Assessment of patients'knowledge, attitude and practice of cross-infection control in the dental clinic during COVID-19 pandemic

Background:The emergence of coronavirus disease 2019 (COVID-19), a highly contagious disease that causes viral respiratory illness, has changed the lifestyle of humans worldwide. Dental practitioners and patients are at high risk of infection during their routine practice due to their exposure to saliva, blood, and droplet production.Aim:To gain insight into the patient's viewpoint regarding the practice, altitude, and knowledge of COVID-19 and its transmission and cross-infection in dental clinics.Methods:This was cross­sectional analytic survey in dentistry during the COVID-19 pandemic. Aself-administered close-ended questionnaire consisting of 32 variables was distributed among the study participants. The data were analysed using the Statistical Package for the Social Sciences (SPSS) version 25. The level of significance was p ≤ 0.05. Results:The age of the participants varied from 20 - 58 years, with a mean age of 34.6 ±5. The majority (89.3%) felt COVID-19 was a highly contagious disease, while 50.0% of the respondents believed that the most common route of COVID-19 transmission in dentistry is through aerosols. The majority, 78.6%, recorded good knowledge of infection control following the COVID-19 outbreak. The number of married patients who had good knowledge of cross-infection control was 118, which was statistically significant.Conclusion:From the study, it is evident that the patients possess a good range of knowledge in both preventive and cross-infection protocols to follow during the COVID-19 pandemic. However, the same cannot be said about the practice

Manifestations oto-rhino-laryngologiques de la COVID-19 chez l' enfant à Brazzaville / Otorhinolaryngological manifestations of COVID-19 in Children in Brazzaville

Introduction.Les infections respiratoires hautes représentent environ 80% des affections ORL de l'enfant. L'objectif de ce travail était de contribuer à la connaissance des manifestations ORL de la covid-19 chez l'enfant afin d'en améliorer la prise en charge. Patients et méthodes. Il s'est agi d'uneétudedescriptive de 12 mois incluant les dossiers des enfants âgés de moins de 18 ans symptomatiques et testés positifs à la COVID-19 par RT-PCR. Il s'agissait des enfants reçus en consultation dans les services d'otorhinolaryngologie de l'hôpital de Référencede Talangaï et du CHU de Brazzaville. Tous les prélèvements étaient acheminés au laboratoire national de santé publique où le diagnostic était fait par RT-PCR. Résultats.Sur un total de 1080 enfants consultés pour une symptomatologie respiratoire ORL, seuls 21 étaient testés positifs à la COVID-19 représentant une prévalence de 1,9%. L'âge moyen était de 12,6 ans ± 5,7 (extrêmes: 3 ­17 ans) avec un ratio de 0,9 légèrement en faveur des filles. La tranche d'âge de 13 à 18 ans était la plus représentative (n=13, soit 61,8%) suivie de 9 à 13 ans (n=4, soit 19,1%) correspondant aux enfants ayant un antécédent personnel d'atopie (80,9%). La symptomatologie était dominée par l'angine érythémateuse (n=17, soit 80,9%) suivie de la rhinopharyngite (n=3, soit 14,4%) et du syndrome de Marschall (n=1, soit 4,7%). Tous les enfants étaient orientés auprès des services habiletés à la prise en charge mais seuls 13 d'entre eux (61,9%) étaient contre-référés et déclarés guéris après un contrôle RT-PCR négatif. Conclusion.Si l'angine érythémateuse domine la symptomatologie COVID-19 chez l'enfant, il en ressort que le syndrome de Marschall reste une exception clinique.

Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management.Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management. Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positive for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positives for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception.

COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults

Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 23­39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% ­ 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35­49 years: OR: 0.28, 95% CI: 0.18­0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07­0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11­0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10­1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1­4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27­7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.

Risk factors of mortality among COVID-19 patients receiving non-invasive ventilation at Addis Ababa governmental COVID-19 treatment centers

Introduction: during the global COVID-19 pandemic, non-invasive ventilation has become a widely utilized method for treating patients experiencing acute respiratory failure. Noninvasive pressure ventilation is frequently employed as a standard approach for managing acute respiratory failure resulting from COVID-19 pneumonia, as opposed to invasive ventilation methods. However, there is a lack of research on its effectiveness. Therefore, this study aimed to determine the risk of mortality among COVID-19 patients receiving non-invasive ventilation. Methods: a multi-centric retrospective cross sectional study was conducted on the records of 402 patients at the Eka Kotebe COVID-19 Center, St. Peter COVID-19 Care Center, and Millennium COVID-19 Treatment Center. The systematic random selection technique was employed in order to select the study unit, and data was extracted from patient charts using a pretested method and validated before being entered into Epi-data Manager 4.6 versions. Descriptive, bivariate, and multivariable analyses were performed using binary logistic regression in SPSS 25. In the multivariate logistic regression, a predictor variable was considered to have a significant connection if its p-value was less than 0.05 at a 95% confidence level. Results: four hundred and two patient records were reviewed during the study period and showed the mean patient´s age was 62.6 years, with male predominance. It revealed that 11.7% [CI: 8.7-15.2] of COVID-19 patients who received non-invasive positive pressure ventilation died, as being critical for COVID-19 patients was a main cause of noninvasive initiation. Patients over the age of 60 were more likely to die among those who received noninvasive ventilation for COVID-19 [AOR = 5.4 95% CI 1.32, 23.1]. Conversely, patients without diabetes were less likely to die [AOR = 0.23 95% CI 0.11, 0.48]. Moreover, patients with a tidal volume greater than 500 ml were more likely to pass away [AOR =2.2 95% CI 1.11,4.43], as were those who were on non-invasive ventilation (NIV) for more than 8 days [AOR = 0.24 95% CI.08, 0.81]. Conclusion: the significance of patients who were given non-invasive ventilators ended up dying. Age, diabetes, and high tidal volumes are linked to a higher risk of death. Non-invasive ventilation for over eight days showed a protective effect. Removing factors that caused NIV and ventilated COVID-19 patients' deaths may reduce mortality.

COVID-19 vaccine acceptance among pregnant women: a multicentre cross-sectional survey in Port Harcourt, Nigeria

Introduction: effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine hesitancy and its associations among pregnant women receiving antenatal care in Port Harcourt, a large cosmopolitan town in Nigeria. Methods: we conducted a cross-sectional online survey over 2 months among consenting pregnant women receiving antenatal care in the 3 largest obstetric service centers in Port Harcourt to evaluate COVID-19 vaccine hesitancy and its associations. Results: the prevalence of vaccine hesitancy was 669 (72.2%). Of the respondents, 27 (2.9%) had been infected or had a close family member infected with SARS-CoV-2, and 897 (96.8%) of them had heard of the COVID-19 vaccine; however, only 133 (14.4%) had been vaccinated against COVID-19. The safety of the mother in 260 (32.8%) and the safety of the unborn baby in 114 (14.4%) of the respondents were the reasons for vaccine hesitancy. A small proportion of women 7(0.9%) were hesitant on religious grounds. Tertiary education, use of childhood immunization for previous infants delivered, and availability of COVID-19 vaccine in the antenatal clinic at no cost to the women, were statistically significant predictors of vaccine uptake among the respondents. Conclusion: the prevalence of vaccine hesitancy among pregnant women in Port Harcourt was 72.2%. Higher academic achievement and availability of the COVID-19 vaccine in the antenatal clinic were predictors of vaccine uptake, while reasons for hesitancy were mostly due to safety concerns for the mother and unborn baby.

Psychological distress among South African healthcare workers during the COVID-19 pandemic

Background: The COVID-19 pandemic has placed immense pressure on healthcare workers (HCWs). Objectives: This study sought to find the prevalence and factors associated with psychological distress among HCWs in South Africa during the beginning phases of COVID-19 and make relevant recommendations. Method: The survey was administered online through a data-free platform. Data were benchmarked to the national population of over 500 000 healthcare professionals in South Africa. Multiple logistic regressions were used to determine association between psychological distress and potential explanatory variables. Results: A total of 7607 healthcare professionals participated in the study (1760 nurses, 2843 medical practitioners and 3004 other healthcare professionals). Half of the nurses, 41% of medical practitioners and 47% of other healthcare professionals were classified as psychologically distressed. Those who were of older age, provided with well-being support services and having a positive outlook on the healthcare system were significantly less likely to be distressed. Being female medical practitioners and female other healthcare professions, requesting routine counselling, being concerned about not having enough leave and that their life insurance policy did not cover COVID-19 were more likely to be distressed. Conclusion: Psychological well-being of HCWs in South Africa is at risk. We recommend that psychological distress of HCWs be routinely assessed and that routine counselling, well-being support services, appropriate hazardous leave and insurance be provided to all HCWs. Contribution: This study adds to the literature on the psychological distress faced by HCWs in South Africa during COVID-19.

The function of competitive intelligence in South African insurance post-COVID-19 outbreak

Background: Competitive intelligence (CI) involves monitoring competitors and providing organizations with actionable and meaningful intelligence. Some studies have focused on the role of CI in other industries post-COVID-19 pandemic. Objectives: This article aims to examine the impact of COVID-19 on the South African insurance sector and how the integration of CI and related technologies can sustain the South African insurance sector post-COVID-19 epidemic. Method: Qualitative research with an exploratory-driven approach was used to examine the impact of the COVID-19 pandemic on the South African insurance sector. Qualitative secondary data analyses were conducted to measure insurance claims and death benefits paid during the COVID-19 pandemic. Results: The research findings showed that the COVID-19 pandemic significantly impacted the South African insurance industry, leading to a reassessment of pricing, products, and risk management. COVID-19 caused disparities in death benefits and claims between provinces; not everyone was insured. Despite challenges, South African insurers remained well-capitalised and attentive to policyholders. Integrating CI and analytical technologies could enhance the flexibility of prevention, risk management, and product design. Conclusion: COVID-19 requires digital transformation and CI for South African insurers' competitiveness. Integrating artificial intelligence (AI), big data (BD), and CI enhances value, efficiency, and risk assessments. Contribution: This study highlights the importance of integrating CI strategies and related technologies into South African insurance firms' operations to aid in their recovery from the COVID-19 crisis. It addresses a research gap and adds to academic knowledge in this area.

Falciparum malaria is associated with risk markers of type 2 diabetes mellitus in individuals with or without COVID-19 exposure

Background: Scientific information on the impact of malaria on the risk of developing type 2 diabetes mellitus (T2DM) after recovery from the coronavirus disease 2019 (COVID-19) is limited in the Ghanaian context. The purpose of this study was to examine the association between selected risk markers of T2DM in falciparum malaria patients post-COVID-19 or not at a tertiary hospital in Ghana. Methodology: This was a descriptive cross-sectional comparative study of 38-recovered COVID-19 adult participants with malaria and 40 unexposed COVID-19 adults with malaria at the Tamale Teaching Hospital, Ghana. Demographic, anthropometric and levels of glucose, insulin, C-reactive protein and lipid profiles were measured in the two groups of participants under fasting conditions. Parasitaemia was assessed microscopically but insulin resistance and beta-cell function were assessed by the homeostatic model. Results: The COVID-19 exposed participants were older (p=0.035) with lower parasitaemia (p=0.025) but higher mean levels of insulin, insulin resistance, and beta-cell function compared with their unexposed counterparts (p<0.05). Parasitaemia correlated positively with a number of the measured indices of diabetogenic risk markers in the COVID-19 exposed group only, and predicted (Adjusted R2=0.751; p=0.031) by beta-cell function, C-reactive protein and triglycerides with the model explaining about 75% of the observed variation. Parasitaemia could only be predicted (Adjusted R2=0.245; p=0.002) by C-reactive protein with the model explaining just about a quarter of the observed variation in the COVID-19 unexposed group. Insulin resistance and sub-optimal beta-cell function were detected in both groups of participants. Conclusion: Falciparum malaria is associated with risk markers for development of T2DM irrespective of COVID-19 exposure. Insulin resistance, inflammation and sub-optimal beta-cell secretory function may drive the risk. The observed diabetogenic risk is higher in the recovered COVID-19 participants.

Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting: Three public sector hospitals in Gqeberha, South Africa. Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71­26.40), being in the lowest income band (AOR = 10.78, 2.55­45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12­8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92­13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98­10.18). Low support at work (AOR = 9.99, 3.66­27.23), medium job satisfaction (AOR = 5.38, 2.65­10.93) and medium support at work (AOR = 3.39, 1.71­6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10­0.80) and high levels of resilience (AOR = 0.08, 0.03­0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

Attitudes and practices of travelers regarding COVID-19 vaccine and adverse reactions

Objective.In the context of the global COVID-19 pandemic, COVID-19 vaccines were made available to different countries. This study aimed to assess travelers' attitudes and practices toward the COVID vaccine and adverse events. Methods. A survey was conducted using a questionnaire from April 1 to June 30, 2021, among travelers who came for their COVID-19 test at the Institut Pasteur of Côte d'Ivoire.Results. A total of 527 travelers agreed to participate in this study, including 336 men and 161 women. Overall, 26% of respondents had already received their COVID-19 vaccine, while 76% of respondents responded they did not want to be vaccinated. The age of those most vaccinated (116) ranged from 25 to 64 years with a small proportion for those over 65 years (0.8%). Travelers (41) to France were the most vaccinated. All vaccinated persons (135) had a high level of education and were either Christian (89 persons), Muslim (45 persons) or animist (1 person). Adverse events related to the COVID vaccination were reported in seven individuals. These included muscle pain, fever and nausea. Conclusion.Negative attitudes towards vaccines are a major public health concern. In view of these results, for awareness raising, vaccination campaign may be focused on youthand people over 65 years of age. Public health messages containing information about vaccine safety should be tailored to address this vaccine hesitancy

Association of acute COVID-19 with 24 hours-pulse wave velocity in cameroonian workers

Introduction. COVID-19appears to have a vascular tropism responsible for diffuse vasculitis-like cell damage. The aim of our study was to evaluate the impact of Sars-Cov-2 infection on arterial stiffness.Material and methods. This was a cross-sectional analytical case-controlstudy with 1:1 matching (1 case to 1 control) over a six-month period from January 1, 2021 to June 30, 2021 at the medical-social centerof the autonomous port of Douala. We measured the pulse wave velocity (PWV) in two groups of patients (group 1: COVID-19and group 2: non-COVID-19) using a MOBIL-O-GRAPH 24h PWA MonitorTM. A p-value < 0.05 was considered significant.Result. A total of 122 patients (61 COVID-19and 61 non-covid) were included in this study, among which 68 (55.7%) male. The mean age was 41±11 years. PWV as well as POV adjusted for age and mean BP were similar in both groups. The mean 24-hour, diurnal and nocturnal PWV were slightly higher in COVID-19patients than in controls by 0.1 m/s (p=0.67), 0.2m/s (p=0.37) and 0.2m/s (p=0.25) respectively. COVID-19infection was not significantly associated with PWV (p=0.082).Conclusion. PWV were slightly higher in COVID-19patients and increased arterial stiffness was not significantly associated with COVID-19status in the acute phase of infection.

Knowledge and practices toward COVID-19 preventive measures and symptoms: A case-control study in Benin

Introduction. Following communication and awareness actions related to COVID-19, we assessed the knowledge and practices about COVID-19 in Benin. Methods. A case-control survey was conducted from 14 September to 20 October 2020 in Benin. Questions relatingto knowledge and practices on COVID-19 were collected through a questionnaire survey. A total of 312 respondents (104 cases and 208 controls) were included in the study. Logistic regression and Spearman correlation tests were used to examine the relation between participants knowledge and practice at a 5% significance level. Results. From the survey, 65.4% of cases and 68.3% of controls knew about COVID-19 transmission via air droplets. Most of the cases (67.31%) and control (79.81%) participants reported cough as a symptom of COVID-19. Handwashing with soap and water was the most protective measure known by 87.5% of cases and 90.87% of controls. Concerning practice, the cloth mask was the type mostly worn by cases (54.81%) and controls (58.65%). Wearing a face mask in public areas was significantly associated with the COVID-19 health status of respondents (OR = 2.98, CI95% [1.16-7.67]; p = 0.022). Furthermore, a significantly positive correlation exists between knowledge of the COVID-19 protective measures and hand hygiene practices when leaving a public place (r = 0.184, p=0.001). Conclusion. Through this study, we observed some discrepancies between the knowledge and practices related to COVID-19 among cases and controls surveyed. Therefore, efforts should be directed toward raising awareness about the disease to improve their knowledge and practices

ARIMA model in predicting of COVID-19 epidemic for the Southern Africa region

Background: Coronavirus pandemic, a serious global public health threat, affects the Southern African countries more than any other country on the continent. The region has become the epicenter of the coronavirus with South Africa accounting for the most cases. To cap the deadly effect caused by the pandemic, we apply a statistical modelling approach to investigate and predict COVID-19 incidence. Methods: Using secondary data on the daily confirmed COVID-19 cases per million for Southern Africa Development Community (SADC) member states from March 5, 2020, to July 15, 2021, we model and forecast the spread of coronavirus in the region. We select the best ARIMA model based on the log-likelihood, AIC, and BIC of the fitted models. Results: The ARIMA (11,1,11) model for the complete data set was finally selected among ARIMA models based upon the parameter test and the Box­Ljung test. The ARIMA (11,1,9) was the best candidate for the training set. A 15-day forecast was also made from the model, which shows a perfect fit with the testing set. Conclusion: The number of new COVID-19 cases per million for the SADC shows a downward trend, but the trend is characterized by peaks from time to time. Tightening up of the preventive measures continuously needs to be adapted in order to eradicate the coronavirus epidemic from the population.

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

Background. In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. Objectives. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021.Methods. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. Results. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached ­ suggesting a slow recovery and continuing impact of the pandemic. Conclusions. TheCOVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets

The COVID-19 pandemic in sub-Saharan Africa: The significance of presumed immune sufficiency

A novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in China in 2019 and later ignited a global pandemic. Contrary to expectations, the effect of the pandemic was not as devastating to Africa and its young population compared to the rest of the world. To provide insight into the possible reasons for the presumed immune sufficiency to coronavirus disease 2019 (COVID-19) in Africa, this review critically examines literature published from 2020 onwards on the dynamics of COVID-19 infection and immunity and how other prevalent infectious diseases in Africa might have influenced the outcome of COVID-19. Studies characterising the immune response in patients with COVID-19 show that the correlates of protection in infected individuals are T-cell responses against the SARSCoV-2 spike protein and neutralising titres of immunoglobin G and immunoglobin A antibodies. In some other studies, substantial pre-existing T-cell reactivity to SARS-CoV-2 was detected in many people from diverse geographical locations without a history of exposure. Certain studies also suggest that innate immune memory, which offers protection against reinfection with the same or another pathogen, might influence the severity of COVID-19. In addition, an initial analysis of epidemiological data showed that COVID-19 cases were not severe in some countries that implemented universal Bacillus Calmette­Guerin (BCG) vaccination policies, thus supporting the potential of BCG vaccination to boost innate immunity. The high burden of infectious diseases and the extensive vaccination campaigns previously conducted in Africa could have induced specific and non-specific protective immunity to infectious pathogens in Africans.

Perspectives of nursing students on challenges of e-learning during early stages of the COVID-19 pandemic

Background: E-learning is becoming an important approach to teaching and learning in higher education institutions, including nursing training. Despite that, there are students who were never introduced to e-learning prior to the coronavirus disease 2019 (COVID-19) pandemic. Their challenges in relation to e-learning could differ from those of other students who had experienced the platform before, especially against the backdrop of the COVID-19 pandemic that brought an abrupt change in the approach to teaching, learning and assessment. Objectives: This study explored and described university nursing students' challenges in relation to e-learning during the early stages of the COVID-19 pandemic in a resource-constrained setting. Method: Qualitative exploratory and contextual design was used. The sample consisted of 17 participants who were conveniently selected, and data were collected by means of two focus groups and five individual interviews. Data analysis followed a qualitative content analysis process. Results: The five categories emanated from analysis are e-learning mode not suitable for practical components, challenges related to assessment of learning, connectivity issues, e-learning is a lonely journey and computer illiteracy and limited skills for the use of e-learning. Conclusion: Nursing students' challenges regarding e-learning during the early stages of the COVID-19 pandemic related to the learning of practical components, assessment, connectivity, a lack of interaction with peers and a lack of the skills required to operate e-learning tools.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

Background: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. Methods: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. Results: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. Conclusion: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI. Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Prevalence of COVID-19 at the Wahgnion-Gold mining site in Burkina Faso and use of RT-PCR initial cycle threshold to monitor the dynamics of SARS-CoV-2 load

Background: To control the spread of coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it is necessary to adequately identify and isolate infectious patients particularly at the work place. Real time polymerase chain reaction (RT-PCR) assay is the recommended confirmatory method for the diagnosis of SARS-CoV-2 infection. The aim of this study was to determine the prevalence of SARSCoV-2 infection in Burkina Faso and to use the initial cycle threshold (Ct) values of RT-PCR as a tool to monitor the dynamics of the viral load. Methodology: Between September 2021 and February 2022, oropharyngeal and/or nasopharyngeal swab samples of consecutively selected COVID-19 symptomatic and apparently healthy workers from the Wahgnion mining site in the South-western Burkina Faso who consented to the study were collected according to the two weeks shift program and tested for SARS-CoV-2 using RT-PCR assay. Patients positive for the virus were followed-up weekly until tests were negative. Association of the initial RT-PCR Ct values with disease duration was assessed by adjusted linear regression approach. Two-sided p value < 0.05 was considered statistically significant. Results: A total of 1506 (92.9% males) participants were recruited into the study, with mean age and age range of 37.18.7 and 18-68 years respectively. The overall prevalence of SARS-CoV-2 infection was 14.3% (216/1506). Of the 82 patients included in the follow-up study, the longest duration of positive RT-PCR test, from the first positive to the first of the two negative RT-PCR tests, was 33 days (mean 11.6 days, median 10 days, interquartile range 8- 14 days). The initial Ct values significantly correlated with the duration of RT-PCR positivity (with ß=-0.54, standard error=0.09 for N gene, and ß=-0.44, standard error=0.09 for ORF1ab gene, p<0.001). Participants with higher Ct values corresponding to lower viral loads had shorter viral clearance time than those of lower Ct values or higher viral loads. Conclusion: Approximately 1 out of 7 tested miners had SARS-CoV-2 infection and the duration of their RT-PCR tests positivity independently correlated with the initial viral load measured by initial Ct values. As participants with lower initial Ct values tended to have longer disease duration, initial RT-PCR Ct values could be used to guide COVID-19 patient quarantine duration particularly at the work place.

Contexte: Pour contrôler la propagation de la maladie à coronavirus 19 (COVID-19) causée par le syndrome respiratoire aigu sévère coronavirus-2 (SRAS-CoV-2), il est nécessaire d'identifier et d'isoler de manière adéquate les patients infectieux, en particulier sur le lieu de travail. Le test de réaction en chaîne par polymérase en temps réel (RT-PCR) est la méthode de confirmation recommandée pour le diagnostic de l'infection par le SRAS-CoV-2. Le but de cette étude était de déterminer la prévalence de l'infection par le SRAS-CoV-2 au Burkina Faso et d'utiliser les valeurs du seuil initial du cycle (Ct) de la RT-PCR comme outil de suivi de la dynamique de la charge virale. Méthodologie: Entre septembre 2021 et février 2022, des écouvillonnages oropharyngés et/ou nasopharyngés de travailleurs symptomatiques COVID-19 et apparemment en bonne santé sélectionnés consécutivement du site minier de Wahgnion dans le sud-ouest du Burkina Faso qui ont consenti à l'étude ont été prélevés selon les deux programme de quart de semaines et testé pour le SRAS-CoV-2 à l'aide d'un test RT-PCR. Les patients positifs pour le virus ont été suivis chaque semaine jusqu'à ce que les tests soient négatifs. L'association des valeurs Ct initiales de la RT-PCR avec la durée de la maladie a été évaluée par une approche de régression linéaire ajustée. Une valeur p bilatérale < 0,05 a été considérée comme statistiquement significative. Résultats: Un total de 1506 participants (92,9% d'hommes) ont été recrutés dans l'étude, avec un âge moyen et une tranche d'âge de 37,1 à 8,7 ans et de 18 à 68 ans, respectivement. La prévalence globale de l'infection par le SRAS-CoV-2 était de 14,3% (216/1506). Sur les 82 patients inclus dans l'étude de suivi, la plus longue durée de test RT-PCR positif, du premier test positif au premier des deux tests RT-PCR négatifs, était de 33 jours (moyenne 11,6 jours, médiane 10 jours, intervalle interquartile 8-14 jours). Les valeurs Ct initiales étaient significativement corrélées à la durée de positivité de la RT-PCR (avec ß=-0,54, erreur standard=0,09 pour le gène N et ß=-0,44, erreur standard=0,09 pour le gène ORF1ab, p<0,001). Les participants avec des valeurs de Ct plus élevées correspondant à des charges virales plus faibles avaient un temps de clairance virale plus court que ceux avec des valeurs de Ct plus basses ou des charges virales plus élevées. Conclusion: Environ 1 mineur testé sur 7 était infecté par le SRAS-CoV-2 et la durée de la positivité de ses tests RTPCR était indépendamment corrélée à la charge virale initiale mesurée par les valeurs Ct initiales. Comme les participants avec des valeurs Ct initiales inférieures avaient tendance à avoir une durée de maladie plus longue, les valeurs Ct initiales de la RT-PCR pourraient être utilisées pour guider la durée de la quarantaine des patients COVID19, en particulier sur le lieu de travail.

Modelling COVID-19 vaccination status and adherence to public health and social measures, Eastern Mediterranean Region and Algeria

Objective: To study the link between coronavirus disease 2019 (COVID-19) vaccination status and adherence to public health and social measures in Members of the Eastern Mediterranean Region and Algeria. Methods: We analysed two rounds of a large, cross-country, repeated cross-sectional mobile phone survey in June­July 2021 and October­November 2021. The rounds included 14 287 and 14 131 respondents, respectively, from 23 countries and territories. Questions covered knowledge, attitudes and practices around COVID-19, and demographic, employment, health and vaccination status. We used logit modelling to analyse the link between self-reported vaccination status and individuals' practice of mask wearing, physical distancing and handwashing. We used propensity score matching as a robustness check. Findings: Overall, vaccinated respondents (8766 respondents in round 2) were significantly more likely to adhere to preventive measures than those who were unvaccinated (5297 respondents in round 2). Odds ratios were 1.5 (95% confidence interval, CI: 1.3­1.8) for mask wearing; 1.5 (95% CI: 1.3­1.7) for physical distancing; and 1.2 (95% CI: 1.0­1.4) for handwashing. Similar results were found on analysing subsamples of low- and middle-income countries. However, in high-income countries, where vaccination coverage is high, there was no significant link between vaccination and preventive practices. The association between vaccination status and adherence to public health advice was sustained over time, even though self-reported vaccination coverage tripled over 5 months (19.4% to 62.3%; weighted percentages). Conclusion Individuals vaccinated against COVID-19 maintained their adherence to preventive health measures. Nevertheless, reinforcement of public health messages is important for the public's continued compliance with preventive measures.

Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study

Background: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. Methods: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. Results: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p < 0.001), fewer antibiotics (p < 0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.