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.

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.

Complications following COVID-19 infection or vaccination in Libyan International Medical University students and their Families

Coronavirus disease 2019 (COVID-19) caused by a novel strain of coronavirus belonging to the genus Beta coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as a major pandemic worldwide. This contagious virus had spread in many different forms, and patients have demonstrated a wide range of symptoms, ranging from moderate to severe illness. This study aims to highlight the important associations between SARS-CoV-2 infection, vaccination, and possible complications at the Libyan International Medical University, Benghazi. This crosssectional survey was conducted among students and their families at Libyan International Medical University in Benghazi, Libya. Among the 100 participants, 72% were between the ages of 18 and 39. Up to (59%) of participants were men. As for the infection with COVID-19, 77% of participants were infected. Most of the participants had no chronic diseases (69%); however, the most common chronic disease was diabetes mellitus (13%). 82% of participants were vaccinated; the most common types of vaccines administered were Sinopharm and Sputnik V (24%). Following vaccination, 71% of participants had no COVID-19 infection, while 29% did get the infection. Regarding this study, after COVID-19 infection, 66% of participants had no complications; however, 17% had pulmonary complications, which was the most common complication among the participants. As for the complications following the vaccination, 81% of participants had none, while there were pulmonary and neurological complications in 7­6%. The results of the study showed that the most frequent complications noticed among the participants following the COVID-19 infection and vaccination were pulmonary and neurological complications.

In-Hospital continuous medical education during the COVID-19 pandemic

Background:The coronavirus disease 2019 (COVID-19) is a highly contagious disease as it is spread by contact with infected surfaces and inhalation of droplets. Several measures have been put in place to prevent the COVID-19 infection one of which is social distancing and physical distancing. Some in-hospital continuous medical education was suspended during the pandemic.Objective of Study: The objective of the study is to investigate the impact of social distancing on In-hospital continuous professional development during the COVID-19 pandemic.Research methodology:This is a cross-sectional study conducted among doctors working in Nigeria irrespective of their cadre or location. Aself-administered online questionnaire was used to generate data for this study. There was no risk of participating in the study. Results:The respondents in this study were 62. The majority 51(82.3%) had different in-hospital continuous medical education (CME) activities during the first wave of the COVID-19 pandemic when there was a ban in Nigeria on the gathering of more than 20 persons; the CME activities were via Zoom video conferencing 44 (71%) App. The majority of the respondents however preferred a face-to-face (physical) meeting [40(74.2%)] and also learnt better during a face-to-face meeting [46(74.2%)]. Conclusion:CME is very important in healthcare so COVID-19 did not stop it although it went through a lot of transformation in the mode it was delivered

Essential health services delivery status during COVID-19 pandemic in Ethiopia: A national mixed-methods survey of primary healthcare units

BACKGROUND: Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19. METHODS: A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically. RESULTS: The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities. CONCLUSION: The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.

Experiences of nursing students preparedness to migrate to online learning during COVID-19 lockdown in Namibia

Background: COVID-19 made it mandatory for Namibian education institutions to transition from traditional face-to-face classroom learning to online learning. Minimal time was available to prepare nursing students to adopt this model of learning, which subsequently influenced their learning experiences. Aim: The aim of the study was to explore and describe nursing students' experiences regarding their preparedness to migrate to online learning during the COVID-19 lockdown at a public university in Namibia. Setting: Semi-structured interviews were conducted in English at the public university in Kavango East, Namibia. Methods: A qualitative approach utilising an exploratory and descriptive design was used. Convenience sampling and a semi-structured interview guide was used to assess the experiences of undergraduate nursing students. Data saturation was achieved after 15 interviews. ATLAS.ti 8 software assisted with management of data that was analysed inductively following the six steps of thematic analysis. Results: The following themes emerged from analysis of the data: (1) students' readiness to migrate to online learning; (2) challenges faced by nursing students during the migration to online learning; and (3) strategies to support the transition from face-to-face to online learning. Conclusion: The study's findings show that the student nurses were unprepared for online learning due to lack of skills and the ability to use technology to navigate online learning platforms. Access to online learning was also hampered by poor Internet connectivity and unreliable electronic devices. Contribution: These findings may be used to develop targeted interventions and strategies to mitigate challenges faced during transition from face-to-face to online learning.

Knowledge and practice of COVID-19 preventive measures: comparative analysis of medical and non-medical students University of Port Harcourt

Background: The influence of COVID-19 has impacted the education sector just like it has other sectors. This study examined the level of knowledge, attitude, and practice of COVID-19 preventive measures among medical and non-medical students of the University of Port Harcourt, Rivers State Method: A comparative cross sectional study design using a selfadministered structured questionnaire involving a total of 406 students; medical (200) and non-medical (200), using multi-stage sampling. Frequency, percentages, means, and standard deviation were used to describe data where necessary. Chi-square and Fisher exact was used to compare knowledge, attitude, and practice of COVID-19 preventive measures between medical and non-medical students. Results: The mean age of medical and non-medical students was 25.04 and 22.59 respectively. A total of 70% from medical students arm received COVID-19 vaccines while 15.5% of non-medical students arm. 152(73.8%) non-medical students and 123(61.5%) medical students had good knowledge of COVID-19. Positive attitude toward COVID-19 preventive measures was showed by 119(59.5%) medical students and 62(30.1%) nonmedical students. Concerning practice of COVID-19 preventive measures, 99(48.1%) medical students and 78(39.0%) non-medical students practiced appropriately. A chi-square test for association showed that gender, academic level, religion, accommodation status, vaccination status, geopolitical zone, and faculty of students were significantly associated with knowledge, attitude, and practice of COVID-19 preventive measures. Chisquare test also showed that knowledge of COVID-19 was significantly associated with the practice of COVID-19 preventive measures. Conclusion: Non-Medical students had better knowledge than medical student although difference was not significant. Attitude was good and practice of COVID-19 preventive measures was poor among medical students, while poor attitude and poor practice among non-medical students was observed.

Resilience of undergraduate health sciences students during COVID-19: An integrative review

Background: COVID-19 pandemic placed pressure on global health systems, healthcare providers and undergraduate students in health sciences. Students experienced change in the teaching and learning as well as the clinical context resulting in increased stress levels. Resilience assisted students to adapt and develop competencies and effective coping mechanisms. Aim: The purpose of this integrative review is to identify resilience of undergraduate students in health sciences during the COVID-19 pandemic. Setting: Online platforms. Methods: An integrative review was conducted with keywords: resilience, undergraduate students, health sciences and COVID-19. Three different searches were conducted for the time frame 2020­2022 on the relevant electronic data bases with full text articles. A total of 1665 records were identified and 49 potentially relevant articles were identified. Screening resulted in 34 articles that were analysed using the John Hopkins critical appraisal criteria. Results: Four themes were identified: attributes of students' resilience, aspects enhancing the development of resilience, aspects hindering the development of resilience and recommendations to cultivate resilience. Conclusion: Resilience is key to withstand the challenges in the global health system. The development of resilience in undergraduate health sciences students should be prioritised to ensure cognitive adaptability, effective coping skills and sufficient support. Contribution: These findings can assist higher educational institutions to improve their undergraduate health science programs to cultivate resilient health care professionals.

Effectiveness and impact of Covid-19 response and vaccination challenges in Namibia: a systematic review

Introduction: Namibia, as with many countries around the world is experiencing devastating impact of Covid-19 disease on the economy, psycho-social interactions, and well-being of the populace. These countries implemented several measures to limit the spread of the virus responsible for the severe acute respiratory syndrome (SARS-CoV-2). Namibia also put measures in place to curtail the spread and fatalities due to the virus. However, the nature and implementation strategies of Public Health regulations seriously have impact on preventing the spread and curtailing fatalities arising from the virus. Objective: This article presents a report on the effectiveness and impact of Public Health measures instituted by the Health Authority towards curtailing the scourge of covid-19 on the general populace. Method: Elements of the PRISMA protocol was utilised in the review which enabled the synthesis of data on focused area. Multifaceted databases on covid19 such as Scopus, ScienceDirect, Google Scholar, World Health Organisation and the Ministry of Health and Social Services of Namibia (MoHSS) among others was used. Result: A steady increase in covid-19 infection at an average rate of eleven (11) per day was noted in the country up till June 2021. Highest rate was linked to densely populated regions of Erongo and Khomas. Control measures for infection prevention and vaccination drive was ineffective majorly as a result of misinformation. 3

Abrupt introduction of distance learning during the covid­19 pandemic: What psychological impact on teachers?

As soon as the COVID 19 , the Moroccan education ministry decided to adopt distance learning (DL). Our target was to study the psychological impact of DL on Moroccan teachers during the pandemic. This cross-sectional study used an online questionnaire based on the Hospital Anxiety and Depression Scale. Among %, and the average age was 41.1±11.5 years. 79.1% participated in DL, 58.8% were required to acquire DL tools and 71.6% had never received DL training. Between the start and the end of confinement, we noticed a decrease in the motivation of teachers.36.2% had definite depressive symptomatology and 41.3% had certain anxiety symptomatology with a significant predominance in women. The frequencies of depression and anxiety were higher in those who had participated in DL, but the association was not significant. Depression was significantly frequent among teachers who were obliged to acquire tools to practice DL P=0.02, those who had never received training DL P=0.046, and those who were not satisfied with the situation P=0.03. We didn't find a direct association between DL and anxiety and depression, which the small sample size may explain, but we did find an association with the variables related to DL

Nigeria Centre for Disease Control awareness creation and risk communication of Covid-19 pandemic amongst non-literate population in south-west Nigeria: lessons for future health campaign

Background: Risk communication of Covid-19 pandemic in Nigeria appeared to be urban-centred with the dominant use of social media, print communication and other controlled media. In such times of public health emergencies, non-literate population could be vulnerable as a result of their limited understanding of the nature of such health risk. Objective: Therefore, the study seeks to investigate the extent to which NCDC communicated the risk of Covid-19 disease to non-literates population in its public health campaign during the pandemic in South-West Nigeria. Methods: The study adopts risk communication theory which advances the approach communication should take during public health emergencies. Using the concurrent mixed method research design, a sample of 420 respondents were purposively selected from 6 towns in the rural areas of Lagos, Oyo and Osun states to examine the level of awareness on Covid-19 pandemic among non-literates. In addition, NCDC risk communication on Covid-19 for non-literates population were analysed from 3 Jingles in Yoruba language as well as 9 flyers designed for Covid-19 disease from NCDC websites. Results: Results showed that NCDC awareness creation on Covid-19 disease for non-literates in Southwest achieved significant success as a result of the medium used in creating awareness. Specifically, radio was highly rated among majority of the respondents (60.4%) followed by Health workers (19.8%) as channels that created understandable message on Covid-19 safety protocols. Further findings on Jingles content revealed that all Covid-19 safety protocols were communicated in Yoruba language for Southwest populace. However, NCDC fall short in communicating Covid-19 risk effectively for non-literates in Southwest as jingles only buttressed the Covid-19 safety protocols and symptoms as well as the need to comply, without educating the masses on the dreadful nature of the disease and its dynamics. Though flyers designed by the NCDC communicated risk to an extent, nevertheless, graphics and symbols on Covid-19 disease were complimented by words in English language only, which could be difficult for non-literates to decipher. Conclusion: Based on the findings, the study recommends that public health agencies need to educate non-literate population about the nature of a disease more than creating awareness about the outbreak of a disease.

Clinical characteristics and variables associated with COVID-19 morbidity and mortality in Luanda, Angola, in the first year of the pandemic

Background: The impact of SARS-CoV-2 infection in Africa is still unclear. In comparison to Europe and North America, morbidity and death rates are lower. Several factors have been proposed, including geographical variation in virus impact, environmental factors, differences in age distribution, and the impact of infectious diseases such as malaria, HIV infection and tuberculosis. Objectives: We investigated the clinical characteristics and putative determinants linked with COVID-19 in Angolan patients. Methods: Cross-sectional study undertaken at Military Hospital, Luanda, from March 2020 to March 2021. The survey collected sociodemographic and clinical information. Results: The sample included 1,683 patients aged ≥18 years, 64% men, with mean age of 46.3 years. SARS-CoV-2 was positive in 39% of the cases with RT-PCR. Patients ≥46 years with a level of education of ≥12 years had a considerably higher likelihood of testing positive. About 58% of positive patients had at least one comorbidity, of which hypertension and Diabetes were associated with SARS-CoV-2 infection. HIV and pulmonary TB were putative protective factors. About 14% of positive patients died. Most deaths occurred in patients ≥46 years, with less education and unemployed. Working as a healthcare practitioner was linked to a protective effect. Malignant diseases were the most common comorbidities associated with death. Conclusions: We identified putative factors related to SARS-CoV-2 infection and mortality. HIV and TB were protective and not associated with mortality. Further study with a broader scope should be conducted to explain the main features related to COVID-19 mortality in Angola

Healthcare professionals' perceived stigmatization about direct care of COVID-19 Patients: development and validation of the discrimination about COVID-19 (DisCOV-19) instrument

Background: The novel coronavirus disease 2019 (COVID-19) is a public health concern worldwide. Healthcare professionals are among the most vulnerable groups in the fight against COVID-19 because they are directly involved in the care of at-risk persons and patients with Covid-19. Objectives: This study aimed to measure the level to which healthcare workers feel that they can be discriminated due to their involvement in the direct care of COVID-19 patients. Methods: A cross-sectional online survey was conducted among healthcare professionals in Nigeria. A nineteen-item discrimination against COVID-19 (DisCOV-19) questionnaire was developed and validated for the study. Descriptive statistics and OneWay Analysis of Variance were used for data analysis. P<0.05 was considered statistically significant. Results: Out of the 286 healthcare practitioners that participated in the study, 58.4% and 30.1% were pharmacists and physicians, respectively. The majority of the participants were at least "moderately concerned" about disability (60.9%), death (71.7%), unknown complications (65.1%), and risk of infecting family members and friends (83.2%) if asked to provide care for COVID-19 patients. The physicians had a significantly higher mean discrimination score compared to the pharmacists (p=0.041). Pharmacists had a significantly lower mean discrimination score than the nurses (p=0.011). Conclusions: Many of the healthcare professionals reported a certain level of concern and perceived that they could face some forms of discrimination for providing care to COVID-19 patients

COVID­19 pandemic fatigue among well­educated Egyptian population: cross­sectional study

Aim: The study explores the emergence of COVID 19 pandemic fatigue among well educated Egyptians measured in terms of their level of adherence toward COVID 19 protective measures along 20 months since the beginning of the pandemic. Setting and Design: A cross sectional study was conducted in October 2021, using an online questionnaire for well educated Egyptians in different governorates. Results: A total of 888 participants completed the questionnaire, their mean age was 39 ± 7.2 years and 60% of them were females. There was a strong association between the presence of either behavioral risk factors or chronic conditions and % of infection. The main sources of COVID 19 information were social media, followed by the Egyptian Ministry of health and population and WHO websites. A pandemic fatigue was observed after nearly 7 to 10 months from the pandemic emergence. The participant's age, previous COVID 19 infection, and occupation status were significant predictors for adherence to COVID 19 protective measures. The participants claimed that difficulty in remaining at home, feeling uncomfortable with face masks, the high cost of protective supplies, absence of governmental enforcement, and forgetfulness are the most perceptive barriers hindering their adherence to COVID 19 protective measures. They suggested some strategies for better adherence and reduced pandemic fatigue that includes: the implementation of governmental enforcement measures, including penalties for nonwearing masks, educational health programs, and availability of free protective supplies at the workplace. Conclusions: Pandemic fatigue was observed after 7 to 10 months from the pandemic emergence even though the high education level of the participants

Blended learning during and beyond the COVID-19 pandemic: Attitudes of nurse educators in Gauteng

Background: The use of blended learning (BL) pedagogy has become inevitable due to contemporary technological innovations in the nursing education sector. As of late, the need to use BL pedagogy has resulted by the sudden occurrence of the COVID-19 pandemic. However, several nurse educators still experience uncertainties in using BL due to technological, psychological, infrastructure and equipment readiness barriers. Aim: To report the attitudes of nurse educators towards the use of BL pedagogy as a new norm of teaching and learning in public nursing education institutions (NEIs) in the Gauteng Province (GP), South Africa, during and beyond the COVID-19 pandemic period. Setting: The study was conducted in five Gauteng public NEIs. Methods: A descriptive non-experimental quantitative design was conducted with 144 nurse educators. Data was collected through a questionnaire. Statistical Analysis Software (SAS) was used to analyse data with the help of a biostatistician. Results: Technologically, only 50% (N = 72) found BL easy to use while 48% (n = 69) were ready and willing to use the BL Psychologically, more than half, that is, 65% (n = 94) lacked the confidence to use BL pedagogy. About 55% (n = 79) reported having inadequate BL infrastructure, while 32% (n = 46) seemed to be satisfied with the availability of effective equipment to support BL pedagogy. Conclusion: Based on the results, it is apparent that nurse educators in Gauteng are not technologically and psychologically ready, since the infrastructure and equipment to support the BL are not adequately provided.

Reducing COVID-19 vaccine hesitancy and improving vaccine uptake in Nigeria

By May 30th, 2022, there were 526,182,662 confirmed COVID-19 cases and 6,286,057 deaths globally; of which Nigeria had recorded 256,028 confirmed cases and 3,143 deaths. By the same time, Nigeria had received a total of 93.9 million doses of the COVID-19 vaccine, enough to vaccinate 25% of the population however, only 27.4 million people (13.3% of the population) had received at least one dose of the vaccine. This article examines available evidence on COVID-19 vaccine hesitancy in Nigeria and makes recommendations for improving its uptake. Major causes of COVID-19 vaccine hesitancy identified in Nigeria were concerns around vaccine efficacy and safety, disbelief in the existence and severity of the disease, and distrust of the government. To reduce COVID-19 vaccine hesitancy and improve vaccine coverage in Nigeria, a mapping of vaccine acceptance and hesitancy across geographies and demographics, increased stakeholder communication, and effective community engagement are needed.

Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD). Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank. Results: The majority of the participants were between ages 31­40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02­10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7­9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6­9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2­13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family. Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

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.