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1.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.12.22283393

ABSTRACT

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.

2.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.10.11.22280952

ABSTRACT

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.

3.
Archives of Disease in Childhood ; 106(Suppl 1):A79-A80, 2021.
Article in English | ProQuest Central | ID: covidwho-1443396

ABSTRACT

BackgroundSimulation has multiple benefits in paediatrics – experiential learning, hands-on skills practice, communication, task prioritisation and human factors challenges to name but a few. We also recognise the significant value of the debrief, and how supporting a peer-led learning conversation helps to both further and consolidate knowledge. During COVID-19, routine face-to-face simulation delivery in our Trust has stopped, begging the question of how we can continue to support our colleagues’ clinical knowledge and skills, bearing in mind that many are now shielding at home.ObjectivesOur solution was to design paediatric emergency simulated scenarios and deliver them virtually to remote learners via video conferencing software, as we believed that this could lead to both effective teaching and learning. We set out to explore the different ways in which this could feasibly be achieved, and through feedback from our learners, establish which methods were most effective. Our goal was the ensure real-time interactivity through engagement from the learners, as this has been a criticism of observing and our involvement with remote simulation in the past.MethodsWe developed 3 distinct forms of virtual simulation:1. Simulation By-Proxy: The set-up was as per traditional face-to-face simulation, with a high-fidelity manikin in a hospital bed surrounded by medical equipment and visible monitoring. The remote learners were shown a webcam view and were asked to work as a team to clearly instruct an in-situ confederate nurse and doctor (with no initiative of their own) to manage a complex child with pneumonia and sepsis.2. Real-time Input: No manakin or bed-space were used. Remote learners were shown a power-point-type presentation which described an evolving clinical case of a paediatric burn. Integrated software allowed real-time group participation in word clouds, prioritisation tasks and multiple-choice questions with anonymous results visible within the presentation (like asking the audience in Who Wants To Be A Millionaire).3. Direct Facilitation: No manakin or bed-space were used. Remote learners were shown a power-point presentation which described an evolving clinical case of paediatric toxic shock syndrome. Learners were numbered upwards from junior to senior, and took turns directing the care of the patient sequentially. Slides showed clinical images such as bedside monitoring, blood gases and laboratory blood results. The scenario was proactively facilitated by the host as the clinical reasoning and management became more complex.ResultsOverall, virtual simulation was very well received in a time when learning has become much more accessible but also more didactic. Our feedback questionnaire from 12 remote learners showed they both enjoyed and engaged with the scenarios, and particular highlights included capturing the sense and pressure of an emergency in methods 1 and 3, passing team leadership on as a baton in method 3, but also the anonymity and group interactivity of method 2. All scenarios benefitted from debrief in the traditional manner.ConclusionsWe believe that virtual simulation has a role in the current healthcare environment, and is both possible and educationally valuable, with many different strengths that can be combined for a blended learning environment.

4.
Religions ; 12(9):682, 2021.
Article in English | MDPI | ID: covidwho-1374486

ABSTRACT

In 2020, as infections of COVID-19 began to rise, Australia, alongside many other nations, closed its international borders and implemented lockdown measures across the country. The city of Melbourne was hardest hit during the pandemic and experienced the strictest and longest lockdown worldwide. Religious and spiritual groups were especially affected, given the prohibition of gatherings of people for religious services and yoga classes with a spiritual orientation, for example. Fault lines in socio-economic differences were also pronounced, with low-wage and casual workers often from cultural and religious minorities being particularly vulnerable to the virus in their often precarious workplaces. In addition, some religious and spiritual individuals and groups did not comply and actively resisted restrictions at times. By contrast, the pandemic also resulted in a positive re-engagement with religion and spirituality, as lockdown measures served to accelerate a digital push with activities shifting to online platforms. Religious and spiritual efforts were initiated online and offline to promote wellbeing and to serve those most in need. This article presents an analysis of media representations of religious, spiritual and non-religious responses to the COVID-19 pandemic in Melbourne, Australia, from January to August 2020, including two periods of lockdown. It applies a mixed-method quantitative and qualitative thematic approach, using targeted keywords identified in previous international and Australian media research. In so doing, it provides insights into Melbourne’s worldview complexity, and also of the changing place of religion, spirituality and non-religion in the Australian public sphere in COVID times.

5.
medrxiv; 2021.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2021.01.21.21250243

ABSTRACT

Introduction Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. This study systematically reviewed the strength of evidence in the published COVID-19 policy impact evaluation literature. Methods We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on November 26, 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation, assessing what impact evaluation method was used, graphical display of outcomes data, functional form for the outcomes, timing between policy and impact, concurrent changes to the outcomes, and an overall rating. Results After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. The majority (n=23/36) of studies in our sample examined the impact of stay-at-home requirements. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-section), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 1/27 studies passed all of the above checks, and 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. Discussion The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigor to be actionable by policy-makers. This was largely driven by the circumstances under which policies were passed making it difficult to attribute changes in COVID-19 outcomes to particular policies. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.

6.
medrxiv; 2020.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2020.08.26.20182279

ABSTRACT

Background COVID-19 poses a major challenge to infection control in care homes. SARS-CoV-2 is readily transmitted between people in close contact and causes disproportionately severe disease in older people. Methods Data and SARS-CoV-2 samples were collected from patients in the East of England (EoE) between 26th February and 10th May 2020. Care home residents were identified using address search terms and Care Quality Commission registration information. Samples were sequenced at the University of Cambridge or the Wellcome Sanger Institute and viral clusters defined based on genomic and time differences between cases. Findings 7,406 SARS-CoV-2 positive samples from 6,600 patients were identified, of which 1,167 (18.2%) were residents from 337 care homes. 30/71 (42.3%) care home residents tested at Cambridge University Hospitals NHS Foundation Trust (CUH) died. Genomes were available for 700/1,167 (60%) residents from 292 care homes, and 409 distinct viral clusters were defined. We identified several probable transmissions between care home residents and healthcare workers (HCW). Interpretation Care home residents had a significant burden of COVID-19 infections and high mortality. Larger viral clusters were consistent with within-care home transmission, while multiple clusters per care home suggested independent acquisitions.

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