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1.
BMJ Glob Health ; 6(12)2021 Dec.
Article in English | MEDLINE | ID: covidwho-1566364
2.
Preprint in English | Other preprints | ID: ppcovidwho-295433

ABSTRACT

Context Contact tracing has been a central COVID-19 transmission control measure. However, without the consideration of the needs of specific populations, public health interventions can exacerbate health inequities. Purpose The purpose of this rapid review was to determine if and how health inequities were included in the design of contact tracing interventions in epidemic settings. Method We conducted a search of the electronic databases MEDLINE and Web of Science. Our inclusion criteria included articles that: (i) described the design of contact tracing interventions, (ii) have been published between 2013 and 2020 in English, French, Spanish, Chinese, or Portuguese, (iii) and included at least 50% of empiricism, according to the Automated Classifier of Texts on Scientific Studies (ATCER) tool. We relied on various tools to extract data. Result Following the titles and abstracts screening of 230 articles, 39 articles met the inclusion criteria. Only seven references were retained after full text review. None of the selected studies considered health inequities in the design of contact tracing interventions. Conclusion The use of tools/concepts for incorporating health inequities, such as the REFLEX-ISS tool, and “proportionate universalism” when designing contact tracing interventions, would enable practitioners, decision makers, and researchers to better consider health inequities.

3.
J Eval Clin Pract ; 2021 Nov 25.
Article in English | MEDLINE | ID: covidwho-1537833

ABSTRACT

Chimamanda Ngozi Adichie showed how a single story is limited and thereby distorts the true nature of an issue. During this COVID-19 pandemic there have been, at least, three consecutive single stories-the 'lethal threat' story, followed by the 'economic threat' story, and finally the 'vaccine miracle' story. None of these single stories can convincingly and permanently capture the dynamics of the pandemic. This is because countries experienced different morbidity and mortality patterns, different socioeconomic disadvantage, age and vulnerability of population, timing and level of lockdown with economic variability, and, despite heavy promotion, vaccines were beset with a significant and variable degree of hesitancy. Lack of transparency, coherence and consistency of pandemic management-arising from holding on to single storylines-showed the global deficiency of public health policy and planning, an underfunding of (public) health and social services, and a growing distrust in governments' ability to manage crises effectively. Indeed, the global management has increased already large inequities, and little has been learnt to address the growing crises of more infectious and potentially more lethal virus mutations. Holding onto single stories prevents the necessary learnings to understand and manage the complexities of 'wicked' problems, whereas listening to the many stories provides insights and pathways to do so effectively as well as efficiently.

4.
J Clin Epidemiol ; 2021 Nov 22.
Article in English | MEDLINE | ID: covidwho-1525844

ABSTRACT

OBJECTIVE: This scoping review aimed to identify how equity has been considered in large-scale infectious disease testing initiatives. STUDY DESIGN AND SETTING: Large-scale testing interventions are instrumental for infectious disease control and a central tool for the coronavirus 19 (COVID-19) pandemic. We searched Web of Science: core collection, Embase and Medline in June 2021 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations for scoping reviews. We critically analyzed the content of all included articles. RESULTS: Our search resulted in 2448 studies of which 86 were included for data extraction after screening. Of the included articles, 80% reported on COVID-19 -related screening programs. None of the studies presented a formal definition of (in)equity in testing, however, 71 articles did indirectly include elements of equity through the justification of their target population. Of these 71 studies, 58% articles indirectly alluded to health equity according to the PROGRESS-Plus framework, an acronym used to identify a list of socially stratifying characteristics driving inequity in health outcomes. CONCLUSION: The studies included in our scoping review did not explicitly consider equity in their design or evaluation which is imperative for the success of infectious disease testing programs.

5.
Preprint in English | EuropePMC | ID: ppcovidwho-292137

ABSTRACT

Background: In Canada and globally, the COVID-19 pandemic has increased social inequities in health (SIH), furthering the vulnerability of certain groups and communities. Contact tracing is a cornerstone intervention with COVID-19 prevention and control programs. The aim of this study was to describe if and how SIH were considered during the design of the COVID-19 contact tracing program in Montréal.Methods: A qualitative case study was carried out in Montréal, based on a “bricolage” conceptual framework describing the consideration for SIH in intervention and policy design. Qualitative data were collected using semi-structured interviews with 16 public health practitioners, recruited using both purposive and snowball sampling. Data was analyzed using thematic analysis, both inductively and deductively.Results: Results showed that SIH were not considered during the design of contract tracing in Montréal, which the respondents thought was due to the crisis nature of the situation. Public health practitioners deplored the Québec government’s lack of will to integrate SIH into the public health response, as well as the lack of preparedness to pandemics.Conclusions: Considering these findings, prior to designing public health interventions, decision-makers need to have a common vision of SIH, allowing to conceptualize and consider SIH better in the future.

8.
Int J Infect Dis ; 110: 155-159, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1380660

ABSTRACT

BACKGROUND: Since the beginning of the pandemic, COVID-19 has been regarded as an exceptional disease. Control measures have exclusively focused on 'the virus', while failing to account for other biological and social factors that determine severe forms of the disease. AIM: We argue that although COVID-19 was initially considered a new challenge, justifying extraordinary response measures, this situation has changed - and so should our response. MAIN ARGUMENTS: We now know that COVID-19 shares many features of common infectious respiratory diseases, and can now ascertain that SARS-CoV-2 has not suddenly presented new problems. Instead, it has exposed and exacerbated existing problems in health systems and the underlying health of the population. COVID-19 is evidently not an 'extraterrestrial' disease. It is a complex zoonotic disease, and it needs to be managed as such, following long-proven principles of medicine and public health. CONCLUSION: A complex disease cannot be solved through a simple, magic-bullet cure or vaccine. The heterogeneity of population profiles susceptible to developing a severe form of COVID-19 suggests the need to adopt varying, targeted measures that are able to address risk profiles in an appropriate way. The critical role of comorbidities in disease severity calls for short-term, virus-targeted interventions to be complemented with medium-term policies aimed at reducing the burden of comorbidities, as well as mitigating the risk of transition from infection to disease. Strategies required include upstream prevention, early treatment, and consolidation of the health system.


Subject(s)
COVID-19 , Animals , Humans , Pandemics , Public Health , SARS-CoV-2 , Zoonoses
9.
BMJ Glob Health ; 6(8)2021 08.
Article in English | MEDLINE | ID: covidwho-1346060

ABSTRACT

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.


Subject(s)
COVID-19 , Emergencies , Government Programs , Health Policy , Humans , SARS-CoV-2
12.
Health Res Policy Syst ; 19(1): 76, 2021 May 06.
Article in English | MEDLINE | ID: covidwho-1219889

ABSTRACT

BACKGROUND: All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems. METHODS: We will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available. DISCUSSION: We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.


Subject(s)
COVID-19 , Pandemics , Brazil , Canada , China , France , Hospitals , Humans , Japan , Mali , Pandemics/prevention & control , Public Health , SARS-CoV-2
13.
J Psychosom Res ; 146: 110504, 2021 07.
Article in English | MEDLINE | ID: covidwho-1219301

ABSTRACT

OBJECTIVES: The aim of this study is to provide information on changes in mental health among disadvantaged immigrants from Sub-Saharan Africa in the Greater Paris area and their level of information about Covid-19. METHODS: Prior to the Covid-19 epidemic, the Makasi community-based cohort followed 850 immigrants from sub-Saharan Africa in the Greater Paris area. Between the 1st of April and the 7th of June 2020, all participants scheduled for a follow-up survey were systematically included into an additional COVID-19-related wave of data collection (N = 100). We compared participants' type of housing, level of food insecurity, work and mental health (PHQ9) before and during the first COVID-19-related lockdown, using paired-Mc Nemar chi-2 tests. We next described their level of information on Covid-19 and policy measures, broken down by sex. RESULTS: Among the 100 participants, 68% had no legal residence permit. Food insecurity was more often reported during lockdown than before (62% vs 52%). 9% of participants had a score indicative of severe depression (PHQ9) before lockdown and 17% afterwards (p = 0.17). Only 51% knew about the possibility of asymptomatic transmission of the COVID-19 virus. CONCLUSIONS: This study brings original information on a hard-to-reach population group. Our results suggest that the lockdown had a detrimental impact on various economic and mental health aspects among disadvantaged migrants residing in the Greater Paris area.


Subject(s)
COVID-19/prevention & control , Consumer Health Information/statistics & numerical data , Emigrants and Immigrants/psychology , Mental Disorders/epidemiology , Vulnerable Populations/psychology , Adult , Africa South of the Sahara/ethnology , COVID-19/epidemiology , Cohort Studies , Emigrants and Immigrants/statistics & numerical data , Female , Humans , Male , Paris/epidemiology , Quarantine/psychology , Surveys and Questionnaires , Vulnerable Populations/statistics & numerical data , Young Adult
14.
Int J Infect Dis ; 106: 65-70, 2021 May.
Article in English | MEDLINE | ID: covidwho-1126870

ABSTRACT

BACKGROUND: Contact tracing has been a central control measure for coronavirus disease 2019 (COVID-19) transmission. However, without consideration of the needs of specific populations, public health interventions can exacerbate health inequities. AIM: The purpose of this rapid review was to determine if and how health inequities were included in the design of contact tracing interventions in epidemic settings. METHODS: A search of the electronic databases MEDLINE and Web of Science was conducted. The following inclusion criteria were applied for article selection: (1) described the design of contact tracing interventions, (2) published between 2013 and 2020 in English, French, Spanish, Chinese, or Portuguese, (3) and included at least 50% of empiricism, according to the Automated Classifier of Texts on Scientific Studies (ATCER) tool. Various tools were used to extract data. RESULTS: Following screening of the titles and abstracts of 230 articles, 39 met the inclusion criteria. Only seven references were retained after full text review. None of the selected studies considered health inequities in the design of contact tracing interventions. CONCLUSIONS: The use of tools/concepts for incorporating health inequities, such as the REFLEX-ISS tool, and 'proportionate universalism' when designing contact tracing interventions, would enable practitioners, decision-makers, and researchers to better consider health inequities.


Subject(s)
Contact Tracing/methods , Health Equity , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Humans
15.
BMC Med Res Methodol ; 21(1): 28, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1079209

ABSTRACT

BACKGROUND: COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT: Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION: Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.


Subject(s)
COVID-19/prevention & control , Global Health , Health Priorities , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19/epidemiology , Health Services Research , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Research Design , Resource Allocation , SARS-CoV-2 , World Health Organization
17.
J Migr Health ; 1-2: 100032, 2020.
Article in English | MEDLINE | ID: covidwho-965869

ABSTRACT

In order to limit the spread of the SARS-CoV-2 virus, the majority of governments have introduced population containment. Certain population groups, including immigrants in precarious situations, are experiencing the impact of this measure in a brutal manner. This article is based on accounts of containment experiences collected by telephone within the framework of a pre-existing intervention research carried out among immigrants to France from Sub-Saharan Africa who are in a precarious situation. It highlights certain social effects of containment and the logics at work in the precarious situations. This research shows how this a priori unprecedented situation affects individual capacities to act and generates a 'disaffiliation process' causing individuals to shift towards 'social non-existence', repeating lived experiences and exacerbating pre-existing logics. The ordeal of containment proves to be an ordinary experience for these individuals.

19.
PLoS Negl Trop Dis ; 14(6): e0008305, 2020 06.
Article in English | MEDLINE | ID: covidwho-592006

ABSTRACT

BACKGROUND: The dengue virus is endemic in many low- and middle-income countries. In Burkina Faso, the proportion of fevers that could be due to dengue is growing. In 2013, a dengue epidemic spread there, followed by other seasonal outbreaks. Dengue is often confused with malaria, and health workers are not trained to distinguish between them. Three training videos using different narrative genres were tested with nursing students from two institutions in Ouagadougou: journalistic, dramatic and animated video. The study aimed to determine if video is an effective knowledge transfer tool, if narrative genre plays a role in knowledge acquisition, and which narrative elements are the most appreciated. METHODOLOGY: A mixed method research design was used. The relative effectiveness of the videos was verified through a quasi-experimental quantitative component with a comparison group and post-test measurements. A qualitative component identified participants' perceptions regarding the three videos. Data were drawn from a knowledge test (n = 482), three focus groups with health professionals' students (n = 46), and individual interviews with health professionals (n = 10). Descriptive statistics and single-factor variance analysis were produced. A thematic analysis was used to analyse qualitative data. PRINCIPAL FINDINGS: Results showed that all three videos led to significant rates of knowledge improvement when compared with the comparison group (p <0.05): 12.31% for the journalistic video, 20.58% for the dramatic video, and 18.91% for the animated video. The dramatic and animated videos produced a significantly higher increase in knowledge than did the journalistic video (with respectively 8.27% (p = 0.003) and 6.59% (p = 0.029) and can be considered equivalent with a difference of 1.68% (p = 0.895). Thematic analysis also revealed that these two videos were considered to be better knowledge transfer tools. Four key aspects are important to consider for a video to be effective: 1) transmitting information in a narrative form, 2) choosing good communicators, 3) creating a visual instrument that reinforces the message and 4) adapting the message to the local context. CONCLUSIONS: Video has proven to be an effective and appreciated knowledge transfer and training tool for health professionals, but the narrative genre of the videos can influence knowledge acquisition. The production of other videos should be considered for training or updating health professionals and their narrative genre taken into consideration. The actual context of constant circulation of new diseases, such as COVID-19, reaffirms the need to train health professionals.


Subject(s)
Audiovisual Aids , Health Personnel/education , Narration , Burkina Faso , Dengue/diagnosis , Diagnostic Errors/prevention & control , Focus Groups , Humans , Information Dissemination/methods , Inservice Training , Knowledge
20.
Glob Public Health ; 15(11): 1603-1616, 2020 11.
Article in English | MEDLINE | ID: covidwho-381937

ABSTRACT

While access to healthcare for permanent residents in Canada is well known, this is not the case for migrants without healthcare coverage. This is the first large-scale study that examines the unmet healthcare needs of migrants without healthcare coverage in Montreal. 806 participants were recruited: 436 in the community and 370 at the NGO clinic. Proportions of individuals reporting unmet healthcare needs were similar (68.4% vs. 69.8%). The main reason invoked for these unmet needs was lacking money (80.6%). Situations of not working or studying, not having had enough food in the past 12 months, not having a medical prescription to get medication and having had a workplace injury were all significantly associated with higher odds of having unmet healthcare needs. Unmet healthcare needs were more frequent among migrants without healthcare coverage than among recent immigrants or the citizens with health healthcare coverage (69%, 26%, 16%). Canada must take measures to enable these individuals to have access to healthcare according to their needs in order to reduce the risk of worsening their health status, something that may have an impact on the healthcare system and population health. The Government of Quebec announced that all individuals without any healthcare coverage will have access to COVID-19 related health care. We hope that this right, the application of which is not yet obvious, can continue after the pandemic for all health care.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Accessibility , Health Services Needs and Demand , Medically Uninsured , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Transients and Migrants , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Quebec/epidemiology , SARS-CoV-2 , Universal Health Insurance
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