{"_asset":{"@search.score":5.2653027,"Name":"The first line. Study on population of caregivers in contact with epidemic patients in the Sahel, the case of SARS-CoV-2","AlternateTitleCommaDelimited":"","Id":"8909","AssetLocationUri":null,"Abstract":"

INTRODUCTION

The health systems of countries in the South and the North have been directly affected by the COVID-19 pandemic. Healthcare workers have paid a high price. The aim of this study was to better describe the personnel who are on the front line when patients visit health care facilities and to analyze their risk factors for exposure, their perception of infection and the prevention practices implemented by these health care workers.

METHODS

A cross-sectional study was conducted over a 6-month period from October 2021 to March 2022 (i.e., at a distance from the index cases) among health care workers in 62 integrated health centers and five public urban hospitals in Niamey and Dosso. Information on socio-demographic characteristics, clinical symptoms, co-morbidities, knowledge and attitudes, and vaccination status was collected by means of a questionnaire. Blood samples were taken for serological analysis for each agent included.

RESULTS

A total of 733 agents were included, mostly women (628, 85.67%) with a mean age of 40.5 years. Only 5.5% (40/733) of the workers reported having been in contact with a positive case of Covid-19. The most common method of protection was the use of alcohol and soap for hand hygiene. 76% of them reported having been vaccinated against the SARS-CoV2 virus. However, only 7.7% reported having used a Covid-19 diagnostic test in the last few months. IgM and IgG COVID-19 serologies were positive in 1.2% and 92.2% of the health care workers, respectively, during the survey period.

CONCLUSION

In Niger, frontline health workers have been widely exposed to SARS CoV-2, but most of them don't think so. As a result, in their daily practice, they make poor use of means to prevent and control COVID-19 infection and rarely use diagnostic tests in case of illness. Vaccination was widely accepted by these staff, according to their statements.

","PublicationOrPresentationDate":"2024-07-26T00:00:00Z","LastModifiedDate":"2024-07-30T20:24:39.739Z","IsDeleted":false,"DigitalObjectIdentifier":"10.21203/rs.3.rs-4675025/v1","ContentTypeName":"Pre-Print","ParentContentTypeName":"Journal Article","JournalName":"Research Square","ContentType":"Journal Article > Pre-Print","AvailabilityTypeId":1,"AvailabilityType":"Full Text","JournalIssue":null,"JournalVolume":null,"JournalPages":null,"JournalAbbreviation":null,"Conference":null,"ConferenceStartDate":null,"ConferenceEndDate":null,"content":"\nPage 1/25\n\nThe �rst line. Study on population of caregivers in\ncontact with epidemic patients in the Sahel, the case\nof SARS-CoV-2\nHamidou Lazoumar Ramatoulaye \n\nCentre de Recherche Médicale et Sanitaire\nKaridio Diori Ibrahim \n\nCentre de Recherche Médicale et Sanitaire\nMahamadou Almahamoudou Maiga \n\nEPICENTRE\nZeinabou Alhassane \n\nCentre de Recherche Médicale et Sanitaire\nFakani Aboutalib Aliane \n\nCentre de Recherche Médicale et Sanitaire\nFrançois Comlan Aida Sylviane \n\nCentre de Recherche Médicale et Sanitaire\nAbdoul Kadiri Aouta Zeinabou \n\nCentre de Recherche Médicale et Sanitaire\nIdi Issa \n\nCentre de Recherche Médicale et Sanitaire\nBibata Abdou Sidikou \n\nCentre de Recherche Médicale et Sanitaire\nGarda Idé Oumarou \n\nCentre de Recherche Médicale et Sanitaire\nAli sidiki \n\nCentre de Recherche Médicale et Sanitaire\nAmina Moussa \n\nCentre de Recherche Médicale et Sanitaire\nMoussa Siga Abdoul Nasser \n\nCentre de Recherche Médicale et Sanitaire\nMariama Abdoulaye \n\nDirection Régionale de la Santé Publique de Niamey\nIbrahim Tassiou \n\nDirection Régionale de la Santé Publique de Dosso\n\nhttps://doi.org/10.21203/rs.3.rs-4675025/v1\nhttps://doi.org/10.21203/rs.3.rs-4675025/v1\n\n\nPage 2/25\n\nSandrine Bouille \nSolidarité Thérapeutique et Initiative pour la Santé\n\nRoubanatou Abdoulaye Mamadou \nSolidarité Thérapeutique et Initiative pour la Santé\n\nSabo Haoua Seini \nCentre de Recherche Médicale et Sanitaire\n\nFranck Lamontagne \nSolidarité Thérapeutique et Initiative pour la Santé\n\nRonan Jambou \nInstitut Pasteur\n\nArticle\n\nKeywords: COVID-19, Health workers, serology, vaccination\n\nPosted Date: July 26th, 2024\n\nDOI: https://doi.org/10.21203/rs.3.rs-4675025/v1\n\nLicense:   This work is licensed under a Creative Commons Attribution 4.0 International License. Read\nFull License\n\nAdditional Declarations: No competing interests reported.\n\nhttps://doi.org/10.21203/rs.3.rs-4675025/v1\nhttps://creativecommons.org/licenses/by/4.0/\nhttps://creativecommons.org/licenses/by/4.0/\n\n\nPage 3/25\n\nAbstract\nThe health systems of countries in the South and the North have been directly affected by the COVID-19\npandemic. Healthcare workers have paid a high price. The aim of this study was to better describe the\npersonnel who are on the front line when patients visit health care facilities and to analyze their risk factors\nfor exposure, their perception of infection and the prevention practices implemented by these health care\nworkers.\n\nMethods A cross-sectional study was conducted over a 6-month period from October 2021 to March 2022\n(i.e., at a distance from the index cases) among health care workers in 62 integrated health centers and\n�ve public urban hospitals in Niamey and Dosso. Information on socio-demographic characteristics,\nclinical symptoms, co-morbidities, knowledge and attitudes, and vaccination status was collected by\nmeans of a questionnaire. Blood samples were taken for serological analysis for each agent included.\n\nResults: A total of 733 agents were included, mostly women (628, 85.67%) with a mean age of 40.5 years.\nOnly 5.5% (40/733) of the workers reported having been in contact with a positive case of Covid-19. The\nmost common method of protection was the use of alcohol and soap for hand hygiene. 76% of them\nreported having been vaccinated against the SARS-CoV2 virus. However, only 7.7% reported having used a\nCovid-19 diagnostic test in the last few months. IgM and IgG COVID-19 serologies were positive in 1.2%\nand 92.2% of the health care workers, respectively, during the survey period.\n\nConclusion: In Niger, frontline health workers have been widely exposed to SARS CoV-2, but most of them\ndon't think so. As a result, in their daily practice, they make poor use of means to prevent and control\nCOVID-19 infection and rarely use diagnostic tests in case of illness. Vaccination was widely accepted by\nthese staff, according to their statements.\n\nIntroduction\nThe COVID-19 pandemic has had an impact on the world of work, particularly in health care settings.\nHealthcare workers (HCPs) have experienced profound changes in their working conditions. However, they\noften had few resources and information at their disposal, especially at the beginning of the pandemic (1).\n\nIn the South, structures such as health centers were at the forefront of receiving patients. Given the\nbanality of the clinical signs of the disease, patients with COVID-19 did not stand out from other\nconsultations. The protective attitude had to be extended to all patients received. The Ministry of Health\norganized a rapid response and mobilized a signi�cant amount of resources to �ght the pandemic.\nHowever, the provision of protective equipment to peripheral health structures was a lengthy process, and\nhealth care workers were ill-equipped for a number of weeks or even months. Respirators were purchased\nto treat severe cases. Biological diagnostics were organized for the whole country.\n\nIn countries like Niger, doctors were able to follow the evolution of knowledge through specialized media\non the Internet, but ultimately it was nurses, caregivers and maintenance staff who were on the front lines\nof the epidemic, with little information available to them most of the time. How did they react? What\n\n\n\nPage 4/25\n\nresources did they really have at their disposal and how did they make use of them? (2)? These questions\nare crucial to anticipate other, potentially more deadly epidemics. And to learn from this di�cult period.\n\nNiger, like other countries in the world, has been confronted with the SARS-CoV-2 disease (COVID-19)\npandemic (o�cially since 19 March 2020), and all the regions of the country have been affected by the\npandemic (3). However, it seems to have been relatively spared by the epidemic in terms of mortality. In\nDecember 2002, a total of 9,506 cases were recorded, including 315 deaths. This represents 0.039% of the\ntotal population. However, several seroprevalence studies conducted in the subregion showed that this\nnumber of infected people was greatly underestimated compared with the number of reported cases (3, 4,\n5). Frontline workers were then largely exposed to positive individuals early in the epidemic. They paid a\nheavy price, with 184 deaths out of a total of 1059 con�rmed cases in the �rst few months of the epidemic\nand 17.4% of the total number of reported deaths (3). According to the number of cases reported, Niamey,\nthe country's capital, was the epicentre of the pandemic. It accounted for more than 70% of the con�rmed\ncases (7).\n\nThe aim of this study was to describe the characteristics of health workers directly or indirectly involved in\nmanaging patients with COVID-19 in primary care structures, as well as their access to personal protective\nequipment, including vaccination. A serological study was carried out to correlate these pro�les with SARS-\nCoV-2 positivity. This was done regardless of the origin of the positivity, infection or vaccination.\n\nPATIENTS, MATERIALS and METHODS\nFramework and study period\n\nThe study was carried out in integrated health centers in Niamey and Dosso and in regional hospitals. It\ntook the form of a cross-sectional survey. The surveys took place from 20 December to 22 February 2022\nin Niamey and from 31 December 2021 to 10 January 2022 in Dosso. Healthcare workers of all ages, sexes\nand professional pro�les in contact with patients and �uids who agreed to answer the questionnaire were\nthe target population of this study.\n\nSampling strategy\n\nThe minimum sample size was calculated globally to ensure an accuracy of +/- 5% of the results obtained.\nA non-response and invalid questionnaire rate of 10% was maintained. A total of 384 people were expected\nto answer the questionnaire correctly, so 422 people had to be interviewed, the number of people enrolled\nwas increased to 733, which was retained to allow for subgroup analyses. In Niamey and Dosso, a sample\nof 633 and 100 respectively was included. The number of agents working in the health facility was used to\ncalculate the number of agents to be registered by structure. Within each health facility, the selection of\nagents was random.\n\nData and samples collected\n\n\n\nPage 5/25\n\nSociodemographic characteristics (sex, age, occupation, etc.), adherence to protective measures, use of\nthe COVID-19 diagnostic test for oneself, signs suggestive of COVID-19 in the last six months, co-\nmorbidities and vaccination status were collected by means of a questionnaire.\n\nFrom all participants, a 2 ml blood sample was collected in a dry tube. The samples were sent to the\nlaboratory in the best conditions in accordance with the recommendations of the laboratory.\n\nSerological techniques\n\nBoth rapid diagnostic tests (TDRs) and ELISA were used to detect anti-SARS CoV-2 IgM and IgG\nantibodies. At the dispensaries, samples were �rst analyzed using STANDARD™ Q Covid-19 IgM/IgG\nCombo Test cassettes (REF/Q-NCOV-01C). All samples were then laboratory ELISA tested using Invitrogen\nHuman SARS-COV-2 Spike Ig Total ELISA Kit (BMS2323TEN) according to the manufacturer's\nrecommendations.\n Anti-SARS-CoV-2 antibody positivity was interpreted according to the vaccination status of the individual.\nIn vaccinated individuals, the presence of antibodies was considered indicative of vaccination. In\nunvaccinated individuals, antibodies were considered indicative of SARS-CoV-2 infection.\n\nAnalyzes of epidemiological data\n\nData were collected by questionnaire, stored in an anonymized database and analysis using R software\nversion3.6.1.\n The seroprevalence of COVID-19 among health workers in the target health facilities was described in\nterms of socio-demographic characteristics, clinical signs compatible with COVID-19 (last 6 months),\nhistory of diagnosis of COVID-19 (documented). Secondly, the knowledge, perceptions, attitudes and\npractices of health professionals regarding COVID-19 and how to prevent it were assessed.\n\nThe descriptive analyses and the analyses of attitudes and practices with regard to COVID-19 were\nfocused on all respondents and the results are presented as percentages. Analyses of risk factors for\nSARS-CoV-2 infection focused only on unvaccinated individuals, using the presence or absence of IgM\nand/or IgG antibodies as the dependent variable. The risk factors associated with positive serology were\ndetermined using logistic regression. The logistic regression was �rst unadjusted and then adjusted.\nUnivariate analysis was performed to select variables to be included in the model using the chi2 test with a\np<0.2 cut-off for selection. Interactions between variables were assessed. Confounding variables and\nassociations were expressed as odd ratios (ORs). 95% con�dence intervals (CI) were used. A p-value <\n0.05 was considered signi�cant.\n\nEthical considerations\n\nThis research was conducted in accordance with the norms and standards of the Helsinki declaration of\nOctober 2013. The personal data recorded and analyzed complies with the recommendations of the\nNational Agency for the Protection of Personal Caracter Data of Niger, under Law 2019-71 of December 24,\n2019 amending Law 2017-28 of May 03, 2017. Its implementing decree is N°2020-309 of April 20, 2020.\n\n\n\nPage 6/25\n\nThe protocol was approved by the National Ethics Committee for Health Research (CNERS) of Niger\n(deliberation order No. 067/2021/CNERS of 28.10.2021). Informed written consent was obtained from all\nhealth professionals involved in the study. An identi�cation number was assigned to all agents enrolled at\nthe study site. Only anonymize personal data were stored to ensure data con�dentiality.\n\nInformation and Consent \n\n Information note \n\nHealth care staff in the departments included in this study were informed about the study's procedures.\nThey were provided with clear and appropriate information regarding the objectives of the study, the nature,\nthe procedures (questionnaire, sampling), the risks, the bene�ts of the study, the management of data\ncon�dentiality and their right to refuse to participate in the study. This information was provided by the\n�eld study implementation team through an information note prior to the administration of the\nquestionnaire and the blood sample.\n\nInformed consent\n\n Informed consent was obtained from all healthcare professionals willing to participate in the study before\nany procedures were performed as part of the study by a trained member of the study team. Each\nparticipant has been informed that participation in the study is voluntary and that they are free to withdraw\nfrom the study without justi�cation at any time, without consequences and without affecting their\nprofessional responsibilities. He also requested permission to take the samples necessary for the study, to\nuse the epidemiological data for the purposes of the study, to transfer the samples concerning him outside\nthe country for further analysis and to retain samples for future research purposes.\n\nRisks and bene�ts \n\nThis survey imposed minimal risk on the participants, involving the collection of a small amount of blood.\nAs an advantage, it has made it possible to adapt the vaccination protocol according to Covid history and\nserological status.\n\nCon�dentiality \n\nAll precautions were implemented to preserve the con�dentiality of the data collected from the health\nworkers entering the study. All subjects who participated in the study were assigned an identi�cation\nnumber by the team for the labeling of questionnaires and clinical samples. The link between this\nidenti�cation number and the individuals was maintained by the investigation team and was not disclosed\nelsewhere. When sharing data with organizations or any agency or institution, they have considered only\nthe study identi�cation number and not identi�able information.\n\nAvailability of data and materials\n\n\n\nPage 7/25\n\nOur data does not involve DNA sequence, RNA sequence, genome assembly, protein sequence or genetic\nvariation data. Rather, epidemiological data (socio-demographic characteristics, risk factors, history of\nillness and vaccination) and laboratory data (SARS-CoV-2 serology) were collected during the\nimplementation of this research. They are entered into a database and form part of the information held by\nthe Ministry of Public Health. These data are available upon reasonable request. If anyone would like to\nhave access to the data from this study, they should contact Dr. Hamidou Lazoumar Ramatoulaye. His e-\nmail is: lramatoulaye@yahoo.fr, Phone: +227 96134073.\n\nRESULTS\nStudy population \n\nA total of 733 caregivers were included in this study (Tables 1 and 2). \n\nTable 1: Socio-demographic characteristics, knowledge and sars-cov 2 serology \n\n\n\nPage 8/25\n\nCharacteristics total\n(%) \n\n nbr +\n(%) \n\n P\nvalue \n\n Characteristics total\n(%) \n\n nbr + (%) P\nvalue \n\nRegion 0.043 Vaccinated 0.258\n\n Dosso 100\n(13.6%)\n\n100 No 178\n(24.3%)\n\n162\n(91.0%)\n\n Niamey 633\n(86.4%)\n\n608\n(96.1%)\n\n Yes 555\n(75.7%)\n\n519\n(93.5%)\n\nDistrict Vaccine\n\nI 122\n(16.6%)\n\n AstraZeneca 116\n(21%)\n\n110\n(94.8%)\n\nII 172\n(23.5%)\n\n Johnson and\nJohnson\n\n127\n(22.8%)\n\n1 (100.0%)\n\nIII 101\n(13.8%)\n\n Sinopharm 312\n(56.2%)\n\n115\n(91.3%)\n\nIV 170\n(23.19%)\n\n N-Miss 178 162\n\nV 68\n(9.3%)\n\n Dose 0.394\n\nDosso 100\n(13.64%)\n\n 1st dose 140\n(25.4%)\n\n129\n(92.1%)\n\nGender 0.410 2nd dose 412\n(74.6%)\n\n388\n(94.2%)\n\n Female 628\n(85.7%)\n\n608\n(96.8%)\n\n N-Miss 181 164\n\n Male 105\n(14.3%)\n\n100\n(95.2%)\n\n Reason for not vaccinated 0.562\n\nMarital status 0.473 Needs more\ninformations\n\n49\n(27.4%)\n\n45 (91.8%)\n\n Currently\nmarried\n\n573\n(78.2%)\n\n552\n(96.3%)\n\n Fear of\nvaccine side\neffects\n\n98\n(54.7%)\n\n87 (88.8%)\n\n Not currently\nmarried\n\n160\n(21.8%)\n\n156\n(97.5%)\n\n Not convinced\nby e�cacy\n\n9 (5.0%) 9 (100.0%)\n\nAge trance 0.902 Vaccine not\noffered\n\n14\n(7.8%)\n\n14\n(100.0%)\n\n 18-39 years 343\n(46.8%)\n\n331\n(96.5%)\n\n Others 9 (5.0%) 8 (88.9%)\n\n 40 and over 390\n(53.2%)\n\n377\n(96.7%)\n\n N-Miss 554 518\n\n\n\nPage 9/25\n\nFunction 0.798 Wearing a mask in the ward\n\n Nurses 323\n(44.1%)\n\n311\n(96.3%)\n\n Not always 433\n(59.1%)\n\n404\n(93.3%)\n\n0.615\n\n Laboratory\nstaff\n\n34\n(4.6%)\n\n32\n(94.1%)\n\n Always 300\n(40.9%)\n\n277\n(92.3%)\n\n Midwife 111\n(15.1%)\n\n108\n(97.3%)\n\n Wearing a mask outside the\nward\n\n0.620\n\n Others 265\n(36.2%)\n\n257\n(97.0%)\n\n Not always 596\n(81.4%)\n\n596 (81.4)\n\nPregnancy 0.774 Always 136\n(18.6%)\n\n135 (18.4)\n\n No 335\n(91.3%)\n\n321\n(95.8%)\n\n Wearing a mask at time of\ncollect\n\n0.878\n\n Yes 32\n(8.7%)\n\n31\n(96.9%)\n\n No 374\n(51.0%)\n\n348\n(51.10.0%)\n\n N-miss 366 Yes 359\n(49.0%)\n\n333\n(48.90%)\n\nMedical ATCDs 0.238 Wearing a mask /\ncolleagues\n\n No 476\n(64.9%)\n\n457\n(96.0%)\n\n Yes almost all 175\n(23.9%)\n\n159\n(90.9%)\n\n0.226\n\n Yes 257\n(35.1%)\n\n251\n(97.7%)\n\n No all 558\n(76.1%)\n\n522\n(93.5%)\n\nClinical signs Patient wearing\na mask \n\narthrosis 2 Yes almost all 139\n(19.0%)\n\n126\n(90.6%)\n\n0.249\n\nheadache 2 No all 594\n(81.0%)\n\n555\n(93.4%)\n\nabdominal pain 4 Has already taken Covid-\ntest\n\nfever 1 No 676\n(92.2%)\n\n629\n(93.0%)\n\n0.607\n\ngoiter 1 Yes 57\n(7.8%)\n\n52 (91.2%)\n\nhemorroïds 1 Respect for\nhygiene rules\n\n0.908\n\ninfection 7 Not always 245\n(33.4%)\n\n228\n(93.1%)\n\n\n\nPage 10/25\n\ngastric ulcer 52 Always 488\n(66.6%)\n\n453\n(92.8%)\n\nSigns of Covid_19 0.726 Alcohol use for\nhands\n\n No 596\n(81.3%)\n\n575\n(96.5%)\n\n No always 305\n(41.6%)\n\n283\n(92.8%)\n\n0.916\n\n Yes 137\n(18.7%)\n\n133\n(97.1%)\n\n Always 428\n(58.4%)\n\n398\n(93.0%)\n\nContact with Covid-19+ 0.918 Soap use for\nhands\n\n No 693\n(94.5%)\n\n644\n(92.9%)\n\n Not always 280\n(38.2%)\n\n261\n(93.2%)\n\n0.798\n\n Yes 40\n(5.5%)\n\n37\n(92.5%)\n\n Always 453\n(61.8%)\n\n420\n(92.7%)\n\nTrained on Covid-19 Consult a doctor when sick 0.414\n\n No 260\n(35.5%)\n\n No 67\n(100.0%)\n\n59 (88.1%)\n\n Yes 473\n(64.5%)\n\n Yes 143\n(100.0%)\n\n131\n(91.6%)\n\n N-Miss 523 491 \n\n Table 2 : Socio-demographic and clinical characteristics of participants in Dosso and Niamey\n\n\n\nPage 11/25\n\n Dosso Niamey Total\n\nGender F H tot F H tot \n\nTotal 90 11 101 540 94 634 735\n\nClass of age\n\n20-29 23 23 111 29 140 163\n\n29-49 55 6 61 324 39 363 424\n\n>50 12 5 17 103 24 127 144\n\nN-miss 2 2 4 4\n\nVaccinated\n\n20-29 52% 52% 59% 62% 59% 58%\n\n29-49 65% 83% 67% 81% 85% 82% 79%\n\n>50 33% 100% 53% 88% 88% 88% 84%\n\ntotal 58% 91% 61% 78% 78% 78% 76%\n\nType of job (Nbr)\n\nadministrative staff 12 2 14 14\n\nward aide 3 1 4 4\n\nwelfare assistance 1 1 11 3 14 15\n\nnurse 60 6 66 223 36 259 325\n\nlab technician 9 9 22 3 25 34\n\nmedical doctor 4 1 5 4 2 6 11\n\nmaid 8 2 10 102 13 115 125\n\nNutritionist 13 4 17 17\n\ncashier 1 1 2 6 2 8 10\n\nmidwife 4 4 106 1 107 111\n\nother 3 1 4 30 25 55 59\n\ntrainee 8 2 10 10\n\nComorbidities (%)\n\nDiabetes 1,11% 9,09% 1,98% 10,93% 0% 9,31% 8,30%\n\nCancer 0% 0% 0% 0,74% 0% 0,63% 0,54%\n\nheart problem 3,33% 0% 2,97% 0,37% 0% 0,32% 0,68%\n\n\n\nPage 12/25\n\nhypertension 16,67% 0% 14,85% 14,63% 0% 12,46% 12,79%\n\nasthma 17,78% 0% 15,84% 3,89% 1,06% 3,47% 5,17%\n\npulmonary problem 7,78% 0% 6,93% 0,37% 0% 0,32% 1,22%\n\nhepatic problem 1,11% 9,09% 1,98% 0,19% 0% 0,16% 0,41%\n\nhematology problem 7,78% 0% 6,93% 1,30% 0% 1,10% 1,90%\n\npregnacy 8,89% 0% 7,92% 4,26% 0% 3,63% 4,35%\n\nHIV 1,11% 0% 0,99% 0,00% 0% 0,00% 0,14%\n\nMarital status\n\nsingle 10 10 56 31 87 97\n\ndivorced 1 1 17 1 18 19\n\nmarried 64 10 74 439 61 500 574\n\nwidow 15 1 16 28 1 29 45\n\nvaccinated\n\nsingle 60,0% 60,0% 57,1% 67,7% 60,9% 60,8%\n\ndivorced 100,0% 100,0% 88,2% 100,0% 88,9% 89,5%\n\nmarried 62,5% 90,0% 66,2% 80,2% 82,0% 80,4% 78,6%\n\nwidow 33,3% 100,0% 37,5% 78,6% 100,0% 79,3% 64,4%\n\ntotal 57,8% 90,9% 61,4% 78,0% 77,7% 77,9% 75,6%\n\nMost of them came from health structures in Niamey (86.4%), the rest from Dosso, 139 km from the\ncapital. In Niamey, health workers from communes II and IV (25.5% and 9.3% respectively) were the most\nrepresented of the �ve communes.\n Females were most represented in this study (85.7%). More than half of the staff were over 40 years old\n(53.2%). Nurses represented 44.1% of the total staff surveyed, followed by other paramedical staff (36.2%),\nmidwives (15.1%) and laboratory staff (4.6%). Most of the women were nurses (44.9%), cleaners (17%) and\nmidwives (17%). The men were nurses (40%), cleaners (14%) or had other functions. No clear difference\nemerged according to the age group of those employed, depending on where they worked. \n A signi�cant proportion had pre-existing comorbidities (257, 35%). These could potentially expose them to\na severe form of Covid-19. The most common of these comorbidities were high blood pressure (12.79%),\ndiabetes (8.30%) and asthma (5.17%). At the time of enrolment, 10% of the 317 women under the age of 40\nwere pregnant. Interestingly, 50% of laboratory technicians and administrative staff reported at least one\ncomorbidity. This was followed by paramedics (40%). \n\nSigns consistent with COVID-19 occurred in 18.7% of the health workers. At enrolment, 14.8% and 20.9% of\npeople in Dosso and Niamey, respectively, had signs potentially associated with COVID. There was no\n\n\n\nPage 13/25\n\nsigni�cant difference according to age. These signs were more common in women than in men (15.5 % vs.\n9 %, 21.3 % vs. 5.3 % in Dosso and Niamey, respectively). They were also more frequent in patients with no\nco-morbidities (Table 3) and in those who reported being in personal contact with COVID+ patients. \n However, despite this evidence, only 57 caregivers (7.77%) performed a COVID-19 diagnostic test at least\nonce since the beginning of the epidemic. \n\nTable 3 : Factors associated with the presence of signs of Covid-19 at enrolment\n\n \n\nDosso Niamey Total\n\nsigns of covid no yes total % pos no yes total % pos Nbr % pos\n\nAge\n\n20-29 20 3 23 13% 119 21 140 15% 163 15%\n\n29-49 51 10 61 16% 288 75 363 21% 424 20%\n\n>50 15 2 17 12% 101 26 127 20% 144 19%\n\nATCD+\n\nno 36 11 47 23% 162 48 210 23% 257 23%\n\nyes 50 4 54 7% 350 74 424 17% 478 16%\n\nGender \n\nFemale 76 14 90 16% 423 117 540 22% 630 21%\n\nMale 10 1 11 9% 89 5 94 5% 105 6%\n\nvaccine \n\nno 34 5 39 13% 115 25 140 18% 179 17%\n\nyes 52 10 62 16% 397 97 494 20% 556 19%\n\nTotal 86 15 101 15% 512 122 634 19% 735 19%\n\nThis low use of diagnostic testing was not correlated with employment, age, sex of the participant or use\nof other protective measures. On the contrary, it may be related to a very low perception of risk related to\nCOVID, as only 5.5% of the participants thought they had been in contact with infected patients. Logistic\nregression analysis to determine the variables in�uencing the use of the Covid-19 test showed that age\ngroup of persons over 50 (P=0.01), married (p=0.03), widowed (p=0.04), occupation as a laboratory\ntechnician (p=0.03), and preventive measures such as wearing a mask (p=0.02) and contact with a Covid-\n19 patient (6.5*10e-5) are factors signi�cantly in�uencing the use of the Covid-19 test (Table 4). \n\nTable 4 : Variables in�uencing the use of the Covid-19 test\n\n\n\nPage 14/25\n\n \n\nVariables\n\nTest Covid-19\n\nn(%) OR IC p\n\nMale 105(14,32) 0,6 [0,21-1,69] 0,33\n\nClass of age \n\n29-49 ans 426(58,12) 4,9 [1,51-16,44] 0,008\n\n>50 172(23,47) 5,8 [1,5-22,61] 0,01\n\nMarital status\n\nDivorced 19(2,59) 0,2 [0,01-1,59] 0,11\n\nMarried 573(78,17) 0,4 [0,13-0,94] 0,03\n\nwidower 45(6,14) 0,2 [0,02-0,98] 0,04\n\nProfession\n\nNurse 323(44,07) 1,5 [0,75-3,11] 0,23\n\nLaborantin 34(4,64) 3,4 [1,01-10,55] 0,03\n\nMidwife 111(15,14) 1,1 [0,41-2,72] 0,91\n\nAntécédents\n\nAsthma 33(4,50) 1,8 [0,60-5,28] 0,29\n\nAutres antécédents 8(1,09) 6,4 [1,27-32,29] 0,02\n\nDiabetes 37(5,05) 1,5 [0,48-4,85] 0,47\n\nHTA 63(8,59) 1,5 [0,57-3,70] 0,42\n\nWearing a mask 359(48,98) 2,1 [1,12-4,05] 0,02\n\nPatient does not wear a mash every day 594(81,04) 1,6 [0,71-3,54] 0,25\n\nContact with a Covid-19 patient 40(5,46) 5,2 [2,32-11,72] 6,5*10e-5\n\nRespect for hand hygiene always 488(66,58) 1 [0,53-1,92] 0,96\n\nWhich protections?\n\nEquipment for the prevention and control of COVID-19 infection was used very inconsistently by healthcare\nworkers. (Table II). Only 66.6% (488/733) of the participants stated that they always complied with the\nhygiene measures against COVID-19 (Table 1 and 5). \n\nTable 5 : Use of safety procedures\n\n\n\nPage 15/25\n\n \n\nDosso Niamey Total %\n\n F H total % F H Total % \n\nTotal 90 11 101 540 94 634 735 \n\nother staff wearing mask in\nward\n\nalmost none 28 2 30 0,297 11 11 0,0174 41 6%\n\nsometime 48 8 56 0,5545 391 71 462 0,7287 518 70%\n\nyes almost ever 14 1 15 0,1485 138 23 161 0,2539 176 24%\n\npatient wearing a mask in\nward\n\nalmost none 45 3 48 48% 12 1 13 2% 61 8%\n\nsometime 45 7 52 51% 412 70 482 76% 534 73%\n\nyes almost ever 1 1 1% 116 23 139 22% 140 19%\n\nwearing a mask in ward\n\nNo 9 9 9% 6 4 10 2% 19 3%\n\nrarely 15 15 15% 8 8 1% 23 3%\n\nsometime 19 4 23 23% 111 27 138 22% 161 22%\n\nfrequently 25 5 30 30% 178 22 200 32% 230 31%\n\never 22 2 24 24% 237 41 278 44% 302 41%\n\nwearing mask outside\nward\n\nNo 45 2 47 47% 64 10 74 12% 121 16%\n\nrarely 14 3 17 17% 24 4 28 4% 45 6%\n\nsometime 15 2 17 17% 229 35 264 42% 281 38%\n\nfrequently 11 2 13 13% 115 22 137 22% 150 20%\n\never 5 2 7 7% 107 23 130 21% 137 19%\n\nrespects of hygien rules\n\nno answer 2 2 2% 1 1 2 0% 4 1%\n\nno 4 4 4% 2 1 3 0% 7 1%\n\nsometime 11 2 13 13% 18 7 25 4% 38 5%\n\n\n\nPage 16/25\n\nmost of time 13 4 17 17% 144 36 180 28% 197 27%\n\never 60 5 65 64% 375 49 424 67% 489 67%\n\nhand washing\n\nNo 19 1 20 20% 8 2 10 2% 30 4%\n\nsometime 46 6 52 51% 44 12 56 9% 108 15%\n\nyes ever 25 4 29 29% 487 79 566 89% 595 81%\n\nhand washing with alcool\n\nno answer 4 1 5 5% 15 7 22 3% 27 4%\n\nno 2 1 3 3% 2 1 3 0% 6 1%\n\nsometime 5 1 6 6% 36 11 47 7% 53 7%\n\nmost of time 16 3 19 19% 171 30 201 32% 220 30%\n\never 63 5 68 67% 316 45 361 57% 429 58%\n\nhand washing with soap\n\nno answer 1 1 2 2% 7 3 10 2% 12 2%\n\nno 0% 4 4 1% 4 1%\n\nsometime 4 4 4% 22 7 29 5% 33 4%\n\nmost of time 14 5 19 19% 175 37 212 33% 231 31%\n\never 71 5 76 75% 332 47 379 60% 455 62%\n\nThe use of alcohol and soap for hand cleaning was reported by 58% and 61% of participants, respectively.\nDuring the present study, 59% of them stated that they didn't wear a mask in the ward and only 49% of\nthem really wore a mask during the registration process of the study. At the same time, 81% said that\npatients didn't wear masks during consultations and 76% said that their own colleagues didn't wear masks.\nNo signi�cant differences in awareness and use of protection were found between men and women or by\nage.\n\n Most participants reported having been vaccinated against COVID (75.7%, 555). Of these, 74.6% (412/555)\nhad received two doses. Sinopharm vaccines were the most commonly used, followed by Johnson &\nJohnson vaccines. Among those who had not been vaccinated, 49% (87/178) of the participants said that\nthey had not done so because they were afraid of the side effects of the vaccine and 25.2% (45/178)\nneeded more time to decide (Table 1). A proportion of women were less vaccinated than men, i.e. those\nliving in rural areas (57%) or living alone (widow or single) (Table 2). The youngest participants were also\nthe least vaccinated (on average 58%) and the oldest were the most vaccinated (on average 84%) (Table\n2). Analysis of factors associated with Covid-19 vaccination among health workers showed that age over\n\n\n\nPage 17/25\n\n50 years (p=0.001), married status (p=0.002), laboratory technician (p=0.003) and midwife (p=0.002) were\nstatistically associated with vaccination.\n\nSerological prevalence and risk factors\n\nIn this study, 708 or 96.58% of health workers were positive for COVID-19 serology (96.1% in Niamey and\n100% in Dosso). No statistical difference in age, sex, employment, presence of clinical signs of Covid-19 or\nmarital status was observed because of this high rate. Most nurses (90.4%), midwives (87.4%) and\nlaboratory workers (76.5%) had had SARS-CoV-2 infection. There was no signi�cant difference between\nhaving clinical symptoms and having anti-SARS-CoV-2.\n\nIn fact, 48.90% of those who wore a mask at the time of sampling, 92.3% of those who always wore a mask\nat the health center and 94.8% of those who always complied with hygiene measures had positive SARS-\nCoV-2 serologies (Table 5). This situation re�ects the idea that contamination may have occurred outside\nthe facility, in a community setting, and most importantly, that the study took place after the virus had\nspread in the community.\n\n Risk factor analysis was performed only on 178 (24.28%) unvaccinated individuals. Among them, the rates\nof positive serology for IgM and IgG were 1.12% and 91.01%, respectively.\n\n Factors associated with positive serology in unvaccinated health workers were: age group (OR 3.84 CI95%\n[1.16 50.40]), history of tuberculosis (OR 3.45 CI95% [0.85, 24.3]) and marital status with higher risk for\nunmarried (7.56, CI95% [1.40, 141]). After adjustment for age, district and employment, safety equipment,\nemployment, type of health structures, etc. were not found to be a risk factor in either Niamey or Dosso\n(Table 6). \n\nTable 6: Factors associated with positive serology among unvaccinated health personnel in health facilities\nin Niamey and Dosso.\n\n\n\nPage 18/25\n\nCharacteristics N Unajusted Ajusted for age\nand district.\n\nAjusted for age,\ndistrict, function.\n\n OR (95%-CI) OR (95%-CI) OR (95%-CI)\n\nDistrict 178\n\n Dosso\n\n Niamey 0.00 - -\n\nAge 178\n\n 18-39 years —\n\n 40 et + 1.16 (0.40,\n3.84)\n\nGender 178\n\n Female —\n\n \n Male\n\n0.58 (0.17,\n2.67)\n\n0.74 (0.21, 3.44) 0.60 (0.15, 3.00)\n\nMarital statuts 178\n\nmarried —\n\n Not married 7.50 (1.46,\n137)\n\n7.74 (1.46, 143) 7.56 (1.40, 141)\n\nFunction 178\n\n Nurses —\n\n Laboratory satff 0.51 (0.10,\n3.79)\n\n0.35 (0.06, 2.86)\n\nMidwide 0.66 (0.18,\n2.75)\n\n0.88 (0.23, 3.70)\n\n Others 1.05 (0.28,\n4.29)\n\n1.08 (0.27, 4.85) \n\nMedical ATCDs 178\n\n No —\n\n Yes 3.70 (0.99,\n24.1)\n\n2.91 (0.75, 19.2) 3.45 (0.85, 24.3)\n\nContact with a person with\nCovid-19\n\n178\n\n No —\n\n Yes 0.68 (0.11,\n13.1)\n\n0.76 (0.12, 15.0) 0.71 (0.11, 14.0)\n\n\n\nPage 19/25\n\nWearing a mask in the ward 178\n\n Not Always —\n\n Always 0.95 (0.34,\n2.93)\n\n1.29 (0.45, 3.99) 1.22 (0.42, 3.82)\n\nWearing a mask outside the\nward\n\n177\n\n Not Always —\n\n Always 1.60 (0.42,\n10.6)\n\n1.97 (0.51, 13.1) 1.82 (0.46, 12.2)\n\nWearing a mask during\nenrolment\n\n178\n\n No —\n\n Yes 0.74 (0.25,\n2.08)\n\n0.83 (0.28, 2.36) 0.76 (0.24, 2.27)\n\nWearing a mask by other\nagents\n\n178\n\n Not Almost —\n\nYes Almost all 0.92 (0.30,\n3.44)\n\n1.28 (0.41, 4.83) 1.21 (0.38, 4.62)\n\nRespect the hygiene rules 178\n\n Not Always —\n\n Always 1.17 (0.38,\n3.31)\n\n1.22 (0.39, 3.52) 1.31 (0.41, 3.95)\n\nUse of alcohol for hands 178\n\n Not Always —\n\n Always 0.94 (0.31,\n2.67)\n\n0.86 (0.28, 2.46) 0.94 (0.29, 2.91)\n\nUse of soap for hands 178\n\n Not always —\n\n Always 0.84 (0.25,\n2.42)\n\n0.77 (0.23, 2.27) 0.82 (0.24, 2.52)\n\nDISCUSSION\nThis cross-sectional observational study was carried out during the second wave of the COVID-19\npandemic in Niger. Caregivers were selected in the capital and in rural areas. The structures studied were\n\n\n\nPage 20/25\n\nmainly �rst-line dispensaries. They provide primary health care with rudimentary equipment, curative\nconsultations, vaccinations, antenatal consultations and maternity care (8).\n\nWho is in �rst line ?\n\nThe study population was representative of staff in this type of primary health care facility. The majority\nwere women (85.7%). More than half were over 40 years old (53.2%). Nurses accounted for 44% of total\nstaff. Among them, 96% in Niamey and 100.0% in Dosso had anti-SARS-CoV-2 antibodies, which is in\nagreement with other studies in Niger, such as in Maradi with 85.4% anti-SARS-CoV-2 seroprevalence\namong staff (18). However, this is much higher than in other published studies, i.e. 19.7% in Kenya (16),\n33% in RDC (17), 15.7% by TDR and 43.5% by ELISA in 2021 in Lubumbashi, Democratic Republic of Congo.\nA large proportion of these positive serologies could be attributed to vaccinated individuals. 75% of them\nreported having been vaccinated. No correlation with age, sex or function was found for this high level of\npositivity. \n\nWhat practices according to the type of staff and their motivation?\n\nOverall, less than half of the staff regularly use the means to prevent and control COVID-19 infection in their\nworkplaces. This is despite the fact that the Ministry of Health has provided this equipment. No use was\nmade of simple strategies such as hand washing with soap or alcohol. Training to reduce the risk of\ntransmission to health workers or patients was also provided to dispensary staff and patients (19). This\npoor use of protection could be due to ignorance, carelessness or lack of time due to workload, as has\nbeen reported in Morocco (20) and Niger (10). However, an important factor could be the belief of most\ncaregivers that they have never been in contact with COVID patients, which is also correlated with a very\nlow use of diagnostic tests available in pharmacies and therefore a misperception of risk. Indeed, a very\nlow perception of risk among caregivers seems to be an important factor in the low compliance with\nprevention advice, such as mask use, hand washing or vaccination. At the same time, this perception could\nexplain the low use of diagnostic tests for patients and, therefore, the low number of cases reported by the\nMinistry of Health. \n To limit the transmission of SARS-CoV-2 virus within health care facilities and the community, measures\nmust be taken to raise awareness and strengthen the protection of health care workers.\n\nWhy this low utilization of diagnosis test?\n\nThe study period included the cold season in Niger. This is associated with many respiratory diseases.\nHowever, although 91.2% of unvaccinated individuals tested positive after this period, only 7.8% of health\nworkers reported using a COVID diagnostic test during this period. Only one case of COVID was\ndocumented with a test among the 733 people enrolled. Irrespective of their co-morbidities, these data\nshow that the use of COVID-19 diagnostic tools by healthcare workers is very low. Interestingly, most of the\ncaregivers reported not having been exposed to COVID-19. This low uptake could be due to stigma, denial\nand neglect. According to Yolande and others in Brazzaville, it could also be due to fear of the results,\nwhich is the main reason for refusal of voluntary screening. There is therefore an urgent need to raise\nawareness among health care workers and to draw their attention to their individual risk factors (21).\n\n\n\nPage 21/25\n\nSources of knowledge also seem to be a pitfall for these workers, especially in remote areas, as they were\nin need of more information about COVID. New educational strategies should be developed for them,\nespecially through the use of smartphones, which are widely available in Africa, even in remote areas. \n\nRelations to vaccination\n\nSince March 2002, the Ministry of Health has conducted several vaccination campaigns against the SARS-\nCoV-2 virus, targeting health workers, military personnel and the elderly (23). However, some mistrust of\nthe e�cacy, safety and security of these vaccines has arisen among the population, including health\nworkers, as a result of the implementation of vaccination. This may be one of the factors that has had a\nnegative impact on vaccination compliance in the general population. \n\nIn this study, more than 75% of the study population reported that they had been vaccinated and had\nreceived two doses. However, in another study, only 42% of health workers were found to be vaccinated\n(10). These results, based on self-declaration, could therefore be questioned. The Sinopharm vaccine was\nthe �rst to be introduced in the country. It was followed by the Johnson & Johnson vaccine, thanks to the\nChinese embassy. \n Overall, fear of side effects, uncertainty, lack of reliable information, fear of the vaccine and lack of\ncon�dence are the main reasons for refusing to vaccinate against COVID-19 (10,27,28). Vaccination rates\nwere much lower in rural areas, especially among women, which may be related to false reports claiming\nthat vaccinated women's fertility decreased. This has been observed in many countries where the medical\nprofession has been poor at supporting vaccination campaigns. In fact, by the end of 2021, only 27 per\ncent of health workers in Africa will have been fully vaccinated against COVID-19. This means that the\nmajority of health workers in Africa are still unvaccinated and remain dangerously exposed to severe forms\nof COVID-19 (24). According to the WHO, this is one of the main reasons for the severe shortage of health\nworkers in Africa, which has a negative impact on access to health services. To date, many countries have\nless than one health worker per 1000 people, and the disease will drastically reduce this number (25). In\nNiger, for example, 184 health workers will have died from COVID-19 by December 2022. Awareness-\nraising campaigns and training are urgently needed to encourage health workers to change their behavior\nto improve acceptance of control measures such as vaccination. \n\nCONCLUSION\nThe majority of frontline health workers in peripheral health structures have been exposed to the SARS\nCoV-2 virus. It is not clear whether this was in a professional or private setting. A large proportion of these\nworkers have been vaccinated, but this is a matter of some concern, and the effectiveness of the vaccine\nmay be questionable. On the other hand, tools for the prevention and control of COVID-19 infection are not\nused on a regular basis by health care workers. It should also be noted that there is very little recourse to\ndiagnosis by healthcare workers themselves, re�ecting a mistrust of the \"screen and treat\" strategy, which\nneeds to be better understood, researched and documented. Better risk analysis and adaptation of\nmessages to these workers regarding control measures are needed to reduce the impact of the COVID-19\nepidemic among these workers and the population attending health facilities. These results raise the\n\n\n\nPage 22/25\n\nquestion of what could be a key factor in a future epidemic, namely the awareness of health care workers\nabout the risks they face.\n\nLIMITS\n\nThe main limitation of this study is the declarative aspect of the survey. Social or professional pressure\nmay have led people to change their answers to make things look better, or not to report not having\nvaccinated. It was also not always possible to con�rm the vaccination status through the records. These\nbiases may vary according to the type of structure (public/private), its size (from hospital to health center),\nthe function of the person (quali�ed/unquali�ed) or their status (individual contractor/contracted).\n\nDeclarations\nCon�icts of interest:\n\nNo con�ict of interest has been declared by the authors.\n\nFunding :\n\nThis study was funded by the French Development Agency (AFD) through the ONG Therapeutic Solidarity\nand Health Initiative (SOLTHIS).\n\nAuthor contributions :\n\nRJ, HLR, FL, RAM, SB participated in the conception and design of the study,\n\nMAM, HLR, RJ, FL participated in the data analysis,\n\nZA FAA, AKAZ, II, BAS, GIO, AS, AM, DSB, CD, AD collected the �eld data,\n\nKDI, FCSC, MSAN participated in the serological analyzes of samples in the laboratory,\n\nHLR, RJ, MAM, KDI, FL contributed to the writing of the text,\n\nHLR, RJ, FL, KDI, MAM, SHS, critically revised the manuscript.\n\nAll authors have read and approved the �nal version of this manuscript.\n\nAcknowledgements: \n\nTo the health personnel of the various Integrated Health Centers (CSI), the Regional Hospital Center and\nthe Mother-Child Health Center of Dosso, to the health structures of the armies, to the Regional\nDirectorates of Public Health (DRSP) of Niamey and Dosso, to all CERMES staff who in one way or another\nparticipated in carrying out this study.\n\n\n\nPage 23/25\n\nTo all the staff of the NGO SOLTHIS and the ISANCO project for all the efforts made, the monitoring and\nongoing support.\n\nTo AFD for funding this research project.\n\nReferences\n1. 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En Afrique, seul un professionnel de la santé sur quatre est entièrement vacciné contre la COVID-19\n[Internet]. OMS | Bureau régional pour l’Afrique. 2023 [cité 25 oct 2023]. Disponible sur:\nhttps://www.afro.who.int/fr/news/en-afrique-seul-un-professionnel-de-la-sante-sur-quatre-est-\nentierement-vaccine-contre-la\n\n\n\nPage 25/25\n\n25. Des pénuries chroniques de personnel entravent les systèmes de santé en Afrique, d’après une étude\nde l’OMS [Internet]. OMS | Bureau régional pour l’Afrique. 2023 [cité 25 oct 2023]. Disponible sur:\nhttps://www.afro.who.int/fr/news/des-penuries-chroniques-de-personnel-entravent-les-systemes-de-\nsante-en-afrique-dapres-une\n\n2�. Snène H, Zargouni A, Fendri M, Blibech H, Jebali A, Debbiche S, et al. Taux de vaccination contre la\nCOVID-19 chez le personnel de santé dans un Centre hospitalo-universitaire à Tunis (Tunisie). Rev Mal\nRespir Actual. 2022;111–2.\n\n27. Paquin Kouassi D, Irika O, Soumahoro SI, Coulibaly M, Yao GHA, Deby Kouame A, et al. Acceptabilité de\nla vaccination contre la COVID-19 chez les professionnels de santé en Côte d’Ivoire, 2021. Santé\nPublique. 2022;34(4):549–56.\n\n2�. Haddouche A, Belabas KA, Kourtaa S, Chetouane R, Fella H. Causes d’hésitation ou de refus de la\nvaccination contre le COVID-19 dans une cohorte de rhumatisants traités par rituximab. Rev Rhum. 1\ndéc 2022;89:A256.\n\n\n","UrlSlug":"preprint-first-line-study-population-caregivers-contact-epidemic-patients-sahel-case-sars-cov-2","collections":[],"countries":[{"Name":"Niger","Id":159}],"asset_languages":[{"AlternateTitle":null,"language":[{"Id":1,"Name":"English"}],"contentTranslation":[],"contentLocation":[]}],"creators":[{"Name":"Lamontagne F","Id":19436,"ac":[{"Order":18}]},{"Name":"Moussa A","Id":34808,"ac":[{"Order":11}]},{"Name":"Jambou R","Id":34809,"ac":[{"Order":19}]},{"Name":"Issa I","Id":34810,"ac":[{"Order":7}]},{"Name":"Sidikou BA","Id":34811,"ac":[{"Order":8}]},{"Name":"Alhassane Z","Id":34812,"ac":[{"Order":3}]},{"Name":"Maiga MA","Id":34813,"ac":[{"Order":2}]},{"Name":"Ramatoulaye HL","Id":34814,"ac":[{"Order":0}]},{"Name":"Ibrahim KD","Id":34815,"ac":[{"Order":1}]},{"Name":"Nasser MSA","Id":34816,"ac":[{"Order":12}]},{"Name":"sidiki A","Id":34817,"ac":[{"Order":10}]},{"Name":"Sylviane FCA","Id":34818,"ac":[{"Order":5}]},{"Name":"Tassiou I","Id":34819,"ac":[{"Order":14}]},{"Name":"Aliane FA","Id":34820,"ac":[{"Order":4}]},{"Name":"Mamadou RA","Id":34821,"ac":[{"Order":16}]},{"Name":"Oumarou GI","Id":34822,"ac":[{"Order":9}]},{"Name":"Zeinabou AKA","Id":34823,"ac":[{"Order":6}]},{"Name":"Bouille S","Id":34824,"ac":[{"Order":15}]},{"Name":"Seini SH","Id":34825,"ac":[{"Order":17}]},{"Name":"Abdoulaye M","Id":34826,"ac":[{"Order":13}]}],"keywords":[{"Name":"Covid-19","Id":5},{"Name":"models of care","Id":9}]}}

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The first line. Study on population of caregivers in contact with epidemic patients in the Sahel, the case of SARS-CoV-2