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Ofori SK, Dankwa EA, Estrada EH, Hua X, Kimani TN, Wade CG, Buckee CO, Murray MB, Hedt-Gauthier BL. COVID-19 vaccination strategies in Africa: A scoping review of the use of mathematical models to inform policy. Trop Med Int Health 2024; 29:466-476. [PMID: 38740040 DOI: 10.1111/tmi.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Mathematical models are vital tools to understand transmission dynamics and assess the impact of interventions to mitigate COVID-19. However, historically, their use in Africa has been limited. In this scoping review, we assess how mathematical models were used to study COVID-19 vaccination to potentially inform pandemic planning and response in Africa. METHODS We searched six electronic databases: MEDLINE, Embase, Web of Science, Global Health, MathSciNet and Africa-Wide NiPAD, using keywords to identify articles focused on the use of mathematical modelling studies of COVID-19 vaccination in Africa that were published as of October 2022. We extracted the details on the country, author affiliation, characteristics of models, policy intent and heterogeneity factors. We assessed quality using 21-point scale criteria on model characteristics and content of the studies. RESULTS The literature search yielded 462 articles, of which 32 were included based on the eligibility criteria. Nineteen (59%) studies had a first author affiliated with an African country. Of the 32 included studies, 30 (94%) were compartmental models. By country, most studies were about or included South Africa (n = 12, 37%), followed by Morocco (n = 6, 19%) and Ethiopia (n = 5, 16%). Most studies (n = 19, 59%) assessed the impact of increasing vaccination coverage on COVID-19 burden. Half (n = 16, 50%) had policy intent: prioritising or selecting interventions, pandemic planning and response, vaccine distribution and optimisation strategies and understanding transmission dynamics of COVID-19. Fourteen studies (44%) were of medium quality and eight (25%) were of high quality. CONCLUSIONS While decision-makers could draw vital insights from the evidence generated from mathematical modelling to inform policy, we found that there was limited use of such models exploring vaccination impacts for COVID-19 in Africa. The disparity can be addressed by scaling up mathematical modelling training, increasing collaborative opportunities between modellers and policymakers, and increasing access to funding.
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Affiliation(s)
- Sylvia K Ofori
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emmanuelle A Dankwa
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eve Hiyori Estrada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinyi Hua
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Teresia N Kimani
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
- Department of Health Services, Kiambu County, Ministry of Health Kenya, Kiambu County, Kenya
| | - Carrie G Wade
- Countway Library, Harvard School of Medicine, Boston, Massachusetts, USA
| | - Caroline O Buckee
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Druetz T, Bicaba F, Zainabou C, Bicaba A. Health Planning in Times of COVID-19 in Burkina Faso: The Role of Its National Strategic Pandemic Management Committee. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241256414. [PMID: 38812430 DOI: 10.1177/2752535x241256414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
CONTEXT Presenting the COVID-19 crisis as a pandemic misleadingly implies a certain homogeneity between the regions of the Globe in terms of their burden and reactions. However, from the outset of the crisis, countries presented different epidemiological realities and sometimes adopted divergent, even opposing measures. Curiously, the heterogeneity of responses persisted as scientific evidence accumulated about COVID-19 and the strategies for dealing with it. CASE STUDY This commentary aims to recount the specific experience of Burkina Faso, and how it reoriented its initial biomedical response into a multisectoral strategy. Burkina Faso set up a committee specifically to examine the effects not only of the pandemic, but also of the control measures. This committee was mandated to decompartmentalize the lens through which the COVID-19 was dealt with. It entered into dialogue with a level of stakeholders often overlooked during national health crisis: communities. As a member of this "National Committee for Crisis Management of the Pandemic", one of the co-authors contributed to its orientations and has witnessed first-hand some of the challenges it faced. RECOMMENDATIONS This experience suggests that the project of extricating the field of public health from medicine is advancing in Burkina Faso. In order to manage future crises more effectively and across different sectors, there is an urgent need to establish state structures and to strengthen public health systems. States need coordination units that have the legitimacy, authority and resources required to mobilize a variety of actors at the community, national and international levels.
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Affiliation(s)
- Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique, Montreal, QC, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
- University Aix-Marseille, Centre d'Etudes et de Recherche sur les Services de Santé et la Qualité de Vie, Marseille, France
| | - Cissé Zainabou
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
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Laverdure S, Kazadi D, Kone K, Callier V, Dabitao D, Dennis D, Haidara MC, Hunsberger S, Mbaya OT, Ridzon R, Sereti I, Shaw-Saliba K. SARS-CoV-2 seroprevalence in vaccine-naïve participants from the Democratic Republic of Congo, Guinea, Liberia, and Mali. Int J Infect Dis 2024; 142:106985. [PMID: 38417612 PMCID: PMC11100347 DOI: 10.1016/j.ijid.2024.106985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES The InVITE study, starting in August 2021, was designed to examine the immunogenicity of different vaccine regimens in several countries including the Democratic Republic of Congo, Guinea, Liberia, and Mali. Prevaccination baseline samples were used to obtain estimates of previous SARS-CoV-2 infection in the study population. METHODS Adult participants were enrolled upon receipt of their initial COVID-19 vaccine from August 2021 to June 2022. Demographic and comorbidity data were collected at the time of baseline sample collection. SARS-CoV-2 serum anti-Spike and anti-Nucleocapsid antibody levels were measured. RESULTS Samples tested included 1016, 375, 663, and 776, from DRC, Guinea, Liberia, and Mali, respectively. Only 0.8% of participants reported a prior positive SARS-CoV-2 test, while 83% and 68% had anti-Spike and anti-Nucleocapsid antibodies, respectively. CONCLUSIONS Overall SARS-CoV-2 seroprevalence was 86% over the accrual period, suggesting a high prevalence of SARS-CoV-2 infection. Low rates of prior positive test results may be explained by asymptomatic infections, limited access to SARS-CoV-2 test kits and health care, and inadequate surveillance. These seroprevalence rates are from a convenience sample and may not be representative of the population in general, underscoring the need for timely, well-conducted surveillance as part of global pandemic preparedness.
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Affiliation(s)
- Sylvain Laverdure
- Laboratory of Human Retrovirology and Immunoinformatics, Frederick National Laboratory, Frederick, MD.
| | - Donatien Kazadi
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of Congo
| | - Kadidia Kone
- University Clinical Research Center (UCRC), University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Viviane Callier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory, Frederick, MD
| | - Djeneba Dabitao
- University Clinical Research Center (UCRC), University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Dehkontee Dennis
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Mory Cherif Haidara
- Partnership of Clinical Research in Guinea (PREGUI), Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Maferinyah, Guinea
| | - Sally Hunsberger
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Olivier Tshiani Mbaya
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory, Frederick, MD
| | - Renee Ridzon
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Irini Sereti
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Katy Shaw-Saliba
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Seytre B, Chaibou S, Simon B. The Drivers of Low Vaccination Utilization in Niger. Am J Trop Med Hyg 2024; 110:529-533. [PMID: 38350141 PMCID: PMC10919170 DOI: 10.4269/ajtmh.23-0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 02/15/2024] Open
Abstract
Vaccination adherence involves the expected benefit of a vaccine and the perceived risk of the disease. To develop an evidence-based communication strategy aimed at improving vaccination coverage in Niger, we conducted a mixed socio-anthropological study of the perceptions among the population on the benefit and the risk of the childhood (Expanded Program on Immunization) and the COVID-19 vaccines. Our results show that negative rumors are not a significant driver of vaccine refusal. The insufficient level of fully vaccinated, compared with partially vaccinated, children might be explained by misunderstandings around the side effects of vaccines and the necessity for full vaccination. Approximately one-fourth of the population is vaccinated against COVID-19, whereas 73.3% think that vaccines against the disease are a "good thing," and 83% of those who have heard messages promoting the vaccination approve of them. This apparent contradiction is explained by a low perception of the risks of COVID-19. More than half of the population surveyed believe that the disease is not present in the country. A large majority believe that only ill people can transmit the disease, whereas only 12.8% think they know anybody who has ever been sick with COVID-19. Three-fourths of the interviewees have seen images from around the world of persons sick or deceased from COVID-19; the same proportion has not seen any such images of affected patients in Niger. Communication to improve COVID-19 uptake should focus on the reality of the disease presence and its transmission and not on rumors surrounding the vaccines.
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Affiliation(s)
| | - Sanoussi Chaibou
- Faculté des Sciences Infirmières Université Laval, Québec, Canada
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de Aguirre PM, Carlos S, Pina-Sánchez M, Mbikayi S, Burgueño E, Tendobi C, Chiva L, Holguín Á, Reina G. High pre-Delta and early-Omicron SARS-CoV-2 seroprevalence detected in dried blood samples from Kinshasa (D.R. Congo). J Med Virol 2024; 96:e29529. [PMID: 38516764 DOI: 10.1002/jmv.29529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 02/02/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
Studies on the impact of the COVID-19 pandemic in sub-Saharan Africa have yielded varying results, although authors universally agree the real burden surpasses reported cases. The primary objective of this study was to determine SARS-CoV-2 seroprevalence among patients attending Monkole Hospital in Kinshasa (D.R. Congo). The secondary objective was to evaluate the analytic performance of two chemiluminescence platforms: Elecsys® (Roche) and VirClia® (Vircell) on dried blood spot samples (DBS). The study population (N = 373) was recruited in two stages: a mid-2021 blood donor cohort (15.5% women) and a mid-2022 women cohort. Crude global seroprevalence was 61% (53.9%-67.8%) pre-Delta in 2021 and 90.2% (84.7%-94.2%) post-Omicron in 2022. Anti-spike (S) antibody levels significantly increased from 53.1 (31.8-131.3) U/mL in 2021 to 436.5 (219.3-950.5) U/mL in 2022 and were significantly higher above 45 years old in the 2022 population. Both platforms showed good analytic performance on DBS samples: sensitivity was 96.8% for IgG (antiN/S) (93.9%-98.5%) and 96.0% (93.0%-98.0%) for anti-S quantification. These results provide additional support for the notion that exposure to SARS-CoV-2 is more widespread than indicated by case-based surveillance and will be able to guide the pandemic response and strategy moving forward. Likewise, this study contributes evidence to the reliability of DBS as a tool for serological testing and diagnosis in resource-limited settings.
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Affiliation(s)
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) Irunlarrea, 3, Pamplona, Spain
| | | | - Samclide Mbikayi
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo
| | - Eduardo Burgueño
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo
| | - Céline Tendobi
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo
| | - Luis Chiva
- Clínica Universidad de Navarra, Pamplona, Spain
| | - África Holguín
- Laboratorio Epidemiología Molecular VIH-1, Hospital Ramón y Cajal -IRYCIS y CIBERESP-RITIP, Madrid, Spain
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Gómez-Pérez GP, de Graaff AE, Dekker JT, Agyei BB, Dada I, Milimo E, Ommeh MS, Risha P, Rinke de Wit TF, Spieker N. Preparing healthcare facilities in sub-Saharan Africa for future outbreaks: insights from a multi-country digital self-assessment of COVID-19 preparedness. BMC Health Serv Res 2024; 24:254. [PMID: 38413977 PMCID: PMC10900561 DOI: 10.1186/s12913-024-10761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/20/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, while maintaining essential healthcare services running. METHODS Between May-November 2020, we performed a survey study with SafeCare4Covid - a free digital self-assessment application - to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) availability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities' location, type, and ownership was also collected. RESULTS Four hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0-100 (n=471) was 58.0 (interquartile range 40.0-76.0), and the average supplies score (n=412) was 61.6 (39.0-83.0). Both scores were significantly lower in rural (capability score, mean 53.6 [95%CI:50.3-57.0]/supplies score, 59.1 [55.5-62.8]) versus urban facilities (capability score, 65.2 [61.7-68.7]/supplies score, 70.7 [67.2-74.1]) (P<0.0001 for both comparisons). Likewise, lower scores were found for public versus private clinics, and for primary healthcare centres versus hospitals. Guidelines for triage and isolation, clinical management of COVID-19, staff mental support, and contact tracing forms were largely missing. Handwashing stations were partially equipped in 33% of facilities. The most missing medical supply was COVID-19 specimen collection material (71%), while 43% of facilities did not have N95/FFP2 respirators and 19% lacked medical masks. CONCLUSIONS A large proportion of public and private African facilities providing basic healthcare in rural areas, lacked fundamental COVID-19-related capabilities and life-saving personal protective equipment. Decentralization of epidemic preparedness efforts in these settings is warranted to protect healthcare workers and patients alike in future epidemics. Digital tools are of great value to timely measure and improve epidemic preparedness of healthcare facilities, inform decision-making, create a more stakeholder-broad approach and increase health-system resilience for future disease outbreaks.
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Affiliation(s)
- Gloria P Gómez-Pérez
- PharmAccess Foundation, Amsterdam, The Netherlands.
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | - Peter Risha
- PharmAccess Tanzania, Dar es Salaam, Tanzania
| | - Tobias F Rinke de Wit
- PharmAccess Foundation, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
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Nanque LM, Jensen AM, Diness A, Nielsen S, Cabral C, Cawthorne D, Martins JSD, Ca EJC, Jensen K, Martins CL, Rodrigues A, Fisker AB. Effect of distributing locally produced cloth facemasks on COVID-19-like illness and all-cause mortality-a cluster-randomised controlled trial in urban Guinea-Bissau. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002901. [PMID: 38349910 PMCID: PMC10863890 DOI: 10.1371/journal.pgph.0002901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
Facemasks have been employed to mitigate the spread of SARS-CoV-2. The community effect of providing cloth facemasks on COVID-19 morbidity and mortality is unknown. In a cluster randomised trial in urban Bissau, Guinea-Bissau, clusters (geographical areas with an average of 19 houses), were randomised to an intervention or control arm using computer-generated random numbers. Between 20 July 2020 and 22 January 2021, trial participants (aged 10+ years) living in intervention clusters (n = 90) received two 2-layer cloth facemasks, while facemasks were only distributed later in control clusters (n = 91). All participants received information on COVID-19 prevention. Trial participants were followed through a telephone interview for COVID-19-like illness (3+ symptoms), care seeking, and mortality for 4 months. End-of-study home visits ensured full mortality information and distribution of facemasks to the control group. Individual level information on outcomes by trial arm was compared in logistic regression models with generalised estimating equation-based correction for cluster. Facemasks use was mandated. Facemask use in public areas was assessed by direct observation. We enrolled 39,574 trial participants among whom 95% reported exposure to groups of >20 persons and 99% reported facemasks use, with no difference between trial arms. Observed use was substantially lower (~40%) with a 3%, 95%CI: 0-6% absolute difference between control and intervention clusters. Half of those wearing a facemask wore it correctly. Few participants (532, 1.6%) reported COVID-19-like illness; proportions did not differ by trial arm: Odds Ratio (OR) = 0.81, 95%CI: 0.57-1.15. 177 (0.6%) participants reported consultations and COVID-19-like illness (OR = 0.83, 95%CI: 0.56-1.24); 89 participants (0.2%) died (OR = 1.34, 95%CI: 0.89-2.02). Hence, though trial participants were exposed to many people, facemasks were mostly not worn or not worn correctly. Providing facemasks and messages about correct use did not substantially increase their use and had limited impact on morbidity and mortality. Trial registration: clinicaltrials.gov: NCT04471766.
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Affiliation(s)
- Line M. Nanque
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Andreas M. Jensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Arthur Diness
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Carlos Cabral
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Dylan Cawthorne
- The Maersk Mc-Kinney Moller Institute, SDU Drone Center, University of Southern Denmark, Odense, Denmark
- Engineers Without Borders Denmark, Copenhagen, Denmark
| | | | - Elsi J. C. Ca
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Kjeld Jensen
- The Maersk Mc-Kinney Moller Institute, SDU Drone Center, University of Southern Denmark, Odense, Denmark
- Engineers Without Borders Denmark, Copenhagen, Denmark
| | | | | | - Ane B. Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
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Gwaikolo C, Sackie-Wapoe Y, Badio M, Glidden DV, Lindan C, Martin J. Prevalence and determinants of post-acute sequelae of COVID-19 in Liberia. Int J Epidemiol 2024; 53:dyad167. [PMID: 38052015 PMCID: PMC10859153 DOI: 10.1093/ije/dyad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Evidence from resource-rich settings indicates that many people continue to have persistent symptoms following acute SARS-CoV-2 infection, called post-acute sequelae of COVID-19 (PASC). Only a few studies have described PASC in sub-Saharan Africa (SSA). We aimed to describe PASC in Liberia. METHODS We randomly sampled all people who were reported from the most populous county to the Liberian Ministry of Health (MOH) as having a laboratory-confirmed SARS-CoV-2 infection from June to August 2021. We interviewed individuals by phone 3 to 6 months later. Those with persistence of at least one symptom were considered to have PASC. RESULTS From among 2848 people reported to the MOH from Montserrado County during the period of interest, we randomly selected 650; of these, 548 (84.3%) were reached and 505 (92.2%) of those who were contacted were interviewed. The median age was 38 years (interquartile range (IQR), 30-49), and 43.6% were female. During acute infection, 40.2% were asymptomatic, 53.9% had mild/moderate disease and 6.9% had severe/critical disease. Among the 59.8% (n = 302) who were initially symptomatic, 50.2% (n = 152) reported at least one persistent symptom; the most common persistent symptoms were fatigue (21.2%), headache (16.2%) and cough (12.6%); 40.1% reported that PASC significantly affected their daily activities. Being hospitalized with moderate disease [adjusted prevalence ratio (aPR), 2.00 (95% CI, 1.59 to 2.80] or severe/critical disease [aPR, 2.11 (95% CI, 1.59 to 2.80)] was associated with PASC, compared with those not hospitalized. Females were more likely than males to report persistent fatigue [aPR, 1.67 (95% CI, 1.08 to 2.57)]. CONCLUSIONS Our findings suggest that persistent symptoms may have affected a large proportion of people with initially symptomatic COVID-19 in west Africa and highlight the need to create awareness among infected people and health care professionals.
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Affiliation(s)
- Cozie Gwaikolo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Moses Badio
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Garchitorena A, Rasoloharimanana LT, Rakotonanahary RJ, Evans MV, Miller AC, Finnegan KE, Cordier LF, Cowley G, Razafinjato B, Randriamanambintsoa M, Andrianambinina S, Popper SJ, Hotahiene R, Bonds MH, Schoenhals M. Morbidity and mortality burden of COVID-19 in rural Madagascar: results from a longitudinal cohort and nested seroprevalence study. Int J Epidemiol 2023; 52:1745-1755. [PMID: 37793001 DOI: 10.1093/ije/dyad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Three years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of COVID-19 in the World Health Organization Africa region. High quality, population-representative studies in Africa are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of COVID-19 in rural, low-resource settings. Here, we estimated the spatio-temporal morbidity and mortality burden associated with COVID-19 in a rural health district of Madagascar until the first half of 2021. METHODS We integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in Ifanadiana District, Madagascar. Socio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect IgG and IgM antibodies against four specific proteins of SARS-CoV-2 in a bead-based multiplex immunoassay. We evaluated spatio-temporal patterns in COVID-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions. RESULTS Eighteen percent of people had been infected by April-June 2021, with seroprevalence increasing with individuals' age. COVID-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. Wealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. Adult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. Less than 10% of mortality in this period would be directly attributed to COVID-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district. CONCLUSION Our study provides a very granular understanding on COVID-19 transmission and mortality in a rural population of sub-Saharan Africa and suggests that the disease burden in these areas may have been substantially underestimated.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- NGO Pivot, Ifanadiana, Madagascar
| | | | - Rado Jl Rakotonanahary
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Michelle V Evans
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Karen E Finnegan
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Samuel Andrianambinina
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Stephen J Popper
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Raphaël Hotahiene
- Direction de lutte contre les maladies transmissibles, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Matthew H Bonds
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Bell D, Brown GW, Oyibo WA, Ouédraogo S, Tacheva B, Barbaud E, Kalk A, Ridde V, Paul E. COVAX - Time to reconsider the strategy and its target. HEALTH POLICY OPEN 2023; 4:100096. [PMID: 37073303 PMCID: PMC10098302 DOI: 10.1016/j.hpopen.2023.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.
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Affiliation(s)
- David Bell
- Independent Consultant, Lake Jackson, TX, USA
| | - Garrett W Brown
- Professor of Global Health Policy, University of Leeds, United Kingdom
| | - Wellington A Oyibo
- University of Lagos, College of Medicine, Department of Medical Microbiology and Parasitology, Lagos, Nigeria
| | - Samiratou Ouédraogo
- Observatoire national de la santé de la population (ONSP), Institut National de Santé Publique (INSP), Ouagadougou, Burkina Faso
| | | | - Elena Barbaud
- University of Leeds, Global Health Research Unit, United Kingdom
| | - Andreas Kalk
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Kinshasa Country Office, Democratic Republic of the Congo
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Elisabeth Paul
- Université libre de Bruxelles, School of Public Health, Belgium
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11
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Otiende M, Nyaguara A, Bottomley C, Walumbe D, Mochamah G, Amadi D, Nyundo C, Kagucia EW, Etyang AO, Adetifa IMO, Brand SPC, Maitha E, Chondo E, Nzomo E, Aman R, Mwangangi M, Amoth P, Kasera K, Ng'ang'a W, Barasa E, Tsofa B, Mwangangi J, Bejon P, Agweyu A, Williams TN, Scott JAG. Impact of COVID-19 on mortality in coastal Kenya: a longitudinal open cohort study. Nat Commun 2023; 14:6879. [PMID: 37898630 PMCID: PMC10613220 DOI: 10.1038/s41467-023-42615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023] Open
Abstract
The mortality impact of COVID-19 in Africa remains controversial because most countries lack vital registration. We analysed excess mortality in Kilifi Health and Demographic Surveillance System, Kenya, using 9 years of baseline data. SARS-CoV-2 seroprevalence studies suggest most adults here were infected before May 2022. During 5 waves of COVID-19 (April 2020-May 2022) an overall excess mortality of 4.8% (95% PI 1.2%, 9.4%) concealed a significant excess (11.6%, 95% PI 5.9%, 18.9%) among older adults ( ≥ 65 years) and a deficit among children aged 1-14 years (-7.7%, 95% PI -20.9%, 6.9%). The excess mortality rate for January 2020-December 2021, age-standardised to the Kenyan population, was 27.4/100,000 person-years (95% CI 23.2-31.6). In Coastal Kenya, excess mortality during the pandemic was substantially lower than in most high-income countries but the significant excess mortality in older adults emphasizes the value of achieving high vaccine coverage in this risk group.
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Affiliation(s)
- M Otiende
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya.
| | - A Nyaguara
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - C Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street London, London, WC1E 7HT, UK
| | - D Walumbe
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - G Mochamah
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - D Amadi
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - C Nyundo
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - E W Kagucia
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - A O Etyang
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - I M O Adetifa
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street London, London, WC1E 7HT, UK
| | - S P C Brand
- The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, CV4 7AL, UK
| | - E Maitha
- Department of Health, Kilifi County, Kilifi, Kenya
| | - E Chondo
- Department of Health, Kilifi County, Kilifi, Kenya
| | - E Nzomo
- Kilifi County Hospital, Kilifi, Kenya
| | - R Aman
- Ministry of Health, Government of Kenya; Afya House, Cathedral Road, Nairobi, Kenya
| | - M Mwangangi
- Ministry of Health, Government of Kenya; Afya House, Cathedral Road, Nairobi, Kenya
| | - P Amoth
- Ministry of Health, Government of Kenya; Afya House, Cathedral Road, Nairobi, Kenya
| | - K Kasera
- Ministry of Health, Government of Kenya; Afya House, Cathedral Road, Nairobi, Kenya
| | - W Ng'ang'a
- Presidential Policy and Strategy Unit, The Presidency, Government of Kenya, Nairobi, Kenya
| | - E Barasa
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - B Tsofa
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - J Mwangangi
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - P Bejon
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7BN, UK
| | - A Agweyu
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
| | - T N Williams
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
- Institute for Global Health Innovation, Imperial College, London, SW72AS, UK
| | - J A G Scott
- KEMRI-Wellcome Research Trust Programme, PO Box 230, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street London, London, WC1E 7HT, UK
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12
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Antonio E, Alobo M, Bayona MT, Marsh K, Ariana P, Norton A. Funding and COVID-19 research in Africa: two years on, are the research needs of Africa being met? OPEN RESEARCH AFRICA 2023; 6:16. [PMID: 38174097 PMCID: PMC10762293 DOI: 10.12688/openresafrica.14185.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic caused significantly lower reported mortalities on the African continent as compared to other regions. Yet, many countries on the continent are still contending with the devastating economic, social and indirect health impacts. African researchers and policy makers have identified research priority areas which take cognisance of the unique research needs of African countries. A baseline assessment of the alignment of funded research in Africa to these priorities and World Health Organization's COVID-19 research priorities was undertaken in July, 2020. We present a two-year update to this analysis of funded COVID-19 research in Africa. METHODS Data captured in the UK Collaborative on Development Research and Global Research Collaboration for Infectious Disease Preparedness COVID-19 Research Project Tracker as of 15th July, 2022 was analysed. An additional analysis of institutions receiving funding for COVID-19 research is presented. We also analysed the change in funding for COVID-19 research in Africa since July, 2020. RESULTS The limited COVID-19 research identified in Africa early in the pandemic has persisted over the subsequent two-year period assessed. When number of projects are considered, governmental funders based in Europe and United States supported the most research. Only nine research funders based in Africa were identified. A number of partnerships between African institutions and institutions based on other continents were identified, however, most research projects were undertaken in research institutions based in Africa only. Our findings highlight the relevance of the WHO research priorities for the pandemic response in Africa. Many research questions raised by African researchers remain unaddressed, among which are questions related to clinical management of COVID-19 infections in Africa. CONCLUSIONS Two years after the identification of Africa's COVID-19 research priorities, the findings suggest a missed opportunity in new research funding to answer pertinent questions for the pandemic response in Africa.
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Affiliation(s)
- Emilia Antonio
- Pandemic Sciences Institute, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Moses Alobo
- Science For Africa Foundation, Nairobi, Nairobi County, Kenya
| | | | - Kevin Marsh
- Science For Africa Foundation, Nairobi, Nairobi County, Kenya
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Alice Norton
- Pandemic Sciences Institute, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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13
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Baldé T, Billaud A, Beadling CW, Kartoglu N, Anoko JN, Okeibunor JC. The WHO African Region Initiative on Engaging Civil Society Organizations in Responding to the COVID-19 Pandemic: Best Practices and Lessons Learned for a More Effective Engagement of Communities in Responding to Public Health Emergencies. Disaster Med Public Health Prep 2023; 17:e445. [PMID: 37551088 DOI: 10.1017/dmp.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Engaging communities is a key factor in efficient response to public health emergencies (PHE). Previous and recent outbreaks have shown that civil society organizations (CSOs) can mobilize the communities to better prepare and respond to a PHE. Consequently, the World Health Organization (WHO) Regional Office for Africa (AFRO) implemented an initiative to partner with community leaders by engaging CSOs. The Civil Society Organization Initiative (CSO Initiative) aims to work directly with well-established community-based organizations to accelerate whole-of-society preparation and response. Twenty-three CSOs from 12 WHO African Region Member States have been supported financially and technically to implement effective community-based interventions to respond to the coronavirus disease (COVID-19) pandemic. After 1 year of implementation (2021), the successes, challenges, and recommendations for maximizing future engagements with CSOs are outlined. As the COVID-19 outbreak is again underlining, partnering with established CSOs to engage diverse social groups from various communities can help provide a timely and efficient response to a PHE.
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Affiliation(s)
- Thierno Baldé
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Anthony Billaud
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Charles W Beadling
- Military and Emergency Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Nellie Kartoglu
- WHO, Country Readiness Strengthening Department, Geneva, Switzerland
| | - Julienne Ngoundoung Anoko
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Joseph Chukwudi Okeibunor
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
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14
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López-Gigosos R, Vegas-Romero M, Mariscal A, Mariscal-López E, Fang J, Gutiérrez-Bedmar M. Excess mortality in 22 European countries in 2020 and 2021: relationship with socioeconomic indicators. Perspect Public Health 2023:17579139231180800. [PMID: 37496392 DOI: 10.1177/17579139231180800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
AIMS For better understanding of the impact of COVID-19 pandemic on mortality in different countries, we studied the excess mortality from any cause during 2020 and 2021 in 22 European countries, and its relationship with three socioeconomic variables: life expectancy at birth in 2019, per capita income, and low education level. METHODS Using an ecological design, we analyzed excess mortality data between January 2020 and December 2021 in 22 European countries, obtained from the EuroMOMO surveillance system. Using weekly Z-score data for each country, we estimated the annual average deviation in mortality during 2020 and 2021 for each country. We analyzed possible relationships between the excess mortality and three independent variables: gross domestic product per capita (GDPpc) in 2020, life expectancy at birth in 2019, and proportion of the population over age 18 years with a lower than secondary education level in 2018. RESULTS In the 22 European countries analyzed, the total number of excess deaths in 2020 and 2021 was 800,011 (11%) more than expected, with deaths among those aged 65 years and over accounting for 87.66% of these. Excess mortality was higher in 2020, especially in Spain, UK, Italy, and France. In 2021, excess mortality was highest in Hungary, the Netherlands, France, and Germany. Excess mortality during 2021 was inversely correlated with life expectancy (r =-.489, p = .021) and income level (r =-.550, p = .008). CONCLUSION Reducing socioeconomic inequalities among countries not only improves conditions of most disadvantages but also will help to reduce excess of mortality from future pandemics.
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Affiliation(s)
- R López-Gigosos
- Department of Preventive Medicine and Public Health, University of Málaga, School of Medicine, Málaga 29071, Spain
| | | | - A Mariscal
- Department of Preventive Medicine and Public Health, University of Málaga, School of Medicine, Málaga, Spain
| | | | - J Fang
- Center for Neurology and Sleep Medicine, San Antonio, TX, USA
| | - M Gutiérrez-Bedmar
- Department of Preventive Medicine and Public Health, University of Málaga, School of Medicine, Málaga, Spain
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15
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Gómez-Pérez GP, de Groot R, Abajobir AA, Wainaina CW, Rinke de Wit TF, Sidze E, Pradhan M, Janssens W. Reduced incidence of respiratory, gastrointestinal and malaria infections among children during the COVID-19 pandemic in Western Kenya: An analysis of facility-based and weekly diaries data. J Glob Health 2023; 13:06024. [PMID: 37448326 DOI: 10.7189/jogh.13.06024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Background Epidemics can cause significant disruptions of essential health care services. This was evident in West-Africa during the 2014-2016 Ebola outbreak, raising concerns that COVID-19 would have similar devastating consequences for the continent. Indeed, official facility-based records show a reduction in health care visits after the onset of COVID-19 in Kenya. Our question is whether this observed reduction was caused by lower access to health care or by reduced incidence of communicable diseases resulting from reduced mobility and social contacts. Methods We analysed monthly facility-based data from 2018 to 2020, and weekly health diaries data digitally collected by trained fieldworkers between February and November 2020 from 342 households, including 1974 individuals, in Kisumu and Kakamega Counties, Kenya. Diaries data was collected as part of an ongoing longitudinal study of a digital health insurance scheme (Kakamega), and universal health coverage implementation (Kisumu). We assessed the weekly incidence of self-reported medical symptoms, formal and informal health-seeking behaviour, and foregone care in the diaries and compared it with facility-based records. Linear probability regressions with household fixed-effects were performed to compare the weekly incidence of health outcomes before and after COVID-19. Results Facility-based data showed a decrease in health care utilization for respiratory infections, enteric illnesses, and malaria, after start of COVID-19 measures in Kenya in March 2020. The weekly diaries confirmed this decrease in respiratory and enteric symptoms, and malaria / fever, mainly in the paediatric population. In terms of health care seeking behaviour, our diaries data find a temporary shift in consultations from health care centres to pharmacists / chemists / medicine vendors for a few weeks during the pandemic, but no increase in foregone care. According to the diaries, for adults the incidence of communicable diseases/symptoms rebounded after COVID-19 mobility restrictions were lifted, while for children the effects persisted. Conclusions COVID-19-related containment measures in Western Kenya were accompanied by a decline in respiratory infections, enteric illnesses, and malaria / fever mainly in children. Data from a population-based survey and facility-based records aligned regarding this finding despite the temporary shift to non-facility-based consultations and confirmed that the drop in utilization of health care services was not due to decreased accessibility, but rather to a lower incidence of these infections.
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Affiliation(s)
- Gloria P Gómez-Pérez
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- PharmAccess Foundation, Amsterdam, the Netherlands
| | - Richard de Groot
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
| | | | - Caroline W Wainaina
- African Population and Health Research Centre, Nairobi, Kenya
- Universiteit Utrecht, Amsterdam, the Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- PharmAccess Foundation, Amsterdam, the Netherlands
| | - Estelle Sidze
- African Population and Health Research Centre, Nairobi, Kenya
| | - Menno Pradhan
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- Vrije Universiteit, Amsterdam, the Netherlands
- Universiteit van Amsterdam, the Netherlands
| | - Wendy Janssens
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- Vrije Universiteit, Amsterdam, the Netherlands
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16
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Bloch EM, Kyeyune D, White JL, Ddungu H, Ashokkumar S, Habtehyimer F, Baker O, Kasirye R, Patel EU, Grabowski MK, Musisi E, Moses K, Hume HA, Lubega I, Shrestha R, Motevalli M, Fernandez RE, Reynolds SJ, Redd AD, Wambongo Musana H, Dhabangi A, Ouma J, Eroju P, de Lange T, Fowler MG, Musoke P, Stramer SL, Whitby D, Zimmerman PA, McCullough J, Sachithanandham J, Pekosz A, Goodrich R, Quinn TC, Ness PM, Laeyendecker O, Tobian AAR. SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019-2022. Transfusion 2023; 63:1354-1365. [PMID: 37255467 PMCID: PMC10525030 DOI: 10.1111/trf.17449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The true burden of COVID-19 in low- and middle-income countries remains poorly characterized, especially in Africa. Even prior to the availability of SARS-CoV-2 vaccines, countries in Africa had lower numbers of reported COVID-19 related hospitalizations and deaths than other regions globally. METHODS Ugandan blood donors were evaluated between October 2019 and April 2022 for IgG antibodies to SARS-CoV-2 nucleocapsid (N), spike (S), and five variants of the S protein using multiplexed electrochemiluminescence immunoassays (MesoScale Diagnostics, Rockville, MD). Seropositivity for N and S was assigned using manufacturer-provided cutoffs and trends in seroprevalence were estimated by quarter. Statistically significant associations between N and S antibody seropositivity and donor characteristics in November-December 2021 were assessed by chi-square tests. RESULTS A total of 5393 blood unit samples from donors were evaluated. N and S seropositivity increased throughout the pandemic to 82.6% in January-April 2022. Among seropositive individuals, N and S antibody levels increased ≥9-fold over the study period. In November-December 2021, seropositivity to N and S antibody was higher among repeat donors (61.3%) compared with new donors (55.1%; p = .043) and among donors from Kampala (capital city of Uganda) compared with rural regions (p = .007). Seropositivity to S antibody was significantly lower among HIV-seropositive individuals (58.8% vs. 84.9%; p = .009). CONCLUSIONS Despite previously reported low numbers of COVID-19 cases and related deaths in Uganda, high SARS-CoV-2 seroprevalence and increasing antibody levels among blood donors indicated that the country experienced high levels of infection over the course of the pandemic.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jodie L White
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Swetha Ashokkumar
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Feben Habtehyimer
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Owen Baker
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Eshan U Patel
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Kate Grabowski
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ezra Musisi
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Khan Moses
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Heather A Hume
- Department of Pediatrics, University of Montreal, Montréal, Quebec, Canada
| | | | - Ruchee Shrestha
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mahnaz Motevalli
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Aggrey Dhabangi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ouma
- MUJHU Research Collaboration, Kampala, Uganda
| | | | - Telsa de Lange
- National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Peter A Zimmerman
- The Center for Global Health & Diseases, Pathology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeffrey McCullough
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jaiprasath Sachithanandham
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Raymond Goodrich
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul M Ness
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Kipchumba Kipruto H, Cyprian Karamagi H, Ngusbrhan Kidane S, Mwai D, Njuguna D, Droti B, Muthigani W, Olwanda E, Kirui E, Adegboyega AA, Onyiah AP, Nabyonga-Orem J. Estimating the economic impact of COVID-19 disruption on access to sexual and reproductive health and rights in Eastern and Southern Africa. Front Public Health 2023; 11:1144150. [PMID: 37427280 PMCID: PMC10324971 DOI: 10.3389/fpubh.2023.1144150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Coronavirus disease 2019 (COVID-19) resulted in the disruption of Sexual and Reproductive Health Rights (SRHR) services in the Eastern and Southern Africa region. To date, studies estimating the impact of COVID-19 disruptions have mainly focused on SRHR services without estimating the economic implication. Method We used national service coverage data on the effectiveness of interventions from the lives saved tool (LiST), a mathematical modeling tool that estimates the effects of service coverage change in mortality. We computed years lost due to COVID-19 disruption on SRHR using life expectancy at birth, number of years of life lost due to child mortality, and life expectancy at average maternal death. We calculated the economic value of the lives saved, using the values of statistical life year for each of the countries, comparing 2019 (pre-COVID-19) to 2020 (COVID-19 era). Findings The total life-years lost were 1,335,663, with 1,056,174 life-years lost attributed to child mortality and 279,249 linked to maternal mortalities, with high case-fatality rates in the Democratic Republic of Congo, Burundi, and Tanzania. The findings show COVID-19 disruptions on SRHR services between 2019 and 2020 resulted in US$ 3.6 billion losses, with the highest losses in Angola (USD 777 million), South Africa (USD 539 million), and Democratic Republic of Congo (USD 361 million). Conclusion The monetized value of disability adjusted life years can be used as evidence for advocacy, increased investment, and appropriate mitigation strategies. Countries should strengthen their health systems functionality, incorporating and transforming lessons learned from shock events.
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Affiliation(s)
- Hillary Kipchumba Kipruto
- Health Information System, Universal Health Coverage Life Course, WHO Regional Office for Africa, Harare, Zimbabwe
| | - Humphrey Cyprian Karamagi
- Data, Analytics and Knowledge Management, WHO Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Solyana Ngusbrhan Kidane
- Data, Analytics and Knowledge Management, WHO Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Daniel Mwai
- Health Economics Unit, University of Nairobi, Nairobi, Kenya
- Ministry of Health, Nairobi, Kenya
| | | | - Benson Droti
- Health Information System, Universal Health Coverage Life Course, WHO Regional Office for Africa, Harare, Zimbabwe
| | | | | | | | - Ayotunde Adenola Adegboyega
- Reproductive Maternal New-born and Child and Adolescent Health, Universal Health Coverage Life Course, WHO Regional Office for Africa, Harare, Zimbabwe
| | - Amaka Pamela Onyiah
- Reproductive Maternal Health and Ageing, Universal Health Coverage Life Course, WHO Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Juliet Nabyonga-Orem
- Health Financing, Universal Health Coverage Life Course WHO Regional Office for Africa Harare, Harare, Zimbabwe
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18
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Perumal R, Shunmugam L, Naidoo K, Wilkins D, Garzino-Demo A, Brechot C, Vahlne A, Nikolich J. Biological mechanisms underpinning the development of long COVID. iScience 2023; 26:106935. [PMID: 37265584 PMCID: PMC10193768 DOI: 10.1016/j.isci.2023.106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
As COVID-19 evolves from a pandemic to an endemic disease, the already staggering number of people that have been or will be infected with SARS-CoV-2 is only destined to increase, and the majority of humanity will be infected. It is well understood that COVID-19, like many other viral infections, leaves a significant fraction of the infected with prolonged consequences. Continued high number of SARS-CoV-2 infections, viral evolution with escape from post-infection and vaccinal immunity, and reinfections heighten the potential impact of Long COVID. Hence, the impact of COVID-19 on human health will be seen for years to come until more effective vaccines and pharmaceutical treatments become available. To that effect, it is imperative that the mechanisms underlying the clinical manifestations of Long COVID be elucidated. In this article, we provide an in-depth analysis of the evidence on several potential mechanisms of Long COVID and discuss their relevance to its pathogenesis.
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Affiliation(s)
- Rubeshan Perumal
- South African Medical Research Council (SAMRC)-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa
- Department of Pulmonology and Critical Care, Division of Internal Medicine, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
- Department of Immunobiology and the University of Arizona Center on Aging, University of Arizona College of Medicine-Tucson, Tucson, AZ 85724, USA
| | - Letitia Shunmugam
- South African Medical Research Council (SAMRC)-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa
| | - Kogieleum Naidoo
- South African Medical Research Council (SAMRC)-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa
| | - Dave Wilkins
- The Global Virus Network, Baltimore, MD 21201, USA
| | - Alfredo Garzino-Demo
- The Global Virus Network, Baltimore, MD 21201, USA
- Department of Molecular Medicine, University of Padova, Padova 1- 35129, Italy
| | - Christian Brechot
- The Global Virus Network, Baltimore, MD 21201, USA
- Infectious Disease and International Health, University of South Florida, Tampa, FL 33620, USA
| | - Anders Vahlne
- The Global Virus Network, Baltimore, MD 21201, USA
- Division of Clinical Microbiology, Karolinska Institute, Stockholm 17165, Sweden
| | - Janko Nikolich
- The Global Virus Network, Baltimore, MD 21201, USA
- The Aegis Consortium for Pandemic-Free Future, University of Arizona Health Sciences, University of Arizona College of Medicine-Tucson, Tucson, AZ 85724, USA
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Martínez-Martínez FJ, Massinga AJ, De Jesus Á, Ernesto RM, Cano-Jiménez P, Chiner-Oms Á, Gómez-Navarro I, Guillot-Fernández M, Guinovart C, Sitoe A, Vubil D, Bila R, Gujamo R, Enosse S, Jiménez-Serrano S, Torres-Puente M, Comas I, Mandomando I, López MG, Mayor A. Tracking SARS-CoV-2 introductions in Mozambique using pandemic-scale phylogenies: a retrospective observational study. Lancet Glob Health 2023; 11:e933-e941. [PMID: 37202028 DOI: 10.1016/s2214-109x(23)00169-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND From the start of the SARS-CoV-2 outbreak, global sequencing efforts have generated an unprecedented amount of genomic data. Nonetheless, unequal sampling between high-income and low-income countries hinders the implementation of genomic surveillance systems at the global and local level. Filling the knowledge gaps of genomic information and understanding pandemic dynamics in low-income countries is essential for public health decision making and to prepare for future pandemics. In this context, we aimed to discover the timing and origin of SARS-CoV-2 variant introductions in Mozambique, taking advantage of pandemic-scale phylogenies. METHODS We did a retrospective, observational study in southern Mozambique. Patients from Manhiça presenting with respiratory symptoms were recruited, and those enrolled in clinical trials were excluded. Data were included from three sources: (1) a prospective hospital-based surveillance study (MozCOVID), recruiting patients living in Manhiça, attending the Manhiça district hospital, and fulfilling the criteria of suspected COVID-19 case according to WHO; (2) symptomatic and asymptomatic individuals with SARS-CoV-2 infection recruited by the National Surveillance system; and (3) sequences from SARS-CoV-2-infected Mozambican cases deposited on the Global Initiative on Sharing Avian Influenza Data database. Positive samples amenable for sequencing were analysed. We used Ultrafast Sample placement on Existing tRees to understand the dynamics of beta and delta waves, using available genomic data. This tool can reconstruct a phylogeny with millions of sequences by efficient sample placement in a tree. We reconstructed a phylogeny (~7·6 million sequences) adding new and publicly available beta and delta sequences. FINDINGS A total of 5793 patients were recruited between Nov 1, 2020, and Aug 31, 2021. During this time, 133 328 COVID-19 cases were reported in Mozambique. 280 good quality new SARS-CoV-2 sequences were obtained after the inclusion criteria were applied and an additional 652 beta (B.1.351) and delta (B.1.617.2) public sequences were included from Mozambique. We evaluated 373 beta and 559 delta sequences. We identified 187 beta introductions (including 295 sequences), divided in 42 transmission groups and 145 unique introductions, mostly from South Africa, between August, 2020 and July, 2021. For delta, we identified 220 introductions (including 494 sequences), with 49 transmission groups and 171 unique introductions, mostly from the UK, India, and South Africa, between April and November, 2021. INTERPRETATION The timing and origin of introductions suggests that movement restrictions effectively avoided introductions from non-African countries, but not from surrounding countries. Our results raise questions about the imbalance between the consequences of restrictions and health benefits. This new understanding of pandemic dynamics in Mozambique can be used to inform public health interventions to control the spread of new variants. FUNDING European and Developing Countries Clinical Trials, European Research Council, Bill & Melinda Gates Foundation, and Agència de Gestió d'Ajuts Universitaris i de Recerca.
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Affiliation(s)
- Francisco José Martínez-Martínez
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | | | - Áuria De Jesus
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Rita M Ernesto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pablo Cano-Jiménez
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | - Álvaro Chiner-Oms
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | - Inmaculada Gómez-Navarro
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | - Marina Guillot-Fernández
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | | | - António Sitoe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Delfino Vubil
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Rubão Bila
- Hospital Distrital da Manhiça, Marracuene, Mozambique
| | | | - Sónia Enosse
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Santiago Jiménez-Serrano
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | - Manuela Torres-Puente
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | - Iñaki Comas
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Mariana G López
- Tuberculosis Genomics Unit, Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain.
| | - Alfredo Mayor
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
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20
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Semakula M, Niragire F, Nsanzimana S, Remera E, Faes C. Spatio-temporal dynamic of the COVID-19 epidemic and the impact of imported cases in Rwanda. BMC Public Health 2023; 23:930. [PMID: 37221533 DOI: 10.1186/s12889-023-15888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Africa was threatened by the coronavirus disease 2019 (COVID-19) due to the limited health care infrastructure. Rwanda has consistently used non-pharmaceutical strategies, such as lockdown, curfew, and enforcement of prevention measures to control the spread of COVID-19. Despite the mitigation measures taken, the country has faced a series of outbreaks in 2020 and 2021. In this paper, we investigate the nature of epidemic phenomena in Rwanda and the impact of imported cases on the spread of COVID-19 using endemic-epidemic spatio-temporal models. Our study provides a framework for understanding the dynamics of the epidemic in Rwanda and monitoring its phenomena to inform public health decision-makers for timely and targeted interventions. RESULTS The findings provide insights into the effects of lockdown and imported infections in Rwanda's COVID-19 outbreaks. The findings showed that imported infections are dominated by locally transmitted cases. The high incidence was predominant in urban areas and at the borders of Rwanda with its neighboring countries. The inter-district spread of COVID-19 was very limited due to mitigation measures taken in Rwanda. CONCLUSION The study recommends using evidence-based decisions in the management of epidemics and integrating statistical models in the analytics component of the health information system.
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Affiliation(s)
- Muhammed Semakula
- I-BioStat, Hasselt University, Hasselt, Belgium.
- College of Business and Economics, Centre of excellence in Data Science, Bio-statistics, University of Rwanda, Kigali, Kigali, Rwanda.
- Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.
| | - François Niragire
- Department of Applied Statistics, University of Rwanda, Kigali, Kigali, Rwanda
| | | | - Eric Remera
- Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
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21
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Lippi G, Mattiuzzi C, Henry BM. Uncontrolled confounding in COVID-19 epidemiology. Diagnosis (Berl) 2023; 10:200-202. [PMID: 36474317 DOI: 10.1515/dx-2022-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Camilla Mattiuzzi
- Service of Clinical Governance, Provincial Agency for Social and Sanitary Services (APSS), Trento, Italy
| | - Brandon M Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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22
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Beye SA, Diallo B, Keita M, Cissoko Y, Ouattara K, Dicko H, Shabani M, Sidibé A, Berthé M, Coulibaly YI, Diani N, Keita M, Toloba Y, Dao S, Suttels V, Coulibaly Y, Dessap AM. Assessment of lung injury severity using ultrasound in critically ill COVID-19 patients in resource limited settings. Ann Intensive Care 2023; 13:33. [PMID: 37103717 PMCID: PMC10134692 DOI: 10.1186/s13613-023-01133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting. METHODS We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings. RESULTS The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound score < 3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23 ± 5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of - 0.38, p < 0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patients' age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score. CONCLUSION Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality.
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Affiliation(s)
- Seydina Alioune Beye
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali.
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali.
| | - Boubacar Diallo
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Modibo Keita
- Department of Public Health, Teaching Hospital (CHU) Dermatology, Bamako, Mali
| | - Yacouba Cissoko
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Infectious Diseases and Tropical Diseases, Point G Teaching Hospital, Bamako, Mali
| | - Khadidia Ouattara
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Pneumology, Point G Teaching Hospital, Bamako, Mali
| | - Hammadoun Dicko
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Majaliwa Shabani
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
| | - Amadou Sidibé
- Department of Intensive Care and Anesthesia/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Modibo Berthé
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
| | - Yaya Ibrahim Coulibaly
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Public Health, Teaching Hospital (CHU) Dermatology, Bamako, Mali
| | - Nouhoum Diani
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Intensive Care and Anesthesia/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mohamed Keita
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yacouba Toloba
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Pneumology, Point G Teaching Hospital, Bamako, Mali
| | - Sounkalo Dao
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
- Department of Infectious Diseases and Tropical Diseases, Point G Teaching Hospital, Bamako, Mali
| | - Veronique Suttels
- National Teaching Hospital for Tuberculosis and Respiratory Diseases (CNHU-PPC), Cotonou, Benin
| | - Youssouf Coulibaly
- Department of Intensive Care and Anesthesia, Point G Teaching Hospital, Bamako, Mali
- Faculty of Medicine and Odonto-Stomatology (FMOS)/University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, 94010, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
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23
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Galli M, Zardini A, Gamshie WN, Santini S, Tsegaye A, Trentini F, Marziano V, Guzzetta G, Manica M, d'Andrea V, Putoto G, Manenti F, Ajelli M, Poletti P, Merler S. Priority age targets for COVID-19 vaccination in Ethiopia under limited vaccine supply. Sci Rep 2023; 13:5586. [PMID: 37019980 PMCID: PMC10075159 DOI: 10.1038/s41598-023-32501-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
The worldwide inequitable access to vaccination claims for a re-assessment of policies that could minimize the COVID-19 burden in low-income countries. Nine months after the launch of the national vaccination program in March 2021, only 3.4% of the Ethiopian population received two doses of COVID-19 vaccine. We used a SARS-CoV-2 transmission model to estimate the level of immunity accrued before the launch of vaccination in the Southwest Shewa Zone (SWSZ) and to evaluate the impact of alternative age priority vaccination targets in a context of limited vaccine supply. The model was informed with available epidemiological evidence and detailed contact data collected across different geographical settings (urban, rural, or remote). We found that, during the first year of the pandemic, the mean proportion of critical cases occurred in SWSZ attributable to infectors under 30 years of age would range between 24.9 and 48.0%, depending on the geographical setting. During the Delta wave, the contribution of this age group in causing critical cases was estimated to increase on average to 66.7-70.6%. Our findings suggest that, when considering the vaccine product available at the time (ChAdOx1 nCoV-19; 65% efficacy against infection after 2 doses), prioritizing the elderly for vaccination remained the best strategy to minimize the disease burden caused by Delta, irrespectively of the number of available doses. Vaccination of all individuals aged ≥ 50 years would have averted 40 (95%PI: 18-60), 90 (95%PI: 61-111), and 62 (95%PI: 21-108) critical cases per 100,000 residents in urban, rural, and remote areas, respectively. Vaccination of all individuals aged ≥ 30 years would have averted an average of 86-152 critical cases per 100,000 individuals, depending on the setting considered. Despite infections among children and young adults likely caused 70% of critical cases during the Delta wave in SWSZ, most vulnerable ages should remain a key priority target for vaccination against COVID-19.
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Affiliation(s)
- Margherita Galli
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Agnese Zardini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | | | | | | | - Filippo Trentini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | | | - Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
| | - Mattia Manica
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
| | - Valeria d'Andrea
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | | | | | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Piero Poletti
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy.
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy.
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
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Bakare AA, Olojede OE, King C, Graham H, Uchendu O, Colbourn T, Falade AG, Alvesson HM. Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study. BMJ Open 2023; 13:e069294. [PMID: 36882237 PMCID: PMC10008198 DOI: 10.1136/bmjopen-2022-069294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE To explore healthcare seeking practices for children and the context-specific direct and indirect effects of public health interventions during the first two waves of COVID-19 in Lagos State, Nigeria. We also explored decision-making around vaccine acceptance at the start of COVID-19 vaccine roll-out in Nigeria. DESIGN, SETTING AND PARTICIPANTS A qualitative explorative study involving 19 semistructured interviews with healthcare providers from public and private primary health facilities and 32 interviews with caregivers of under-five children in Lagos from December 2020 to March 2021. Participants were purposively selected from healthcare facilities to include community health workers, nurses and doctors, and interviews were conducted in quiet locations at facilities. A data-driven reflexive thematic analysis according to Braun and Clark was conducted. FINDINGS Two themes were developed: appropriating COVID-19 in belief systems, and ambiguity about COVID-19 preventive measures. The interpretation of COVID-19 ranged from fearful to considering it as a 'scam' or 'falsification from the government'. Underlying distrust in government fuelled COVID-19 misperceptions. Care seeking for children under five was affected, as facilities were seen as contagious places for COVID-19. Caregivers resorted to alternative care and self-management of childhood illnesses. COVID-19 vaccine hesitancy was a major concern among healthcare providers compared with community members at the time of vaccine roll-out in Lagos, Nigeria. Indirect impacts of COVID-19 lockdown included diminished household income, worsening food insecurity, mental health challenges for caregivers and reduced clinic visits for immunisation. CONCLUSION The first wave of the COVID-19 pandemic in Lagos was associated with reductions in care seeking for children, clinic attendance for childhood immunisations and household income. Strengthening health and social support systems with context-specific interventions and correcting misinformation is crucial to building adaptive capacity for response to future pandemics. TRIAL REGISTRATION NUMBER ACTRN12621001071819.
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Affiliation(s)
- Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Omotayo E Olojede
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hamish Graham
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Centre for International Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Obioma Uchendu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Department of Paediatrics, University of Ibadan College of Medicine, Ibadan, Nigeria
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25
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Heuschen AK, Abdul-Mumin A, Abubakari A, Agbozo F, Lu G, Jahn A, Müller O. Effects of the COVID-19 pandemic on general health and malaria control in Ghana: a qualitative study with mothers and health care professionals. Malar J 2023; 22:78. [PMID: 36872343 PMCID: PMC9986038 DOI: 10.1186/s12936-023-04513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND COVID-19 has severely impacted health systems and the management of non-COVID-19 diseases, including malaria, globally. The pandemic has hit sub-Saharan Africa less than expected; even considering large underreporting, the direct COVID-19 burden was minor compared to the Global North. However, the indirect effects of the pandemic, e.g. on socio-economic inequality and health care systems, may have been more disruptive. Following a quantitative analysis from northern Ghana, which showed significant reductions in overall outpatient department visits and malaria cases during the first year of COVID-19, this qualitative study aims to provide further explanations to those quantitative findings. METHODS In the Northern Region of Ghana, 72 participants, consisting of 18 health care professionals (HCPs) and 54 mothers of children under the age of five, were recruited in urban and rural districts. Data were collected using focus group discussions with mothers and through key informant interviews with HCPs. RESULTS Three main themes occurred. The first theme-general effects of the pandemic-includes impacts on finances, food security, health service provision as well as education and hygiene. Many women lost their jobs, which increased their dependance on males, children had to drop out of school, and families had to cope with food shortages and were considering migration. HCPs had problems reaching the communities, suffered stigmatisation and were often barely protected against the virus. The second theme-effects on health-seeking-includes fear of infection, lack of COVID-19 testing capacities, and reduced access to clinics and treatment. The third theme-effects on malaria-includes disruptions of malaria preventive measures. Clinical discrimination between malaria and COVID-19 symptoms was difficult and HCPs observed increases in severe malaria cases in health facilities due to late reporting. CONCLUSION The COVID-19 pandemic has had large collateral impacts on mothers, children and HCPs. In addition to overall negative effects on families and communities, access to and quality of health services was severely impaired, including serious implications on malaria. This crisis has highlighted weaknesses of health care systems globally, including the malaria situation; a holistic analysis of the direct and indirect effects of this pandemic and an adapted strengthening of health care systems is essential to be prepared for the future.
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Affiliation(s)
- Anna-Katharina Heuschen
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.
| | - Alhassan Abdul-Mumin
- School of Medicine, Department of Paediatrics and Child Health, University for Development Studies, Tamale, Ghana.,Tamale Teaching Hospital, Tamale, Ghana
| | - Abdulai Abubakari
- School of Public Health, Department of Global Health, University for Development Studies, Tamale, Ghana
| | - Faith Agbozo
- Fred Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Guangyu Lu
- School of Public Health, Medical School, Yangzhou University, Yangzhou, China
| | - Albrecht Jahn
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Olaf Müller
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
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Olu OO, Waya JLL, Bankss S, Maleghemi S, Guyo AG. Integrated approaches to COVID-19 emergency response in fragile, conflict-affected and vulnerable settings: a public health policy brief. J Public Health Policy 2023; 44:122-137. [PMID: 36564482 PMCID: PMC9782278 DOI: 10.1057/s41271-022-00383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
In the absence of fully effective measures to prevent and treat COVID-19, the limited access to and hesitancy about vaccines, the prolongation of the on-going pandemic is likely. This underscores the need to continue to respond and maintain preparedness, preferably using a more sustainable approach. A sustainable management is particularly important in fragile, conflict-affected and vulnerable countries of sub-Saharan Africa given several peculiar challenges. This Viewpoint proposes policy options to guide transitioning from current COVID-19 emergency response interventions to longer-term and more sustainable responses in such settings. In the long term, a shift in policy from a vertical to a more effective approach should integrate response coordination, surveillance, case management, risk communication and operational support, among other elements, for better results. We call on public health policymakers, partners and donors to support full implementation of these policy options in a holistic manner to encompass all emerging public health threats.
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Affiliation(s)
- Olushayo Oluseun Olu
- World Health Organization COVID-19 preparedness and response team, Juba, Republic of South Sudan.
| | - Joy Luba Lomole Waya
- World Health Organization COVID-19 preparedness and response team, Juba, Republic of South Sudan
| | - Sandra Bankss
- World Health Organization COVID-19 preparedness and response team, Juba, Republic of South Sudan
| | - Sylvester Maleghemi
- World Health Organization COVID-19 preparedness and response team, Juba, Republic of South Sudan
| | - Argata Guracha Guyo
- World Health Organization COVID-19 preparedness and response team, Juba, Republic of South Sudan
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27
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Mohammed NI, Mackenzie G, Ezeani E, Sidibeh M, Jammeh L, Sarwar G, Saine AKF, Sonko B, Gomez P, Dondeh BL, Hossain MJ, Jasseh M, Usuf E, Prentice AM, Jeffries D, Dalessandro U, Roca A. Quantifying excess mortality during the COVID-19 pandemic in 2020 in The Gambia: a time-series analysis of three health and demographic surveillance systems. Int J Infect Dis 2023; 128:61-68. [PMID: 36566776 PMCID: PMC9780021 DOI: 10.1016/j.ijid.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Estimates for COVID-19-related excess mortality for African populations using local data are needed to design and implement effective control policies. METHODS We applied time-series analysis using data from three health and demographic surveillance systems in The Gambia (Basse, Farafenni, and Keneba) to examine pandemic-related excess mortality during 2020, when the first SARS-CoV-2 wave was observed, compared to the pre-pandemic period (2016-2019). RESULTS Across the three sites, average mortality during the pre-pandemic period and the total deaths during 2020 were 1512 and 1634, respectively (Basse: 1099 vs 1179, Farafenni: 316 vs 351, Keneba: 98 vs 104). The overall annual crude mortality rates per 100,000 (95% CI) were 589 (559, 619) and 599 (571, 629) for the pre-pandemic and 2020 periods, respectively. The adjusted excess mortality rate was 8.8 (-34.3, 67.6) per 100,000 person-month with the adjusted rate ratio (aRR) = 1.01 (0.94,1.11). The age-stratified analysis showed excess mortality in Basse for infants (aRR = 1.22 [1.04, 1.46]) and in Farafenni for the 65+ years age group (aRR = 1.19 [1, 1.44]). CONCLUSION We did not find significant excess overall mortality in 2020 in The Gambia. However, some age groups may have been at risk of excess death. Public health response in countries with weak health systems needs to consider vulnerable age groups and the potential for collateral damage.
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Affiliation(s)
- Nuredin I Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Murdoch Children's Research Institute, Melbourne, Australia
| | - Esu Ezeani
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Mamadi Sidibeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Lamin Jammeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Aji Kumba Folawiyo Saine
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bakary Sonko
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Pierre Gomez
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bai Lamin Dondeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Momodou Jasseh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Effua Usuf
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - David Jeffries
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Umberto Dalessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
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Msemo OA, Pérez-Alós L, Minja DT, Hansen CB, Gesase S, Mtove G, Mbwana J, Larsen VML, Bøgestad ECS, Grunnet LG, Christensen DL, Bygbjerg IC, Burgner D, Schmiegelow C, Garred P, Hjort L. High anti-SARS-CoV-2 seroprevalence among unvaccinated mother-child pairs from a rural setting in north-eastern Tanzania during the second wave of COVID-19. IJID REGIONS 2023; 6:48-57. [PMID: 36466214 PMCID: PMC9709504 DOI: 10.1016/j.ijregi.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Background The reported infection rates and burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in low- and middle-income countries, including those in sub-Saharan Africa, are relatively low compared to the rates and burden in Europe and America, partly due to limited testing capability. Unlike many countries, Tanzania has implemented neither mass screening nor restrictive measures such as lockdowns to date. The prevalence of SARS-CoV-2 infection in rural mainland Tanzania is largely unknown. Methods A cross-sectional study was conducted between April and October 2021 to assess the anti-SARS-CoV-2 seroprevalence among mother-child pairs (n = 634 children, n = 518 mothers) in a rural setting in north-eastern Tanzania. Results A very high prevalence of anti-SARS-CoV-2 antibody titres was found, with seroprevalence rates ranging from 29% among mothers and 40% among children, with a dynamic peak in seropositivity incidence at the end of July/early August being revealed. Significant differences in age, socioeconomic status, and body composition were associated with seropositivity in mothers and children. No significant associations were observed between seropositivity and comorbidities, including anaemia, diabetes, malaria, and HIV. Conclusions The transmission of SARS-CoV-2 in a rural region of Tanzania during 2021 was high, indicating a much higher infection rate in rural Tanzania compared to that reported in the UK and USA during the same period. Ongoing immune surveillance may be vital to monitoring the burden of viral infection in rural settings without access to molecular genotyping, where the load of communicable diseases may mask COVID-19. Surveillance could be implemented in tandem with the intensification of vaccination strategies.
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Affiliation(s)
- Omari Abdul Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel T.R. Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - George Mtove
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Joyce Mbwana
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Victoria Marie Linderod Larsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Emilie Caroline Skuladottir Bøgestad
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | | | - Dirk Lund Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Burgner
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark,Department of Obstetrics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Hjort
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Corresponding author: Line Hjort, he Novo Nordisk Foundation Centre for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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29
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Moeti M, Makubalo L, Gueye AS, Balde T, Karamagi H, Awandare G, Thumbi SM, Zhang F, Mutapi F, Woolhouse M. Conflicting COVID-19 excess mortality estimates. Lancet 2023; 401:431. [PMID: 36774149 PMCID: PMC9910847 DOI: 10.1016/s0140-6736(23)00112-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Matshidiso Moeti
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Lindiwe Makubalo
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Abdou Salam Gueye
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Thierno Balde
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Humphrey Karamagi
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Gordon Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA; Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Feifei Zhang
- National Institute of Health Data Science, Peking University, Beijing, China; Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Francisca Mutapi
- Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Mark Woolhouse
- Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK.
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30
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Olamijuwon E, Konje E, Kansiime C, Kesby M, Keenan K, Neema S, Asiimwe B, Mshana SE, Mushi MF, Loza O, Sunday B, Sandeman A, Sloan DJ, Benitez-Paez F, Mwanga JR, Sabiiti W, Holden MTG. Antibiotic dispensing practices during COVID-19 and implications for antimicrobial resistance (AMR): parallel mystery client studies in Uganda and Tanzania. Antimicrob Resist Infect Control 2023; 12:10. [PMID: 36774512 PMCID: PMC9919751 DOI: 10.1186/s13756-022-01199-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 12/07/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Over-the-counter antibiotic access is common in low-and-middle-income countries and this may accelerate antimicrobial resistance. Our study explores critical aspects of the drug seller-client interaction and antibiotic dispensing patterns for simulated COVID-19 symptoms during the pandemic in two study sites in Tanzania and Uganda, countries with different government responses to the pandemic. METHODS Research assistants posing as clients approached different types of drug sellers such as pharmacies (Pharms), drug shops (DSs), and accredited drug dispensing outlets (ADDOs) in Mwanza, Tanzania (nPharms = 415, nADDOs = 116) and Mbarara, Uganda (nPharms = 440, nDSs = 67), from June 10 to July 30, 2021. The mystery clients held no prescription and sought advice for simulated COVID-19 symptoms from the drug sellers. They documented the quality of their interaction with sellers and the type of drugs dispensed. RESULTS Adherence to COVID-19 preventive measures and vigilance to COVID-19 symptoms was low in both sites but significantly higher in Uganda than in Tanzania. A higher percentage of drug sellers in Mbarara (Pharms = 36%, DSs = 35%, P-value = 0.947) compared to Mwanza (Pharms = 9%, ADDOs = 4%, P-value = 0.112) identified the client's symptoms as possibly COVID-19. More than three-quarters of drug sellers that sold prescription-only medicines in both Mbarara (Pharms = 86%, DSs = 89%) and Mwanza (Pharms = 93%, ADDOs = 97%) did not ask the MCs for a prescription. A relatively high percentage of drug sellers that sold prescription-only medicines in Mwanza (Pharms = 51%, ADDOs = 67%) compared to Mbarara (Pharms = 31%, DSs = 42%) sold a partial course without any hesitation. Of those who sold antibiotics, a higher proportion of drug sellers in Mbarara (Pharms = 73%, DSs = 78%, P-value = 0.580) compared to Mwanza (Pharms = 40% ADDOs = 46%, P-value = 0.537) sold antibiotics relevant for treating secondary bacterial infections in COVID-19 patients. CONCLUSION Our study highlights low vigilance towards COVID-19 symptoms, widespread propensity to dispense prescription-only antibiotics without a prescription, and to dispense partial doses of antibiotics. This implies that drug dispensing related to COVID-19 may further drive AMR. Our study also highlights the need for more efforts to improve antibiotic stewardship among drug sellers in response to COVID-19 and to prepare them for future health emergencies.
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Affiliation(s)
- Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL, UK.
| | - Eveline Konje
- grid.411961.a0000 0004 0451 3858Department of Biostatistics and Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Catherine Kansiime
- grid.11194.3c0000 0004 0620 0548School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mike Kesby
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Katherine Keenan
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Stella Neema
- grid.11194.3c0000 0004 0620 0548Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Benon Asiimwe
- grid.11194.3c0000 0004 0620 0548Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen E. Mshana
- grid.411961.a0000 0004 0451 3858Department of Microbiology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Martha F. Mushi
- grid.411961.a0000 0004 0451 3858Department of Microbiology, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Olga Loza
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Benjamin Sunday
- grid.33440.300000 0001 0232 6272Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alison Sandeman
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
| | - Derek J. Sloan
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
| | - Fernando Benitez-Paez
- grid.11914.3c0000 0001 0721 1626School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL UK
| | - Joseph R. Mwanga
- grid.411961.a0000 0004 0451 3858Department of Biostatistics and Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Wilber Sabiiti
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
| | - Matthew T. G. Holden
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St Andrews, St Andrews, KY16 9AL UK
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Villar J, Soto Conti CP, Gunier RB, Ariff S, Craik R, Cavoretto PI, Rauch S, Gandino S, Nieto R, Winsey A, Menis C, Rodriguez GB, Savasi V, Tug N, Deantoni S, Fabre M, Martinez de Tejada B, Rodriguez-Sibaja MJ, Livio S, Napolitano R, Maiz N, Sobrero H, Peterson A, Deruelle P, Giudice C, Teji JS, Casale RA, Salomon LJ, Prefumo F, Cheikh Ismail L, Gravett MG, Vale M, Hernández V, Sentilhes L, Easter SR, Capelli C, Marler E, Cáceres DM, Albornoz Crespo G, Ernawati E, Lipschuetz M, Takahashi K, Vecchiarelli C, Hubka T, Ikenoue S, Tavchioska G, Bako B, Ayede AI, Eskenazi B, Thornton JG, Bhutta ZA, Kennedy SH, Papageorghiou AT. Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study. Lancet 2023; 401:447-457. [PMID: 36669520 PMCID: PMC9910845 DOI: 10.1016/s0140-6736(22)02467-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. METHODS INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. FINDINGS We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. INTERPRETATION COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. FUNDING None.
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Affiliation(s)
- Jose Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | | | - Robert B Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | - Shabina Ariff
- Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Paolo I Cavoretto
- Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Obstetrics and Gynaecology Department, Milan, Italy
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | - Serena Gandino
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
| | - Adele Winsey
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Camilla Menis
- Department of Clinical Sciences and Community Health, University of Milan, NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriel B Rodriguez
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, L- Sacco Hospital ASST Fatebenefratelli Sacco, Department of Biological and Clinical Sciences, University of Milan, Milan, Italy
| | - Niyazi Tug
- Department of Obstetrics and Gynecology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Sonia Deantoni
- Neonatal Care Unit, Department of Public Health and Pediatrics, School of Medicine, University of Turin, Turin, Italy
| | - Marta Fabre
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Begoña Martinez de Tejada
- Department of Pediatrics, Gynecology & Obstetrics, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Stefania Livio
- Children's Hospital V Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nerea Maiz
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron, Barcelona Hospital Campus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Helena Sobrero
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Carolina Giudice
- Servicio de Neonatologia, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Jagjit S Teji
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Roberto A Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Michael G Gravett
- Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Marynéa Vale
- Hospital Universitário da Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | - Valeria Hernández
- Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Sarah R Easter
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carola Capelli
- Servicio de Neonatología del Departamento Materno Infantil, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Emily Marler
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | - Ernawati Ernawati
- Medical Faculty Universitas Airlangga - Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Michal Lipschuetz
- Obstetrics and Gynecology Division- Hadassah Medical Center Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Teresa Hubka
- Ascension-Resurrection Medical Center, Chicago, Illinois, USA
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | - Babagana Bako
- Department of Obstetrics and Gynaecology, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Adejumoke I Ayede
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | - Jim G Thornton
- University of Nottingham Medical School, University of Nottingham, Nottingham, UK
| | - Zulfiqar A Bhutta
- Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; St George's University Hospitals NHS Foundation Trust, London, UK.
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Odhiambo JN, Dolan CB, Troup L, Rojas NP. Spatial and spatio-temporal epidemiological approaches to inform COVID-19 surveillance and control: a systematic review of statistical and modelling methods in Africa. BMJ Open 2023; 13:e067134. [PMID: 36697047 PMCID: PMC9884571 DOI: 10.1136/bmjopen-2022-067134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Various studies have been published to better understand the underlying spatial and temporal dynamics of COVID-19. This review sought to identify different spatial and spatio-temporal modelling methods that have been applied to COVID-19 and examine influential covariates that have been reportedly associated with its risk in Africa. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Thematically mined keywords were used to identify refereed studies conducted between January 2020 and February 2022 from the following databases: PubMed, Scopus, MEDLINE via Proquest, CINHAL via EBSCOhost and Coronavirus Research Database via ProQuest. A manual search through the reference list of studies was also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Peer-reviewed studies that demonstrated the application of spatial and temporal approaches to COVID-19 outcomes. DATA EXTRACTION AND SYNTHESIS A standardised extraction form based on critical appraisal and data extraction for systematic reviews of prediction modelling studies checklist was used to extract the meta-data of the included studies. A validated scoring criterion was used to assess studies based on their methodological relevance and quality. RESULTS Among 2065 hits in five databases, title and abstract screening yielded 827 studies of which 22 were synthesised and qualitatively analysed. The most common socioeconomic variable was population density. HIV prevalence was the most common epidemiological indicator, while temperature was the most common environmental indicator. Thirteen studies (59%) implemented diverse formulations of spatial and spatio-temporal models incorporating unmeasured factors of COVID-19 and the subtle influence of time and space. Cluster analyses were used across seven studies (32%) to explore COVID-19 variation and determine whether observed patterns were random. CONCLUSION COVID-19 modelling in Africa is still in its infancy, and a range of spatial and spatio-temporal methods have been employed across diverse settings. Strengthening routine data systems remains critical for generating estimates and understanding factors that drive spatial variation in vulnerable populations and temporal variation in pandemic progression. PROSPERO REGISTRATION NUMBER CRD42021279767.
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Affiliation(s)
- Julius Nyerere Odhiambo
- Ignite Global Health Research Lab, Global Research Institute, William & Mary, Williamsburg, Virginia, USA
- Kinesiology and Health Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Carrie B Dolan
- Ignite Global Health Research Lab, Global Research Institute, William & Mary, Williamsburg, Virginia, USA
- Kinesiology and Health Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Lydia Troup
- Ignite Global Health Research Lab, Global Research Institute, William & Mary, Williamsburg, Virginia, USA
| | - Nathaly Perez Rojas
- Ignite Global Health Research Lab, Global Research Institute, William & Mary, Williamsburg, Virginia, USA
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The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature 2023; 613:130-137. [PMID: 36517599 DOI: 10.1038/s41586-022-05522-2] [Citation(s) in RCA: 221] [Impact Index Per Article: 221.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022]
Abstract
The World Health Organization has a mandate to compile and disseminate statistics on mortality, and we have been tracking the progression of the COVID-19 pandemic since the beginning of 20201. Reported statistics on COVID-19 mortality are problematic for many countries owing to variations in testing access, differential diagnostic capacity and inconsistent certification of COVID-19 as cause of death. Beyond what is directly attributable to it, the pandemic has caused extensive collateral damage that has led to losses of lives and livelihoods. Here we report a comprehensive and consistent measurement of the impact of the COVID-19 pandemic by estimating excess deaths, by month, for 2020 and 2021. We predict the pandemic period all-cause deaths in locations lacking complete reported data using an overdispersed Poisson count framework that applies Bayesian inference techniques to quantify uncertainty. We estimate 14.83 million excess deaths globally, 2.74 times more deaths than the 5.42 million reported as due to COVID-19 for the period. There are wide variations in the excess death estimates across the six World Health Organization regions. We describe the data and methods used to generate these estimates and highlight the need for better reporting where gaps persist. We discuss various summary measures, and the hazards of ranking countries' epidemic responses.
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Mgbere O, Nwabuko OC, Olateju OA, Adepoju OE, Liaw W, Darkoh C, Essien EJ. Population-based assessment of the burden of COVID-19 infection in African countries: a first-year report card and public health implications. Ther Adv Infect Dis 2023; 10:20499361231202116. [PMID: 37779674 PMCID: PMC10540606 DOI: 10.1177/20499361231202116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/02/2023] [Indexed: 10/03/2023] Open
Abstract
Background The COVID-19 pandemic constitutes a global health threat and poses a major burden on the African continent. We assessed the real-world burden of COVID-19 infection in African Union (AU) member states to determine the distributional patterns of epidemiological measures during the first 1 year of the pandemic. Methods This retrospective cross-sectional study utilized COVID-19 data from publicly available data repositories of the African Center for Disease Control and Prevention and Our World in Data for the period February 2020 to January 2021. AU member states were classified into low, medium, and high burdens based on COVID-19 morbidity. We conducted descriptive and inferential analyses of COVID-19-reported cases, deaths, recoveries, active cases, COVID-19 tests, and epidemiological measures that included morbidity and mortality rates, case fatality rate (CFR), and case ratios. Results A total of 3.21 million cases were reported during the 1-year period, with 2.6 million recoveries, 536,784 cases remaining active, and 77,486 deaths. Most countries (49.1%, n = 26) in AU experienced a low burden of COVID-19 infection compared to 28.3% (n = 15) with medium burden and 22.6% (n = 12) with high burden. AU nations with a high burden of the disease were mainly in the northern and southern regions. South Africa recorded the highest number of cases (1.31 million), followed by Morocco with 457,625 and Tunisia with 175,065 cases. Correspondently, death tolls for these countries were 36,467, 7888, and 5528 deaths, respectively. Of the total COVID-19 tests performed (83.8 million) during the first 1 year, 62.43% were from high-burden countries. The least testing occurred in the medium-burden (18.42%) countries. The overall CFR of AU was 2.21%. A morbidity rate of 327.52/105 population and mortality rate of 5.96/105 population were recorded during the first 1-year period with significant variations (p < 0.0001) across burden levels. Continental morbidity and mortality rates of 17,359/105 and 315.933/105 populations were recorded with significant correlation (r = 0.863, p < 0.0001) between them and variations across selected epidemiological measures by COVID-19 burden levels. Conclusion Understanding the true burden of the disease in AU countries is important for establishing the impact of the pandemic in the African continent and for intervention planning, preparedness, and deployment of resources during COVID-19 surges and future pandemics.
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Affiliation(s)
- Osaro Mgbere
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, 5055 Medical Cir. Houston, TX 77204-5000, USA
- Institute of Community Health, University of Houston College of Pharmacy, Houston, TX, USA
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
- Public Health Science and Surveillance Division, Houston Health Department, Houston, TX, USA
| | - Ogbonna Collins Nwabuko
- Department of Haematology and Blood Transfusion, Federal Medical Centre, Umuahia, Abia State, Nigeria
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Olajumoke A. Olateju
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Omolola E. Adepoju
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Winston Liaw
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Charles Darkoh
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, TX, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, TX, USA
| | - Ekere James Essien
- Institute of Community Health, University of Houston College of Pharmacy, Houston, TX, USA
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
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Balde T, Oyugi B, Karamagi H, Okeibunor JC, Conteh IN, Ejiofor NE, Atuhebwe P, Nanyunja M, Diallo AB, Mihigo R, Yoti Z, Braka F, Gueye AS. Framing the future of the COVID-19 response operations in 2022 in the WHO African region. Glob Health Action 2022; 15:2130528. [PMID: 36314610 PMCID: PMC9629107 DOI: 10.1080/16549716.2022.2130528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND With the evolving epidemiological parameters of COVID-19 in Africa, the response actions and lessons learnt during the pandemic's past two years, SARS-COV 2 will certainly continue to circulate in African countries in 2022 and beyond. As countries in the African continent need to be more prepared and plan to 'live with the virus' for the upcoming two years and after and at the same time mitigate risks by protecting the future most vulnerable and those responsible for maintaining essential services, WHO AFRO is anticipating four interim scenarios of the evolution of the pandemic in 2022 and beyond in the region. OBJECTIVE In preparation for the rollout of response actions given the predicted scenarios, WHO AFRO has identified ten strategic orientations and areas of focus for supporting member states and partners in responding to the COVID-19 pandemic in Africa in 2022 and beyond. METHODS WHO analysed trends of the transmissions since the first case in the African continent and reviewed lessons learnt over the past months. RESULTS Establishing a core and agile team solely dedicated to the COVID-19 response at the WHO AFRO, the emergency hubs, and WCOs will improve the effectiveness of the response and address identified challenges. The team will collaborate with the various clusters of the regional office, and other units and subunits in the WCOs supported with good epidemics intelligence. COVID-19 pandemic has afflicted global humanity at unprecedented levels. CONCLUSION Two years later and while starting the third year of the COVID-19 response, we now need to change and adapt our strategies, tools and approaches in responding timely and effectively to the pandemic in Africa and save more lives.
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Affiliation(s)
- Thierno Balde
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Boniface Oyugi
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo,Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, CanterburyUK
| | - Humphrey Karamagi
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Joseph Chukwudi Okeibunor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo,CONTACT Joseph Chukwudi Okeibunor World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Ishata Nannie Conteh
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Nonso Ephraim Ejiofor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Phionah Atuhebwe
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Miriam Nanyunja
- Emergency Preparedness and Response Hub, World Health Organisation Emergency Hub for East and Southern Africa, Nairobi, Kenya
| | - Amadou Bailo Diallo
- Emergency Preparedness and Response Hub, World Health Organisation Emergency Hub for East and Southern Africa, Nairobi, Kenya,World Health Organisation Emergency Hub for West and Central Africa, Dakar, Senegal
| | - Richard Mihigo
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Zabulon Yoti
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Fiona Braka
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Abdou Salam Gueye
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
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Ridde V, Kane B, Mbow NB, Senghor I, Faye A. The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal. BMJ Glob Health 2022; 7:bmjgh-2022-010062. [PMID: 36526299 PMCID: PMC9764624 DOI: 10.1136/bmjgh-2022-010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers. METHODS This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews. RESULTS The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes. CONCLUSION Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France,Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Babacar Kane
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Ndeye Bineta Mbow
- Foundiougne, Sénégal, Departmental Health Insurance Unit, Foundiougne, Senegal
| | - Ibrahima Senghor
- Koungheul, Sénégal, Departmental Health Insurance Unit, Koungheul, Senegal
| | - Adama Faye
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
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Gebremichael B, Hailu A, Letebo M, Berhanesilassie E, Shumetie A, Biadgilign S. Impact of good governance, economic growth and universal health coverage on COVID-19 infection and case fatality rates in Africa. Health Res Policy Syst 2022; 20:130. [PMID: 36437476 PMCID: PMC9702649 DOI: 10.1186/s12961-022-00932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted lives across all countries and communities. It significantly reduced the global economic output and dealt health systems across the world a serious blow. There is growing evidence showing the progression of the COVID-19 pandemic and the impact it has on health systems, which should help to draw lessons for further consolidating and realizing universal health coverage (UHC) in all countries, complemented by more substantial government commitment and good governance, and continued full implementation of crucial policies and plans to avert COVID-19 and similar pandemic threats in the future. Therefore, the objective of the study was to assess the impact of good governance, economic growth and UHC on the COVID-19 infection rate and case fatality rate (CFR) among African countries. METHODS We employed an analytical ecological study design to assess the association between COVID-19 CFR and infection rate as dependent variables, and governance, economic development and UHC as independent variables. We extracted data from publicly available databases (i.e., Worldometer, Worldwide Governance Indicators, Our World in Data and WHO Global Health Observatory Repository). We employed a multivariable linear regression model to examine the association between the dependent variables and the set of explanatory variables. STATA version 14 software was used for data analysis. RESULTS All 54 African countries were covered by this study. The median observed COVID-19 CFR and infection rate were 1.65% and 233.46%, respectively. Results of multiple regression analysis for predicting COVID-19 infection rate indicated that COVID-19 government response stringency index (β = 0.038; 95% CI 0.001, 0.076; P = 0.046), per capita gross domestic product (GDP) (β = 0.514; 95% CI 0.158, 0.87; P = 0.006) and infectious disease components of UHC (β = 0.025; 95% CI 0.005, 0.045; P = 0.016) were associated with COVID-19 infection rates, while noncommunicable disease components of UHC (β = -0.064; 95% CI -0.114; -0.015; P = 0.012), prevalence of obesity among adults (β = 0.112; 95% CI 0.044; 0.18; P = 0.002) and per capita GDP (β = -0.918; 95% CI -1.583; -0.254; P = 0.008) were associated with COVID-19 CFR. CONCLUSIONS The findings indicate that good governance practices, favourable economic indicators and UHC have a bearing on COVID-19 infection rate and CFR. Effective health system response through a primary healthcare approach and progressively taking measures to grow their economy and increase funding to the health sector to mitigate the risk of similar future pandemics would require African countries to move towards UHC, improve governance practices and ensure economic growth in order to reduce the impact of pandemics on populations.
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Affiliation(s)
| | - Alemayehu Hailu
- Department of Global Public Health and Primary Care, Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States of America
| | - Mekitew Letebo
- Independent Public Health Analyst and Research Consultant, P.O. BOX 24414, Addis Ababa, Ethiopia
| | - Etsub Berhanesilassie
- Independent Public Health Analyst and Research Consultant, P.O. BOX 24414, Addis Ababa, Ethiopia
| | | | - Sibhatu Biadgilign
- Independent Public Health Analyst and Research Consultant, P.O. BOX 24414, Addis Ababa, Ethiopia.
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Agusi ER, Allendorf V, Eze EA, Asala O, Shittu I, Dietze K, Busch F, Globig A, Meseko CA. SARS-CoV-2 at the Human-Animal Interface: Implication for Global Public Health from an African Perspective. Viruses 2022; 14:v14112473. [PMID: 36366571 PMCID: PMC9696393 DOI: 10.3390/v14112473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has become the most far-reaching public health crisis of modern times. Several efforts are underway to unravel its root cause as well as to proffer adequate preventive or inhibitive measures. Zoonotic spillover of the causative virus from an animal reservoir to the human population is being studied as the most likely event leading to the pandemic. Consequently, it is important to consider viral evolution and the process of spread within zoonotic anthropogenic transmission cycles as a global public health impact. The diverse routes of interspecies transmission of SARS-CoV-2 offer great potential for a future reservoir of pandemic viruses evolving from the current SARS-CoV-2 pandemic circulation. To mitigate possible future infectious disease outbreaks in Africa and elsewhere, there is an urgent need for adequate global surveillance, prevention, and control measures that must include a focus on known and novel emerging zoonotic pathogens through a one health approach. Human immunization efforts should be approached equally through the transfer of cutting-edge technology for vaccine manufacturing throughout the world to ensure global public health and one health.
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Affiliation(s)
- Ebere Roseann Agusi
- National Veterinary Research Institute, Vom 930001, Nigeria
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
- Department of Microbiology, University of Nigeria Nsukka, Enugu 410001, Nigeria
| | - Valerie Allendorf
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
- Correspondence: (A.G.); (V.A.)
| | | | - Olayinka Asala
- National Veterinary Research Institute, Vom 930001, Nigeria
| | - Ismaila Shittu
- National Veterinary Research Institute, Vom 930001, Nigeria
| | - Klaas Dietze
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
| | - Frank Busch
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
| | - Anja Globig
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
- Correspondence: (A.G.); (V.A.)
| | - Clement Adebajo Meseko
- National Veterinary Research Institute, Vom 930001, Nigeria
- College of Veterinary Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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Bradshaw D, Dorrington R, Moultrie T, Groenewald P, Moultrie H. Underestimated COVID-19 mortality in WHO African region. Lancet Glob Health 2022; 10:e1559. [PMID: 36240818 PMCID: PMC9553192 DOI: 10.1016/s2214-109x(22)00425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; Department of Family Medicine and Public Health, University of Cape Town, Rondebosch, South Africa.
| | - Robert Dorrington
- Centre for Actuarial Research, University of Cape Town, Rondebosch, South Africa
| | - Tom Moultrie
- Centre for Actuarial Research, University of Cape Town, Rondebosch, South Africa
| | - Pam Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Harry Moultrie
- Centre for Tuberculosis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Meagher K. Crisis Narratives and the African Paradox: African Informal Economies, COVID-19 and the Decolonization of Social Policy. DEVELOPMENT AND CHANGE 2022; 53:1200-1229. [PMID: 36718282 PMCID: PMC9877792 DOI: 10.1111/dech.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This article challenges the role of COVID-19 crisis narratives in shaping social policy choices in Africa. The COVID-19 pandemic has focused attention on Africa's vast informal economies, both as a symbol of the continent's intense vulnerability to the ravages of the pandemic, and as a puzzle in the face of the uneven and limited effects of COVID-19 across the continent. Indeed, an examination of statistical and documentary evidence reveals an inverse relationship between COVID-19 fatalities and the size of African informal economies, and a perverse relationship between best-practice COVID social protection responses and levels of COVID-19 mortality. Scrutinizing the evidence behind African COVID-19 crisis narratives raises questions about the ability of donor-led digitized social protection paradigms to address social needs in highly informalized, low-resource environments. This article highlights the role of crisis narratives as an exercise of power geared to remastering, homogenizing and reimagining African informal economies in ways that facilitate particular types of development intervention, sidelining alternative, more socially grounded policy perspectives. Through a closer examination of historical and contemporary realities in Africa's vast and varied informal economies, the article highlights the need to decolonize social policy by privileging local needs and policy perspectives over global policy agendas in the interest of transformative rather than palliative policy responses.
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Bepouka B, Mayasi N, Mandina M, Longokolo M, Odio O, Mangala D, Mbula M, Kayembe JM, Situakibanza H. Risk factors for mortality in COVID-19 patients in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0276008. [PMID: 36251715 PMCID: PMC9576083 DOI: 10.1371/journal.pone.0276008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Aim Mortality rates of coronavirus-2019 (COVID-19) disease continue to increase worldwide and in Africa. In this study, we aimed to summarize the available results on the association between sociodemographic, clinical, biological, and comorbidity factors and the risk of mortality due to COVID-19 in sub-Saharan Africa. Methods We followed the PRISMA checklist (S1 Checklist). We searched PubMed, Google Scholar, and European PMC between January 1, 2020, and September 23, 2021. We included observational studies with Subjects had to be laboratory-confirmed COVID-19 patients; had to report risk factors or predictors of mortality in COVID-19 patients, Studies had to be published in English, include multivariate analysis, and be conducted in the sub-Saharan region. Exclusion criteria included case reports, review articles, commentaries, errata, protocols, abstracts, reports, letters to the editor, and repeat studies. The methodological quality of the studies included in this meta-analysis was assessed using the methodological items for nonrandomized studies (MINORS). Pooled hazard ratios (HR) or odds ratios (OR) and 95% confidence intervals (CI) were calculated separately to identify mortality risk. In addition, publication bias and subgroup analysis were assessed. Results and discussion Twelve studies with a total of 43598 patients met the inclusion criteria. The outcomes of interest were mortality. The results of the analysis showed that the pooled prevalence of mortality in COVID-19 patients was 4.8%. Older people showed an increased risk of mortality from SARS-Cov-2. The pooled hazard ratio (pHR) and odds ratio (pOR) were 9.01 (95% CI; 6.30–11.71) and 1.04 (95% CI; 1.02–1.06), respectively. A significant association was found between COVID-19 mortality and men (pOR = 1.52; 95% CI 1.04–2). In addition, the risk of mortality in patients hospitalized with COVID-19 infection was strongly influenced by chronic kidney disease (CKD), hypertension, severe or critical infection on admission, cough, and dyspnea. The major limitations of the present study are that the data in the meta-analysis came mainly from studies that were published, which may lead to publication bias, and that the causal relationship between risk factors and poor outcome in patients with COVID-19 cannot be confirmed because of the inherent limitations of the observational study. Conclusions Advanced age, male sex, CKD, hypertension, severe or critical condition on admission, cough, and dyspnea are clinical risk factors for fatal outcomes associated with coronavirus. These findings could be used for research, control, and prevention of the disease and could help providers take appropriate measures and improve clinical outcomes in these patients.
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Affiliation(s)
- Ben Bepouka
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- * E-mail:
| | - Nadine Mayasi
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ossam Odio
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Donat Mangala
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Marie Kayembe
- Pneumology Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Tang X, Pei Y, Wang X, Jiang L, Liu P, Chen Y, Meng Z. Mental health and fatigue status of the medical workforce during the COVID-19 outbreak in the Yangzhou city, China. Front Psychiatry 2022; 13:1018069. [PMID: 36325526 PMCID: PMC9618953 DOI: 10.3389/fpsyt.2022.1018069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background When the coronavirus disease 2019 (COVID-19) erupted in Yangzhou, China, at the end of July 2021, medical workers in Yangzhou immediately joined the frontline for the fight against the pandemic. This study aimed to identify the mental health and fatigue experienced by the medical workers in Yangzhou during the COVID-19 outbreak. Methods We included 233 medical workers who participated in the front-line work for more than 1 month through the questionnaire, including doctors, nurses, medical technicians and medical students. The generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and Fatigue self-assessment scale (FSAS) were administered to the participants and their responses were evaluated. Results A total of 233 eligible questionnaires were received. Among them, 130 people (57.08%) were probably anxious and 141 (60.52%) people were clinically depressed. Poor sleep was considered an independent risk factor for anxiety (OR = 7.164, 95% CI: 3.365 15.251, p = 0.000) and depression (OR = 6.899, 95% CI: 3.392 14.030, p = 0.000). A high PHQ-9 score was considered an independent risk factor for general fatigue (OR = 1.697, 95% CI: 1.481 1.944, p = 0.000). Mental fatigue (OR = 1.092, 95% CI: 1.027 1.161, p = 0.005) and fatigue response to sleep/rest (OR = 1.043, 95% CI: 1.011 1.076 p = 0.008) were considered independent risk factors for general fatigue. Conclusion Poor quality of sleep led to probable anxiety, depression, and general fatigue. Mental fatigue and fatigue response to sleep/rest were independent risk factors for depression, which merits attention for battling COVID-19.
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Affiliation(s)
- Xiaojia Tang
- Department of Rehabilitation Medicine, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yunlong Pei
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Li Jiang
- Department of Geriatric Neurologist, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Peipei Liu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yingzhu Chen
- Department of Geriatric Neurologist, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhaoxiang Meng
- Department of Rehabilitation Medicine, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
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Underestimated COVID-19 mortality in WHO African region - Authors' reply. Lancet Glob Health 2022; 10:e1560. [PMID: 36240819 PMCID: PMC9553201 DOI: 10.1016/s2214-109x(22)00415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022]
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Were FN, Jere KC, Armah GE, Mphahlele MJ, Mwenda JM, Steele AD. Maintaining Momentum for Rotavirus Immunization in Africa during the COVID-19 Era: Report of the 13th African Rotavirus Symposium. Vaccines (Basel) 2022; 10:vaccines10091463. [PMID: 36146541 PMCID: PMC9503285 DOI: 10.3390/vaccines10091463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
The 13th African Rotavirus Symposium was held as a virtual event hosted by the University of Nairobi, Kenya and The Kenya Paediatric Association on 3rd and 4th November 2021. This biennial event organized under the auspices of the African Rotavirus Network shapes the agenda for rotavirus research and prevention on the continent, attracting key international and regional opinion leaders, researchers, and public health scientists. The African Rotavirus Network is a regional network of institutions initially established in 1999, and now encompassing much of the diarrheal disease and rotavirus related research in Africa, in collaboration with the World Health Organization African Regional Office (WHO-AFRO), Ministries of Health, and other partners. Surges in SARS-CoV2 variants and concomitant travel restrictions limited the meeting to a webinar platform with invited scientific presentations and scientific presentations from selected abstracts. The scientific program covered updates on burden of diarrheal diseases including rotavirus, the genomic characterization of rotavirus strains pre- and post-rotavirus vaccine introduction, and data from clinical evaluation of new rotavirus vaccines in Africa. Finally, 42 of the 54 African countries have fully introduced rotavirus vaccination at the time of the meeting, including the two recently WHO pre-qualified vaccines from India. Nonetheless, the full benefit of rotavirus vaccination is yet to be realized in Africa where approximately 80% of the global burden of rotavirus mortality exists.
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Affiliation(s)
- Frederick N. Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi 00625, Kenya
- Kenya Paediatric Association, Nairobi 00100, Kenya
| | - Khuzwayo C. Jere
- Malawi-Liverpool-Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences, Blantyre 312225, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK
| | - George E. Armah
- Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Accra LG 581, Ghana
| | | | - Jason M. Mwenda
- WHO Regional Office for Africa, Brazzaville P.O. Box 2465, Congo
| | - A. Duncan Steele
- Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Correspondence: ; Tel.: +1-(206)-915-3677
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Epidemiological Comparison of Four COVID-19 Waves in the Democratic Republic of the Congo, March 2020-January 2022. J Epidemiol Glob Health 2022; 12:316-327. [PMID: 35921045 PMCID: PMC9346056 DOI: 10.1007/s44197-022-00052-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Nationwide analyses are required to optimise and tailor activities to control future COVID-19 waves of resurgence continent-wide. We compared epidemiological and clinical outcomes of the four COVID-19 waves in the Democratic Republic of Congo (DRC). METHODS This retrospective descriptive epidemiological analysis included data from the national line list of confirmed COVID-19 cases in all provinces for all waves between 9 March 2020 and 2 January 2022. Descriptive statistical measures (frequencies, percentages, case fatality rates [CFR], test positivity rates [TPR], and characteristics) were compared using chi-squared or the Fisher-Irwin test. RESULTS During the study period, 72,108/445,084 (16.2%) tests were positive, with 9,641/56,637 (17.0%), 16,643/66,560 (25.0%), 24,172/157,945 (15.3%), and 21,652/163,942 (13.2%) cases during the first, second, third, and fourth waves, respectively. TPR significantly decreased from 17.0% in the first wave to 13.2% in the fourth wave as did infection of frontline health workers (5.2% vs. 0.9%). CFR decreased from 5.1 to 0.9% from the first to fourth wave. No sex- or age-related differences in distributions across different waves were observed. The majority of cases were asymptomatic in the first (73.1%) and second (86.6%) waves, in contrast to that in the third (11.1%) and fourth (31.3%) waves. CONCLUSION Despite fewer reported cases, the primary waves (first and second) of the COVID-19 pandemic in the DRC were more severe than the third and fourth waves, with each wave being associated with a new SARS-CoV-2 variant. Tailored public health and social measures, and resurgence monitoring are needed to control future waves of COVID-19.
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