Race against death or starvation? COVID-19 and its impact on African populations

Development of a core outcome set for maternal and perinatal health research and surveillance in light of emerging and ongoing epidemic threats

Background

Maternal and perinatal health is often directly and indirectly affected during infectious disease epidemics. Yet, a lack of evidence on epidemics' impact on women and their offspring delays informed decision-making for healthcare providers, pregnant women, women in the post-pregnancy period and policy-makers. To rapidly generate evidence in these circumstances, we aim to develop a Core Outcome Set (COS) for maternal and perinatal health research and surveillance in light of emerging and ongoing epidemic threats.

Methods

We will conduct a Systematic Review and a four-stage modified Delphi expert consensus. The systematic literature will aim to inform experts on outcomes reported in maternal and perinatal research and surveillance during previous epidemics. The expert consensus will involve two individual, anonymous online surveys to rate outcomes' importance and suggest new ones, one virtual meeting to discuss disagreements, and one in-person meeting to agree on the final COS, outcomes definitions and measurement methods. Four panels will be established to participate in the modified Delphi with expertise in (a) maternal and perinatal health, (b) neonatal health, (c) public health and emergency response, and (d) representation of civil society. We will recruit at least 20 international experts for each stakeholder group, with diverse backgrounds and gender, professional, and geographic balance. Only highly-rated outcomes (with at least 80% of ratings being 7-9 on a 9-point Likert scale) and no more than 10% of low ratings (1-3) will be included in the final COS.

Conclusions

Implementing this COS in future maternal and perinatal research and surveillance, especially in the context of emerging and ongoing epidemic threats, will facilitate the rapid and systematic generation of evidence. It will also enhance the ability of policy-makers, healthcare providers, pregnant women and women in the post-pregnancy period and their families to make well-informed choices in challenging circumstances.

Programs to Prevent Violence Against Children in Sub-Saharan Africa: A Systematic Review

Violence against children-which includes maltreatment (including physical, sexual, psychological and emotional violence, and neglect), bullying (including cyberbullying), youth violence (including physical assault with or without weapons), intimate partner violence (including exposure to domestic violence and direct involvement in teen dating violence), and sexual violence-continues to present itself as a significant public health crisis in Sub-Saharan Africa (SSA) leading to numerous short- and long-term deleterious outcomes. As such, the prevention of violence against children in SSA is a critical public health priority. In this systematic literature review, we identified 45 articles that reported on results from 22 programs that seek to reduce violence against children in SSA. Results suggested that programs that focus on (1) economic strengthening, (2) teachers schools, (3) entire families, (4) caregivers only, and (5) children only are generally effective in reducing violence against children by promoting focused action on the mechanisms of change (e.g., parenting skills, enhanced parent-child relationships, resistance skills for children). To date, no research in SSA has examined the impact of policy interventions on childhood victimization or community-level interventions to change norms and values that support violence against children. Future research is needed to examine the impacts of comprehensive efforts to prevent violence against children in SSA as well as factors that predict uptake and sustainability of such prevention efforts in SSA.

COVID-19-Induced Inequalities and Mental Health: Testing the Moderating Roles of Self-rated Health and Race/Ethnicity

This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults.

Containing COVID-19 and the social costs on human rights in African countries

Multiple social interventions were introduced to contain the COVID-19 pandemic across Africa, limiting social engagement, school and workplace attendance, and travel. In anticipation of negative economic consequences and social impact, many governments introduced cash transfers, social pensions, food aid, and utility and tax waivers. However, people living precariously and/or under conditions of structural vulnerability were often unable to access to this support. A rapid review was undertaken on COVID-19 and the effects of interventions on human rights in African countries, examining primary studies, editorial notes, opinion papers, and literature reviews, with focus on qualitative approaches and discussions. In examining the links between health, human rights and non-pharmaceutical interventions on vulnerable populations, the review identified that: (1) people who were vulnerable were excluded from or not adequately represented in policy responses to COVID-19; (2) the precarious socio-economic conditions of these populations were not adequately addressed by dominant policy responses; and (3) only partial support was offered to those whose relationship with the state was ambiguous or conditional, so compromising human rights. Interactions between health, human rights, and underlying social and economic conditions amplified poor health and impoverishment of those who were already vulnerable. The challenge is to find a balance between stopping the spread of COVID-19 and the protection of human rights; to implement population-specific responses to supplement uniform public health responses; and to address causes (structural vulnerability) rather than symptoms. There is a need to plan rather than react to pandemics, and to co-construct interventions with rather than delivering instructions to populations. These recommendations serve as instruments to be considered when designing new policies, to incorporate a human rights perspective in responses to current and future pandemics.

Social consequences of COVID-19 on fertility preference consistency and contraceptive use among Nigerian women: insights from population-based data

BACKGROUND

Emerging evidence from high income countries showed that the COVID-19 pandemic has had negative effects on population and reproductive health behaviour. This study provides a sub-Saharan Africa perspective by documenting the social consequences of COVID-19 and its relationship to fertility preference stability and modern contraceptive use in Nigeria.

METHOD

We analysed panel data collected by Performance Monitoring for Action in Nigeria. Baseline and Follow-up surveys were conducted before the COVID-19 outbreak (November 2019-February 2020) and during the lockdown respectively (May-July 2020). Analysis was restricted to married non-pregnant women during follow-up (n = 774). Descriptive statistics and generalized linear models were employed to explore the relationship between selected social consequences of COVID-19 and fertility preferences stability (between baseline and follow-up) as well as modern contraceptives use.

RESULTS

Reported social consequences of the pandemic lockdown include total loss of household income (31.3%), food insecurity (16.5%), and greater economic reliance on partner (43.0%). Sixty-eight women (8.8%) changed their minds about pregnancy and this was associated with age groups, higher wealth quintile (AOR = 0.38, CI: 0.15-0.97) and household food insecurity (AOR = 2.72, CI: 1.23-5.99). Fertility preference was inconsistent among 26.1%. Women aged 30-34 years (AOR = 4.46, CI:1.29-15.39) were more likely of inconsistent fertility preference compared to 15-24 years. The likelihood was also higher among women with three children compared to those with only one child (AOR = 3.88, CI: 1.36-11.08). During follow-up survey, 59.4% reported they would feel unhappy if pregnant. This was more common among women with tertiary education (AOR = 2.99, CI: 1.41-6.33). The odds increased with parity. The prevalence of modern contraceptive use was 32.8%. Women aged 45-49 years (AOR = 0.24, CI: 0.10-0.56) were less likely to use modern contraceptives than those aged 15-24 years. In contrast, the odds of contraceptive use were significantly higher among those with three (AOR = 1.82, CI: 1.03-3.20), four (AOR = 2.45, CI: 1.36-4.39) and at least five (AOR = 2.89, CI: 1.25-6.74) children. Unhappy disposition towards pregnancy (AOR = 2.48, CI: 1.724-3.58) was also a significant predictor of modern contraceptive use.

CONCLUSION

Some social consequences of COVID-19 affected pregnancy intention and stability of fertility preference but showed no independent association with modern contraceptive use.

COVID-19 Pandemic, Air Quality, and PM2.5 Reduction-Induced Health Benefits: A Comparative Study for Three Significant Periods in Beijing

Previous studies have estimated the influence of control measures on air quality in the ecological environment during the COVID-19 pandemic. However, few have attached importance to the comparative study of several different periods and evaluated the health benefits of PM2.5 decrease caused by COVID-19. Therefore, we aimed to estimate the control measures' impact on air pollutants in 16 urban areas in Beijing and conducted a comparative study across three different periods by establishing the least squares dummy variable model and difference-in-differences model. We discovered that restriction measures did have an apparent impact on most air pollutants, but there were discrepancies in the three periods. The Air Quality Index (AQI) decreased by 7.8%, and SO2, NO2, PM10, PM2.5, and CO concentrations were lowered by 37.32, 46.76, 53.22, 34.07, and 19.97%, respectively, in the first period, while O3 increased by 36.27%. In addition, the air pollutant concentrations in the ecological environment, including O3, reduced significantly, of which O3 decreased by 7.26% in the second period. Furthermore, AQI and O3 concentrations slightly increased compared to the same period in 2019, while other pollutants dropped, with NO2 being the most apparent decrease in the third period. Lastly, we employed health effects and environmental value assessment methods to evaluate the additional public health benefits of PM2.5 reduction owing to the restriction measures in three periods. This research not only provides a natural experimental basis for governance actions of air pollution in the ecological environment, but also points out a significant direction for future control strategies.

Revisiting air quality during lockdown persuaded by second surge of COVID-19 of megacity Delhi, India

Is the impact of city-scale lockdown in response to 2nd surge of COVID-19, behavioural changes in people owing to yearlong cohabitation with COVID-19, and partial vaccination on air quality different from the impact of nationwide lockdown during COVID-19's 1st surge in March 2020? Targeting this objective, the present work has selected four phases pre-lockdown and lockdown of 1st and 2nd cycles of lockdown taking average air quality index (NAQI) from Central Pollution Control Board (CPCB). The results clearly show that both the nationwide lockdown and the city-scale restriction are responsible for improving air quality in India's megacity Delhi, but the rate of improvement was higher (39%) during the first cycle of lockdown (nationwide) than during the second cycle of lockdown (city-scale). During city-scale lockdown, the disparity in NAQI between the core and the periphery is obvious. Due to the effect of economic activities surrounding Delhi, around 10 km of the city's interior has experienced high NAQI. The reason for the lower NAQI improvement during the second lockdown cycle is likely due to relief from initial fear following a year of cohabitation with COVID-19, partial vaccination, and partial relaxation in industrial sectors to avoid the economic hardships experienced during the first lockdown cycle.

COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs

This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.

COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs

This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.

Risk communication and community engagement strategies for COVID-19 in 13 African countries

Background: Coronavirus disease 2019 (COVID-19) outbreak is a major threat facing health systems globally and African countries are not an exception. Stakeholders, governments, and national authorities have mounted responses to contain the pandemic. This study aimed to catalogue the risk communication and community engagement (RCCE) strategies as well as the challenges facing RCCE in 13 African countries.

Methods: We conducted a narrative review of evidence to answer the aim of the study. The search was conducted in March 2021 and evidence published between December 2019 and February 2021 were included. Data reported in this article were obtained from reports, literature in peer-reviewed journals, grey literature and other data sources in 13 African countries. The 13 countries include Ethiopia, Ghana, Kenya, Algeria, Angola, Cote d’Ivoire, the Democratic Republic of the Congo, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia. The authors also snowball further data to gather information for this review.

Results: Most of the priority African countries have RCCE strategies to contain the transmission and spread of the coronavirus. Our findings revealed RCCE strategies in the 13 African countries focused on training and capacity building, risk communication systems, internal and partners’ coordination, community engagement, public communication, contending uncertainty, addressing misperceptions and managing misinformation. However, the RCCE response activities were not without challenges, which included distrust in government, cultural, social, and religious resistance, and inertia among others.

Conclusion: With the similar RCCE approaches and interventions seen across the countries, it is clear that countries are learning from each other and from global health organizations to develop COVID-19 RCCE programs. It is important for African countries to address the challenges facing RCCE in order to effectively contain the pandemic and to prepare for future public health emergencies.

Expected Impacts of COVID-19: Considering Resource-Limited Countries and Vulnerable Population

Coronavirus disease in 2019 emerged in Wuhan, Hubei Province, China, in December 2019. After a month, it was declared a global threat to public health. The effects of the pandemic could be socio-economic, undermining the health system and risking livelihoods. Vulnerability to this infection has been associated with underlying comorbidities such as hypertension, diabetes, coronary heart disease, chronic respiratory diseases, cancer, and compromised immune systems. Co-morbidity has been common to the elderly, the disabled, and the homeless. In addition, more severe coronavirus disease outcomes have been reported in older males than females. Nonetheless, multiple variables are related to the concept of cultural gender that should be taken into account as women in more affected sectors are economically disadvantageous and over-represented. Similarly, although children are not the face of this pandemic, calamity has a profound effect on their welfare, especially for those living in poor and inconvenient situations. Moreover, the economic influence could be profound and universal when viewed through a migration lens as it is exacerbating xenophobic and discriminatory treatment. Protection measures to mitigate the outbreak of a pandemic, such as social distancing, may reduce social support for certain categories relied on for their day-to-day activities. The mental health of people would definitely be affected by the additional psychosocial burden of the pandemic, particularly in vulnerable groups. Integrated approaches are therefore mandatory to assist these groups and contain the pandemic.

Transforming Food Systems in Africa under Climate Change Pressure: Role of Climate-Smart Agriculture

Low-income producers and consumers of food in Africa are more vulnerable to climate change, owing to their comparatively limited ability to invest in more adapted institutions and technologies under increasing climatic risks. Therefore, the way we manage our food systems needs to be urgently changed if the goal is to achieve food security and sustainable development more quickly. This review paper analyzes the nexus “climate-smart agriculture-food systems-sustainable development” in order to draw sound ways that could allow rapid transformation of food systems in the context of climate change pressure. We followed an integrative review approach based on selected concrete example-experiences from ground-implemented projects across Africa (Ghana, Senegal, Mali, Burkina Faso, in West Africa, Ethiopia, Kenya, Rwanda, and Tanzania in East Africa). Mostly composed of examples from the Climate Change, Agriculture, and Food Security (CCAFS) Research Program of the CGIAR (former Consultative Group on International Agricultural Research) and its partners, these also included ground initiatives from non-CGIAR that could provide demonstrable conditions for a transformative agriculture and food systems. The lessons learnt from the ground implementation of climate-smart agriculture (CSA), in the African context, were instrumental to informing the actions areas of the food-system transformation framework suggested in this paper (reroute, de-risk, reduce, and realign). Selected CSA example-cases to inform these action areas included 24 initiatives across Africa, but with a focus on the following studies for an in-depth analysis: (1) the climate-smart village approach to generate knowledge on climate-smart agriculture (CSA) technologies and practices for their scaling, (2) the use of climate information services (CIS) to better manage climate variability and extremes, and (3) the science–policy interfacing to mainstream CSA into agricultural development policies and plans. The analysis of these examples showed that CSA can contribute driving a rapid change of food systems in Africa through: (1) the implementation of relevant climate-smart technologies and practices to reroute farming and rural livelihoods to new climate-resilient and low-emission trajectories; (2) the development and application of weather and climate information services (WCIS) that support de-risking of livelihoods, farms, and value chains in the face of increasing vagaries of weather and extreme events; (3) the use of climate-smart options that minimize waste of all the natural resources used for growing, processing, packaging, transporting, and marketing food, and therefore mitigating the carbon footprint attached to this food loss and waste; and (4) the realignment of policies and finance that facilitate action in the four proposed action areas through the identification of news ways to mobilize sustainable finance and create innovative financial mechanisms and delivery channels.