187. Characterizing Household Clustering of COVID-19 Cases in Fulton County, Georgia, June 2020–April 2021

Background Households are important for SARS-CoV-2 transmission due to close proximity in enclosed living spaces over long durations. Using contact tracing, the secondary attack rate in households is estimated at 18-20%, yet no studies have examined COVID-19 clustering within households, an important measure to inform testing and prevention. We sought to quantify and characterize household clustering of COVID-19 cases in Fulton County, Georgia. Methods We used state surveillance data to identify all PCR- or antigen-confirmed cases of COVID-19 in Fulton County. Clustered cases were defined as cases with matching street address, including unit number. Communal places (e.g., nursing homes, correctional facilities) were excluded, as were apartments missing unit number. Household clusters were defined as ≥2 COVID-19 cases at the same residential address with positive sample collection dates within 14 days of one another. We described proportion of COVID-19 cases that were clustered, stratified by age, sex, and race/ethnicity over time. Results There were 60,614 COVID-19 cases with available address reported in Fulton County during 6/1/20–4/30/21. Of these, 25,149 (41.6%) had an address that matched at least one other case; 20,793 (34.3%) were from 8,582 household clusters with positive sample collection dates within 14 days (Fig 1). Majority of clusters had 2 individuals (N=6119, 71%), though some had ≥6 individuals (N=79, 0.9%). Clustering increased through January 2021 (Fig 2). Children were more likely to be in household clusters (Fig 4) and 15% of clusters had a child as first diagnosed case with increases since January 2021 (Fig 3). Consistently higher clustering was observed among Hispanic persons, with rising clustering among Asian persons (Fig 5). Figure 1. Distribution of household-clustered COVID-19 cases in Fulton county between June, 2020 and April 2021 Figure 2. Proportion of COVID-19 cases that were part of a household cluster, Fulton County, June 2020–April 2021. Error bars denote 95% confidence interval around the point estimate. Figure 3. Age of first diagnosis among households with at least 2 cases diagnosed within 14 days Conclusion One-third of COVID-19 cases in Fulton County were part of a household cluster. The higher proportion of children in household clusters likely reflects higher probability of living in a home with an adult caregiver. Higher household clustering among Hispanic and Asian persons, regardless of age, may reflect larger households (supported by census data) or increased exposures outside the house. Timely testing for household members to prevent ongoing transmission remains essential. Figure 4. Proportion of COVID-19 cases that were part of a household cluster, by age – Fulton County, June 2020–March 2021 Proportion of COVID-19 cases that were part of a household cluster in Fulton County stratified by race/ethnicity over time Disclosures All Authors: No reported disclosures

Contextualizing the Politics of Ten-Household Cluster Initiatives (Nyumba Kumi) for Human Security in Kenya

National security has been a preserve of the State to the detriment of the welfare of the masses. Human security on the other hand incorporates the basic security elements that are globally recognized and touch on the daily lives of the masses. The Ten Household Cluster Initiatives that have been practiced in East Asia, Caribbean and parts of Western Europe and adapted in Eastern Africa are an avenue through which human security can be addressed though they are tightly controlled by the state and characterized by human rights flaws. Their rationalization is anchored in theories of individualism and communitarianism that locate the roles of individuals and groups in power relations. Kenya's Nyumba Kumi initiative should be redesigned and implemented with hindsight onto the global and continental initiatives. It is imperative to hybridize the initiative with elements from East Asia, Western Europe and Africa for it to make impact on human security. An ideological backup is also needed to entrench it in the population that has been convinced that the initiative is basically a socialist strategy to control the masses. Yet this strategy can be modernized to address not only security but also social, economic and enviornmnetal concerns in neighborhoods and communities.

The study on the proposal an integrated ecological model directed to zero emissions of households whose livelihood is planted rice in the Mekong delta

The research has proposed the model of integrated farming production towards zero - emissions based on the foundation of rice farming cultivation. The model of application of ecological solutions, the turnaround, and self-contained energy flow solutions with taking advantage of the existing ecological and environmental conditions of the locality help to maintain livelihoods for the people. Model of a typical application for the household cluster in Dinh Thanh, Thoai Son, An Giang province. The result shows that a straw volume used for the planting of straw mushrooms brings new sources of income to increase the 7.000.000 VND mushroom crop in 40 days, in addition, the rotting medium for growing straw mushrooms, which can be used the flowers to bring effectively revenues in the idle time. At the same time, 2m3/day of livestock and wastewater is processed and reused for agriculture, 39.065,31 tons/year collected in the form of biological gases serving cooking and the amount of straw 6-7 tons of straw/ha is reused by producing Biochar for agriculture, improve the land, improve the efficiency of fertilizer use for households to ensure the requirements of environmental protection, reduce the dependence of existing livelihoods on external factors such as prices, food, human,…. After using Biochar combined with manure for rice fields, helping people reduce 50% of the cost of using chemical fertilizers/ha, equivalent to 5,000,000 VND/ha. This can be seen as the best-integrated model for households whóe the main inheritance is rice cultivation combining livestock, the ability to apply long-term and can easily develop on a wide area, as well as increasing the likelihood of linking for many households to create mutual support in the case of a residential cluster with other livelihood activities besides rice cultivation.

Availability of health facilities and utilization of maternal and newborn postnatal care in rural Malawi

Background This study explored the role of health facility availability as it relates to maternal and newborn PNC use in rural Malawi. Methods Malawi Demographic and Health Survey (MDHS) 2015–16 data, MDHS 2015–16 household cluster GPS data, Malawi Service Provision Assessment (MSPA) 2013–14 data and MSPA 2013–14 facility GPS data were used. Household clusters were spatially linked with facilities using buffers. Descriptive analyses were performed and generalized estimating equations (GEE) were used to determine the effects of having different types of facilities at varying distances from household clusters on receipt of maternal and newborn PNC in rural Malawi. Results In rural Malawi, around 96% of women had facilities providing PNC within 10 km of where they live. Among women who have clinic-level facilities within 5 km of where they live, around 25% had clinic-level facilities that provide PNC. For rural women who gave birth in the past 5 years preceding the survey, only about 3% received maternal PNC within 24 h and about 16% received maternal PNC within the first week. As for newborn PNC, 3% of newborns had PNC within 24 h and about 26% had newborn PNC within the first week. PNC mostly took place at facilities (94% for women and 95% for newborns). For women who delivered at home, having a health center providing PNC within 5 km was positively associated with maternal and newborn PNC. For women who delivered at facilities, having a health center providing PNC within 5 km was positively associated with maternal PNC and having a health center providing PNC between 5 km and 10 km was positively associated with both maternal and newborn PNC. Regardless of the place of delivery and distance band, having a clinic-level facility providing PNC did not have significant positive effects on maternal and newborn PNC. Conclusions Providers should be trained to perform quality PNC at all facilities. It would also be important to address concerns related to health workers. Lastly, it would be key to increase community awareness about the importance of seeking timely PNC and about the utility of lower-level facilities for receiving preventative PNC.

Evaluation of the Impact of Meningococcal Serogroup A Conjugate Vaccine Introduction on Second-Year-of-Life Vaccination Coverage in Burkina Faso

Background After successful meningococcal serogroup A conjugate vaccine (MACV) campaigns since 2010, Burkina Faso introduced MACV in March 2017 into the routine Expanded Programme for Immunization schedule at age 15–18 months, concomitantly with second-dose measles-containing vaccine (MCV2). We examined MCV2 coverage in pre- and post-MACV introduction cohorts to describe observed changes regionally and nationally. Methods A nationwide household cluster survey of children 18–41 months of age was conducted 1 year after MACV introduction. Coverage was assessed by verification of vaccination cards or recall. Two age groups were included to compare MCV2 coverage pre-MACV introduction (30–41 months) versus post-MACV introduction (18–26 months). Results In total, 15 925 households were surveyed; 7796 children were enrolled, including 3684 30–41 months of age and 3091 18–26 months of age. Vaccination documentation was observed for 86% of children. The MACV routine coverage was 58% (95% confidence interval [CI], 56%–61%) with variation by region (41%–76%). The MCV2 coverage was 62% (95% CI, 59%–65%) pre-MACV introduction and 67% (95% CI, 64%–69%) post-MACV introduction, an increase of 4.5% (95% CI, 1.3%–7.7%). Among children who received routine MACV and MCV2, 93% (95% CI, 91%–94%) received both at the same visit. Lack of caregiver awareness about the 15- to 18-month visit and vaccine unavailability were common reported barriers to vaccination. Conclusions A small yet significant increase in national MCV2 coverage was observed 1 year post-MACV introduction. The MACV/MCV2 coadministration was common. Findings will help inform strategies to strengthen second-year-of-life immunization coverage, including to address the communication and vaccine availability barriers identified.

Intensified household contact tracing, prevention and treatment support versus enhanced standard of care for contacts of tuberculosis cases in South Africa: study protocol for a household cluster-randomised trial

Background Household contact tracing of index TB cases has been advocated as a key part of TB control for many years, but has not been widely implemented in many low-resource setting because of the current dearth of high quality evidence for effectiveness. Innovative strategies for earlier, more effective treatment are particularly important in contexts with hyper-endemic levels of HIV, where levels of TB infection remain extremely high. Methods We present the design of a household cluster-randomised controlled trial of interventions aimed at improving TB-free survival and reducing childhood prevalence of Mycobacterium tuberculosis infection among household contacts of index TB cases diagnosed in two provinces of South Africa. Households of index TB cases will be randomly allocated in a 1:1 ratio to receive either an intensified home screening and linkage for TB and HIV intervention, or enhanced standard of care. The primary outcome will compare between groups the TB-free survival of household contacts over 15 months. All participants, or their next-of-kin, will provide written informed consent to participate. Discussion Evidence from randomised trials is required to identify cost-effective approaches to TB case-finding that can be applied at scale in sub-Saharan Africa. Trial registration ISRCTN16006202 (01/02/2017: retrospectively registered) and NHREC4399 (11/04/2016: prospectively registered). Protocol version: 4.0 (date: 18th January 2018).