Implementation and contribution of temperature screening and handwashing practice at points of entry for COVID-19 pandemic response in a humanitarian crisis setting

Introduction over the last decade, insecurity in the Lake Chad Basin has triggered an unprecedented humanitarian crisis in the Niger´s Diffa Region with a significant population movement. In this humanitarian setting, we reviewed the implementation process and the contribution of temperature screening and handwashing practice at points of entry as part of non-pharmaceutical interventions against COVID-19. Methods in Diffa, border officers were trained on the fundamentals of infection prevention and control in relation to COVID-19 readiness and response and a 14-day district response team was constituted. To examine the significance of the implementation process of temperature screening and handwashing practices at points of entry, we conducted a secondary analysis of data submitted by the six health districts of the Diffa Region between March and July 2020. Results travellers screened for fever ranged from 10,499 (in March 2020) to 62,441 (in April 2020) with the health districts of Diffa (mean: standard error of the mean: 25,999: 9,220) and of Bosso (mean: standard error of the mean: 30.4: 19.1) accounting for the most and the least of activities during the entire period, respectively. Overall, 125/169,475 travellers presented fever and were effectively quarantined. Only the Ngourti Health District reported travellers who declined handwashing (54/169,475);this was during the first three months of the first wave of the COVID-19 pandemic. Conclusion we have documented a successful implementation of measures related to temperature screening with some unsubstantial denial of handwashing. Given the importance of border traffic due to insecurity in the Diffa Region, maintaining temperature screening and handwashing in this humanitarian setting is necessary but requires coordinated actions of all stakeholders involved in the region.

Implementation and contribution of temperature screening and handwashing practice at points of entry for COVID-19 pandemic response in a humanitarian crisis setting.

Introduction: over the last decade, insecurity in the Lake Chad Basin has triggered an unprecedented humanitarian crisis in the Niger´s Diffa Region with a significant population movement. In this humanitarian setting, we reviewed the implementation process and the contribution of temperature screening and handwashing practice at points of entry as part of non-pharmaceutical interventions against COVID-19. Methods: in Diffa, border officers were trained on the fundamentals of infection prevention and control in relation to COVID-19 readiness and response and a 14-day district response team was constituted. To examine the significance of the implementation process of temperature screening and handwashing practices at points of entry, we conducted a secondary analysis of data submitted by the six health districts of the Diffa Region between March and July 2020. Results: travellers screened for fever ranged from 10,499 (in March 2020) to 62,441 (in April 2020) with the health districts of Diffa (mean: standard error of the mean: 25,999: 9,220) and of Bosso (mean: standard error of the mean: 30.4: 19.1) accounting for the most and the least of activities during the entire period, respectively. Overall, 125/169,475 travellers presented fever and were effectively quarantined. Only the Ngourti Health District reported travellers who declined handwashing (54/169,475); this was during the first three months of the first wave of the COVID-19 pandemic. Conclusion: we have documented a successful implementation of measures related to temperature screening with some unsubstantial denial of handwashing. Given the importance of border traffic due to insecurity in the Diffa Region, maintaining temperature screening and handwashing in this humanitarian setting is necessary but requires coordinated actions of all stakeholders involved in the region.

Active search for COVID-19 cases during integrated supportive supervision using an electronic platform to improve healthcare workers performance in Niger: the legacy of the polio eradication program.

The implementation of electronic data collection during supportive supervision visits (ISS) using the Open Data Kits (ODK) Collection in Niger has provided a factual basis for monitoring the performance of the Polio eradication program (PEP) and the immunization program. With the notification of the first case of COVID-19 on 19 March 2020, there was a rapid need for quality knowledge to monitor the pandemic. For the first time in Niger, we initiated a six-month (May to October 2020) joint ISS-COVID-19 surveillance program to improve and monitor healthcare workers' performance to efficiently investigate COVID-19 cases in eight provinces. Overall, 1,378 ISS visits were performed through 390 health facilities, during which 4,638 health workers were trained and 527,151 medical records were reviewed, of which 28 suspected cases of COVID-19 were found. Field visits for contact tracing in their communities were accomplished and closed monitoring ensured until full recovery. Building on the tradition of PEP, a problem-solving process, feedback and on-the-job training on COVID-19 surveillance is set to enhance notification in the coming weeks and months. This is facilitated by accurate use of ODK Collect for real-time data surveillance successfully implemented. Other topics in the briefing included fundamentals of infection prevention and control for COVID-19 for both health professionals and community leaders. From this experience, the ISS has emerged as a key component of COVID-19 surveillance, especially in regions with a fragile health system. Our observation is a step forward for pragmatic interventional studies.

Clinical features and predictors of mortality among hospitalized patients with COVID-19 in Niger.

INTRODUCTION: COVID-19 has spread across the African continent, including Niger. Yet very little is known about the phenotype of people who tested positive for COVID-19. In this humanitarian crises region, we aimed at characterizing variation in clinical features among hospitalized patients with COVID-19-like syndrome and to determine predictors associated with COVID-19 mortality among those with confirmed COVID-19. METHODS: The study was a retrospective nationwide cohort of hospitalized patients isolated for COVID-19 infection, using the health data of the National Health Information System from 19 March 2020 (onset of the pandemic) to 17 November 2020. All hospitalized patients with COVID-19-like syndrome at admission were included. A Cox-proportional regression model was built to identify predictors of in-hospital death among patients with confirmed COVID-19. RESULTS: Sixty-five percent (472/729) of patients hospitalized with COVID-19 like syndrome tested positive for SARS-CoV-2 among which, 70 (15%) died. Among the patients with confirmed COVID-19 infection, age was significantly associated with increased odds of reporting cough (adjusted odds ratio [aOR] 1.02; 95% confidence interval [CI] 1.01-1.03) and fever/chills (aOR 1.02; 95% CI 1.02-1.04). Comorbidity was associated with increased odds of presenting with cough (aOR 1.59; 95% CI 1.03-2.45) and shortness of breath (aOR 2.03; 95% CI 1.27-3.26) at admission. In addition, comorbidity (adjusted hazards ratio [aHR] 2.04; 95% CI 2.38-6.35), shortness of breath at baseline (aHR 2.04; 95% CI 2.38-6.35) and being 60 years or older (aHR 5.34; 95% CI 3.25-8.75) increased the risk of COVID-19 mortality two to five folds. CONCLUSION: Comorbidity, shortness of breath on admission, and being aged 60 years or older are associated with a higher risk of death among patients hospitalized with COVID-19 in a humanitarian crisis setting. While robust prospective data are needed to guide evidence, our data might aid intensive care resource allocation in Niger.

[Organization of a free mass distribution campaign of long-lasting insecticidal mosquito nets in the context of COVID-19 in Niger]. / Organisation d´une campagne de masse et gratuite de distribution des moustiquaires imprégnées d´insecticides à longue durée d´action dans le contexte de la COVID-19 au Niger.

Long-lasting insecticidal mosquito nets (LLIMNs) are needed for malaria vector control. However, their distribution is not yet optimal in sub-Saharan regions. According to projections, COVID-19 pandemic will further delay the distribution of LLIMNs. In Niger, a distribution campaign of LLIMNs with a multi-sectoral approach (state-partner-civil society) was organized in compliance with barrier measures for preventing transmission of COVID-19. A door-to-door strategy was chosen to implement this campaign, in order to avoid entry into confined spaces and to engage community. A total of 13,994,681 people received LLIMNs (reflecting a success rate of 101%) in six targeted regions. A collective effort is needed to sustain the fight against malaria in the COVID-19 era.

Community-based surveillance contribution to the response of COVID-19 in Niger.

INTRODUCTION: the COVID-19 pandemic has spread across all countries in Africa, with much of the model forecasting disastrous results owing to weak health services and political uncertainty. In Niger, an adaptive solution to the COVID-19 pandemic has been implemented by community-based surveillance system (CBS) to complement passive case-finding in health systems. METHODS: the CBS program was designed to use the current CBS polio network spanning 37 health districts in six regions. Between April and November 2020, 150 community health workers (CHWs) were equipped to improve integrated disease surveillance and response (IDSR) preparedness and response to the COVID-19 pandemic. We retrospectively analysed the health data of the National Health Information System to describe the effect of CBS in COVID-19 surveillance. RESULTS: overall, trained CHWs were able to raise awareness among 2,681,642 persons regarding COVID-19 preventions and controls strategies. They reported 143 (84%) valid alerts resulting in two positive COVID-19 cases missing in the community. In addition, CHWs added to the contact tracing of 37 individuals and informed about the deaths in the community. CONCLUSION: community-based surveillance improved COVID-19 response in Niger. Logistic assistance and ongoing training are the foundations for increasing and sustaining the sensitivity of CBS systems in response to the COVID-19 pandemic to deter hotspots across countries.

[The impact of the COVID-19 pandemic on health service utilisation in the City of Niamey: a study conducted in 17 health care facilities from January to June 2020]. / Impact de la pandémie de la COVID-19 sur l'utilisation des services de santé dans la ville de Niamey: une analyse dans 17 formations sanitaires de janvier à juin 2020.

COVID-19 pandemic has posed huge challenges for the health system in Africa; however they haven´t been well quantified. The purpose of this study was to assess the impact of COVID-19 pandemic on curative and preventive activities in health care facilities at 17 integrated health centers in Niamey by comparing the first half of 2020 and the first half of 2019. The differences were more pronounced in the second quarter of 2020, with a 34% reduction (95% CI: -47% to -21%) for curative care, 61% (95% CI: -74% to -48%) for pentavalent vaccines 1 and 3 and 36% (95% CI: -49% to -23%) for VAR 1. A nearly zero gain of 1% (95% IC: -2% to 4%) was reported for prenatal care attendance, thus reversing the gains of the first quarter. The COVID-19 pandemic has had negative effects on service deliveries to the most vulnerable groups, such as women and children. New strategies, such as community engagement, are essential.

Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future?

Vaccine hesitancy, which embodies the unwillingness to receive vaccines when vaccination services are available and accessible, is one of the greatest threats to global health. Although vaccine hesitancy has existed among a small percentage of people for centuries, its harmful effects are likely to be more pronounced during the COVID-19 pandemic than ever before. COVID-19 vaccine hesitancy will pose substantial risks for both people who delay or refuse to be vaccinated and the wider community. It will make communities unable to reach thresholds of coverage necessary for herd immunity against COVID-19, thus unnecessarily perpetuating the pandemic and resulting in untold suffering and deaths. Vaccine hesitancy is pervasive, misinformed, contagious, and is not limited to COVID-19 vaccination. Our work shows that vaccine hesitancy is a complex and dynamic social process that reflects multiple webs of influence, meaning, and logic. People's vaccination views and practices usually comprise an ongoing engagement that is contingent on unfolding personal and social circumstances, which can potentially change over time. Therefore, as COVID-19 vaccination rolls out globally, scientists and decision-makers need to investigate the scale and determinants of vaccine hesitancy in each setting; so that tailored and targeted strategies can be developed to address it.

[COVID-19 control in Niger: an assessment of infection prevention and control practices at healthcare facilities in the city of Niamey]. / La lutte contre le COVID-19 au Niger: l´évaluation de la prévention et contrôle des infections dans les formations sanitaires de la communauté urbaine de Niamey.

Niger has been facing the coronavirus disease 2019 (COVID-19) pandemic since 19th March 2020. In this article we report an assessment of infection prevention and control (IPC) practices at healthcare facilities in the city of Niamey in Niger and propose solutions. This assessment focused on the 12 themes contained in the World Health Organization IPC assessment framework for healthcare facilities. The assessment was conducted in 83 public and private healthcare facilities, which represent 60% of healthcare facilities in the city of Niamey. At the level of tertiary healthcare facilities, the overall IPC score was 75% which represents a moderate level of compliance with recommended IPC practices. At the level of private healthcare facilities, the overall score was 53%; also, a moderate level of performance. Finally, the overall IPC score was 45% at primary public healthcare facilities; which shows a very low level of adherence to IPC recommendations. IPC practices in public and private healthcare facilities in Niamey remain a challenge for healthcare authorities. Developing a tailored restorative plan would be helpful in meeting this challenge.