ABSTRACT
Background: The novel Coronavirus was first detected in Wuhan, China in December 2019. In Ethiopia, The COVID-19 pandemic was expanding geopgraphically overtime. Understanding the spatial variation of the pandemic and the level of compliances towards COVID-19 prevention strategies is important to guide focused prevention and control efforts. Aim: This study aimed to explore the level of compliance and spatial variation in COVID-19 prevention strategies in major cities and towns in the Amhara region, Ethiopia. Methods: A community based observational survey was conducted from June 25 to August 10, 2020, in 16 selected cities and towns of the Amhara region. The level of compliance with hand hygiene, physical distancing and mask utilization as per the WHO recommendations were observed from 6,002 individuals and 346 transport services. Getis-Ord Gi* statistics were used to identify hot spot areas with a low level of compliance with COVID-19 preventive strategies. Spatial interpolation was performed to predict the level of compliance for un-sampled areas in the region. Results: The practice of hand hygiene, physical distancing and mask utilization were 12.0%, 13% and 26%, respectively. COVID-19 prevention strategies were found to be spacially non-random in Amhara region (Global Moran's I = 0.23, z-score = 9.5, P-value < 0.001). Poor (Hot Spot Areas) COVID-19 Prevention practices were spatially clustered at Northern Amhara (Metema, Gondar, and Woghemira town) and Western Amhara (Moarkos, Enjibara, And Bahir Dar town).Southern (Shewa Robit, and Kemissie Twon) and Eastern (Dessie, Kombolcha, Wolidiya, and Kobo) parts of the Amhara region were spatially clustered as cold spots (better practice) for COVID-19 prevention strategies. With regards to the practice of COVID19 prevention strategies, practices were low in northern and northwestern parts of the region (5%), whereas this was found to be much higher in the southern part of the region (41%). Conclusion: The level of compliance with regards to hand hygiene, physical distancing and mask utilization exhibit spatial variation across the region. Continuous community-based education using different modalities are necessary to increase the practice of hand hygiene, physical distancing and mask utilization.
ABSTRACT
The role of antihypertensives, especially Renin-Angiotensin-Aldosterone System inhibitors, is still debatable in COVID-19-related severity and outcome. Therefore, we search for a more global analysis of antihypertensive medication in relation to SAS-CoV-2 severity using prescription data worldwide. The association between the percentage use of different types of antihypertensive medications and mortality rates due to a SARS-CoV-2 infection during the first 3 weeks of the pandemic was analyzed using random effects linear regression models for 30 countries worldwide. Higher percentages of prescribed angiotensin receptor blockers (ARBs) (ß, 95% confidence interval [CI]; -0.02 [-0.04 to -0.0012]; p = .042) and calcium channel blockers (CCBs) (ß, 95% CI; -0.023 [-0.05 to -0.0028]; p = .0304) were associated with a lower first 3-week SARS-CoV-2-related death rate, whereas a higher percentage of prescribed angiotensin-converting enzyme inhibitors (ACEis) (ß, 95% CI; 0.03 [0.0061-0.05]; p = .0103) was associated with a higher first 3-week death rate, even when adjusted for age and metformin use. There was no association between the amount of prescribed beta-blockers (BBs) and diuretics (Diu) and the first 3-week death rate. When analyzing the combination of drugs that is used by at least 50% of antihypertensive users, within the different countries, countries with the lowest first 3-week death rates had at least an angiotensin receptor blocker as one of the most often prescribed antihypertensive medications (ARBs/CCBs: [ß, 95% CI; -0.02 [-0.03 to -0.004]; p = .009], ARBs/BBs: [ß, 95% CI; -0.03 [-0.05 to -0.006]; p = .01]). Finally, countries prescribing high-potency ARBs had lower first 3-week ARBs. In conclusion, ARBs and CCB seem to have a protective effect against death from SARS-CoV-2 infection.