testing & surveillance: Senegal

Senegal, along with three other countries, was selected for this study a priori (not through an Exemplar country selection process). These countries were selected for their variability in COVID-19 responses and outcomes, their experience in managing past epidemics of global concern, their strong partnerships between in-country research institutions and ministries of health, facilitating access to data and enabling the translation of findings to action, and the representation of Francophone and Anglophone communities to enhance South-to-South collaboration. While Senegal is not a positive outlier with respect to its COVID-19 response, there are lessons that can be learned from how the country innovated to address challenges. Furthermore, documenting the country’s response may also inform improvements for future preparedness and response efforts.

This research and analysis was conducted by research partners at the Université Cheikh Anta Diop of Dakar, Senegal, and the Makerere University School of Public Health.

Introduction and Key Takeaways

Between March 2, 2020, and June 30, 2021, over 576,000 COVID-19 tests were conducted in Senegal, with nearly 43,000 people testing positive.^1,2 The country also recorded 1,166 confirmed COVID-19 deaths.³ Senegal’s health officials leveraged the country’s long experience with epidemiological surveillance for diseases like yellow fever, as well as its proximity to Ebola virus disease outbreaks in nearby countries, for its COVID-19 response. Challenges in Senegal’s testing and surveillance systems persisted, ranging from gaps in data use to guide decision makers and long waiting times for laboratory test results, to burnout among health care workers. Despite these, Senegal leveraged digital tools, such as DHIS2, built on lessons and structures from previous epidemics, and launched innovative partnerships to develop affordable rapid diagnostic tests (RDTs). Since the start of the pandemic, Senegal has strengthened risk communication strategies, expanded lab capacity and genotyping, and scaled the use of RDTs.

Senegal confronted a third and more deadly wave of COVID-19 starting in June 2021. The surge in cases was largely attributed to the spread of the more transmissible Delta variant (which accounted for 50 percent of samples genotyped in Senegal by June 30, 2021), the relaxation of mobility and travel restrictions, the reduction in case detection and contact tracing, and low COVID-19 vaccination coverage (about three percent of people in Senegal have received at least one vaccine dose).⁵

The following findings are organized according to the Testing & Surveillance framework.

What was Senegal’s Pre-Pandemic Context? How did it Respond to COVID-19?

Disease Outbreak Experience

As early as the 1980s, Senegal began epidemiological surveillance for cholera, meningitis, yellow fever, measles, and other contagious diseases. After West Africa’s 2014–2015 Ebola virus disease outbreak, during which Senegal recorded one laboratory-confirmed case and no deaths,⁶ officials set up the country’s Centre des Opérations d'Urgence Sanitaire (Public Health Emergency Operations Center or COUS) to further strengthen pandemic surveillance. The COUS surveillance system used District Health Information Software 2 (DHIS2) to track disease information from health huts to health posts, district health centers, regional offices, and finally the Ministry of Health. The COUS surveillance system has been recognized by the WHO and the Africa CDC as a model for neighboring countries. Throughout the COVID-19 pandemic (and before), representatives from other countries such as Guinea, The Gambia, Burkina Faso, Mali and Cameroon have called on the COUS for guidance, and visited Senegal to learn from this model.

Assessment of Pre-Pandemic Preparedness

Senegal used the Integrated Disease Surveillance and Response strategy to monitor and report on high-priority diseases, which now includes COVID-19. Senegal’s Integrated Disease Surveillance and Response system facilitated the most efficient use of scarce resources. It collected information on 44 diseases and reported on 16 of them on a weekly basis. To make these reports, officials used electronic versions of the Integrated Disease Surveillance and Response notification tools on smartphones for the community level, tablets for the health post level, and computers for the district, regional, and national levels. Additionally, there is a direct data pipeline from the electronic Integrated Disease Surveillance and Response data collection tools to the country’s national health information system (built on DHIS2) enabling near real-time monitoring.

Despite this system, a Joint External Evaluation, conducted between 2016 and 2017, of Senegal’s International Health Regulations’ (2005) core capacities found that Senegal had a solid foundation for preventing, detecting, and responding to public health threats.⁷ Strengths included a multisectoral platform for coordinating and monitoring interventions as part of the implementation of a “One Health” approach. The evaluation also noted that the reliance on external funding threatened the sustainability of progress made in Senegal, and called out the lack of effective coordination between the surveillance and response pillars. Key recommendations included:

• The legislative framework should be more rapidly strengthened and implemented in order to ensure effective collaboration between the key sectors involved in preventing, preparing for, detecting and responding to public health events.
• The Government should take steps to significantly increase funding for activities aimed at strengthening the International Health Regulation capacities.
• The Office of the Prime Minister is encouraged to continue its role as general coordinator and facilitator in order to ensure that a multisectoral approach is taken to improving health security, while the role of the Ministry of Health and Social Welfare in coordinating operations should also be strengthened.
• The International Health Regulations focal point, which must be a unit and not an individual, should be located within a structure that has the skills and the administrative and legal authority in terms of surveillance and operations.
• An action plan should be drawn up with the same energy as that observed during the self-assessment and the JEE. It is essential that the national action plan take into account the results of the external evaluation and that it is completed before the end of the first quarter of 2017.

In another recent global assessment (the Global Health Security Index, published in 2019) that scored countries’ health security preparedness and response capacities, the global average score was 40.2 out of a possible 100. Senegal scored 37.9 and ranked 95 out of 195 total countries.⁸

How did Senegal Respond to COVID-19?

Senegal’s experience with previous epidemics contributed to the speed and organization of its COVID-19 response, since officials could use already established and well-used coordination structures such as the COUS. In January 2020, the COUS assessed the country’s response capacity and used the results to develop the COVID-19 National Multisectoral Contingency Plan for the improvement of the country’s pandemic response at all levels. The contingency plan thoroughly outlines the roles and responsibilities for different sectors, from the Ministry of Health and Social Action (focusing on the role of labs, pharmacies, hospitals, and research institutes), to the Ministries of the Interior and Public Security, Armed Forces, Agriculture, Transport, Environment, and Commerce. Officials followed the plan’s recommendations in adapting the World Health Organization’s (WHO) case management guidelines for influenza-like illnesses, as well as convening an expert group to develop a COVID-19 risk communication strategy to encourage public awareness of, and involvement in, the country’s pandemic response. This communication strategy was piloted in the Dakar region, then disseminated for wider regional adaptation.

In February 2020, South Africa and Senegal were the only countries in Africa with laboratories able to carry out RT-PCR tests.⁹ Senegal also had an emergency stock of personal protective equipment in reserve. Senegal reinforced this reserve for the COVID-19 pandemic using domestic resources and the support of international partners, including the World Bank, the United Nations Development Programme, LuxDev, and the Chinese government.

In April 2021, a risk communication and community engagement strategy was launched with three goals: develop a communication plan for large community gatherings, disseminate a strategy for vaccination against COVID-19, and communicate the need to comply with non-pharmaceutical interventions and preventive measures. Successes include the Ministry of Health and Social Action’s publication of a weekly report on the status of COVID-19, and daily televised press briefings on the COVID-19 situation across the country.

What was Senegal’s Testing Strategy? How did it Establish Testing Capacity?

Like many countries, Senegal took a risk-based approach to testing – prioritizing those at risk of exposure (like health care workers) and those at risk of severe outcome from the disease (like people over the age of 60, and those with comorbidities). At the beginning of the COVID-19 epidemic in Senegal, public health workers offered free testing to symptomatic individuals and all contacts of confirmed cases. Officials also required people in quarantine or isolation to get tested and present a negative result before they could be discharged. Senegal required travelers to get tested for COVID-19 (which travelers paid for) and to show a negative result before they could enter the country.

As community transmission increased and the supply of testing materials dwindled, access to testing was further limited. In July 2020, officials changed strategy: only high-risk and vulnerable contacts (such as people over 60 years of age, and people with comorbidities) received free public testing, and they were not required to undergo follow-up tests if they received a negative result. Travelers were still required to undergo and pay for tests and present a negative result before they could enter the country.

As of June 2021, testing (both PCR and RDT) is only free for symptomatic individuals and contacts of confirmed cases. Travelers are still required to pay for tests, though ECOWAS lowered the cost to US$50 at all points of entry in May 2021 (previously, some travelers were charged up to US$100 per test).¹⁰

Testing Value Chain

SOURCING TESTING SUPPLIES

At the beginning of the COVID-19 outbreak in Senegal, most testing supplies, including laboratory equipment, were donor-sourced via partnerships with the Clinton Health Access Initiative, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and World Bank, among others. With assistance from the “Institut Pasteur de Dakar” (Pasteur Institute of Dakar), the Senegalese government mobilized rapidly to ensure the availability of testing and supplies; the Directorate of Pharmacy and Medicine managed procurement; and the National Pharmacy Supply took charge of supply management and storage. This system has worked well and as of June 2021, there were no stockouts reported at the national level in Senegal. Additionally, this steady supply has enabled a national-level response to district-level stockouts when they occur.

The Senegalese government provided tests to public labs, such as the military lab at the Hôpital Militaire de Ouakam (Ouakam Military Hospital). Private labs such as the Pasteur Institute of Dakar and the “Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations” (Institute for Health Research, Epidemiological Surveillance and Training; IRESSEF), provided mandatory tests to everyone traveling out of the country, and sourced tests separately.¹¹

At first, polymerase chain reaction (PCR) was Senegal’s only testing modality. To improve case detection and turnaround time of test results, a collaborative RDT development platform known as DiaTropix began to pilot low-cost, locally manufactured antigen RDT kits in July 2020. Other RDTs, such as the Panbio COVID-19 Antigen Rapid Test by Abbott and Standard Q COVID-19 Ag Test by SD Biosensor, have been in wider use since November 2020.¹² (See case study below.)

DiaTropix Development of Rapid Diagnostics Tests DiaTropix is a collaborative rapid diagnostics test (RDT) development platform between Mologic, a British biotech company, and the Pasteur Institute of Dakar. The COVID-19 RDT is expected to cost US$1 and deliver results within 10 minutes. Over time, production capacity is expected to reach four million units per year. In 2020, this testing began being piloted in four regions across Senegal.13 The overarching goal of the project extends beyond COVID-19—it is to improve access to diagnostics for epidemic and neglected diseases in Senegal and beyond. Over time, the project aims to produce RDTs for Ebola, dengue, yellow fever, measles, meningitis, and rubella. The project has three funding partners (Mérieux Foundation, Institut de Recherche pour le Développement [Research Institute for Development], and FIND, the global alliance for diagnostics) and two industrial partners (Mologic and bioMérieux).4 The Pasteur Insititute of Dakar officially inaugurated DiaTropix on November 16, 2020, and the ceremony was chaired by the Minister of Health and Social Action, and ambassadors from France, the United Kingdom, and Germany. By July 2021, the Pasteur Institute of Dakar had produced one million screening kits, with 50,000 delivered to the Ministry of Health in Senegal. The remaining stock has been sold to other countries in the ECOWAS region and beyond.

SAMPLE COLLECTION AND TEST DEMAND

To increase Senegal’s testing capacity, in May 2020 officials set up decentralized point-of-care GeneXpert testing in the 12 regions hardest hit by the pandemic. The country’s testing capacity improved rapidly between March 2020 and July 2020: the number of laboratories with the capacity to test for COVID-19 increased from one (the Pasteur Institute of Dakar) to 18.

The number of tests those labs could now perform likewise increased. By December 2020, labs across Senegal’s 14 regions had the capacity to process 5,000 PCR tests per day. By the peak of the third wave in July 2021, the daily rate of PCR and RDTs was around 10,000 tests per day (about 7,000 RDTs and 3,000 PCR tests). Tests were distributed according to need and prioritized for the capital city of Dakar, which was the epicenter of COVID-19. Like in many countries, the underreporting of RDT results continues to be a problem in Senegal.

The state supported the decentralization of laboratories across Senegal, in order to provide health services equitably across the country. This support included the government paying for tests and inputs the labs needed to operate. The government also paid for some laboratory staff to be deployed to other labs to help build testing capacity nationwide. Decentralization took place once technical capacities at the regional laboratories was confirmed.¹⁴

“The indications of screening are problematic. At the very beginning, all contacts were systematically detected; but when there were many, with the problems associated with testing across the country, the choice was to screen for contacts that were symptomatic. It is obvious that, with this strategy, we miss out on positive contact cases that are asymptomatic, so lo and behold, there was really hyper-targeting in the tests that did not allow [for] an accurate idea of the number of cases.”

- Key informant, Manager at Epidemic Treatment Center

However, widespread misinformation about COVID-19 created stigma around the disease, which discouraged people from getting tested. Overall, detection of early and asymptomatic cases was limited.

SAMPLE DELIVERY

Thanks to the deployment of point-of-care and rapid testing, Senegal’s turnaround time from sample collection to delivering to laboratory improved from two–three days in March 2020 to nine hours (median turnaround time) by November 2020. During the peak of the third wave in July 2021, however, total turnaround times increased to three-seven days (and in some contexts one-two weeks), before returning to an average turnaround time of 24-48 hours. This was, in part, because false negatives were an issue with the scale of RDTs. If someone symptomatic received a negative result with an RDT, confirmation was required via PCR and labs quickly became overwhelmed. Additional measures were put in place to reinforce capacity, boost health human resources and decentralize efforts to reduce turnaround time.

ASSESSMENT OF LABORATORIES

Senegal was able to rely on in-country PCR and GeneXpert testing capacity, as well as comprehensive quality assurance systems for lab networks conducting COVID-19 tests. To be certified, labs needed to internally monitor the performance of their workstations, verify testing instruments, verify new batches of kits, and ensure staff competency in assessing and monitoring samples and test procedures, kits, and instruments against established criteria.

RESULTS COMMUNICATION

Test results were returned over the phone or in writing via email notification. By June 2021, results were delivered between 15-24 hours via SMS that included a code to see results online. Paper-based results were also made available for people without phones or access to the internet, who were instructed to pick them up at laboratories.

What was Senegal’s Surveillance Strategy? How did it use Data to Guide Public Health Actions?

Senegal had a decentralized surveillance strategy, which relied on officials at the regional and district levels to test, trace, and isolate individuals at high risk of contracting COVID-19. By May 2020, there were contact tracing teams working out of 79 district health centers across the country. In the early phase of the outbreak, district health officials and providers conducted active case-finding through contact tracing, with isolation and quarantine in separate facilities to follow. Then, as the number of cases and contacts increased, officials adopted new public health measures to reduce transmission, including home-based quarantine and isolation.

Surveillance Activities by Level

LEVEL	SURVEILLANCE ACTIVITIES
Community	Community health alert system, supported advocacy campaigns
Health district	Investigate reported cases
	Contact tracing, testing, isolation
	Use of DHIS2 COVID-19 tracker module
National	Point of entry screenings
	Prevalence surveys
	Genomic sequencing and monitoring
	Use of DHIS2 COVID-19 dashboards and other tools

Senegal’s surveillance strategy was limited by a lack of resources, especially fuel and vehicles for local surveillance activities. Technical partners (such as WHO, CDC, USAID, and World Bank) provided significant financial support for all other structures involved in supervision, contact tracing, and capacity building of community health workers from decentralized health districts through the federal level.

Surveillance Modalities

COMMUNITY-BASED SURVEILLANCE

To improve case detection, officials established a national toll-free call center to process pandemic alerts from community health workers and others at the local level. Once a case was reported, the call center informed district officials for follow-up. By March 19, 2020, the call center had received 672 calls which were largely requests for information, but that led to the investigation of 18 suspected cases.¹⁵

This call center system identified the country’s first case of COVID-19. Along with advocacy campaigns, it enabled Senegal to foster community ownership over surveillance. Widespread misinformation and negative perceptions about COVID-19, however, made community members hesitant to report neighbors or family members suspected of having the disease.

Temperature checks were also established as a surveillance and containment measure in public places like markets, schools, hospitals, airports, businesses, government buildings, and hotels. (It is worth noting that symptom screens and temperature checks have been found to have limited impact and can be inefficient in the context of asymptomatic transmission.¹⁶ )

A national serological survey conducted between October and November 2020 estimated the national seroprevalence at 28.4 percent. There was substantial regional variability, with Ziguinchor, Sédhiou, Dakar, and Kaolack recording the highest seroprevalence. Another serological survey conducted between June and September 2020 among hemodialysis patients in Senegal found the seroprevalence of SARS-CoV-2 antibodies was 21.1 percent.¹⁷ Another serological survey with post-mortem surveillance is anticipated to start in November 2021.

CONTACT TRACING

Senegal’s contact-tracing system was decentralized and run at the health district level (see case study on the use of DHIS2 below). In April 2020, at the beginning of the epidemic in Senegal, health officials set up contact-tracing teams led by local staff in 79 district-level health centers. District officials investigated all suspected cases, reported locations of known cases, and traced all contacts. Local teams relied on manual contact tracing, where cases try to remember their contacts, as opposed to automated methods where technology (location tracking or Bluetooth, for example) can be leveraged to determine contacts. (See figure below.)

Although tests were reserved for at-risk and symptomatic people only, many of those tested received their results within 24 hours. This enabled swift identification of contacts and mobilization of tracers.

ISOLATION AND QUARANTINE

Clear protocols were established for contacts of positive cases once they had been identified via tracing. Before July 2020, both symptomatic and asymptomatic contacts were placed in designated isolation facilities for 14 days. These facilities were in hospitals or, for travelers arriving from high-risk countries, in hotels. For the duration of their isolated stays, contacts were observed by health workers.

In July 2020, to free up hospital beds for clinical care as case numbers grew, and to avoid hotel isolation as costs grew prohibitively, the Senegalese government adjusted its policy to allow for at-home isolation. These cases were supervised by district health authorities, who followed up regularly by phone or in-person visit. Initially, health authorities required a negative COVID-19 test before an isolated patient could be discharged, but this rule changed along with clinical criteria.

In May 2020, the WHO published new recommendations as a result of evolving evidence and more comprehensive clinical care guidance.¹⁸ Criteria for discharging patients from isolation (i.e., discontinuing transmission-based precautions) without retesting was now as follows:

• For symptomatic patients: 10 days after symptom onset, plus at least three additional days without symptoms (including without fever and respiratory symptoms)
• For asymptomatic cases: 10 days after positive test for SARS-CoV-2

This home-based care strategy helped decongest health facilities that previously had to provide space for isolation. It also saved tests and testing capacity for use in the context of new and suspected cases rather than discharge.

POINT OF ENTRY SURVEILLANCE

Fraudulent negative COVID-19 tests, in which results were faked for travelers, were a known problem in Senegal. One of the country’s designated labs, the IRESSEF, drew attention to this issue, and Senegal’s Ministry of Justice has been working to resolve it, with the police having since intervened. In the meantime, the importation of cases from other countries remained a significant concern. Because Senegal was one of the first countries to establish strong testing capacities for COVID-19 in Africa, the country saw an influx of tourists and travelers from other countries.

GENOMIC SURVEILLANCE

Genomic sequencing and variant monitoring were also part of Senegal’s surveillance strategy from the beginning of the pandemic. Health officials conducted these in Senegal at the Pasteur Institute of Dakar and IRESSEF, in collaboration with regional laboratories and these data were used by policymakers to inform non-pharmaceutical interventions, such as lockdowns and travel bans. Among 275 travelers tested between April and May 2021, Alpha, Beta, Delta, and Gamma variants were detected. By June 2020, Delta accounted for 50 percent of the samples genotyped in Senegal.

In November 2021, the Bill & Melinda Gates Foundation launched the Global Immunology and Immune Sequencing for Epidemic Response (GIISER) program. Senegal is one of the eight countries that will receive funding to expand their existing immunological capacity.

Data Management, Reporting, and Use

DATA USE, STORAGE, AND TECHNOLOGIES

In January 2020, prior to the outbreak of COVID-19 in Senegal, the Ministry of Health and Social Action, with support from the University of Oslo in Norway, developed a COVID-19 tracker module for DHIS2 to improve reporting and monitoring. At the local government level (the prefecture), the health district organization compiled and uploaded data to the platform. Initially, they did this every day, but then they shifted to weekly reporting.

Use of DHIS2 for COVID-19 Tracking in Senegal Senegal started implementing District Health Information Software 2 (DHIS2) in 2013, and the tool was used nationally by 2014. DHIS2 is used at all levels of the health system, from public health establishments to local health posts, and across programs (e.g., tuberculosis). It also has been piloted in the private sector.19 A set of COVID-19 modules to collect and analyze case data was rolled out within six days following the identification of known cases in March 2020. Tracker, a module in use prior to COVID-19, was also used to follow up on individual cases and support contact tracing. A technical team comprising members from the Health Information Systems Program (which manages DHIS2 software development), PATH (a nongovernmental organization), the government’s information technology unit, and COUS collaborated to quickly adapt and implement the new modules. Initial online trainings were conducted for all regions and districts. These have been followed up with supervision to reduce errors in data entry. While the rollout faced challenges, including the lack of experience of the team in charge (who had not been able to benefit beforehand from training) and the unique coding at the district level of COVID-19 patients, the use of DHIS2 has supported the centralization of all COVID-19 case data and facilitated monitoring and analysis in Senegal.

The Ministry of Health and Social Action, the Ministry of the Digital Economy and Telecommunications, and the Organization of Information and Communication Technology Professions partnered to build additional software for data analysis, called Daan Covid. The system was established to manage data coming from Epidemic Treatment Centers. In general, the information management system increased the availability of data for decision making, but at the time of publication the system was not yet integrated with DHIS2. Community cases, in particular, were not always reported, and the data collected were not fully analyzed at lower levels.

Gaps in data analysis capacities, particularly at the district level were a challenge in Senegal. To address this, the Ministry of Health has partnered with academic institutions like the University Cheikh Anta Diop of Dakar, to train health agents in monitoring and evaluation, and epidemiology.

How did Senegal Coordinate its Testing and Surveillance Efforts?

Even before officials were notified of Senegal’s first positive COVID-19 test on March 2, 2020, they activated a coordination structure inherited from the 2014 Ebola outbreak. The National Committee for Epidemic Management (similar to other countries’ presidential task forces, such as Nigeria’s) began meeting in February to coordinate Senegal’s response and the various sectors involved. This included nongovernmental organizations, academic institutions such the Pasteur Institute of Dakar and IRESSEF, private health research institutions that worked closely with the government of Senegal, and private companies. The country also activated COUS in early March when the first positive test was reported.

“For the experience we have gained in the management of previous epidemics, it is important to know that Senegal is not at its first epidemic. We have had to manage a lot of epidemics…Take as an example the Ebola virus disease: even if we had only one case, it is this epidemic—that experience— [that] allowed us to strengthen our system. And it is precisely after this epidemic that the COUS Health Emergency Operations Center was created, with the main mission of preparing the response to the public health emergency.”

- Key informant, Representative at the Centre des Opérations d'Urgence Sanitaire (COUS)

At the same time, each of Senegal’s 14 regions established an incident-management system under the direction of the regional chief medical officer. In each of the country’s 79 health districts, investigation teams were responsible for COVID-19 case investigation and contact tracing.

What are the Key Lessons from Senegal’s Response to COVID-19?

Senegal’s experience with surveillance for other infectious diseases gave it tools and strategies it could adapt for its COVID-19 response. The government leveraged partnerships with academics and the private sector to innovate and build capacity across the country. However, limited resources, the underreporting of cases, health care worker burnout, and gaps in data use capabilities were challenges in Senegal’s response.

Conclusion

Senegal’s COVID-response strategies leveraged the epidemiological-surveillance tools and coordination structures it had developed in response to previous outbreaks of other diseases, such as yellow fever and Ebola virus disease. However, capacity gaps, resource limitations, and community stigma associated with COVID-19 are ongoing, making a robust pandemic response difficult to sustain.

Additionally, in the spring and summer of 2021 Senegal experienced a surge in COVID-19 cases—especially among younger people­—with higher disease severity and higher mortality. Factors contributing to this surge in new cases include: the lifting of mobility restrictions with increased international travel; the introduction of new variants (including Alpha, Beta, Delta, and others; Delta became the major genotype in early June 2021); poor adherence to NPIS, especially mask wearing and social distancing; health care worker burnout; and low vaccine coverage.

Senegal implemented a resurgence plan in response to this more recent wave of infections, scaling up testing access and capacity by rolling out RDTs (and scaling the development of RDTs locally), increasing the number of PCR labs, and boosting genomic surveillance activities. While Senegal has experienced challenges with its COVID-19 response, there are lessons that can be learned from how the country innovated and adapted strategies to address these challenges. Documenting the country’s response may also inform improvements for future pandemic preparedness and response efforts.

AUTHORS Alice Namale, Ibrahima Seck, Issakha Diallo, Mamadou M. M. Leye, Youssou Ndiaye, Manel Fall, Ndeye M. Sougou, Oumar Bassoum, Thané G. Diaw, Talla Cissé, Rhoda K. Wanyenze