusiveness (full engagement, equal participation, leadership, decision-making and ownership of all stakeholders using a multisectoral and transdisciplinary, One Health approach), and coherence (to reduce the fragmentation, competition and duplication and promote logical, consistent programmes aligned with international instruments)

Update on current views and advances on RSV infection (Review).

Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood

Prevalence and risk factors of acute respiratory infection by human respiratory syncytial virus in children at Provincial General Hospital of Bukavu, Democratic Republic of the Congo

Thesis (MMedSc)--Stellenbosch University, 2017.ENGLISH ABSTRACT : Human Respiratory Syncytial Virus (HRSV) is the major cause of acute respiratory infection in children (ARI) and it is responsible for substantial morbidity and mortality, especially in younger children. The present study had two main objectives. The first one was to determine the prevalence of HRSV and non-HRSV ARI in children under the age of 5 years at the Provincial General Hospital of Bukavu (PGHB). The second objective was to analyse factors associated with the risk of ARI to be diagnosed as lower respiratory tract infection (LRTI). A total of 146 children under 5 years visiting the PGHB for ARI between August and December 2016 were recruited. A clinical examination was made and a questionnaire was completed by the parent or the guardian after which a nasopharyngeal swab was performed to collect respiratory fluid. The sample was analysed by a multiplex reverse transcriptase polymerase chain reaction for the detection of 15 different viruses, among which HRSV A and B, Influenza A and B, human Rhinovirus (HRV) A/B/C, Parainfluenza (PIV) viruses 1, 2, 3 and 4, Adenovirus (ADV), Bocavirus, Coronavirus OC43 and 229E/NL63, Enterovirus and human Metapneumovirus. Of 146 samples collected, 84 (57.5%) displayed a positive result of at least one of the 15 viruses. The overall prevalence of HRSV was 21.2%. HRSV A (30, 20.5%) was the virus the most detected, followed by HRV (24, 16.4%), PIV3 (20, 16.6) and ADV (7, 4.79%). The other viruses were detected in three or less cases. There were only 11 (7.5%) of co-infection. In bivariate analyses, HRSV infection, malnutrition, younger age, rural settings, low income and mother illiteracy were associated with the risk of ARI to be diagnosed as LRTI. However, in multivariate analyses, only HRSV infection and younger age predicted LRTI. Children with HRSV infection had 6.45 times higher odds to exhibit LRTI when compared to children without HRSV infection. Older children (by one month) had 6% lower odds of LRTI than younger children (adjusted odds ratio = 0.94, 95% CI: 0.90 – 0.97, p-value = 0.004).AFRIKAANSE OPSOMMING : Respiratoriese sinsitiale virus (RSV) is die hoofoorsaak van akute respiratoriese infeksie (ARI) by kinders en dit is verantwoordelik vir erge morbiditeit en mortaliteit, veral by jonger kinders. Die huidige studie het twee hoofdoelwitte gehad. Die eerste een was om die voorkoms van RSV en nie-RSV ARI in kinders onder die ouderdom van 5 jaar by die Provinsiale Algemene Hospitaal van Bukavu (PGHB) te bepaal. Die tweede doel was om faktore te analiseer wat verband hou met die risiko dat ARI gediagnoseer word as lae lugweginfeksie. 'n Totaal van 146 kinders onder 5 jaar wat die PGHB vir ARI besoek het tussen Augustus en Desember 2016 is gewerf vir die studie. 'n Kliniese ondersoek is gedoen en 'n vraelys is deur die ouer of voog voltooi, waarna respiratoriese vloeistof met behulp van 'n nasofaringeale depper versamel is. Die monster is geanaliseer met behulp van 'n multiplex-omgekeerde transkriptase-polimerase kettingreaksie vir die opsporing van 15 verskillende virusse, waaronder RSV A en B, Influenza A en B, menslike Rhinovirus (HRV) A / B / C, Parainfluenza virus (PIV) 2, 3 en 4, Adenovirus (ADV), Bocavirus, Coronavirus OC43 en 229E / NL63, Enterovirus en menslike Metapneumovirus. Van 146 monsters wat versamel is, is minstens een van die 15 virusse bevestig in 84 (57.5%) gevalle. Die algehele voorkoms van RSV was 21.2%. RSV A (30, 20.5%) was die virus wat die meeste bespeur is, gevolg deur HRV (24, 16.4%), PIV3 (20,16.6) en ADV (7, 4.79%). Die ander virusse is slegs in drie of minder gevalle bevestig. Daar was slegs 11 (7.5%) ko-infeksie. In ʼn twee-veranderlike analise is RSV-infeksie, wanvoeding, jonger ouderdom, landelike woongebiede, lae inkomste en ongeletterdheid in moeders geassosieer met die risiko dat ARI gediagnoseer word as lae lugweginfeksie. In ʼn meer-veranderlike analise het slegs RSV-infeksie en jonger ouderdom lae lugweginfeksie voorspel. Kinders met RSV-infeksie het ʼn 6.45 keer hoër kans gehad om lae lugweginfeksie te vertoon in vergelyking met kinders sonder RSV-infeksie. Ouer kinders (met een maand) het ʼn 6% laer kans gehad op lae lugweginfeksie as jonger kinders (aangepaste kansverhouding = 0.94, 95% CI: 0.90 – 0.97, p-waarde = 0.004)

Incidence of Coronavirus Disease 2019 (COVID-19) among healthcare workers during the first and second wave in the Democratic Republic of the Congo: a descriptive study

Abstract Background Healthcare workers (HCWs) are at the frontline of response to the COVID-19 pandemic. Protecting HCWs is of paramount importance to the World Health Organization (WHO). Outbreak investigation which is based on a critical assessment of core components of infection prevention and control (IPC) programs allows for the identification of different sources of exposure to the COVID-19 virus and for informing additional IPC recommendations. To date, the Democratic Republic of the Congo (DRC) is categorized as a high-risk country due to weaknesses in the health system, low capacity for diagnosis, socioeconomic characteristics of the population, and insufficient vaccination coverage. Aim To investigate the burden of COVID-19 among HCWs and identification of IPC gaps to reduce HCWs-associated infection at different levels (facilities, communities, and points of entry) following the WHO strategy for IPC program implementation during the first to the third wave of the pandemic. Methods A retrospective cohort study was conducted using the DRC National Department of Health (NDOH) database and WHO questionnaire suspected and confirmed COVID-19 cases among HCWs from 10/03/2020 to 22/06/2021. The investigation was conducted by a trained IPC response team to identify the sources of the exposures. The questionnaire included demographics, profession, types of interaction between HCWs and patients, and community-based questions regarding family members and other behaviors. These variables were assessed using a multimodal strategy framework. Knowledge and adherence to IPC gaps using WHO guidelines were performed for each COVID-19-positive or suspected HCW. WHO rapid Scorecard dashboard was conducted for evaluating healthcare facilities (HCFs) performance during the COVID-19 pandemic. Results Cumulative incidence of positive HCWs was 809 /35,898(2.2%) from the first to the third wave of COVID-19 among 6 provinces of DRC. The distribution of the HCWs infected by COVID-19 was predominated by nurses (42%), doctors (27%), biologists (8%), environmental health practitioners (5%), interns (3%), and other categories (15%). Other categories included nutritionists, physiotherapists, midwives, pharmacists, and paramedics. The investigation revealed that about 32% of HCWs were infected from household contacts, 11% were infected by HCFs, 35% were infected in the community and 22% were infected from unknown exposures. The mean score of IPC performance for all evaluated HCFs was 27/42(64%). This shows that IPC performance was moderate. Lower or minimal performance was noted in the implementation of the IPC program at the national and facility level, triage and screening, isolation handwashing and multimodal strategies of hand hygiene, PPE availability, and rationale, waste segregation, waste disposal, sterilization, and training of HCWs. Conclusion This study revealed that the prevalence of HCWs who tested positive for the COVID-19 virus was high among frontline healthcare workers from 6 provinces of DRC. A high prevalence of nosocomial infection was correlated with insufficient IPC adherence in the context of COVID-19. Strategies to strengthen IPC capacity building and provide HCWs with sufficient PPE stocks and budgets may improve IPC performance in the Democratic Republic of the Congo. This will further allow for adherence to WHO recommendations for successful program implementation to minimize COVID-19 transmission in HCFs, communities, and public gatherings. And this may be transferable to other infectious diseases

Antimicrobial resistance in urinary isolates from inpatients and outpatients at a tertiary care hospital in South-Kivu Province (Democratic Republic of Congo)

Background: The rate of antimicrobial resistant isolates among pathogens causing urinary tract infections (UTIs) in Democratic Republic of Congo (DRC) is not known. The aim of the current study was to determine this rate at the Bukavu Provincial General Hospital (province of South-Kivu, DRC). Findings. A total of 643 isolates (both from inpatients and outpatients) collected from September 2012 to August 2013 were identified using biochemical methods, and tested for antimicrobial susceptibility. The isolates were further screened for Extended-Spectrum Beta-Lactamases (ESBL) production. Beta-lactamase AmpC phenotype was investigated in 20 antibiotic-resistant isolates. Escherichia coli (58.5%), Klebsiella spp. (21.9%) and Enterobacter spp. (16.2%) were the most frequent uropathogens encountered. Rare uropathogens included Citrobacter spp. Proteus spp. and Acinetobacter spp. Resistance was significantly more present in inpatients isolates (22.1% of isolates) when compared to outpatients isolates (8.4% of isolates), (p-value <0.001). Antibiotic-resistant isolates displayed resistance to common antimicrobial drugs used for UTIs treatment in South Kivu province, namely: ciprofloxacin, ampicillin and third generation cephalosporins. ESBL-phenotype was present in 92.9% of antibiotic-resistant isolates. Only amikacin, nitrofurantoin and imipenem displayed satisfactory activity against antibiotic resistant isolates. Conclusions: This study confirms the presence of antibiotic-resistant uropathogens (mainly ESBL-producers isolates) at the Bukavu General Hospital. This study should serve as a wake-up call and help to raise awareness about the threat to public health of antibiotic resistance in this DRC province. © 2014 Irenge et al. licensee BioMed Central Ltd.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Antimicrobial resistance of bacteria isolated from patients with bloodstream infections at a tertiary care hospital in the Democratic Republic of the Congo

Background. Bloodstream infection (BSI) is a life-threatening condition that requires rapid antimicrobial treatment. Methods. We determined the prevalence of bacterial isolates associated with BSI at Bukavu General Hospital (BGH), South Kivu Province, Democratic Republic of the Congo, and their patterns of susceptibility to antimicrobial drugs, from February 2013 to January 2014. Results. We cultured 112 clinically relevant isolates from 320 blood cultures. Of these isolates, 104 (92.9%) were Gram-negative bacteria (GNB), with 103 bacilli (92.0%) and one coccus (0.9%). Among GNB, Escherichia coli (51.9%), Klebsiella spp. (20.2%), Enterobacter spp. (6.7%), Shigella spp. (5.8%) and Salmonella spp. (4.8%) were the most frequent agents causing BSIs. Other GNB isolates included Proteus spp., Citrobacter spp. and Pseudomonas aeruginosa (both 2.9%), and Acinetobacter spp. and Neisseria spp. (both 0.9%). High rates of resistance to co-trimoxazole (100%), erythromycin (100%) and ampicillin (66.7 - 100%) and moderate to high resistance to ciprofloxacin, ceftazidime, ceftriaxone, cefuroxime and cefepime were observed among GNB. Furthermore, there were high rates of multidrug resistance and of extended-spectrum β-lactamase (ESBL) production phenotype among Enterobacteriaceae. Gram-positive bacteria included three Staphylococcus aureus isolates (2.7%), four oxacillin-resistant coagulase-negative staphylococci (CoNS) isolates (3.6%) and one Streptococcus pneumoniae (0.9%). No oxacillin-resistant S. aureus was isolated. Among clinically relevant staphylococci, susceptibility to co-trimoxazole and ampicillin was low (0 - 25%). In addition, 58 contaminant CoNS were isolated from blood cultures, and the calculated ratio of contaminants to pathogens in blood cultures was 1:2. Conclusions. Multidrug-resistant and ESBL-producing GNB are the leading cause of BSI at BGH