ABSTRACT
Background. In South Africa (SA), >2.4 million cases of COVID19 and >72 000 deaths were recorded between March 2020 and 1 August 2021, affecting the country's 52 districts to various extents. SA has committed to a COVID19 vaccine roll-out in three phases, prioritising frontline workers, the elderly, people with comorbidities and essential workers. However, additional actions will be necessary to support efficient allocation and equitable access for vulnerable, access-constrained communities. Objectives. To explore various determinants of disease severity, resurgence risk and accessibility in order to aid an equitable, effective vaccine roll-out for SA that would maximise COVID19 epidemic control by reducing the number of COVID19 transmissions and resultant deaths, while at the same time reducing the risk of vaccine wastage. Methods. For the 52 districts of SA, 26 COVID19 indicators such as hospital admissions, deaths in hospital and mobility were ranked and hierarchically clustered with cases to identify which indicators can be used as indicators for severity or resurgence risk. Districts were then ranked using the estimated COVID19 severity and resurgence risk to assist with prioritisation of vaccine roll-out. Urban and rural accessibility were also explored as factors that could limit vaccine roll-out in hard-to-reach communities. Results. Highly populated urban districts showed the most cases. Districts such as Buffalo City, City of Cape Town and Nelson Mandela Bay experienced very severe first and second waves of the pandemic. Districts with high mobility, population size and density were found to be at highest risk of resurgence. In terms of accessibility, we found that 47.2% of the population are within 5 km of a hospital with ≥50 beds, and this percentage ranged from 87.0% in City of Cape Town to 0% in Namakwa district. Conclusions. The end goal is to provide equal distribution of vaccines proportional to district populations, which will provide fair protection. Districts with a high risk of resurgence and severity should be prioritised for vaccine roll-out, particularly the major metropolitan areas. We provide recommendations for allocations of different vaccine types for each district that consider levels of access, numbers of doses and cold-chain storage capability.
Subject(s)
Humans , Male , Female , Epidemiology , COVID-19 Vaccines , COVID-19 , Risk FactorsABSTRACT
Anthropometric measurements and food consumption survey were undertaken to assess the nutritional status of children in a village of the Upper East Region of Ghana. Results showed that mean body weight and height of 3 to 12 year-old children were about 80 per cent and 90 per cent of Harvard Standard; respectively. Mean energy intake was about 70 per cent of RDA (Recommended Dietary Allowance by FAO/WHO). Though mean intake of dietary proteins was comparable to the RDA; the animal protein portion was only about 5 per cent. Iron; niacin and thiamin intakes were comparable to the RDAs. Calcium and riboflavin intakes were low; being about half of the RDAs. Wide individual variations of retinol intakes were observed among the subjects. The poor dietary situation might be a major contributory factor to the low anthropometric indices of the children in this region