Overall, the study included 90 participants, 46 from the Kinshasa site and 44 from the Kimpese site (Figure 1).
The quantitative part of the study involved 60 people from both sites, 30 from the rural area and 30 from the urban area. Two focus groups were held at the Centre Hospitalier du Mont Amba, respectively attended by 8 men and 8 women. In the Kimpese health zone, 8 men gathered in the village of Kilueka, and 6 women in the village of Yanga dia Songa.
In quantitative data, most participants were male (55%). Civil servants accounted for 42%, followed by farmers (20%) and the unemployed (12%). Christianity was the predominant religion, and radio was recognised by 42% as the main source of information, followed by television (22%). Social networks provided the information for 17% (Figure 2).
Perception of the government's response to COVID-19
In Kinshasa, 67% of interviewees said they trusted government reports on the Covid-19 pandemic, versus 47% of participants in Kimpese. In Kinshasa, most interviewees (73%) believed that the government had a strong pandemic response team, compared to 50% noted in Kimpese (Table 1).
Table 1. Perception of the government's response to COVID-19 (Adapted from COVID Score-10 questionnaire, Lazarus et al., 2020).
| Questions | KINSHASA,
N (%) | KIMPESE,
N (%) | p |
|---|
| Yes | Partially | No | Yes | Partially | No | |
|---|
| I trusted the government's reports on the spread of the epidemic and the statistics on the number of cases of COVID-19 and deaths. | 20
(67%) | 1
(3.3%) | 9
(30%) | 14
(47%) | 3
(10%) | 13
(43%) | 0.32 |
| The government provided mental health services to help people suffering from loneliness, depression and anxiety caused by the COVID-19 epidemic. | 5
(17%) | 0 (0%) | 25
(83%) | 3
(10%) | 10
(33%) | 17
(57%) | <0.01 |
| The government cooperated with other countries and international partners such as the World Health Organisation (WHO) to combat the COVID-19 pandemic. | 27
(90%) | 2
(6.7%) | 1
(3.3%) | 30
(100%) | 0
(0%) | 0
(0%) | 0.24 |
| The government has communicated clearly to ensure that everyone has the information they need to protect themselves and others from COVID-19, regardless of socio-economic level, migrant status, ethnicity or language. | 21
(70%) | 8
(27%) | 1
(3.3%) | 21
(70%) | 5
(17%) | 4
(13%) | 0.35 |
| The government has given everyone access to a free and reliable screening test for COVID-19 in the event of symptoms. | 15
(50%) | 4
(13%) | 11
(37%) | 23
(77%) | 7
(23%) | 0
(0%) | <0.01 |
| The government ensured that we always had full access to the health services we needed during the epidemic. | 12
(40%) | 7
(23%) | 11
(37%) | 20
(67%) | 7
(23%) | 3
(10%) | 0.037 |
| The government provided special protections for vulnerable groups at higher risk such as the elderly, the poor, migrants, prisoners and the homeless during the COVID-19 epidemic. | 0
(0%) | 2
(6.7%) | 28
(93%) | 3
(10%) | 11
(37%) | 16
(53%) | <0.01 |
| The government had a strong pandemic response team, including public health and medical experts, to manage our national response to the COVID-19 outbreak. | 22
(73%) | 1
(3.3%) | 7
(23%) | 15
(50%) | 7
(23%) | 8
(27%) | 0.053 |
| The government helped me and my family to meet our daily needs during the COVID-19 epidemic in terms of income, food and housing. | 17
(57%) | 1
(3.3%) | 12
(40%) | 10
(33%) | 13
(43%) | 7
(23%) | <0.01 |
For symptomatic individuals, half of people in Kinshasa had free and reliable access to COVID-19 testing, versus 77% in Kimpese. Most participants (90% in Kinshasa and 100% in Kimpese) affirmed that the DRC government liaised with other countries and international partners to fight the COVID-19 pandemic. For both sites, 70% of respondents believed that the government had clearly communicated on Covid-19, regardless of socio-economic level, ethnicity or language. However, 83% of interviewees in Kinshasa versus 57% in Kimpese assumed that the DRC government did not provide mental health services to help people suffering from Covid-19 associated loneliness, depression and anxiety. Additionally, 93% of respondents in Kinshasa versus 53% in Kimpese believed that the government had not provided special protections for vulnerable groups (elderly, the poor, migrants, prisoners, and the homeless) during the COVID-19 pandemic.
Most respondents in Kinshasa were aware of the mitigation measures taken by the government against COVID-19 such as mandatory mask wearing, ban on public gatherings (closure of schools, universities, churches, restaurants and bars), lockdown and travel restrictions. The government has also encouraged the use of infection prevention measures such as masks, hand sanitisers and social distancing.
One participant said:
"There were adverts on television to raise people's awareness and in strategic places like supermarkets, banks, shops, schools and hospitals, there was water to wash your hands, all these preventive measures were a condition of access to all these places".
And another added: "Of course, but it was serious at the start of the pandemic, hand washing had a good impact on infectious diseases".
Regarding travel, most opinions expressed were unanimous:
"The instructions were there, but they weren't respected, because people travelling within the country travelled easily; there was much more rigour for those travelling outside the country".
Regarding the lockdown, respondents in Kinshasa said that it had not been applied throughout the city, but only observed at the beginning. One woman added: "No, because where I live there has never been any containment".
When asked about the availability and importance of laboratory tests, respondents replied: "Yes, there were free laboratory tests, which were very important and available, but they weren't reliable. Yes, everyone was entitled to a free COVID screening test".
"The tests were paid for at the airport when you travelled abroad, costing US$30 or US$40. The tests were used to detect positive cases and isolate them from the rest of the population".
On the therapeutic protocols used:
According to a nurse at the Mont Amba Hospital, "There was a protocol that we adapted for anyone positive for COVID-19 to follow but not a new specific drug, this protocol was effective for the majority of patients even if some showed resistance".
For a companion: "Yes, the traditional plant-based medicines (kongo a bololo, sinda, bulukutu). The medicines were really effective".
As for the disruption to other routine services, one mother said: "Yes, services were disrupted because health professionals were afraid to see patients, especially without protective equipment".
Another said: "Certain diseases were neglected, such as HIV, and all patients who came in with symptoms similar to those of COVID were received with difficulty and designated as suffering from COVID".
Strategies for improving national responses to pandemics
Among the strategies proposed by the people interviewed, we noted the following:
"Raise people's awareness, explain the pandemic in a down-to-earth way to get down to the lowest level of understanding because in the community Covid was referred to as a disease of the rich and white".
"Raise awareness and give people on low incomes the means to protect themselves and others, because certain measures were costly for some. The government needs to show more responsibility.
In Kimpese, most participants provided information on the barrier measures introduced by the government i.e. the wearing of face masks; physical and social distancing; hand washing; a ban on public gatherings (church, mourning, school, market), hand-shaking and hugging, travelling abroad. According to the participants, the government had strongly encouraged the use of these preventive measures, especially in the capital and large cities. They believe that mitigation measures have had a positive impact in preventing infections. They maintain that lockdown was used in large cities, while free laboratory tests were reserved for large health facilities. They support that routine healthcare was not disrupted and traditional remedies were widely used, especially in rural areas, as the disease manifested itself in the form of flu.
Regarding adherence to preventive measures, a resident of Kilueka said: "There was one measure that put a lot of pressure on hand washing, physical distancing and the wearing of mufflers everywhere and at all times, especially on public transport. We were very pleased with all these measures, which could well reduce the rate of contamination".
A resident of Yanga dia Songa said: "It's true that the government has encouraged the use of infection prevention measures, but what's regrettable is that the emphasis was very much on the capital (Kinshasa), while we in the provinces were somewhat sidelined. There was a lack of attention for us in the provinces".
"The capital is more overcrowded than our province. For example, here you can travel just as many kilometres without meeting ten or fifteen people along the way. You can leave our village and go to the next village without meeting a single person on the way, so you're free to move around. But in the big centres you must be very careful, because there are lots of people moving around at the same time, and you shouldn't get mixed up with them, because you run the risk of contaminating yourself”.
About the lockdown
"In my opinion, this lockdown was not a good thing, it put us in a difficult situation, because it was impossible to manage to find enough to feed our children. Apart from that, the state banned school, so the children stayed at home for a long time, which was a real disruption, and I didn't like it.
Travel restrictions
"Yes, the government had banned travel at the start of the pandemic, and it was only afterwards that vaccination cards were required at checkpoints, as well as having a temperature taken before going through.
Screening tests
When asked if your government had used laboratory tests, one replied
"In Kimpese, Covid-19 tests were carried out at the Evangelical Medical Institute (IME). That's where we heard that so many people had been contaminated by this virus".
"Symptoms of Covid-19 were communicated, and we were ordered to accompany anyone showing these symptoms to the IME. Infected people were put in isolation, no one was allowed near them, it was always there at the IME", added another respondent.
Treatment options
A Kilueka resident had this to say about treatments for COVID-19:
"I can add that COVID-19 used to scare us when you had intermittent fevers and a persistent cough, so we had to start thinking about fumigation, which is a traditional practice that helped us to resolve the problem a little without using modern medicines. …The leaves used in this practice were "KONGO YA SIKA", "MBOTA", "ACACIA", "MAZUDI", lemon leaves and other plants. All these plant leaves were boiled in the same pot and then tipped into a bucket to inhale the smoke they gave off.
Strategies for improving national responses to pandemics
Among the strategies proposed by respondents in the Kimpese health zone, we noted the following:
"This disease really bothered us. All our activities were blocked and disrupted. Especially as we didn't go out, we just stayed at home. Because it was impossible to sell our goods or even to buy things. What the government should be doing is taking precautions, such as making food available to the population”.
"In my opinion, the government needs to improve the health systems, especially in terms of equipment, so that this problem of confusion no longer exists. If there is a good screening device, then COVID will be COVID and malaria will remain malaria”.
"For the next pandemics, the government should think about the needs of the population, for example that masks should be given free of charge, hand washing equipment, and why not that food should be free of charge for as long as it lasts".
Gains from the pandemic
According to the farmers, the government's management of the COVID-19 pandemic has had some positive consequences: "What we have gained from this period is the rigour of our borders, where there was too much complacency. Anyone could cross the border without being checked. Today, thanks to COVID-19, checks are even carried out at provincial entrances, and this approach can help the government to respond better in the event of a future pandemic”.
