Health Workers Approach to the Interface of Malaria/COVID-19/Non-Malarial Febrile Illness in Kinshasa, DRC

Abstract

The global prioritization of pandemic response efforts following the emergence of SARS-CoV-2 coupled with the febrile symptom overlap between COVID-19 and malaria risked decades of malaria progress and highlighted the pre-existing challenges health systems and health workers face in appropriately diagnosing and treating febrile illnesses. This study explores how health workers at primary health care facilities in Kinshasa province, DRC are approaching diagnosis and treatment of fevers, the symptom overlap of the malaria/COVID-19/non-malarial febrile illness (NMFI) interface. 152 health workers from 34 health facilities in Lingwala urban Health Zone, and 251 health workers from 76 health facilities in Maluku I peri urban and rural Health Zone completed the structured Health Worker Questionnaire that assessed their training, knowledge, attitudes, and behaviours as they relate to fever diagnosis and treatment, and COVID-19 vaccination. Health workers reported receiving the most training on malaria (55.8%) followed by COVID-19 (34.2%), and IMCI (29.0%). Notably, since 2020 health workers indicated they received more COVID-19 training than malaria or IMCI. Participants underperformed on many of the IMCI and fever diagnosis questions. Malaria was the most commonly provided diagnosis in both health zones despite their differing low and high malarial endemicities. 95.3% agreed that RDTs make their job easier, but 46.6% also expressed that RDTs can get in the way. Lastly, the most common reason for vaccine hesitancy among the 183 (45.4%) unvaccinated health workers was fear/fear of side effects (35.0%). There appears to be a disease specific approach to health worker training. Complex social and context-specific factors may influence malaria being provided as a common diagnosis for IMCI vignettes. Health workers appear to adhere to most diagnostic and treatment guidelines on malaria but not for COVID-19. Vaccine hesitancy is lower than what previous literature had anticipated but still needs to be addressed.