The most affected age group was 10 - 14 years, representing 44.5% of cases. The mean age was 9.88 ± 5.49 years ( Table 1 ).

The study population consisted of 33 males (73.3%) and 12 females (26.7%), resulting in a male-to-female sex ratio of 2.75 ( Table 2 ).

The majority of patients were from Watsa, comprising 53.3% of the cases, followed by Isiro, which accounted for 31.1% of the cases ( Table 3 ).

The comorbidities noted in descending order were allergic rhinitis, asthma, sickle cell anemia, HIV, epilepsy and finally malnutrition ( Table 4 ).

More than half of the mothers were engaged in trading or farming, and 40% (18 cases) had been in contact with known COVID-19 cases. Additionally, 37.78% (17 cases) of the fathers were employed as civil servants at KIBALI GOLD Mining Company.

Asymptomatic cases accounted for 33.3% (15 cases).

Fever 66.6%, rhinorrhea 57.77%, followed by cough, were the most noted reasons for consultation ( Table 5 ).

The Polymerase Chain Reaction (PCR) test was positive in 51.11% of participants, corresponding to 23 cases. All cases were due to the Omicron variant. There were no specific lesions in 12 patients (26%) who had the standard X-ray.

All patients received treatment according to the WHO COVID-19 guidelines adopted in the DRC, which included:

No complications or deaths were reported

A total of 569 cases were documented, including 45 children aged 0 to 19 years, representing 7.9% of the cohort. This prevalence is higher compared to Camara et al. in Guinea (2.59%) and other studies, such as those conducted by Qiu et al. in China and Nicole le Seaux in Canada, which reported prevalence between 1.5% and 5% [3] [6] [7] .

The Age

The participants’ ages ranged from 0 to 19 years, with a mean age of 9.88 ± 5.49 years. The most prevalent age group was adolescents of 10 to 14 years old (n = 20, 44.5%). This finding contrasts with Claude-Audrey et al. in Yaoundé, who reported 50% of children aged 13 to 19 years with a mean age of 10.89 ± 7.13 years. In contrast, Camara et al. in Guinea observed a higher prevalence in the 0 - 4-year age group (38.62%). Viner et al. and Zhu et al. identified higher frequencies in the age group over 10 years. This trend is consistent with global observations by the American Academy of Pediatrics, the European Centre for Disease Prevention and Control, and INSP Québec (2021). Adolescents’ cellular physiology, which mimics adult cellular regeneration mechanisms with slower epithelial turnover, may explain these observations [6] . Additionally, children might exhibit different physiological responses compared to adults at various stages of infection. Recent studies suggest that children may have fewer ACE2 receptors, potentially limiting SARS-CoV-2 infection [8] . Furthermore, innate immunity, potentially “trained” by previous viral and bacterial infections or live vaccines such as BCG, may provide enhanced protection [9] . Cross-immunity with other coronaviruses and pre-existing respiratory infections could also be factors [10] . In contrast to other respiratory infections, such as legionella, RSV, influenza, measles, and varicella, which are generally more severe in adults, SARS-CoV-2-induced pathology might involve exaggerated immune responses, potentially differing in children.

A significant male predominance was observed among pediatric COVID-19 cases, with 73.3% of cases being male, resulting in a sex ratio of 2.75. This is comparable to the findings by Claude-Audrey et al. in Yaoundé, which reported a male predominance of 52% and a sex ratio of 1.08. In contrast, Camara et al. in Conakry found a higher proportion of females with a sex ratio of 1.52. The increased male susceptibility may be attributed to higher expression of immune system proteins and a longer half-life of antibodies in females, as suggested by other studies [3] [6] .

Half of the patients resided in the Watsa health zone, a strategic geographic area at the entry point to Haut-Uélé province. The region’s high mobility is influenced by the presence of Kibali Gold Mining, subcontracting activities, artisanal mining, and the international Duembe market, which attracts people from Uganda, South Sudan, and Congo. These factors contribute to significant movement of people and goods, increasing the risk of transmission due to close proximity and the breakdown of hygiene measures [3] - [5] .

More than half of the mothers were traders and farmers, with 40% (18 cases) being identified as contacts. Additionally, 37.78% (17 cases) of fathers were employed as civil servants at Kibali Gold Mining. Transmission was predominantly intra-familial, as schools were closed, and children remained at home while parents were at work. Close contacts, primarily mothers and/or fathers, were the most common sources of infection. Most studies have identified household exposure as a major risk factor for COVID-19 transmission in children [3] .

The most frequent admission reasons were fever (66.66%, 30 cases), followed by rhinorrhea (57.77%, 26 cases) and cough (31.11%, 14 cases). These findings align with observations by Mercier et al. at the University of Paris. While children typically experience milder forms of COVID-19, severe cases do occur. Clinical presentations in children can vary and may include rhinorrhea, cough, fever, dysphagia, and occasionally gastrointestinal symptoms (diarrhea and/or vomiting), non-specific rashes, and irritability. Severe adult markers, such as pneumonia with typical radiographic findings, anosmia, or acrocyanosis, are less common in children, particularly before age 10. Few young patients require oxygen therapy or intensive care, and when they do present with pneumonia, it is generally less severe [11] - [14] .

All patients showed improvement under treatment and did not exhibit severe symptoms as outlined by the WHO COVID-19 management protocol. The relatively mild severity of COVID-19 in children is supported by epidemiological data from the United States, where, among 149,000 confirmed cases from February 12 to April 2, 2020, only 2572 (1.7%) were children under 18 years. According to a British study, higher adult mortality is linked to acute respiratory distress syndrome and multi-organ failure, with pro-inflammatory cytokine levels potentially causing more severe responses in adults compared to children [14] - [17] .

Limitations include low alert reporting from the community and healthcare facilities, risky behaviors, non-compliance with preventive measures, and limited resources for comprehensive testing such as complete blood counts, D-dimers, prothrombin time, and activated partial thromboplastin time. The absence of these tests in peripheral facilities poses a risk of patient loss during disruptions.