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Predictors of Non-Adherence to Public Health Instructions During the COVID-19 Pandemic in the Democratic Republic of the Congo

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Predictors of Non-Adherence to Public Health Instructions During the COVID-19 Pandemic in the Democratic Republic of the Congo Journal of Multidisciplinary Healthcare Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Predictors of Non-Adherence to Public Health Instructions During the COVID-19 Pandemic in the Democratic Republic of the Congo This article was published in the following Dove Press journal: Journal of Multidisciplinary Healthcare 1,2 Michel Kabamba Nzaji, Background: Adherence to public health instructions for the COVID-19 is important for Guillaume Ngoie Mwamba,1,3 Judith Mbidi Miema,2 controlling the transmission and the pandemic’s health and economic impacts. The aim of 1 Elie Kilolo Ngoy Umba, this study was to determine the associated factors of non-adherence to public health and Ignace Bwana Kangulu,1 Deca Blood Banza Ndala,4 social measures instructions. Paul Ciamala Mukendi,5 Methods: This was a cross-sectional study conducted with 1913 participants in two Denis Kabila Mutombo, 4 Marie Claire Balela Kabasu,4 provinces of DRC, Mbuji-Mayi, and Kamina. Predictors of non-adherence to COVID-19 Moise Kanyki Katala,4 John Kabunda Mbala,4 preventive measures were identified using binary logistic regression analysis. P-value<0.05 6 Oscar Luboya Numbi was considered as a significant predictor. 1Department of Public Health, Faculty of Medicine, Results: Among 1913 participants (1057 [55.3%] male, age 34.1 [14.9] years), 36.6% were University of Kamina, Kamina, Democratic Republic of the Congo; 2Operational Research defined as non-adherents. Non-adherence was associated with never studied and primary Unit, Ministry of Health, National Expanded Program for Immunization, Kinshasa, Democratic education level [adjusted odds ratio (aOR)=1.63, CI=1.31–2.03], unemployed status Republic of the Congo; 3Village Reach, Kinshasa, Democratic Republic of the Congo; 4Department [aOR=1.29, CI=1.01–1.67], living in Kamina (Haut-Lomami province) [aOR=1.63, of Epidemiology and Public Health, Nursing Care CI=1.31–2.03], female gender of head of household [aOR=1.53, CI=1.16–2.03], no attending Section, Higher Institute of Medical Techniques of Lubumbashi, Lubumbashi, Democratic Republic of lectures/discussions about COVID-19 [aOR=1.61, CI=1.08–2.40], not being satisfied with the Congo; 5Department of Teaching and Administration in Nursing, Nursing Section, Higher the measures taken by the Ministry of Health [aOR=2.26, CI=1.78–2.81], not been regularly Institute of Medical Techniques of Mbuji-Mayi, informed about the pandemic [aOR=2.25, CI=1.80–2.03], and bad knowledge about COVID- Mbuji-Mayi, Democratic Republic of the Congo; 6Department of Public Health, Faculty of Medicine, 19 [aOR=2.36, CI=1.90–2.93]. University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo Conclusion: The rate of non-observance of preventive measures for the COVID-19 pan­ demic is high, and different factors contributed. The government has to counsel the perma­ Video abstract nent updating of messages taking into account the context and the progress of the pandemic by using several communication channels. Keywords: predictors, adherence, public health instructions, COVID-19 pandemic, DR Congo Introduction Coronaviruses (CoV) are zoonotic pathogens that can be transmitted via animal-to- human and human-to-human interactions. They are known to cause diseases including the common cold and Severe Acute Respiratory Syndrome (SARS).1 Point your SmartPhone at the code above. If you have a QR Originating from the city of Wuhan, Hubei Province, China, the 2019 novel code reader the video abstract will appear. Or use: https://youtu.be/RBTcuSkgNco coronavirus (2019-nCoV) is rapidly spreading to the rest of the world. The circum­ stantial evidence that links the first case of COVID-19 to the Huanan South Seafood Market that sells various exotic live animals suggests that the zoonotic Coronavirus crossed the barrier from animal to human at this wet market.2 It has since become Correspondence: Michel Kabamba Nzaji 3 Email [email protected] a global public health emergency. submit your manuscript | www.dovepress.com Journal of Multidisciplinary Healthcare 2020:13 1215–1221 1215 DovePress © 2020 Kabamba Nzaji et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/ http://doi.org/10.2147/JMDH.S274944 terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Kabamba Nzaji et al Dovepress The World Health Organization (WHO) designated media can affect the public’s knowledge about the risk COVID-19 a pandemic on March 11, 2020.4 The African perception and community engagement, thereby influen­ region remains the least affected continent, with 99,433 cing their decision to adopt protective measures.14,15 It is cases and 3078 deaths, but the numbers are increasing. therefore important to understand how the populations risk COVID-19 is majorly affecting many countries all over perception and their engagement. The best way to limit the the world, whereas Africa is the last continent to be hit by spread of the COVID-19 depends on public adherence to the pandemic. the public health instructions. The aim of this study is to Many countries around the world are majorly affected by identify predictors of non-adherence to public health COVID-19, but Africa is the last continent to be hit by the instructions. pandemic.5 The first case of COVID-19 in Africa was con­ firmed in Egypt on February 14, 2020, and Nigeria reported Methods the first confirmed case in sub-Saharan Africa, in an Italian Study Design, Site, and Participants patient who flew to Nigeria from Italy on February 25, An analytical cross-sectional survey was conducted in the 6 2020. The government response to the pandemic on the towns of Mbuji-Mayi (Kasai oriental province) and continent has not been without challenges. Airport screening Kamina (Haut-Lomami province) in DRC, in May 2020. has been implemented and mitigation efforts such as hand washing, social distancing, and stay-at-home lockdown Study Population, Inclusion, and Exclusion measures have also been adopted. However, in the long- term these measures are unsustainable due to the socioeco­ Criteria nomic dynamics in most African states.7 The target was the female or male population, aged at least In the Democratic Republic of the Congo (DRC), the 18 years living in both cities for at least 6 months. We first COVID-19 case was reported on March 10, 2020.8 included all participants who gave consent to participate in According to the latest report from the DRC COVID-19 the study and were found at home at the moment of the Taskforce and Ministry of Health, the numbers of infected survey. We excluded those who did not give consent for people in DRC reached 2660 on 27 May 2020, including participation in the study and were not found at home at 69 deaths.9 Since the first case of 2019-nCoV was regis­ the moment of the survey. tered in the DRC, no cases have been reported in Mbuji- Mayi and Kamina. Sampling Vaccine may not be available in the early stages of The sample size was calculated using the following for­ a pandemic. So, non-medical measures such as the promo­ mula: n≥(Zα2.p.q)/d2, where the p represents the propor­ tion of individual protection (hand hygiene and face tion of non-adherence to public health measures during the masks), imposing travel restrictions, and social distancing COVID-19 pandemic (we assumed that p=50% because of possibly infected cases are essential to reduce the pos­ this proportion in the DRC is unknown), q(1−p), z-value sibility for new infections.10 The willingness of the general of the standard normal distribution corresponding to public plays an important and decisive role in achieving a significance level of alpha of 0.01 (2.58) and d the such measures recommended by public health precision degree that we assumed to be 3% too. The authorities.11 minimal size computed was 1849 participants. A total of It remains the health issues to lead the population to 1913 participants present in the health facilities were observe unconditionally these recommended preventive selected. actions. However, it remains difficult to motivate people to adopt preventive behavior. Risk perception is identified Data Collection as one of the factors contributing to an increase in public Data were collected with the use of a semi structured participation in adopting preventive measures.12,13 A high tablet-based questionnaire, which consisted of two parts: level of people’s risk perception can influence the intention demographics and KAP. Demographic variables included to adopt protective measures. Effective risk communica­ age, gender of interviewee, gender of head of household, tion is an essential element of outbreak management. marital status, religion, current employment status, town, Receiving information through different origins such as and the source information of COVID-19 related knowl­ the ministry of health, frontline workers, and social edge. The second part included 23 questions regarding 1216 submit your manuscript | www.dovepress.com Journal of Multidisciplinar y Healthcar e 2020:13 DovePress Dovepress Kabamba Nzaji et al COVID-19 related knowledge, and the last seven ques­ Results tions probing for observance to each of the instructions The overall data are described in Table 1. In summary, of released to the public by the Ministry of Health.
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