Primeira Conferência Científica sobre COVID-19 em Moçambique com Uso Combinado de Plataformas de Informação e Comunicação / First Scientific Conference on COVID-19 in Mozambique with Combined Use of Information and Communication Platforms

O Instituto Nacional de Saúde (INS) organi zou, entre os dias 17 e 18 de Junho do presen te ano, a primeira Conferência Científica sobre a COVID-19 no país. O evento teve lugar nas instalações do INS, em Marracuene, tendo sido transmitida em directo por várias plataformas de comunicação e informação, uma vez que, pelo contexto da pandemia, não era possível realizar um evento presencial abrangente. Em cada um dos dias, houve uma sessão plenária seguida de painéis, com um orador e três comentadores. As sim, a conferência ligou entre si investigadores, académicos e público em geral através de várias plataformas de comunicação e informação (televi são, rádio, jornal e plataformas digitais: facebook, youtube e zoom) num evento que visava promo ver o debate científico sobre a COVID-19, e os desafios que ela coloca à sociedade moçambicana. Pretendia também analisar a resposta à pandemia em Moçambique e no mundo, nos planos eco nómico, social, cultural e, particularmente, no campo das ciências biomédicas. O modelo virtual desta conferência, permitiu a interacção com os participantes, tendo estes gozado da possibilidade de colocar questões aos membros do painel.

The National Institute of Health (INS) organized, between the 17th and 18th of June of this year, the first Scientific Conference on COVID-19 in the country. The event took place at the INS premises, in Marracuene, and was broadcast live by various communication and information platforms, since, due to the context of the pandemic, it was not possible to hold a comprehensive face-to-face event. On each day, there was a plenary session followed by panels, with one speaker and three commentators. Thus, the conference connected researchers, academics and the general public through various communication and information platforms (television, radio, newspaper and digital platforms: facebook, youtube and zoom) in an event that aimed to promote the scientific debate on COVID-19, and the challenges it poses to Mozambican society. It also intended to analyze the response to the pandemic in Mozambique and in the world, at the economic, social, cultural levels and, particularly, in the field of biomedical sciences. The virtual model of this conference allowed interaction with the participants, who enjoyed the possibility of asking questions to the panel members.

The challenge of COVID-19 case identification and ascertainment in sub-Saharan Africa: the case of Cameroon

Confirmation of COVID-19 infection is still challenging in Cameroon due to lack of sufficient RT-PCR tests and screening capacity. International organizations as well as philanthropic donators initially provided these tests. Due to limited kits availability, mass screening is currently a luxury that the country cannot afford. This impacts on estimates of disease prevalence, on the understanding of its burden and delays the implementation of targeted preventive measures. Besides RT-PCR, chest CT-scan could be a useful tool for screening purposes. However, its sensitivity and cost make its integration in management algorithms difficult. We discuss below the challenges and potential solutions that could ease the diagnosis of COVID-19 infection in Cameroon

COVID-19 Pandemic in Nigeria: A review

Background: An ongoing outbreak of pneumonia associated with a novel coronavirus was reported in Wuhan city, China. This new virus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses. That disease, caused by the SARS-CoV-2, has been named coronavirus disease 2019 (COVID-19) by the WHO. The outbreak has since spread across the globe, including countries in Africa. Main body: The dominant mode of transmission is from the respiratory tract, via droplets or indirectly via fomites, and to a lesser extent via aerosols. The rapidity with which the infection spread throughout the world was unexpected. The disease has now affected 212 countries, areas, or territories, with more than 2.1 million total confirmed cases and over 144 thousand fatalities as at the time of writing. It, therefore, behooves countries of the world to take firm public health measures for the pandemic is to be contained. Conclusion: Nigeria, with a population of at least 170 million people, is of global interest because a rapid rise in the number of infected people will have serious implications not only for the country but for the whole African continent

Ebola virus disease preparedness in countries bordering Democratic Republic of Congo: lessons from west African outbreak: Ebola virus disease preparedness

Background: Ebola virus disease ravaged three West African countries in the wake of 2014 which was seen as the deadliest Ebola Virus Disease (EVD) outbreak in history. Several lessons were taken out of the West African outbreak one of which is the lack of preparedness by countries in the region.Materials and Methods: This paper looked at the mistakes of the West African outbreak and reports how such mistakes were corrected in the current outbreak going on in the Democratic Republic of Congo (DRC). Preparedness efforts are currently taking place in countries bordering DRC which included quick detection and response to an eventual EVD event.Results: This paid off on several occasions when cases from DRC to Uganda were quickly detected and response was as quick as possible. Preparedness carried out in Countries bordering DRC included setting up of Rapid Response Team (RRT) and training of these teams both at country and regional level. All members of the RRT were trained in all areas of readiness which included community engagement, laboratory, logistics, surveillance, case management, sample collection, packaging and shipment as well as Infection Prevention and Control (IPC).Conclusion: These trainings have led to readiness to an eventual EVD event. Countries now have the ability to respond quickly with better Emergency Operation Centre (EOC) for EVD

Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Background: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. Methods: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. Results: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. Conclusion: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. African relevance: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening

COVID-19 response in Ethiopia: challenges and opportunities

Ethiopia implemented public health measures to curve COVID pandemics earlier than many countries. Airport screening, followed by partial closure of international flights and quarantine of all international travelers have slowed the trajectory of COVID-19 pandemics in its early phase. Early adoption of Public health measures including hand hygiene and use of facemask have also contributed to the slow trajectory seen in the early days of the pandemics. Unfortunately, early gains have been beset by slow scale-up of public health measures, recent lifting of the state of emergency and public fatigue. Hospitals are already at capacity and not equipped to handle even the lowest estimate the country expects at the peak of the pandemic. To mitigate the impact of the pandemics, Ethiopia must return to the basics of public health measures: increase testing, upscale contact tracing, social distancing and universal use of face mask quickly and across the country

A rapid review of the effectiveness of screening practices at airports, land borders and ports to reduce the transmission of respiratory infectious diseases such as COVID-19

Background. Travel screening for infectious diseases is often implemented to delay or prevent the entry of infected persons to a country/area.Objectives. To evaluate the effectiveness of different point-of-entry screening strategies in achieving a reduction in imported COVID-19 transmission.Methods. A rapid evidence review was conducted, systematically searching PubMed and Google Scholar and grey literature on 27 March 2020.Results. We screened 1 194 records. Nine potential full-text articles were assessed for eligibility and included. Three articles investigated the effectiveness of entry-based thermal and body temperature scanning. Entry-based infrared thermal or body temperature scanning for COVID-19 was unlikely to be effective. Two systematic reviews found no additional benefit of travel restrictions/screening. In a COVID-19 modelling study, airport screening was not effective, with exit and entry thermal scanning identifying half and missing almost half of infected travellers. Two other modelling studies found that entry-based travel screening would achieve only modest delays in community transmission, while international travel quarantine could reduce case importations by 80%.Conclusions. There is insufficient evidence to support entry and exit screening at points of entry, as these strategies detect just over half of the infected cases, missing almost half at entry points. The benefits of airport screening therefore need to be context specific and weighed against the resources and cost of implementation, the contribution of imported cases to total cases, and the benefits of identifying 50% of cases in the South African context with the country's high HIV and tuberculosis prevalence and limited resources to deal with a pandemic of this nature

Healthcare workers' adherence to infection prevention and control guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis

COVID-19 spreads easily between people who are in close contact, or through coughs and sneezes. As the number of cases continues to increase, healthcare workers (HCWs) are notably at risk as a result of frequency of contact with suspected cases or infected people. Use of infection prevention and control (IPC) strategies by HCWs is therefore important. We summarise the evidence from a rapid Cochrane qualitative evidence synthesis by Houghton et al. on barriers and facilitators to HCWs' adherence to IPC guidelines for respiratory infectious diseases

Transmission of respiratory viruses when using public ground transport: A rapid review to inform public health recommendations during the COVID-19 pandemic

In response to the COVID-19 pandemic, numerous countries worldwide declared national states of emergency and implemented interventions to minimise the risk of transmission among the public. Evidence was needed to inform strategies for limiting COVID-19 transmission on public transport. On 20 March 2020, we searched MEDLINE, CENTRAL, Web of Science and the World Health Organization's database of 'Global research on coronavirus disease (COVID-19)' to conduct a rapid review on interventions that reduce viral transmission on public ground transport. After screening 74 records, we identified 4 eligible studies. These studies suggest an increased risk of viral transmission with public transportation use that may be reduced with improved ventilation. International and national guidelines suggest the following strategies: keep the public informed, stay at home when sick, and minimise public transport use. Where use is unavoidable, environmental control, respiratory etiquette and hand hygiene are recommended, while a risk-based approach needs to guide the use of non-medical masks

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes

Isolation and quarantine in South Africa during COVID-19: Draconian measures or proportional response?

In the midst of an unprecedented public health crisis, extraordinary containment measures must be implemented. These include both isolation and quarantine, either on a voluntary basis or enforced. In the transition from voluntary to mandatory isolation, conflicts arise at the intersection of ethics, human rights and the law. The Siracusa Principles adopted by the United Nations Economic and Social Council in 1985 and enshrined in international human rights legislation and guidelines specify conditions under which civil liberties may be infringed. In order for isolation processes in South Africa to claim legitimacy, it is important that these principles as well as national laws and constitutional rights are embedded in state action

Personal protective equipment (PPE) in a pandemic: Approaches to PPE preservation for South African healthcare facilities

Personal protective equipment (PPE) is key to protecting healthcare workers from COVID-19 infection, but the pandemic has disrupted supply chains globally and necessitated rapid review of the scientific evidence for PPE re-use. In South Africa, where the COVID-19 epidemic is still developing, healthcare facilities have a short window of opportunity to improve PPE supply chains, train staff on prudent PPE use, and devise plans to track and manage the inevitable increases in PPE demand. This article discusses the available PPE preservation strategies and addresses the issue of decontamination and re-use of N95 respirators as a last-resort strategy for critical shortages during the pandemic

Reintroduction of elective paediatric otolaryngology procedures in South Africa during the COVID-19 pandemic

Cancelling elective clinical consultations and surgical procedures was instrumental in assisting hospitals prepare for the COVID-19 crisis. Essential bed space was made available, and it allowed mobilisation of health workers and enforced social distancing. A shift in patient-centred ethics to public health ethics was required to provide a utilitarian approach to the crisis. However, at some point, clinicians need to start becoming patient centred again, and this needs to happen within the utilitarian framework. Children only account for 1 - 5% of confirmed COVID-19 cases, and they present with a much milder disease spectrum than adults. Consequently, paediatric units may be at the forefront of implementing reintroduction of patient-centred elective clinical and surgical procedures. The following recommendations provide a framework to do this in a way that minimises risk to patients and clinicians. They are the first paediatric guidelines in the literature to propose a strategy to reintroduce elective surgical procedures

Mothers' knowledge of mother-to-child transmission of HIV and infant feeding practices in Juba, South Sudan

Introduction: While exclusive breastfeeding for the first six months of life is recommended for HIV-infected mothers, this may not be practiced fully in South Sudan; exclusive formula feeding, which is the best alternative to breastfeeding, may not be practical. Objective: To assess the knowledge of mother-to-child transmission of HIV (MTCT) and practices of feeding infants in the first six months of life among HIV-infected mothers attending Antiretroviral Therapy Centres in Juba Teaching Hospital (JTH) and Juba Military Hospital (JMH). Method: A cross-sectional study in which 304 HIV-infected mothers with children aged 6-18 months were interviewed between October and December 2016 using structured questionnaires. Key informant interviews (KIIs) and focus group discussions (FGDs) were also conducted using interview guides. Quantitative data was analysed using Statistics Package for Social Sciences software. Chi-square test was used to test the presence of significant association between the variables and the association is statistically significant when the p-value is < 0.05. Multiple logistic regression analysis was used to identify which predictor variables have major effect on the dependent variable. Qualitative data was transcribed in English and summarized according to the key themes, and the information obtained was used to supplement and interpret the findings of the quantitative data. Results: Only 120 (40%) of the HIV-infected mothers had a good knowledge of MTCT; 213 mothers (70.1%) practiced mixed feeding, 70 (23.0%) practiced exclusive breastfeeding and 20 (6.6%) practiced exclusive formula feeding. The factors that were found to have a positive effect on choice of infant feeding methods were having more than one child (odds ratio = 0.303, 95% Confidence interval: 0.161-0.571, p = 0.001) and participation in the prevention of motherto-child transmission of HIV programme (PMTCT) (odds ratio = 2.260, 95% Confidence interval: 1.251-4.084, p = 0.007). Stigma (p = 0.248) and mothers' knowledge of MTCT (p = 0.072) were not statistically significantly associated with the mothers' infant feeding practices. Conclusion: Knowledge of MTCT is low. Mixed feeding before six months of age is predominant among the HIV-infected mothers. It is therefore recomm;ended that HIV-infected mothers receive adequate information from counsellors regarding MTCT and exclusive breastfeeding for the first six months of an infant's life

Profile and management of central nervous system malformations in a tertiary hospital

Background: Central Nervous System (CNS) malformations rank among the commonest malformations. These may be identified in utero or noticed immediately after birth. Most studies showed Myelomeningocoele, a Neural Tube Defect (NTD) to be the commonest. Severe defects have a significant impact on long term disability. While some are preventable, most are surgically managed. Objective: To study the profile and management of CNS malformation in a tertiary hospital. Method: we undertook a 3-year retrospective study of the profile and surgical management, including the postoperative complications among Neonates admitted into the Special Care Baby Unit (SCBU). Data on place of delivery, Gender, Gestational age, Mode of delivery, Prenatal Diagnosis (Ultrasound Scan), types of malformations, types of surgeries, and postoperative complications were retrieved. Result: We found 71 patients with CNS anomalies (31.8% of all congenital anomalies), in delivery 10 (14.1%), out delivery 46(64.8%). Male=43, females=28. Term gestation 66 (93%), preterm 3(4.2%), post-term 2(2.8%). Delivered by Vagina (SVD) in 65(91.6%), Caesarean section 4(5.6%), and undocumented in 4(5.6%). Prenatal diagnosis in only 3(4.2%). Myelomeningocoele was 35(49.3%), meningocoele was 9(12.7%), Hydrocephalus was 18(25.3%), anencephaly was 1(1.4%), occipital Encephalocoele was 6(8.5%), Sincipital Encephalocoele was 2(2.8%). Operated on 53(75%), LAMA/lost to follow was 13(18%), preoperative death was 5(7%). Excision and closure of Neural Tube Defect were 34(64.2%), VP Shunt was 13(24.5%), Excision and closure of occipital Encephalocoele were 5(9.4%) craniofacial excision and repair of Sincipital Encephalocoele was 1(1.9%). CSF leak in 4(28.6%), wound infection in 3(21.4%), shunt infection and obstruction in 2(14.3%) each. meningitis, hypertrophied scar, and pseudo meningocoele in 1(7.1%) each. Conclusion: The commonest CNS anomaly is a Myelomeningocoele a preventable condition, Sincipital Encephalocoele is not common in our environment. Concomitant treatment of hydrocephalus averts post excision CSF Leak