The first year of the COVID-19 pandemic in humanitarian settings: epidemiology, health service utilization, and health care seeking behavior in Bangui and surrounding areas, Central African Republic.

BACKGROUND: Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas. METHODS: This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions. RESULTS: The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from - 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; - 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from - 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care. CONCLUSIONS: A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed.

Global prospects to deliver safe drinking water services for 100 million rural people by 2030

The climate crisis and global pandemic have accelerated the urgency of providing safe drinking water services around the world. Global progress to safe drinking water is off-track with uncertain and limited data on the extent and performance of rural water service providers to inform policy and investment decisions. This report documents a global diagnostic survey to evaluate the status and prospects of rural water service providers from 68 countries. The service providers describe providing drinking water services to a population of around 15 million people through over 3 million waterpoints. The data provides information on the scale and sustainability of rural water services to examine: . The extent and type of professional water service provision in rural areas globally;. Self-reported metrics of operational and financial performance;and, . The size and scope of current rural service providers that could transition to resultsbased funding. Five major findings emerge. First, most service providers aim to repair broken infrastructure in three days or less. Second, almost all service providers reported at least one type of water safety activity. Third, most service providers collect payments for water services. Fourth, about one third of service providers reported major negative shocks to their operations from the COVID-19 pandemic. Fifth, non-governmental service providers in low income countries less often report receiving subsidies for operations, and more often report paying part of user fees to government, including through taxes. Most rural water service providers are working towards provision of affordable, safe and reliable drinking water services. Key barriers to progress include sustainable funding and delivery of services at scale. We propose four conditions to promote scale and sustainability based on policy alignment, public finance, professional service delivery, and verifiable data. To illustrate these conditions, we consider the differing context and service delivery approaches in the Central African Republic and Bangladesh. We conclude by identifying a group of 77 service providers delivering water services for about 5 million people in 28 countries. These 77 service providers report operational metrics consistent with a results-based contracting approach. Technical assistance might support many more to progress. We argue that government support and investment is needed to rapidly progress to the scale of 100 million people to provide evidence of pathways to universal drinking water services for billions more.

Weekly epidemiological record

Yellow fever transmission in Africa included outbreaks and cases in countries with a history of YF mass vaccination campaigns (Cameroon, Central African Republic, Ghana), escalating the concern raised by the re-emergence of outbreaks in West Africa in 2020. In 2021, those outbreaks affected populations that had not been reached by immunization services, including people living in areas with compromised security and people missed in large-scale campaigns. The resurgence of intense viral transmission highlights the importance of achieving and maintaining equitable, high vaccination coverage of all at-risk populations. COVID-19 continued to impact YF control in 2021. The type of effect changed as countries prioritized vaccination against COVID-19, which led to postponement or de-prioritization of YF vaccination in some countries and affected vaccine acceptance. Despite the challenges, priority countries made good progress in implementing the Eliminate Yellow fever Epidemics (EYE) strategy in 2021, with >48 million people reached through reactive, catch-up and preventive YF vaccination campaigns in Africa.

Malaria research in the Central African Republic from 1987 to 2020: an overview.

BACKGROUND: The national malaria control policy in the Central African Republic (CAR) promotes basic, clinical, and operational research on malaria in collaboration with national and international research institutions. Preparatory work for the elaboration of National Strategic Plans for the implementation of the national malaria control policy includes developing the research component, thus requiring an overview of national malaria research. Here, this survey aims to provide an inventory of malaria research as a baseline for guiding researchers and health authorities in choosing the future avenues of research. METHODS: Data sources and search strategy were defined to query the online Medline/PubMed database using the "medical subject headings" tool. Eligibility and study inclusion criteria were applied to the selected articles, which were classified based on year, research institute affiliations, and research topic. RESULTS: A total of 118 articles were retrieved and 51 articles were ultimately chosen for the bibliometric analysis. The number of publications on malaria has increased over time from 1987 to 2020. These articles were published in 32 different journals, the most represented being the Malaria Journal (13.73%) and the American Journal of Tropical Medicine and Hygiene (11.76%). The leading research topics were drug evaluation (52.94%), expatriate patients (23.54%), malaria in children (17.65%), morbidity (13.7%), and malaria during pregnancy (11.76%). The publications' authors were mainly affiliated with the Institut Pasteur of Bangui (41%), the French Military Medical Service (15.5%), and the University of Bangui (11.7%). Collaborations were mostly established with France, the UK, and the USA; some collaborations involved Switzerland, Austria, Pakistan, Japan, Sri Lanka, Benin, Cameroun, Ivory Coast, and Madagascar. The main sources of research funding were French agencies (28.6%) and international agencies (18.3%). Most studies included were not representative of the whole country. The CAR has the capacity to carry out research on malaria and to ensure the necessary collaborations. CONCLUSION: Malaria research activities in the CAR seem to reflect the priorities of national policy. One remaining challenge is to develop a more representative approach to better characterize malaria cases across the country. Finally, future research and control measures need to integrate the effect of COVID-19.

Education increases teleneurology utilization: towards the Intersectoral Global Action Plan on epilepsy in Africa

Background and aims: Epilepsy burden in sub-Saharan Africa (SSA) has increased dramatically in the last 20 years. People with epilepsy (PWE) are estimated to be over 20 millions, with about 1 neurologist every 3-5 millions inhabitants, meaning more than 90% of epileptic patients are managed by health workers (HW) with insufficient education in Epilepsy, and 75% of them have no access to treatments. Moreover COVID-19 pandemic is affecting epilepsy management in SSA through care disruption. Teleneurology has the potential to improve this situation, although poor education of HW is associated with its underutilization. We measured the changes of teleneurology requests from primary cares in SSA after an education program on epilepsy. Methods: Global Health Telemedicine (GHT) offers remote advices and education to HW of the Disease Relief through Excellent and Advanced Means (DREAM) program active in 10 SSA countries. GHT-DREAM recently started an epilepsy program in Malawi and Central African Republic (CAR) with education and training courses delivered both locally and remotely. Results: In Malawi and CAR DREAM follows 18,770 patients, 569 (3,0%) suffering from epilepsy. The total number of teleneurology requests increased from 91 in 2019 to 141 in 2020 to 802 in 2021;>90% were for PWE. Conclusion: Education and training in epilepsy increased the number of tele-requests by improving knowledge and communication between SSA HW and European neurologists. Partnerships can bring neurologists where there are none, contributing to limit COVID-19 care disruption thus reducing the treatment gap in SSA. Our results move towards the Intersectoral Global Action Plan 2022-2031 in SSA. (Figure Presented).

Response to COVID-19 in the Central African Republic: Coping Strategies Combined With China's Experience.

Objectives: The weak health system, domestic political unrest, poverty, and many other factors in the Central African Republic (CAR) have left the country underprepared for the COVID-19 pandemic, resulting in a greater health threat to the entire country. Rapid measures must therefore be taken to prevent the further spread of COVID-19. Methods: This work encompassed a review of relevant literature. We aim to analyze how far Chinese COVID measures can be transferred to the context of the CAR. Results: We argue that the measure that the CAR can learn from China's success is the involvement of community workers and that greater investment in this model may be the optimal solution. Help from the international community is urgently needed. Conclusion: The CAR can benefit from China's successful experience in fighting the epidemic, but the disparity in the combined power of the two countries does not allow for simple replication of China's strategy.

[COVID-19: Myth or reality? Note on the case of the city of Bossangoa (Central African Republic)]. / COVID-19: Mythe ou réalité ? Note sur le cas de la ville de Bossangoa (République centrafricaine).

In May 2021, Covid-19 infections are present in Bossangoa, Central African Republic, with an apparent low incidence and a low morbidity. The population equates them with a local pathology considered trivial and does not respect the barrier measures decided by the country's authorities.

Factors Associated with Healthy Life Expectancy: An Ecological Analysis of Global Data

Healthy life expectancy (HALE) measures the quality of life a person expects to live. This study aims to find out the most associated factors of HALE at birth globally. The data of 212 countries came from the World Health Organization, Worldometer, World Bank, and United Nations. HALE at birth is considered as the dependent variable;and social, economic, and health factors are considered as the predictors. Descriptive statistics, Pearson’s correlation analysis, and multiple linear regression models were used as the statistical tools to reach the objective. The results revealed that HALE is found lower in Central African Republic and higher in Singapore. The highest death rate due to coronavirus disease 2019 (COVID 19), alcohol consumption rate, human immunodeficiency virus (HIV) prevalence rate, and average household size are found in Nicaragua, Moldova Republic, Eswatini, and Senegal, respectively. And the lowest recovery rate from COVID 19, and universal health coverage (UHC) service index are found in Tajikistan, and Montserrat, respectively. The recovery rate from COVID 19, UHC service index, gross domestic product (GDP), current health expenditure, tuberculosis (TB) incidence, tobacco smoking, HIV prevalence rate and average household size were significantly correlated with the HALE at birth. The multiple linear regression models identified that the UHC service index, alcohol consumption rate, HIV prevalence rate and average household size are the most associate factors of HALE at birth globally. Therefore, the necessary steps should be taken to maximize the UHC service index, and to minimize the alcohol consumption rate, HIV prevalence rate and average household size for increasing the HALE at birth in the world.

Asymptomatic Malaria Infections in the Time of COVID-19 Pandemic: Experience from the Central African Republic.

According to the latest World Health Organization malaria report, 95% of 241 million global malaria cases and 96% of 627,000 malaria deaths that were recorded in 2020 occurred in Africa. Compared to 2019, 14 million more cases and 69,000 more malaria deaths were recorded, mainly because of disruptions to medical services during the COVID-19 pandemic. The aim of this study was to assess the prevalence of asymptomatic malaria cases in children and adults living in the Dzanga Sangha region in the Central African Republic (CAR) during the COVID-19 pandemic. Rapid immunochromatographic assays for the qualitative detection of Plasmodium species (P. falciparum, P. vivax, P. ovale/P. malariae) circulating in whole blood samples were used. A screening was performed in the group of 515 patients, 162 seemingly healthy children (aged 1-15) and 353 adults, all inhabiting the villages in the Dzanga Sangha region (southwest CAR) between August and September 2021. As much as 51.2% of asymptomatic children and 12.2% of adults had a positive result in malaria rapid diagnostic tests (mRDTs). Our findings demonstrated a very high prevalence of asymptomatic malaria infections in the child population. Limited access to diagnostics, treatment and prevention of malaria during the global COVID-19 pandemic and less medical assistance from developed countries may be one of the factors contributing to the increase in the prevalence of disease in Africa.

A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy.

BACKGROUND: Since the novel coronavirus emerged in late 2019, the scientific and public health community around the world have sought to better understand, surveil, treat, and prevent the disease, COVID-19. In sub-Saharan Africa (SSA), many countries responded aggressively and decisively with lockdown measures and border closures. Such actions may have helped prevent large outbreaks throughout much of the region, though there is substantial variation in caseloads and mortality between nations. Additionally, the health system infrastructure remains a concern throughout much of SSA, and the lockdown measures threaten to increase poverty and food insecurity for the subcontinent's poorest residents. The lack of sufficient testing, asymptomatic infections, and poor reporting practices in many countries limit our understanding of the virus's impact, creating a need for better and more accurate surveillance metrics that account for underreporting and data contamination. OBJECTIVE: The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with new and decomposable surveillance metrics of COVID-19 that overcome data limitations and contamination inherent in public health surveillance systems. In addition to prevalence of observed daily and cumulative testing, testing positivity rates, morbidity, and mortality, we derived COVID-19 transmission in terms of speed, acceleration or deceleration, change in acceleration or deceleration (jerk), and 7-day transmission rate persistence, which explains where and how rapidly COVID-19 is transmitting and quantifies shifts in the rate of acceleration or deceleration to inform policies to mitigate and prevent COVID-19 and food insecurity in SSA. METHODS: We extracted 60 days of COVID-19 data from public health registries and employed an empirical difference equation to measure daily case numbers in 47 sub-Saharan countries as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Kenya, Ghana, Nigeria, Ethiopia, and South Africa have the most observed cases of COVID-19, and the Seychelles, Eritrea, Mauritius, Comoros, and Burundi have the fewest. In contrast, the speed, acceleration, jerk, and 7-day persistence indicate rates of COVID-19 transmissions differ from observed cases. In September 2020, Cape Verde, Namibia, Eswatini, and South Africa had the highest speed of COVID-19 transmissions at 13.1, 7.1, 3.6, and 3 infections per 100,0000, respectively; Zimbabwe had an acceleration rate of transmission, while Zambia had the largest rate of deceleration this week compared to last week, referred to as a jerk. Finally, the 7-day persistence rate indicates the number of cases on September 15, 2020, which are a function of new infections from September 8, 2020, decreased in South Africa from 216.7 to 173.2 and Ethiopia from 136.7 to 106.3 per 100,000. The statistical approach was validated based on the regression results; they determined recent changes in the pattern of infection, and during the weeks of September 1-8 and September 9-15, there were substantial country differences in the evolution of the SSA pandemic. This change represents a decrease in the transmission model R value for that week and is consistent with a de-escalation in the pandemic for the sub-Saharan African continent in general. CONCLUSIONS: Standard surveillance metrics such as daily observed new COVID-19 cases or deaths are necessary but insufficient to mitigate and prevent COVID-19 transmission. Public health leaders also need to know where COVID-19 transmission rates are accelerating or decelerating, whether those rates increase or decrease over short time frames because the pandemic can quickly escalate, and how many cases today are a function of new infections 7 days ago. Even though SSA is home to some of the poorest countries in the world, development and population size are not necessarily predictive of COVID-19 transmission, meaning higher income countries like the United States can learn from African countries on how best to implement mitigation and prevention efforts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/21955.