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Additional file 1: Table 1a Pre-study questions on participants’ socio-demographic characteristics and social media use. Table 1b List of most popular social media platforms in Australia (July 2020) and answer categories on how often they are used in the past month. Table 2 Post-study questions on recognition and appreciation of social media food promotions. Table 3 Coding of composite food or beverages on social media into core and non-core classifications. Table 4 Participants’ duration of use, device used to access, and main reason for using their favourite social media platforms.

IntroductionHealth service use among the general public can decline during infectious disease outbreaks and has been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) implemented public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone, to mitigate impact of the pandemic.MethodsUsing data from the Health Management Information System (January 2018 - December 2020), we evaluated the impact of the pandemic on the use of essential health services (total visits, maternal health, vaccinations, visits for common infectious diseases, and diagnosis of non-communicable diseases) using interrupted time series with mixed effects segmented Poisson regression models during the first wave of the pandemic. Analyses were stratified by age, sex, health facility, and neighbourhood.ResultsHealth service use dropped rapidly following the start of the pandemic and ranged from 16% for hypertension diagnoses to 39% for diabetes diagnoses. However, reductions were highly concentrated in Gombe (81% decline in total visits) relative to health zones without lockdown. When the lockdown was lifted, total visits, visits for infectious diseases, and diagnoses for non-communicable diseases increased approximately two-fold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.ConclusionThe COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than pre-pandemic levels.Summary BoxWhat is already known about this subjectSubstantial declines in the use of health services among the general public have been well-documented during previous outbreaks of infectious diseases.Modelled studies predicted substantial increases in morbidity and mortality in many low- and middle-income countries (LMICs) mainly due to expected declines in the use of health services among the general public.Only a small number of studies have so far evaluated the impact of the COVID-19 pandemic on the use of health services in LMICs and none have also evaluated both the implementation and lifting of lockdown measures.What are the new findingsThis study found that overall use of health services declined in Kinshasa but was most pronounced in the Gombe health zone which was subject to strict lockdown measures.Some health services were more affected than others, most notably visits and tests for malaria and visits for new diagnoses of non-communicable diseases. Maternal and child health services were relatively unaffected.When the lockdown measures were lifted, health service utilization rebounded but remained at levels lower than those observed pre-pandemic.What do the new findings implyThe COVID-19 pandemic has likely had important effects on the use of health services among the general public throughout LMICs. However, evidence from Kinshasa suggests the effects may not be as widespread as previously assumed.The impact of strict social distancing measures needs on COVID-19 outcomes needs to be weighed off against the potential population-level health effects of these policies in various international contexts.

Een verkenning naar draagvlak, haalbaarheid, betaalbaarheid en impact De overheid stimuleert dat basisscholen kinderen helpen om gezond te leven. Een gezonde schoollunch en meer bewegen onder schooltijd kunnen hierbij helpen. Uit onderzoek blijkt dat hier draagvlak voor is onder ouders, kinderen en scholen. Ook is het haalbaar, mits al deze partijen worden betrokken bij de organisatie. Ouders zijn bereid om mee te betalen (1,75 euro per kind per dag), maar daarmee zijn de kosten (2,40 euro per kind per dag voor de zelfsmeerlunch en 4,50 euro voor de schoollunch met beweegactiviteiten) niet gedekt. Ondersteuning is dus nodig om minder draagkrachtige gezinnen financieel te steunen. Bij een zelfsmeerlunch maken kinderen zelf op school een gezonde lunch klaar. Ze eten dan meer fruit, groente en bruinbrood en drinken meer melk en water. Voor een zelfsmeerlunch is minimaal 30 minuten tijd nodig. Een cateraar kan de benodigdheden inkopen en leveren. De school kan dit ook zelf doen, maar dat vraagt om een goede coördinatie. Extra beweegmomenten zijn mogelijk door tijdens de lessen korte momenten daarvoor in te lassen. Pedagogisch medewerkers, zoals van de naschoolse opvang, en buurtsportcoaches van gemeenten, kunnen helpen bij sport- en spelactiviteiten. Door beweegactiviteiten en de zelfsmeerlunch hebben kinderen een gezonder gewicht. Het percentage kinderen van 4 tot 18 jaar met overgewicht zou kunnen dalen van 13,5 procent naar 10,2 procent in 2040, en met obesitas van 2,8 procent naar 2,3 procent. In de toekomst kan de daling eraan bijdragen dat minder volwassenen overgewicht, obesitas en diabetes hebben. Dan moeten de kinderen het veranderde gedrag wel blijven volhouden als ze volwassen zijn. Om kinderen hierbij te helpen kunnen schoollunches en beweegactiviteiten worden aangevuld met activiteiten op de middelbare school en in de wijk. Aanleiding voor deze verkenning zijn eerdere succesvolle projecten met gezonde schoollunches en meer bewegen in het basisonderwijs.