Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 20;17(1):24.
doi: 10.1186/s13031-023-00523-y.

The first year of the COVID-19 pandemic in humanitarian settings: epidemiology, health service utilization, and health care seeking behavior in Bangui and surrounding areas, Central African Republic

Chiara Altare  1   2 , Natalya Kostandova  3   4 , Gbètoho Fortuné Gankpe  5 , Patricia Nalimo  5 , Abdoul Azizi Almoustapha Abaradine  5 ; IMPACT CAR Team; Sophie Bruneau  6 , Caroline Antoine  6 , Paul B Spiegel  3   4
Affiliations

The first year of the COVID-19 pandemic in humanitarian settings: epidemiology, health service utilization, and health care seeking behavior in Bangui and surrounding areas, Central African Republic

Chiara Altare et al. Confl Health. .

Abstract

Background: Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas.

Methods: This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions.

Results: The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from - 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; - 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from - 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care.

Conclusions: A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed.

Keywords: COVID-19; Central African Republic; Health care seeking behavior; Health care utilization; Humanitarian settings.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trend of testing, incidence, and positivity rate per 100,000 population, March 2020 to April 2021, Central African Republic. Note: Testing rate only reflects tests conducted at the Institut Pasteur as the total number of conducted tests at the LNBCSP was unavailable
Fig. 2
Fig. 2
Percent deviation from expected values by indicator and health district, 2017–2021, Central African Republic
See this image and copyright information in PMC

References

    1. Johns Hopkins Coronavirus Resource Center. COVID-19 Dashboard, https://coronavirus.jhu.edu/map.html (2020, accessed 12 May 2021).
    1. Cameron E, Nuzzo JB, Bell J. Global Health Security Index, https://www.ghsindex.org (2019).
    1. IFRC, IOM, UNHCR, et al. Interim Guidance on Scaling-up COVID-19 Outbreak Readiness and Response Operations in camps and camp-like settings. Geneva, https://interagencystandingcommittee.org/other/interim-guidance-scaling-... (2020).
    1. Lau LS, Samari G, Moresky RT, et al. COVID-19 in humanitarian settings and lessons learned from past epidemics. Nat Med. 2020;26:647–648. doi: 10.1038/s41591-020-0851-2. - DOI - PubMed
    1. Gilbert M, Pullano G, Pinotti F, et al. Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet. 2020;395:871–877. doi: 10.1016/S0140-6736(20)30411-6. - DOI - PMC - PubMed

LinkOut - more resources