Economic vulnerability and poor service delivery made it more difficult for shack-dwellers to comply with COVID-19 restrictions

This study utilized the descriptive-survey method of research. The primary source of data is the survey questionnaire administered to three (3) groups of respondents. The study was conducted in Pangasinan involving eight (8) municipalities who have been SGLG Awardees for three (3) consecutive years. The respondents of this study were barangay officials, community residents, LGU employees and department heads. The data collected were tabulated, analyzed, and interpreted using various statistical tools using frequency, percentage, and weighted mean. To determine the significant difference in the responses of the three (3) groups of respondents, the Analysis of Variance (ANOVA) was used with Statistics Package for Social Sciences (SPSS) Version 17.0. Findings revealed that the delivery of basic government services in the areas of Agriculture, Environment and Natural Resources, Housing, Public Works, Public Buildings and Other Facilities, Social Welfare and Development, Information and Communication System, Tourism Facilities, and Other Services and Facilities were assessed by the respondents to be of Moderate Extent. Only the Health Service was assessed by the three (3) groups of respondents as delivered to the Full Extent. Results further revealed that there is no significant difference in the assessment of the three (3) groups of respondents on the extent of delivery of basic services of the SGLG LGU Awardees in the province of Pangasinan. Relative to challenges faced by the SGLG LGU Awardees in the delivery of basic services, the respondents identified a lack of public involvement in municipal planning and programs as the main challenge while inaccessibility of community for services was the least challenges faced by the SGLG LGU Awardees. The correlation analysis implies that there is a negative relationship between the delivery of services and the challenges faced by the SGLG LGU awardees

was switched to oral valganciclovir at a dose of 150 mg twice daily, and the AUC 0 -12 was 24.5 mg . h/L. After 19 days of treatment, CMV PCR became negative. Oral valganciclovir was stopped after 4 weeks without adverse events. Along with the CMV PCR test becoming negative, proteinuria dramatically decreased, anaemia improved and digestive symptoms disappeared. At the 1 year follow-up, a CMV test was still negative and no relapse of nephrotic syndrome was noticed.

Background: There is a paucity of data to assess the impact of the COVID-19 pandemic on persons with disabilities (PwDs) in India. About 27.4 million cases were reported as of 27 May 2021. The continuing pandemic in the form of subsequent waves is expected to have negative repercussions for the disabled globally, particularly in India, where access to health, rehabilitation, and social care services is very limited. Therefore, this study aimed to assess the impact of the COVID-19 pandemic and lockdown restrictions on PwDs in India. Objective: To determine the level of disruption due to COVID-19 and the associated countrywide lockdown restrictions on PwD in India during the first wave. Methods: Using a cross-sectional, mixed-methods approach, data were collected from a representative sample of 403 persons with disabilities in 14 states in India during the COVID-19 first wave at two different points in time (Lockdown and post-lockdown phase). Factors associated with the negative impact were examined using the Chi-square test for associations. The paired comparisons between ‘lockdown’ with the ‘post-lockdown’ phase are presented using McNemar’s test and the marginal homogeneity test to compare the proportions. Additionally, a subsample of the participants in the survey was identified to participate in in-depth interviews and focus group discussions to gain in-depth insights on the study question and substantiate the quantitative findings. The framework approach was used to conduct a thematic analysis of the qualitative data. Results: About 60% of the PwDs found it difficult to access emergency medical services during the lockdown, and 4.6% post lockdown (p < 0.001). Likewise, 12% found it difficult to access rehabilitation services during the lockdown, and 5% post lockdown (p = 0.03). About 76% of respondents were apprehensive of the risk of infection during the lockdown, and this increased to 92% post lockdown (p < 0.001). Parents with children were significantly impacted due to lockdown in the areas of Medical (p = 0.007), Rehabilitation (p = 0.001), and Mental health services (p = 0.001). The results from the qualitative study supported these quantitative findings. PWDs felt that the lockdown restrictions had negatively impacted their productivity, social participation, and overall engagement in everyday activities. Access to medicines and rehabilitation services was felt to be extremely difficult and detrimental to the therapeutic benefits that were gained by them during the pre-pandemic time. None of the pandemic mitigation plans and services was specific or inclusive of PWDs. Conclusions: COVID-19 and the associated lockdown restrictions have negatively impacted persons with disabilities during the first wave in India. It is critical to mainstream disability within the agenda for health and development with pragmatic, context-specific strategies and programs in the country.

The article “Hypertension in Sub-Saharan Africa” by Addo et al has documented both the high prevalence of hypertension, especially in urban areas, and poor control of hypertension in sub-Saharan Africa.1 In 1992, we reported the high prevalence of hypertensive disease in a population sample from Benin, Nigeria and the strong association with higher socioeconomic class and body weight.2 Previous reports from the World Health Organization (WHO) and other groups have warned of the growing epidemic of hypertension and vascular disease and, most important, the need for both population-based approaches to reduce the epidemic, including the reduction of salt in the diet and treatment of BP using inexpensive drug therapies.3,4 There is a need for better data on the prevalence of hypertension and risk factors related to both hypertension and vascular disease in sub-Saharan Africa. The most important imperative at the present time is to effectively blunt this growing epidemic of vascular disease. This epidemic of vascular disease is following the path characteristic of many other countries and especially in the United States, with initial high rates of hypertension and vascular disease among the upper socioeconomic groups and then explosive epidemics of both hypertension and vascular disease among lower income populations, especially the black population in the United States.5 The key variables that drive the epidemics are the greater use of processed foods, higher intake of calories, decreased physical activity leading to weight gain, and the reduction of foods high in potassium.6 The epidemic, as noted, has begun in the upper social classes and in urban …

This study investigated the economic impacts of the COVID-19 restrictions on businesses and livelihoods. Study participants included 25 informal sector workers who were sampled purposively and conveniently. Qualitative thematic analysis was used for interpreting the data generated from the study. The findings revealed that these workers were adversely affected economically by the COVID-19 lockdown and other restrictions, disrupting their business operations, and plunging their livelihoods into extreme poverty. It was also revealed that the high number of informal sector workers in the 'hand-to-mouth' work culture category in Kumasi cited to have flouted the COVID-19 lockdown regulation due to the unbearable economic surge it had inflicted on their livelihood support systems. The study suggests that immediate economic mitigation strategies set out by the Coronavirus Alleviation Programme (CAP) as well as financial agencies must factor the economic needs of the informal sector workers in the hand-to-mouth work culture category and offer them robust financial relief to assist them recover from economic impacts due to the COVID-19.

Subjective responses of satisfaction with basic services delivery is an indicator of service delivery performance. This study provides an overview of the status of basic service delivery and determines the factors associated with service delivery satisfaction within informal settlements targeted for upgrading in South Africa. A multinomial logistic regression was used to analyze the relationship between satisfaction with basic services of water, sanitation, refuse and electricity with several predictors including individual factors, household factors, community factors and service-related factors. The most common source of drinking water, toilet facility and refuse disposal method were communal tap (55%) pit latrine (53%) and local authorities (34%), respectively. Approximately 52% of the respondents in the study reported not having access to electricity. Results also show that satisfaction in basic services delivery varies and is influenced by service-related factors. Interventions targeted at improving the quality of basic service provided are essential to meet the targets set out in the sustainable development goals.

Privacy of personal information is a protected human right both under the international human rights and national laws, statutes and regulations, subject to so exceptions that include protecting public health. The COVID-19 pandemic has challenged and overwhelmed the status quo in every human sphere, including the conventional surveillance of infectious diseases, contact tracing, isolation, reporting and vaccination while simultaneously protecting the privacy of personal data. The pandemic had led national governments, institutions and agencies to adopt mobile applications for collecting, analysing, managing and sharing critical personal data of individuals infected with or exposed to COVID-19. These data may be centralized at a central database, or localized in individuals’ phones. While the benefits of sharing private information for achieving public health needs may not be disputed, the risk of breach of personal privacy is, also, enormous. Consequently, it forced the national governments into a dilemma of either succumbing to public health needs, or strictly respecting and protecting the privacy of individuals, or balancing the two conflicting demands. There is a massive body of literature on the security and privacy of such mobile applications, but none has adequately explored and discussed the public interest justifications under the Saudi Arabian laws for the alleged privacy breaches. This paper explored the COVID-19 surveillance mobile app technologies in use in Saudi Arabia for their potential risks of data breaches under the prevailing data protection laws and regulations with a view to understanding if such breaches are obligated, allowed, or justified under the laws. Our findings suggest that any potential risk of a breach to the individuals’ privacy of personal information under the law would seem to have been properly balanced against (justified by) the public health needs to protect the society during the COVID-19 pandemic.

Food delivery applications (FDAs) shined during COVID-19 global lockdown restrictions. Consequently, lifestyle changes imposed a greater use of these applications over this period. These changes may strongly influence the nutritional health of individuals, particularly adult Saudi females. A cross-sectional study was performed to examine the influence of using FDAs during COVID-19 lockdown restrictions on attitude behaviours, including dietary habits and preferences among Saudi adult females. Participants voluntarily submitted their answers to a questionnaire administered via the Google Survey platform. Results illustrated that most Saudi female users of FDAs were aged between 18–24 years with 64.9%, 91.5% being single and 37% ordering food online within one to two days a month. There was a significant association between the influence of using FDAs during COVID-19 lockdown restrictions and age, education, and average days of ordering food online (p ˂ 0.05). Another important factor is that higher education was associated with more frequent use of the FDAs, there were direct relationships between education level and using FDAs, 58% of the participants were educated as undergraduate or postgraduate. Although lifestyle changes increased the use of FDAs during COVID-19 global lockdown restrictions, these changes may negatively affect individuals’ dietary habits and preferences, particularly adult Saudi females. These findings can aid in promoting healthy diet management globally and in Saudi Arabia unless the governments lead to significant beneficial changes toward improving food delivery applications.

Objective: COVID-19 restrictions precipitated rapid work practice changes for family and mental health practitioners, including care via telehealth and secondary exposures to COVID-19 induced violence in client. This descriptive study aimed to examine stress and health among practitioners during COVID-19 restrictions. Method: Participants, recruited via professional networks, were 320 maternal and child health (MCH), child and youth mental health (CYMH) and adult mental health (AMH) practitioners from Victoria, Australia. Participants reported family violence among cases, workplace stress, and mental and physical health problems during COVID-19 restrictions, via an online survey. Results: Rising family violence incidence, including emotional abuse and serious threats against a woman (>25%), child emotional abuse/neglect, and child exposure to family violence were reported. Higher violence was reported by CYMH and AMH than MCH practitioners. We found increases in practitioner stress due to workplace practice changes and exposure to family violence. Highest stress was among CYMH and AHM practitioners. Participants reported worsening mental (63.2%) and physical (51.2%) health. Negative affect was higher among CYMH than MCH participants. Conclusion: Findings demonstrate pressure on family and mental health workforces during COVID-19. Provision of training and support to manage secondary stress from exposures to trauma and changing workplace practices is indicated. KEY POINTS What is already known about this topic: (1) Family and mental health practitioners’ mental health is below normative levels due to exposure to secondary traumatic stress exposure and associated compassion fatigue. (2) Periods of natural and community disaster elevate pressure and distress among mental health professionals and contribute to risk for workforce attrition and among client families are also associated with increased risks for intimate partner violence due to financial pressures and inadequate and confined housing. (3) Concerns about family violence during COVID-19 lockdown restrictions have arisen from publicly available reports of increases in emergency department domestic violence-related injuries and urgent applications to the Family Courts, but research data pertaining to levels of family violence during COVID-19 are scarce. What this study adds: (1) Family and mental health practitioners, especially those in child/youth and adult mental health sectors, reported increased proportions of caseloads in which incidents of family violence occurred during stage-3 COVID-19 lockdown restrictions in Victoria, Australia, contributing to exposure of practitioners to secondary trauma. (2) Practitioners reported higher workplace stress (due to changed work practices and family violence) during COVID-19 restrictions and greater stress was related to greater negative affect, sleep problems, headaches, and gastrointestinal problems. (3) Urgent attention to training and support of family and mental health workers providing care to distressed families during periods of community and natural disaster is indicated.

Report of the APhA Stakeholder Conference on Improving Patient Access to Injectable Medications

IntroductionLockdown restrictions due to the COVID-19 pandemic have reduced the number of injuries recorded. However, little is known about the impact of easing COVID-19 lockdown restrictions on the nature and outcome of injuries. This study aims to compare injury patterns prior to and after the easing of COVID-19 lockdown restrictions in Saudi Arabia.MethodData were collected retrospectively from the Saudi TraumA Registry for the period between March 25, 2019, and June 21, 2021. These data corresponded to three periods: March 2019–February 2020 (pre-restrictions, period 1), March 2020–June 2020 (lockdown, period 2), and July 2020–June 2021 (post easing of restrictions, period 3). Data related to patients’ demographics, mechanism and severity of injury, and in-hospital mortality were collected and analysed.ResultsA total of 5,147 traumatic injury patients were included in the analysis (pre-restrictions n = 2593; lockdown n = 218; post easing of lockdown restrictions n = 2336). An increase in trauma cases (by 7.6%) was seen in the 30–44 age group after easing restrictions (n = 648 vs. 762, p < 0.01). Motor vehicle crashes (MVC) were the leading cause of injury, followed by falls in all the three periods. MVC-related injuries decreased by 3.1% (n = 1068 vs. 890, p = 0.03) and pedestrian-related injuries decreased by 2.7% (n = 227 vs. 143, p < 0.01); however, burn injuries increased by 2.2% (n = 134 vs. 174, p < 0.01) and violence-related injuries increased by 0.9% (n = 45 vs. 60, p = 0.05) post easing of lockdown restrictions. We observed an increase in in-hospital mortality during the period of 12 months after easing of lockdown restrictions—4.9% (114/2336) compared to 12 months of pre-lockdown period—4.3% (113/2593).ConclusionThis is one of the first studies to document trauma trends over a one-year period after easing lockdown restrictions. MVC continues to be the leading cause of injuries despite a slight decrease; overall injury cases rebounded towards pre-lockdown levels in Saudi Arabia. Injury prevention needs robust legislation with respect to road safety measures and law enforcement that can decrease the burden of traumatic injuries.

There are many elements of the global medical research and development enterprise that contribute to the discovery, development, manufacture, distribution and regulation of vaccines. These include academic scientists, government funding and regulatory agencies, commercial vaccine manufacturers in the western world and essentially generic vaccine manufacturers in the developing world. The central tenets of our system as it exists today are 1) that public health need will drive fundamental research supported by government at academic institutions, and 2) that the resulting discoveries will be translated into useful products, because public health need can be converted into an economic return for the vaccine industry and its shareholders. In those instances where public health need exists in parallel with potential economic return, the system works surprisingly well.

Estimating Eye Care Workforce Supply and Requirements

This Review initiates a wide-ranging discussion over 2023 by selecting and exploring core themes to be investigated more deeply in papers submitted to the Vaccines Special Issue on the "Future of Epidemic and Pandemic Vaccines to Serve Global Public Health Needs". To tackle the SARS-CoV-2 pandemic, an acceleration of vaccine development across different technology platforms resulted in the emergency use authorization of multiple vaccines in less than a year. Despite this record speed, many limitations surfaced including unequal access to products and technologies, regulatory hurdles, restrictions on the flow of intellectual property needed to develop and manufacture vaccines, clinical trials challenges, development of vaccines that did not curtail or prevent transmission, unsustainable strategies for dealing with variants, and the distorted allocation of funding to favour dominant companies in affluent countries. Key to future epidemic and pandemic responses will be sustainable, global-public-health-driven vaccine development and manufacturing based on equitable access to platform technologies, decentralised and localised innovation, and multiple developers and manufacturers, especially in low- and middle-income countries (LMICs). There is talk of flexible, modular pandemic preparedness, of technology access pools based on non-exclusive global licensing agreements in exchange for fair compensation, of WHO-supported vaccine technology transfer hubs and spokes, and of the creation of vaccine prototypes ready for phase I/II trials, etc. However, all these concepts face extraordinary challenges shaped by current commercial incentives, the unwillingness of pharmaceutical companies and governments to share intellectual property and know-how, the precariousness of building capacity based solely on COVID-19 vaccines, the focus on large-scale manufacturing capacity rather than small-scale rapid-response innovation to stop outbreaks when and where they occur, and the inability of many resource-limited countries to afford next-generation vaccines for their national vaccine programmes. Once the current high subsidies are gone and interest has waned, sustaining vaccine innovation and manufacturing capability in interpandemic periods will require equitable access to vaccine innovation and manufacturing capabilities in all regions of the world based on many vaccines, not just "pandemic vaccines". Public and philanthropic investments will need to leverage enforceable commitments to share vaccines and critical technology so that countries everywhere can establish and scale up vaccine development and manufacturing capability. This will only happen if we question all prior assumptions and learn the lessons offered by the current pandemic. We invite submissions to the special issue, which we hope will help guide the world towards a global vaccine research, development, and manufacturing ecosystem that better balances and integrates scientific, clinical trial, regulatory, and commercial interests and puts global public health needs first.

The historical epidemiology of global disease challenges