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

Impact of COVID-19 on management outcome of cervicofacial infections in a maxillofacial centre

INTRODUCTION: Cervicofacial infections (CFI) are life-threatening and constitute some of the common emergencies seen by the oral and maxillofacial surgeon on a regular basis. The COVID-19 pandemic resulted in reduced human activities for most of 2020 including the first worldwide lockdown. At the height of the pandemic, it was expected that the number of patients presenting with cervicofacial infections would drop as with most health conditions. The purpose of this study was to determine the impact of COVID-19 on the management and outcome of cervicofacial infections in a tertiary maxillofacial institution. PATIENTS AND METHODS: A retrospective analysis of patients who presented at the Maxillofacial clinic with cervicofacial infections and were subsequently admitted into the ward during the lockdown (2020) was compared with those of the previous year (2019) and the year after (2021).RESULTS: The total number of patients seen and admitted with cervicofacial infections in 2020 was 39(31.2%) which was lower than that seen the preceding year 48(38.4%) but higher than 38(30.4%) of the year after. 116 patients were treated while nine patients left hospital without treatment. All patients presented with extensive cervicofacial infections, involving more than three fascial spaces and were treated using parenteral antibiotics with surgical incision and drainage under local anesthesia. There were more deaths in 2020 (n=10) than in the preceding year (n=8) and the year after (n=7).CONCLUSION: A high percentage of CFI was admitted duringCOVID-19 period compared to the previous and following years. Involvement of multiple fascial spaces was also noted

INTRODUCTION: Les infections cervico-faciales (ICF) mettent la vie en danger et constituent certaines des urgences les plus courantes que rencontre régulièrement le chirurgien buccal et maxillo-facial. La pandémie de COVID-19 a entraîné une réduction des activités humaines pendant la majeure partie de l'année 2020, y compris le premier verrouillage mondial. Au plus fort de la pandémie, on s'attendait à ce que le nombre de patients présentant des infections cervico-faciales diminue comme pour la plupart des problèmes de santé. Le but de cette étude était de déterminer l'impact de COVID19 sur la gestion et le résultat des infections cervicofaciales dans une institution tertiaire maxillo-faciale. PATIENTS ET MÉTHODES: Une analyse rétrospective des patients qui se sont présentés à la clinique maxillo-faciale avec des infections cervico-faciales et ont ensuite été admis dans le service pendant le lockdown (2020) a été comparée à celles de l'année précédente (2019) et de l'année suivante (2021). RÉSULTATS: Le nombre total de patients vus et admis pour des infections cervico-faciales en 2020 était de 39 (31,2 %), ce qui était inférieur à celui de l'année précédente (48 (38,4 %)) mais supérieur à celui de l'année suivante (38 (30,4 %)). 116 ont été traités tandis que neuf patients ont quitté l'hôpital sans traitement. Tous les patients présentaient des infections cervico-faciales étendues, impliquant plus de trois espaces fasciaux et ont été traités à l'aide d'antibiotiques parentéraux, avec incision chirurgicale et drainage sous anesthésie locale. Il y a eu plus de décès en 2020 (n=10) que l'année précédente (n=8) et l'année suivante (n=7). CONCLUSION: Bien qu'un pourcentage élevé de FCI ait été admis pendant la période COVI-19 par rapport aux années précédentes et suivantes, l'implication de multiples espaces fasciaux a également été constatée

Community contribution to the control of Ebola outbreaks in Uganda, 2000-2022

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Interim guidelines for home-based isolation & care of confirmed COVID-19 cases

Homebased care for suspected or confirmed COVID -19 patients is the holistic and integrated care provided for asymptomatic and symptomatic confirmed cases of COVID-19 in the comfort of their homes. It encompasses biomedical, physical, psychosocial, palliative, and other aspects of care provided by patients, family members, community volunteers and /or healthcare workers under the supervision of a treatment centre with appropriate facilities for evaluation when necessary. As majority of patients are asymptomatic or mild and require minimal interventions for care, the home is an ideal place to manage such patients in a cost-effective manner with satisfactory outcomes. This allows the focus of institutional care to the management of moderate to severe cases. Patients who meet the criteria for home- based isolation and care after assessment of clinical risk, home risk, Infection Prevention and Control, adherence to guidelines, waste management and other factor are enrolled into a specific home- based care team attached to an isolation/treatment centre for supportive care. They are followed up to discharge after a minimum of 10 days after exposure, confirmation of test positivity, or onset of symptoms. The frequency of follow up is mainly based on the clinical risk assessment. Patients whose clinical risk or condition deteriorate are evacuated preferably to their supervising treatment centre. Specific roles of all stakeholders and personnel are clearly delineated with protocols and procedures for data management also well spelt out. Ultimately, it is envisaged that this revision of the home -based care guideline for management of asymptomatic and mild suspected or confirmed cases of COVID-19 would ensure efficient and effective management of covid-19 patients in their home with improved outcomes.

Community approaches to epidemic management in South Sudan. Lessons from local healthcare systems in tackling COVID-19

Across South Sudan, long before the global COVID-19 pandemic emerged, communities have created systems and structures to control the spread of epidemics and infectious diseases. South Sudanese people have extensive knowledge of infectious diseases and experience of organizing responses to epidemics during wars and other crises. Most people have experience of multiple epidemics within their households and neighbourhoods. Many informal healthcare providers have been involved directly in organized medical responses to past epidemic outbreaks: in several areas of the country people have been involved in contact tracing and infection management since the 1970s. This research report details community infectious disease management strategies developed within the realities of South Sudan's local healthcare systems. Because the South Sudan clinical healthcare sector is overstretched and only semi-functional, the majority of South Sudanese people mostly rely on non-clinical medical advice and support from a wide field of healthcare workers and caregivers, including small private clinics and unlicenced pharmaceutical sellers, traditional herbal and surgical experts, midwives and spiritual healers. South Sudanese community-led infectious disease management relies on symptomatic identification, the containment of potential infections through applying knowledge of infection vectors and pathologies, and creative treatment using a high level of botanical knowledge. There are multiple, locally-specific methods used by communities for interrupting infection transmission and managing epidemics. For airborne diseases or infections spread through contact, people often organize houses for self-isolation, mark out separate food and water access points for households, make homemade rehydration salts, carefully manage dirty linen, bed spaces and drinking water provision to avoid cross-contamination, and use urine, hot water and ashes for disinfecting. Different communities across the country use crossed posts, rope barriers, or ash markings across paths to warn people away from sick households in quarantine. Particular care is taken to avoid transmission to high-risk residents, especially pregnant and post-partum women and young children. Across research sites, people are already working on developing local safety measures and strategies to prevent the further spread of COVID-19 in South Sudan. This research documents these community infectious disease management strategies, based on sustained investigative research in the Yei, Juba, Wau, Malakal, Aweil West and Rubkona areas, both in-person and remotely via telephone, from August to November 2020.1 The health and wellbeing of the team and our interviewees was the prioritythroughout the project. Interviewees include midwives and traditional birth attendants, male and female nurses, herbal experts, traditional healers, pharmacists, chiefs and community elders, elderly women, and local public health workers, among many others. Recommendations for action include: 1. Collaborate with wider non-clinical health workers and caregivers, who are often first responders, including women, midwives, herbal experts and local pharmaceutical sellers. Include these workers in public health planning and clinical training. 2. Support communities with the broad epidemiological and logistical skills to prepare for COVID-19 and other epidemic outbreaks. Build sustained and detailed public health information systems to help local non-clinical and clinical workers plan locally appropriate infectious disease management strategies. More detailed and sustained information drives, in partnership with local first responders, will also build trust and counter misinformation and fatigue. 3. Localise epidemic response planning. Central planning is heavy handed and ineffective, overlooking critical local knowledge and community leadership that will make responses effective. Public health strategies should aim to build on measures people already take to try to protect themselves and their communities from multiple infectious diseases.

Immunization Monitoring and Vaccine-Preventable Diseases Surveillance Data Management in the African Region

Countries in the WHO African Regionhave well-established national immunization programmes and disease control programmes working towards the different goals for the control of vaccine-preventable diseases; and generating coverage and surveillance data. WHO provides technical support to standardize the approaches; methodology; and tools used for data management. The datasets are shared with WHO for purposes of monitoring the coverage and disease trends across the Region. This article reviews the methods WHO employs to build capacity in this field of data management across the Region and the resultant achievements and gaps. Despite the recent improvements in some aspects of data quality; important policy; technical and managerial gaps remain; which need to be addressed in order to ensure that the data coming out of these national programmes are of optimal quality

The End of AIDS: Possibility or Pipe Dream? A Tale of Transitions

Globally; in the last 20 years health has improved. In this generally optimistic setting HIV and AIDS accounts for the fastest growing burden of disease. The data show the bulk of this is experienced in Southern Africa. In this region; HIV and AIDS (and tuberculosis [TB]) peaks among young adults. Women carry the greater proportion of infections and provided most of the care. South Africa has the dubious distinction of having the largest number of people living with HIV in the world; 6.4 million. HIV began spreading from about 1990 and today the prevalence among antenatal clinic attendees is 29.5. A similar situation exists in other nations of the region. It is an expensive disease; requiring more resources than are available; and it is slipping off the global agenda; both in terms of attention and international funding. Those halcyon days of the decade from 2000 to 2010 are over. This paper explores the concept of three transition points: economic; epidemiological and programmatic. The first two have been developed and written about by others. We add a third transition point; namely programmatic; argue this is an important concept; and show how it can become a powerful tool in the response to the epidemic.The economic transition point assesses HIV incidence and mortality of people infected with HIV. Until the number of newly infected people falls below the number of deaths of people living with HIV; the demand for treatment and costs will increase. This is a concern for the health sector; finance ministry and all working in the field of HIV. Once an economic transition occurs the treatment future is predictable and the number of people living with HIV and AIDS decreases. This paper plots two more lines. These are the number of new people from the HIV infected pool initiated on treatment and the number of people from the HIV infected pool requiring treatment. This introduces new transition points on the graph. The first when the number of people initiated on treatment exceeds the number of people needing treatment. The second when the number initiated on treatment exceeds the new infections.That is the theory. When we applied South African data from the ASSA2008 model; we were able to plot transition points marking progress in the national response. We argue these concepts can and should be applied to any country or HIV epidemic

Interface entre programmes verticaux et services de sante generaux. Comment optimiser cette relation dans les systemes de sante d'Afrique Subsaharienne?

En Afrique subsaharienne; l'interface entre les programmes verticaux et les services de sante generaux (SSG) est un domaine prioritaire de recherche. En effet; les approches horizontale et verticale d'offre de soins ont ete diversement utilisees pour delivrer des soins aux patients. Mais de nombreux besoins de sante des populations sont restes non couverts. Ceci a engendre des tensions sur le choix de l'approche la mieux adaptee et un debat d'ecole s'est installe au sein de la communaute de sante publique mondiale. Ce debat perdure depuis des decennies et a ete largement nourri par des positions ideologiques opposees. Aujourd'hui; en Afrique subsaharienne; la performance des systemes de sante reste globalement faible. Pourtant; les ressources allouees aux systemes de sante ont considerablement augmente a partir des annees 2000 suite a l'emergence des Initiatives Globales de Sante (IGS) qui se focalisent sur des problemes de sante specifiques. Ces IGS mobilisent des fonds et de l'expertise qui pourraient etre utilises pour renforcer les systemes de sante afin qu'ils deviennent plus performants et puissent mieux repondre aux attentes des populations. Les etudes sur la relation entre ces IGS et les systemes de sante ont surtout analyse leurs effets au niveau national ou leur impact sur des indicateurs specifiques de sante. Les effets des programmes sur les systemes locaux de sante et surtout sur les hopitaux de district (HD) ont ete peu etudies. Cette recherche vise a fournir davantage de donnees empiriques sur l'interface entre les programmes verticaux et les SSG en Afrique subsaharienne. Le document comporte cinq parties. La premiere partie concerne l'introduction; les hypotheses et les objecti

Health transition in Africa: practical policy proposals for primary care

Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS; tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example; age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people; primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well; within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa; they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition

Strengthening public health laboratories in the WHO African Region: a critical need for disease control

Despite the progress and efforts being made to strengthen laboratory capacities in the Region; challenges remain. The purpose of this document is to raise awareness on the need to strengthen public health laboratory services and propose actions for building national laboratory capacity

Adoption of Formal HIV and AIDS Workplace Policies: An Analysis of Industry/Sector Variations

Addressing HIV and AIDS is the responsibility of many stakeholders including private sector companies. However; increasing evidence reveals that the majority of companies around the world are yet to acknowledge and respond to HIV and AIDS as a workplace issue. One factor that has been identified in the literature as playing a role in determining whether a company responds to HIV and AIDS; or not; is the industry/sector in which a company operates. This study therefore sought to empirically examine whether in the context of Malawi there were significant variations in the adoption of formal HIV and AIDS workplace policies based on the industry/sector in which a company was operating; as well as analyse the dynamics underlying such variations. Using survey data collected from 152 randomly selected private sector companies in Malawi; the results of this study revealed significant variations in the adoption of HIV and AIDS workplace policies among companies operating in various sectors. Companies in the service sector were leading the adoption compared to companies in other sectors such as the trading sector. Furthermore; the evidence from this study showed that differences in staff participation in the activities of HIV and AIDS institutions may explain the industry/sector variations. These results provide an important avenue to scale up company responses to HIV and AIDS by intensifying staff participation in the activities of HIV and AIDS institutions. Such institutions appear to play a vital role of providing up to date HIV and AIDS-related information upon which companies are able to develop a business case for responding to the epidemic

How Successful is South Africa in Decreasing Communicable Diseases?

The success of the public health sanitation movement included the use of vaccines; and antibiotics led many to assume that all infectious diseases would sooner or later succumb to medical technology and public health measures. Unfortunately this did not happen. Late in the 20th century and now early in the 21st century we see the onset of new communicable diseases such as HIV/ AIDS and severe acute respiratory syndrome (SARS) and the resurgence of old communicable diseases such as tuberculosis (TB) and malaria. The persistence of measles as a major killer of over one million children per year represents a failure in effective use of both the vaccines and the health systems in developing countries. Nowhere else can we see these problems better than in our own backyard

Circoncision et prevention du VIH : en complement du preservatif dans certaines populations

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Monitoring and evaluation of Integrated Disease Surveillance and Response in selected districts in Tanzania

Integrated Disease Surveillance and Response (IDSR) is a strategy developed by the World Health Organization. Regional Office for Africa in 1998. The Ministry of Health; Tanzania has adopted this strategy for strengthening communicable diseases surveillance in the country. In order to improve the effectiveness of the implementation of IDSRmonitoring and evaluating the performance of the surveillance system; identifying areas that require strengthening and taking action is important. This paper presents the findings of baseline data collection for the period October - December 2003 in 12 districts representing eight regions of Tanzania. The districts involved were Mbulu; Babati; odoma Rural; Mpwapwa; Igunga; Tabora Urban; Mwanza Urban; Muleba; Nkasi; Sumbawanga Rural; Tunduru and Masasi. Results are grouped into three key areas: surveillance reporting; use of surveillance data and management of the IDSR system. In general; reporting systems are weak; both in terms of receiving all reports from all acilities in a timely manner; and in managing those reports at the district level. Routine analysis of surveillance data is not being done at facility or district levels; and districts do not monitor the performance of their surveillance system. There was also good communication and coordination with other sectors in terms of sharing information and resources. It is important that districts' capacity on IDSR is strengthened to enable them monitor and evaluate their own performance using established indicators

The Need for Law in the Control of HIV/AIDS in Uganda

Two decades have passed since the AIDS epidemic emerged. during this short period the disease has taken root particularly in sub-Saharan Africa where out of the total global estimate of 40 million by the end of 2001; 28.1 million are within sub-Saharan Africa as the epicentre of the disease. The disease is decimating the youth at a highly alarming rate and is putting considerable pressure on resources for the care of the AIDS victims and theor orphans. The disease has dawned on a region deeply colonised by poverty; wars and insurgency in the presence of inadequate health care infrastructures and economies. AIDS is making an already bad situation worse. HIV/AIDS has vehemently condemed sub-Saharan Africa to immense suffering. According to the end of 2001 global estimates for children and adults by the World Health Organisation; the new HIV infections during the year 2001 is 5 million. Such a figure is unacceptable; as it is a real threat to Africa where the problem is greatest

HIV/AIDS Surveillence Report

The HIV/AIDS infection rates from the major sentinel surveillance sites continue to show declining trends. In the major urban areas where this trend has been observed since 1992; antenatal prevalence rates in Nsambya and Rubaga; for example have continued to decline from 13.4and 14.2in 1998 to 12.4and 10.5respectively in 1999. In Jinja and Mbarara sentinel sites; the rates have remained relatively stable between 1998 and 1999 while clear declines were recorded in both Mbale and Tororo sentinel sites. The declines in all these situations continue to be most significant in the young age groups 15-24 years. In rural areas; where trends have in the past exhibited a mixed pattern of stablisation and decline; prevalence rates now appear to be on a clear downward trend. Antenatal prevalence rates for example in Matany and Mutolere sentinel sites have steadily declined from 2.8and 4.2in 1993 to 0.9and 2.3respectively in 1999. Similar observations were made in Lacor Hospital; Gulu; Northern Uganda where trends have fallen from 27.1in 1993 to notable among the young age cohorts. Data from the Kyamulibwa general population cohort continue to show declining prevalence rates for both young males and females. The greatest decline was observed among males aged 20-24 years. There has also been an observed decline in incidence for adults of all years (PY) of observation in 1990 to 3.2/1000 PY in 1998. The decline among males was from 9.4/1000 PY in 1990 tp 2.4/1000 PY in 1998 compared with 6.0/1000 PY in 1990 and 4.0/1000 PY in 1998 for females. Likewise; data from the AIDS Information Centre continues to show declining HIV sero-prevalence among young persons seeking voluntary counselling and testing. among the 15-24 year olds; the prevalence rates have declined from 11among males and 29in females in 1992 to 2.5and 12.1respectively in 1999. In this report; we also present trends of HIV infection rates among STD patients attending a major referral STD clinic in Kampala. The prevalence rates among STD patients have continued to decline from 20.4in 1998 t0 23.0in 1999. These rates have always been higher ona verage than those of antenatal mothers from any of the antenatal sentinel sites. In spite of the observed dent in the HIV/AIDS epidemic; it is important to note that the HIV infection rates are still unacceptably high. Clearly; this points out the need for continued concerted efforts to sustain and improve the existing AIDS prevention and control initiatives. The programme needs to sustain the achievements of the high levels of awareness and knowledge and ensure that they transform into higher levels of behaviour change