Altare Chiara, Kostandova Natalya, Gankpe Gbètoho Fortuné, Nalimo Patricia, Almoustapha Abaradine Abdoul Azizi, Bruneau Sophie, Antoine Caroline, Spiegel Paul B
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA.
Confl Health. 2023 May 20;17(1):24. doi: 10.1186/s13031-023-00523-y.
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.
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.
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.
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.
尽管关于新冠病毒病（COVID-19）的证据越来越多，但在人道主义环境中开展的研究很少，且尚无研究调查该大流行在中非共和国的直接和间接影响。我们研究了班吉及其周边地区大流行第一年的COVID-19流行病学、卫生服务利用情况以及医疗保健寻求行为。
这项混合方法研究包括四个部分：对报告的COVID-19病例数据进行描述性流行病学分析；使用常规卫生服务数据对卫生服务利用情况进行中断时间序列分析；对医护人员关于卫生服务如何受到影响的看法进行定性分析；以及通过家庭调查和焦点小组讨论对社区成员的医疗保健寻求行为进行研究。
中非共和国的COVID-19流行病学情况与大多数其他国家一致，接受检测的人群及阳性病例大多为男性。检测能力主要集中在班吉，且偏向有症状的病例、旅行者和某些职业。检测阳性率很高，许多病例未被诊断出来。在大多数研究地区，门诊咨询、呼吸道感染咨询和产前护理均有所减少。各地区的累积差异范围为：贝古阿的门诊咨询减少46000次，班吉3区增加7000次；贝古阿的呼吸道感染咨询减少9337次，班吉1区增加301次；宾博的产前护理咨询减少2895次，班吉2区增加702次。疑似疟疾的咨询结果不一，而卡介苗接种剂量有所增加。与2021年夏季相比，大流行开始时报告寻求医疗护理的社区成员减少，尤其是在城市地区。害怕检测呈阳性以及遵守相关限制是寻求医疗护理的主要障碍。
在班吉及其周边地区，COVID-19大流行的第一年存在对感染情况的严重低估以及卫生服务利用减少的情况。提高分散检测能力并加大维持卫生服务利用的力度对未来疫情至关重要。需要更好地了解医疗保健可及性，这将需要加强国家卫生信息系统以确保获得可靠和完整的数据。还需要进一步研究公共卫生措施如何与安全限制相互作用。
