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1.
Ther Adv Infect Dis ; 9: 20499361221103876, 2022.
Article in English | MEDLINE | ID: covidwho-2064694

ABSTRACT

Background: Systematic assessment of childhood asthma is challenging in low- and middle-income country (LMIC) settings due to the lack of standardised and validated methodologies. We describe the contextual challenges and adaptation strategies in the implementation of a community-based asthma assessment in four resource-constrained settings in Bangladesh, India, and Pakistan. Method: We followed a group of children of age 6-8 years for 12 months to record their respiratory health outcomes. The study participants were enrolled at four study sites of the 'Aetiology of Neonatal Infection in South Asia (ANISA)' study. We standardised the research methods for the sites, trained field staff for uniform data collection and provided a 'Child Card' to the caregiver to record the illness history of the participants. We visited the children on three different occasions to collect data on respiratory-related illnesses. The lung function of the children was assessed in the outreach clinics using portable spirometers before and after 6-minute exercise, and capillary blood was examined under light microscopes to determine eosinophil levels. Results: We enrolled 1512 children, 95.5% (1476/1512) of them completed the follow-up, and 81.5% (1232/1512) participants attended the lung function assessment tests. Pre- and post-exercise spirometry was performed successfully in 88.6% (1091/1232) and 85.7% (1056/1232) of children who attempted these tests. Limited access to health care services, shortage of skilled human resources, and cultural diversity were the main challenges in adopting uniform procedures across all sites. Designing the study implementation plan based on the local contexts and providing extensive training of the healthcare workers helped us to overcome these challenges. Conclusion: This study can be seen as a large-scale feasibility assessment of applying spirometry and exercise challenge tests in community settings of LMICs and provides confidence to build capacity to evaluate children's respiratory outcomes in future translational research studies.

2.
J Clin Epidemiol ; 147: 11-20, 2022 07.
Article in English | MEDLINE | ID: covidwho-2061466

ABSTRACT

OBJECTIVES: Year-to-year variation in respiratory viruses may result in lower attack rates than expected. We aimed to illustrate the impact of year-to-year variation in attack rates on the likelihood of demonstrating vaccine efficacy (VE). STUDY DESIGN AND SETTING: We considered an individually randomized maternal vaccine trial against respiratory syncytial virus (RSV)-associated hospitalizations. For 10 RSV-associated hospitalizations per 1,000 infants, sample size to have 80% power for true VE of 50% and 70% was 9,846 and 4,424 participants. We reported power to show VE for varying attack rates, selected to reflect realistic year-to-year variation using observational studies. Eight scenarios including varying number of countries and seasons were developed to assess the influence of these trial parameters. RESULTS: Including up to three seasons decreased the width of the interquartile range for power. Including more seasons concentrated statistical power closer to 80%. Least powered trials had higher statistical power with more seasons. In all scenarios, at least half of the trials had <80% power. For three-season trials, increasing the sample size by 10% reduced the percentage of underpowered trials to less than one-quarter of trials. CONCLUSION: Year-to-year variation in RSV attack rates should be accounted for during trial design. Mitigation strategies include recruiting over more seasons, or adaptive trial designs.


Subject(s)
Clinical Trials as Topic , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus Vaccines , Hospitalization , Humans , Incidence , Infant , Research Design , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/prevention & control , Seasons , Vaccine Efficacy
3.
Commun Med (Lond) ; 2: 119, 2022.
Article in English | MEDLINE | ID: covidwho-2042347

ABSTRACT

Background: Short-term prediction of COVID-19 epidemics is crucial to decision making. We aimed to develop supervised machine-learning algorithms on multiple digital metrics including symptom search trends, population mobility, and vaccination coverage to predict local-level COVID-19 growth rates in the UK. Methods: Using dynamic supervised machine-learning algorithms based on log-linear regression, we explored optimal models for 1-week, 2-week, and 3-week ahead prediction of COVID-19 growth rate at lower tier local authority level over time. Model performance was assessed by calculating mean squared error (MSE) of prospective prediction, and naïve model and fixed-predictors model were used as reference models. We assessed real-time model performance for eight five-weeks-apart checkpoints between 1st March and 14th November 2021. We developed an online application (COVIDPredLTLA) that visualised the real-time predictions for the present week, and the next one and two weeks. Results: Here we show that the median MSEs of the optimal models for 1-week, 2-week, and 3-week ahead prediction are 0.12 (IQR: 0.08-0.22), 0.29 (0.19-0.38), and 0.37 (0.25-0.47), respectively. Compared with naïve models, the optimal models maintain increased accuracy (reducing MSE by a range of 21-35%), including May-June 2021 when the delta variant spread across the UK. Compared with the fixed-predictors model, the advantage of dynamic models is observed after several iterations of update. Conclusions: With flexible data-driven predictors selection process, our dynamic modelling framework shows promises in predicting short-term changes in COVID-19 cases. The online application (COVIDPredLTLA) could assist decision-making for control measures and planning of healthcare capacity in future epidemic growths.

4.
J Res Med Sci ; 27: 57, 2022.
Article in English | MEDLINE | ID: covidwho-2024814

ABSTRACT

At a time when the COVID-19's second wave is still picking up in countries like India, a number of reports describe the potential association with a rise in the number of cases of mucormycosis, commonly known as the black fungus. This fungal infection has been around for centuries and affects those people whose immunity has been compromised due to severe health conditions. In this article, we provide a detailed overview of mucormycosis and discuss how COVID-19 could have caused a sudden spike in an otherwise rare disease in countries like India. The article discusses the various symptoms of the disease, class of people most vulnerable to this infection, preventive measures to avoid the disease, and various treatments that exist in clinical practice and research to manage the disease.

5.
Open Forum Infect Dis ; 9(8): ofac352, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2008601

ABSTRACT

We conducted a scoping review of the epidemiological literature from the past 50 years to document the contribution of influenza virus infection to extrapulmonary clinical outcomes. We identified 99 publications reporting 243 associations using many study designs, exposure and outcome definitions, and methods. Laboratory confirmation of influenza was used in only 28 (12%) estimates, mostly in case-control and self-controlled case series study designs. We identified 50 individual clinical conditions associated with influenza. The most numerous estimates were of cardiocirculatory diseases, neurological/neuromuscular diseases, and fetal/newborn disorders, with myocardial infarction the most common individual outcome. Due to heterogeneity, we could not generate summary estimates of effect size, but of 130 relative effect estimates, 105 (81%) indicated an elevated risk of extrapulmonary outcome with influenza exposure. The literature is indicative of systemic complications of influenza virus infection, the requirement for more effective influenza control, and a need for robust confirmatory studies.

6.
J Glob Health ; 12: 04065, 2022 Aug 17.
Article in English | MEDLINE | ID: covidwho-1994425

ABSTRACT

Background: The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders. Methods: Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19. Results: Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts. Conclusions: Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.


Subject(s)
COVID-19 , Reproductive Health Services , COVID-19/drug therapy , COVID-19/epidemiology , Communicable Disease Control , Female , Humans , Uganda/epidemiology
7.
Lancet ; 399(10340): 2047-2064, 2022 05 28.
Article in English | MEDLINE | ID: covidwho-1864651

ABSTRACT

BACKGROUND: Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infection in young children. We previously estimated that in 2015, 33·1 million episodes of RSV-associated acute lower respiratory infection occurred in children aged 0-60 months, resulting in a total of 118 200 deaths worldwide. Since then, several community surveillance studies have been done to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated acute lower respiratory infection morbidity and mortality at global, regional, and national levels in children aged 0-60 months for 2019, with focus on overall mortality and narrower infant age groups that are targeted by RSV prophylactics in development. METHODS: In this systematic analysis, we expanded our global RSV disease burden dataset by obtaining new data from an updated search for papers published between Jan 1, 2017, and Dec 31, 2020, from MEDLINE, Embase, Global Health, CINAHL, Web of Science, LILACS, OpenGrey, CNKI, Wanfang, and ChongqingVIP. We also included unpublished data from RSV GEN collaborators. Eligible studies reported data for children aged 0-60 months with RSV as primary infection with acute lower respiratory infection in community settings, or acute lower respiratory infection necessitating hospital admission; reported data for at least 12 consecutive months, except for in-hospital case fatality ratio (CFR) or for where RSV seasonality is well-defined; and reported incidence rate, hospital admission rate, RSV positive proportion in acute lower respiratory infection hospital admission, or in-hospital CFR. Studies were excluded if case definition was not clearly defined or not consistently applied, RSV infection was not laboratory confirmed or based on serology alone, or if the report included fewer than 50 cases of acute lower respiratory infection. We applied a generalised linear mixed-effects model (GLMM) to estimate RSV-associated acute lower respiratory infection incidence, hospital admission, and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. We estimated country-level RSV-associated acute lower respiratory infection incidence through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality. This review was registered in PROSPERO (CRD42021252400). FINDINGS: In addition to 317 studies included in our previous review, we identified and included 113 new eligible studies and unpublished data from 51 studies, for a total of 481 studies. We estimated that globally in 2019, there were 33·0 million RSV-associated acute lower respiratory infection episodes (uncertainty range [UR] 25·4-44·6 million), 3·6 million RSV-associated acute lower respiratory infection hospital admissions (2·9-4·6 million), 26 300 RSV-associated acute lower respiratory infection in-hospital deaths (15 100-49 100), and 101 400 RSV-attributable overall deaths (84 500-125 200) in children aged 0-60 months. In infants aged 0-6 months, we estimated that there were 6·6 million RSV-associated acute lower respiratory infection episodes (4·6-9·7 million), 1·4 million RSV-associated acute lower respiratory infection hospital admissions (1·0-2·0 million), 13 300 RSV-associated acute lower respiratory infection in-hospital deaths (6800-28 100), and 45 700 RSV-attributable overall deaths (38 400-55 900). 2·0% of deaths in children aged 0-60 months (UR 1·6-2·4) and 3·6% of deaths in children aged 28 days to 6 months (3·0-4·4) were attributable to RSV. More than 95% of RSV-associated acute lower respiratory infection episodes and more than 97% of RSV-attributable deaths across all age bands were in low-income and middle-income countries (LMICs). INTERPRETATION: RSV contributes substantially to morbidity and mortality burden globally in children aged 0-60 months, especially during the first 6 months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease worldwide, with one in every 50 deaths in children aged 0-60 months and one in every 28 deaths in children aged 28 days to 6 months attributable to RSV. For every RSV-associated acute lower respiratory infection in-hospital death, we estimate approximately three more deaths attributable to RSV in the community. RSV passive immunisation programmes targeting protection during the first 6 months of life could have a substantial effect on reducing RSV disease burden, although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented. FUNDING: EU Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe (RESCEU).


Subject(s)
Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Respiratory Tract Infections , Child , Child, Preschool , Cost of Illness , Global Health , Hospital Mortality , Hospitalization , Humans , Infant , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Tract Infections/epidemiology
8.
J Glob Health ; 12: 05013, 2022 May 14.
Article in English | MEDLINE | ID: covidwho-1847638

ABSTRACT

Background: To date, COVID-19 vaccine coverage in the African region falls far too short of global goals. Increasing vaccination rates requires understanding barriers to vaccination so that effective interventions that sensitively and effectively address barriers to vaccination can be implemented. Methods: To assess COVID-19 vaccination levels and identify major barriers to vaccine uptake we conducted a population-based, cross-sectional survey among 1662 adults 18 and older from August 25 to October 29 2021 in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area, Mpumalanga, South Africa. Results: Half of participants reported receiving a COVID-19 vaccine (50.4%) with 41.1% being fully vaccinated and 9.3% being partially vaccinated; 49.6% were unvaccinated. More women than men were vaccinated (55.5% vs 42.8%, P < 0.001), and older age groups were more likely to be vaccinated than younger age groups (P < 0.001). Among the unvaccinated, 69.0% planned to get vaccinated as soon as possible, while 14.7% reported definitely not wanting the vaccine. Major barriers to vaccination included lacking information on eligibility (12.3%) or where to get vaccinated (13.0%), concerns about side effects (12.5%), and inconvenient hours and locations for vaccination (11.0%). Confidence in the safety and efficacy of COVID-19 vaccines was higher among those vaccinated than unvaccinated (75.3% vs 51.2%, 75.8% vs 51.0%, both P < 0.001, respectively). Conclusions: Increasing vaccination in South Africa beyond current levels will require a concerted effort to address concerns around vaccine safety and increase confidence in vaccine efficacy. Clarifying eligibility and ensuring access to vaccines at times and places that are convenient to younger populations, men, and other vulnerable groups is necessary.


Subject(s)
COVID-19 , Vaccines , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , South Africa/epidemiology , Vaccination Hesitancy
9.
J Glob Health ; 12: 05012, 2022 04 14.
Article in English | MEDLINE | ID: covidwho-1847637

ABSTRACT

Background: In November 2020, the World Health Organization (WHO) created interim guidance on how to integrate testing for SARS-CoV-2 into existing influenza surveillance systems. Influenza-like illness (ILI) and severe acute respiratory illness (SARI) case definitions have been used to specify the case definition of COVID-19 for surveillance purposes. This review aims to assess whether the common clinical features of COVID-19 have changed to the point that the criteria used to identify both COVID-19 and influenza in surveillance programs needs to be altered. Methods: A systematic review of reviews following PRISMA-P guidelines was conducted using the "COVID-19 evidence review" database from August 19, 2020, to August 19, 2021. Reviews providing pooled estimates of the prevalence of clinical features of COVID-19 within the general population, diagnosed by polymerase chain reaction or rapid diagnostic test, were included. These were critically appraised and sensitivity analysis was undertaken to examine potential causes of bias. Results: Fourteen reviews were identified, including three on adults only and three on children only. For all reviews, combined fever (median prevalence = 73.0%, IQR = 58.3-78.7) and cough (45.1%, IQR = 28.9-54.0) were the most common features. These were followed by loss of taste or smell (45.1%, IQR = 28.9-54.0), hypoxemia (33%, one review), fatigue (26.4%, IQR = 9.0-39.4) and expectoration (23.9%, IQR = 23.3-25.5). Fever and cough continued to be the most prevalent features for adults and children, with subsequent symptoms being similar for adults only. However, the pattern differed for children, with headache (34.3%, IQR = 18-50.7) and nasal congestion (20%, one review) being the third and fourth commonest symptoms. Conclusions: The prevalent features found in this recent review were the same as the ones identified at the beginning of the pandemic. Therefore, the current approach of using the ILI and SARI criteria which incorporate fever and cough will identify COVID-19 cases in addition to influenza. Interestingly, children may present with different features, as headaches and nasal congestion were more common in this group. Future research could examine this further and investigate whether symptomology changes with new variants of COVID-19.


Subject(s)
COVID-19 , Influenza, Human , Virus Diseases , Adult , Child , Cough , Humans , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Meta-Analysis as Topic , SARS-CoV-2 , Systematic Reviews as Topic
10.
J Glob Health ; 12: 06001, 2022.
Article in English | MEDLINE | ID: covidwho-1811192

ABSTRACT

Background: Pneumonia is the leading cause of under-five child deaths globally and in Bangladesh. Hypoxaemia or low (<90%) oxygen concentration in the arterial blood is one of the strongest predictors of child mortality from pneumonia and other acute respiratory infections. Since 2014, the World Health Organization recommends using pulse oximetry devices in Integrated Management of Childhood Illness (IMCI) services (outpatient child health services), but it was not routinely used in most health facilities in Bangladesh until 2018. This paper describes the stakeholder engagement process embedded in an implementation research study to influence national policy and programmes to introduce pulse oximetry in routine IMCI services in Bangladesh. Methods: Based on literature review and expert consultations, we developed a conceptual framework, which guided the planning and implementation of a 4-step stakeholder engagement process. Desk review, key informant interviews, consultative workshops and onsite demonstration were the key methods to involve and engage a wide range of stakeholders. In the first step, a comprehensive desk review and key informant interviews were conducted to identify stakeholder organisations and scored them based on their power and interest levels regarding IMCI implementation in Bangladesh. In the second step, two national level, two district level and five sub-district level sensitisation workshops were organised to orient all stakeholder organisations having high power or high interest regarding the importance of using pulse oximetry for pneumonia assessment and classification. In the third step, national and district level high power-high interest stakeholder organisations were involved in developing a joint action plan for introducing pulse oximetry in routine IMCI services. In the fourth step, led by a formal working group under the leadership of the Ministry of Health, we updated the national IMCI implementation package, including all guidelines, training manuals, services registers and referral forms in English and Bangla. Subsequently, we demonstrated its use in real-life settings involving various levels of (national, district and sub-district) stakeholders and worked alongside the government leaders towards carefully resuming activities despite the COVID-19 pandemic. Results: Our engagement process contributed to the national decision to introduce pulse oximetry in routine child health services and update the national IMCI implementation package demonstrating country ownership, government leadership and multi-partner involvement, which are steppingstones towards scalability and sustainability. However, our experience clearly delineates that stakeholder engagement is a context-driven, time-consuming, resource-intensive, iterative, mercurial process that demands meticulous planning, prioritisation, inclusiveness, and adaptability. It is also influenced by the expertise, experience and positionality of the facilitating organization. Conclusions: Our experience has demonstrated the value and potential of the approach that we adopted for stakeholder engagement. However, the approach needs to be conceptualised coupled with the allocation of adequate resources and time commitment to implement it effectively.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated , Bangladesh , Child , Humans , Oximetry , Pandemics , Policy , Stakeholder Participation
11.
J Migr Health ; 5: 100098, 2022.
Article in English | MEDLINE | ID: covidwho-1773513

ABSTRACT

The rapid spread of COVID-19 has overwhelmed the existing health care systems, finding it challenging to provide essential health services besides the COVID-19 response interventions. Refugees are disproportionately affected by the COVID-19 pandemic because of the barriers they face to access health care. However, there is limited research that investigates how access to HIV/AIDS or TB care services by urban refugees is affected during pandemics such as the COVID-19. This study adopted a cross-sectional survey utilizing quantitative (N=229) and qualitative data (26 in-depth interviews and 8 key informant interviews) held among urban refugees living in Kampala, Uganda. Results revealed that more females (75%) than males (25%) were able to access TB or HIV/AIDS services during COVID-19 related lockdowns. A decrease in queues, delivery of drugs through Village Health Teams (VHTs), proximity to health facilities, supply of necessities like food and the reception at the health facilities facilitated access to TB or HIV/AIDS services. On the other hand, restrictions on public transport, high transport costs, unemployment and subsequent poverty were barriers to access to TB or HIV/AIDS services. Results offer major insights into the effect of COVID-19 control measures on disruption of access to services particularly in relation to being able to access service points. The findings suggest that recognizing structural barriers to uninterrupted or continued access to HIV/AIDS or TB services during pandemics such as COVID-19 can go a long way in helping stakeholders to design measures that make it possible for more urban refugees to access HIV/AIDS or TB services.

12.
J Infect Dis ; 225(6): 957-964, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1735580

ABSTRACT

Nonpharmaceutical interventions (NPIs) were widely introduced to combat the coronavirus disease 2019 (COVID-19) pandemic. These interventions also likely led to substantially reduced activity of respiratory syncytial virus (RSV). From late 2020, some countries observed out-of-season RSV epidemics. Here, we analyzed the role of NPIs, population mobility, climate, and severe acute respiratory syndrome coronavirus 2 circulation in RSV rebound through a time-to-event analysis across 18 countries. Full (re)opening of schools was associated with an increased risk for RSV rebound (hazard ratio [HR], 23.29 [95% confidence interval {CI}, 1.09-495.84]); every 5°C increase in temperature was associated with a decreased risk (HR, 0.63 [95% CI, .40-.99]). There was an increasing trend in the risk for RSV rebound over time, highlighting the role of increased population susceptibility. No other factors were found to be statistically significant. Further analysis suggests that increasing population susceptibility and full (re)opening of schools could both override the countereffect of high temperatures, which explains the out-of-season RSV epidemics during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus, Human , Climate , Humans , Pandemics , Respiratory Syncytial Virus Infections/prevention & control , Respiratory Syncytial Virus, Human/pathogenicity , Seasons , Temperature
13.
Lancet Glob Health ; 10(3): e348-e359, 2022 03.
Article in English | MEDLINE | ID: covidwho-1683793

ABSTRACT

BACKGROUND: Pneumonia accounts for around 15% of all deaths of children younger than 5 years globally. Most happen in resource-constrained settings and are potentially preventable. Hypoxaemia is one of the strongest predictors of these deaths. We present an updated estimate of hypoxaemia prevalence among children with pneumonia in low-income and middle-income countries. METHODS: We conducted a systematic review using the following key concepts "children under five years of age" AND "pneumonia" AND "hypoxaemia" AND "low- and middle-income countries" by searching in 11 bibliographic databases and citation indices. We included all articles published between Nov 1, 2008, and Oct 8, 2021, based on observational studies and control arms of randomised and non-randomised controlled trials. We excluded protocol papers, articles reporting hypoxaemia prevalence based on less than 100 pneumonia cases, and articles published before 2008 from the review. Quality appraisal was done with the Joanna Briggs Institute tools. We reported pooled prevalence of hypoxaemia (SpO2 <90%) by classification of clinical severity and by clinical settings by use of the random-effects meta-analysis models. We combined our estimate of the pooled prevalence of pneumonia with a previously published estimate of the number of children admitted to hospital due to pneumonia annually to calculate the total annual number of children admitted to hospital with hypoxaemic pneumonia. FINDINGS: We identified 2825 unique records from the databases, of which 57 studies met the eligibility criteria: 26 from Africa, 23 from Asia, five from South America, and four from multiple continents. The prevalence of hypoxaemia was 31% (95% CI 26-36; 101 775 children) among all children with WHO-classified pneumonia, 41% (33-49; 30 483 children) among those with very severe or severe pneumonia, and 8% (3-16; 2395 children) among those with non-severe pneumonia. The prevalence was much higher in studies conducted in emergency and inpatient settings than in studies conducted in outpatient settings. In 2019, we estimated that over 7 million children (95% CI 5-8 million) were admitted to hospital with hypoxaemic pneumonia. The studies included in this systematic review had high τ2 (ie, 0·17), indicating a high level of heterogeneity between studies, and a high I2 value (ie, 99·6%), indicating that the heterogeneity was not due to chance. This study is registered with PROSPERO, CRD42019126207. INTERPRETATION: The high prevalence of hypoxaemia among children with severe pneumonia, particularly among children who have been admitted to hospital, emphasises the importance of overall oxygen security within the health systems of low-income and middle-income countries, particularly in the context of the COVID-19 pandemic. Even among children with non-severe pneumonia that is managed in outpatient and community settings, the high prevalence emphasises the importance of rapid identification of hypoxaemia at the first point of contact and referral for appropriate oxygen therapy. FUNDING: UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109).


Subject(s)
Hypoxia/epidemiology , Internationality , Pneumonia/epidemiology , Child, Preschool , Comorbidity , Developing Countries/statistics & numerical data , Humans , Infant , Poverty , Prevalence
14.
Health Syst Reform ; 8(1): e2019571, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1642261

ABSTRACT

Coronavirus disease 2019 (COVID-19) knows no borders and no single approach may produce a successful impact in controlling the pandemic in any country. In Southern Africa, where migration between countries is high mainly from countries within the Southern African Development Community (SADC) countries to South Africa, there is limited understanding of how the COVID-19 crisis is affecting the social and economic life of migrants and migrant communities. In this article, we share reflections on the impact of COVID-19 on people on the move within Southern Africa land border communities, examine policy, practice, and challenges affecting both the cross-border migrants and host communities. This calls for the need to assess whether the current response has been inclusive enough and does not perpetuate discriminatory responses. The lockdown and travel restrictions imposed during the various waves of the COVID-19 pandemic in SADC countries, more so in South Africa where the migrant population is high, denote that most migrants living with other comorbidities especially HIV/TB and who were enrolled in chronic care in their countries of origin were exposed to challenges of access to continued care. Further, migrants as vulnerable groups have low access to COVID-19 vaccines. This made them more vulnerable to deterioration of preexisting comorbidities and increased the risk of migrants becoming infected with COVID-19. It is unfortunate that certain disease outbreaks have been racialized, creating potential xenophobic environments and fear among migrant populations as well as gender inequalities in access to health care and livelihood. Therefore, a successful COVID-19 response and any future pandemics require a "whole system" approach as well as a regional coordinated humanitarian response approach if the devastating impacts on people on the move are to be lessened and effective control of the pandemic ensured.


Subject(s)
COVID-19 , Transients and Migrants , Africa, Southern , COVID-19 Vaccines , Communicable Disease Control , Humans , Pandemics , Policy , SARS-CoV-2
15.
BMJ Glob Health ; 6(7)2021 07.
Article in English | MEDLINE | ID: covidwho-1504985

ABSTRACT

INTRODUCTION: The burden of acute lower respiratory infections (ALRI), and common viral ALRI aetiologies among 5-19 years are less well understood. We conducted a systematic review to estimate global burden of all-cause and virus-specific ALRI in 5-19 years. METHODS: We searched eight databases and Google for studies published between 1995 and 2019 and reporting data on burden of all-cause ALRI or ALRI associated with influenza virus, respiratory syncytial virus, human metapneumovirus and human parainfluenza virus. We assessed risk of bias using a modified Newcastle-Ottawa Scale. We developed an analytical framework to report burden by age, country and region when there were sufficient data (all-cause and influenza-associated ALRI hospital admissions). We estimated all-cause ALRI in-hospital deaths and hospital admissions for ALRI associated with respiratory syncytial virus, human metapneumovirus and human parainfluenza virus by region. RESULTS: Globally, an estimated 5.5 million (UR 4.0-7.8) all-cause ALRI hospital admissions occurred annually between 1995 and 2019 in 5-19 year olds, causing 87 900 (UR 40 300-180 600) in-hospital deaths annually. Influenza virus and respiratory syncytial virus were associated with 1 078 600 (UR 4 56 500-2 650 200) and 231 800 (UR 142 700-3 73 200) ALRI hospital admissions in 5-19 years. Human metapneumovirus and human parainfluenza virus were associated with 105 500 (UR 57 200-181 700) and 124 800 (UR 67 300-228 500) ALRI hospital admissions in 5-14 years. About 55% of all-cause ALRI hospital admissions and 63% of influenza-associated ALRI hospital admissions occurred in those 5-9 years globally. All-cause and influenza-associated ALRI hospital admission rates were highest in upper-middle income countries, Asia-Pacific region and the Latin America and Caribbean region. CONCLUSION: Incidence and mortality data for all-cause and virus-specific ALRI in 5-19 year olds are scarce. The lack of data in low-income countries and Eastern Europe and Central Asia, South Asia, and West and Central Africa warrants efforts to improve the development and access to healthcare services, diagnostic capacity, and data reporting.


Subject(s)
Global Health , Respiratory Tract Infections , Adolescent , Child , Hospital Mortality , Hospitalization , Hospitals , Humans , Respiratory Tract Infections/epidemiology
16.
Lancet Digit Health ; 3(10): e676-e683, 2021 10.
Article in English | MEDLINE | ID: covidwho-1442654

ABSTRACT

BACKGROUND: Community mobility data have been used to assess adherence to non-pharmaceutical interventions and its impact on SARS-CoV-2 transmission. We assessed the association between location-specific community mobility and the reproduction number (R) of SARS-CoV-2 across UK local authorities. METHODS: In this modelling study, we linked data on community mobility from Google with data on R from 330 UK local authorities, for the period June 1, 2020, to Feb 13, 2021. Six mobility metrics are available in the Google community mobility dataset: visits to retail and recreation places, visits to grocery and pharmacy stores, visits to transit stations, visits to parks, visits to workplaces, and length of stay in residential places. For each local authority, we modelled the weekly change in R (the R ratio) per a rescaled weekly percentage change in each location-specific mobility metric relative to a pre-pandemic baseline period (Jan 3-Feb 6, 2020), with results synthesised across local authorities using a random-effects meta-analysis. FINDINGS: On a weekly basis, increased visits to retail and recreation places were associated with a substantial increase in R (R ratio 1·053 [99·2% CI 1·041-1·065] per 15% weekly increase compared with baseline visits) as were increased visits to workplaces (R ratio 1·060 [1·046-1·074] per 10% increase compared with baseline visits). By comparison, increased visits to grocery and pharmacy stores were associated with a small but still statistically significant increase in R (R ratio 1·011 [1·005-1·017] per 5% weekly increase compared with baseline visits). Increased visits to parks were associated with a decreased R (R ratio 0·972 [0·965-0·980]), as were longer stays at residential areas (R ratio 0·952 [0·928-0·976]). Increased visits to transit stations were not associated with R nationally, but were associated with a substantial increase in R in cities. An increasing trend was observed for the first 6 weeks of 2021 in the effect of visits to retail and recreation places and workplaces on R. INTERPRETATION: Increased visits to retail and recreation places, workplaces, and transit stations in cities are important drivers of increased SARS-CoV-2 transmission; the increasing trend in the effects of these drivers in the first 6 weeks of 2021 was possibly associated with the emerging alpha (B.1.1.7) variant. These findings provide important evidence for the management of current and future mobility restrictions. FUNDING: Wellcome Trust and Data-Driven Innovation initiative.


Subject(s)
COVID-19 , Commerce , Pandemics , Parks, Recreational , Transportation , Travel , Workplace , Behavior , COVID-19/epidemiology , COVID-19/transmission , Humans , Incidence , Models, Biological , Recreation , SARS-CoV-2 , United Kingdom/epidemiology
17.
Lancet Infect Dis ; 21(12): 1615-1617, 2021 12.
Article in English | MEDLINE | ID: covidwho-1356506
18.
Influenza Other Respir Viruses ; 15(6): 804-812, 2021 11.
Article in English | MEDLINE | ID: covidwho-1295030

ABSTRACT

BACKGROUND: Several local studies showed that the 2009 influenza pandemic delayed the RSV season. However, no global-level analyses are available on the possible impact of the 2009 influenza pandemic on the RSV season. OBJECTIVES: We aim to understand the impact of the 2009 influenza pandemic on the RSV season. METHODS: We compiled data from published literature (through a systematic review), online reports/datasets and previously published data on global RSV seasonality and conducted a global-level systematic analysis on the impact of the 2009 influenza pandemic on RSV seasonality. RESULTS: We included 354 seasons of 45 unique sites, from 26 countries. Globally, the influenza pandemic delayed the onset of the first RSV season by 0.58 months on average (95% CI: 0.42, 0.73; maximum delay: 2.5 months) and the onset of the second RSV season by a lesser extent (0.25 months; 95% CI: 0.12, 0.39; maximum delay: 3.4 months); no delayed onset was observed for the third RSV season. The delayed onset was most pronounced in the northern temperate, followed by the southern temperate, and was least pronounced in the tropics. CONCLUSIONS: The 2009 influenza pandemic delayed the RSV onset on average by 0.58 months and up to 2.5 months. This suggests evidence of viral interference as well as the impact of public health measures and has important implications for preparedness for RSV season during the ongoing COVID-19 pandemic and future pandemics.


Subject(s)
COVID-19 , Influenza, Human , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Humans , Infant , Influenza, Human/epidemiology , Pandemics , Respiratory Syncytial Virus Infections/epidemiology , SARS-CoV-2 , Seasons
19.
Lancet Glob Health ; 9(6): e740-e741, 2021 06.
Article in English | MEDLINE | ID: covidwho-1233654
20.
J Glob Health ; 11: 10001, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1154786

ABSTRACT

BACKGROUND: Understanding the risk factors for poor outcomes among COVID-19 patients could help identify vulnerable populations who would need prioritisation in prevention and treatment for COVID-19. We aimed to critically appraise and synthesise published evidence on the risk factors for poor outcomes in hospitalised COVID-19 patients. METHODS: We searched PubMed, medRxiv and the WHO COVID-19 literature database for studies that reported characteristics of COVID-19 patients who required hospitalisation. We included studies published between January and May 2020 that reported adjusted effect size of any demographic and/or clinical factors for any of the three poor outcomes: mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation. We appraised the quality of the included studies using Joanna Briggs Institute appraisal tools and quantitatively synthesised the evidence through a series of random-effect meta-analyses. To aid data interpretation, we further developed an interpretation framework that indicated strength of the evidence, informed by both quantity and quality of the evidence. RESULTS: We included a total of 40 studies in our review. Most of the included studies (29/40, 73%) were assessed as "good quality", with assessment scores of 80 or more. We found that male sex (pooled odds ratio (OR) = 1.32 (95% confidence interval (CI) = 1.18-1.48; 20 studies), older age (OR = 1.05, 95% CI = 1.04-1.07, per one year of age increase; 10 studies), obesity (OR = 1.59, 95% CI = 1.02-2.48; 4 studies), diabetes (OR = 1.25, 95% CI = 1.11-1.40; 11 studies) and chronic kidney diseases (6 studies; OR = 1.57, 95% CI = 1.27-1.93) were associated with increased risks for mortality with the greatest strength of evidence based on our interpretation framework. We did not find increased risk of mortality for several factors including chronic obstructive pulmonary diseases (5 studies), cancer (4 studies), or current smoker (5 studies); however, this does not indicate absence of risk due to limited data on each of these factors. CONCLUSION: Male sex, older age, obesity, diabetes and chronic kidney diseases are important risk factors of COVID-19 poor outcomes. Our review provides not only an appraisal and synthesis of evidence on the risk factors of COVID-19 poor outcomes, but also a data interpretation framework that could be adopted by relevant future research.


Subject(s)
COVID-19 , Hospitalization , Intensive Care Units , Respiration, Artificial , Severity of Illness Index , Aged , COVID-19/epidemiology , COVID-19/mortality , COVID-19/therapy , Comorbidity , Female , Humans , Male , Risk Factors , SARS-CoV-2
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