Public Health Emergency Management Research Articles

Detecting synthetic population bias using a spatially-oriented framework and independent validation data

Models of human mobility can be broadly applied to find solutions addressing diverse topics such as public health policy, transportation management, emergency management, and urban development. However, many mobility models require individual-level data that is limited in availability and accessibility. Synthetic populations are commonly used as the foundation for mobility models because they provide detailed individual-level data representing the different types and characteristics of people in a study area. Thorough evaluation of synthetic populations is required to detect data biases before the prejudices are transferred to subsequent applications. Although synthetic populations are commonly used for modeling mobility, they are conventionally validated by their sociodemographic characteristics, rather than mobility attributes. Mobility microdata provides an opportunity to independently/externally validate the mobility attributes of synthetic populations. This study demonstrates a spatially-oriented data validation framework and independent data validation to assess the mobility attributes of two synthetic populations at different spatial granularities. Validation using independent data (SafeGraph) and the validation framework replicated the spatial distribution of errors detected using source data (LODES) and total absolute error. Spatial clusters of error exposed the locations of underrepresented and overrepresented communities. This information can guide bias mitigation efforts to generate a more representative synthetic population.

From theory to practice: Analyzing factors that foster the successful implementation of the one health approach for enhancing health security in Cameroon

BackgroundMultisectoral collaboration is crucial in effectively managing public health emergencies. The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, has gained recognition as an effective strategy. This study analysis the factors influencing the implementation of the One Health approach in Cameroon and examines its effects on public health emergency management. MethodA survey was conducted among 44 stakeholders from key sectors involved in implementing the “One Health approach” in Cameroon. Data were collected with a structured questionnaire using a self-administered approach. Statistical analysis using the Ki Square test was conducted to identify associations between variables. ResultsThe findings revealed that stakeholders in Cameroon lacked prior training on the One Health approach, primarily due to its absence in their academic programs. However, ad hoc trainings during public health emergencies were effective in involving various sectors. Limited communication and collaboration between different sectors, often operating in silos, posed significant challenges. Stakeholders with previous collaborative experiences and existing relationships demonstrated a greater propensity for multisectoral collaboration. The involvement of environmental health professionals in collaboration activities was limited, highlighting the need for improved engagement. Strong leadership, supported by coordination structures and platforms, played a critical role in facilitating collaboration during public health emergencies. Communication channels, such as regular multisectoral meetings, were essential in fostering relationships and trust among stakeholders. However, financial constraints hindered cross-sector cooperation. ConclusionTo enhance multisectoral collaboration in public health emergency management, there is a need to prioritize training on the One Health approach and promote cross-sector communication and collaboration. Strengthening coordination structures and platforms, improving resource allocation, and fostering a culture of accountability and trust are crucial for effective implementation. This study provides insights into the challenges and opportunities in implementing the One Health approach in Cameroon and offers valuable lessons for other countries seeking to enhance their multisectoral response to public health emergencies.

Evolutionary game analysis of multiple subjects in the management of major public health emergencies

The frequent occurrence of major public health emergencies (MPHEs) significantly challenges national security, economic stability, social operation and the safety of people's lives and property worldwide. Consequently, enhancing the emergency management of MPHEs is critically urgent. This paper constructs a game model involving local government, social organisations, and the public for MPHE management, exploring strategy combinations and influencing factors across various scenarios. Several results were obtained. (1) Local government, social organisations, and the public each have positive and negative strategy choices based on cost–benefit analysis, leading to eight different strategy combinations. Furthermore, all three take positive strategies as the optimal way to achieve the game equilibrium. (2) The transformation of strategy combinations is primarily influenced by the cost-benefit gap and the strategic decisions of local government. (3) Altering a subject's initial strategy value doesn't change its final choice but impacts the time to achieve a stable strategy equilibrium. The severity of local government punishments on social organisations influences their strategic choices and the time to optimal strategy, whereas rewards to the public or social organisations only affect the time to achieve this strategy. The findings of this study can not only help improve the collaborative governance system of MPHEs but also provide scientific guidance on how governments can manage MPHEs.

Coordination and modularization: the experience of the joint prevention and control mechanism to COVID emergencies in China.

The integration of disparate emergency resources and the improvement of emergency response teamwork are the underlying trends and shared requirements for building resilience in an era of multiple global public health crises. This study investigated the emergency response with emergency collaboration networks of each functional module and the overall Joint Epidemic Prevention and Control Mechanism (JPCM) network in China's COVID outbreak prevention and control. The study employed a scholarly framework of "the integration of JPCM coordination and emergency collaborative modularization" to explore the attributes of JPCM using social network analysis. The data were obtained from administrative records from JPCM's official website, spanning January 2020 to December 2022. The study examined the JPCM coordination and found several functional working modules of JPCM, such as Interrupt Spread, Manage Supply, Medical Rescue, Restore Work and Production, and Implement Responsibility modules. The network structure indicators showed that the Manage Supply module had the most extensive network connectivity, the shortest communication distance, and the most consistent collaboration. The E-I index of the overall JPCM network and the Manage Supply network were - 0.192 and - 0.452, respectively (at p < 0.001 and p < 0.05), indicating more internal relationships than external relationships. The E-I index of the Medical Rescue and Implement Responsibility collaboration networks were 0.122 and 0.147, respectively (at p < 0.001 and p < 0.05), indicating more external relationships than internal relationships. The QAP regression analysis showed that the most vital driver on the overall JPCM network was the Interrupt Spread module, followed by the Implement Responsibility and Medical Rescue modules. The Interrupt Spread module initiated emergency coordination with most departments and agencies. The Manage Supply module ensured the flow of medical supplies and survival essentials, while the Medical Rescue module addressed the core aspects of the health emergency response. The Restore Work and Production module repaired the halt in production and livelihoods caused by the outbreak, strengthening and developing emergency coordination and roles across emergency organizations. The Implement Responsibility module provided more heterogeneous emergency response resources for the overall JPCM coordination, complementing the COVID cross-organizational emergency response coordination. The study on the JPCM case in China improves public health emergency management and aids informed decision-making.

A Study on the Impact of Information Framework on Residents’ Willingness to Cooperate in the Context of Public Health Emergencies: The Mediating Effect of Perceived Effectiveness and the Moderating Effect of Self-Construal

This study explores the mechanism of the impact of information framework on residents’ willingness to cooperate in the context of public health emergencies, and introduces perceived effectiveness as a mediator variable and self-construal as a moderator variable, to enrich the research perspective. The data were collected by questionnaire method. 96 effective questionnaires were collected in the first experiment, and 144 effective questionnaires were collected in the second experiment. SPSS was used to test independent samples, one-way ANOVA, Bootstrap mediation test, two-way ANOVA, and so on, to verify the mediating role of perceived effectiveness and the moderating role of self-construal. The purpose is to provide a new perspective of intervention for the improvement of residents’ willingness to cooperate in the context of public health emergencies, and to provide theoretical basis and reference for improving the efficiency of public health emergency management and control, to promote social cooperation to cope with public health emergencies.

Information sharing across institutions: Practices and barriers during public health emergencies in Ethiopia

BackgroundRapid, integrated information exchange between stakeholders is critical for effective emergency preparedness and response. However, many low- and middle-income countries face barriers to seamless data sharing. While information accessibility is recognized as important for evidence-based decision-making and resource allocation in Ethiopia, factors influencing current health information sharing practices among stakeholders involved in public health emergency management programs are unclear. This study aims to examine multi-sectoral stakeholders' perspectives and experiences with health data sharing during emergencies in Ethiopia, to identify opportunities and challenges influencing practices to strengthen the national public health emergency response system. MethodsA mixed-methods study was conducted between June and August 2023, involving a survey of 169 stakeholders actively involved in PHEM programs in Ethiopia as well as 23 in-depth interviews with key informants in senior leadership or advisory roles. The data was analyzed using descriptive statistics in SPSS and thematic analysis of qualitative transcripts. ResultsDuring emergencies, it was observed that data sharing between different entities occurred. Quantitative findings showed the predominant types of health data shared between stakeholders during emergencies included hospital data (109, 64.5 %), clinical case information, and laboratory results. Challenges limiting effective coordination included issues like limited functionality of digital health systems (75, 44 %), incompatible data formats (13, 34 %), and financial constraints (83, 49 %) and and socio-cultural barriers constrain current practices in Ethiopia. Qualitative interviews identified five themes around risk communication and inclusive alert systems. Experts emphasized tailored, multichannel outreach but noted infrastructure gaps and digital divides currently limit poorer communities' engagement. ConclusionWhile collaborative health information exchange during emergencies is recognized as important, systemic, financial, and socio-cultural barriers constrain current practices in Ethiopia. Targeted strategies including capacity building, investment in integrated data infrastructure, economic optimization through innovative financing models, trust-based relationship development, and locally relevant communication channels informed by stakeholder perspectives can optimize information accessibility, coordination, quality, and equity of healthcare services during public health emergencies.

Evaluation and associated factors of public health emergency management among medical college students in a city in Southwest China: a cross-sectional study

BackgroundColleges and universities face an increased risk of public health emergencies. Among them, medical colleges and universities deserve more attention as they serve as the play a fundamental role in providing public health emergency services and in cultivating medical professionals. Effectively managing infectious disease prevention and control, as well as responding to public health emergencies in medical colleges and universities, is of great importance for enhancing the capacity of social emergency governance and improving the completeness of the public health system. This study aims to understand the management of public health emergencies in medical colleges in a city in southwest China, explore the factors associated with medical college students’ evaluations, and provide recommendations for emergency management mechanisms in colleges and universities.MethodsIn total, 781 medical college students were selected through stratified random sampling and surveyed using a questionnaire. The main factors affecting students’ evaluation of emergency management were analyzed using multiple linear regression and structural equation modeling.ResultsThe overall emergency management situation in medical colleges was relatively complete, with satisfactory results. Medical college students’ satisfaction with the timeliness of prevention measures was the highest, while the publicity and education were the lowest. Multiple linear regression analysis showed that grades, emergency education, -simulation training, -information reporting, and dynamic adjustment measures were associated with the evaluation of emergency management by medical students.ConclusionsAlthough the evaluation of emergency management in medical colleges was generally positive, certain limitations still existed. To improve the development of the public health system, colleges and universities should constantly reform and innovate emergency management mechanisms according to the important links in the prevention and control processes.

The Impact of COVID-19 on Thailand’s Public Health Emergency Management System: A Case Study

Purpose: This phenomenological qualitative research investigates Public Health Emergency Management (PHEM) in response to COVID-19, with a specific focus on the case of Thailand’s Health Region 9 (Nakhon Ratchasima) and its program known as COVID-19 Back Home. Method: The study gathers data through in-depth interviews with four groups comprising a total of 112 individuals from three Thai provinces. The collected data is subjected to content analysis, and the findings are analyzed using a framework based on system theory. Results and conclusion: The successful management of subjects returning home is highlighted, resulting in saving numerous patients' lives. The study identifies various suggestions and success factors for each phase of the management process. The research sheds light on PHEM situations in response to COVID-19, specifically examining Health Region 9's COVID-19 Back Home program. Implications of the research: The study provides valuable insights into the inputs, activities, and processes involved in managing such situations, showcasing successful strategies, collaborative efforts, and behavioral changes. Originality/value: The identified suggestions and success factors can inform and improve future management approaches.

Spatiotemporal distribution of climate-sensitive disease incidences in ethiopia: a longitudinal retrospective analysis of Malaria, Meningitis, Cholera, Dysentery, Leishmaniasis and Dengue fever between 2010 and 2022/2023

BackgroundUnderstanding the temporal and geographic distribution of disease incidences is crucial for effective public health planning and intervention strategies. This study presents a comprehensive analysis of the spatiotemporal distribution of disease incidences in Ethiopia, focusing on six major diseases: Malaria, Meningitis, Cholera and Dysentery, over the period from 2010 to 2022, whereas Dengue Fever and Leishmaniasis from 2018 to 2023.MethodsUsing data from Ethiopian public health institute: public health emergency management (PHEM), and Ministry of Health, we examined the occurrence and spread of each disease across different regions of Ethiopia. Spatial mapping and time series analysis were employed to identify hotspots, trends, and seasonal variations in disease incidence.ResultsThe findings reveal distinct patterns for each disease, with varying cases and temporal dynamics. Monthly wise, Malaria exhibits a cyclical pattern with a peak during the rainy and humid season, while Dysentery, Meningitis and Cholera displays intermittent incidences. Dysentery cases show a consistent presence throughout the years, while Meningitis remains relatively low in frequency but poses a potential threat due to its severity. Dengue fever predominantly occurs in the eastern parts of Ethiopia. A significant surge in reported incident cases occurred during the years 2010 to 2013, primarily concentrated in the Amhara, Sidama, Oromia, Dire Dawa, and Benishangul-Gumuz regions.ConclusionsThis study helps to a better understanding of disease epidemiology in Ethiopia and can serve as a foundation for evidence-based decision-making in disease prevention and control. By recognizing the patterns and seasonal changes associated with each disease, health authorities can implement proactive measures to mitigate the impact of outbreaks and safeguard public health in the region.

Modeling COVID-19 spread using multi-agent simulation with small-world network approach

BackgroundThe rapid global spread of COVID-19 has seriously impacted people’s daily lives and the social economy while also posing a threat to their lives. The analysis of infectious disease transmission is of significant importance for the rational allocation of epidemic prevention and control resources, the management of public health emergencies, and the improvement of future public health systems.MethodsWe propose a spatiotemporal COVID-19 transmission model with a neighborhood as an agent unit and an urban spatial network with long and short edge connections. The spreading model includes a network of defined agent attributes, transformation rules, and social relations and a small world network representing agents’ social relations. Parameters for each stage are fitted by the Runge-Kutta method combined with the SEIR model. Using the NetLogo development platform, accurate dynamic simulations of the spatial and temporal evolution of the early epidemic were achieved.ResultsExperimental results demonstrate that the fitted curves from the four stages agree with actual data, with only a 12.27% difference between the average number of infected agents and the actual number of infected agents after simulating 1 hundred times. Additionally, the model simulates and compares different “city closure” scenarios. The results showed that implementing a ‘lockdown’ 10 days earlier would lead to the peak number of infections occurring 7 days earlier than in the normal scenario, with a reduction of 40.35% in the total number of infections.DiscussionOur methodology emphasizes the crucial role of timely epidemic interventions in curbing the spread of infectious diseases, notably in the predictive assessment and evaluation of lockdown strategies. Furthermore, this approach adeptly forecasts the influence of varying intervention timings on peak infection rates and total case numbers, accurately reflecting real-world virus transmission patterns. This highlights the importance of proactive measures in diminishing epidemic impacts. It furnishes a robust framework, empowering policymakers to refine epidemic response strategies based on a synthesis of predictive modeling and empirical data.

The impact of public health emergency perception on psychological crisis in the Chinese context: the role of social support and psychological targeting

ABSTRACT The COVID-19 pandemic has caused many barriers in workplaces, including employees’ psychological crises. This study explores how employees respond to public health emergencies during the COVID-19 pandemic. Based on a survey of employees working in different sectors in China during the pandemic, we examined the relationship between public health emergency perception and psychological crisis. Multi-level regressions as well as mediation and moderation tests were used to test the hypotheses. The findings indicate that public health emergency perception reduces psychological crisis, and social support mediates the relationship between public health emergency perception and psychological crisis. Not only that, but psychological targeting moderates the relationship between public health emergency perception and psychological crisis, in such a way that the negative effect between public health perception and psychological crisis is attenuated when psychological targeting is at a higher level. The research provides unique theoretical implications for the emergency management of public health emergencies and has important practical implications for the orderly restoration of work order and the protection of employee health after the COVID-19 pandemic.

A war without smoke: Infectious disease panic and its response—A case study of Macao-Portuguese government’s prevention and control of cholera from 1912 to 1949

With the time frame 1912–1949, and according to the recording in the government gazettes and Chinese press, this essay systematically discusses the powerful and effective measures and achievements in cholera prevention, epidemic prevention, and infectious disease control of the Macao-Portuguese government. Meanwhile, it analyzes and investigates the cooperation and interaction in cholera prevention between the Macao and Hong Kong governments and emphasizes the critical significance of regional developments of Macao’s cholera prevention and control, that is, with the internal control to lower incidence and external control to minimize importation and diffusion, the aim to control cholera was achieved thus allayed the public panic among Macao and perimeter zone, creating advantages to stabilize economic development, social order and peaceful living environment in Macao as well as other Cantonese regions. As one of the seaport cities that adopted the European medical system and model and implemented free cholera vaccination for all, the fighting process and measures of Macao-Portuguese government adopted to control the cholera epidemic show that cholera, a dreadful infectious disease, can be effectively managed as long as scientific and appropriate methods are taken. Sorting out the types and characteristics of infectious diseases in Macao during this period and the mechanism of combining medical and preventive treatment at that time, and analyzing the effectiveness of the administration of disease prevention and control by the Macao-Portuguese government and the limitations of governance under the conflict between Chinese and Portuguese will have important academic significance for understanding the efficiency and deficiency of Macao-Portuguese governance towards disease control, the construction, development and change of the urban public health emergency management system and the urban governance. The more important significance will bring to the urban public health emergency management system and the urban governance in modern China.

Introducing www.epidemic-em.org: A Collection of Online Resources and Training Materials for Strengthening use of Emergency Operations Centers for Epidemic Response.

This work aimed to demonstrate that a website, www.epidemic-em.org, encompassing "static" resources, and videos, as well as other tools, can be used to strengthen public health emergency management capacity during epidemic response. Existing resources were updated and developed for self-directed Emergency Operations Centers' capacity strengthening, in order to encompass current best practices, and to emphasize how public health emergency management concepts can support epidemic response activities. These materials formed the core of the website, launched in June 2020, to which country case studies were added. In 2021, a pilot virtual training program was designed using recorded video lectures and interviews with global experts in addition to the website material, which was delivered to South African responders. The website has been accessed in more than 135 countries, demonstrating widespread reach and interest in online and freely accessible materials to support public health emergency operations. Over 30 people participated in the pilot virtual training, and the evaluation showed improvement in knowledge, confidence in using emergency management concepts for epidemic response, and positive feedback on the virtual modality. Online tools can expand access to materials and resources for public health emergency management capacity strengthening. Virtual modalities can further serve as a powerful complement, and perhaps replacement, for traditional in-person technical assistance, despite some limitations.

The Importance of Public Health Emergency Management in Countries: The Role of WHO

The Importance of Public Health Emergency Management in Countries: The Role of WHO

Epidemiological characteristics of public health emergency events of varicella in China, 2006-2021

Objective: To understand the epidemiological characteristics of public health emergency events (PHEE) of varicella in China from 2006 to 2021 and related response performances. Methods: The data of varicella PHEE in 31 provinces of China from 2006 to 2021 were collected through the Public Health Emergency Management Information System, Microsoft Excel 2019 software and SPSS 26.0 statistical software were used to conduct descriptive epidemiological, statistical analysis on the time, area, location distribution, scale and epidemic management. Results: A total of 11 443 PHEE involving 341 048 related cases were reported from 2006 to 2021, with an annual attack rate of 1.78%-3.80% and a total attack rate of 2.33% (341 048/14 624 042). The number of PHEE and related cases of varicella decreased from 1 107 (35 349) in 2007 to 262 (6 884) in 2012 (Z=-2.40, P<0.001), then increased year by year to 1 318 (42 649) in 2019 (Z=2.58, P<0.001), with a significant decline since 2020. The varicella PHEE in China presents the seasonal characteristics,the peak is from April to June and from October to December, respectively. The sub-peak of varicella PHEE in eastern China generally appears 1-2 months earlier than in central and western China. Varicella PHEE reports are mainly distributed in eastern China, the attack rate is relatively high in western China, school-reported varicella PHEE was 88.26% of the total reports (10 099/11 443). The epidemic scale of varrcella PHEE typically range from 10 to 29 cases per year among the given outbreaks. The M (Q1, Q3) of average number of cases, average duration, and average reporting interval of PHEE were 23 (16,35), 20 (14, 26) days, and 9 (5,19) days, respectively, and the reporting interval was positively correlated with the duration (r=0.854, P<0.001). Conclusions: The varicella PHEE in China from 2006 to 2021 has not been effectively controlled. Schools are the key places to prevent and control varicella PHEE. Improving the sensitivity of varicella PHEE monitoring, strengthening the timely disposal of varicella epidemic, and promoting varicella vaccination are effective measures to prevent and control varicella PHEE.

Coordination strategies and concept of operations implemented during activation of public health emergency operations center for COVID-19 response in Pakistan

Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies/departments in Pakistan. Health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to emergencies. We conducted an assessment of public health emergency response coordination implemented during the COVID-19 at strategic level. This was mix-method qualitative study. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment. The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies. Effective public health emergency response is based on multi-departmental coordination, resource mobilization, and clear roles for each agency. Pakistan must proactively address these challenges for pandemic response in future.

China after COVID-19

Background:&#x0D; The COVID-19 pandemic has seriously affected global public health security and economic development, and is a huge test for China and other countries around the world. Among the factors affecting the outbreak of the epidemic, human abuse of wildlife appears to be the most important. Under the influence of relevant factors, China has formulated and implemented policies, laws and regulations on a comprehensive ban on wildlife.&#x0D; Objectives:&#x0D; Through the integration and impact analysis of China's comprehensive wildlife fasting policy and relevant laws and regulations, this paper aims to provide reference for other countries in epidemic prevention and control and the improvement of public health governance.&#x0D; Methods:&#x0D; Through the integration of relevant policies and regulations and detailed introduction, the author studied from three aspects: policies and regulations related to people's life, health and safety, improvement of public health and safety risk prevention and promotion of environmental protection and human civilization development, and analyzed its impact on all aspects of human society, especially public health safety and emergency management system and management capacity, to remind people to change the habit of over eating wild animals.&#x0D; Results:&#x0D; The article is of reference and guiding significance in promoting the global implementation of comprehensive fasting for wild animals, and in the current epidemic prevention and control of other countries, maintaining social public health and security governance, and safeguarding human health.&#x0D; Main Contribution to Evidence-Based Practice:&#x0D; The article demonstrates that the relevant policies, laws and regulations of China's comprehensive prohibition of wildlife have reference and guiding significance for epidemic prevention, maintenance of social public health and safety management, and protection of human health. In addition, it has promoted the global implementation of a comprehensive ban on wildlife.

Social support and community embeddedness protect against post-disaster depression among immigrants: a Vietnamese American case study.

Immigrants often face increased vulnerabilities to disaster-related poor health and recovery, compared to mainstream populations. Little is known about Hurricane Harvey's impacts among the storm affected area's large Vietnamese American population. Our study documented diverse psychological experiences and recovery challenges 1 year post-storm among a sample of 120 Vietnamese Americans residing in the Houston, Texas area. Using linear regression modeling, we examined the association between social support and depressive symptom development among these storm-affected Vietnamese Americans. Social support encapsulating both social embeddedness and perceived support was measured by the Louisville Social Support Scale and depressive symptom development was measured by 18 items that assessed emotional distress. These items included loss of appetite, loss of concentration, exposure to persistent pain, and the exhibition of hopelessness, tiredness, sadness, frustration, discouragement, desperation, exhaustion, disgraced, anger, and craziness. We found adverse post-disaster health outcomes, as well as potential avenues to mitigate them, that should be taken into consideration in the design and implementation of inclusive disaster programs. A high level of social support lowered depressive symptomology among Vietnamese Americans post-Hurricane Harvey, even when accounting for Hurricane Harvey-related home damages and injuries/illness. The negative association between social support and depressive symptom development remained after accounting for both post-storm self-rated mental and physical health. Our results suggested that public health practitioners and emergency management entities should prioritize social support resources to foster mental well-being after hurricanes among Vietnamese Americans as future hurricanes are expected to be stronger and more prevalent along the United States Gulf Coast.

Trend analysis of malaria in urban settings in Ethiopia from 2014 to 2019

BackgroundUrbanization generally improves health outcomes of residents and is one of the potential factors that might contribute to reducing malaria transmission. However, the expansion of Anopheles stephensi, an urban malaria vector, poses a threat for malaria control and elimination efforts in Africa. In this paper, malaria trends in urban settings in Ethiopia from 2014 to 2019 are reported with a focus on towns and cities where An. stephensi surveys were conducted.MethodsA retrospective study was conducted to determine malaria trends in urban districts using passive surveillance data collected at health facilities from 2014 to 2019. Data from 25 towns surveyed for An. stephensi were used in malaria trend analysis. Robust linear models were used to identify outliers and impute missing and anomalous data. The seasonal Mann-Kendal test was used to test for monotonic increasing or decreasing trends.ResultsA total of 9,468,970 malaria cases were reported between 2014 and 2019 through the Public Health Emergency Management (PHEM) system. Of these, 1.45 million (15.3%) cases were reported from urban settings. The incidence of malaria declined by 62% between 2014 and 2018. In 2019, the incidence increased to 15 per 1000 population from 11 to 1000 in 2018. Both confirmed (microscopy or RDT) Plasmodium falciparum (67%) and Plasmodium vivax (28%) were reported with a higher proportion of P. vivax infections in urban areas. In 2019, An. stephensi was detected in 17 towns where more than 19,804 malaria cases were reported, with most of the cases (56%) being P. falciparum. Trend analysis revealed that malaria cases increased in five towns in Afar and Somali administrative regions, decreased in nine towns, and had no obvious trend in the remaining three towns.ConclusionThe contribution of malaria in urban settings is not negligible in Ethiopia. With the rapid expansion of An. stephensi in the country, the receptivity is likely to be higher for malaria. Although the evidence presented in this study does not demonstrate a direct linkage between An. stephensi detection and an increase in urban malaria throughout the country, An. stephensi might contribute to an increase in malaria unless control measures are implemented as soon as possible. Targeted surveillance and effective response are needed to assess the contribution of this vector to malaria transmission and curb potential outbreaks.

Understanding post-COVID-19 hierarchy of public transit needs: Exploring relationship between service attributes, satisfaction, and loyalty

Introduction and objectiveCOVID-19 transforms travel behavior and undermines public transit (PT) operations even though the disease is under control. PT recovery partly requires instruments to prioritize service quality and satisfaction improvement based on travelers' transit needs. However, there is limited understanding of psychological needs for post-COVID-19 transit use and how the needs affect satisfaction and loyalty. Thus, this study explored the influences of post-COVID-19 psychological needs for bus service attributes on satisfaction and loyalty and thereby built a bus need hierarchy for riders in different use stages to distinguish critical service attributes from basic and excitement ones by applying Maslow's need hierarchy theory. MethodsA face-to-face questionnaire survey with systematic sampling collected data from 204 bus riders in Kaohsiung, which is a transit-developing city of Taiwan and whose PT ridership and service levels had drastically reduced because of the pandemic. Factor analysis was used to construct bus service attributes, and structural equation modeling was applied to analyze the influence of bus service attributes on overall satisfaction with and loyalty to bus services. ResultsResults indicated that (1) riders included epidemic prevention needs in transit safety assessment and (2) pursued the needs for safety, reliability, and comfort to increase overall satisfaction and thereby form loyalty; and (3) safety and reliability were respectively critical needs of riders in the beginning and intermediate use stages, whereas comfort persisted in critical needs throughout all use stages. ConclusionsThe findings implied the necessity of satisfying the needs for safety with epidemic prevention for initiating post-COVID-19 transit use and service quality improvement priorities for different PT use and system contexts. The implications can also be applied to future public health emergency management for PT administrators.