Points of entry dynamics: understanding the cross-border threats for Ebola virus disease and COVID-19 in Ghana using a logic model approach

Background. The influx of people across the national borders of Ghana has been of interest and concern in the public health and national security community in recent times due to the low capacity for the prevention and management of epidemics and other public health risks. Although the International Health Regulations (IHR) stipulate core public health capacities for designated border facilities such as international airports, seaports, and ground crossings, contextual factors that influence the attainment of effective public health measures and response capabilities remain understudied. Objective. To assess the relationship between contextual factors and COVID-19 procurement to help strengthen infrastructure resources for points of entry (PoE) public health surveillance functions, thereby eliminating gaps in the design, implementation, monitoring, and evaluation of pandemicrelated interventions in Ghana. Materials and Methods. This study employed a mixed-methods design, where quantitative variables were examined for relationships and effect size interactions using multiple linear regression techniques and the wild bootstrap technique. Country-level data was sourced from multiple publicly available sources using the social-ecological framework, logic model, and IHR capacity monitoring framework. The qualitative portion included triangulation with an expert panel to determine areas of convergence and divergence. Results. The most general findings were that laboratory capacity and KIA testing center positively predicted COVID-19 procurement, and public health response and airline boarding rule negatively predicted COVID-19 procurement. Conclusion. Contextual understanding of the COVID-19 pandemic and Ebola epidemic is vital for strengthening PoE mitigation measures and preventing disease importation.

A human rights-based approach to coercive public health interventions: lessons from the HIV and COVID-19 pandemics

The SARS-CoV-2 outbreak and its impact on countries across the globe has been unprecedented. The lack of pharmaceutical interventions to prevent or treat infection have left States with limited avenues to control the spread of the virus. Many countries have introduced stringent lockdowns along with regulatory regimes that give governments new powers to compel compliance with these regulations and to punish non-compliance. This article investigates the use of compelled public health interventions during both the HIV and COVID-19 pandemics and how these can be aligned to human rights. This includes discussion on the use of interventions such as mandatory quarantine and isolation, compelled testing, criminalisation of HIV and SARS-CoV-2 transmission in Africa. This article also outlines what State obligations are in relation to pandemic responses, both in terms of mandating an effective response and which human rights principles should underscore these responses. Using South Africa as a case study, this article analyses whether the use of these interventions complies with international human rights law. We assess the use of compelled public health interventions in both the HIV and COVID-19 pandemics against established human rights principles applicable to pandemic responses. This article discusses lessons to be learnt about the relationship between human rights and public health interventions across both pandemics so as to guide human rights-based approaches to future pandemics as well as subsequent stages of the SARS-CoV-2 pandemic.

South Africa's COVID-19 Tracing Database: Risks and rewards of which doctors should be aware

In response to the COVID-19 pandemic, South Africa (SA) has established a Tracing Database, collecting both aggregated and individualised mobility and locational data on COVID-19 cases and their contacts. There are compelling public health reasons for this development, since the database has the potential to assist with policy formulation and with contact tracing. While potentially demonstrating the rapid facilitation through technology of an important public service, the Tracing Database does, however, infringe immediately upon constitutional rights to privacy and heightens the implications of ethical choices facing medical professionals. The medical community should be aware of this surveillance innovation and the risks and rewards it raises. To deal with some of these risks, including the potential for temporary rights- infringing measures to become permanent, there are significant safeguards designed into the Tracing Database, including a strict duration requirement and reporting to a designated judge. African states including SA should monitor this form of contact tracing closely, and also encourage knowledge-sharing among cross-sectoral interventions such as the Tracing Database in responding to the COVID-19 pandemic

Investigation of an outbreak of acute respiratory disease in Côte d'Ivoire in april 2007

Background: This study aim was to investigate an outbreak of human cases of unexplained influenza-like illness and fatal acute respiratory infection (ARI); with simultaneous poultry illness and high mortality raising concerns of possible influenza A (H5N1); virus in Cote d'Ivoire in February and March 2007. Materials and Methods: To investigate the outbreak; we conducted active surveillance in the community and reviewed health registries. Persons meeting the case definition were asked to provide nasopharyngeal specimens. On the basis of clinical and epidemiological information; specimens were tested using conventional RT-PCR for the M gene of the influenza viruses and hemagglutinin H5 of avian influenza A (H5N1); virus; negative samples were tested for other respiratory viruses. Specimens from healthy animals were also collected. Results: Between October 2006; and February 2007; 104 suspected cases of Acute Respiratory Disease that included; 31 deaths recorded. We collected and tested 73 nasopharyngeal specimens; of which; 2; were positive for human Coronavirus OC43 and 1 for influenza C virus. No pathogens were identified in animal specimens. Conclusions: The investigation quickly ruled out influenza A (H5N1); virus as the cause and found laboratory-confirmed cases of influenza C virus and human Coronavirus OC 43 for the first time in both Cote d'Ivoire and in a Sub-Saharan African country. However we were not able to show that these viruses caused the outbreak. Monitoring of influenza viruses must be a priority but other respiratory viruses and non-viral causes may be of interest too

Motivation and job satisfaction of Health Surveillance Assistants in Mwanza; Malawi: an Explorative Study

Aim: Improving community health worker's performance is vital for an effective health system in developing countries. In Malawi; hardly any research has been done on factors that motivate this cadre. This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district; Malawi; in order to inform development of strategies to influence staff motivation for better performance. Methods Seven key informant interviews; six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. The focus was on HSAs motivation and job performance. Data were supplemented with results from a district wide survey involving 410 households; which included views of the community on HSAs performance. Qualitative data were analysed with a coding framework; and quantitative data with the Statistical Package for Social Sciences (SPSS).Results The main satisfiers identified were team spirit and coordination; the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers that were found were low salary and position; poor access to training; heavy workload and extensive job description; low recognition; lack of supervision; communication and transport. Managers and had a negative opinion of HSA perfomance; the community was much more positive: 72.9of all respondents had a positive view on the performance of their HSA. Conclusion Activities associated with worker appreciation; such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation; including human resource management and other measures relating to coordination of and support to the work of HSAs

Awareness and Knowledge of Disease Surveillance and Notification by Health-Care Workers and Availability of Facility Records in Anambra State; Nigeria

Background: Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases; personnel; and materials that are organized to collect data which are utilized for informed decision making. The knowledge about DSN is very important for the reporting of notifiable diseases. Objective: The aim of this study is to examine the awareness and knowledge of health-care workers about DSN; and availability of facility records in Anambra State; Nigeria. Materials and Methods: The study was a descriptive cross-sectional one in which relevant data were collected from health-care workers selected by a multistage sampling technique. Qualitative information was also elicited by key informant interviews; whereas an observational checklist; preceded by a desk review was used to examine the availability of facility records. Results: Although 89.8 of the health-care workers were aware of the DSN system; only 33.3; 31.1; and 33.7 of them knew the specific uses of forms IDSR 001; IDSR 002; and IDSR 003 (IDSR: Integrated Diseases Surveillance and Response); respectively. Knowledge of use of the various forms at the facility and local government area (LGA) levels were generally low; although the observational checklist revealed that IDSR 001 and IDSR 002 forms were predominantly found in primary health-care facilities. HMIS forms were less likely to be available in secondary health-care facilities (?[2]=7.67; P=0.005). Conclusions: Regular training and retraining of concerned health-care workers on DSN at the LGA level is recommended. This should run concurrently with adequate and regular provision of IDSR forms; copies of the standard case definitions; and other necessary logistics to the health-care facilities by the local and state governments

Implementation of the International Health Regulations (2005) in the African Region

The International Health Regulations (IRH; 2005) are a legally binding international instrument for preventing and controlling the spread of diseases internationally while avoiding unnecessary interference with international travel and trade. Under the IHRs that were adopted on 23 May 2005 and entered into force on 15 June 2007; Member States have agreed to comply with the rules therein in order to contribute to regional and international public health security. Obligations also include the establishment of IHR National Focal Points (NFP) defined as a national centre designated by each Member State; and accessible at all times for communication with WHO IHR Contact Points. Furthermore; Member States were requested to designate experts for the IHR roster; enact appropriate legal and administrative instruments and mobilize resources through collaboration and partnership building. The Fifty-sixth session of the WHO Regional Committee for Africa called for the implementation of the IHR in the context of the regional Integrated Disease Surveillance and Response (IDSR) strategy considering the commonalities and synergies between IHR (2005) and the IDSR. They both aim at preventing and responding to public health threats and/or events of national and international concern. This document discusses the issues and challenges and proposes actions that Member States should take to ensure the required IHR core capacities are acquired in the WHO African Region