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Background: Despite increased social vulnerability and barriers to care, there has been a paucity of data on SARS-CoV-2 incidence among key populations in sub-Saharan Africa. We seek to characterize active infections and define transmission dynamics of SARS-CoV-2 among people who inject drugs (PWID) and their sexual and injecting partners from Nairobi and the coastal region in Kenya. Method(s): This was a nested cross-sectional study of SARS-CoV-2 infection from April to July 2021 within a cohort study of assisted partner services for PWID in Kenya. A total of 1000 PWID and their partners (500 living with and 500 living without HIV) were recruited for SARS-CoV-2 antibody testing, of whom 440 were randomly selected to provide self-collected nasal swabs for real-time PCR testing. Whole genome sequencing (WGS) was completed on a limited subset of samples (N=23) with cycle threshold values 32.0. Phylogenetic tree construction and analysis was performed using the Nextstrain pipeline and compared with publicly available SARS-CoV-2 sequences from GenBank. Result(s): A total of 438 (99.5%) participants provided samples for SARS-CoV-2 PCR testing. Median age was 37 (IQR 32-42);128 (29.2%) were female;and 222 (50.7%) were living with HIV. The overall prevalence of SARS-CoV-2 infection identified by RT-PCR was 86 (19.6%). In univariate analyses, there was no increased relative risk of SARSCoV- 2 infection related to positive HIV status, frequenting an injection den, methadone treatment, unstable housing, report of any high-risk exposure, or having a sexual or injecting partner diagnosed with COVID-19 or who died from COVID-19 or flu-like illness. Eight samples were successfully sequenced via WGS and classified as WHO variants of concern: 3 Delta, 3 Alpha, and 2 Beta. Seven were classified into clades predominantly circulating in Kenya during 2021. Notably, two sequences were identical and matched identically to another Kenyan sequence, which is consistent with, though not indictive of, a transmission linkage. Conclusion(s): Overall, the risk of SARS-CoV-2 infection in this population of PWID and their partners was not significantly associated with risk factors related to injection drug use. At a genomic level, the SARS-CoV-2 strains in this study were consistent with contemporary Kenyan lineages circulating during the time and not unique to PWID. Prevention efforts, therefore, must also focus on marginalized groups for control given the substantial amount of mixing that likely occurs between populations.
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Objective: The COVID-19 pandemic has presented a unique challenge for inpatient rehabilitation facilities to deliver safe and effective rehabilitation for patients recovering from COVID-19 and other rehabilitation diagnoses. There is a paucity of research assessing the effectiveness of inpatient rehabilitation on patients with COVID-19. The objective of this study was to compare post-acute rehabilitation outcomes of patients with debility and COVID-19 to outcomes of patients with debility only. Design(s): Retrospective Cohort Study Setting: Single inpatient rehabilitation facility Participants: Patients admitted for debility from April 1, 2020 to July 30, 2020. COVID-19 status was determined by a positive PCR test during the acute care or inpatient rehabilitation hospitalization period. Intervention(s): None Main Outcome Measure(s): Differences in admission and discharge functional performance scores (GG scores) and length of stay were compared. Rehabilitation efficiency, the average increase per day in functional performance score, was calculated. Result(s): 560 patients admitted for debility were reviewed. There were 83 (14.8%) patients admitted with COVID-19, who were on average 61 years old, male (55.4%), and African American (72.3%). Patients admitted with COVID-19 had a mean GG score gain of 26 points and median length of stay of 15 days. Patients admitted without COVID-19 had a mean GG score gain of 18 and median length of stay of 15 days. Compared to patients without COVID-19, patients with COVID-19 had a comparable length of stay but a significantly increased change in GG score at discharge (p < 0.001) and higher rehabilitation efficiency (p=0.001). Conclusion(s): There was a significantly greater improvement in GG scores and rehabilitation efficiency for patients with debility and COVID-19 compared to patients with debility without COVID-19. Our findings suggest that patients with debility and COVID- 19 benefit from acute inpatient rehabilitation and may be even more amenable to intensive therapeutic rehabilitation compared to patients with debility without COVID-19.
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Background: In sub-Saharan Africa many persons who inject drugs (PWID) are living with undiagnosed or untreated HIV and experience high levels of poverty, housing instability, and co morbid conditions that contribute to worse outcomes from SARS-CoV-2. We sought to determine SARS-CoV-2 antibody prevalence and risk factors for PWID and their sexual and injecting partners in Kenya. Identifying the burden of infection in marginalized populations like PWID may contribute to controlling the pandemic in LMIC Methods: In a nested cross-sectional study, we recruited PWID living with HIV and their injecting and/or sexual partners in Nairobi, Kilifi, and Mombasa counties at needle and syringe programs (NSP). Blood samples were collected from consenting participants at enrollment to determine SARS-CoV-2 antibodies using a Platellia BioRad SARS-CoV-2 total antibody enzyme-linked immunosorbent assay. Baseline data was collected on HIV status, antiretroviral therapy (ART) and methadone adherence. Logistic regression was used to identify factors associated with antibody positivity Results: In total,1000 participants were enrolled in the study between April and July 2021, of whom 323 (32.3%) were women and 677 (67.7%) were men. Median age of participants was 36 years (Interquartile range [IQR]: 30, 42). SARS-CoV-2 positivity was reported in 309 (30.9%) of the participants. Of the participants who tested positive for SARS-CoV-2 antibodies, 39.5% did not report any symptoms at any time during the last 3 months. Men were significantly less likely than women to have SARS-CoV-2 antibodies (Odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52, 0.94;p<0.016). Participants from the Coast region had lower odds of SARS-CoV-2 antibody positivity compared to the Nairobi region (OR 0.72, 95% CI, 0.54, 0.95;p<0.019) and participants who had a sexual or injecting partner diagnosed with COVID-19 were more likely to have SARS-CoV-2 antibodies detected (OR 2.12, 95% CI 1.02, 4.39;p<0.042). Living with HIV was not significantly associated with presence of SARS-CoV-2 antibodies Conclusion: SARS-CoV-2 antibody was detected in 30.9% of participants in this cohort of PWID and their partners, suggesting high transmission rates within this key population. SARS-CoV-2 seroprevalence was similar for people living with and without HIV;no increase in risk was found for those living with HIV. This cohort represents an at-risk population that should be considered for COVID-19 vaccination, surveillance and other targeted public health measures.
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Purpose Climate variability, accompanied by rapid urbanization and rising population disproportionality, impacts urban poor settlements. This paper aims to analyse the climate resilience for the urban poor in Ahmedabad through the lens of WASH development strategies. To assess the adaptive capacities of urban poor communities, a framework in the form of a vulnerability matrix has been used consisting of four key parameters - tenure, basic services, mobilization and partnership and disaster management capacities. The matrix implicitly recommends area-specific interventions to boost adaptive capacities and improve resilience based on WASH services. Design/methodology/approach This paper was designed to assess the climate resilience of WASH services in the urban poor settlements of Ahmedabad city. In all, seven slums were selected using a stratified sampling approach considering topography, access to WASH services and urban heat island effect. These slums were then assessed using a theoretical framework having four key parameters - tenure, basic service, mobilization and partnership and disaster management capacities. The data for the analysis was collected from both secondary and primary sources. For the latter, semi-structured interviews with key stakeholders, observational field visits and focused group discussions with the communities were done. Findings A ladder form of assessment matrix was derived from a thorough literature review and various pre-existing theories. This matrix consists of four key parameters - tenure, basic service, mobilization and partnership and disaster management capacities. The slums were evaluated by applying this framework, and direct and indirect relationships were established between the said parameters. Research limitations/implications This paper was adapted in the light of various obstacles put forward by the Covid-19 pandemic. Some of the interviews with the bureaucrats and external researchers were conducted online, while the engagement with the slum dwellers was in-person, considering appropriate social and/or physical distancing norms. Implications of the Covid-19 second wave restricted the involvement of researchers with the communities at an ethnographic level. Originality/value The ladder form of vulnerability assessment framework has been developed and contextualized using the insights from literature review, field visits and multi-stakeholder consultations. It was helpful in identifying aspects that require suitable interventions for improving and imparting resilience among the urban poor settlements. The learnings from this paper are significant for planners and decision-makers in identifying and prioritizing context-specific future projects for a city.
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Background The covid-19 pandemic has had a profound impact on healthcare service delivery. Acute cardiovascular care however remains a priority despite the pandemic. Patients presenting with non-ST elevation MI (NSTEMI) have been poorly characterized during the pandemic. Methods We conducted a retrospective study of patients diagnosed with NSTEMI during the peak of the pandemic between April-May 2020 at our tertiary centre in the UK. Data were collected from electronic patient clinical records including time from admission to angiography, length of stay, mortality, prescription of secondary prevention pharmacotherapy, and referral to cardiac rehabilitation. We compared this data to the same time period in 2019. Results As can be seen from table 1, in 2020, the mean age, median time to angiography, and length of stay were all significantly lower than the control period of 2019. Prescription of secondary prevention medication (Aspirin, P2Y12 inhibitor, Beta-blocker, Statin, and ACEi/ARB) and referral to cardiac rehabilitation also improved in 2020, however, neither was statistically significant. During the 2020 period, 1 patient died due to late presentation NSTEMI and multi-organ failure. There were 3 deaths in 2019: complications following coronary bypass surgery, upper GI bleed and a subarachnoid haemorrhage. Table 1 Comparison of NSTEMI patients in 2019 and 202020192020 p-valueAge (years) 71.2 ± 12.265.0 ± 12.1 p<0.01 NSTEMI patients 5659P=NSNSTEMI undergoing angiography 5053P=NS Median Time to angiography (hours) 68.614 p<0.01 Median length of stay (days)5 (IQR 2:8)2 (IQR 1:4) p<0.01 Referral to cardiac rehabilitation 77.4% 84.5% P=NS Prescription of secondary prevention medication 69.8% 72.4% P=NS. Conclusion Our results show that the mean age of the patients presenting with NSTEMI during the peak of the Covid-19 pandemic was younger suggesting that elderly patients failed to present. Compared to 2019, there was a significant improvement in patient treatment times with a significantly shorter stay in the hospital, probably as a result of the reduction in elective activity allowing un-restrained access to the catheter labs. We also saw improvement in prescription for secondary prevention and referral to cardiac rehabilitation services during this time suggesting that there may have been improved focus on these aspects of care again.
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Objective: The transition to medical school is challenging;even more so with the added stress and isolation from the COVID-19 pandemic. While studies have examined medical student wellness programs, few have been implemented during a pandemic, a time of high uncertainty and change. The purpose of this study was to evaluate a novel wellness program, Creating Caring Communities (CCC), its impact on students, and its helpfulness in their transition to medical school during COVID-19. Methods: All incoming first-year medical students (N=183) were required to participate in the mandatory first two of six, one-hour virtual sessions of CCC;a checkin with 10 students and 2 trained facilitators to create a safe space for connectivity and sharing. An online SurveyMonkey was administered to all participants after the sixth session to assess program impact, social isolation, meaningful experience, and helpfulness of CCC in the transition to medical school. Descriptive and bivariate analyses, including crosstabs, were completed using SPSS.25. Openended questions were thematically analyzed. Results: 126 M1 participants completed the post-CCC evaluation (68.9% response rate). Social isolation scores were consistent with the national average for the U.S. general adult population (M=51.96, SD=6.94). M1s who attended more than two sessions (39%) had significantly greater reports of meaningful experiences and helpfulness in transitioning to medical school (respectively, 58.1%;70.8%) compared to M1s who attended two or fewer sessions (respectively, 41.9%;29.2%;p<.05). When asked about the most valuable aspects of CCC, the most common themes reported were: building connections (49.6%), having a safe place to share experiences (17.0%), and not feeling alone (12.6%). Conclusion: Many students found that CCC was helpful with their transition to medical school. Future program refinement should consider whether sessions should be mandatory, the timing and length of the program, and participant input prior to starting CCC for group placement based on individual needs and interests.
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With the Fourth Industrial Revolution, cities are being acknowledged by various city leaders, urbaniste, and urban enthusiasts as the employing giants of the world. Urbanization has led to people migrating to urban nodes, not only from rural to urban but from urban to urban areas as well, thereby, leading to a significant influx of migrants. This is more evident in the fast-growing secondary cities that are becoming the new job centres. However, while incorporating a Master Planning and Development Planning approach, there is a consequential crisis of resource and infrastructure while accommodating the new residents. Coupled with the rise of health emergencies such as cholera and now, recently, COVID-19, the cities are calling for better management and administration of resources, especially water resources in the cities of the global south. As envisioned in various debates, 2/3rd of the world's population shall reside in urban areas. Self-sufficiency and resource management are going to be prime concerns soon. In Bhuj, the district headquarters of Kutch in Gujarat, India, a water crisis is already evident, and the city will need to cope up with this increasing demand for the better. This provides a potential for the development of a framework that can lay out a more efficient system for resource provision and administration. The Smart Cities initiative can act as a tool for bridging the gaps between technology and sociology. This study, therefore, acknowledges the potential by understanding the concept of smart cities, the application, and nuances of the concept in India, where the concept has started to hold ground as a notion in the form of Government-led Smart City Competitions. This research aims to study the various frameworks and mechanisms related to smart cities and Smart Cities Mission, and how the different verticals of the framework, i.e. physical, social, economic, and governance points of view, are co-dependent on each other. The study also acknowledges the existing arguments surrounding the potential of secondary cities like Bhuj, and how the efficiency in terms of water sensitivity can be improved optimally by bringing all stakeholders to the table and trigger discussions to provide a better quality of life to the citizens. The paper aims at urban enthusiasts, academicians, citizen groups, and decision-makers to dive into the potentials of the water-sensitive aspects of the Smart Cities Mission and how secondary fast-growing cities can gain some headway with this. © Published under licence by IOP Publishing Ltd.