Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review

Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.

Towards equitable and sustainable availability of blood products in Zimbabwe: An analysis of strengths, weaknesses, opportunities and challenges

Blood transfusion can be a lifesaving intervention in a number of medical emergencies. To attain sustainable and equitable availability of blood products, it is important to understand the strengths, weaknesses, opportunities, and challenges of the national blood services programme. We, therefore, with this letter to the editor, discuss some of the strengths, weaknesses, opportunities and threats to the Zimbabwean programme since its inception. Despite several strengths and opportunities that the national blood services of Zimbabwe (NBSZ) leverages on, we argue that among other challenges, donor shortages and an upsurge of transfusion transmittable infections in the eligible donor population continue to be the biggest threats to the achievement of the programme objectives. These can be addressed through expanding the blood donor base and the catchment area. Additionally, improving the level of knowledge and attitude towards blood donation in the communities is critical for driving the sustainable and equitable distribution of safe blood products to the population.

Epidemiological surveillance of enteric viral diseases using wastewater in Africa - A rapid review

Viral enteric pathogens remain an important cause of diarrhoeal outbreaks among children in sub-Saharan Africa (SSA). Consequently, diarrhoeal illness remains a significant cause of morbidity and mortality in the under-fives in SSA. These outbreaks associated with viral pathogens tend to be seasonal and early warning systems for impending outbreaks could be very crucial for triggering preventive public health response and building public health resilience to deal with increased demand for medical services. Wastewater surveillance for pathogens is an important epidemiological component that could inform early warning systems. The objective of this rapid review was to evaluate the use of wastewater for epidemiology surveillance of enteric viral pathogens. Nine studies met the inclusion criteria. Eight viral pathogens were reviewed and analysed from 6 countries that performed wastewater analysis. Six studies explored the epidemiologic significance of viral pathogens in wastewater. The findings of this review revealed that monitoring of wastewater can provide an additional tool to determine the epidemiology of viral pathogens circulating in the community thereby providing early warning of potential outbreaks using wastewater-based epidemiology methods. Five of the included studies revealed the occurrence of viral pathogens in raw sewage and treated wastewater as an indication of inefficient elimination of viruses leading to potential release into water sources which presents a public health risk, increasing the risk of inducing gastroenteritis in the population. Six studies revealed the need for public health authorities to realise the potential benefit of environmental surveillance (ES) as an additional tool to determine the epidemiology of viral pathogens circulating in each community. Despite the significant public health challenge associated with enteric viral pathogens in sub-Saharan Africa, there remains remarkable underinvestment in potentially epidemiologically beneficial research, including wastewater-based epidemiology for these infections.

Human papillomavirus genotype distribution in genital warts among women in Harare-Zimbabwe

This study aimed to determine the prevalence of HPV genotypes in genital warts among women in Harare, Zimbabwe. Women aged 18-45 years attending gynaecology and genitourinary clinics with a clinical diagnosis of genital-warts were recruited. HPV-DNA was extracted from tissue biopsies. HPV-DNA testing and typing was done by Southern Dot Blot Hybridisation. A hundred samples from 100 women were analysed. Median age of participants was 30.3 years (range 18-45 years). Seventy-eight percent of participants were HIV infected. HPV prevalence was 98%. Low risk genotypes predominated at 86% prevalence. The most prevalent genotypes were 11 (47%), 6 (42%) and 16 (14%). This is the first study on HPV genotype distribution among women with genital warts in Zimbabwe. The high prevalence of HR-HPV 16 in clinically benign lesions shows that warts should have histological analysis to exclude pre-malignancy and malignancy.Impact statementWhat is already known on this subject? Genital warts (GWs), also known as condylomata acuminata (EAC), are a clinical manifestation of persistent infection with 'low risk' or non-oncogenic HPV genotypes. HPV 6 and 11 are examples of low risk genotypes, and both are associated with 90% of GWs. Data on HPV genotypes causing genital warts in the population under study are scarce.What do the results of this study add? A high prevalence (98%) of HPV DNA in genital warts, confirms that the biopsied lesions were HPV related. Over and above the high prevalence of low risk HPV 11 (47%) and HPV 6 (42%), the women had 14% prevalence of HPV 16, an oncogenic genotype, in genital warts. Seventy-eight percent of the participants were HIV infected. The HIV infected women had a 33.3% prevalence of HR-HPV as compared to the 15.8% prevalence in the HIV uninfected women.What are the implications of these findings for clinical practice and/or further research? The population under study will benefit more if an HPV vaccine that includes anti-HPV 6 and 11 is used. The high prevalence of the HR-HPV in apparently benign lesions shows that warts should have histological analysis to exclude vulvar cancer and vulvar intraepithelial neoplasia. All women presenting with genital warts should be offered an HIV test.