SARS-CoV-2 seroepidemiology, infection prevention and control practices, and occupational risks during healthcare worker reduction: a repeated cross-sectional study in Côte d'Ivoire, 2022

Introduction Healthcare workers in sub-Saharan Africa face increased SARS-CoV-2 risk throughout the coronavirus disease 2019 (COVID-19) pandemic, yet evidence on infection dynamics and infection prevention and control (IPC) performance in primary and secondary facilities where workforce shortages are common remains scarce. Methods We conducted a repeated cross-sectional study among healthcare workers in 13 public primary- and secondary-level facilities across three regions of Côte d’Ivoire during periods of seasonal workforce reduction (March–April and August 2022). Near-census enrollment of present staff was combined with structured questionnaires assessing infection prevention and control (IPC) practices and occupational exposure. Active SARS-CoV-2 infection was detected by nasopharyngeal RT‒qPCR. Seroprevalence was determined via Wantai total anti-RBD antibody ELISA with nucleocapsid IgG confirmation (VIROTECH). Analyses were performed with R 4.3.1 via RStudio and the tidyverse, survey and epiR packages. Results Among 465 healthcare workers surveyed in Côte d’Ivoire in March–April 2022 (T1) and 357 in August 2022 (T2), eye/face protection was critically scarce (face shields 5.6–8.8%; goggles 3.9–10.3%), particularly in secondary-level facilities. Hand hygiene adherence across the five WHO moments remained consistently and significantly lower in secondary facilities than in primary facilities, without improvement over time. The adjusted seroprevalence was 2.1–3.5 times higher in women than in men and was highest in the 25–49-year age group. High occupational risk was associated with 4.2–7.8-fold higher odds of seropositivity. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure has remained heavily concentrated among frontline clinical staff and has worsened with seasonal workforce reduction. Conclusion Seasonal staff shortages and persistent IPC gaps increase SARS-CoV-2 risk, necessitating urgent PPE equity and resilient workforce planning.