Arbovirus and its potential to lead the next global pandemic from sub-Saharan Africa: What lessons have we learned from COVID-19?

Risk and predisposing factors for viral zoonoses abound in the sub-Saharan Africa (SSA) region with significant public health implications. For several decades, there have been several reports on the emergence and re-emergence of arbovirus infections. The lifetime burden of arboviral diseases in developing countries is still poorly understood. Studies indicate significant healthcare disruptions and economic losses attributed to the viruses in resource-poor communities marked by impairment in the performance of daily activities. Arboviruses have reportedly evolved survival strategies to aid their proliferation in favorable niches, further magnifying their public health relevance. However, there is poor knowledge about the viruses in the region. Thus, this review presents a survey of zoonotic arboviruses in SSA, the burden associated with their diseases, management of diseases as well as their prevention and control, mobility and determinants of infections, their vectors, and co-infection with various microorganisms. Lessons learned from the ongoing coronavirus disease 2019 (COVID-19) pandemic coupled with routine surveillance of zoonotic hosts for these viruses will improve our understanding of their evolution, their potential to cause a pandemic, control and prevention measures, and vaccine development.Copyright © GERMS 2022.

Do The Research Training Interests And Needs Of Medical Students Vary Internationally? A Global Study

Introduction: This study aims to understand the current landscape of global medical student knowledge, resources, and barriers pertaining to research compared with clinical experience. Method(s): A survey was created by a diverse focus group to ascertain medical student perceptions of clinical and research experience. The survey was distributed to medical students through social media networks via international partnerships from Nov 1st - Dec 31st 2020. The analysis included statistical characteristics and a comparison between regions. Result(s): A total of 357 medical students from 26 countries completed the survey. Respondents were majority female (60.8%) from Latin America (58.9%), North America (25.8%), and Sub-Saharan Africa or other regions (18.2%). 10.9% of students had an additional graduate-level degree. The majority of students were interested in conducting research as medical students (87.1%) and as future physicians (58%). Overwhelmingly, students felt that research was an important component of medical training (88.5%). The majority of students were not required to participate in research to graduate from training (59%) and had not participated in the research (53%). There were several reported barriers to research, including lack of research opportunities (68.7%), lack of mentors (56.6%), lack of formal training (56.3%), and barriers due to the COVID-19 (49.9%). Conclusion(s): Despite significant interest in research, medical students globally report a lack of formal research training, opportunities, and several barriers to conducting research, including the COVID-19 pandemic. This survey demonstrates a need for student research training internationally, as well as highlights a possible role for further evaluation of research training needs.

REACTOGENICITY AMONG PEOPLE LIVING WITH HIV AFTER mRNA-1273 VACCINE IN UBUNTU STUDY

Background: The tolerability of mRNA COVID-19 vaccines among people living with HIV (PLWH) has been understudied in vaccine trials. CoVPN 3008 (Ubuntu) is the largest multicenter Phase 3 efficacy trial of mRNA vaccines in sub-Saharan Africa. Method(s): We enrolled adults age >=18 years living with HIV or another comorbidity associated with severe COVID-19. Previously vaccinated individuals were excluded. Baseline testing included HIV, CD4 count and HIV viral load (VL) (if HIV+), anti-SARS-CoV-2 antibodies, and nasal swab SARS-CoV-2 nucleic acid amplification test (NAAT). All participants receive vaccinations at months 0 and 6, and SARS-CoV-2 seronegative individuals also receive vaccination at month 1. This analysis includes mRNA-1273 vaccinations at months 0 and 1. Reactogenicity (solicited adverse events [AEs]) was assessed among a representative subset of participants (Safety Subset, SS) for 7 days post-vaccination. Baseline characteristics associated with moderate/severe reactogenicity events were assessed by univariate and multivariate logistic regression. Result(s): 14002 participants were enrolled in the trial (1510 into the SS) at 46 sites from 2 Dec 2021 to 9 Sep 2022. At baseline in the SS, 71% (1065) were female, median age 38 years (IQR 32-46), and median BMI 25.0 (IQR 20.7-30.2). 73% (1108) were SARS-CoV-2 seropositive, and 8.7% (131) had a positive nasal NAAT swab. 16% (197) had a history of tuberculosis. 84% (1267) were PLWH, with median CD4 count of 614 cells/muL (IQR 414-861);7.8% had CD4 count < 200. 21% (238) had detectable HIV VL (>=50 copies/mL), with median VL 1660 (IQR 182-23932). 14% (172/1262) and 12% (64/542) of PLWH reported moderate/severe reactogenicity after the 1st and 2nd vaccination (Figure), with no hospitalizations. Female PLWH and CD4 count >500 had 35% (p=0.03) and 44% (p=0.04) increased odds of moderate/severe reactogenicity, respectively. Other baseline characteristics were not associated with the odds of reporting moderate/severe reactogenicity among PLWH after 1st vaccination. Similar trends were seen after the 2nd vaccination, but none reached statistical significance. In multivariate models, female sex remained associated with increased odds of moderate/severe reactogenicity after the 2nd vaccination. Conclusion(s): Similar to observations in HIV-negative populations, mRNA-1273 was well tolerated by PLWH with more reactogenicity in females. Impaired inflammatory responses among participants with CD4 counts < 500 cell/muL may explain less moderate/severe reactions.

Advancing detection and response capacities for emerging and re-emerging pathogens in Africa

Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.Copyright © 2022 Elsevier Ltd

Burnout among healthcare workers during public health emergencies in sub-Saharan Africa: Contributing factors, effects, and prevention measures

Countries in sub-Saharan Africa (SSA) are expected to experience more public health emergencies (PHEs) in the near future. The fragile health systems emanating from poor health governance, inadequate health infrastructure, shortage of healthcare workers (HCWs), inadequate essential medicines and technology, and limited funding will make responses to these outbreaks slow and ineffective as seen with the COVID-19 pandemic. The workload for HCWs will grow due to these PHEs, which will increase the likelihood that they may experience burnout. This narrative review loosely followed the guidelines provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement. Google Scholar, PubMed, and ScienceDirect databases were used to retrieve relevant articles. Two reviewers assessed the titles and abstracts of all identified articles and extracted the data independently and compared their results thereafter. The causes of burnout among HCWs, its impact on patients, HCWs, and healthcare institutions, as well as preventive steps that should be taken to safeguard HCWs from burnout, are all covered in this article.Copyright © 2023 The Author(s)

CROI 2022: Epidemiologic Trends and Prevention for HIV and SARS-CoV-2

At the 2022 Conference on Retroviruses and Opportunistic Infections, several speakers discussed disparities in HIV and COVID-19 infections and outcomes. Although the lifetime risk of HIV infection in the United States is higher overall in males than females, Black females have higher risk than White males. In 12 countries in sub-Saharan Africa, women aged 15 to 34 years accounted for more than half of all infections. Because knowledge of HIV serostatus is important for treatment and for prevention, several novel strategies were evaluated in the distribution of HIV self-test kits to undertested populations in the United States and sub-Saharan Africa. Data were presented on new products in the pre-exposure prophylaxis (PrEP) pipeline, including long-acting injectable cabotegravir, islatravir, vaginal rings, and in-situ forming implants. Challenges remain in the roll-out of oral PrEP, and a number of innovative strategies to address barriers were discussed. Models suggest that the greatest impact of novel PrEP agents would be to increase the pool of persons using PrEP, rather than through improved efficacy. COVID-19 caused substantial declines in HIV and sexually transmitted infection prevention and treatment services, which have started to rebound, but are not yet at prepandemic levels in several settings.Copyright © 2022, IAS-USA. All rights reserved.

Evaluation and Prediction of COVID-19 Case Fatality Rates from 156 countries

Background: Understanding the key factors affecting case fatality rates (CFRs) of COVID-19 is essential to guiding national response to pandemics. We aimed to investigate the country and period features of CFR in COVID-19 and predict the changes in CFR. Method(s): Cross-temporal and cross-country variations in CFR were identified by Extreme Gradient Boosting models using multiple features, and the effects of features were explained by applying SHapley Additive exPlanations. Result(s): The determinants of CFR changed during the COVID-19 pandemic from health conditions to a mixed effect dominated by vaccination rates (Fig 1). Overall, most countries have concurrent risk factors besides the main risk factors, and 156 countries were grouped into five clusters based on key CFR risk factors (Fig 1). A low vaccination rate drove cluster 1 was found primarily in sub-Saharan Africa and Latin America. Aging drove cluster 2, primarily distributed in the high-income European countries, and a high burden of disease characterises cluster 3 and low GDP related cluster 4 were scattered across continents. Furthermore, simulating a 5% increase in vaccination rates resulted in a 31.2% and 15.0% change in CFR for cluster 1 and cluster 3, respectively, but only 3.1% for cluster2. (Fig 1). Conclusion(s): The features affecting COVID-19 CFRs show diversity across countries, and declining CFRs require more than increasing vaccination coverage. (Figure Presented).

New FIP resources to advance Pharmacy education and early career development

Introduction: During the COVID-19 pandemic, FIP Education (FIPEd) continued to produce reports, guidance documents, toolkits and virtual programmes to advance pharmacy education and early career development. Method(s): FIPEd, consisting of academic pharmacy section (AcPS), academic institutional membership (AIM), workforce development hub (WDH), university twinning and networking scheme (UNITWIN) - collaborating with Board Pharmaceutical Sciences (BPS), Board Pharmaceutical Practice (BPP), Young Pharmacists Group (YPG), and International Pharmaceutical Students' Federation (IPSF), developed resources, through consultation and validation, to advance pharmacy education and training programmes. Result(s): FIPEd resources 2020 - 2022 span a wide perspective of areas: 1) Global Competency Framework v2 (2020) - competencies for early career development;2) Digital Health in Pharmacy Education report (2020) and Train the Trainer Course (2022) - current status and development of digital health education programmes;3) UNITWIN Pharmacy Education in Sub-Saharan Africa report (2020) and 4) UNITWIN Pathfinder Toolkit (2021) - led to UNITWIN Regional Workshops and Global Summit 2021, subject of the FIP Workshop at EAFP 2022 with a regional specific roadmap for the European region;5) FIP WiSE - Women in Science and Education toolkit (2021) - promote positive practice environments for women in science and education;6) FIP AIM Enhancing academic leadership horizons in trying times virtual course (2021) - academic leadership skills development;7) Global Humanitarian Competency Framework (2021) - competencies for pharmacists working in humanitarian arenas;8) Curriculum for pharmacy students on substandard and falsified medicines (2021) - collaboration with WHO;9) FIP handbooks for accreditors and providers of programmes supporting the FIP platform for provision through partnerships (2022) - a new FIP programme whereby the FIP Seal assures programme providers align with the FIP mission and meet quality criteria. Upcoming resources for 2022 include: Competency Framework for Pharmaceutical Educators;Competency Based Education Handbook;Quality Assurance education tool;Impact of pharmaceutical workforce on health improvement and outcomes tool;Interprofessional Education Readiness tool. Conclusion(s): FIP resources have been used effectively by educators globally as guides to advancing pharmacy education. These new resources provide further guidance to assure pharmacy education programmes prepare graduates for contemporary and future-oriented careers to meet societal needs.

COVID-19: Rebooting pharmacy education in resource-limited settings

Globally, the COVID-19 pandemic has aggravated inequalities in access to quality pharmacy education, particularly in resource-limited settings in Africa (Engle, 2020;Fuller et al., 2020). This is a serious concern for Africa especially, given that sub-Saharan Africa ranks lowest on the global pharmaceutical workforce index and has a disproportionately high burden of infectious and non-communicable diseases, combined with weak health systems (World Health Organisation [WHO], 2013;Bates et al., 2018). Copyright © 2020 FIP.

[Impact of COVID-19 on public health in sub-Saharan Africa]. / Impact de la COVID-19 sur la santé publique en Afrique subsaharienne.

Objective: This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa. Method: A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years. Results: The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system. Conclusion: Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.

Acceptability of wearing mask during a 5-week training course for health care personnel in the context of Covid-19

Introduction: Wearing a mask is one of the least costly measures for containing the spread of the Covid-19. This is one of the protective measures put in place by the coordinating team of the inter-university diploma on Antibiology and Antibiotic Therapy in Sub-Saharan Africa for its 2021 session. The objective of our study was to evaluate the acceptability of wearing a mask by health personnel from sub-Saharan Africa during the 05-week training course. Method(s): A descriptive cross-sectional study was conducted from July 15 to November 15, 2021. The survey was the study method, using individual interview and observation as study techniques. During the individual interview it was administered a semi-structured questionnaire including the aspects related to observation. Result(s): A total of 58 people were interviewed (35 +/- 0.83 years, 75.86% males). The most represented professions were medical specialists 31.03%, biologists 29.31% and general practitioners 18.27%. 56.90% of the participants wore the mask systematically, 34.48% wore it often with an average of 7 h24 of daily wear and 58.6% respected the instructions on the proper use of masks. The main inconvenience of wearing the mask was the problem of comfort for 46.55%. For 12.07%, the respiratory history (asthma, pneumonia, tuberculosis) contributed to the discomfort of wearing the mask, with respiratory difficulty being the discomfort felt. Conclusion(s): The wearing of masks during the 5-week training in the context of Covid-19 is globally accepted by the health personnel. The health personnel have a fairly good knowledge of the interest of this measure.

Time to appropriate care-seeking for Covid - 19 symptoms

Background. in sub-Saharan Africa, the symptoms of covid-19 are similar to those of several pathologies frequently encountered in this region, which can confuse the diagnosis both for the patient and for health structures with limited resources. We studied self-reported time to care-seeking from the onset of covid-19 symptoms. Methods. This was a cross-sectional study. Patient'files who attended the medical emergencies Unit of Brazzaville University Hospital, for symptoms suggestive of Covid - 19 between May 2020 and February 2022, were collected. The diagnosis of Covid-19 was confirmed by RT-PCR or antigen test. Delay, between the rise of Covid- 19 symptoms and the attendance at the medical emergencies Unit, was recovered from the history of the disease reported by the patients themselves. When the patient had reported a duration of 'about one week' in the delay we noted '7 days' and 'about 2 weeks' corresponded to '14 days' taking this into account we used the Weibull regression model accelerated failure-time metric to identify potential risk factors which were subsequently presented as a time ratio (TR). Results. 102 patients were included, 57 (55.88%) were women, the median age was 64 years (Interquartile Range (IQR): 56 - 71), history of hypertension and diabetes was found respectively in 51 (50%) and 27 (26.47%) patients. 13 (12.75%) were vaccinated against Covid - 19. The median time to care-seeking was 7 days (IIQ: 5 - 7). Being vaccinated (adjusted Time Ratio (aTR): 1.69 (95% CI: 1.09 - 2.6) p=0.02) and having a cough (aTR: 1.74 (95% CI: 1.2 - 2.52) p=0.03) was associated with a longer time to care-seeking. On the other hand, being Hypertensive (aTR: 0.68 (95% CI: 0.51 - 0.9) p= 0.006), asthenic (aTR: 0.46 (95% CI: 0.23 - 0.91) p= 0.03) and having respiratory distress (aTR: 0.48 (95% CI: 0.26 - 0.89) p=0.03) were associated with a faster time to care-seeking. Conclusion. the vaccine increases time for care-seeking, especially when it is associated with the classic signs of COVID-19 such as cough. To limit the undernotification of cases in sub-Saharan Africa, Covid 19 testing must be generalized.

An Innovative Model to Eradicate Hcv in Undocumented Migrants and Low-Income Refugees in Italy

Background: To validate an innovative eradication model for HCV infection in undocumented migrants and low-income refugees living Southern Italy. Method(s): a prospective, multicenter, collaborative study was started in June 2018 with The study was stopped in February 2020 due to the outbreak of SARS-CoV- 2 infection in Italy and was resumed in February 2021 until November 2021. At the six 1st level centers participating to the study volunteer associations that deal with the first needs of disadvantaged people performed the enrolment and the screening for anti-HCV, HBsAg and anti-HIV;epidemiological data were collected in an electronic database. Anti-HCV- positive subjects were sent to two 3rd level centers for the clinical, virological and therapeutic evaluation. For the HCV-RNA- positive subjects HCV genotyping and a clinical, biochemical and ultrasound staging was performed. The HCV RNA-positive subjects have been treated with sofosbuvir-velpatasvir for 12 weeks and followed for 12 months from the end of therapy Results: Of the 3,991 migrants observed in the study period, 3,897 (97.6%) accepted to be screened. They were young (median age 26 years), predominantly male (85.9%) and came from North Africa (3.8%), from Sub-Saharan Africa (68.4%), from Eastern Europe (8.1%), from Indo-Pakistan (17%) and from other countries (2.7%). Of the 3,897 enrolled subjects, 185 (4.7%) resulted anti-HCV positive. The Figure shows the HCV-cure cascade. All the 185 anti-HCV- positive subjects were linked to care at 3rdID and tested for HCV RNA and 53 (28.6%) resulted HCV-RNA positive. Of these, 48 (90.6%) started DAA regimen with sofosbuvir plus velpatasvir (16 with GT 1b, 11 with 1a, 16 with 3, 3 with 4 and 2 with 2). Of these 48 subjects, 47 (97.9%) showed a SVR12 and SVR 24, and one dropped-out in follow-up after the stop of DAA treatment. No subject had adverse event. Conclusion(s): This model seems to be effective to eradicate HCV infection among a difficult-to- manage population, such as undocumented migrants and low-income refugees. (Figure Presented).

Special challenges in mathematics education in Sub Sahara Africa

Educational difficulties in mathematics education in Africa are diverse. Research shows that the challenges experienced in mathematics education are a by-product of those in education in general, and these span from policy, curriculum, instruction, learning, and information technology to infrastructure. Earlier commissioned studies by the World Bank revealed that there is a growing recognition that countries in sub-Saharan Africa (n = 48) need to improve their performance in the science, technology, engineering, and mathematics subjects if they were to grasp their full latent potential in a competitive global market that is increasingly shaped by the new technologically dependent world order. This study endeavors to document recently identified special challenges in mathematics education in Africa revealed in research over the past two years. Fifty-eight articles were reviewed, of which seven papers provide annotation of major findings of outstanding interest.

Development and Implementation of a Novel Global Health Track in Pediatric Gastroenterology, Hepatology, and Nutrition Fellowship

Background Global health interest continues to rise among pediatric trainees including those entering pediatric fellowships. While global health opportunities are being incorporated into many pediatric fellowship programs, there remains a paucity of global health training in pediatric gastroenterology, hepatology, and nutrition (GHN) fellowships. In a 2014 survey by Jirapinyo et al. only 17% of responding GHN fellowships offered global health training activities. A 2018 survey by Crouse et al. showed that 34% of responding GHN fellowships offered global health electives, and none had formal global health tracks. We believe that creating a formalized global health track for GHN fellows will not only appeal to the increasing interest among applicants, but also provide a firm knowledge base on GHN topics specific to a more global level, build international collaborations, and contribute a unique perspective in our field. We aim to describe our experience with the development and implementation of a novel global health track in a pediatric GHN fellowship. Methods Planning commenced January 2021. A multidisciplinary team was assembled bringing together experts in different areas including those in other subspecialties involved in global health fellowship training. The team involved in development included GHN program director, GHN division chief, pediatric emergency medicine global health fellowship director, director of the pediatric infectious disease fellowship tropical and global medicine track, and Baylor international pediatric AIDS initiative (BIPAI) chief medical officer. Input was also received on certain aspects of the curriculum from the pediatric viral hepatitis program director, dieticians, a radiologist, an ultrasound technologist, and the pediatric point-of-care ultrasound fellowship program director. Existing clinical niche track curriculum developed within the GHN department at Texas Children's Hospital were used as a guide for the structure and different aspects to be incorporated into the track including, but not limited to, clinical activities, procedural opportunities, research, education, and teaching. Results A comprehensive, multifaceted global health curriculum was developed, and implementation began in July 2021. Clinical activities include participation in pediatric and adult viral hepatitis clinics, nutrition focused clinics, and tropical medicine clinic. Global health electives abroad were explored but deferred given travel restrictions during the COVID-19 pandemic. For procedural opportunities an ultrasound curriculum was developed including point of care ultrasound training as well as more focused training in liver, biliary, and gastrointestinal disease. A fellowship research project was developed in conjunction with the Baylor International Pediatric AIDS Initiative (BIPAI) network in sub-Saharan Africa with mentorship both from faculty in the GHN department as well as the BIPAI network locally and abroad. The project is public health focused examining hepatitis B screening rates and prevalence among people living with HIV in sub-Saharan Africa. Education includes attendance of lectures given in different departments as well as cross departmental within the institution, and global lectures attended virtually. Other educational activities include review of a global health focused GHN topics and assembly of a library of resources including recent seminal papers for current and future fellows to use for review. Last, completion of the Diploma in Tropical Medicine and the Certificate of knowledge in Clinical Tropical Medicine and Travelers' Health Examination. Teaching opportunities include involvement in general global health education for US-based medical students and residents interested in pursuing careers in global health, and teaching residents and faculty on topics such as viral hepatitis, malnutrition, and diarrhea. Conclusion We have developed to our knowledge the first formal global health track in pediatric GHN fellowship that is feasible to integrate into the 2nd and 3rd year and omplete in the available time frame. Participation in the global health track by the first fellow is still in process and improvements are being made based on experience. A multidisciplinary team including support within the fellowship program and experts in global health training is essential to the success of a pediatric GHN global health track. International relationships either previously established by the fellow, within the department, or the institution are also necessary for the success of the track. We believe that this track will help to equip future gastroenterologists to pursue a career with a focus in global health. Future directions include recruiting future fellows to complete the curriculum within our institution, formal evaluation by fellows participating in the curriculum, and securing ongoing funding. We also hope to incorporate global health electives abroad when feasible.

Maternal mortality in modern world

Aim: to analyze the causes and level of global maternal mortality (MM) according to the data published within the last 7 years. Materials and Methods. Search for publications in the PubMed/MEDLINE database was conducted according to the criteria: meta-analysis, free full-text, English, 2015-2021 period. The PICO principle (Patient/Problem, Intervention, Comparison, Outcome) and the keywords "maternal mortality causes", "maternal death causes", "maternal outcomes" were used. The search was finished on October 13, 2021 after retrieving 137 results. Results. The rate of MM and cause pattern has been changing during COVID-19 pandemic. The first weeks of the COVID-19 lockdown showed that in-hospital mortality among pregnant women increased from 0.13 up to 0.20 % (p = 0.01) and in MM the proportion of respiratory diseases elevated up to 32 % versus 5.6%. Certain geographic regions of the world showed that MM due to COVID-19 reached extremely high values extending 3399 per 100,000 live births as well as increased general MM rate. Heart and vascular diseases (pericarditis, myocardial infarction, thromboembolism) have a significant position among the causes of MM. The rate of MM due to cardiovascular disease was inversely related to the population income level. Cardiomyopathy is the cause of death in 4 % (95 % confidence interval (95 % CI) = 2-7) of mothers in developed countries and 14 % (95 % CI = 10-18) in developing countries. The mortality rate 6 weeks after delivery among women with pregnancy-related myocardial infarction was 5.03 % (95 % Cl = 3,78-6,27), whereas it associated with thromboembolism among women with a mechanical heart valve was related to the agent used to prevent thrombosis, ranging from 0.9 (95 % CI = 0.1-1.6) for vitamin K antagonists up to 3.4 (95 % CI = 0-7.7) for unfractionated heparin per 100 pregnancies with a mechanical heart valve. After 2000, the proportion of anesthesia among immediate MМ causes decreased from 3.5 % (95 % CI = 2.9-4.3) down to 2.4 % (95 % CI = 1.9-2.9) in low- and middle-income countries. High MM odds due to maladjusted pregnancy are still observed: OR (odds ratio) = 17 (95 % CI = 9.6-28.8) for hypertension, OR = 3.70 (95 % CI = 1.72-7.99) for HELLP syndrome with acute kidney injury. Severe obstetric complications cause MM in sub-Saharan Africa and South Asia: bleeding (OR = 28.8;95 % CI = 20.3-40.7), preeclampsia or eclampsia (OR = 9.13;95 % CI = 6.10-13.7), maternal infections in antenatal period (OR = 2.80;95 % CI = 1.63-4.80). About 67 % of pregnant women in such countries obtain no antenatal care (OR = 2.80;95% CI = 1.63-4.80), predominantly giving birth at home in sub-Saharan Africa. In Ethiopia, ММ results from obstructed home delivery resulting in maternal death in 17.27 %, where uterine rupture is cause of death in 7.75 % of women. Conclusion. The COVID-19 pandemic contributed a lot to MM. Diseases of the cardiovascular system markedly elevate the MM risk and long-term mortality after delivery. For countries with traditionally home births in the absence of medical care, a high MM remains due to complicated and protracted labor complicated by uterine rupture.

USING MOBILE PHONES FOR COLLECTING HEALTH INFORMATION IN THE SUB SAHARAN AFRICA DURING THE COVID-19 PANDEMIC: TAKING LESSONS FROM THE WORLD DEVELOPMENT INDICATORS DATABASE

Objective The primary aim of this study was to portray the level of spread and the dynamic of diffusion of mobile phone technology in sub-Saharan Africa during the last two decades. The secondary aim was to investigate factors related to the use of mobile phone technology in sub-Saharan Africa and to derive profiles of the most suitable areas to conduct mobile phone technology-based research. Methods The present work was based on the data collected by the World Bank database;a collection of public access data derived from yearly surveys conducted at country level. Two methods were applied to perform the selection of variables related to the diffusion of mobile phones in sub-Saharan Africa. Firstly, a Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied. Afterwards, a system of simultaneous equation was applied to estimate the model coefficients and determine the joint statistical significance. Results The number of mobile phones subscriptions in relation to the population of sub-Saharan Africa has increased consistently during the period 2000 to 2010. The rate of mobile phones subscriptions in relation to the population ranged between less than 1% to more than 90%. Urban areas and having a lower number of people leaving in slums seems to be the most suitable places to conduct mobile phone-based interviews. This information is useful in identifying countries and macro areas to conduct mobile phone interviews;and this could be extended to smallest area within a country. Discussion More effort is required to better understand how to identify areas suitable for conducting research using mobile phones and other electronic-based tools. Such an effort should be based on individual level surveys to understand not only the material possibility but also the will to participate to research based on data capturing made by mobile phones and similar tools.

A model to eradicate HCV in undocumented migrants and low-income refugees in Italy

Background and aims: To validate an innovative eradication model for HCV infection in undocumented migrants and low-income refugees living Southern Italy. Method: a prospective, multicenter, collaborative study was started in June 2018 with The studywas stopped in February 2020 due to the outbreak of SARS-CoV-2 infection in Italy and was resumed in February 2021. At the six 1st level centers participating to the study volunteer associations that deal with the first needs of disadvantaged people performed the enrolment and the screening for anti-HCV, HBsAg and anti-HIV;epidemiological data were collected in an electronic database. Anti-HCV-positive subjects were sent to two 3rd level centers for the clinical, virological and therapeutic evaluation. For the HCV-RNA-positive subjects HCV genotyping and a clinical, biochemical and ultrasound staging was performed. The HCV RNApositive subjects have been treated with sofosbuvir-velpatasvir for 12 weeks and followed for 12 months from the end of therapy. Results: Of the 3, 991 migrants observed in the study period, 3, 897 (97.6%) accepted to be screened. They were young (median age 26 years), predominantly male (85.9%) and came from North Africa (3.8%), from Sub-Saharan Africa (68.4%), from Eastern Europe (8.1%), from Indo-Pakistan (17%) and from other countries (2.7%). Of the 3, 897 enrolled subjects, 185 (4.7%) resulted anti-HCV positive. The Figure shows the HCV-cure cascade. All the 185 anti-HCV-positive subjects were linked to care at 3rdID and tested for HCV RNA and 53 (28.6%) resulted HCV-RNA positive. Of these, 46 (86.8%) started DAA regimen with sofosbuvir plus velpatasvir (15 with GT 1b, 10 with 1a, 16 with 3, 3 with 4 and 2 with 2). Forty-two completed the follow-up and 4 was still pending. Of these 42 subjects, 41 (97.6%) showed a SVR12 and SVR 24, and one dropped-out in follow-up after the stop of DAA treatment. No subject had adverse event. (Figure Presented) Conclusion: This model seems to be effective to eradicate HCV infection among a difficult-to-manage population, such as undocumented migrants and low-income refugees