The COVID-19 pandemic and its prolonged impacts on food prices, food consumption and diet quality in sub-Saharan Africa (preprint)

Background Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods, nutrition, and food security, with recovery slowed down by lagging vaccination progress. Objective This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. Methods We conducted a repeated cross-sectional study and used a mobile platform to collect data. Data collected from round 1 (July-November, 2020) and round 2 (July-December, 2021) were considered. We assessed participants' dietary intake of 20 food groups over the previous seven days. The studys primary outcome was the Prime Diet Quality Score (PDQS), with higher scores indicating better dietary quality. We used linear regression and generalized estimating equations to assess factors associated with diet quality during COVID-19. Results Most of the respondents were male and the mean age ({+/-}SD) was 42.4 ({+/-}12.5) years. Mean PDQS ({+/-}SD) was low at 19.1 ({+/-}3.8) before COVID-19, 18.6({+/-}3.4) in Round 1, and 19.4({+/-}3.8) in Round 2. A majority of respondents (80%) reported higher than expected prices for all food groups during the pandemic. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), older age (estimate: 30-39 years: 0.77, 95% CI: 0.35, 1.19, or 40 years or older: 0.72, 95% CI: 0.30, 1.13), and medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81) were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) associated with lower PDQS. Conclusion Diet quality which had declined early in the pandemic had started to improve. However, consumption of healthy diets remained low, and food prices remained high. Efforts should continue to improve diet quality for sustained nutrition recovery through mitigation measures, including social protection.

Perceptions and predictors of COVID-19 vaccine hesitancy among health care providers across five countries in sub-Saharan Africa (preprint)

The African continent has some of the world’s lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among health care providers (HCP) is another factor that could adversely affect efforts to control infections on the continent. We sought to understand the extent of COVID-19 vaccine hesitancy among HCP, and its contributing factors in Africa. We evaluated COVID-19 vaccine hesitancy among 1,499 HCP enrolled in a repeated cross-sectional telephone survey in Burkina Faso, Ethiopia, Nigeria, Tanzania and Ghana. We defined COVID-19 vaccine hesitancy among HCP as self-reported responses of definitely not, maybe, unsure, or undecided on whether to get the COVID-19 vaccine, compared to definitely getting the vaccine. We used Poisson regression models to evaluate factors influencing vaccine hesitancy among HCP. Approximately 65.6% were nurses and the mean age (±SD) of participants was 35.8 (±9.7) years. At least 67% of the HCP reported being vaccinated. Reasons for low COVID-19 vaccine uptake included concern about vaccine effectiveness, side effects and fear of receiving unsafe and experimental vaccines. COVID-19 vaccine hesitancy affected 45.7% of the HCP in Burkina Faso, 25.7% in Tanzania, 9.8% in Ethiopia, 9% in Ghana and 8.1% in Nigeria. Respondents reporting that COVID-19 vaccines are very effective (RR:0.21, 95% CI:0.08, 0.55), and older HCP (45 or older vs.20-29 years, RR:0.65, 95% CI: 0.44,0.95) were less likely to be vaccine-hesitant. Nurses were more likely to be vaccine-hesitant (RR 1.38, 95% CI: 1.00,1.89) compared to doctors. We found higher vaccine hesitancy among HCP in Burkina Faso and Tanzania. Information asymmetry among HCP, beliefs about vaccine effectiveness and the endorsement of vaccines by the public health institutions may be important. Efforts to address hesitancy should address information and knowledge gaps among different cadres of HCP and should be coupled with efforts to increase vaccine supply.

COVID-19 disruptions of food systems and nutrition services in Ethiopia: Evidence of the impacts and policy responses (preprint)

BackgroundSince its first case of COVID-19 on March 13, 2020 and Ethiopia has exerted efforts to curb the spread of the Coronavirus disease 2019 (COVID-19) without imposing a nationwide lockdown. Globally, COVID-19 related disruptions and mitigation measures have impacted livelihoods and food systems, nutrition, as well as access and use of health services. ObjectiveTo develop a comprehensive understanding of the impacts of the COVID-19 pandemic on food security and maternal and child nutrition and health services and to synthesize lessons from policy responses to the COVID-19 pandemic in Ethiopia. MethodsWe conducted a review of literature and 8 key informant interviews across government agencies, donors, and non-governmental organizations (NGOs), to map the impacts of the COVID-19 pandemic on the food and health systems in Ethiopia. We summarized policy responses and identified recommendations for future actions related to the COVID-19 pandemic and other future emergencies. ResultsThe impacts of the COVID-19 pandemic were felt across the food system. Disruptions were noted in inputs supply due to travel restrictions and closed borders restricting trade, reduced in-person support by agriculture extension workers, income losses, increases in food prices, and the reduction in food security and consumption of less diverse diets. Maternal and child health services were disrupted due to fear of contacting COVID-19, diversion of resources, and lack of personal protective equipment. Disruptions eased over time due to the expansion of social protection, through the Productive Safety Net Program, and the increased outreach and home service provision by the health extension workers. ConclusionEthiopia experienced disruptions to food systems and expanded existing social protection and public health infrastructure and leveraged partnerships with non-state actors. Nevertheless, vulnerabilities and gaps remain and there is a need for a long-term strategy that considers the cyclical nature of COVID-19 cases.

Levels and determinants of COVID-19 vaccine hesitancy among sub-Saharan African adolescents (preprint)

COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the levels and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2803 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 15% in rural Kersa, 24% in rural Ibadan, 31% in rural Nouna, 33% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 64% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.61; 95% CI: 3.10, 4.22) and lack of effectiveness (aPR: 3.59; 95% CI: 3.09, 4.18) were associated with greater vaccine hesitancy. The levels of COVID-19 vaccine hesitancy among adolescents are alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.