key: cord-0983881-n9dxzuby
authors: Qaderi, Shohra; Ahmadi, Attaullah; Lowe, Mat; Ochuba, Chikodili; Lucero-Prisno, Don Eliseo
title: The daunting task of fighting against COVID-19 in Guinea-Bissau
date: 2021-03-03
journal: Public Health Pract (Oxf)
DOI: 10.1016/j.puhip.2021.100097
sha: 74c06829183ddb5f00b698858f327ac6a8151f6e
doc_id: 983881
cord_uid: n9dxzuby

nan

The novel coronavirus disease (COVID-19) is a global public health emergency [1] . In many West African countries such as Guinea Bissau, the COVID-19 pandemic presents a major health and development challenge [2] . In this paper we aim to highlight how the general lack of development and weak healthcare system may present a major challenge in addressing the COVID-19 situation in Guinea Bissau. We also provide some key recommendations for addressing the development and healthcare system challenges facing Guinea Bissau's COVID-19 response.

Guinea-Bissau has the highest prevalence of Human Immunodeficiency Virus (HIV) and tuberculosis in West Africa, the highest rate of maternal mortality rate and the lowest expectancy of life [3] . The country is ill prepared to face this major exogenous shock, and at the risk of setback of some of the development gains obtained in recent years. Poor investment in the health system during the last decades and low government health expenditure led to poor capacity building to combat COVID-19. According to the Universal Health Coverage (UHC) partnership, there are inadequate health professionals, less than 5 physicians per 100,000 persons and poorly trained clinical and managerial systems [4] .

Health care workers in the country face the challenge of inadequate equipment and facilities, resulting in a significant number of health staff being infected at the beginning of the pandemic, including all Intensive Care Unit (ICU) personnel [5] . The capacity of the laboratories is still limited by the shortage of trained personnel to run the tests, and inadequate stock of materials. It is therefore essential to train, equip and strengthen the diagnostic capacities. In the region, the laboratory capacity has now been expanded from just two referral laboratories to a larger set of countries [6] . This is however inadequate to estimate the extent of community spread of the pandemic in the country.

Early nationwide containment measures such as airport and land border travel ban, shutdown of schools, restaurants and bars were employed even before the first case was recorded. Lock downs and curfews consequently affected the income of most of the population adversely. This was aggravated by the fact that the country is dependent on import hence, a rupture of international food supply chains constrained access to food thereby intensifying food insecurity in the country. Aged adults who were compelled to stay at home received no support from the government and on exhausting their merely savings, they were forced to go back to work, hence increasing the risk of viral spread [7] . In most countries several approaches are provided to disseminate information about the pandemic, including the use of mobile applications, and social media platforms [8] , however, due to poor widespread of smartphones and internet services in Guinea-Bissau, this approach gained little or no success.

Underlying medical conditions are seen as a high risk factor among Bissau-Guineans. Conditions which are linked with the severity of COVID-19 such as cardiovascular disease, respiratory conditions and chronic illness account for 13%, 2% and 16% morbidity respectively [9, 10] . The already challenged health system which is lacking in adequate healthcare facilities is overburdened by the pandemic hence high mortality rates among the population with underlying health conditions. About 30% of all deaths in the country were as a result of comorbidities. It is therefore crucial to prevent the transmission of the infection in this country so as to avoid overwhelming rates of infections and consequent deaths. The health care system mostly depends on global donors like the World Health Organization (WHO) and the United States Agency for International Development (USAID) [4] , which challenge sustainable funding of the health sector especially in the face of the pandemic.

The impacts of COVID-19 go far beyond the health of the Bissau-Guineans. It is evident in their daily life. The pandemic has led many to slide into poverty because of the adverse effect on their means of livelihood as well as on their health. Although measures are already on the ground to contain the spread of COVID-19, more is needed to be done by the Government in order to make available necessary protective equipment needed for the task at hand. The country is also in dire need of external assistance from global organizations. In addition, training of caregivers and proper education of the population on the pandemic and preventive measures to be imbibed will go a long way to inculcate caution in the nationals. Paying special attention to the vulnerable population and those with underlying disease, will also help decline case fatality rates. A high level of interventions from international donors and stake holders are required to assist Guinea-Bissau in launching mass COVID-19 vaccination programs as no one is safe if all is not safe. 

The authors declare no competing interests.

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