The implementation of infection prevention and control measures and health care utilisation in ACF-supported health facilities during the COVID-19 pandemic in Kinshasa, Democratic Republic of the Congo, 2020

ABSTRACT

Background

Infection prevention and control (IPC) was a central component of the Democratic Republic of the Congo’s COVID-19 response in 2020, aiming to prevent infections and ensure safe health service provision.

Objectives

We aimed to assess the evolution of IPC capacity in 65 health facilities supported by Action Contre la Faim in three health zones in Kinshasa (Binza Meteo (BM), Binza Ozone (BO), and Gombe), investigate how triage and alert validation were implemented, and estimate how health service utilisation changed in these facilities (April–December 2020).

Methods

We used three datasets: IPC Scorecard data assessing health facilities’ IPC capacity at baseline, monthly and weekly triage data, and monthly routine data on eight health services. We examined factors associated with triage and isolation capacity with a mixed-effects negative binomial model and estimated changes in health service utilisation with a mixed-model with random intercept and long-term trend for each health facility. We reported incidence rate ratios (IRRs) for level change when the pandemic began, for trend change, and for lockdown and post-lockdown periods (Gombe). We estimated cumulative and monthly percent differences with expected consultations.

Results

IPC capacity reached an average score of 90% by the end of the programme. A one-point increase in the IPC score was associated with +6% and +5% increases in triage capacity in BO and Gombe, respectively, and with +21% and +10% increases in isolation capacity in the same zones. When the pandemic began, decreases were seen in outpatient consultations (IRR: 0.67, 95% confidence interval (CI) [0.48–0.95] BM&BO-combined; IRR: 0.29, 95%CI [0.16–0.53] Gombe), consultations for respiratory tract infections (IRR: 0.48, 95%CI [0.28–0.87] BM&BO-combined), malaria (IRR: 0.60, 95%CI [0.43–0.84] BM&BO-combined, IRR: 0.33, 95%CI [0.18–0.58] Gombe), and vaccinations (IRR: 0.27, 95%CI [0.10–0.71] Gombe). Maternal health services decreased in Gombe (ANC1: IRR: 0.42, 95%CI [0.21–0.85]).

Conclusions

The effectiveness of the triage and alert validation process was affected by the complexity of implementing a broad clinical definition in limited-resource settings with a pre-pandemic epidemiological profile characterised by infectious diseases with symptoms like COVID-19. Readily available testing capacity remains key for future pandemic response to improve the disease understanding and maintain health services.

KEYWORDS:

• COVID-19
• Infection prevention and control
• Kinshasa
• Democratic Republic of the Congo
• Routine health services

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

We would like to acknowledge ACF health and WASH team in Kinshasa, DRC who implemented the IPC activities in the health facilities that were included in the analysis.

Author contribution

Conceptualization: CA, NK, LMB, CAN, MP; Data collection: LMB; Writing of original draft: CA; Review and editing: CA, LMB, NK, CAN, SB, JNM, MP.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data were obtained from the National Health Information System and should be requested from DRC MoH.

Ethics and consent

Johns Hopkins Bloomberg School of Public Health’s IRB determined this to be non-human subject research (IRB 13392, 10 July 2020). No consent was requested as no personal identifiable information was included in the data.

Paper context

Infection prevention and control activities were a central component in the COVID-19 response and supported triage, alert investigation, and surveillance activities. However, implementing triage and alert validation processes in a low-resource setting with a pre-pandemic epidemiological profile characterised by infectious diseases with symptoms like COVID-19 is challenging, not always feasible, and little documented. Context-specific considerations are required, and testing capacity remains key for future pandemic responses.

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2258711.

Additional information

Funding

No specific funding covered this work.