The Need for the Right Socio-Economic and Cultural Fit in the COVID-19 Response in Sub-Saharan Africa: Examining Demographic, Economic Political, Health, and Socio-Cultural Differentials in COVID-19 Morbidity and Mortality

Unraveling the effects of the Ebola experience on behavior choices during COVID-19 in Liberia: a mixed-methods study across successive outbreaks

BACKGROUND

The burden of the COVID-19 pandemic in terms of morbidity and mortality differentially affected populations. Between and within populations, behavior change was likewise heterogeneous. Factors influencing precautionary behavior adoption during COVID-19 have been associated with multidimensional aspects of risk perception; however, the influence of lived experiences during other recent outbreaks on behavior change during COVID-19 has been less studied.

METHODS

To consider how the direct disease experience ("near misses") and behavior change during the 2014-2016 Ebola virus disease (EVD) outbreak may have impacted behavior change during the early waves of the COVID-19 outbreak in West Africa, we analyzed data from a mixed-methods study that included a phone-based survey and in-depth interviews among vaccinated Liberian adults. Logistic regression via generalized estimating equations with quasi-likelihood information criterion (QIC)-based model selection was conducted to evaluate the influence of the interaction between and individual effects of the outbreak (EVD and COVID-19) and the "near-miss" experience on adoption of individual precautionary behaviors. Thematic analysis of interview transcripts explored reasons for differential behavior adoption between the two outbreaks.

RESULTS

At the population level, being a "near miss" was not associated with significantly different behavior during COVID-19 versus Ebola; however, overall, people had lower odds of adopting precautionary behaviors during COVID-19 relative to during Ebola. Participants who report near miss experiences during Ebola were significantly more likely to report having a household member test positive for COVID-19 (p<0.001). Qualitatively, participants often reflected on themes around more proximal and personal experiences with Ebola than with COVID-19; they also commented on how EVD led to better preparedness at the systems level and within communities for how to behave during an outbreak, despite such awareness not necessarily translating into action during COVID-19.

CONCLUSIONS

The results suggest that perceived proximity and intensity to disease threats in space and time affect behavioral decisions. For successive disease threats, comparisons of the present outbreak to past outbreaks compound those effects, regardless of whether individuals were directly impacted via a "near-miss" experience. Measures, such as risk communication and community engagement efforts, that gauge and reflect comparisons with previous outbreaks should be considered in response strategies to enhance the adoption of precautionary behavior.

Four Years Since COVID-19 Day Zero: A Time to Evaluate Past and Future Pandemic Control Policies and Practices in Sub-Saharan Africa?

Four years after the first case of COVID-19, the world is still determining how best to prevent and control the long-term effects of SARS-CoV-2 infection. Non-pharmaceutical interventions (NPIs) were employed at the start of the pandemic as the only available options, prior to effective vaccines and antiviral agents. The World Health Organization recommended dual vaccination for 70% worldwide as the threshold for a return to "normal" community life. Immunization rates needed to increase in all global regions, irrespective of socioeconomic status, necessitating more equitable access. During the pandemic, wealthier countries hoarded vaccine supplies even when their citizens were immunized. This highlights the already enormous difficulties in healthcare provision faced by low-income sub-Saharan African countries, which remain at risk as industrialized nations have progressed to a post-pandemic era. Thus, in addition to redoubling vaccination efforts public health policymakers should consider ongoing and future use of NPIs. In this narrative account, we advocate that various NPI practices should not be shelved; rather, more research is needed to evaluate their impact in parallel with booster vaccination. This especially applies to so-called "long COVID". Lessons learned from implementing best practices in resource-limited settings should be incorporated into preparedness guidelines for future infectious disease outbreaks.

Assessing climate change and urban poverty in the context of the COVID 19 lockdowns: Rethinking personality and societal challenges in Zimbabwe

The study explored the challenges urbanites faced due to climate change and the COVID-19 pandemic. Urban vulnerability ills such as food insecurity, poverty and malnutrition have increased as climate change and COVID-19 jointly affect societies. Urban residents have resorted to urban farming and street vending as coping strategies. COVID-19 protocols and strategies for social distancing have compromised the urban poor livelihoods. Due to lockdown protocols such as curfew, closure of businesses, and the limited number of people doing certain activities, the urban poor often compromised lockdown rules to earn a living. The study used document analysis to gather data on climate change and poverty amidst the COVID-19 pandemic. Academic journals, newspaper articles, books and information from various reliable websites were used for data collection. Content and thematic analysis were used to analyse data, while data triangulation from various sources enhanced data reliability and trustworthiness. The study found that climate change increased food insecurity in urban areas. Low agricultural output and climate change impacts compromised food availability and affordability for urbanites. The COVID-19 protocols increased financial constraints on urbanites as lockdown restrictions negatively impacted income from formal and informal jobs. The study recommends looking beyond the virus for prevention strategies to improve poor peoples' livelihoods. Countries must develop response strategies to cushion the urban poor from climate change and the COVID-19 impact. Developing countries are urged to sustainably adapt to climate change through scientific innovation to promote people's livelihoods.

[Epidemiological characteristics of the Covid-19 epidemic between 2020 and 2022 in Kongo central, DRC]

Introduction

The Democratic Republic of Congo (DRC) has experienced widespread community transmission of SARS-CoV-2 and has recorded four successive waves from March 2020 to March 2022. The objective of this study is to determine the socio-demographic characteristics of Covid-19 patients during these epidemic waves in the province of Kongo central and to identify factors associated with deaths.

Material and methods

This is a cross-sectional study of Covid-19 data from the provincial surveillance system. The data consisted of epidemiological surveillance data, laboratory data (tests), hospital data and patient follow-up data. We determined the characteristics of positive cases throughout the period and implemented logistic regression of factors associated with death.

Results

During the successive waves, 9, 573 positive cases were reported in the province, 546 cases in the first wave and 6, 346 in the fourth wave. Seven positive cases out of 10 concerned people aged 25 to 64. The districts of Matadi, Moanda and Mbanza-Ngungu were the most affected. Age above 64 [OR: 7.2 CI:5.1-10.3] and wave 2 [OR: 4.4 CI:1.6-12.4] were the factors statistically associated with death.

Conclusion

As in other African settings, age, comorbidities, higher socio-professional level and living in urban areas were the major risk factors for severe forms of the disease and death. Our analysis underlines the importance of collecting and analysing several epidemiological variables down to the provincial level over time for a better continuous knowledge of the situation.

Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study

Background

The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown.

Aim

The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria.

Patients and Methods

The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted.

Results

A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality.

Conclusion

These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.

Efficacy of government laws to contain SARS-CoV-2 spread in Mozambique

Background

The purpose of this research was to assess the relationship between infection by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) containment measures implemented in Mozambique and the spread of SARS-CoV-2 from March 17, 2020, to September 30, 2021.

Materials and Methods

The number of SARS-CoV-2 tests conducted, the positivity rate for SARS-CoV-2, the daily hospitalization due to COVID-19, and the average number of patients hospitalized with COVID-19 each day were all documented in a database, from which the positivity rate and weekly growth rate were calculated. Seven milestones were specified, each corresponding to a critical date in the legal measures linked to confinement and relaxation of measures. To compare SARS-CoV-2 data, three periods were created for each milestone: Period 1 = 15 days before the date of the decree; Period 2 = Date of the decree to the 15th day after; and Period 3 = from the 16th day to the 30th day of the decree date. ANOVA was used to compare the average values for each indicator between the three times for each milestone.

Results

A comparison of all indicators in each milestone's three periods reveals no consistent significant impact of the measures, regardless of the tendency to lockdown or provide relief.

Conclusion

No relationship was discovered between the legal measures for SARS-CoV-2 pandemic control and the positive rate and growth rates, as well as the number of hospitalized people. Because it was not feasible to determine the degree of efficacy of each specific measure, this conclusion is related to the measures as a whole.

HIV care experiences and health priorities during the first wave of COVID-19: clients' perspectives - a qualitative study in Lusaka, Zambia

BACKGROUND

The novel COVID-19 pandemic threatened to disrupt access to human immunodeficiency (HIV) treatment for persons living with HIV (PLHIV), two-thirds of whom live in sub-Saharan Africa. To inform a health system response supportive of continuity of care, we sought to understand clients' HIV care experiences and health priorities during the first wave of COVID-19 outbreak in Lusaka, Zambia.

METHODS

Leveraging a study cohort of those who completed periodic SMS surveys on HIV care, we purposefully sampled 25 PLHIV after first confirmed COVID-19 case was reported in Zambia on 18th March 2020. We phone-interviewed participants, iteratively refining interview guide to capture emergent themes on COVID-19 awareness, health facility interactions, and social circumstances, which we analyzed using matrix analysis.

RESULTS

All participants were aware of COVID-19, and HIV care experiences and health priorities of clients were affected by associated changes at health system, household, and individual level. The health system instituted early clinic visits to provide 6-months of antiretroviral therapy (ART) for stable patients and 3-months for unstable patients to reduce clinic visits and wait times. Most patients welcomed this long-desired extended appointment spacing. Some reported feeling respected and engaged when health care workers telephoned requesting their early clinic visit. However, others felt discouraged by an absence of physical distancing during their clinic visit due to 'severe acute respiratory syndrome coronavirus 2' (SARS-CoV-2) infection concerns. Several expressed a lack of clarity regarding next viral load monitoring date and means for receiving results. Patients suggested regular patient-facility communication by telephone and SMS. Patients emphasized that COVID-19 restrictions led to loss of employment and household income, exacerbating poverty and difficulties in taking ART. At individual level, most participants felt motivated to stay healthy during COVID-19 by ART adherence and regular laboratory monitoring.

CONCLUSIONS

Clients' HIV care and health priorities during the first wave of COVID-19 in Lusaka province were varied with a combination of positive and negative experiences that occurred especially at health system and individual levels, while at household level, the experiences were all negative. More research is needed to understand how patients practice resiliency in the widespread context of socio-economic instability. Governments and patients must work together to find local, health systems solutions to support ART adherence and monitoring. Additionally, the health system should consider how to build on changes for long-term HIV management and service delivery.

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.

Understanding the COVID-19 pandemic prevalence in Africa through optimal feature selection and clustering: evidence from a statistical perspective

The COVID-19 pandemic, which outbroke in Wuhan (China) in December 2019, severely hit almost all sectors of activity in the world as a consequence of the restrictive measures imposed. Two years later, Africa still emerges as the least affected continent by the pandemic. This study analyzed COVID-19 prevalence across African countries through country-level variables prior to clustering. Using Spearman-rank correlation, multicollinearity analysis and univariate filtering, 9 country-level variables were identified from an initial set of 34 variables. These variables relate to socioeconomic status, population structure, healthcare system and environment and the climatic setting. A clustering of the 54 African countries is further carried out through the use of agglomerative hierarchical clustering (AHC) method, which generated 3 distinctive clusters. Cluster 1 (11 countries) is the most affected by COVID-19 (median of 63,508.6 confirmed cases and 946.5 deaths per million) and is composed of countries with the highest socioeconomic status. Cluster 2 (27 countries) is the least affected (median of 4473.7 confirmed cases and 81.2 deaths per million), and mainly features countries with the least socioeconomic features and international exposure. Cluster 3 (16 countries) is intermediate in terms of COVID-19 prevalence (median of 2569.3 confirmed cases and 35.7 deaths per million) and features countries the least urbanized and geographically close to the equator, with intermediate international exposure and socioeconomic features. These findings shed light on the main features of COVID-19 prevalence in Africa and might help refine effectively coping management strategies of the ongoing pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10668-022-02646-3.

Ethnolinguistic diversity and the spread of communicable diseases: a cross-country study on the COVID-19 pandemic

Motivated by the varying effectiveness of government intervention policies to contain the COVID-19 pandemic, and the potential positive relationship between ethnolinguistic diversity and social distance, this paper aims to provide empirical evidence on the relationship between ethnolinguistic diversity and the spread of COVID-19. In particular, using global data from 113 developed and developing countries during the early stages of the pandemic (from 31 December 2019 to 8 July 2020), we have found a significant negative effect of ethnolinguistic diversity on the spread of the virus. The result is robust to alternative measures of ethnolinguistic diversity and estimator that addresses endogeneity. Moreover, we also show that the impact of ethnolinguistic diversity on the spread of COVID-19 differs in economies characterized by different levels of democracy, policy stringency on addressing COVID-19 and health expenditure.

Sustainable Development Goals in the COVID-19 Pandemic: A Narrative Review

The present narrative review aimed to analyze the impact of the COVID-19 pandemic on the sustainable development goals (SDGS). This information would allow a better comprehension of the actual state of the SDGS and a more efficient programming in future interventions. To achieve the objective of the study, a consensual and critical review was carried out using both primary sources, such as scientific articles, and secondary sources, such as bibliographic indexes, web pages and databases. The Sustainable Development Goals are a global call to action to end poverty, close the gender gap, protect the planet, and improve the lives of people around the world. In 2015, the United Nations General Assembly adopted 17 goals as part of the 2030 Agenda for Sustainable Development, which sets out a plan to achieve the goals in 15 years. However, the COVID-19 pandemic crisis has been a turning point in the achievement of these goals, due to all its consequences at the political, economic, and socio-cultural levels. This review can be used as a guide for future research and reviews in order to understand the status of each of the SDGs and what actions have been taken and proposed in the aftermath of the pandemic in recent years.

Coordination mechanisms for COVID-19 in the WHO Regional office for Africa

Aim

This study describes the coordination mechanisms that have been used for management of the COVID 19 pandemic in the WHO AFRO region; relate the patterns of the disease (length of time between onset of coordination and first case; length of the wave of the disease and peak attack rate) to coordination mechanisms established at the national level, and document best practices and lessons learned.

Method

We did a retrospective policy tracing of the COVID-19 coordination mechanisms from March 2020 (when first cases of COVID-19 in the AFRO region were reported) to the end of the third wave in September 2021. Data sources were from document and Literature review of COVID-19 response strategies, plans, regulations, press releases, government websites, grey and peer-reviewed literature. The data was extracted to Excel file database and coded then analysed using Stata (version 15). Analysis was done through descriptive statistical analysis (using measures of central tendencies (mean, SD, and median) and measures of central dispersion (range)), multiple linear regression, and thematic analysis of qualitative data.

Results

There are three distinct layered coordination mechanisms (strategic, operational, and tactical) that were either implemented singularly or in tandem with another coordination mechanism. 87.23% (n = 41) of the countries initiated strategic coordination, and 59.57% (n = 28) initiated some form of operational coordination. Some of countries (n = 26,55.32%) provided operational coordination using functional Public Health Emergency Operation Centres (PHEOCs) which were activated for the response. 31.91% (n = 15) of the countries initiated some form of tactical coordination which involved the decentralisation of the operations at the local/grassroot level/district/ county levels. Decentralisation strategies played a key role in coordination, as was the innovative strategies by the countries; some coordination mechanisms built on already existing coordination systems and the heads of states were effective in the success of the coordination process. Financing posed challenge to majority of the countries in initiating coordination.

Conclusion

Coordinating an emergency is a multidimensional process that includes having decision-makers and institutional agents define and prioritise policies and norms that contain the spread of the disease, regulate activities and behaviour and citizens, and respond to personnel who coordinate prevention.

Response to COVID-19 in the Central African Republic: Coping Strategies Combined With China’s Experience

Objectives: The weak health system, domestic political unrest, poverty, and many other factors in the Central African Republic (CAR) have left the country underprepared for the COVID-19 pandemic, resulting in a greater health threat to the entire country. Rapid measures must therefore be taken to prevent the further spread of COVID-19.

Methods: This work encompassed a review of relevant literature. We aim to analyze how far Chinese COVID measures can be transferred to the context of the CAR.

Results: We argue that the measure that the CAR can learn from China’s success is the involvement of community workers and that greater investment in this model may be the optimal solution. Help from the international community is urgently needed.

Conclusion: The CAR can benefit from China’s successful experience in fighting the epidemic, but the disparity in the combined power of the two countries does not allow for simple replication of China’s strategy.

Environmental orientation, relational capital and SMEs performance: do religious, cultural and mimetic orientations matter in a Sub-Saharan African economy?

Purpose

Using the institutional and natural resource-based view theories, the purpose of this study is to examine the influence of religious, cultural and mimetic orientations on proactive environmental strategy, corporate environmental responsibility and traditional environmental strategy. Relying on data collected from managers of small and medium-sized enterprises (SMEs), the study further examines how proactive environmental strategy, corporate environmental responsibility and traditional environmental strategy drive relational capital and firm performance of SMEs operating in Ghana.

Design/methodology/approach

The study employed a survey research design, a quantitative approach and a partial least square structural equation modelling technique in making data analysis and interpretations due to its appropriateness for predictive research models.

Findings

The results suggest that mimetic orientation robustly and significantly influence the dimensions of environmental orientation. While religious orientation only had a robust and significant influence on proactive environmental strategy, cultural orientation robustly and significantly influences both proactive and traditional environmental strategies. Despite the positive and significant interactions that exist between proactive environmental strategy, corporate environmental responsibility, traditional environmental strategy, relational capital and firm performance, the findings particularly revealed that proactive and environmental strategies insignificantly correlated with relational capital contrary to past study findings.

Originality/value

The study is among the few to examine how religious, cultural and mimetic orientations interrelate with proactive and traditional environmental orientations, relational capital and firm performance in an emerging economy. Based on the findings, implications and directions for future research are discussed while also providing guidance for policymakers, regulatory bodies, scholars and practitioners.

[Response to the COVID-19 Pandemic in Chile, Colombia, and Peru from a children's rights perspectiveResposta à pandemia de COVID-19 no Chile, Colômbia e Peru com foco nos direitos da criança]

Objective

Describe the strategies established by Chile, Colombia, and Peru during the first year of the COVID-19 pandemic and compare them from a children's rights perspective.

Methods

A qualitative study with comparative analysis of public policies was conducted around seven cat-egories constructed by the Latin American Chapter of the International Society for Social Pediatrics and Child Health, based on the Convention on the Rights of the Child. Country documents were selected based on convenience sampling and were analyzed in deliberative dialogues.

Results

173 documents from the three countries were reviewed. There was convergence around: prioritization of prevention of community transmission of the virus over promotion of the exercise of children's rights; lack of participation of children and adolescents in the process of developing public policies; and lack of progress in the recognition and protection of the exercise of children's rights overall. There were no major divergences beyond identified inequality gaps grounded in the reality of each country.

Conclusion

The pandemic has affected the functioning of the economic, social, health, education, environmental, and governance systems in these three countries. While this study shows progress in the inclusion of the children's rights approach in formulated policies, the recognition of children and adolescents as holders of social and political rights could allow the construction of collective alternatives that guarantee health and well-being for all people throughout the life course.

Mental health and coping strategies during the COVID-19 pandemic: A qualitative study of unemployed and employed people in Nigeria

The coronavirus disease 2019 (COVID-19) significantly disrupted human activities all over the world. Despite this, little or nothing is known about mental health and coping strategies during the COVID-19 pandemic among the unemployed and employed people in Nigeria. Therefore, this study was an effort towards bridging this knowledge gap. We employed a qualitative design with 66 participants (age range = 18-62 years) who described how the COVID-19 pandemic affected their mental health and how they coped during the COVID-19 pandemic. The data were analyzed using thematic analysis. Our findings revealed distressing impacts (e.g., depressive and anxious impacts, stress, loss of job, financial challenges, loneliness, etc.) for the unemployed and employed groups. Further, the unemployed group utilized more positive coping strategies (e.g., engaging in activities, hope, relaxation, connecting with others, etc.) than the employed group; whereas, only the employed group utilized a maladaptive coping strategy (alcohol consumption). These data have practical implications for protecting mental health and fostering positive coping in these groups during and beyond the COVID-19 pandemic.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

COVID-19 pandemic decision support system for a population defense strategy and vaccination effectiveness

The year 2020 ended with a significant COVID-19 pandemic, which traumatized almost many countries where the lockdowns were restored, and numerous emotional social protests erupted. According to the World Health Organization, the global epidemiological situation in the first months of 2021 deteriorated. In this paper, the decision-making supporting system (DMSS) is proposed to be an epidemiological prediction tool. COVID-19 trends in several countries and regions, take into account the big data clouds for important geophysical and socio-ecological characteristics and the expected potentials of the medical service, including vaccination and restrictions on population migration both within the country and international traffic. These parameters for numerical simulations are estimated from officially delivered data that allows the verification of theoretical results. The numerical simulations of the transition and the results of COVID-19 are mainly based on the deterministic approach and the algorithm for processing statistical data based on the instability indicator. DMSS has been shown to help predict the effects of COVID-19 depending on the protection strategies against COVID-19 including vaccination. Numerical simulations have shown that DMSS provides results using accompanying information in the appropriate scenario.

Can home gardening significantly reduce food insecurity in South Africa during times of economic distress?

South African food distribution. Existing challenges will be greatly exacerbated by an economic recession projected to be worse than the Great Depression. Home gardens are decidedly utilised to fortify food security and economic resiliency in the face of crises, especially in impoverished communities. For these communities, home garden produce favourably augments diets consisting predominantly of industrially produced staples and the surplus yield can be sold. Despite many campaigns to alleviate food insecurity – some aimed at developing industrial agriculture and others to establish and uplift home gardens – malnutrition and hunger still plague the impoverished. Dissection of these campaigns reveals common flaws in those that failed and key aspects related to those that succeeded, with successful projects even managing to provide a household’s total supply of vegetables. One of the crucial failings was a ‘top-down’ approach that condescended to participants, ignoring existing knowledge, preferences and social consolidation whilst focusing on meticulously consistent packaged methodologies. Successful projects exalted recipients’ own bid for food sovereignty and increased individual and community capacity by providing insightful consultation and access to requested necessary inputs. Obstacles especially present in South Africa include drought and collapse of social capital after withdrawal of institutional support. It has been proven possible that these can be overcome with application of technologies, such as rainwater harvesting, and the creation of common cause such as in national drives. This review of the literature clearly reveals that purposefully uplifted home and community gardens alleviate food insecurity.

A Sociodemographic Profile of Mask Use During the COVID-19 Outbreak Among Young and Elderly Individuals in Brazil: Online Survey Study

BACKGROUND

Sociodemographic variables may impact decision making regarding safety measures. The use and selection of adequate face masks is a safety and health measure that could help minimize the spread of COVID-19 infection.

OBJECTIVE

This study aims to examine sociodemographic variables and factors relating to COVID-19 that could impact decision making or the choice to use or not use face masks in the prevention and care of a possible COVID-19 infection among a large sample of younger and older Brazilian people.

METHODS

An online survey composed of 14 closed-ended questions about sociodemographic variables and COVID-19 was used. A total of 2673 participants consisted of Brazilian people (aged ≥18 years) from different states of Brazil and were grouped according to age (≤59 years and ≥60 years). To compare the variables of interest (associated with wearing a face mask or not), chi-square and likelihood ratio tests were used (with P<.05 being significant).

RESULTS

Most of the participants in both groups were women from the southeast region who had postgraduate degrees. Approximately 61% (1452/2378) of individuals aged ≤59 years and 67.8% (200/295) of those aged ≥60 years were not health professionals. In the group aged ≤59 years, 83.4% (1983/2378) did not show COVID-19 signs and symptoms, and 97.3% (2314/2378) were not diagnosed with COVID-19. In the older adult group, 92.5% (273/295) did not show signs and symptoms of COVID-19, and 98.3% (290/295) were not diagnosed with the disease. The majority of the participants in both groups reported using face masks, and their decision to use face masks was influenced by the level of education and their occupation as a health professional.

CONCLUSIONS

Younger and older adults have worn face masks during the COVID-19 outbreak. It is difficult to measure how much of a positive impact this attitude, habit, and behavior could have on the degree of infection and spread of the disease. However, it can be a positive indicator of adherence to the population's security and safety measures during the pandemic.

COVID-19-related attitudes, risk perceptions, preventive behaviours and economic impact in sub-Saharan African countries: implementing a longitudinal phone-based survey protocol in rural Senegalese households

INTRODUCTION

Rural areas are considered safe havens against the increased spread of COVID-19 and associated restrictive measures, especially in contexts where public authorities are not in a position to systematically and substantially ease COVID-19-induced economic shocks. In the current sub-Saharan Africa context, still marked by uncertainty surrounding the spread of COVID-19, we present the protocol of an ongoing longitudinal study aimed at investigating COVID-19-related attitudes, risks perceptions, preventive behaviours and economic impact in rural areas in Senegal.

METHODS AND ANALYSIS

A prospective randomised longitudinal study of 600 households located in three semiurban villages and nine randomly selected rural villages in the Niakhar area (located 135 km East of Dakar). Three ad hoc phone surveys are administered to 600 heads of households, their housewives in charge of managing the household and a relative living temporarily in the household, respectively. In addition to sharing identical sets of questions on several topics (risks perceptions, attitudes to curfew, attitudes to vaccines, beliefs about COVID-19 infection), the three separate survey questionnaires also include other topics (economic impact, local preventive strategies) whose related questions differ between questionnaires. As analysing evolutions is the study's primary focus, data on all the topics covered will be collected in three waves unless the spread of COVID-19 by mid-2021 justifies extending data collection. The present article presents the study protocol and details about the implementation of the first wave of data collection which started in July 2020. The decision to wait before presenting the protocol was based on the unprecedented context the COVID-19 pandemic.

ETHICS AND DISSEMINATION

The survey's protocol was approved by the Senegalese National Ethical Committee for Research in Health (131/MSAS/CNERS/Sec) and received authorisation from both the Senegalese Ministry of Health (619/MSAS/DPRS/DR) and the French Commission on Information Technology and Liberties (CNIL 2220771).

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.

Pay-as-you-go liquefied petroleum gas supports sustainable clean cooking in Kenyan informal urban settlement during COVID-19 lockdown

Approximately 2.8 billion people rely on polluting fuels (e.g. wood, kerosene) for cooking. With affordability being a key access barrier to clean cooking fuels, such as liquefied petroleum gas (LPG), pay-as-you-go (PAYG) LPG smart meter technology may help resource-poor households adopt LPG by allowing incremental fuel payments. To understand the potential for PAYG LPG to facilitate clean cooking, objective evaluations of customers' cooking and spending patterns are needed. This study uses novel smart meter data collected between January 2018-June 2020, spanning COVID-19 lockdown, from 426 PAYG LPG customers living in an informal settlement in Nairobi, Kenya to evaluate stove usage (e.g. cooking events/day, cooking event length). Seven semi-structured interviews were conducted in August 2020 to provide context for potential changes in cooking behaviours during lockdown. Using stove monitoring data, objective comparisons of cooking patterns are made with households using purchased 6 kg cylinder LPG in peri-urban Eldoret, Kenya. In Nairobi, 95% of study households continued using PAYG LPG during COVID-19 lockdown, with consumption increasing from 0.97 to 1.22 kg/capita/month. Daily cooking event frequency also increased by 60% (1.07 to 1.72 events/day). In contrast, average days/month using LPG declined by 75% during lockdown (17 to four days) among seven households purchasing 6 kg cylinder LPG in Eldoret. Interviewed customers reported benefits of PAYG LPG beyond fuel affordability, including safety, time savings and cylinder delivery. In the first study assessing PAYG LPG cooking patterns, LPG use was sustained despite a COVID-19 lockdown, illustrating how PAYG smart meter technology may help foster clean cooking access.

Willingness to receive future COVID-19 vaccines following the COVID-19 epidemic in Shanghai, China

BACKGROUND

There are no pharmacological interventions currently available to prevent the transmission of SARS-CoV-2 or to treat COVID-19. The development of vaccines against COVID-19 is essential to contain the pandemic. we conducted a cross-sectional survey of Shanghai residents to understand residents' willingness to be vaccinated with any future COVID-19 vaccines and take measures to further improve vaccination coverage.

METHODS

We conducted a cross-sectional survey using self-administered anonymous questionnaires from 1 July to 8 September 2020. The main outcome was willingness of participants, and any children or older individuals living with them, to receive future COVID-19 vaccines. Logistic regression analyses were used to explore potential factors associated with vaccination willingness.

RESULTS

A total of 1071 participants were asked about their willingness to receive future COVID-19 vaccines, for themselves and at least 747 children and 375 older individuals (≥60 years old) living with them. The highest proportion of expected willingness to vaccinate was among participants (88.6%), followed by children (85.3%) and older individuals (84.0%). The main reasons for reluctance to vaccinate among 119 participants were doubts regarding vaccine safety (60.0%) and efficacy (28.8%). Participants with a self-reported history of influenza vaccination were more likely to accept COVID-19 vaccines for themselves [adjusted odds ratio (OR) = 1.83; 95% confidence interval (CI): 1.19-2.82], their children (adjusted OR = 2.08; 95%CI: 1.30-3.33), and older individuals in their household (adjusted OR = 2.12; 95%CI: 1.14-3.99). Participants with older individuals in their families were less willing to vaccinate themselves (adjusted OR = 0.59; 95%CI: 0.40-0.87) and their children (adjusted OR = 0.58; 95%CI: 0.38-0.89).

CONCLUSIONS

Participants were more reluctant to accept COVID-19 vaccines for older individuals living with them. The presence of older individuals in the home also affected willingness of participants and their children to be vaccinated.

Rapid Scoping Review on the Topic of Ensuring Social Protection and Basic Services to Inform the United Nations Framework for the Immediate Socioeconomic Response to COVID-19

This rapid scoping review has informed the development of the UN Research Roadmap for the COVID-19 Recovery on the topic of “Ensuring Social Protection and Basic Services.” The aim was to provide a robust synthesis of key concepts and existing evidence drawn from a wide range of disciplines to support the identification and appraisal of research priorities. An emergent theme has been the notion that measures implemented in response to COVID-19 merely ameliorate symptoms of entrenched, systemic gender-, age-, and race-based inequity, inequality, and exclusion. Key findings include the critical role of contextual and community-based knowledge for informing the design, development, and delivery of programs, as well as the urgent need for implementation science to move existing knowledge into action. This review also describes how the disruption associated with “shock events” such as the COVID-19 pandemic is often associated with unusually high levels of interest and willingness to invest in programs and policies to strengthen strained systems. As such, an unprecedented window of opportunity exists to leverage measures implemented in response to the COVID-19 pandemic to effect large-scale, sustainable change and thereby increase the resiliency of our interconnected systems for the future.

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.

Challenges Associated With the Response to the Coronavirus Disease (COVID-19) Pandemic in Africa-An African Diaspora Perspective

The 2014-2016 Ebola outbreak in West Africa extracted huge health, social, and economic costs. How can lessons learnt during the 2014-2016 Ebola outbreak in West Africa help to mitigate the likelihood of a long-term devastating effect of the coronavirus disease (COVID-19) outbreak on the African continent? Despite COVID-19 spreading quickly across the globe after being first reported in Wuhan, China on December 31, 2019, African countries remained relatively unaffected until the second week of March 2020. The majority of Africa countries have been at low to moderate risk. However, they have experienced many sociocultural, economic, political, and structural challenges. These have included laboratory capacity and logistical challenges; ill-equipped public health systems; land border permeability, and delayed preparedness to transnational threats; and abject economic deprivation, lack of basic infrastructure, and associated sociocultural implications. There needs to be a strong country-level leadership to coordinate and own all aspects of the responses to the COVID-19 pandemic in a collaborative, transparent, and accountable way. Strategic and sustained response plans to fight the pandemic should incorporate culturally competent strategies that harness different cultural practices and strengthen cultural security. They should also promote and strengthen the implementation of the International Health Regulations.

A Hybrid Modeling Technique of Epidemic Outbreaks with Application to COVID-19 Dynamics in West Africa

The widely used logistic model for epidemic case reporting data may be either restrictive or unrealistic in presence of containment measures when implemented after an epidemic outbreak. For flexibility in epidemic case reporting data modeling, we combined an exponential growth curve for the early epidemic phase with a flexible growth curve to account for the potential change in growth pattern after implementation of containment measures. We also fitted logistic regression models to recoveries and deaths from the confirmed positive cases. In addition, the growth curves were integrated into a SIQR (Susceptible, Infective, Quarantined, Recovered) model framework to provide an overview on the modeled epidemic wave. We focused on the estimation of: (1) the delay between the appearance of the first infectious case in the population and the outbreak ("epidemic latency period"); (2) the duration of the exponential growth phase; (3) the basic and the time-varying reproduction numbers; and (4) the peaks (time and size) in confirmed positive cases, active cases and new infections. The application of this approach to COVID-19 data from West Africa allowed discussion on the effectiveness of some containment measures implemented across the region.

The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study

BACKGROUND

Although the first wave of the COVID-19 pandemic progressed more slowly in Africa than the rest of the world, by December, 2020, the second wave appeared to be much more aggressive with many more cases. To date, the pandemic situation in all 55 African Union (AU) Member States has not been comprehensively reviewed. We aimed to evaluate reported COVID-19 epidemiology data to better understand the pandemic's progression in Africa.

METHODS

We did a cross-sectional analysis between Feb 14 and Dec 31, 2020, using COVID-19 epidemiological, testing, and mitigation strategy data reported by AU Member States to assess trends and identify the response and mitigation efforts at the country, regional, and continent levels. We did descriptive analyses on the variables of interest including cumulative and weekly incidence rates, case fatality ratios (CFRs), tests per case ratios, growth rates, and public health and social measures in place.

FINDINGS

As of Dec 31, 2020, African countries had reported 2 763 421 COVID-19 cases and 65 602 deaths, accounting for 3·4% of the 82 312 150 cases and 3·6% of the 1 798 994 deaths reported globally. Nine of the 55 countries accounted for more than 82·6% (2 283 613) of reported cases. 18 countries reported CFRs greater than the global CFR (2·2%). 17 countries reported test per case ratios less than the recommended ten to 30 tests per case ratio range. At the peak of the first wave in Africa in July, 2020, the mean daily number of new cases was 18 273. As of Dec 31, 2020, 40 (73%) countries had experienced or were experiencing their second wave of cases with the continent reporting a mean of 23 790 daily new cases for epidemiological week 53. 48 (96%) of 50 Member States had five or more stringent public health and social measures in place by April 15, 2020, but this number had decreased to 36 (72%) as of Dec 31, 2020, despite an increase in cases in the preceding month.

INTERPRETATION

Our analysis showed that the African continent had a more severe second wave of the COVID-19 pandemic than the first, and highlights the importance of examining multiple epidemiological variables down to the regional and country levels over time. These country-specific and regional results informed the implementation of continent-wide initiatives and supported equitable distribution of supplies and technical assistance. Monitoring and analysis of these data over time are essential for continued situational awareness, especially as Member States attempt to balance controlling COVID-19 transmission with ensuring stable economies and livelihoods.

FUNDING

None.

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study

BACKGROUND

Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries.

METHODS

An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure.

RESULTS

Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls.

CONCLUSIONS

The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures.

Addressing Africa's pandemic puzzle: Perspectives on COVID-19 transmission and mortality in sub-Saharan Africa

To date, SARS-CoV-2 (the virus that causes COVID-19) has spread to almost every region of the world, infecting millions and resulting in the deaths of hundreds of thousands of people. Although it was predicted that Africa would suffer a massive loss of life due to this pandemic, the number of COVID-19 cases has been relatively low across the continent. Researchers have speculated that several factors may be responsible for this outcome in Africa, including the extensive experience that countries have with infectious diseases and the young median age of their populations. However, it is still important for African countries to adopt aggressive and bold approaches against COVID-19, in case the nature of the pandemic changes. This short review will summarize the status of the outbreak in Africa and propose possible reasons for current trends, as well as discuss interventions aimed at preventing a rapid increase in the number of COVID-19 cases in the future.

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

BACKGROUND

Born in the Chinese city of Wuhan, the consequences of the coronavirus pandemic on global health and economies have been and continue to be devastating. In Africa, its countries grieve for unprecedented burdens of caseloads and mortality due to COVID-19, the virus responsible for the disease. This narrative review aims to establish the scale of the health and economic crisis wrought by the pandemic in Africa, including its impact on the informal economic sector, projections of the effect on national GDP, as well as its political dimensions.

METHODS

Documentary evidence issued between January and 8 August 2020 was sought from the Google Scholar, PubMed, Scopus, and Web of Science databases. Searches of published and unpublished abstracts were also conducted from appropriate websites, government documents, organizational reports, newspaper commentaries, and reports issued by global, regional, and local centers of disease control and prevention.

RESULTS

The COVID-19 pandemic is responsible for a fourfold crisis in Africa: (1) a health crisis: the victimization of frontline healthcare workers and the looming caseload and death tolls with 1.039 million (12%) cases being confirmed and over 22,966 (2.4%) deaths as of 8 August 2020. The highest death toll was recorded in Southern Africa of 11,024 (48%) followed by North Africa with 6,989 (29.2%) deaths; (2) a social crisis: with the violation of human rights, the killing of citizens by security forces and increased crime. This, in turn, exacerbates social inequalities, the breakdown of households, instances of social unrest, and general impoverishment; (3) an economic crisis: manifested by a decline in GDP and mass unemployment; (4) a political crisis: implementation of measures that may not be appropriate for Africa, discrimination of refugees and immigrants, evacuation of citizens to their home countries, resulting in distrust of political leaders and postponement of national elections, and mounting cases of conflicts and unrest.

CONCLUSION

Lockdown during the COVID-19 outbreak is a prevention mechanism in affluent countries, in contrast to developing regions such as Africa, where it is a race against death and starvation. Policymakers must apply novel and locally relevant prevention and management strategies to cope with this growing disaster.

Economic stimulus for COVID-19 pandemic and its determinants: evidence from cross-country analysis

Countries around the world are announcing stimulus packages in response to the COVID 19 pandemic. This research attempts to measure the extent and progress of stimulus packages by proposing a multidimensional index that standardizes governments' economic responses and allows us to examine the differences in economic policies from country to country. We apply the Euclidean distance formula to develop the new index and then identify the determinants of the economic stimulation of COVID-19 through beta-regression. The results show that Chile, Switzerland, Croatia, Sweden and the Netherlands responded more strongly to the COVID-19 pandemic, while the remaining countries responded slightly to the pandemic. Empirical results also indicate that most countries increased COVID-19 economic support, although not significantly. Finally, the results of the beta regression show that the median age of the population, the number of hospitals, beds per capita, the number of total COVID-19 cases, GDP, health care expenditure and the index of the severity of the government's response is significantly related to the level of the countries' stimulus packages.

A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy

BACKGROUND

Since the novel coronavirus emerged in late 2019, the scientific and public health community around the world have sought to better understand, surveil, treat, and prevent the disease, COVID-19. In sub-Saharan Africa (SSA), many countries responded aggressively and decisively with lockdown measures and border closures. Such actions may have helped prevent large outbreaks throughout much of the region, though there is substantial variation in caseloads and mortality between nations. Additionally, the health system infrastructure remains a concern throughout much of SSA, and the lockdown measures threaten to increase poverty and food insecurity for the subcontinent's poorest residents. The lack of sufficient testing, asymptomatic infections, and poor reporting practices in many countries limit our understanding of the virus's impact, creating a need for better and more accurate surveillance metrics that account for underreporting and data contamination.

OBJECTIVE

The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with new and decomposable surveillance metrics of COVID-19 that overcome data limitations and contamination inherent in public health surveillance systems. In addition to prevalence of observed daily and cumulative testing, testing positivity rates, morbidity, and mortality, we derived COVID-19 transmission in terms of speed, acceleration or deceleration, change in acceleration or deceleration (jerk), and 7-day transmission rate persistence, which explains where and how rapidly COVID-19 is transmitting and quantifies shifts in the rate of acceleration or deceleration to inform policies to mitigate and prevent COVID-19 and food insecurity in SSA.

METHODS

We extracted 60 days of COVID-19 data from public health registries and employed an empirical difference equation to measure daily case numbers in 47 sub-Saharan countries as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R.

RESULTS

Kenya, Ghana, Nigeria, Ethiopia, and South Africa have the most observed cases of COVID-19, and the Seychelles, Eritrea, Mauritius, Comoros, and Burundi have the fewest. In contrast, the speed, acceleration, jerk, and 7-day persistence indicate rates of COVID-19 transmissions differ from observed cases. In September 2020, Cape Verde, Namibia, Eswatini, and South Africa had the highest speed of COVID-19 transmissions at 13.1, 7.1, 3.6, and 3 infections per 100,0000, respectively; Zimbabwe had an acceleration rate of transmission, while Zambia had the largest rate of deceleration this week compared to last week, referred to as a jerk. Finally, the 7-day persistence rate indicates the number of cases on September 15, 2020, which are a function of new infections from September 8, 2020, decreased in South Africa from 216.7 to 173.2 and Ethiopia from 136.7 to 106.3 per 100,000. The statistical approach was validated based on the regression results; they determined recent changes in the pattern of infection, and during the weeks of September 1-8 and September 9-15, there were substantial country differences in the evolution of the SSA pandemic. This change represents a decrease in the transmission model R value for that week and is consistent with a de-escalation in the pandemic for the sub-Saharan African continent in general.

CONCLUSIONS

Standard surveillance metrics such as daily observed new COVID-19 cases or deaths are necessary but insufficient to mitigate and prevent COVID-19 transmission. Public health leaders also need to know where COVID-19 transmission rates are accelerating or decelerating, whether those rates increase or decrease over short time frames because the pandemic can quickly escalate, and how many cases today are a function of new infections 7 days ago. Even though SSA is home to some of the poorest countries in the world, development and population size are not necessarily predictive of COVID-19 transmission, meaning higher income countries like the United States can learn from African countries on how best to implement mitigation and prevention efforts.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/21955.

Physical Activity and Sociodemographic Profile of Brazilian People during COVID-19 Outbreak: An Online and Cross-Sectional Survey

The Coronavirus Disease 2019 (COVID-19) outbreak has created an unprecedented impact on global health and further aggravated the physical inactivity pandemic. For this reason, the understanding of sociodemographic variables in the context of physical activity levels are important for the field of public health in order to assist in relevant public health decisions. Our main aim was to characterize sociodemographic variables and physical activity levels and their association with COVID-19 aspects. We applied an online Google survey with closed questions in Brazilian people of different age and regions, both sexes and physical activity levels (n = 1.726). Our main results were that participants who had symptoms of COVID-19 had the highest percentage of level 1 of physical activity (the lowest level according to the classification used) and those who showed no symptoms had the highest percentage of levels 2 and 3 of physical activity; that is, close to the light/moderate levels of physical activity. This cross-sectional study in the Brazilian population provided important sociodemographic data and COVID-19 aspects regarding the level of physical activity. It is possible to assume that the regular practice of physical activity could positively impact health status and quality of life and be a tool in the field of public health to cope (from a physical and mental point of view) with disease scenarios that require quarantine.

COVID-19 Pandemic: Knowledge and Attitudes in Public Markets in the Former Katanga Province of the Democratic Republic of Congo

Background. Public markets were exempted from the restrictive regulations instituted to limit the rapid spread of the COVID-19 pandemic in the Democratic Republic of the Congo (DRC). In the early stage of the pandemic, we assessed people’s knowledge, attitudes, and behavior on public markets towards COVID-19. Methods. We conducted a cross-sectional study from 16 to 29 April 2020 among sellers and customers frequenting the food sections of ten public markets in three large cities (Kolwezi, Likasi, and Lubumbashi) and one small town (Lwambo) of the former Katanga province. We administered a questionnaire on knowledge (about clinical characteristics, transmission and prevention) and on attitudes in relation to COVID-19. We also observed prevailing practices (hand-washing and mask-wearing). Results: Of the 347 included participants (83% women, 83% sellers), most had low socioeconomic status and a low level of education. Only 30% of participants had correct knowledge of COVID-19. The majority of the respondents (88%) showed no confidence in the government’s ability to manage the upcoming pandemic crisis. Nearly all respondents (98%) were concerned about the associated increase in food insecurity. Preventive practices were rarely in place. Conclusion: For an effective implementation of measures to prevent the spread of COVID-19 in Africa, appropriate health education programs to improve knowledge and attitudes are warranted among the population frequenting public markets.

The impact of COVID-19 lockdown in a developing country: narratives of self-employed women in Ndola, Zambia

Women are normally self-employed in businesses involving buying and selling of goods. Such businesses were severely affected by the COVID-19 pandemic lock-down. The researchers explored the impact the of COVID-19 lockdown on self-employed women. The researchers used a qualitative approach. Interviews were used to collect data. Forty participants took part in the study. The data was thematically analyzed. The researchers found that participants were affected by Inadequate food supplies, Hopelessness to revive business, Poor access to health services, Psychological trauma, Defaulting medications, and Challenges of keeping children indoors. There is need to provide social and economic support to self-employed women.

Measuring geographical disparities in England at the time of COVID-19: results using a composite indicator of population vulnerability

OBJECTIVES

The growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics.

DESIGN

We combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability.

SETTING

91 Clinical Commissioning Groups (CCGs) in England.

MAIN OUTCOME MEASURES

We merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities.

RESULTS

We find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments.

CONCLUSIONS

Evidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.

Factors Influencing the Frequency of Airway Infections in Underage Refugees: A Retrospective, Cross Sectional Study

Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.

Child Healthcare and Immunizations in Sub-Saharan Africa During the COVID-19 Pandemic

Since COVID-19 in the pediatric population is infrequently severe, the indirect costs of the pandemic, related to the measures implemented to deal with the spread of the virus, can be worse than the infection itself. To assess this issue, we evaluated the number of children vaccinated or evaluated for the most common diseases in a poor village in Sierra Leone, showing a worrisome drop in vaccinations performed and children evaluated for acute diseases. Our preliminary findings highlight that support is needed to guarantee basic services to children during the COVID-19 pandemic, particularly in poor settings where preventive measures can be lifesaving in the long term.