World Health Organization African Region Research Articles

Level of Antimalarial Drug Utilization Amongst Teaching and Non-Teaching Staff of University of Port Harcourt, Rivers State, Nigeria

Malaria is still a threat to public health till date in all malaria endemic regions of the world. The World Health Organization (WHO) African Region continues to carry a disproportionately high share of the global malaria burden with malaria being the 2^nd leading cause of death from infectious diseases in Africa, after HIV/AIDS. Assessment of drug use patterns is becoming increasingly necessary toward promoting rational use of drugs globally. Misuse of drugs occurs in all countries and irrational practices are especially common and costly in developing countries. The study investigated the level of antimalarial drug utilization amongst Teaching and non-Teaching staff of University of Port Harcourt, Rivers State. It was a cross sectional questionnaire based study. The study assessed the knowledge, attitude and malaria preventive practices of three hundred and sixty seven (367) respondents gotten from amongst the Teaching and Non-Teaching staff of the University. SPSS version 20 was used for the analysis. Chi squared test was used to assess relationships. The study revealed that three hundred and forty four (93.7%) of the Staff frequently treated malaria with Artemisinin-based Combination Therapy (ACT) while monotherapy stood at 3.6%. Most of the Staff also had a good knowledge of symptoms of malaria and got treatment from authorized sources such as hospitals and pharmacies. Eighty six (23.4%) of the Staff do not complete the treatment regimen. The major preventive practices prevalent among the study group are covering home windows with net (91%) and spraying of insecticides (86.7%). ACTs are the most predominantly used antimalarial amongst staffers of the University. If drug utilization pattern of anti-malarial drugs is however not monitored, there is the possibility of early emergence of resistance to the highly effective anti-malarial drugs presently in use.

A mapping of health education institutions and programs in the WHO African Region

Background: Information on health education institutions is required for planning, implementing and monitoring human resources for health strategies. Details on the number, type and distribution of medical and health science programs offered by African higher education institutions remains scattered. Methods: We merged and updated datasets of health professional and post-graduate programs to develop a mapping of health education institutions covering the World Health Organization African Region as of 2021. Results: Nine hundred and nine (909) institutions were identified in the 47 countries. Together they offered 1,157 health professional programs (235 medicine, 718 nursing, 77 public health and 146 pharmacy) and 1,674 post-graduate programs (42 certificates, 1,152 Master’s and 480 PhDs). Regionally, East Africa had the most countries with multiple academic health science centres - institutions offering medical degrees and at least one other health professional program. Among countries, South Africa had the most institutions and post-graduate programs with 182 and 596, respectfully. A further five countries had between 53-105 institutions, 12 countries had between 10 and 37 institutions, and 28 countries had between one and eight institutions. One country had no institution. Countries with the largest populations and gross domestic products had significantly more health education institutions and produced more scientific research (ANOVA testing). Discussion: We envision an online database being made available in a visually attractive, user-friendly, open access format that nationally, registered institutions can add to and update. This would serve the needs of trainees, administrators, planners and researchers alike and support the World Health Organization’s Global strategy on human resources for health: workforce 2030.

Global, regional and national burden of disease attributable to 19 selected occupational risk factors for 183 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

ObjectivesWe provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors.MethodsThe WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens.ResultsGlobally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84–1.92] million deaths and 89.72 (95% UR 88.61–90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups.ConclusionsThe WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden.

Predictors of COVID-19 epidemics in countries of the World Health Organization African Region

Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning.

The Global Landscape of Pediatric Bacterial Meningitis Data Reported to the World Health Organization-Coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019.

BackgroundThe World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.MethodsSentinel hospitals report cases of children <5 years of age hospitalized for suspected meningitis. Laboratories report confirmatory testing results and strain characterization tested by polymerase chain reaction. In 2019, the network included 123 laboratories that follow validated, standardized testing and reporting strategies.ResultsFrom 2014 through 2019, >137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region.ConclusionsThis multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.

An insight into the implementation of the global action plan on antimicrobial resistance in the WHO African region: A roadmap for action

IntroductionThe Global Action Plan (GAP) on antimicrobial resistance (AMR) delivers a ‘One Health’ strategy for the development of the national action plan. It encourages the optimal use of antimicrobials and strengthens the evidence base through surveillance and research. MethodsThis study evaluated the current status of implementation of the GAP on AMR in World Health Organization (WHO) African countries via a retrospective, cross-sectional analysis of routinely collected data on AMR. A SWOT analysis was used to identify the strengths, weaknesses, opportunities and threats involved in the GAP implementation. A roadmap for action was proposed. ResultsThe overall mean GAP performance score across all the countries that were assessed was 32% ± SD12 (95% CI 27–36%). The mean thematic scores were 59% ± 12 (53–65%) for multi-sector and One Health collaboration; 50% ± 22 (42–58%) for developing national AMR action plans; 38% ± 12 (33–42%) for awareness and training; 18% ± 13 (13–23%) for surveillance; 33% ± 13 (29–38%) for infection prevention and control; and 28% ± 23 (20–37%) for optimal use of antimicrobial medicines in human, animal and plant health. The difference in GAP performance scores between African sub-regions and between income categories was not statistically significant (P > 0.05). While seven countries exhibited strengths in two themes, 25 countries exhibited weaknesses across all themes. Six threats and six opportunities were identified to inform a practical roadmap for AMR action. ConclusionThe findings from this study indicate that the overall GAP implementation on AMR in the WHO African region is inadequate. Some thematic GAP scores appeared to be relatively good, but on closer inspection, individual indicators revealed a lack of progress and implementation, requiring action.

Best Paper Selection

Ahmed K, Bukhari MA, Mlanda T, Kimenyi JP, Wallace P, Okot Lukoya C, Hamblion EL, Impouma B. Novel Approach to Support Rapid Data Collection, Management, and Visualization During the COVID-19 Outbreak Response in the World Health Organization African Region: Development of a Data Summarization and Visualization Tool. https://publichealth.jmir.org/2020/4/e20355/ Garcia M, Lipskiy N, Tyson J, Watkins R, Esser ES, Kinley T. Centers for Disease Control and Prevention 2019 novel coronavirus disease (COVID-19) information management: addressing national health-care and public health needs for standardized data definitions and codified vocabulary for data exchange. https://academic.oup.com/jamia/article/27/9/1476/5907876 Gong M, Liu L, Sun X, Yang Y, Wang S, Zhu H. Cloud-Based System for Effective Surveillance and Control of COVID-19: Useful Experiences From Hubei, China. https://www.jmir.org/2020/4/e18948/ Reeves JJ, Hollandsworth HM, Torriani FJ, Taplitz R, Abeles S, Tai-Seale M, Millen M, Clay BJ, Longhurst CA. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. https://academic.oup.com/jamia/article/27/6/853/5811358

Intra Action Review of the COVID-19 Pandemic Response in Africa: Best Practices, Challenges, and Perspectives for the Future

Background: The COVID-19 pandemic has continued to spread throughout the globe and in all African countries with major public health and economic impacts. Methods: We have conducted a detailed synthesis of intra-action review (IAR) reports from 18 countries in the World Health Organization (WHO) African Region, which were available as of March 2021. We conducted a thematic analysis across ten preparedness and response domains, namely, governance, leadership and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic. Findings: The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases, and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and sub-national levels. Interpretation: These findings suggest that African countries’ response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared to countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks. Funding Information: World Health Organization Regional Office for Africa. Declaration of Interests: We declare no competing interests.

Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012\u20132019: a secondary data analysis

BackgroundNigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria.MethodsThis retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019.ResultsCumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases.ConclusionsSokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

Impact of Rotavirus Vaccine Introduction on Rotavirus Hospitalizations Among Children Under 5 Years of Age-World Health Organization African Region, 2008-2018.

Rotavirus is the leading cause of acute gastroenteritis (AGE) among children worldwide. Prior to rotavirus vaccine introduction, over one third of AGE hospitalizations in Africa were due to rotavirus. We describe the impact of rotavirus vaccines using data from the African Rotavirus Surveillance Network (ARSN). For descriptive analysis, we included all sites reporting to ARSN for any length of time between 2008 and 2018. For vaccine impact analysis, continuous surveillance throughout the year was required to minimize potential bias due to enrollment of partial seasons and sites had to report a minimum of 100 AGE cases per year. We report the proportion of rotavirus AGE cases by year relative to vaccine introduction, and the relative reduction in the proportion of rotavirus AGE cases reported following vaccine introduction. From 2008 to 2018, 97 366 prospectively enrolled hospitalized children <5 years of age met the case definition for AGE, and 34.1% tested positive for rotavirus. Among countries that had introduced rotavirus vaccine, the proportion of hospitalized AGE cases positive for rotavirus declined from 39.2% in the prevaccine period to 25.3% in the postvaccine period, a 35.5% (95% confidence interval [CI]: 33.7-37.3) decline. No declines were observed among countries that had not introduced the vaccine over the 11-year period. Rotavirus vaccine introduction led to large and consistent declines in the proportion of hospitalized AGE cases that are positive for rotavirus. To maximize the public health benefit of these vaccines, efforts to introduce rotavirus vaccines in the remaining countries in the region and to improve coverage should continue.

Implementation of the World Health Organization recommendation on the use of rotavirus vaccine without age restriction by African countries

The World Health Organization (WHO) recommended the worldwide use of rotavirus vaccines initially in 2007 and 2009 applying a strict age restriction criterion due to the potential for age-related association with increased risk of intussusception in infants. The restriction was relaxed in the 2013 after detailed review of robust safety data generated in post-marketing surveillance studies. We assessed the status of the implementation of the 2013 recommendation to remove age restriction in the WHO African region (AFR). Of the approximately 75% (35/47) of countries that had introduced the vaccine by 2018, only 43% (15/35) removed age restriction, exclusively from South and East sub-region (78%, 14/18). Avoiding confusion at the health facilities and financial constraints particularly resources required for re-training the health workers, use of vaccine off-label were cited as the main reasons for not implementing the 2013 WHO recommendation on age restriction removal. The 2013 WHO recommendation has not been fully implemented by African countries, suggesting the need for technical advisory bodies to further guide the countries, continue monitoring the implementation status and impact on the rotavirus vaccine coverage and intussusception in the Africa region.

Baseline Mapping of Neglected Tropical Diseases in Africa: The Accelerated WHO/AFRO Mapping Project.

.Mapping is a prerequisite for effective implementation of interventions against neglected tropical diseases (NTDs). Before the accelerated World Health Organization (WHO)/Regional Office for Africa (AFRO) NTD Mapping Project was initiated in 2014, mapping efforts in many countries were frequently carried out in an ad hoc and nonstandardized fashion. In 2013, there were at least 2,200 different districts (of the 4,851 districts in the WHO African region) that still required mapping, and in many of these districts, more than one disease needed to be mapped. During its 3-year duration from January 2014 through the end of 2016, the project carried out mapping surveys for one or more NTDs in at least 2,500 districts in 37 African countries. At the end of 2016, most (90%) of the 4,851 districts had completed the WHO-required mapping surveys for the five targeted Preventive Chemotherapy (PC)-NTDs, and the impact of this accelerated WHO/AFRO NTD Mapping Project proved to be much greater than just the detailed mapping results themselves. Indeed, the AFRO Mapping Project dramatically energized and empowered national NTD programs, attracted donor support for expanding these programs, and developed both a robust NTD mapping database and data portal. By clarifying the prevalence and burden of NTDs, the project provided not only the metrics and technical framework for guiding and tracking program implementation and success but also the research opportunities for developing improved diagnostic and epidemiologic sampling tools for all 5 PC-NTDs—lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma.

COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk “stepping back in time” in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage.

The state of health research governance in Africa: what do we know and how can we improve?

BackgroundThe developments in global health, digital technology, and persistent health systems challenges, coupled with global commitments like attainment of universal health coverage, have elevated the role of health research in low- and middle-income countries. However, there is a need to strengthen health research governance and create a conducive environment that can promote ethics and research integrity and increase public trust in research.ObjectiveTo assess whether the necessary structures are in place to ensure health research governance.MethodsEmploying a cross-sectional survey, we collected data on research governance components from 35 Member States of the World Health Organization (WHO) African Region. Data were analysed using basic descriptive and comparative analysis.Results Eighteen out of 35 countries had legislation to regulate the conduct of health research, while this was lacking in 12 countries. Some legislation was either grossly outdated or too limiting in scope, while some countries had multiple laws. Health research policies and strategies were in place in 16 and 15 countries, respectively, while research priority lists were available in 25 countries. Overlapping mandates of institutions responsible for health research partly explained the lack of strategic documents in some countries. The majority of countries had ethical committees performing a dual role of ethical and scientific review. Research partnership frameworks were available to varying degrees to govern both in-country and north–south research collaboration. Twenty-five countries had a focal point and unit within the ministries of health (MoH) to coordinate research.ConclusionGovernance structures must be adaptive to embrace new developments in science. Further, strong coordination is key to ensuring comprehensiveness and complementarity in both research development and generation of evidence. The majority of committees perform a dual role of ethics and scientific review, and these need to ensure representation of relevant expertise. Opportunities that accrue from collaborative research need to be seized through strong MoH leadership and clear partnership frameworks that guide negotiations.

Violence and COVID-19 across the Globe.

Violence and COVID-19 across the Globe Virginia Brennan, PhD, MAEditor, JHCPU As the summer of 2021 simmers on, JHCPU again publishes a large collection of papers delving into the complex sea of health inequities. In this Note, to stand in for the large array of topics the issue covers, I highlight a small selection, two papers concerning violence, two on COVID-19, and two concerning sub-Saharan African nations. Violence courses through American society unabated, rising exponentially over time. Much of this is gun violence, and virtually all of it inflicts both physical and mental trauma. The first highlighted paper on violence is by Corbin et al., who worked with 88 survivors of violent assault (gunshot, stabbing, or assault) who had presented to emergency rooms within the previous month, administering clinical scales for PTSD (PCL-5), depression (PHQ-8), and sleep (PROMIS®) to evaluate the mental health sequelae of violence. They report, "High proportions of participants met criteria for prospective PTSD (59.1%), major depression (44.3%) or disordered sleep (34.1%), with 27.3% meeting criteria for all three conditions." The authors conclude that survivors of violence should routinely be assessed for these conditions and referred for treatment as needed. This work serves as a powerful reminder of the seen and unseen damage inflicted by violence. Maternal morbidity as a term of art in public health refers to death due to complications from pregnancy or childbirth and does not encompass deaths due to "accidental or incidental" causes, specifically homicide, suicide, substance overdose, and motor vehicle accidents. As Bright et al. report, such traumatic causes of maternal death (death during pregnancy and a brief neonatal period) are far more common than medical causes of maternal death. Furthermore, pregnancy appears to be a time of increased vulnerability to violence; the authors note that in the U.S. in 2015, "4% of all deaths of women of reproductive age were attributed to homicide, but between 8% and 13% of maternal deaths were attributed to homicide." An underlying implication, on my reading, is advice something like this: "If you want to talk about major causes of maternal mortality, then talk about guns, drugs, and cars." The authors argue for three practical steps to reduce these traumatic causes of maternal death. COVID-19 continues its battle with the world population over 20 months since its inception. I highlight two of a number of papers in this issue concerning the pandemic. The first concerns Centers for Independent Living, federally-funded, community-based organizations designed and operated by people with disabilities. Centers for Independent Living initiatives include individual and systems advocacy, peer support, information and referral, independent living skills training, and transition services. Kennedy and colleagues surveyed 144 Center for Independent Living administrators and staff concerning what is needed by people with disabilities during the COVID-19 [End Page ix] pandemic. The strongest outcome recalls a refrain so often heard during crises: This emergency has laid bare the already over-burdened lives of a group of people most at risk, in this case people with disabilities. What the people with disabilities need during the pandemic is what they have always needed, but more so: health and safety, long-term supportive services, and reduction of social isolation and economic insecurity. Hernandez Caceres and colleagues analyzed the time series of daily cases in the World Health Organization African Region (WHOAR) from February 26th to December 29th, 2020. They provide an overview of the first wave (peaking around July 20th, 2020) and the second wave (either ongoing or having given way to a third wave) across WHOAR. The authors also provide basic reproduction numbers for the virus in WHOAR. Editor's note: By July 2021, both the number of confirmed cases and the number of COVID-19 deaths in sub-Saharan Africa have exceeded the predictions for August 2021 made by these models. The Literature Review by Abasse et al. might better be classified as a policy brief. It concerns the health system and the health status of the citizens of a particular sub-Saharan country—Comoro Islands—in systematic comparison with those of its neighbors, Mauritius and Seychelles. The Comoros, which was colonized by the French...

COVID-19 epidemic in The World Health Organization African Region (WHOAR): Situation and forecast.

To describe the dynamics and forecast the main parameters of the COVID-19 pandemic, the time series of daily cases in the World Health Organization African Region (WHOAR) from February 26th to December 29th, 2020 was analyzed. Estimates for expected values of parameters characterizing an epidemic (size of the epidemic, turning point, maximum value of daily cases, and basic reproductive number) were provided for both the first and the second wave, and for the entire ongoing pandemic in WHOAR. To this aim, the classical SIR (Susceptible-Infected-Removed) model and its approximations were applied to each identified wave. Our results suggest that the turning point of the COVID-19 first wave took place around July 20th, 2020. The first wave was expected to disappear by mid-December 2020, with a total of 1,200,000 expected cases. The second wave apparently started around August 19th, with an expected turning point by January 12th, 2021. The second wave is expected to end by August 9th, 2021, with 1,800,000 cumulative cases, and mounting up to 3,000,000 total cases between February 2020 and August 2021. Estimated basic reproduction numbers (R0) were 1.27 (first wave) and 1.15 (second wave); the expected total number of deaths is around 66,000 victims.

Analysing the reported incidence of COVID-19 and factors associated in the World Health Organization African region as of 31 December 2020.

This study analysed the reported incidence of COVID-19 and associated epidemiological and socio-economic factors in the WHO African region. Data from COVID-19 confirmed cases and SARS-CoV-2 tests reported to the WHO by Member States between 25 February and 31 December 2020 and publicly available health and socio-economic data were analysed using univariate and multivariate binomial regression models. The overall cumulative incidence was 1846 cases per million population. Cape Verde (21 350 per million), South Africa (18 060 per million), Namibia (9840 per million), Eswatini (8151 per million) and Botswana (6044 per million) recorded the highest cumulative incidence, while Benin (260 per million), Democratic Republic of Congo (203 per million), Niger (141 cases per million), Chad (133 per million) and Burundi (62 per million) recorded the lowest. Increasing percentage of urban population (β = -0.011, P = 0.04) was associated with low cumulative incidence, while increasing number of cumulative SARS-CoV-2 tests performed per 10 000 population (β = 0.0006, P = 0.006) and the proportion of population aged 15-64 years (adjusted β = 0.174, P < 0.0001) were associated with high COVID-19 cumulative incidence. With limited testing capacities and overwhelmed health systems, these findings highlight the need for countries to increase and decentralise testing capacities and adjust testing strategies to target most at-risk populations.

The impact of the COVID-19 pandemic on measles surveillance in the World Health Organisation African Region, 2020.

Introductionfollowing the declaration of the COVID-19 pandemic, many countries imposed restrictions on public gatherings, health workers were repurposed for COVID-19 response, and public demand for preventive health services declined due to fear of getting COVID-19 in health care settings. These factors led to the disruption in health service delivery, including childhood immunization, in the first months of the pandemic. Measles surveillance supported with laboratory confirmation, is implemented in the African Region as part of the strategies towards attaining measles elimination. World Health Organisation developed guidelines to assist countries to continue to safely provide essential health services including immunization and the surveillance of vaccine preventable diseases during the pandemic.Methodswe analysed the measles case-based surveillance and laboratory databases for the years 2014 to 2020, to determine the impact of the COVID-19 pandemic on measles surveillance, comparing the performance in 2020 against the preceding years.Resultsthe weekly reporting of suspected measles cases declined starting in April 2020. Twelve countries had more than 50% decline in both the number of reported cases as well as in the number of specimens collected in 2020, as compared to the mean for the years 2014-2018. In 2020, only 30% of the specimens from suspected measles cases arrived at the national laboratory within 3 days of collection. At Regional level, 86% of the districts reported suspected measles cases in 2020, while the non-measles febrile rash illness rate was 2.1 per 100,000 population, which was the lowest rate documented since 2014. Only 11 countries met the targets for the two principal surveillance performance indicators in 2020 as compared to an average of 21 countries in the years 2014-2019.Conclusionthe overall quality of measles surveillance has declined during the COVID pandemic in many countries. Countries should implement immediate and proactive measures to revitalise active surveillance for measles and monitor the quality of surveillance. We recommend that countries consider implementing specimen collection and testing methods that can facilitate timely confirmation of suspected measles cases in remote communities and areas with transportation challenges.

Estimating the SARS-CoV2 infections detection rate and cumulative incidence in the World Health Organization African Region 10 months into the pandemic.

As of 03 January 2021, the WHO African region is the least affected by the coronavirus disease-2019 (COVID-19) pandemic, accounting for only 2.4% of cases and deaths reported globally. However, concerns abound about whether the number of cases and deaths reported from the region reflect the true burden of the disease and how the monitoring of the pandemic trajectory can inform response measures.We retrospectively estimated four key epidemiological parameters (the total number of cases, the number of missed cases, the detection rate and the cumulative incidence) using the COVID-19 prevalence calculator tool developed by Resolve to Save Lives. We used cumulative cases and deaths reported during the period 25 February to 31 December 2020 for each WHO Member State in the region as well as population data to estimate the four parameters of interest. The estimated number of confirmed cases in 42 countries out of 47 of the WHO African region included in this study was 13 947 631 [95% confidence interval (CI): 13 334 620-14 635 502] against 1 889 512 cases reported, representing 13.5% of overall detection rate (range: 4.2% in Chad, 43.9% in Guinea). The cumulative incidence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was estimated at 1.38% (95% CI: 1.31%-1.44%), with South Africa the highest [14.5% (95% CI: 13.9%-15.2%)] and Mauritius [0.1% (95% CI: 0.099%-0.11%)] the lowest. The low detection rate found in most countries of the WHO African region suggests the need to strengthen SARS-CoV-2 testing capacities and adjusting testing strategies.

Predictors of COVID-19 Epidemics in Countries of the World Health Organisation African Region

Background: WHO African Region countries have experienced very different COVID-19 epidemics. This study aimed to identify predictors for the timing of the first COVID-19 case and the per capita mortality rate during the first and second pandemic wave in the region, and to test for any impact of countermeasures.Methods: We performed a region-wide, country-based observational study. Data on COVID-19 cases and deaths for all 47 countries in the WHO African Region were obtained from the WHO COVID-19 Dashboard. A set of predictors classified to nine categories were collected and used as explanatory variables. We applied Cox proportional hazards regression models, generalized linear mixed models and multinomial logistic regression models as appropriate.Findings: Predictors for an earlier first case were a more urban population, high volume of international air travel and more land borders, and better COVID-19 test capacity. Predictors for a high per capita mortality rate during the first wave were a more urban population, more pre-pandemic international air travel and higher prevalence of HIV. The stringency and timing of government restrictions on behaviour were not associated with a lower per capita mortality rate in the first wave. A more urban population and a higher infectious disease resilience score were associated with more stringent restrictions and/or a higher per capita mortality rate in the first wave. The predictor set for the second wave was similar, and first wave per capita mortality predicted that in the second wave. These results were not altered when measures of national testing effort were included in the models.Interpretation: COVID-19 in Africa arrived earlier and caused greater mortality in countries with more international travel and a more urban population. Mortality was exacerbated by high HIV prevalence; it is not clear whether this is a direct or indirect effect. Countries that were better prepared and judged to have more resilient health systems were worst affected, both by the disease and by the imposition of restrictions. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa.Funding Statement: National Institute for Health Research, Darwin Trust of EdinburghDeclaration of Interests: The authors disclose no conflicts of interest.