The contribution of reduced COVID-19 test time in controlling the spread of the disease: A simulation-based approach

The novel coronavirus COVID-19 has known a large spread over the globe threatening human health. Recommendations from WHO and specialists insist on testing on a mass scale. However, health systems do not have enough resources. The current process requires the isolation of testees in the hospitals’ isolation rooms for several hours until the test results are revealed, limiting hospitals’ capacities to test large numbers of cases. The aim of this paper was to estimate the impact of reducing the COVID-19 test time on controlling the pandemic spread, through increasing hospitals’ capacities to test on a mass scale. First, a discrete-event simulation was used to model and simulate the COVID-19 testing process in Morocco. Second, a mathematical model was developed to demonstrate the effect of accurate identification of infected cases on controlling the disease’s spread. Simulation results showed that hospitals’ testing capacities could be increased six times if the test duration fell from 10 hours to 10 minutes. The reduction of test time would increase testing capacities, which help to identify all the infected cases. In contrast, the simulation results indicated that if the infected population is not accurately identified and no precautionary measures are taken, the virus will continue to spread until it reaches the total population. Reducing test time is a vital component of the response to the COVID-19 pandemic. It is essential for the effective implementation of policies to contain the virus.

Development of the first edition of African treatment guidelines for common bacterial infections and syndromes

Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines – including drug selection, route of administration, formulation, dosage, and therapy duration – and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines.

The influence of incentives on community health worker motivation in the provision of family planning. A case of Msalala and Shinyanga Districts, Tanzania

Community health workers (CHWs) are essential in the provision of a wide range of services, including family planning. In Tanzania, deployment of CHWs has largely been supported by non-governmental organizations (NGOs) who often determine their incentives. A mix of incentives is required to increase CHW motivation and, ultimately, performance. This qualitative study aimed to explore how incentives influence CHW motivation in the provision of family planning services in Msalala and Shinyanga districts. The study included focus group discussions and in-depth interviews with 21 CHWs, 12 supervisors and eight policy makers and NGO representatives. Transcripts were coded and narratives were written on types of incentives, motivating and demotivating factors. The study revealed that although CHW motivation was related to feelings of accomplishment and respect from the community, financial incentives were found equally important for motivation. While most CHWs received non-financial incentives, CHWs had unequal access to financial incentives. Key informants confirmed that there was no coordination on incentives at district level. Some CHWs reported demotivation because of misconceptions and unacceptance of family planning in the community and irregular supply of contraceptives. Results from this study show that motivation of voluntary CHWs in Msalala and Shinyanga districts is currently sub-optimal, because of inequity in access to (financial) incentives. There is a need for better coordination and standardization of CHW incentives. Advocacy is needed to increase funding for CHWs’ deployment and remuneration. This would increase CHW motimotivation and ultimately performance, also in the field of family planning.

Factors influencing uptake of schistosomiasis research findings in ingwavuma area, uMkhanyakude District, Kwazulu-Natal, South Africa

Background: Research uptake is concerned with spreading ideas across multiple levels of the community. Barriers such as poverty, lack of infrastructure, illiteracy and culture prevent information sharing in arid rural areas of sub-Saharan Africa. Objective: This study explores the factors influencing schistosomiasis research uptake and the available channels for the uptake of research findings from a transdisciplinary and eco-health research project on schistosomiasis in Ingwavuma area, uMkhanyakude district, KwaZulu-Natal province in South Africa. Methods: This case study conducted in 2017 involved 78 primary school children and 73 heads of household recruited through convenience and purposive sampling. Data were collected through focus group discussions, then transcribed and analysed by the researcher using thematic analysis. Results: Factors such as poor knowledge, water and sanitation problems, and lack of sufficient health workers hindered the uptake of schistosomiasis research findings. Participants recommended several platforms to share schistosomiasis research findings with the community, including: door to door visits; social gatherings such as sports events, talent shows, and religious gatherings; mass media platforms such as radio and television; social media platforms such as WhatsApp, Facebook and Twitter; and printed media such as posters, booklets and pamphlets. Conclusions: There is a need to train health workers and peer educators in this area of South Africa to educate people about schistosomiasis infection, screening and treatment through home visits or social events. Schistosomiasis research findings must be synthesised and packaged in different forms for dissemination via multimedia media-based communication channels.

Nigerian neonatologists perception and experience with retinopathy of prematurity

Background: Retinopathy of Prematurity (ROP) is an avoidable condition that affects premature infants exposed to oxygen stresses at or soon after birth. In low- and middle-income countries, like Nigeria, neonatal mortality rates are high and very few infants live to develop ROP. With recent better care, ROP is now being diagnosed. Objective: This study aimed to characterize what Nigerian neonatologists understand about ROP. Methods: At a joint meeting of Nigerian pediatric ophthalmologists and neonatologists in Kebbi State held 26-29 July 2018, questionnaires collected attendees’ perspective and experience with ROP including causes, risk factors and experiences. Results: Fifty-one neonatologists out of 71 returned a completed questionnaire (response rate: 71.8%). The male:female ratio was 1:1.8, and approximately 40% were aged 41-50 years (n=20, 39.22%). Only 3 (6.39%) had experience managing infants below 500g that survived. A majority managed babies with a mean weight of 913g ± 300.37 and age of 27.87 weeks ±2.37. Most had no access to oxygen monitors (n=39,78%). Most had 10 babies to one monitor and used average settings of 90- 95%. One third had seen a case of ROP (n=15,29.41%). Only 5.88% (n=3) were unaware of uncontrolled oxygen use as a risk factor. Only 4 (8.89%) had a functional screening team. None were aware of local screening guidelines. Conclusions: Regular educational programs, collaborative clinical presentations and webinars about ROP targeted at the neonatologists and parents, including establishment of screening programs across country will likely help reduce the burden of ROP blindness in Nigeria.

Chronic diseases of lifestyle risk factor profiles of a South African rural community

Globally, chronic diseases of lifestyle account for millions of dollars spent annually on health. These diseases share similar risk factors including: physical inactivity, obesity, cigarette smoking, and hypertension among others. This study sought to assess risk factors for chronic diseases of lifestyle of a rural community in South Africa. This study used a survey design with data randomly collected using the WHO STEPS Instrument for Chronic Disease Risk Factor Surveillance from participants who attended routine checks from February to October 2018 from a trained healthcare practitioner. Informed consent was sought from all participants before the administration of the instrument. The research setting was the community Primary Health Center. About 54.0% of participants presented with no family history of hypertension but 19.7% had a family history of type II diabetes mellitus. More women were found to be hypertensive, with the majority (93.4%) monitoring their blood pressure. The study revealed that more men were current smokers. A large number of participants were engaged in a sedentary lifestyle with about one-third of the participants reported being obese. Physical inactivity, sedentary lifestyle, and hypertension were among the lifestyle-related risk factors for chronic diseases among residents of this rural community.

Profiles of microorganisms isolated from neonates’ blood cultures, incubators, cradles, ventilators, washbasins, and health-workers of Libreville University Hospital Neonatal Service: focus on infection prevention and control measures

Background: Nosocomial infection outbreaks in neonatal services are a serious healthcare concern in both developed and developing countries, but few studies have been conducted in sub-Saharan Africa. Objective: This study explored the etiology of septicemia in neonates and associated patterns of antimicrobial susceptibility in Gabon. Methods: We analyzed cultures from neonates’ blood and swabs from medical personnel and equipment located in the neonatology service. Results: Sixty-eight microorganisms were isolated from the medical personnel and equipment; 46 microorganisms were isolated from neonates’ blood culture. Klebsiella pneumoniae spp pneumoniae was the most common bacteria found in both (30.6% and 26.9%, respectively). All Klebsiella pneumoniae spp pneumonia isolates were resistant to amoxicillin with clavulanic acid, gentamycin resistance ranged from 93% to 100%, and cephalosporin resistance ranged from 33.3% to 47%. Conclusions: Awareness of the etiology, prevalence, and outcome of nosocomial infection is the first and most important step to appropriate interventions

Effectiveness of rotavirus vaccine in the prevention of diarrhoeal diseases among children under age five years in Kavango East and West Regions, Namibia

Background: Diarrheal diseases due to rotavirus infection contribute greatly to morbidity and mortality rates of babies and young children in many developing countries. This public health concern can effectively be reduced by the use of the rotavirus vaccine, though there is an anecdotal evidence indicating that despite introduction of the vaccine the number of cases of diarrhoea diseases are still high in Namibia, particularly in Kavango east and west regions. Objective: This study evaluated the effectiveness of the rotavirus vaccine in preventing diarrhoea cases among children under age five years in Kavango regions. Methods: The study employed a quasiexperimental design comparing diarrhoea cases before (2010-2013) and after (2014- 2017) introduction of the rotavirus vaccine among children under age five years. Data were extracted from District Health Information System version 2 and analysed by using one way analysis of covariance. Results: Before introduction of the rotavirus vaccine, there were 14 500 diarrhoea cases, which is 1.6% rate of infection. After introduction of the rotavirus vaccine, there were 14 400 diarrhoea cases, which is 1.58% rate of infection. This is supported by the effect size (partial eta2) of 0.01%, which is very small. The trend of diarrhoea cases after rotavirus vaccine introduction fluctuated with no major decline of diarrhoea cases. Conclusions: The study concluded that rotavirus vaccine is less effective in preventing diarrhoea diseases among children under age five years in the Kavango regions. Further research is needed to substantiate these findings as other factors can contribute to fluctuation of diarrhoea cases.

Measles outbreak investigation in a highly vaccinated community in the Centre region of Cameroon

Background: Measles remains a threat in many African settings due to sub-optimal routine immunisation and catchup campaigns. The Global Vaccine Action Plan goal to eliminate measles by 2020 remains unmet as several countries reported an increase in cases in 2019. In Cameroon, a measles-rubella vaccination campaign was organised in 2019 to reduce the cohort of susceptible children. However, in 2020, eleven suspected cases of measles were notified in the Sa’a Health District and five were confirmed. Objective: This report summarizes a measles outbreak investigation and contact tracing in a highly vaccinated community residing in the Sa’a Health District of Cameroon. Methods: Outbreak investigations were carried out in the Sa’a, Nlong-Onambele and Nkolmgbana health areas from 18 to 21 February 2020. A register review from December 2019 to February 2020 was carried out in all health facilities of the affected health areas. followed by contact tracing in the community. Results: Thirty households were visited in four neighbourhoods. Six missed Epidemiologically-linked cases were discovered in the community, bringing the total number of suspected and confirmed cases to 17. Thirty-five percent of the cases had not received any measles-containing vaccine; 35% of the cases were aged 5 years or older; 53% had history of travel. Community transmission only occurred in the Sa’a health area through a breakthrough case. Conclusions: This outbreak investigation portrayed the role that adequate vaccination coverage plays in preventing widespread outbreaks. Nonetheless, community sensitisation and routine immunisation require strengthening in order to erase pockets of susceptible children.

Effectiveness of Yoruba language radio jingles in promoting knowledge, attitude and practices regarding Lassa fever among women in Ondo state, Nigeria

Background: Lassa fever is one of the known Neglected Tropical Diseases (NTDs) that plague some states in Nigeria. Radio jingles in indigenous language have been adopted as a veritable risk communication approach to promote public knowledge in the bid to reduce the incidence of Lassa fever outbreaks in Ondo state which has recorded the highest number of victims in recent times. Given the high level of women’s contribution in home keeping, food storage as well as maintenance of environmental hygiene practices, their knowledge, attitudes, and practices (KAP), is fundamental for the control of Lassa fever. Objective: The study examines the efficacy of indigenous (Yoruba) language radio jingles on knowledge, attitudes, and practices towards Lassa fever prevention among women in Ondo state. Methods: The study adopted a qualitative approach using Focus Group Discussion as the method of data collection. Results: Majority of the sampled respondents showed ample knowledge of Lassa fever. However, most respondents showed poor attitude towards the rodent vector and the recommended preventive measures have not been fully adopted by the majority of the respondents due to some identified barriers that hinder them from performing certain preventive practices. Conclusion: The radio jingles in Yoruba language have succeeded in promoting adequate knowledge of Lassa fever among women in Ondo state. Although attitude towards the disease vector is still poor and total compliance with the recommended preventive practices that will reduce the spate of Lassa fever in the state have not been achieved.