UCLA

Mounting an effective response to an emergent pathogen, such as SARS-CoV-2, can be particularly challenging for public health systems that are overburdened and under resourced, like that in the Democratic Republic of the Congo (DRC). Conversely, the DRC has an extensive history combatting infectious diseases, and perhaps, one of the most practiced health workforces, globally, in the prevention and control of emergent diseases, such as Ebola virus disease (EVD). However, the extent of knowledge, attitudes, and practice (KAP) among HCWs in DRC during the COVID-19 pandemic is not well understood. This dissertation utilizes repeated measures of KAP collected via 25 phone interviews among four cohorts of Congolese HCWs (N=545) from communities with varied EVD history throughout a year of the pandemic (August 2020 to August 2021) to enhance awareness of fluctuations in KAP over time and between cohorts in this population. Chapter 1 summarizes the epidemiology and prevention and control strategies for COVID-19 and EVD, both generally and in the context of DRC. Chapter 2 assesses potential and perceived COVID-19 risk reported by the sample; the probability of providing care to a patient with COVID-19 symptoms increased modestly in each cohort throughout the study, while perceptions of risk remained comparatively stable over time but differed by cohort. Chapter 3 assesses perceptions of efficacy of six COVID-19 prevention behaviors and compliance with those same behaviors; most of the sample consistently reported the efficacy of each behavior throughout the study, but fluctuations in compliance with mask wearing, avoiding gathering, and socially distancing were observed over time as well as differences between cohorts. Chapter 4 assesses workplace safety measures specifically during periods of concurrent EVD outbreaks in Mbandaka and Beni. Perceptions of workplace safety remained relatively stable during the study regardless of EVD outbreaks, but cohort differences were observed. Fluctuations in access to cloth and surgical face masks over time and consistently low access to N95 face masks were also found. This dissertation establishes a reference for KAP among a sample of HCWs in DRC during a major infectious disease event and indicates that longitudinal and subnational analyses are warranted to adequately identify potential barriers to future outbreak response.