Global health
Original research
Factors associated with adherence to COVID-19 prevention measures in the Democratic Republic of the Congo (DRC): results of an online survey 
John Dinanga Ditekemena1, Dalau Mukadi Nkamba1,2, Hypolite Mavoko Muhindo3, Nelson Fodjo Siewe4, Christophe Luhata1, Rafael Van den Bergh4, Antoinette Tshefu Kitoto1, Wim Van Damme5, Jean Jacques Muyembe6, Robert Colebunders4

Author affiliations
Objectives We aimed to assess the level of adherence to COVID-19 preventive measures in the Democratic Republic of the Congo (DRC) and to identify factors associated with non-adherence.

Design A cross-sectional population-based online survey.

Settings The study was conducted in 22 provinces of the DRC. Five provinces with a satisfactory number of respondents were included in the analysis: Haut Katanga, Kasaï-Central, Kasaï-Oriental, Kinshasa and North Kivu.

Participants The participants were people aged ≥18 years, living in the DRC. A total of 3268 participants were included in the study analysis.

Interventions Both convenience sampling (surveyors themselves contacted potential participants in different districts) and snowball sampling (the participants were requested to share the link of the questionnaire with their contacts) methods were used.

Primary and secondary outcome measures We computed adherence scores using responses to 10 questions concerning COVID-19 preventive measures recommended by the WHO and the DRC Ministry of Health. We used logistic regression analysis with generalised estimating equations to identify factors of poor adherence. We also asked about the presence or absence of flu-like symptoms during the preceding 14 days, whether a COVID-19 test was done and the test result.

Results Data from 3268 participants were analysed. Face masks were not used by 1789 (54.7%) participants. Non-adherence to physical distancing was reported by 1364 (41.7%) participants. 501 (15.3%) participants did not observe regular handwashing. Five variables were associated with poor adherence: lower education level, living with other people at home, being jobless/students, living with a partner and not being a healthcare worker.

Conclusion Despite compulsory restrictions imposed by the government, only about half of the respondents adhered to COVID-19 preventive measures in the DRC. Disparities across the provinces are remarkable. There is an urgent need to further explore the reasons for these disparities and factors associated with non-adherence.


Dr Eric Mafuta Musalu, MPH, PhD
Professeur Associé/Associate Professor
Management et Politique de Systèmes de Santé
Phone: +243 810318918/+243998705153