Reactivation of Surgical Campaigns after the Covid Pandemic: Surgeons in Action with Hernia International Foundations in 2022

Aim: The Cirujanos en Accion and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed. Material/ Methods: We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge. Result(s): Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals);local staff;1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.) Conclusion(s): 9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future.

Peacekeeping Operations: Challenges and Opportunities in the Midst of Health Crises

The COVID-19 crisis has brought about significant challenges to international organizations operating in fragile contexts. Among others, the case of United Nations (UN) and its peacekeeping operations (PKOs) counting more than 80, 000 personnel from 121 countries is certainly prominent. Not only do PKOs rely on international personnel's frequent rotations, but they also rely on freedom of movement to carry out their mandate. How have PKOs adapted and responded to the crisis? How do PKOs balance the need to protect vulnerable civilians with support to governments' responses to the crisis and safeguard legitimacy? This chapter explores the impact of the health crisis due to the COVID-19 pandemic on PKOs by focusing on two key aspects. First, it evaluates the current PKO efforts in managing the crisis in light of two previous health emergencies occurring in the midst of PKOs, namely Ebola in Western Africa and cholera in Haiti. It will reflect on the legitimacy costs associated with the risk of UN personnel being seen as vector of the disease. Second, it identifies challenges and opportunities created by the emergency. The key challenges stem from the inevitable delay or interruption of ongoing negotiation processes, and the associated risks of armed groups taking advantage of the uncertain situation. But there are some opportunities to consider. Operational adaptation becomes a need as missions have to prioritize civilians' protection without violating governments' policies on movement. Furthermore, halting frequent personnel rotations has likely increased cohesion within missions among soldiers but also between soldiers and missions' leaders. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Covid-19 Seroprevalence in Vaccine-Naive Populations: Drc, Guinea, Liberia, and Mali

Background: As part of an international multi-country study on COVID-19 vaccine immunogenicity (InVITE, NCT05096091), we sought to characterize baseline anti-Nucleocapsid (N) and anti-Spike (S) seropositivity by country and by self-report of prior positive SARS-CoV-2 test result. Method(s): 3063 vaccine-naive individuals from the InVITE study cohort, who received a COVID-19 vaccine as part of their country's national immunization programs at participating sites in Democratic Republic of Congo (DRC), Guinea, Liberia and Mali, were enrolled between August 2021 and February 2022. Demographic and baseline characteristics were collected at study enrollment. Blood was collected at baseline prior to initiation of the vaccine regimen. SARS-CoV-2 anti-S antibody and anti-N antibody levels were measured using Quanterix anti-S IgG semi-quantitative antibody and BioRad Platelia SARSCoV- 2 anti-N Total Ab assays, respectively. Demographic characteristics were assessed for association with positive anti-S and anti-N serology. Result(s): Baseline demographics and serology results by country and overall are shown in the table. Conclusion(s): Despite low numbers of prior self-reported positive SARS-CoV-2 test, the serology results in this cohort indicate prior infection in a significant proportion of the InVITE study participants prior to receipt of a first dose of COVID-19 vaccination. These results suggest widespread previous SARS-CoV-2 infections that were unrecognized possibly due to mild-no symptoms, poor access to/availability of testing and/or limited monitoring through surveillance. Baseline Demographics and Serology Results.

Epidemics of Neglect

The COVID-19 pandemic has exposed multiple fault lines in the performances of health services at every level – from community to national to global – in ensuring universal, equitable access to preventive and curative care. Tragically, this has been to the detriment of those who have suffered and died not only from COVID-19, but also from the myriad other ailments affecting people around the world. Of those, we wish to highlight here some key categories of diseases that have caused a greater burden of illness and deaths as a consequence of the policies and political decisions made in relation to the COVID-19 pandemic. In our view, these should be considered epidemics or, more accurately, syndemics – the clustering and interactions of two or more diseases or health conditions and socio-environmental factors – of neglect.

Israel's COVID-19 Diplomacy in Sub-Saharan Africa and Central Europe

Israel's aid initiatives have historically been facilitated through the Agency for International Development Cooperation (MASHAV). However, the COVID-19 pandemic impacted MASHAVs ability to provide assistance due to budget cuts and government instability. As such, Israel's COVID-19 diplomacy initiative took on greater importance in maintaining its presence and reputation internationally. This article analyzes Israel's approach to COVID-19 diplomacy, which involved providing medical teams, PPE, and surplus vaccines to approximately 20 countries, and examines the political and strategic calculations behind Israel's decision to extend assistance to specific countries. The article argues that Israel's COVID-19 diplomacy initiative was more limited in scope and geography compared to other countries with similar economic development levels, and aid efforts were concentrated in regions where Israel has sought to increase its involvement in recent years, particularly sub-Saharan Africa and Central Europe. Finally, the article assesses the impact of Israel's COVID-19 diplomacy initiative on its diplomatic relations with recipient countries and the broader international community.

The lasting influence of Ebola: a qualitative study of community-level behaviors, trust, and perceptions three years after the 2014-16 Ebola epidemic in Liberia.

The majority of disease transmission during the 2014-16 West Africa Ebola epidemic was driven by community-based behaviors that proved difficult to change in a social paradigm of misinformation, denial, and deep-seated distrust of government representatives and institutions. In Liberia, perceptions and beliefs about Ebola during and since the epidemic can provide insights useful to public health strategies aimed at improving community preparedness. In this 2018 study, we conducted nine focus groups with Liberians from three communities who experienced Ebola differently, to evaluate behaviors, attitudes, and trust during and after the epidemic. Focus group participants reported that some behaviors adopted during Ebola have persisted (e.g. handwashing and caretaking practices), while others have reverted (e.g. physical proximity and funeral customs); and reported ongoing distrust of the government and denial of the Ebola epidemic. These findings suggest that a lack of trust in the biomedical paradigm and government health institutions persists in Liberia. Future public health information campaigns may benefit from community engagement addressed at understanding beliefs and sources of trust and mistrust in the community to effect behavior change and improve community-level epidemic preparedness.

Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics.

BACKGROUND: COVID-19 has caused significant public health problems globally, with catastrophic impacts on health systems. This study explored the adaptations to health services in Liberia and Merseyside UK at the beginning of the COVID-19 pandemic (January-May 2020) and their perceived impact on routine service delivery. During this period, transmission routes and treatment pathways were as yet unknown, public fear and health care worker fear was high and death rates among vulnerable hospitalised patients were high. We aimed to identify cross-context lessons for building more resilient health systems during a pandemic response. METHODS: The study employed a cross-sectional qualitative design with a collective case study approach involving simultaneous comparison of COVID-19 response experiences in Liberia and Merseyside. Between June and September 2020, we conducted semi-structured interviews with 66 health system actors purposively selected across different levels of the health system. Participants included national and county decision-makers in Liberia, frontline health workers and regional and hospital decision-makers in Merseyside UK. Data were analysed thematically in NVivo 12 software. RESULTS: There were mixed impacts on routine services in both settings. Major adverse impacts included diminished availability and utilisation of critical health services for socially vulnerable populations, linked with reallocation of health service resources for COVID-19 care, and use of virtual medical consultation in Merseyside. Routine service delivery during the pandemic was hampered by a lack of clear communication, centralised planning, and limited local autonomy. Across both settings, cross-sectoral collaboration, community-based service delivery, virtual consultations, community engagement, culturally sensitive messaging, and local autonomy in response planning facilitated delivery of essential services. CONCLUSION: Our findings can inform response planning to assure optimal delivery of essential routine health services during the early phases of public health emergencies. Pandemic responses should prioritise early preparedness, with investment in the health systems building blocks including staff training and PPE stocks, address both pre-existing and pandemic-related structural barriers to care, inclusive and participatory decision-making, strong community engagement, and effective and sensitive communication. Multisectoral collaboration and inclusive leadership are essential.

Financing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities.

INTRODUCTION: Neglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective. METHODS: We carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach. FINDINGS: We found that decentralization for NTD financing is not yet achieved - financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government's limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients). CONCLUSION: Our findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.

Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020-2021.

Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.

Exploring the effects of new viral illnesses on pregnancy outcomes in sub- Saharan Africa

In sum, the totality of the available evidence suggests that there is currently limited research data relating to the pathogenesis, consequences, and outcomes of pregnancy in African women infected with new viral illnesses such as COVID-19, Lassa fever, and Ebola virus disease. World Health Organization (2020) Ebola virus disease. https://www.who.int/news-room/fact-sheets/detail/ebolavirus-disease 7. In Guidelines for screening and caring for pregnant women with Ebola virus disease for health care providers in US hospitals. Jamieson DJ, Uyeki TM, Callaghan WM, Meaney-Delman D, Rasmussen SA. What obstetrician-gynecologist should know about Ebola: a perspective from the Centers for Disease Control and Prevention.

Epidemiological characteristics of Lassa fever cases in Liberia: a retrospective analysis of surveillance data, 2019-2020.

OBJECTIVES: Liberia is endemic to Lassa fever (LF) and has the largest reported per capita incidence of LF patients in the West African region. Cases of the disease increased unprecedentedly in 2019 and 2020, characterized by a geographical drift in epidemiology and seasonal variation of occurrence. This study aims to describe the epidemiological and clinical characteristics of LF in Liberia from 2019 to 2020. METHODS: A retrospective study was conducted on cases of LF confirmed at the National Public Health Reference Laboratory from January 2019 to December 2020. Medical records were reviewed, and epidemiological and clinical data were collected in an organized manner. Descriptive and inferential statistics were carried out using Epi Info (version 7.2.5.0). RESULTS: A total of 382 suspected LF cases were reported, of which 103 were laboratory-confirmed, yielding a case positivity rate of 27% (103/382). The median age of the LF cases was 20 (IQR: 9-30). Children younger than 18 years accounted for 40.8% (42/103) of the cases and healthcare workers' cases constituted 7.7% of the cases. Bong, Nimba, and Grand Bass accounted for 87.4% of the cases with cases in new counties like Lofa, Margibi, and Grand Kru. Hemorrhage (aOR:10.2; 95% CI: 3.11-33.81), patients who did not receive ribavirin (aOR: 4.4; 95% CI: 1.12-17.57, P = 0.034), and patients aged 40 years or older (aOR: 6.2; 95% CI: 1.19-32.53, P = 0.049) were associated with LF mortality. CONCLUSION: The LF cases in 2019 and 2020 had a high case fatality rate and spread to new counties that had not previously reported LF. The disease occurred during most of the rainy season instead of the usual dry season. There is an urgent need to lower morbidity and mortality, improve early presentation to the hospital, and early initiation of appropriate medical care.

Planning for the next pandemic: facts and figures

The world is not prepared,” said the report by the Global Preparedness Monitoring Board (GPMB), a body co-convened by the World Bank and World Health Organization (WHO). According to the World Wide Fund For Nature, three or four new zoonotic diseases are emerging each year, and the problem is likely to worsen because of the need to feed a growing population and demand for wild meat as both a necessity and delicacy. According to the GPMB, the 20 per cent fall in Sierra Leone was enough to wipe out five years of development. [...]pressure looks set to grow to contain crop diseases, amid the world’s growing population and a rise in the number of people facing food insecurity from 23 per cent in 2014 to 26 per cent in 2018, according to the UN’s Food and Agriculture Organization.

Summit spurs pledges on malaria, neglected diseases

See PDF] According to the World Health Organization (WHO), Africa was home to 95 per cent of global malaria cases and 96 per cent of malaria deaths in 2020 , with children under five accounting for about 80 per cent of all malaria deaths in the region. Harper urged countries where NTDs are endemic to commit to bring treatment into their health systems and train their health workers to support this, especially in remote communities that also need access to clean water and sanitation. Melanie Renshaw, a senior technical advisor of the African Leaders Malaria Alliance, describes malaria and NTDs as pathfinders for sustainable pandemic preparedness and response and the long-term strengthening of health systems.

Ebola: 20,000 vaccine doses to tackle Guinea outbreak

Mass immunisation got under way on Tuesday (February 23) after 11,000 doses of the Ebola vaccine landed in the West African country as part of an emergency response to the outbreak, the World Health Organization (WHO) confirmed on Twitter. Drawing on experience of the latest Ebola outbreak in the Democratic Republic of Congo (DRC), experts believe that the vaccine rollout, which began nine days after the first cases were confirmed, is a crucial part of the emergency response. According to Wolz, if communities are involved in and support the response, the benefit is “huge”.

The COVID-19 Pandemic and Early Childhood Education in Ethiopia, Liberia, and Pakistan: Perspectives of Pre-primary School Teachers

School closures due to the COVID-19 pandemic have affected teachers and changed their role significantly. This chapter explores the extent to which early childhood education (ECE) teachers were engaged in children’s early learning during school closure through communication with their parents and families in three countries: Ethiopia, Liberia, and Pakistan. Using mobile phone surveys and key informant interviews, we investigate the support pre-primary teachers received during school closures and how they were able to support children’s home-based learning and prepare for school reopening. In all three countries, many teachers were in contact with children and families during school closures, yet the percentage varies by country, from 33% in Ethiopia to 64% in Liberia and 100% in Pakistan. Teachers in Ethiopia and Pakistan reported that children from disadvantaged backgrounds were missing out on essential support, but about 70% of ECE teachers sought to accommodate their learning needs or support psychosocial well-being. We discuss policy implications to support ECE teachers and children in the current and future crises in order to improve responsiveness and resilience in ECE systems. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The influence of first wave of COVID-19 outbreak on routine healthcare services, Liberia, August 2020: a mixed study approach.

BACKGROUND: The COVID-19 pandemic left countries to rapidly implement diverse and stringent public health measures without recourse to mitigate its effect on the sustenance of routine healthcare services. This study described routine health service disruption and restoration strategies at 6 months into the epidemic in Liberia. METHODS: Liberia, with 15 counties, has 839 health facilities, with one-third in Montserrado County. A cross-sectional study using a mixed approach - quantitative and qualitative research with concurrent triangulation was conducted using a structured guide for group discussions among key health workers at 42 secondary and most patronized health facilities in 14 counties and 7 Montserrado districts. Additionally, routine health data between January and June 2019 and 2020 were extracted from the source documents to the electronic checklist. We performed a descriptive analysis of quantitative data and plotted the line graph of the relative percentage change. Transcribed audio recording notes were synthesized using ATLAS ti for content analysis to identify the themes and subthemes in line with the study objectives and excerpts presented in the results. RESULTS: Liberia declared COVID-19 outbreak on March 16, 2020. From conducted interviews at 41 health facilities, 80% reported disruption in routine health services. From January to June 2020, scheduled routine immunization outreaches conducted decreased by 47%. Using a relative percentage change, outpatient attendance decreased by 32% in May, inpatient admission by 30% in April, malaria diagnosis and treatment by 40% in April, and routine antenatal obstetric care by 28% in April. The fear of contacting COVID-19 infection, redeployment of healthcare workers to COVID-19 response, restriction of movement due to lockdown, inadequate or lack of PPE for healthcare workers, lack of drugs and vaccine supplies for clients, and partial closure of routine healthcare services were common perceived reasons for disruptions. Massive community health education and strict compliance with COVID-19 nonpharmacological measures were some of the health facility recovery strategies. CONCLUSIONS: The COVID-19 outbreak in Liberia caused a disruption in routine healthcare services, and strategies to redirect the restoration of routine healthcare services were implemented. During epidemics or global health emergencies, countries should sustain routine health services and plan for them.

Assessment of Infection Prevention and Control Measures at Points of Entry in Sierra Leone in 2021: A Cross-Sectional Study

Implementing and monitoring infection prevention and control (IPC) measures at immigration points of entry (PoEs) is key to preventing infections, reducing excessive use of antimicrobials, and tackling antimicrobial resistance (AMR). Sierra Leone has been implementing IPC measures at four PoEs (Queen Elizabeth II Quay port, Lungi International Airport, and the Jendema and Gbalamuya ground crossings) since the last Ebola outbreak in 2014–2015. We adapted the World Health Organization IPC Assessment Framework tool to assess these measures and identify any gaps in their components at each PoE through a cross-sectional study in May 2021. IPC measures were Inadequate (0–25%) at Queen Elizabeth II Quay port (21%;11/53) and Jendema (25%;13/53) and Basic (26–50%) at Lungi International Airport (40%;21/53) and Gbalamuya (49%;26/53). IPC components with the highest scores were: having a referral system (85%;17/20), cleaning and sanitation (63%;15/24), and having a screening station (59%;19/32). The lowest scores (0% each) were reported for the availability of IPC guidelines and monitoring of IPC practices. This was the first study in Sierra Leone highlighting significant gaps in the implementation of IPC measures at PoEs. We call on the AMR multisectoral coordinating committee to enhance IPC measures at all PoEs.

Reported health system solutions implemented to contain COVID-19 in six West African countries: a media content analysis

Background: When COVID-19 began to spread globally, concerns for high morbidity and mortality rates in West African countries started to grow. Nevertheless, West African countries have had lower morbidity and mortality rates than other countries in the world. Little research has been done to investigate what health system solutions these countries implemented to decrease COVID-19-related morbidity and mortality rates earlier in the pandemic.

Improvements in malaria testing and treatment after a national community health worker program in rural Liberia

Background: Progress in reducing malaria incidence and deaths has stalled, in part due to limited access to quality malaria testing and treatment amongst rural populations. This time-series analysis aims to describe changes in rural malaria diagnosis and treatment before and during the rollout of Liberia's National Community Health Assistant (CHA) program. It also explores how malaria service delivery changed during the COVID-19 epidemic.

Community-based trial assessing the impact of annual versus semiannual mass drug administration with ivermectin plus albendazole and praziquantel on helminth infections in northwestern Liberia.

We assessed the impact of three annual vs five semiannual rounds of mass drug administration (MDA) with ivermectin plus albendazole followed by praziquantel for the control or elimination of lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminth (STH) infections and schistosomiasis in Lofa County, Liberia. The study started in 2012 and was interrupted in 2014 during the Ebola virus outbreak. Repeated cross-sectional surveys were conducted in individuals 5 years and older to measure infection markers. Wuchereria bancrofti antigenemia prevalences decreased from 12.5 to 1.2% (90% reduction) and from 13.6 to 4.2% (69% reduction) one year after three rounds of annual or five rounds of semiannual MDA, respectively. Mixed effects logistic regression models showed decreases in odds of antigenemia positivity were 91 and 74% at that time in the annual and semiannual treatment zones, respectively (p < 0.001). Semiannual MDA was slightly more effective for reducing Onchocerca volvulus microfiladermia prevalence and at follow-up 3 were 74% (from 14.4 to 3.7%) and 83% (from 23.6 to 4.5%) in the annual and semiannual treatment zones, respectively. Both treatment schedules had similar beneficial effects on hookworm prevalence. Thus, annual and semiannual MDA with ivermectin and albendazole had similar beneficial impacts on LF, onchocerciasis, and STH in this setting. In contrast, MDA with praziquantel had little impact on hyperendemic Schistosoma mansoni in the study area. Results from a long-term follow-up survey showed that improvements in infection parameters were sustained by routine annual MDA provided by the Liberian Ministry of Health after our study endpoint.