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Front Public Health ; 9: 654299, 2021.
Article in English | MEDLINE | ID: covidwho-1348570


There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.

COVID-19 , COVID-19 Testing , Humans , Madagascar/epidemiology , Pandemics , SARS-CoV-2 , Seroepidemiologic Studies
American Journal of Public Health ; 111(3):342-343, 2021.
Article in English | ProQuest Central | ID: covidwho-1197954


Beyond the tremendous grief and psychological toll, the loss of a parent often reduces income for the family;loss of a maternal parent in particular is associated with increases in malnutrition and death in sub-Saharan Africa.1,2 Orphaned children are at increased risk of loss of education.3 HIV is still a highly stigmatized condition in many places, and the loss of a parent combined with this stigmatization can lead to mental health issues such as depression. Safety net policies, designed to prevent households from falling below a minimum threshold of poverty or health, could be deployed;indeed, decoupling health access from the abilityto pay through Universal Health Care Coverage policies is one of the most prominent of the United Nations' Sustainable Development Goals (https://sdgs. A 2014 observational study in South Africa found that "cash plus care" (microtransfer plus "care" in the form of positive parenting and teacher-mentor support) was the most effective measure at reducing HIV risk behavior in adolescent girls, and the only effective measure in adolescent boys.