Infection prevention and control measures during the COVID-19 pandemic in sub-Saharan Africa: a multinational cross-sectional study.

OBJECTIVES

To assess the implementation of infection prevention and control (IPC) measures and associated factors in healthcare in low-resource settings during the COVID-19 pandemic.

DESIGN

Multinational cross-sectional study.

SETTING

The study was conducted from February to November 2022 in Côte d'Ivoire, Democratic Republic of Congo, Madagascar and Nigeria.

PARTICIPANTS

A total of 6749 healthcare workers (HCWs) at 324 healthcare facilities (HCFs) were enrolled from different levels of care and types.

PRIMARY AND SECONDARY OUTCOMES: Standardised HCW and HCF questionnaires assessed COVID-19-related exposures and IPC measures and descriptive analyses were conducted overall and by country and HCF. Partial proportional odds models were used to assess factors associated with HCW compliance to hand hygiene and mask wearing.

RESULTS

Among 324 HCFs, the reported presence of IPC programmes ranged from 51.4% (n=111) at primary non-hospitals to 83.3% (n=18) at tertiary HCFs. More than half reported no patient or HCW screening (57.4%, n=186). Only 19.8% (n=64) reported handrub at point of care in every room. Among 6749 enrolled HCWs, 54.0% were working in high-risk patient care. More HCWs reported sufficient availability of masks (62.7%, n=4231) compared with respirators (28.5%, n=1926). HCW compliance with hand hygiene and mask wearing, respectively, was improved by presence of an IPC programme (OR: 1.3, 95% CI 1.2 to 1.5; OR: 1.4, 95% CI 1.2 to 1.6), IPC training received by the HCW (OR: 1.5, 95% CI 1.3 to 1.7; OR: 1.3, 95% CI 1.2 to 1.5) and availability of handrub and masks, respectively (OR: 5.9, 95% CI 4.1 to 8.4; OR: 2.3, 95% CI 2.0 to 2.7).

CONCLUSIONS

We conducted a large survey including HCFs across levels of care and type in urban and rural regions in sub-Saharan Africa. Critical gaps in IPC programmes and access to IPC equipment during the COVID-19 pandemic hindered HCW compliance with recommended IPC practices. To improve general infection control and pandemic preparedness in low-resource settings, continued focus on strengthening IPC programmes and ensuring access to materials/equipment is essential.