As of June 11, 2020, the Democratic Republic of the Congo (DRC) has reported 4,258 COVID-19 cases with 90 deaths. With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. The DRC recently controlled its tenth Ebola virus disease (EVD) outbreak, but COVID-19 and a new EVD outbreak beginning on June 1, 2020 in the northwestÉquateur Province have added an additional burden to health services. Although the epidemiology and transmission of EVD and COVID-19 differ, leveraging the public health infrastructures and experiences from coordinating the EVD response to guide the public health response to COVID-19 is critical. Building on the DRC's 40 years of experience with 10 previous EVD outbreaks, we highlight the DRC's multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. We also highlight remaining challenges and discuss the way forward for achieving control of both COVID-19 and EVD in the DRC.

BackgroundAlthough malaria rapid diagnostic tests (RDT) are simple to perform, they remain subject to errors, mainly related to the post-analytical phase. We organized the first large scale SMS based external quality assessment (EQA) on correct reading and interpretation of photographs of a three-band malaria RDT among laboratory health workers in the Democratic Republic of the Congo (DR Congo).Methods and FindingsHigh resolution EQA photographs of 10 RDT results together with a questionnaire were distributed to health facilities in 9 out of 11 provinces in DR Congo. Each laboratory health worker answered the EQA by Short Message Service (SMS). Filled-in questionnaires from each health facility were sent back to Kinshasa. A total of 1849 laboratory health workers in 1014 health facilities participated. Most frequent errors in RDT reading were i) failure to recognize invalid (13.2–32.5% ) or negative test results (9.8–12.8%), (ii) overlooking faint test lines (4.1–31.2%) and (iii) incorrect identification of the malaria species (12.1–17.4%). No uniform strategy for diagnosis of malaria at the health facility was present. Stock outs of RDTs occurred frequently. Half of the health facilities had not received an RDT training. Only two thirds used the RDT recommended by the National Malaria Control Program. Performance of RDT reading was positively associated with training and the technical level of health facility. Facilities with RDT positivity rates >50% and located in Eastern DR Congo performed worse.ConclusionsOur study confirmed that errors in reading and interpretation of malaria RDTs are widespread and highlighted the problem of stock outs of RDTs. Adequate training of end-users in the application of malaria RDTs associated with regular EQAs is recommended.

No abstract

No abstract

Purpose Nationwide analyses are required to optimise and tailor activities to control future COVID-19 waves of resurgence continent-wide. We compared epidemiological and clinical outcomes of the four COVID-19 waves in the Democratic Republic of Congo (DRC). Methods This retrospective descriptive epidemiological analysis included data from the national line list of confirmed COVID-19 cases in all provinces for all waves between 9 March 2020 and 2 January 2022. Descriptive statistical measures (frequencies, percentages, case fatality rates [CFR], test positivity rates [TPR], and characteristics) were compared using chi-squared or the Fisher–Irwin test. Results During the study period, 72,108/445,084 (16.2%) tests were positive, with 9,641/56,637 (17.0%), 16,643/66,560 (25.0%), 24,172/157,945 (15.3%), and 21,652/163,942 (13.2%) cases during the first, second, third, and fourth waves, respectively. TPR significantly decreased from 17.0% in the first wave to 13.2% in the fourth wave as did infection of frontline health workers (5.2% vs. 0.9%). CFR decreased from 5.1 to 0.9% from the first to fourth wave. No sex- or age-related differences in distributions across different waves were observed. The majority of cases were asymptomatic in the first (73.1%) and second (86.6%) waves, in contrast to that in the third (11.1%) and fourth (31.3%) waves. Conclusion Despite fewer reported cases, the primary waves (first and second) of the COVID-19 pandemic in the DRC were more severe than the third and fourth waves, with each wave being associated with a new SARS-CoV-2 variant. Tailored public health and social measures, and resurgence monitoring are needed to control future waves of COVID-19.