World Health Organization Africa Research Articles

Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region

IntroductionThe COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic.MethodsWe extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo.ResultsAll 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision.ConclusionStrengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo.

The World Health Organization Africa region has high regional hepatitis B virus (HBV) prevalence, and evidence suggests more frequent horizontal HBV transmission than other regions. Context-specific epidemiological studies are needed to inform additional HBV prevention measures. In the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care in high-volume maternity clinics in Kinshasa, Democratic Republic of Congo. We recruited households of pregnant women ("index mothers") who were HBsAg-positive and HBsAg-negative, defining households as index-positive and index-negative, respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates. We enrolled 1006 participants from 200 households (100 index-positive, 100 index-negative) across Kinshasa. HBsAg-positivity prevalence was more than twice as high in index-positive households (5.0% [95% confidence interval {CI}, 2.8%-7.1%]) as in index-negative households (1.9% [95% CI, .6%-3.2%]). HBsAg-positivity prevalence was 3.3 (95% CI, .9-11.8) times as high among direct offspring in index-positive versus index-negative households. Factors associated with HBsAg positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among offspring in index-positive households. Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.

Barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of oral health policies in the WHO Africa region: A scoping review protocol.

Evidence-informed oral health policies (OHP) can be instrumental in ending the neglect of oral health globally. When appropriately developed and implemented, OHP can improve the efficiency of healthcare systems and the quality of health outcomes. However, more than half of the countries in the World Health Organization (WHO) African region do not have an oral health policy or even the existence of a policy in need of additional and more national-specific OHP as part of non-communicable diseases and universal health coverage agendas. The objective of this protocol's study is to determine the barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in the WHO Africa region. We will conduct a systematic search in Global Health, Embase, PubMed, PAIS, ABI/Inform, Web of Science, Academic Search Complete, Scopus, databases that index gray literature, and the WHO policy repositories. We will include qualitative, quantitative, or mixed-methods research studies and OHP documents published since January 1, 2002, which address stakeholders' perceptions and experiences regarding barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in countries part of the WHO African region. We will produce descriptive statistics (frequencies and proportions) for quantitative data and conduct descriptive content analysis for qualitative data. To effectively establish evidence-based OHP in the WHO African region, it is crucial to recognize existing challenges and opportunities for progress. The findings of this review will be relevant for Chief Dental Officers at ministries of health, administrators of dental schools, or academic institutions in the WHO African region and will inform a stakeholder dialogue meeting in Kenya in November of 2023. Open Science Framework: https://doi.org/10.17605/OSF.IO/9KMWR.

Morbidity and mortality burden of COVID-19 in rural Madagascar: results from a longitudinal cohort and nested seroprevalence study.

Three years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of COVID-19 in the World Health Organization Africa region. High quality, population-representative studies in Africa are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of COVID-19 in rural, low-resource settings. Here, we estimated the spatio-temporal morbidity and mortality burden associated with COVID-19 in a rural health district of Madagascar until the first half of 2021. We integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in Ifanadiana District, Madagascar. Socio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect IgG and IgM antibodies against four specific proteins of SARS-CoV-2 in a bead-based multiplex immunoassay. We evaluated spatio-temporal patterns in COVID-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions. Eighteen percent of people had been infected by April-June 2021, with seroprevalence increasing with individuals' age. COVID-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. Wealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. Adult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. Less than 10% of mortality in this period would be directly attributed to COVID-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district. Our study provides a very granular understanding on COVID-19 transmission and mortality in a rural population of sub-Saharan Africa and suggests that the disease burden in these areas may have been substantially underestimated.

Barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of oral health policies in the WHO Africa region: A scoping review protocol

Background: Evidence-informed oral health policies (OHP) can be instrumental in ending the neglect of oral health globally. When appropriately developed and implemented, OHP can improve the efficiency of healthcare systems and the quality of health outcomes. However, more than half of the countries in the World Health Organization (WHO) African region did not have an oral health policy or even the existence of a policy in need of additional and more national-specific OHP as part of non-communicable diseases and universal health coverage agendas. The objective of this protocol’s study is to determine the barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in the WHO Africa region. Methods: We will conduct a systematic search in Global Health, Embase, PubMed, PAIS, ABI/Inform, Web of Science, Academic Search Complete, Scopus, databases that index gray literature, and the WHO policy repositories. We will include qualitative, quantitative, or mixed-methods research studies and OHP documents published since January 1, 2002, which address stakeholders' perceptions and experiences regarding barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in countries part of the WHO African region. We will produce descriptive statistics (frequencies and proportions) for quantitative data and conduct descriptive content analysis for qualitative data. Discussion: To effectively establish evidence-based OHP in the WHO African region, it is crucial to recognize existing challenges and opportunities for progress. The findings of this review will be relevant for Chief Dental Officers at ministries of health, administrators of dental schools, or academic institutions in the WHO African region and will inform a stakeholder dialogue meeting in Kenya in November of 2023. Registration: Open Science Framework: https://doi.org/10.17605/OSF.IO/9KMWR

Rubella virus genotype 2B endemicity and related utility of serum-based molecular characterization in Uganda

There are 13 globally recognized rubella virus genotypes of which only 2 (1E and 2B) have been detected recently. The largest percentage of all reported rubella virus sequences come from China and Japan with Africa reporting limited data. In a bid to address the lack of rubella genotype data in Uganda and the World Health Organization Africa region, we sought to characterize rubella viruses retrospectively using sera collected from suspected measles patients that turned out rubella IgM positive.Seven sequences belonging to genotype 2B sub-lineage 2B-L2c were obtained. These sequences clustered with other genotype 2B sequences previously reported from Uganda. None of the other genotypes (1E and 1G) reported from Uganda in the earlier years were detected. In addition, none of the sequences were obtained after the introduction of the measles-rubella containing vaccine. The above highlight the need for continuous rubella virological surveillance to confirm interruption of endemic rubella genotype circulation.

Assessing the capacity of primary health care facilities in Nigeria to deliver eye health promotion: Results of a mixed-methods feasibility study.

Over 25 million people in sub-Saharan Africa are blind or visually impaired, the majority from avoidable causes. Health promotion and disease prevention are important strategies for eye health, through good governance, health literacy and increasing access to eye care services. To increase equity in access for eyecare services, the World Health Organization Africa Region developed a package of interventions for primary eye care, which includes health promotion. The aim of this study was to assess the capacity of the primary healthcare system to deliver health promotion for eye care in Nigeria. Mixed methods were used during a survey of 48 government-owned primary health care facilities in Anambra state, Nigeria: interviews with district health supervisors, facility staff and village health workers, and a desk review of policy documents for primary health care and eye care in Nigeria. Findings were benchmarked against the capacities needed to deliver health promotion agreed through a Delphi exercise and were analysed using the World Health Organization's health system building blocks. Eye health promotion policies exist but are fragmented across different national health policies. Health promotion activities focussed on "mobilising" community members to access care provided in facilities, particularly for women of childbearing age and young children, and health education was limited. Only one in ten facilities engaged the elderly and a fifth delivered health promotion for eye care. Health promotion activities were supervised in 43.2% of facilities and transport to remote areas was limited. A robust eye health promotion strategy needs to be included in the National Eye Health Policy. The scope of existing health promotion will need to expand to include eye conditions and different age groups. Increasing eye health literacy should be emphasized. Governance, training health workers in eye health promotion, educational materials, and transport to visit communities will also be needed.

Mapping research evidence on perinatal asphyxia within the sustainable development era in sub-Saharan Africa: a scoping review protocol

BackgroundApproximately 45% of all under-five child deaths are among newborn infants, babies in their first 28 days of life, or the neonatal period every year in the World Health Organization (WHO) Africa Region. To facilitate the achievement of Sustainable Development Goal (SDG) 3.2, innovative interventions are needed to address this challenge. Thus, this scoping review aims to map research evidence on perinatal asphyxia among neonates in the WHO Africa Region.MethodsThis scoping review will be guided by the Arksey and O’Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute checklist for scoping reviews. Relevant published literature will be searched using a combination of keywords, Boolean terms, and Medical Subject Headings in the following databases: PubMed, SCOPUS, CINAHL, and Web of Science from January 2016 onwards. We will further search the World Health Organization and government websites, as well as the reference list of included studies for potentially eligible studies. This scoping review will include research evidence involving countries in the WHO Africa Region, with a focus on the burden of perinatal asphyxia, contributory/associated factors of perinatal asphyxia, clinical interventions for perinatal asphyxia, and interventions/strategies for the prevention of perinatal asphyxia in the SDGs era. Two reviewers will independently sort the studies to include and exclude, guided by the eligibility criteria. Also, the data from the included studies will be extracted and any discrepancies resolved using a third reviewer. Thematic analysis will be conducted, and the findings reported using both qualitative tables and figures. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) will be followed to report this study’s results. Quality appraisal of the included studies will be done utilising the mixed methods appraisal tool version 2018.ConclusionThis scoping review results may reveal research evidence gaps to inform future primary studies, systematic reviews and meta-analyses; and possibly contribute towards the realisation of the SDG 3.2 by countries in the WHO Africa Region. The finding of this review will be disseminated using multiple channels such as workshops, peer review publications, conferences, and social media.

National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country’s progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.

Mapping research evidence on implementation of the WHO ‘best buys’ and other interventions for the prevention and control of non-communicable diseases in sub-Saharan Africa: a scoping review protocol

BackgroundThe rising burden of non-communicable diseases (NCDs) is a global health concern. To reduce the burden of morbidity, mortality and disability due to NCDs, the World Health Organization (WHO) developed ‘best buys’ and other interventions for the prevention and control of NCDs by member countries. However, their extent of implementation especially in sub-Saharan African countries (SSA) is not known. Therefore, this scoping review aims to map and describe research evidence on implementation of the WHO’s ‘best buys’ and other interventions for reducing unhealthy diets in SSA.MethodsThis review will be guided by the enhanced version of Arksey and O’Malley’s framework and the recent Joanna Briggs Institute guidelines for scoping reviews. To identify the relevant published literature for this review, a comprehensive keyword search will be conducted in PubMed, SCOPUS, EBSCOhost (CINAHL, Health Resource and PsycINFO) and Cochrane Library from 2017 to 2021. Boolean terms (‘AND’ and ‘OR’), as well as Medical Subject Heading terms, will be included where essential. Government websites of SSA countries, the WHO’s website and Google Scholar will be consulted for grey literature such as governmental policies/strategies focus on reducing unhealthy diets. Moreover, the reference list of included evidence sources will be searched for additional literature. Two reviewers will independently screen the articles at the abstract and full-text screening phases guided by the review eligibility criteria. Also, all relevant data will be extracted independently by two reviewers, analysed thematically and the findings reported qualitatively.DiscussionThe evidence produced by this review will help identify implementation and policy gaps to inform future implementation research/interventions studies using a variety of evidence-based strategies towards the prevention and control of NCDs due to unhealthy diets in the WHO Africa Region. Platforms such as peer review journals, policy briefs and conferences will be used to disseminate this review’s findings.

Strengthening Health Systems Using Innovative Digital Health Technologies in Africa.

While effective health systems are needed to advance Universal Health Coverage and actualize the health Sustainable Development Goals, information system verticalization remains a challenge among African health systems. Most investments are vertical, partner-driven and program-specific with limited system-wide impacts. Poor linkages exist amongst different solutions as they are not designed to capture robust data across multiple programmatic areas. To address these challenges, the World Health Organization Africa Regional Office has proposed the adoption of a Digital Health Platform (DHP) to streamline different solutions to a cohesive whole. The DHP presents a pragmatic approach of bringing multiple platforms together using recognized standards to create a national infostructure, which bridges information solutions toward healthy and sustainable outcomes. It has capacities to curate accurate, high fidelity and timely data feedback loops needed to strengthen and continuously improve program delivery, monitoring, management, and informed decision-making at every level of the health system regardless of location. This paper contributes to the ongoing regional conversations on the need to harness innovative digital solutions to improve healthcare delivery in Africa.

Exploring the feasibility of integration of surveillance for intussusception into the routine monitoring of adverse events following immunization by countries of the WHO African Region for Africa.

Surveillance for intussusception (IS) post-rotavirus vaccine introduction in World Health Organization Africa Region (WHO/AFRO) has been restricted mainly to the large referral teaching hospitals. The choice of these facilities for surveillance was made to utilize the abundant expertise of specialists in paediatrics and surgery in these hospitals who can diagnose and manage such patients with IS. The surveillance has been well coordinated by the African Intussusception Surveillance Network established in 2012. This network has supported surveillance across the African region and has accumulated a huge database of IS cases in children < 1 year with findings that have demonstrated safety of the monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline). However, safety data on the pentavalent and RotaTeq (Merck Vaccine) is not yet available from the African region. Although, this network has provided much needed data, there is an inherent bias in monitoring and reporting of IS cases in only large tertiary hospitals. This time limited special project does not capture suspected intussusception cases with no access to hospital facilities used for monitoring IS. Additionally, the design requires extensive resources to support collection of high-quality data for monitoring IS, which is unsustainable. For these reasons suitable linkages between IS monitoring and routine Adverse Event Following Immunization (AEFI) should be established for continuity of monitoring of this condition. We propose alignment of the two systems that offers opportunity for high profile recognition and to enhance a sustainable system for diagnosis, treatment and continuous assessment of intussusception occurring in infancy.

Primary health care facility readiness to implement primary eye care in Nigeria: equipment, infrastructure, service delivery and health management information systems

BackgroundOver two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper.MethodsThis was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02.ResultsThere are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers.ConclusionA policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria.

Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar.

There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district—community, primary care centers, hospital—including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.

Pairs of independent nationally representative vaccination coverage surveys conducted within one year of each other: A global overview covering 2000–2019

BackgroundPopulation-based surveys play an important role in measuring vaccination coverage. Surveys measuring vaccination coverage may be commissioned by the Expanded Programme on Immunization (EPI surveys) or part of multi-domain non-EPI surveys such as Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). Surveys conducted too close in time to each other may not only be an inefficient use of resources but may also create problems for programme staff when results suggest inconsistent patterns of programme performance for similar time periods. ObjectiveTo summarize the occurrence of vaccination coverage surveys conducted close in time during 2000–2019 and compare results of EPI and non-EPI coverage surveys when the surveys were conducted within one year of each other. MethodsUsing a database of published national-level vaccination coverage survey results compiled by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), the authors abstracted information on survey field work dates, sample size, percentage of children with documented history of vaccination and the percent coverage, as well as published uncertainty intervals from DHS and MICS, for the first and third doses of diphtheria-tetanus toxoid-pertussis containing vaccine (DTP1, DTP3) and first dose of measles containing vaccine (MCV1). Survey results of EPI and non-EPI surveys were compared. ResultsThe authors identified 646 surveys with final reports and estimates of national-level vaccination coverage for DTP1, DTP3, or MCV1 from a total of 687 surveys with data collection start date from 2000 to 2019. Of the 140 countries with at least one vaccination coverage survey, a median of four surveys was observed. Most countries were Gavi-eligible and located in the WHO Africa Region. Sixty-six survey dyads were identified where an EPI survey occurred within one year of a non-EPI survey. For the 66 dyads, in 49 of 59 with information available, EPI surveys reported higher proportion of documented evidence of vaccination and EPI survey results tended to suggest higher levels of vaccination coverage compared to the non-EPI surveys; quite often, differences were substantial. Surveys that found higher proportions of children with documented vaccination evidence tended to also find higher proportions of children who had been vaccinated. SummaryOpportunities exist to improve overall planning of vaccination coverage measurement in population-based household surveys so that both EPI and non-EPI surveys are more comparable and survey coverage estimates are more appropriately spaced in time. When surveys occur too close in time, careful attention is warranted to ensure comparability and assess sources of documented evidence of vaccination and related coverage differences.

Monitoring Quality of Care in the WHO Africa Region-A study design for measurement and tracking, towards UHC attainment

ABSTRACT This paper reports on the design of a study to generate a quality of care index for countries in the World Health Organization Africa Region. Quality of care, for all people at all times, remains pivotal to the advancement of the 2030 agenda and the attainment of Universal Health Coverage. We present a study protocol for deriving a quality of care index, hinged on indicators and data elements currently monitored through routine information systems and institutionalized facility assessments in the World Health Organization Africa Region. This paper seeks to offer more insight into options in the Region for strengthening monitoring processes of quality of care, as a step towards generating empirical evidence which can galvanize action towards an improved care process. The methodology proposed in this study design has broad implications for policymaking and priority setting for countries, emphasizing the need for robust empirical measures to understand the functionality of health systems for the delivery of quality essential services. Application of this protocol will guide policymaking, as countries work to increasingly improve quality of care and adopt policies that will best facilitate their advancement towards Universal Health Coverage.

The WHO African Region: Research Priorities on Sexual and Reproductive Health and Rights

Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.

A Review on Knowledge, Attitude, and Practice during the COVID-19 Pandemic in Ethiopia

World Health Organization declared the novel coronavirus as a global public health emergency on January 30, 2020. COVID-19 has infected more than 17,660,523 people worldwide, with more than 680,894 deaths in different regions and countries. Based on the World Health Organization Africa report, as of 02 August, 2020, a cumulative total of 802,792 confirmed COVID-19 cases with 13,779 deaths have been reported across all African countries in the region. In Ethiopia the virus spreads alarmingly because the community did not practice the information given by Ministry of Health and the Government; as of August 2, 2020, 17,999 cases and 284 deaths have been reported. The level of panic in peoples is associated with knowledge and attitude according to Researchers. Good Knowledge, Attitude and Practice can be used to assess the current conditions and if it is used properly it plays a pivotal role to control the spread of COVID-19. Therefore, the government and ministry of health must give information to the society through TV, radio and social media repeatedly. Therefore, the aim of the current study was to assess/review the knowledge, attitude and perception of the population towards COVID-19 pandemic in Ethiopia. Keywords: Ethiopia, practice, COVID-19, pandemic DOI: 10.7176/JHMN/84-01 Publication date: December 31 st 2020

Prevention Harmful Consumption of Alcohol and Drugs in Sao Tome and Principe Through Public Health Communication: The Scientific Protocol

Sao Tome and Principe is an African low-and-middle-income country, where extreme poverty causes major health inequalities. No systematic research has been done on the consumption of alcohol and drugs in Sao Tome and Principe, and only overall statistics are available based on the importation of alcoholic drinks and their distribution among the population. There are also no studies on consumption of alcohol and illicit substances in children and youth and no preventive measures being undertaken. Besides that, manual databases present significant limitations, considering the lack of causes associated with mortality rates (0 - 5 years and > 5), and the difficulty to establish a cause/effect relation between diseases, deaths and life expectancy. No relevant data with burden of life was found in the reports of Centro Nacional de Endemias or the non-governmental, organization Instituto Marques de Valle Flor, a facilitator on healthcare clinical specialties selected on a voluntary basis by doctors from Portuguese hospitals. So, we proposed to provide a first overview of family and housing conditions, and above all, the consumption of alcohol and illegal drugs in young people. Thus, a project, the National Survey on Harmful Consumption of Alcohol and Drugs in Schools of Sao Tome and Principe, will be realized in order to better characterize the situation among children and young students and test public health communication strategies and preventive interventions aimed at this target-population. Interventions were designed taking into consideration local sociocultural realities of target audiences. We considered dialect language, single-parent families (matriarchal structure) and polygamy (mostly) in men and a country and governments led by men (patriarchal structure) and, in which the woman's role, as Food and Agriculture Organization of the United Nations reports, remains overlooked. Subsequently, we will collect traditional alcohols samples from the two main islands for analysis (at Laboratório de Estudos Farmacêuticos and Laboratório Nacional de Engenharia Civil - Portugal) and to determine heavy metals in the production process and impact on burden of life. In order to characterise the country's situation in terms of alcohol and illicit substances consumption a literature review was carried out through a search in several international electronic databases, such as those of the World Health Organization, World Health Organization Africa, United Nation, The Lancet and Lancet Global Health, etc. Available data of the following institutions of Sao Tome and Príncipe was also analyzed: National Institute of Statistics, Ministry of Education, Culture and Training and Ministry of Health and Social Affairs. Several interviews with community and church leaders as well as with members of catholic missions were carried out to better understand the local situation. Following this, a nationwide cross-sectional survey of a sample of 2064 students will be carried out. This will include a questionnaire on socio-demographic characteristics, lifestyles, health behaviors/attitudes, alcohol and illicit substances consumption. Finally, based on the overall diagnosis obtained, some edutainment health communication preventive interventions will be tested in the primary schools of three districts (EDUCA_TURTLE) and on the radio journalists (EDUCA_PRESS). These were evaluated by primary school teachers and by radio journalists.

Measuring maternal near-miss in a middle-income country: assessing the use of WHO and sub-Saharan Africa maternal near-miss criteria in Namibia

ABSTRACTBackground: Namibia, a middle-income country in sub-Saharan Africa (SSA), plans to use the Maternal Near Miss (MNM) approach. Adaptations of the World Health Organization (WHO) MNM defining criteria (‘WHO MNM criteria’) were previously proposed for low-income settings in sub-Saharan Africa (‘SSA MNM criteria’), but whether these adaptations are required in middle-income settings is unknown.Objective: To establish MNM criteria suitable for use in Namibia, a middle-income country in SSA.Methods: Cross-sectional study from 1 March 2018 to 31 May 2018 in four Namibian hospitals. Pregnant women or within 42 days of termination of pregnancy or birth, fulfilling at least one WHO or SSA MNM criterion were included. Records of women identified by either only WHO criteria or only SSA criteria were assessed in detail.Results: 194 Women fulfilled any MNM criterion. WHO criteria identified 61 MNM, the SSA criteria 184 MNM. Of women who only fulfilled any of the unique SSA MNM criteria, 18 fulfilled the criterion ‘eclampsia’, one ‘uterine rupture’ and five ‘laparotomy’. These women were assessed to be MNM. Thresholds for blood transfusion to define MNM due to haemorrhage were two units in the SSA and five in WHO set. Two or three units were given to 95 women for mild/moderate haemorrhage or chronic anaemia who did not fulfil any WHO criterion and were not considered MNM. Fourteen women who were assessed to be MNM from severe haemorrhage received four units.Conclusions: WHO MNM criteria may underestimate and SSA MNM criteria overestimate the prevalence of MNM in a middle-income country such as Namibia, where MNM criteria ‘in between’ may be more appropriate. Namibia opts to apply a modification of the WHO criteria, including eclampsia, uterine rupture, laparotomy and a lower threshold of four units of blood to define MNM. We recommend that other middle-income countries validate our criteria for their setting.