Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 10 de 10
Filter
1.
CMAJ ; 193(24): E921-E930, 2021 06 14.
Article in French | MEDLINE | ID: covidwho-1551317

ABSTRACT

CONTEXTE: Les interventions non pharmacologiques demeurent le principal moyen de maîtriser le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) d'ici à ce que la couverture vaccinale soit suffisante pour donner lieu à une immunité collective. Nous avons utilisé des données de mobilité anonymisées de téléphones intelligents afin de quantifier le niveau de mobilité requis pour maîtriser le SRAS-CoV-2 (c.-à-d., seuil de mobilité), et la différence par rapport au niveau de mobilité observé (c.-à-d., écart de mobilité). MÉTHODES: Nous avons procédé à une analyse de séries chronologiques sur l'incidence hebdomadaire du SRAS-CoV-2 au Canada entre le 15 mars 2020 et le 6 mars 2021. Le paramètre mesuré était le taux de croissance hebdomadaire, défini comme le rapport entre les cas d'une semaine donnée et ceux de la semaine précédente. Nous avons mesuré les effets du temps moyen passé hors domicile au cours des 3 semaines précédentes à l'aide d'un modèle de régression log-normal, en tenant compte de la province, de la semaine et de la température moyenne. Nous avons calculé le seuil de mobilité et l'écart de mobilité pour le SRAS-CoV-2. RÉSULTATS: Au cours des 51 semaines de l'étude, en tout, 888 751 personnes ont contracté le SRAS-CoV-2. Chaque augmentation de 10 % de l'écart de mobilité a été associée à une augmentation de 25 % du taux de croissance des cas hebdomadaires de SRAS-CoV-2 (rapport 1,25, intervalle de confiance à 95 % 1,20­1,29). Comparativement à la mobilité prépandémique de référence de 100 %, le seuil de mobilité a été plus élevé au cours de l'été (69 %, écart interquartile [EI] 67 %­70 %), et a chuté à 54 % pendant l'hiver 2021 (EI 52 %­55 %); un écart de mobilité a été observé au Canada entre juillet 2020 et la dernière semaine de décembre 2020. INTERPRÉTATION: La mobilité permet de prédire avec fiabilité et constance la croissance des cas hebdomadaires et il faut maintenir des niveaux faibles de mobilité pour maîtriser le SRAS-CoV-2 jusqu'à la fin du printemps 2021. Les données de mobilité anonymisées des téléphones intelligents peuvent servir à guider le relâchement ou le resserrement des mesures de distanciation physique provinciales et régionales.


Subject(s)
COVID-19/prevention & control , Geographic Mapping , Mobile Applications/standards , Patient Identification Systems/methods , COVID-19/epidemiology , COVID-19/transmission , Canada/epidemiology , Humans , Mobile Applications/statistics & numerical data , Patient Identification Systems/statistics & numerical data , Quarantine/methods , Quarantine/standards , Quarantine/statistics & numerical data , Regression Analysis , Time Factors
3.
BMJ Open ; 11(11): e055530, 2021 11 22.
Article in English | MEDLINE | ID: covidwho-1528555

ABSTRACT

INTRODUCTION: With over 82.4 million forcibly displaced persons worldwide, there remains an urgent need to better describe culturally, contextually and age-tailored strategies for preventing COVID-19 in humanitarian contexts. Knowledge gaps are particularly pronounced for urban refugees who experience poverty, overcrowded living conditions and poor sanitation access that constrain the ability to practise COVID-19 mitigation strategies such as physical distancing and frequent hand washing. With over 1.4 million refugees, Uganda is sub-Saharan Africa's largest refugee hosting nation. More than 90 000 of Uganda's refugees live in Kampala, most in informal settlements, and 27% are aged 15-24 years old. There is an urgent need for tailored COVID-19 responses with urban refugee adolescents and youth. This study aims to evaluate the effectiveness of an 8-week interactive informational mobile health intervention on COVID-19 prevention practices among refugee and displaced youth aged 16-24 years in Kampala, Uganda. METHODS AND ANALYSIS: We will conduct a pre-test/post-test study nested within a larger cluster randomised trial. Approximately 385 youth participants will be enrolled and followed for 6 months. Data will be collected at three time points: before the intervention (time 1); immediately after the intervention (time 2) and at 16-week follow-up (time 3). The primary outcome (self-efficacy to practise COVID-19 prevention measures) and secondary outcomes (COVID-19 risk awareness, attitudes, norms and self-regulation practices; depression; sexual and reproductive health practices; food and water security; COVID-19 vaccine acceptability) will be evaluated using descriptive statistics and regression analyses. ETHICS AND DISSEMINATION: This study has been approved by the University of Toronto Research Ethics Board, the Mildmay Uganda Research Ethics Committee, and the Uganda National Council for Science & Technology. The results will be published in peer-reviewed journals, and findings communicated through reports and conference presentations. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04631367).


Subject(s)
COVID-19 , Refugees , Telemedicine , Adolescent , Adult , COVID-19 Vaccines , Humans , Randomized Controlled Trials as Topic , SARS-CoV-2 , Uganda , Young Adult
4.
Ann Epidemiol ; 66: 37-43, 2022 02.
Article in English | MEDLINE | ID: covidwho-1509562

ABSTRACT

PURPOSE: There is scant research examining urban refugee youth mental health outcomes, including potential impacts of the COVID-19 pandemic. We examine prevalence and ecosocial risk factors of depression in the periods before and after the COVID-19 pandemic declaration among urban refugee youth in Kampala, Uganda. METHODS: Data from a cohort of refugee youth (n = 367) aged 16-24 years were collected in periods before (February 2020) and after (December 2020) the WHO COVID-19 pandemic declaration. We developed crude and adjusted generalized estimating equation logistic regression models to examine demographic and ecosocial factors (food insecurity, social support, intimate partner violence) associated with depression, and include time-ecosocial interactions to examine if associations differed before and after the pandemic declaration. RESULTS: The prevalence of depression was high, but there was no significant difference before (27.5%), and after (28.9%) the pandemic declaration (P = .583). In adjusted models, food insecurity (aOR: 2.54; 95% CI: 1.21-5.33) and experiencing violence (aOR: 2.53; 95% CI: 1.07-5.96) were associated with increased depression, and social support was associated with decreased depression (aOR: 0.85; 95% CI: 0.81-0.89). CONCLUSIONS: These findings highlight the urgent need for interventions to address chronic depression, food insecurity, and ongoing effects of violence exposure among urban refugee youth in Kampala.


Subject(s)
COVID-19 , Refugees , Adolescent , Adult , COVID-19/epidemiology , Cohort Studies , Depression/epidemiology , Humans , Longitudinal Studies , Pandemics , Prevalence , Uganda/epidemiology , Young Adult
6.
Glob Health Action ; 14(1): 1940763, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1360274

ABSTRACT

With over 1.4 million refugees, Uganda is Sub-Saharan Africa's largest refugee-hosting nation. Bidi Bidi, Uganda's largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16-24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention's efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts.


Subject(s)
COVID-19 , Rape , Refugees , Sex Offenses , Adolescent , Communicable Disease Control , Humans , Pilot Projects , Rape/prevention & control , SARS-CoV-2 , Uganda , Young Adult
7.
Sci Data ; 8(1): 173, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1315604

ABSTRACT

The COVID-19 pandemic has demonstrated the need for real-time, open-access epidemiological information to inform public health decision-making and outbreak control efforts. In Canada, authority for healthcare delivery primarily lies at the provincial and territorial level; however, at the outset of the pandemic no definitive pan-Canadian COVID-19 datasets were available. The COVID-19 Canada Open Data Working Group was created to fill this crucial data gap. As a team of volunteer contributors, we collect daily COVID-19 data from a variety of governmental and non-governmental sources and curate a line-list of cases and mortality for all provinces and territories of Canada, including information on location, age, sex, travel history, and exposure, where available. We also curate time series of COVID-19 recoveries, testing, and vaccine doses administered and distributed. Data are recorded systematically at a fine sub-national scale, which can be used to support robust understanding of COVID-19 hotspots. We continue to maintain this dataset, and an accompanying online dashboard, to provide a reliable pan-Canadian COVID-19 resource to researchers, journalists, and the general public.


Subject(s)
COVID-19 , Databases, Factual , Vaccination/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Canada/epidemiology , Data Collection , Humans , Pandemics
8.
CMAJ ; 193(17): E592-E600, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1207650

ABSTRACT

BACKGROUND: Nonpharmaceutical interventions remain the primary means of controlling severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) until vaccination coverage is sufficient to achieve herd immunity. We used anonymized smartphone mobility measures to quantify the mobility level needed to control SARS-CoV-2 (i.e., mobility threshold), and the difference relative to the observed mobility level (i.e., mobility gap). METHODS: We conducted a time-series study of the weekly incidence of SARS-CoV-2 in Canada from Mar. 15, 2020, to Mar. 6, 2021. The outcome was weekly growth rate, defined as the ratio of cases in a given week versus the previous week. We evaluated the effects of average time spent outside the home in the previous 3 weeks using a log-normal regression model, accounting for province, week and mean temperature. We calculated the SARS-CoV-2 mobility threshold and gap. RESULTS: Across the 51-week study period, a total of 888 751 people were infected with SARS-CoV-2. Each 10% increase in the mobility gap was associated with a 25% increase in the SARS-CoV-2 weekly case growth rate (ratio 1.25, 95% confidence interval 1.20-1.29). Compared to the prepandemic baseline mobility of 100%, the mobility threshold was highest in the summer (69%; interquartile range [IQR] 67%-70%), and dropped to 54% in winter 2021 (IQR 52%-55%); a mobility gap was present in Canada from July 2020 until the last week of December 2020. INTERPRETATION: Mobility strongly and consistently predicts weekly case growth, and low levels of mobility are needed to control SARS-CoV-2 through spring 2021. Mobility measures from anonymized smartphone data can be used to guide provincial and regional loosening and tightening of physical distancing measures.


Subject(s)
COVID-19 Testing/trends , COVID-19/prevention & control , Disease Transmission, Infectious/prevention & control , COVID-19/epidemiology , Canada/epidemiology , Female , Forecasting , Humans , Incidence , Interrupted Time Series Analysis , Male , Physical Distancing , Public Health , Quarantine/trends
9.
JMIR Res Protoc ; 10(2): e26192, 2021 Feb 02.
Article in English | MEDLINE | ID: covidwho-1059620

ABSTRACT

BACKGROUND: HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. OBJECTIVE: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. METHODS: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. RESULTS: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. CONCLUSIONS: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations. TRIAL REGISTRATION: ClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26192.

10.
CMAJ Open ; 8(3): E545-E553, 2020.
Article in English | MEDLINE | ID: covidwho-740586

ABSTRACT

BACKGROUND: Nonpharmaceutical interventions (NPIs) are the primary tools to mitigate early spread of the coronavirus disease 2019 (COVID-19) pandemic; however, such policies are implemented variably at the federal, provincial or territorial, and municipal levels without centralized documentation. We describe the development of the comprehensive open Canadian Non-Pharmaceutical Intervention (CAN-NPI) data set, which identifies and classifies all NPIs implemented in regions across Canada in response to COVID-19, and provides an accompanying description of geographic and temporal heterogeneity. METHODS: We performed an environmental scan of government websites, news media and verified government social media accounts to identify NPIs implemented in Canada between Jan. 1 and Apr. 19, 2020. The CAN-NPI data set contains information about each intervention's timing, location, type, target population and alignment with a response stringency measure. We conducted descriptive analyses to characterize the temporal and geographic variation in early NPI implementation. RESULTS: We recorded 2517 NPIs grouped in 63 distinct categories during this period. The median date of NPI implementation in Canada was Mar. 24, 2020. Most jurisdictions heightened the stringency of their response following the World Health Organization's global pandemic declaration on Mar. 11, 2020. However, there was variation among provinces or territories in the timing and stringency of NPI implementation, with 8 out of 13 provinces or territories declaring a state of emergency by Mar. 18, and all by Mar. 22, 2020. INTERPRETATION: There was substantial geographic and temporal heterogeneity in NPI implementation across Canada, highlighting the importance of a subnational lens in evaluating the COVID-19 pandemic response. Our comprehensive open-access data set will enable researchers to conduct robust interjurisdictional analyses of NPI impact in curtailing COVID-19 transmission.


Subject(s)
COVID-19/therapy , Pandemics/prevention & control , Social Media/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , COVID-19 Testing/methods , Canada/epidemiology , Geography , Government , Humans , Infection Control/methods , Pandemics/legislation & jurisprudence , Physical Distancing , Policy , SARS-CoV-2/genetics , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL