Knowledge, risk-perception, and uptake of COVID-19 prevention measures in sub-Saharan Africa: a scoping review

Background: The COVID-19 pandemic has almost affected the entire globe and is currently in a resurgent phase within the sub-Saharan African region. Objective: This paper presents results from a scoping review of literature on knowledge, risk-perception, conspiracy theories and uptake of COVID-19 prevention measures in sub-Saharan Africa. Methods: We used the following search terms: 'COVID-19', 'knowledge', 'perceptions', 'perspectives', 'misconceptions', 'conspiracy theories', 'practices' and 'sub-Saharan Africa'. Basing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines, we identified 466 articles for review; 36 articles met the inclusion criteria. We extracted data on knowledge, risk perception, conspiracy theories and uptake of COVID-19 primary prevention measures. Results: Knowledge of COVID-19 was high (91.3-100%) and associated with age and education; risk-perception was equally high (73.3-86.9%) but varied across studies. Uptake of handwashing with water and soap or hand-sanitizing ranged between 63-96.4%, but wearing of face masks and social distancing fared poorly (face masks: 2.7%-37%; social distancing: 19-43%). Conclusion: While knowledge of COVID-19 is nearly universal, uptake of COVID-19 prevention measures remains sub-optimal to defeat the pandemic. These findings suggest a need for continued health promotion to increase uptake of the recommended COVID-19 prevention measures in sub-Saharan Africa

Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics

Effectiveness of the credit-line approach for support of CD4 equipment functionality in northern Uganda

Background: Improving laboratory service delivery requires a functioning logistics and supply system. Uganda's Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment.Objectives: We examined the effectiveness of the credit-line approach in improving laboratory service delivery by using the functionality of CD4 test equipment as a proxy indicator. Method: A cross-sectional survey was conducted at 7 level-three health centres (HC IIIs); 18 level-four health centres (HC IVs); and 10 hospitals in 15 districts of mid-northern Uganda; including the Lango (17 facilities) and Acholi sub-regions (18 facilities); between July 2013 and August 2013. Functionality; was determined through self- and interviewer-administered questionnaires. The chi-squared test was used to assess differences in functionality by subregion; facility type; and equipment type.Results: A total of 38 CD4 test analysers were assessed. Of these; 26 (68%) were functional. In hospitals; 85% of CD4 analysers were functional; in HC IVs; 67% were functional and in HCIIIs; 43% were functional. The differences did not reach statistical significance. In the Langosub-region; 72% of analysers were functional; in the Acholi sub-region; 65% were functional. Non-functionality was mainly due to lack of reagents and cartridges; as well as low staffing levels of laboratory technicians with the skills necessary to operate the equipment.Conclusion: The credit-line approach supported the functionality of CD4 equipment in the surveyed facilities. However; there is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care; especiallyat HC IIIs

Living with Obstetric Fistula: Perceived Causes, Challenges and Coping Strategies among Women Attending the Fistula Clinic at Mulago Hospital, Uganda.

Aims: To determine perceived causes, challenges and coping mechanisms of women living with obstetric fistula (OF) in Uganda. Study Design: Cross-sectional study. Place and Duration of the Study: Mulago National Referral Hospital Uganda – January to July 2009. Methodology: Thirty women with OF were interviewed on challenges, coping mechanisms and perceived causes of OF using semi-structured questionnaires. Two focus group discussions were held with 10 caretakers of the women with OF and key informant interviews with 10 health care providers. Results: Majority of the women (21; 70%) were young (<25 years) had primary education (20; 67%) and had lived with OF for 2-9 years (20; 67%). The main perceived causes of OF were injury by surgeon (8; 27%), delivery of a big baby (7; 23%) and prolonged labor (4; 13%). Nearly all women with OF (27; 90%) reported that OF had detrimentally affected their health and well being; 26 women (87%) lost their children at birth or within the neonatal period. Families were affected by high cost of treatment (13; 43%); provision of basic items (10; 32%), and suffered stress (17; 55%). Women coped with OF by hiding from the general public (27; 90%), maintaining strict hygiene (25; 83%), ignoring people’s comments (23; 75%) or resorting to prayer (18; 57%). Conclusion: Women with OF experienced physical, emotional and socio-economic challenges and coped with OF through non-effective social measures. There is need to strengthen strategies to prevent OF and enhance OF rehabilitation services for affected women and their families.