Factors associated with Coronavirus disease 2019 (COVID-19) and an assessment of adherence to infection prevention and control (IPC) guidelines among health workers —Nakonde District, Zambia, 2020

Introduction: Health workers play a critical role in the clinical management of COVID-19 patients. However, research on their infection risk and clinical characteristics, particularly in Africa, is emerging. We investigated risk factors for COVID-19 infection and assessed adherence to infection prevention and control (IPC) guidelines among health workers in Nakonde District. Methods: A case-control study among health workers at Nakonde Urban Health Centre and Nakonde District Hospital was conducted from 15 to 25 May 2020. A standardized questionnaire covering demographic information; possible exposure to persons with COVID-19; adherence to infection prevention and control measures was administered to all health workers present at these facilities. Descriptive statistics were performed and logistic regression was used to calculate the odds ratio (OR) and 95% CIs. Results: A total of 197 HCWs are deployed in the two facilities out of which we obtained 138 responses. Seventy-five (54%) had complete responses that were analyzed in this study. Among the 75, 54 (72%) were female. The median age for all the HCWs that responded was 30 years (IQR 26-33). Thirty-seven (49%) were laboratory-confirmed COVID-19 cases. Symptoms that were exhibited among HCWs with COVID-19 included cough (49%), headache (43%), runny nose (32%) and fatigue (18%); fever was rarely reported (8%). Cough was associated with being a case of COVID-19 (OR 4.2 95% CI 1.5-11.9). Coexisting conditions were similar among the cases and controls. There were no statistically significant differences in exposures between HCWs with confirmed COVID-19 and those without (OR 0.96; 95% CI 0.4-2.5). The WHO five moments of hand hygiene recommended for health workers were practiced by (64%). Non availability of Personal Protective Equipment was reported by 70% of HCWs and this was similar among the cases of COVID-19 and the non-cases. Conclusion: Given the critical role HCWs play in looking after the sick, continued protection of this population at work, at home, and in the community through surveillance should be a national priority

Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo

Abstract Background From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018–2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. Main text Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. Conclusions Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now