Strengthening the evidence base for decisions on public health and social measures

Surfing Corona waves - instead of breaking them: Rethinking the role of natural immunity in COVID-19 policy

In the first two years of the pandemic, COVID-19 response policies have aimed to break Corona waves through non-pharmaceutical interventions and mass vaccination. However, for long-term strategies to be effective and efficient, and to avoid massive disruption and social harms, it is crucial to introduce the role of natural immunity in our thinking about COVID-19  (or future "Disease-X") control and prevention. We argue that any Corona or similar virus control policy must appropriately balance five key elements simultaneously: balancing the various fundamental interests of the nation, as well as the various interventions within the health sector; tailoring the prevention measures and treatments to individual needs; limiting social interaction restrictions; and balancing the role of vaccinations against the role of naturally induced immunity. Given the high infectivity of SARS-CoV-2 and its differential impact on population segments, we examine this last element in more detail and argue that an important aspect of 'living with the virus' will be to better understand the role of naturally induced immunity in our overall COVID-19 policy response. In our eyes, a policy approach that factors natural immunity should be considered for persons without major comorbidities and those having 'encountered' the antigen in the past.

How level of understanding and type of used sources relate to adherence to COVID-19 public health measures in Canada

Previous studies have highlighted the importance of promoting health literacy and minimizing misinformation to encourage higher adherence to key public health measures during the COVID-19 pandemic. This study explores how one's self-reported understanding of information and types of sources used to get information regarding COVID-19 can hinder adherence to public health measures implemented by the Canadian government. Data was collected following a longitudinal design of 11 time points for April 2020 to April 2021. The sub-sample used for this study included 2659 Canadians who completed the survey for at least four time points. Using Latent Class Growth Analysis, we modelled typical trajectories of adherence to three key public health measures: staying home, social distancing and mask wearing. Overall, a lower level of understanding was associated with lower adherence trajectories to public health measures, and vice-versa. Adjusted odds ratio (AOR) showed that the higher the level of understanding, the higher were the chances of following a high adherence trajectory. The type of used sources also showed a significant statistical association with adherence trajectories for social distancing and staying home (AOR: between 1.1 and 3.4). These results are discussed considering future policy implications.

Evidence-based intrapartum care practice and associated factors among obstetric care providers working in hospitals of the four Wollega Zones, Oromia, Ethiopia

BACKGROUND

Even though Evidence-Based Practice (EBP) is a key component of quality of Intrapartum care and links to improved health care outcomes, consistent application of EBP in patient care remains a challenge for health care providers. In the study area, there are no previous studies conducted on evidence-based Intrapartum care practice among obstetric care providers. Therefore, this study was aimed to assess the magnitude of evidence based intra-partum care practice and its associated factors among obstetric care providers working in hospitals of Wollega zones, Oromia Region, West Ethiopia, 2022.

METHOD

An institution-based cross-sectional study using quantitative method was conducted from January to April/2022 in 11 hospitals of the four Wollega zones. All obstetric care providers (278) who were practicing intrapartum care in the selected hospitals were included. The data was collected using structured self-administered questionnaire and observational checklist. Data was entered via Epi-Data version 3.1 and analyzed by SPSS version 25 statistical software. To see the association between the independent variables and evidence based Intrapartum care practice, multivariable logistic regression analysis was done. The statistical significance of association was declared at p-value ≤ 0.05. Tables, figures and charts were also used in descriptive statistics.

RESULT

The overall magnitude of evidence-based Intrapartum care practice was found to be 63.7% [95% CI (59.7, 67.7)]. There was a statistically significant association between evidence-based Intrapartum care practice and having good knowledge about Intrapartum care practice [AOR = 2.95; 95% CI (1.52,5.73)], positive attitude towards Intrapartum care practice [AOR = 3.13; 95% CI (1.59,6.16)], availability of updated Intrapartum care guideline [AOR = 2.88; 95% CI (1.46,5.70)], number of obstetric care providers per a shift (≥5 care providers) [AOR = 2.31; 95% CI (1.01,5.29)], number of deliveries within a day (<10 deliveries) [AOR = 4.61; 95% CI (2.28,9.31)], educational level (MSc and above) [AOR = 5.75; 95% CI (2.23,14.84)] at p-value ≤ 0.05.

CONCLUSION

Our study revealed that, magnitude of evidence-based Intrapartum care practice was found to be low according to the WHO recommendation. These findings indicate that additional attention and monitoring is required to implement current Intrapartum care practices with the WHO guidelines.

Transmission dynamics of varicella before, during and after the COVID-19 pandemic in Japan: a modelling study

Public health and social measures (PHSMs) targeting the coronavirus disease 2019 (COVID-19) pandemic have potentially affected the epidemiological dynamics of endemic infectious diseases. In this study, we investigated the impact of PHSMs for COVID-19, with a particular focus on varicella dynamics in Japan. We adopted the susceptible-infectious-recovered type of mathematical model to reconstruct the epidemiological dynamics of varicella from Jan. 2010 to Sep. 2021. We analyzed epidemiological and demographic data and estimated the within-year and multi-year component of the force of infection and the biases associated with reporting and ascertainment in three periods: pre-vaccination (Jan. 2010-Dec. 2014), pre-pandemic vaccination (Jan. 2015-Mar. 2020) and during the COVID-19 pandemic (Apr. 2020-Sep. 2021). By using the estimated parameter values, we reconstructed and predicted the varicella dynamics from 2010 to 2027. Although the varicella incidence dropped drastically during the COVID-19 pandemic, the change in susceptible dynamics was minimal; the number of susceptible individuals was almost stable. Our prediction showed that the risk of a major outbreak in the post-pandemic era may be relatively small. However, uncertainties, including age-related susceptibility and travel-related cases, exist and careful monitoring would be required to prepare for future varicella outbreaks.

Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review

Background

Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements.

Methods

We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality.

Results

Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness.

Conclusions

Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-00935-7.