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Cassim N, Hans L, Venter WDF, Somayya S, Da Silva P, Stevens WS. National Impact of SARS-CoV-2 Infection on HIV Virological Suppression in South Africa. J Acquir Immune Defic Syndr 2023; 94:381-386. [PMID: 37732871 DOI: 10.1097/qai.0000000000003307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Coronavirus disease (COVID-19) severely disrupted routine health care globally. This study assessed the impact of successive COVID-19 waves on HIV viral load (VL) suppression in South Africa, using the national public sector laboratory database. Guidelines recommend VL monitoring at 6 months after treatment initiation, annually once if suppressed, or more frequently if unsuppressed. METHODS Specimen-level VL data were extracted for the period January 2019-December 2021. We assessed the national percentage of samples with a VL <50 (virological suppression), 50-999 (low-level viremia), and ≥1000 (viremia) copies/mL. Data were analyzed by calendar year and month. Data for 2019 (pre-COVID-19) were compared with the 2020 and 2021 calendar years (lockdowns imposed). The national number of COVID-19 cases was reported to indicate the wave periods as follows: 1 (ancestral)-June-August 2020; 2 (Beta)-December 2020-January 2021; 3 (Delta)-June-August 2021, and 4 (Omicron)-December 2021. RESULTS Data are reported for 17,460,264 samples, with 5,608,733, 5,840,056, and 6,011,475 tests performed in 2019, 2020, and 2021 respectively. Overall, a VL of <50, 50-999, and ≥1000 copies/mL were reported for 69.4%, 17.3%, and 13.4% of samples, respectively. A VL <50 copies/mL was reported for 67.7%, 70.3%, and 70.0% of patients in 2019, 2020, and 2021, respectively. For the 2020 and 2021 calendar years, the monthly percentage of patients with a VL <50 copies/mL ranged between 64.6% and 72.7%. CONCLUSION Our findings indicate that COVID-19 has not had a substantial impact on the percentage of samples with virological suppression at the national level.
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Affiliation(s)
- Naseem Cassim
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa; and
| | - Lucia Hans
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa; and
| | - W D Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarang Somayya
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa; and
| | - Pedro Da Silva
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa; and
| | - Wendy Susan Stevens
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa; and
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Ahmead M, Daghlas F. The effect of the COVID-19 pandemic on the provision of outpatient clinic services in East Jerusalem hospitals: patients' perspectives. Front Public Health 2023; 11:1252449. [PMID: 38074699 PMCID: PMC10704241 DOI: 10.3389/fpubh.2023.1252449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Due to the decreased availability, accessibility, and quality of services, the COVID-19 pandemic has an impact on the healthcare system. In the wake of the COVID-19 pandemic, patients' perceptions of healthcare have changed, and out-patient visits to clinics have decreased. As part of the COVID-19 outbreak in East Jerusalem, this study aims to assess how patients perceive the way that outpatient clinic services were delivered before and during COVID-19 outbreak. Methodology Convenience sampling and self-reported questionnaires were used in a cross-sectional study. Three hundred people from three significant outpatient clinic hospitals in East Jerusalem-Al-Makassed Hospital, Augusta Victoria Hospital, and Sant-Joseph Hospital- made up the sample. Multivariate tests, frequencies, and percentages were used in the statistical analysis. Results The results showed that the most of the participants (98.6%) had negative opinion when the current situation is compared with before the COVID-19 period in terms of accessibility, availability of resources, quality of care, attitudes and patient's preference. Finally, multivariate analysis indicated a significant relationship between participant opinion and education level and participants with educational levels of 12 study years or less had more positive opinions of the delivery of the healthcare system during the COVID-19 outbreak period than the group with more than 12 study years. Also, the multivariate analysis revealed a significant `relationship between participant opinion and the duration of the illness as those with years of illness and less had more negative opinion toward the delivery of the healthcare system than those with more than 3 years of illness. Conclusion This study found that when the current situation during the COVID-19 outbreak is compared to before the COVID-19 period in terms of accessibility, availability of resources, quality of care, attitudes, and patient preferences, the majority of the participants with chronic diseases or cancer had a negative opinion. Policymakers and health managers should enhance patient preferences and attitudes during the COVID-19 pandemic and other pandemics by increasing accessibility, availability of health resources, and the quality of healthcare.
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Heunis C, Chikobvu P, Muteba M, Kigozi-Male G, Engelbrecht M, Mushori P. Impact of COVID-19 on selected essential public health services - lessons learned from a retrospective record review in the Free State, South Africa. BMC Health Serv Res 2023; 23:1244. [PMID: 37951875 PMCID: PMC10640739 DOI: 10.1186/s12913-023-10166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. METHODS A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon rank-sum tests. A 5% statistical significance level was considered. RESULTS Over the study period, the median values for the annual number of PHC visits was 1.80, 55.30% for non-referred OPD visits, 69.40% for ART commencement, 95.10% and 18.70% for DS-TB confirmation and treatment commencement respectively, and 93.70% for BCG coverage. While BCG coverage increased by 5.85% (p = 0.010), significant declines were observed in PHC utilisation (10.53%; p = 0.001), non-referred OPD visits (12.05%; p < 0.001), and ART commencement (9.53%; p = 0.017) rates. Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics - as well as the entire quadruple burden of disease - in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning. CONCLUSIONS The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a decline in PHC service utilisation and the decreased numbers of new patients commencing ART, we also learned that EPHS delivery in the province was fragile.
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Affiliation(s)
- Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa.
| | - Perpetual Chikobvu
- Free State Department of Health, Bloemfontein, South Africa
- Department of Community Health, University of the Free State, Bloemfontein, South Africa
| | - Michel Muteba
- World Health Organization, Bloemfontein, South Africa
| | - Gladys Kigozi-Male
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Teuteberg N, Barnard MM, Fernandez A, Cloete K, Mukosi M, Pitcher R. The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa. Cureus 2023; 15:e47616. [PMID: 38021905 PMCID: PMC10667617 DOI: 10.7759/cureus.47616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.
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Affiliation(s)
- Nolene Teuteberg
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
| | - Michelle M Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Keith Cloete
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Matodzi Mukosi
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
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Cassim N, Coetzee LM, da Silva MP, Stevens WS, Glencross DK. Using laboratory data to assess the impact of coronavirus (COVID-19) on reflex cryptococcal antigenaemia (CrAg) testing in South Africa. PLoS One 2023; 18:e0292062. [PMID: 37768950 PMCID: PMC10538795 DOI: 10.1371/journal.pone.0292062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China. Due to the rapid spread globally, it was declared a pandemic in March 2020. Social distancing and lockdown measures were introduced to limit transmission. These strategies could potentially impact the diagnosis and treatment of patients with advanced HIV who are susceptible to secondary infections like cryptococcal disease. In South Africa, reflexed cryptococcal antigenaemia (CrAg) testing and pre-emptive antifungal treatment are recommended preceding antiretroviral therapy initiation for patients with a CD4<100 cells/μl. This study aimed to assess the impact of COVID-19 on CrAg testing in South Africa. METHODS Specimen-level data was extracted for individuals ≥15 years from the National Health Laboratory Services repository for calendar years 2018 to 2021. Test volumes and CrAg positivity were assessed at national and provincial levels, by age category and gender. The percentage change in annual and monthly CrAg test volumes for 2020 and 2021 (during lockdown levels) are compared to data reported for 2018. The monthly median CD4 and the percentage of samples with a count <25, 25-50, 51-75 and >75-<100 cells/μl were assessed. RESULTS Specimen data of 11 944 929 CD4 results included 1 306 456 CrAg tests. Annual CD4 and CrAg test volumes declined by 22.4% and 27.8% for 2020 and 2021 respectively (relative to 2018). There were 23 670 CrAg positive outcomes in 2018 compared to 21 399 (-9.6%) and 17 847 (-24.6%) in 2020 and 2021 respectively. A monthly test volume reduction of up to 36.6%, 35.5%, 36.1% and 13.3% was reported for infection waves one to four. CrAg detection increased from 6.3% in 2018 to 7.5% in 2020. More testing was offered to males (>56%) with a higher detection rate of 8.1% in 2020. Between 81.0% and 81.8% of testing was for patients aged 20 to 49 years. The monthly percentage of specimens <25 cells/μl ranged from 30.2% (June 2019) to 35.3% (August 2020). Overall, the monthly median CD4 ranged from 39 (IQR: 15-70)(August 2020) to 45 (IQR: 19-72)(March 2019) cells/μl. In 2020, the provincial percentage change in CrAg test volumes ranged from 2.9% to -33.7%. CONCLUSION Our findings confirmed the impact of lockdown measures on both the absolute number of CrAg tests performed and detection (increase in 2020). A smaller impact on the median CD4 was noted. The long-term impact on patient management in immune- compromised individuals needs further investigation.
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Affiliation(s)
- Naseem Cassim
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa
| | - Lindi Marie Coetzee
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa
| | - Manuel Pedro da Silva
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa
| | - Wendy Susan Stevens
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa
| | - Deborah Kim Glencross
- Wits Diagnostics Innovation Hub (DIH), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), National Priority Programme (NPP), Johannesburg, South Africa
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Wiebe LE, Alvesson HM, Stassen W. Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa. BMJ Open 2023; 13:e070982. [PMID: 37147101 PMCID: PMC10163331 DOI: 10.1136/bmjopen-2022-070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES To determine emergency department (ED) physicians' perceptions regarding hospital companions being prohibited from accompanying the patient during COVID-19. DESIGN Two qualitative datasets were combined. Data collected included voice recordings, narrative interviewing and semistructured interviews. A reflexive thematic analysis was conducted and guided by the Normalisation Process Theory. SETTING Six hospital EDs in the Western Cape, South Africa. PARTICIPANTS Convenience sampling was used to recruit a total of eight physicians working full time in the ED during COVID-19. RESULTS The lack of physical companions provided an opportunity for physicians to assess and reflect on a companion's role in efficient patient care. Physicians perceived that the COVID-19 restrictions illuminated that patient companions engaged in the ED as providers contributing to patient care by providing collateral information and patient support, while simultaneously engaging as consumers detracting physicians from their priorities and patient care. These restrictions prompted the physicians to consider how they understand their patients largely through the companions. When companions became virtual, the physicians were forced to shift how they perceive their patient, which included increased empathy. CONCLUSION The reflections of providers can feed into discussions about values within the healthcare system and can help explore the balance between medical and social safety, especially with companion restrictions still being practised in some hospitals. These perceptions illuminate various tradeoffs physicians had to consider throughout the pandemic and may be used to improve companion policies when planning for the continuation of the COVID-19 pandemic and future disease outbreaks.
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Affiliation(s)
- Lauren E Wiebe
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Baatiema L, Sanuade OA, Allen LN, Abimbola S, Hategeka C, Koram KA, Kruk ME. Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review. J Glob Health 2023; 13:06006. [PMID: 36862142 PMCID: PMC9980283 DOI: 10.7189/iogh.13.06006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs). Methods We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English. Results After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients' time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period. Conclusions Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.
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Affiliation(s)
- Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Olutobi A Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Luke N Allen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Mayers PM, Olckers L, Prinsloo EL, Raine J, Zweigenthal V. Reflections of volunteer counselors working remotely during the COVID-19 pandemic-Implications for policy and practice. J Nurs Scholarsh 2023; 55:239-252. [PMID: 36510097 PMCID: PMC9877706 DOI: 10.1111/jnu.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE We reflect on our experience of running a remote volunteer counseling service, known as the Counseling Collective, to support patients and their families during the second wave of the COVID-19 pandemic in Cape Town, South Africa, and the learning and implications for practice and policy regarding the effective utilization of volunteers during a crisis or disaster context. BACKGROUND The Beta SARS-Co-2 variant dominated the second COVID-19 wave which gained momentum in December 2020, as public sector health teams prepared to deescalate services over the South African summer season. The ferocity with which the wave hit the city soon made it clear that volunteers would be needed to assist with counseling services as the Beta variant caused serious disease, resulting in a significant upswing in hospitalisations and deaths. METHODS Four counselors and a colleague with oversight responsibilities of the volunteers reflected on the service we provided. This was done with the benefit of hindsight a year after the activities of the Counseling Collective were wrapped up. LESSONS LEARNED Virtual volunteers are a largely untapped resource in the South African health care system. Much is to be gained by using this underutilized resource to deliver patient-centred services, especially in times of crisis. CONCLUSION Networks of retired and self-employed health professionals, particularly nurses,-skilled volunteers-are a valuable resource and can be deployed for critical work using their versatile skillsets, in public health emergencies. Telephonic consultations are a useful modality for providing quality care and need to be built into the business of health services. Skills to conduct such consultations and for the provision of palliative care services need to be mainstreamed into the skillsets of health professionals. POLICY AND CLINICAL RELEVANCE Public health disaster plans should include a blueprint for the rapid recruitment and deployment of volunteer counselors to assist permanent staff in providing crucial patient-centred care.
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Affiliation(s)
- Pat M. Mayers
- University of Western CapeCape TownSouth Africa,University of Cape TownCape TownSouth Africa
| | | | | | - Joy Raine
- Private PracticeCape TownSouth Africa
| | - Virginia Zweigenthal
- School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa,Western Cape Department of HealthCape TownSouth Africa
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Lemoine P, Ebert D, Koga Y, Bertin C. Public interest and awareness regarding general health, sleep quality and mental wellbeing during the early COVID-19 pandemic period: An exploration using Google trends. SLEEP EPIDEMIOLOGY 2022; 2:100017. [PMID: 35673330 PMCID: PMC8604793 DOI: 10.1016/j.sleepe.2021.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
The internet network continues to be a major source of health-related information. Our research provides insights into the online health-seeking behaviors of the general population, and evaluates the potential relationship between the COVID-19 pandemic and public interest and awareness of general sleep health, mental health and wellbeing. Google Trends' weekly relative search volumes (RSVs) were examined during 2020 for searches specifically related to COVID-19 symptoms, and for searches related to general health, sleep and wellbeing, in the United Kingdom, the United States of America, France, Italy and Japan. To obtain insight into the association between the initiation of public restrictions and online search trends, we assessed a six-week period; the 'early pandemic period' (EPP) (01 March 2020 - 11 April 2020). To provide a meaningful pre-pandemic comparison, a similar period during 2019 (03 March - 13 April 2019) was compared for RSV and median difference analysis. The EPP was associated with increased online searches related to COVID-19 symptoms, as compared with those related to more general sleep health, mental health and wellbeing. The latter search terms frequently showed a decrease or minimal change in RSV during the EPP compared with the equivalent period in 2019. This finding illustrates the potential link between the COVID-19 pandemic and online search behavior and corroborates existing findings regarding internet searches during this period. Proactive communication by healthcare professionals during future pandemics and as an ongoing measure could help prevent public neglect of general health and wellbeing symptoms, and encourage reporting and early intervention.
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Affiliation(s)
- Patrick Lemoine
- Clinique Lyon Lumière, Meyzieu, Lyon, France,Corresponding author
| | - David Ebert
- Department of Sport and Health Sciences, Psychology and Digital Mental Health Care, Technical University Munich, Germany
| | - Yoshihiko Koga
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Claire Bertin
- Global Medical Nutritionals, Consumer Healthcare, Sanofi, Paris, France
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Maziar P, Maher A, Alimohammadzadeh K, Jafari M, Hosseini SM. Identifying the preparedness components in COVID-19: Systematic literature review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:385. [PMID: 36618467 PMCID: PMC9818771 DOI: 10.4103/jehp.jehp_28_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/03/2022] [Indexed: 06/17/2023]
Abstract
In 2019, the COVID-19 pandemic posed a major challenge to the world. Since the world is constantly exposed to communicable diseases, comprehensive preparedness of countries is required. Therefore, the present systematic review is aimed at identifying the preparedness components in COVID-19. In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Science Direct, Iran Medex, Magiran, and Scientific Information Database were searched from 2019 to 2021 to identify preparedness components in COVID-19. Thematic content analysis method was employed for data analysis. Out of 11,126 journals retrieved from searches, 45 studies were included for data analysis. Based on the findings, the components of COVID-19 preparedness were identified and discussed in three categories: governance with three subcategories of characteristics, responsibilities, and rules and regulations; society with two subcategories of culture and resilience; and services with three subcategories of managed services, advanced technology, and prepared health services. Among these, the governance and its subcategories had the highest frequency in studies. Considering the need to prepare for the next pandemic, countries should create clear and coherent structures and responsibilities for crisis preparedness through legal mechanisms, strengthening the infrastructure of the health system, coordination between organizations through analysis and identification of stakeholders, culture building and attracting social participation, and service management for an effective response.
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Affiliation(s)
- Pooneh Maziar
- Ph.D. Student of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ali Maher
- Department of Health Policy, Economics and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Department of Health Services Management, North Tehran Branch, Health Economics Policy Research Center, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Mehrnoosh Jafari
- Department of Health Services Management, School of Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
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Ashkir S, Khaliq OP, Hunter M, Moodley J. Maternal vaccination: A narrative review. S Afr J Infect Dis 2022; 37:451. [PMID: 36262428 PMCID: PMC9575370 DOI: 10.4102/sajid.v37i1.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background Vaccinations in general are considered to be one of the greatest achievements in medicine, saving millions of lives globally. Aim This narrative review highlights issues related to vaccination in pregnancy and provides information on those vaccines registered for use in pregnancy. Method Published articles on vaccinations in pregnancy are included in this review. The search engines used included PubMed, Medline, Google Scholar, and ScienceDirect. Results Vaccinations during pregnancy are more likely to be administered in high income countries (HICs) compared to low-income countries (LICs) due to easier access to healthcare services and better communicable disease awareness. Maternal and perinatal morbidity and mortality rates associated with infectious diseases are higher in LICs with access to maternal care services, infrastructure and hospital equipment lacking in these settings. Conclusion Suitable vaccinations are recommended for use in pregnancy to prevent harm to women, their foetuses and newborns from some communicable diseases, and they have resulted in declines in maternal and infant morbidity and mortality. Furthermore, this review has shown that vaccination during pregnancy is not only safe for both the woman and her foetus but also effective. Therefore, health professionals and national governments should strongly consider approved vaccinations prior to or during pregnancy. Contribution This review provides insight on the necessity of vaccination during pregnancy. In addition, it urges health professionals to inform patients of the importance of regular antenatal visits, and to receive the required vaccinations for a better health outcome.
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Affiliation(s)
- Sahra Ashkir
- Women’s Health and HIV, Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Olive P. Khaliq
- Department of Paediatrics and Child Health, Faculty of Health Sciences, School of Clinical Medicine, The University of the Free State, Bloemfontein, South Africa
| | - Mehreen Hunter
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jagidesa Moodley
- Women’s Health and HIV, Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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12
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Belita E, Neil-Sztramko SE, Miller A, Anderson LN, Apatu E, Bellefleur O, Kapiriri L, Read K, Sherifali D, Tarride JÉ, Dobbins M. A scoping review of strategies to support public health recovery in the transition to a "new normal" in the age of COVID-19. BMC Public Health 2022; 22:1244. [PMID: 35739496 PMCID: PMC9219400 DOI: 10.1186/s12889-022-13663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pandemic, public health systems need to re-start the delivery of core public health programming alongside COVID-19 activities. The purpose of this scoping review was to identify strategies that support the re-integration of core public health programming alongside ongoing pandemic or emergency response. Methods The Joanna Briggs Institute methodology for scoping reviews was used to guide this study. A comprehensive search was conducted using: a) online databases, b) grey literature, c) content experts to identify additional references, and d) searching reference lists of pertinent studies. All references were screened by two team members. References were included that met the following criteria: a) involved public health organizations (local, regional, national, and international); b) provided descriptions of strategies to support adaptation or delivery of routine public health measures alongside disaster response; and c) quantitative, qualitative, or descriptive designs. No restrictions were placed on language, publication status, publication date, or outcomes. Data on study characteristics, intervention/strategy, and key findings were independently extracted by two team members. Emergent themes were established through independent inductive analysis by two team members. Results Of 44,087 records identified, 17 studies were included in the review. Study designs of included studies varied: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Included studies were from North America (n = 10), Africa (n = 4), and Asia (n = 3) and addressed various public health disasters including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1). Five emergent themes were identified on strategies to support the re-integration of core public health services: a) community engagement, b) community assessment, c) collaborative partnerships and coordination, d) workforce capacity development and allocation, and e) funding/resource enhancement. Conclusion Emergent themes from this study can be used by public health organizations as a beginning understanding of strategies that can support the re-introduction of essential public health services and programs in COVID-19 recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13663-2.
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Affiliation(s)
- Emily Belita
- School of Nursing, McMaster University, 1280 Main St. West, HSC 2J22, Hamilton, ON, L8S 4K1, Canada.
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Alanna Miller
- National Collaborating Centre for Methods and Tools, McMaster Innovation Park, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Olivier Bellefleur
- Centre de collaboration nationale sur les politiques publiques et la santé (CCNPPS), National Collaborating Centre for Healthy Public Policy (NCCHPP) , 190, boulevard Crémazie Est, Montréal, Québec, H2P 1E2, Canada
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main St. W. KTH 236, Hamilton, ON, L8S 4M4, Canada
| | - Kristin Read
- National Collaborating Centre for Methods and Tools, McMaster Innovation Park, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, 1280 Main Street West , Hamilton, ON, L8S 4K1, Canada
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, National Collaborating Centre for Methods and Tools , 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
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Missed Opportunities for Vaccination and Associated Factors among Children Attending Primary Health Care Facilities in Cape Town, South Africa: A Pre-Intervention Multilevel Analysis. Vaccines (Basel) 2022; 10:vaccines10050785. [PMID: 35632542 PMCID: PMC9144782 DOI: 10.3390/vaccines10050785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0–23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0–23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers’ low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13–11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25–0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07–0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06–0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.
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Oosthuizen SJ, Bergh AM, Silver A, Malatji RE, Mfolo V, Botha T. The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme. S Afr Fam Pract (2004) 2022; 64:e1-e12. [PMID: 35384679 PMCID: PMC8990513 DOI: 10.4102/safp.v64i1.5359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. METHODS This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. RESULTS Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers' response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. CONCLUSION Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.
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Affiliation(s)
- Sarie J Oosthuizen
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, SAMRC Research Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria.
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15
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Sociability, Social Isolation, and Social Interaction During the First Months of COVID-19 Pandemic: a Qualitative Analysis of Brazilian, Finnish, and American Adults. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC8942390 DOI: 10.1007/s43076-022-00172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The
social distancing imposed by the pandemic transformed how people interact with others, and little is known about how it has impacted new ways of sociability and if culture influences this process. This is a qualitative study exploring changes in the configurations of social interactions and the resources for sociability that adults in Brazil, the USA, and Finland have developed during the initial stage of quarantine. A total of 95 participants (ages between 20 and 60) experiencing social isolation either living alone or with their partners (without children) completed online questionnaires about their interactive experiences. The questionnaire was composed of multiple choices, addressing the frequency, types, and length of social interactions before and during the pandemic, and open questions focusing on the participants’ experiences on online interactions during the pandemic. Frequencies were analyzed through a paired-sample t-test, and open-ended responses were thematically analyzed. Results revealed, first, that social isolation did not represent a significant change in the composition of the participants’ social network, but family bonds became the main connection during the period, and other sources of social interaction were kept due to the possibility of interaction through virtual means. Although the frequency of social interactions reduced, their significance increased. Second, virtual environments reframed social interactions, influencing individual’s bodily perceptions such as differences in attentional demands, communication processes, and awareness of their own image, and the interaction itself. Third, cultural values seemed to influence the way participants signified their interactive experiences. This study suggests that although virtual environments changed the ways interactions happen, virtual encounters were essential for maintaining participants’ social networks.
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16
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Oduwole EO, Laurenzi CA, Mahomed H, Wiysonge CS. Enhancing Routine Childhood Vaccination Uptake in the Cape Metropolitan District, South Africa: Perspectives and Recommendations from Point-of-Care Vaccinators. Vaccines (Basel) 2022; 10:vaccines10030453. [PMID: 35335085 PMCID: PMC8950960 DOI: 10.3390/vaccines10030453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Vaccination, and particularly childhood vaccination, is widely acknowledged as one of the greatest public health interventions in history. Nevertheless, challenges exist that threaten the progress of childhood vaccination in many parts of the world. We investigated challenges to vaccination experienced by point-of-care vaccinators in the Cape Town Metropolitan District (Cape Metro), and reported on their current and proposed efforts to combat these challenges. Semi-structured interviews were conducted with 19 vaccinators in 16 purposively selected healthcare facilities in the Cape Metro from September to November 2019. Interviews were transcribed and analysed using thematic and narrative analysis methods. Challenges of both the demand and the supply side of routine vaccination were reported by the study participants, as were contextual challenges such as community safety issues. Defaulting was the most common challenge encountered, reported by 16 of the 19 participants. The use of computerized appointment systems, the enlistment of community health workers to track down defaulters, and the use of certificates to incentivize caregivers are part of the creative ways of mitigating some of the challenges encountered by these vaccinators. Their insightful recommendations can positively influence the landscape of childhood vaccination uptake in the Cape Metro and beyond if adapted and applied.
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Affiliation(s)
- Elizabeth O. Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa;
- Correspondence: ; Tel.: +27-08-2799-0866
| | - Christina A. Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa;
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
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17
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Mulaudzi M, Kiguwa P, Zharima C, Otwombe K, Hlongwane K, Dietrich JJ. Sexual Risk Behaviors Among Youth in Soweto, South Africa During the COVID-19 National Lockdown. Sex Med 2022; 10:100487. [PMID: 35131540 PMCID: PMC9023243 DOI: 10.1016/j.esxm.2021.100487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/12/2021] [Accepted: 12/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Assessment of sexual risk behavior among youths is crucial for HIV prevention strategies. However, the literature on sexual behavior in youth during the COVID-19 pandemic is sparse. AIM This study surveyed sexual risk behavior among youth in Soweto, South Africa during the COVID-19 pandemic national lockdown in 2020. METHODS We conducted a cross-sectional telephonic survey on socio-demographics and HIV risk behaviors among youth aged 18-24 years during level 3 of the lockdown. Frequencies and their respective percentages were determined for categorical variables and stratified by biological sex. Chi-square analysis was used to compare categorical variables. All data were analyzed using SAS software. OUTCOMES A risk assessment for HIV questionnaire was used to assess sexual risk behaviors. Also, substance use was assessed through a developed yes/no questionnaire. RESULTS Of the 129 participants, 83.0% (n = 107) had a sexual partner; 52% of those who had a sexual partner were females, 60.7% (65/107) had one current sexual partner and 39.2% (42/107) had more than 1 sexual partner. Most reported sex within 1 week (54.2%, n = 58/107) and 30.8% within a month (30.8%, n = 33/107). Sex was with a dating partner (86.0%, n = 92/107) and 63% used a condom during last sexual contact. Males were more likely than females to have one-night stand sexual partners (23.5% vs 7.1%; P = .0176), make weekly changes in partners (17.7% vs 5.4%; P = .0442) and used condoms with their partners (92.2% vs 53.6%; P < .0001) during last sexual contact. The majority reported alcohol use (69.0%, n = 89/129). Males were more likely than females to use alcohol on a weekly basis (21.4% vs 6.4%; P = .0380). About 55.9% had penetrative sex under the influence of substances. CLINICAL TRANSLATION This study gives an insight to the sexual risk behaviors among young people which is crucial for HIV prevention interventions. STRENGTH & LIMITATIONS This was the first study investigating sexual behavior in youth during the COVID-19 pandemic. The main limitations of this study relate to the sample size and sampling strategy. As the sample was not representative of the population of young people in Soweto and South Africa, the results cannot be generalized. However, the findings have relevance for future research in HIV prevention for young people in other settings in South Africa. CONCLUSIONS Interventions on promoting sexual health and reducing HIV risk behavior such as sex following alcohol consumption in young people are needed, especially during a pandemic such as COVID-19. Mulaudzi M, Kiguwa P, Zharima C, et al., Sexual Risk Behaviors Among Youth in Soweto, South Africa During the COVID-19 National Lockdown. Sex Med 2021;10:100487.
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Affiliation(s)
- Mamakiri Mulaudzi
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,School of Community and Health Development, Faculty of Humanities, Psychology Department, University of the Witwatersrand, Johannesburg, South Africa,Corresponding Author: Mamakiri Mulaudzi, Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road Diepkloof, Soweto, Johannesburg, 1864, South Africa.
| | - Peace Kiguwa
- School of Community and Health Development, Faculty of Humanities, Psychology Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janan J. Dietrich
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa,African Social Sciences Unit of Research and Evaluation (ASSURE), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Oosthuizen S, Bergh AM, Silver A, Malatji R, Mfolo V, Botha T. Maternity healthcare providers’ self-perceptions of well-being during COVID-19: A survey in Tshwane Health District, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e10. [PMID: 35144457 PMCID: PMC8831906 DOI: 10.4102/phcfm.v14i1.3034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/01/2022] Open
Abstract
Background: Mental health manifestations such as depression and anxiety disorders became more marked during the coronavirus disease 2019 (COVID-19) pandemic as frontline healthcare workers struggled to maintain high-quality intrapartum care and essential health services.Aim: This study aimed to identify maternity healthcare providers’ self-perceptions of changes in their feelings of mental well-being.Setting: Ten midwife obstetric units and the labour wards of four district hospitals in Tshwane Health District, South Africa.Methods: We conducted an anonymous, cross-sectional survey amongst a convenience sample of 114 maternity healthcare workers to gauge the changes in healthcare workers’ experience and perceptions of well-being during the COVID-19 pandemic. Four items measured the perceived changes on a scale of 0–10 for the periods before and during COVID-19, respectively, namely feelings of fear or anxiety, stress, depression and anger.Results: The majority of participants were professional nurses (37%) and advanced midwives (47%). They reported a significant change in well-being from before the pandemic to during the pandemic with regard to all four items (p 0.0001). The biggest ‘before-during’ difference was in perceptions of fear or anxiety and the smallest difference was in perceptions of anger. A framework was constructed from the open-ended responses to explain healthcare workers’ understanding and perceptions of increased negative feelings regarding their mental well-being.Conclusion: The observed trends in the changes in healthcare workers’ self-perceptions of their mental well-being highlight the need for further planning to build resilient frontline healthcare workers and provide them with ongoing mental health support and improved communication pathways.
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Affiliation(s)
- Sarie Oosthuizen
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, South African Medical Research Council, Research Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria.
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19
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Mathamo A, Naidoo KL, Dorward J, Archary T, Bottomley C, Archary M. COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa. South Afr J HIV Med 2022; 23:1424. [PMID: 36575700 PMCID: PMC9772656 DOI: 10.4102/sajhivmed.v23i1.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic poses challenges to paediatric and adolescent HIV treatment programme. Modelling exercises raised concerns over potential impact of disruptions. Objectives To describe the impact of the COVID-19 pandemic on viral load (VL) testing among infants, children and adolescents on antiretroviral treatment (ART) in Durban, South Africa. Method Routinely collected, aggregated data of monthly VL counts done on all those less than 19 years old from January 2018 to January 2022 was analysed. An interrupted time series analysis using a Prais-Winsten linear regression model, including terms for lockdowns and excess mortality determined VL trends. Results The unadjusted mean VL was 2166 (confidence interval [CI]: 252.2) and 2016 (CI: 241.9), P = 0.039, and percentage VL suppression rates (72.9%, CI: 2.4% vs 73.6%, CI: 1.8%) across COVID and pre-COVID periods, showing no significant difference, P = 0.262. In the interrupted time series analysis, modelled monthly VL counts did not differ significantly by lockdown level (e.g., level 5 lockdown: -210.5 VLs, 95% CI: -483.0 to +62.1, P = 0.138) or excess mortality (-0.1, 95% CI: -6.3 to 6.1, P = 0.969). A significant downward trend in VL testing over time, including during the pre-COVID-19 period (-6.6 VL per month, 95% CI: -10.4 to -2.7, P = 0.002), was identified. Conclusion Viral load suppression for children and adolescents were not negatively affected by COVID-19. A trend of decrease in VL testing predated COVID-19. What this study adds Evidence presented that HIV VL testing and suppression rates in children and adolescents in a high burden setting were sustained through the COVID pandemic.
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Affiliation(s)
- Asandile Mathamo
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kimesh L Naidoo
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.,Department of Paediatrics, King Edward VIII Hospital, Durban, South Africa
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Thashir Archary
- Department of Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Moherndran Archary
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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20
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Rispel LC, Marshall C, Matiwane B, Tenza IS. Innovations, contestations and fragilities of the health system response to COVID-19 in the Gauteng Province of South Africa. PLoS One 2021; 16:e0261339. [PMID: 34919565 PMCID: PMC8682886 DOI: 10.1371/journal.pone.0261339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background Gauteng province, with 26.3% of South Africa’s population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa’s reported COVID-19 cases. Aim The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. Material and methods Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data. Results Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response. Conclusion Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.
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Affiliation(s)
- Laetitia C. Rispel
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Carol Marshall
- School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Busisiwe Matiwane
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Immaculate Sabelile Tenza
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
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Melariri HI, Kalinda C, Chimbari MJ. Training, Attitudes, and Practice (TAP) among healthcare professionals in the Nelson Mandela Bay municipality, South Africa: A health promotion and disease prevention perspective. PLoS One 2021; 16:e0259884. [PMID: 34818364 PMCID: PMC8612580 DOI: 10.1371/journal.pone.0259884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 10/28/2021] [Indexed: 12/20/2022] Open
Abstract
Background Healthcare professionals (HCPs) play a pivotal role in ensuring access to quality healthcare of patients. However, their role in health promotion (HP) and disease prevention (DP) has not been fully explored. This study aimed at determining how training, attitude, and practice (TAP) of HCPs influence their practice of HP and DP. Methods Data on TAP regarding HP and DP were collected from 495 HCPs from twenty-three hospitals in the study area using a standardized questionnaire. Bivariate, univariate, and multivariate analyses were conducted to describe how the TAP of HCPs influence their HP and DP practices. The analysis was further desegregated at the three levels of healthcare (primary, secondary and tertiary levels). Results Most of the medical doctors 36.12% (n = 173), registered nurses 28.39% (n = 136), and allied health professionals (AHPs) 11.27% (n = 54) indicated the absence of coordinated HP training for staff in their facilities. Similarly, 32.93% (n = 193) of the HCPs, indicated having participated in HP or DP training. Among those that had participated in HP and DP training, benefits of training were positive behaviour, attributions, and emotional responses. When compared at the different levels of healthcare, enhanced staff satisfaction and continuing professional development for HP were statistically significant only at the tertiary healthcare level. Multivariate analysis showed a likelihood of reduced coordinated HP training for staff among medical doctors (Coef 0.15; 95% CI 0.07–0.32) and AHPs (Coef 0.24; 95% CI 0.10–0.59) compared to nurses. Furthermore, medical doctors (Coeff: 0.66; 95% CI: 0.46–0.94) were less likely to agree that HCPs should model good health behavior to render HP services as compared to nurses. Conclusion Training in HP and DP empowers HCPs with the requisite knowledge and attitude necessary for effective practice. Several HCPs at different levels of care had limited knowledge of HP and DP because of inadequate training. We recommend a strategy aimed at addressing the knowledge and attitudinal gaps of HCPs to ensure effective HP and DP services to patients.
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Affiliation(s)
- Herbert I. Melariri
- College of Health Sciences, University of KwaZulu Natal, Howard College Campus, Durban, South Africa
- Eastern Cape Department of Health, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
- * E-mail:
| | - Chester Kalinda
- College of Health Sciences, University of KwaZulu Natal, Howard College Campus, Durban, South Africa
- University of Global Health Equity (UGHE), Bill and Joyce Cummings Institute of Global Health, Kigali, Rwanda
| | - Moses J. Chimbari
- College of Health Sciences, University of KwaZulu Natal, Howard College Campus, Durban, South Africa
- Great Zimbabwe University, Masvingo, Zimbabwe
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Crowley T, Kitshoff D, De Lange-Cloete F, Baron J, De Lange S, Young C, Esterhuizen T, Couper I. Reorganisation of primary care services during COVID-19 in the Western Cape, South Africa: Perspectives of primary care nurses. S Afr Fam Pract (2004) 2021; 63:e1-e10. [PMID: 34879690 PMCID: PMC8661113 DOI: 10.4102/safp.v63i1.5358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary care nurses play a pivotal role in the response to disasters and pandemics. The coronavirus diseases 2019 (COVID-19) pandemic required preventative, diagnostic, and curative measures for persons presenting with symptoms of COVID-19 by healthcare providers, whilst continuing other essential services. We aimed to investigate the reorganisation of primary care services during COVID-19 from the perspectives of primary care nurses in the Western Cape province of South Africa. METHODS We administered an online survey with closed and open-ended questions to professional nurses enrolled for a Postgraduate Diploma in Primary Care Nursing at Stellenbosch University (2020) and alumni (2017-2019) working in the Western Cape. Eighty-three participants completed the questionnaire. RESULTS The majority of the participants (74.4%) reported that they were reorganising services using a multitude of initiatives in response to the diverse infrastructure, logistics and services of the various healthcare facilities. Despite this, 48.2% of the participants expressed concerns, which mainly related to possible non-adherence of patients with chronic conditions, the lack of promotive and preventative services, challenges with facility infrastructure, and staff time devoted to triage and screening. More than half of the participants (57.8%) indicated that other services were affected by COVID-19, whilst 44.6% indicated that these services were worse than before. CONCLUSION Our findings suggest that the very necessary reorganisation of services that took place at the start of the COVID-19 pandemic in South Africa enabled effective management of patients infected with COVID-19. However, the reorganisation of services may have longer-term consequences for primary care services in terms of lack of care for patients with other conditions, as well as preventive and promotive care.
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Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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23
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Bolarinwa OA. Factors associated with access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. ACTA ACUST UNITED AC 2021; 79:186. [PMID: 34702340 PMCID: PMC8548264 DOI: 10.1186/s13690-021-00701-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence has shown that the prescribed lockdown and physical distancing due to the novel coronavirus disease 2019 (COVID-19) have made accessing essential health care services much more difficult in low-and middle-income countries. Access to contraception is an essential service and should not be denied, even in a global crisis, because of its associated health benefits. Therefore, it is important to maintain timely access to contraception without unnecessary barriers. Hence, this study examines the factors contributing to limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. METHODS This study used the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM) wave 1 survey dataset. The NIDS-CRAM is a nationally representative survey of the National Income Dynamics Survey (NIDS) conducted via telephone interview during COVID-19 in the year 2020. This is the first secondary dataset on COVID-19 conducted by NIDS during pandemic. A total of 5304 respondents were included in the study. Data were analysed using frequencies distribution percentages, chi-square test and multivariable logistic regression analysis. RESULTS Almost one-quarter (22.40%) of South Africans could not access condoms, and every 7 in 10 South Africans preferred public source of condoms during the COVID-19 pandemic. Those who were from other population groups [AOR = 0.37; 95% CI = 0.19-0.74] and those who were in the third wealth quintile [AOR = 0.60; 95% CI = 0.38-0.93] had lower odds of having access to condoms while those respondents who were aged 25-34 [AOR = 0.48; 95% CI = 0.27-0.83] and those with a secondary level of education and above [AOR = 0.24; 95% CI = 0.08-0.71] were less likely to prefer public source of condom. CONCLUSIONS This study concludes that there was limited access to condoms during the COVID-19 pandemic and that the preferred source of condoms was very skewed to public sources in South Africa. Strategic interventions such as community distribution of free condoms to avert obstruction of condom access during the COVID-19 pandemic or any future pandemics should be adopted.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,Obaxlove Consult, Lagos, 100009, Nigeria. .,Department of Global Public Health, School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
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Micah AE, Cogswell IE, Cunningham B, Ezoe S, Harle AC, Maddison ER, McCracken D, Nomura S, Simpson KE, Stutzman HN, Tsakalos G, Wallace LE, Zhao Y, Zende RR, Abbafati C, Abdelmasseh M, Abedi A, Abegaz KH, Abhilash ES, Abolhassani H, Abrigo MRM, Adhikari TB, Afzal S, Ahinkorah BO, Ahmadi S, Ahmed H, Ahmed MB, Ahmed Rashid T, Ajami M, Aji B, Akalu Y, Akunna CJ, Al Hamad H, Alam K, Alanezi FM, Alanzi TM, Alemayehu Y, Alhassan RK, Alinia C, Aljunid SM, Almustanyir SA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amu H, Ancuceanu R, Andrei CL, Andrei T, Angell B, Anjomshoa M, Antonio CAT, Antony CM, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Arrigo A, Ashraf T, Atnafu DD, Ausloos M, Avila-Burgos L, Awan AT, Ayano G, Ayanore MA, Azari S, Azhar GS, Babalola TK, Bahrami MA, Baig AA, Banach M, Barati N, Bärnighausen TW, Barrow A, Basu S, Baune BT, Bayati M, Benzian H, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhaskar S, Bibi S, Bijani A, Bodolica V, Bragazzi NL, Braithwaite D, Breitborde NJK, Breusov AV, Briko NI, Busse R, Cahuana-Hurtado L, Callander EJ, Cámera LA, Castañeda-Orjuela CA, Catalá-López F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chen S, Cicero AFG, Dadras O, Dahlawi SMA, Dai X, Dalal K, Dandona L, Dandona R, Davitoiu DV, De Neve JW, de Sá-Junior AR, Denova-Gutiérrez E, Dhamnetiya D, Dharmaratne SD, Doshmangir L, Dube J, Ehsani-Chimeh E, El Sayed Zaki M, El Tantawi M, Eskandarieh S, Farzadfar F, Ferede TY, Fischer F, Foigt NA, Freitas A, Friedman SD, Fukumoto T, Fullman N, Gaal PA, Gad MM, Garcia-Gordillo MA, Garg T, Ghafourifard M, Ghashghaee A, Gholamian A, Gholamrezanezhad A, Ghozali G, Gilani SA, Glăvan IR, Glushkova EV, Goharinezhad S, Golechha M, Goli S, Guha A, Gupta VB, Gupta VK, Haakenstad A, Haider MR, Hailu A, Hamidi S, Hanif A, Harapan H, Hartono RK, Hasaballah AI, Hassan S, Hassanein MH, Hayat K, Hegazy MI, Heidari G, Hendrie D, Heredia-Pi I, Herteliu C, Hezam K, Holla R, Hossain SJ, Hosseinzadeh M, Hostiuc S, Huda TM, Hwang BF, Iavicoli I, Idrisov B, Ilesanmi OS, Irvani SSN, Islam SMS, Ismail NE, Isola G, Jahani MA, Jahanmehr N, Jakovljevic M, Janodia MD, Javaheri T, Jayapal SK, Jayawardena R, Jazayeri SB, Jha RP, Jonas JB, Joo T, Joukar F, Jürisson M, Kaambwa B, Kalhor R, Kanchan T, Kandel H, Karami Matin B, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Keikavoosi-Arani L, Khader YS, Khajuria H, Khalilov R, Khammarnia M, Khan J, Khubchandani J, Kianipour N, Kim GR, Kim YJ, Kisa A, Kisa S, Kohler S, Kosen S, Koteeswaran R, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kumar GA, Kusuma D, Lamnisos D, Lansingh VC, Larsson AO, Lasrado S, Le LKD, Lee SWH, Lee YY, Lim SS, Lobo SW, Lozano R, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahdavi MM, Majeed A, Makki A, Maleki A, Malekzadeh R, Manda AL, Mansour-Ghanaei F, Mansournia MA, Marrugo Arnedo CA, Martinez-Valle A, Masoumi SZ, Maude RJ, McKee M, Medina-Solís CE, Menezes RG, Meretoja A, Meretoja TJ, Mesregah MK, Mestrovic T, Milevska Kostova N, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mohajer B, Mohamed TA, Mohammadi M, Mohammadian-Hafshejani A, Mohammed S, Moitra M, Mokdad AH, Molokhia M, Moni MA, Moradi Y, Morze J, Mousavi SM, Mpundu-Kaambwa C, Muriithi MK, Muthupandian S, Nagarajan AJ, Naimzada MD, Nangia V, Naqvi AA, Narayana AI, Nascimento BR, Naveed M, Nayak BP, Nazari J, Ndejjo R, Negoi I, Neupane Kandel S, Nguyen TH, Nonvignon J, Noubiap JJ, Nwatah VE, Oancea B, Ojelabi FAO, Olagunju AT, Olakunde BO, Olgiati S, Olusanya JO, Onwujekwe OE, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, Padubidri JR, Palladino R, Panda-Jonas S, Park EC, Pashazadeh Kan F, Pawar S, Pazoki Toroudi H, Pereira DM, Perianayagam A, Pesudovs K, Piccinelli C, Postma MJ, Prada SI, Rabiee M, Rabiee N, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rahmani AM, Ram U, Ranabhat CL, Ranasinghe P, Rao CR, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Reiner Jr RC, Renzaho AMN, Reshmi B, Riaz MA, Ripon RK, Saad AM, Sahraian MA, Sahu M, Salama JS, Salehi S, Samy AM, Sanabria J, Sanmarchi F, Santos JV, Santric-Milicevic MM, Sathian B, Savic M, Saxena D, Sayyah M, Schwendicke F, Senthilkumaran S, Sepanlou SG, Seylani A, Shahabi S, Shaikh MA, Sheikh A, Shetty A, Shetty PH, Shibuya K, Shrime MG, Shuja KH, Singh JA, Skryabin VY, Skryabina AA, Soltani S, Soofi M, Spurlock EE, Stefan SC, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Taddele BW, Tefera YG, Thavamani A, Tobe-Gai R, Topor-Madry R, Tovani-Palone MR, Tran BX, Tudor Car L, Ullah A, Ullah S, Umar N, Undurraga EA, Valdez PR, Vasankari TJ, Villafañe JH, Violante FS, Vlassov V, Vo B, Vollmer S, Vos T, Vu GT, Vu LG, Wamai RG, Werdecker A, Woldekidan MA, Wubishet BL, Xu G, Yaya S, Yazdi-Feyzabadi V, Yiğit V, Yip P, Yirdaw BW, Yonemoto N, Younis MZ, Yu C, Yunusa I, Zahirian Moghadam T, Zandian H, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Ziapour A, Zuniga YMH, Hay SI, Murray CJL, Dieleman JL. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050. Lancet 2021; 398:1317-1343. [PMID: 34562388 PMCID: PMC8457757 DOI: 10.1016/s0140-6736(21)01258-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING Bill & Melinda Gates Foundation.
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Abstract
Background: In May 2020, the African Journal of Primary Health Care and Family Medicine invited submissions on lessons learnt from responses to the COVID-19 pandemic from primary care providers in Africa. This included descriptions of innovations and good practices, the management of COVID-19 in district health services and responses of communities to the outbreak. Aim: To synthesise the lessons learnt from the COVID-19 pandemic in the Africa region. Methods: A thematic document analysis was conducted on twenty-seven short report publications from Botswana, Ghana, Nigeria, South Africa, Uganda and Zimbabwe. Findings: Eight major themes were derived from the data: community-based activities; screening and testing; reorganisation of health services; emergency care for COVID-19; maintenance of essential non-COVID-19 health services; caring for the vulnerable; use of information technology; and reframing training opportunities. Community health workers were a vital community resource, delivering medications and other supplies to homes, as well as following up on patients with chronic conditions. More investment in community partnerships and social mobilisation was proposed. Difficulties with procurement of test kits and turn-around times were constraints for most countries. Authors described how services were reorganised for focused COVID-19 activities, sometimes to the detriment of essential services and training of junior doctors. Innovations in use of internet technology for communication and remote consultations were explored. The contribution of family medicine principles in upholding the humanity of patients and their families, clear leadership and planning, multidisciplinary teamwork and continuity of care was emphasised even in the context of providing critical care. Conclusions: The community-orientated primary care approach was emphasised as well as long-term benefits of technological innovations. The pandemic exposed the need to deliver on governmental commitments to strengthening primary health care and universal health coverage.
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van Wyngaard A, Whiteside A. AIDS and COVID-19 in southern Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 20:117-124. [PMID: 34264162 DOI: 10.2989/16085906.2021.1948877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
By the end of the first year of the COVID-19 pandemic, in February 2021, the numbers of cases and deaths in southern Africa were low in absolute and relative numbers. The BBC ran a story (which was later retracted) headlined "Coronavirus in Africa: Could poverty explain mystery of low death rate?". A heading in the New York Post said: "Scientists can't explain puzzling lack of coronavirus outbreaks in Africa". Journalist Karen Attiah concluded: "It's almost as if they are disappointed that Africans aren't dying en masse and countries are not collapsing". We wondered if the knowledge that southern African countries have acquired in their struggle against AIDS has contributed to a more effective approach against COVID-19. The viral origins of the diseases through zoonotic events are similar; neither has a cure, yet. In both diseases, behaviour change is an important prevention tool, and there are specific groups that are more vulnerable to infection. Equally, there are important differences: most people with COVID-19 will recover relatively quickly, while people living with HIV will need lifelong treatment. COVID-19 is extremely infectious, while HIV is less easily transmitted.
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Affiliation(s)
- Arnau van Wyngaard
- Shiselweni Home-Based Care, Department of Science of Religion and Missiology, University of Pretoria, Piet Retief, South Africa
| | - Alan Whiteside
- Balsillie School of International Affairs, Waterloo, Canada
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COVID-19 and the Gaping Wounds of South Africa's Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination. Vaccines (Basel) 2021; 9:vaccines9070691. [PMID: 34201684 PMCID: PMC8310047 DOI: 10.3390/vaccines9070691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Despite South Africa's substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.
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Chetty S, Bangalee V. Lessons from COVID-19 in South Africa: Keeping our environment clean should be the first law of health. S Afr Fam Pract (2004) 2021; 63:e1-e3. [PMID: 34212751 PMCID: PMC8252181 DOI: 10.4102/safp.v63i1.5297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the links between poor hygiene, unclean environments and human health cannot be overemphasised, particularly in South Africa with its high incidence of infectious diseases and overburdened health system. One very controllable factor that is often overlooked is the poor disposal of litter and waste management and its adverse effects on public health. By wearing masks, regular handwashing and sanitising, as well as making sure that neighbourhoods and public spaces are clean and safe, the spread of COVID-19 and other diseases can be prevented.
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Affiliation(s)
- Sarentha Chetty
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Pharmacy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, Singh U, Ohene-Kwofie D, Buckland R, Ndagurwa P, Gareta D, Gunda R, Mngomezulu T, Nxumalo S, Wong EB, Kahn K, Siedner MJ, Maimela E, Tollman S, Collinson M, Herbst K. Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study. JMIR Public Health Surveill 2021; 7:e26073. [PMID: 33827046 PMCID: PMC8121138 DOI: 10.2196/26073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In March 2020, South Africa implemented strict nonpharmaceutical interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 months, NPI policies were eased in stages according to a national strategy. COVID-19 spread throughout the country heterogeneously; the disease reached rural areas by July and case numbers peaked from July to August. A second COVID-19 wave began in late 2020. Data on the impact of NPI policies on social and economic well-being and access to health care are limited. OBJECTIVE We aimed to determine how rural residents in three South African provinces changed their behaviors during the first COVID-19 epidemic wave. METHODS The South African Population Research Infrastructure Network nodes in the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of longitudinal telephone surveys among randomly sampled households from rural and periurban surveillance populations every 2-3 weeks. Interviews included questions on the following topics: COVID-19-related knowledge and behaviors, the health and economic impacts of NPIs, and mental health. We analyzed how responses varied based on NPI stringency and household sociodemographics. RESULTS In total, 5120 households completed 23,095 interviews between April and December 2020. Respondents' self-reported satisfaction with their COVID-19-related knowledge and face mask use rapidly rose to 85% and 95%, respectively, by August. As selected NPIs were eased, the amount of travel increased, economic losses were reduced, and the prevalence of anxiety and depression symptoms fell. When the number of COVID-19 cases spiked at one node in July, the amount of travel dropped rapidly and the rate of missed daily medications doubled. Households where more adults received government-funded old-age pensions reported concerns about economic matters and medication access less often. CONCLUSIONS South Africans complied with stringent, COVID-19-related NPIs despite the threat of substantial social, economic, and health repercussions. Government-supported social welfare programs appeared to buffer interruptions in income and health care access during local outbreaks. Epidemic control policies must be balanced against the broader well-being of people in resource-limited settings and designed with parallel support systems when such policies threaten peoples' income and access to basic services.
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Affiliation(s)
- Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana
| | - Joseph Tlouyamma
- Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
- Department of Computer Science, School of Mathematical and Computer Sciences, Faculty of Science and Agriculture, University of Limpopo, Mankweng, South Africa
| | - Tinofa Mutevedzi
- Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Johannesburg, South Africa
| | - Chodziwadziwa Whiteson Kabudula
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruth Mahlako
- Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Daniel Ohene-Kwofie
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rose Buckland
- Institute for Global Health, University College London, London, United Kingdom
| | - Pedzisai Ndagurwa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama, Birmingham, Birmingham, AL, United States
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Harvard Medical School and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States
| | - Eric Maimela
- Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
- Department of Public Health, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana
| | - Mark Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Johannesburg, South Africa
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30
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Waya JLL, Ameh D, Mogga JLK, Wamala JF, Olu OO. COVID-19 case management strategies: what are the options for Africa? Infect Dis Poverty 2021; 10:30. [PMID: 33731226 PMCID: PMC7968554 DOI: 10.1186/s40249-021-00795-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has put a strain on health systems globally. Although Africa is the least affected region to date, it has the weakest health systems and an exponential rise in cases as has been observed in other regions, is bound to overwhelm its health systems. Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic. The World Health Organization (WHO) recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility; however, where this is not possible due to the health system capacity, patients can be isolated in re-purposed facilities or at home. An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases, given the already limited health infrastructure and health workforce, and the risk of nosocomial transmission. Use of repurposed facilities requires additional resources, including health workers. Home isolation, on the other hand, would be a challenge given the poor housing, overcrowding, inadequate access to water and sanitation, and stigma related to infectious disease that is prevalent in many African societies. Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited. These unique cultural, social, economic and developmental differences on the continent, call for a tailored approach to COVID-19 case management strategies. This article proposes three broad case management strategies based on the transmission scenarios defined by WHO, and the criteria and package of care for each option, for consideration by policy makers and governments in African countries. Moving forward, African countries should generate local evidence to guide the development of realistic home-grown strategies, protocol and equipment for the management of COVID-19 cases on the continent
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Affiliation(s)
- Joy Luba Lomole Waya
- World Health Organization COVID-19 Preparedness and Response Team, Juba, Republic of South Sudan.
| | - David Ameh
- World Health Organization COVID-19 Preparedness and Response Team, Juba, Republic of South Sudan
| | - Joseph Lou K Mogga
- World Health Organization COVID-19 Preparedness and Response Team, Juba, Republic of South Sudan
| | - Joseph F Wamala
- World Health Organization COVID-19 Preparedness and Response Team, Juba, Republic of South Sudan
| | - Olushayo Oluseun Olu
- World Health Organization COVID-19 Preparedness and Response Team, Juba, Republic of South Sudan
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31
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Finsterer J, Scorza FA, Scorza CA, Fiorini AC. SARS-CoV-2 and myasthenia. J Med Virol 2021; 93:4133-4135. [PMID: 32910499 DOI: 10.1002/jmv.26501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/22/2022]
Affiliation(s)
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brasil
| | - Carla A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brasil
| | - Ana C Fiorini
- Departamento de Fonoaudiologia, Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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32
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Williams I, Essue B, Nouvet E, Sandman L, Razavi SD, Noorulhuda M, Goold S, Danis M, Biemba G, Abelson J, Kapiriri L. Priority setting during the COVID-19 pandemic: going beyond vaccines. BMJ Glob Health 2021; 6:e004686. [PMID: 33461979 PMCID: PMC7816921 DOI: 10.1136/bmjgh-2020-004686] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - S Donya Razavi
- Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
| | - Mariam Noorulhuda
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Godfrey Biemba
- National Health Research Authority and Public Health, Lusaka Apex Medical University, Lusaka, Zambia
| | - Julia Abelson
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
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33
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Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, Singh U, Ohene-Kwofie D, Buckland R, Ndagurwa P, Gareta D, Gunda R, Mngomezulu T, Nxumalo S, Wong EB, Kahn K, Siedner MJ, Maimela E, Tollman S, Collinson M, Herbst K. Protective behaviours and secondary harms from non-pharmaceutical interventions during the COVID-19 epidemic in South Africa: a multisite prospective longitudinal study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33200146 PMCID: PMC7668759 DOI: 10.1101/2020.11.12.20230136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: In March 2020 South Africa implemented strict non-pharmaceutical interventions (NPIs) to contain Covid-19. Over the subsequent five months NPIs were eased in stages according to national strategy. Covid-19 spread throughout the country heterogeneously, reaching rural areas by July and peaking in July-August. Data on the impact of NPI policies on social and economic wellbeing and access to healthcare is limited. We therefore analysed how rural residents of three South African provinces changed their behaviour during the first epidemic wave. Methods: The South African Population Research Infrastructure Network (SAPRIN) nodes in Mpumalanga (Agincourt), KwaZulu-Natal (AHRI) and Limpopo (DIMAMO) provinces conducted longitudinal telephone surveys among randomly sampled households from rural and peri-urban surveillance populations every 2-3 weeks. Interviews included questions on: Covid-19 knowledge and behaviours; health and economic impact of NPIs; and mental health. Results: 2262 households completed 10,966 interviews between April and August 2020. By August, self-reported satisfaction with Covid-19 knowledge had risen from 48% to 85% and facemask use to over 95%. As selected NPIs were eased mobility increased, and economic losses and anxiety and depression symptoms fell. When Covid-19 cases spiked at one node in July, movement dropped rapidly, and missed daily medication rates doubled. Economic concerns and mental health symptoms were lower in households receiving a greater number of government-funded old-age pensions. Conclusions: South Africans reported complying with stringent Covid-19 NPIs despite the threat of substantial social, economic and health repercussions. Government-supported social welfare programmes appeared to buffer interruptions in income and healthcare access during local outbreaks. Epidemic control policies must be balanced against impacts on wellbeing in resource-limited settings and designed with parallel support systems where they threaten income and basic service access.
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Affiliation(s)
- Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joseph Tlouyamma
- DIMAMO Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa.,Faculty of Science and Agriculture, School of Mathematical and Computer Sciences, Department of Computer Science, University of Limpopo, Limpopo, South Africa
| | - Tinofa Mutevedzi
- DSI-MRC South African Population Research Infrastructure Network, South Africa
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruth Mahlako
- DIMAMO Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Daniel Ohene-Kwofie
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rose Buckland
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Pedzisai Ndagurwa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Harvard Medical School and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Maimela
- DIMAMO Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa.,Department of Public Health, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Mark Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,DSI-MRC South African Population Research Infrastructure Network, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,DSI-MRC South African Population Research Infrastructure Network, South Africa
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