This blog is a part of # COVID19Africa Series. Click for French version.
Does COVID-19 seem like a bad dream in which a significant number of people worldwide are killed, and drastic lockdown measures have a profound impact on the daily lives of millions of citizens? In our region, the virus is also affecting some of our close neighbors, especially Senegal, where the number of cases has just passed the 1000 mark, with 9 deaths. But what is happening in Mauritania?
This blog is a follow-up of the blog article published on 11 April 2020 on the BMJ Global Health.
We had to rid ourselves of an illusion: on April 29, the country registered its 8th Corona case after 20 days without any new cases. The population was kept on edge wondering whether this was an imported case, or the first case of the much-feared community transmission. As of the 4th of May, there has only been one death and one active case; six patients have been declared cured. Would the country emerge relatively unscathed from Covid-19? Or is the current situation simply due to the shortage of screening tests (only 1,759 tests have been carried out on a population of 4 million)? Will we soon see an increase in number of cases?
The government has announced two further measures: the compulsory wearing of face masks for all Ministry of Interior and Decentralisation and Ministry of Defense personnel, and the systematic screening of all quarantined persons.
It was joy and excitement on social media and in the street: “Mauritania is the first African country to have zero cases.” Religious leaders demanded the reopening of the mosques, especially at the beginning of Ramadan; shopkeepers wanted all restrictions lifted, and youngsters wanted to play their sport again in the evening.
Meanwhile in Bababé, a rural district in southern Mauritania, on the banks of the Senegal River, the population is gradually getting used to the containment measures. It tries to build a survival-oriented resilience through solidarity initiatives like the distribution of food, hygiene kits, and protection of Talibé children (living and working in a Koran school).
Bababé is one of the five districts in the Brakna region, one of the poorest regions, with a poverty incidence of 43.3% compared to 31% nationally. This precarious socio-economic situation appears to be worsening because of the impact of the restrictive measures on trade and transport. Moreover, the shortage of water at this time of the year especially affects the most vulnerable and does nothing to facilitate the adherence to recommended virus control and prevention.
Setting up quarantine measures in a rural setting is challenging. Eighteen people who crossed the border between Senegal and Mauritania, thereby defying the government’s lockdown rules, were put into quarantine. The community showed no mercy and felt that “these people deserved it” because they did not observe the rules from the beginning. The men and women in quarantine, sometimes with young children, have been sorely tested. They received no psychosocial assistance and were kept away from their loved ones for 21 days, instead of 14, because of the late delivery of COVID-19 tests. Fortunately, none of them tested positive, and they were able to return to their families.
However, the challenges are growing. Despite the arrangements made in Bababé to deal with COVID-19, such as the set-up of a triage system, the training of the district medical officer and the receipt of protective gear, the population has stayed away from health facilities for fear of contracting the virus. Or maybe they are afraid they will be quarantined? This situation has been made worse by rumors that vaccines against COVID-19 may be dangerous and deadly to the African population. Even though no cases have been diagnosed in Bababé, primary health care is being put to the test in this already fragile health setting. Could the “collateral damage” caused by COVID-19 be worse than the disease itself?
Meanwhile the momentum of community initiatives continues; the women of Bababé have created the ”Faandu Almudo” project that takes care of Talibé children, providing them with a daily meal. This community initiative also has a health dimension because it (indirectly) impacts the nutritional health of these children who could no longer go begging for their dinner due to the curfew that was imposed.
The community-based monitoring and early warning system continues to prove its worth and has detected the majority of illegal border crossings. It also helps to raise community awareness of the importance of seeking health care in health facilities. However, the community workers in the field are badly hit by the lack of logistical resources and technical support, jeopardizing their work. While the authorities continue to prepare the various control and case management mechanisms, communities are trying hard to cope with the harsh realities.
About the authors
Yahya Gnokane is a medical doctor and expert in health services organisation. Since 2018, he has worked for the AI-PASS programme as a technical assistant in the district of Bababé.
Kirsten Accoe is a midwife and expert in public health. She has worked in the Public Health Department of the Institute of Tropical Medicine, Antwerp, Belgium, and is responsible for the scientific follow-up of the AI-PASS program on the level of two districts.
Bart Criel is a medical doctor and expert in public health. He is Professor at the Public Health Department of the Institute of Tropical Medicine, Antwerp, Belgium. He is coordinating the overall scientific follow-up of the AI-PASS programme.
Enabel is the Belgian development agency responsible, through a delegated agreement with the European Union, for the implementation of the institutional support component of the Health Sector Support Programme (PASS), funded by the European Union in Mauritania under the 11th EDF (European Development Fund). Enabel is currently technically supporting the Mauritanian government in controlling the COVID-19 pandemic. Enabel has a collaboration agreement with the Department of Public Health of the Institute of Tropical Medicine Antwerp to ensure the scientific follow-up of the PASS programme. In order to contain the occurrence of possible conflicts of interest, the three authors remained at all times critically reflective of their position in the programme.
 Permanent Survey on Household Living Conditions (EPCV), conducted in 2014 by the National Statistical Office (ONS)