COVID-19 breakthrough infection after four doses of the vaccines: a case report

The COVID-19 vaccines provide a high degree of protection against severe disease, hospitalisation, and death. However, no vaccine claimed 100% effectiveness and it is expected that a small proportion of vaccinated individuals may develop a breakthrough infection due to individual differences, virus variants and other factors. We conducted an epidemiological investigation and analysis of an imported case who had finished four doses of vaccination, and in order to provide a relevant reference for regular epidemic prevention and control in the post-pandemic era.

High seroprevalence of anti-SARS-CoV-2 antibodies in the capital of Chad

Background. Since the start of the COVID-19 pandemic, Chad has had 7,417 confirmed cases and 193 deaths, one of the lowest in Africa. Objective. This study assessed SARS-CoV-2 immunity in N'Djamena. Methods. In August-October 2021, eleven N'Djamena hospitals collected outpatient data and samples. IgG antibodies against SARSCoV- 2 nucleocapsid protein were identified using ELISA. "Bambino Gesu" Laboratory, Rome, Italy, performed external quality control with chemiluminescence assay. Results. 25-34-year-old (35.2%) made up the largest age group at 31.9 12.6 years. 56.4% were women, 1.3 women/men. The 7th district had 22.5% and the 1st 22.3%. Housewives and students dominated. Overall seroprevalence was 69.5% (95% CI: 67.7-71.3), females 68.2% (65.8-70.5) and males 71.2% (68.6-73.8). >44-year-old had 73.9% seroprevalence. Under-15s were 57.4% positive. Housewives (70.9%), civil servants (71.5%), and health workers (9.7%) had the highest antibody positivity. N'Djamena's 9th district had 73.1% optimism and the 3rd district had 52.5%. Seroprevalences were highest at Good Samaritan Hospital (75.4%) and National General Referral Hospital (74.7%). Conclusion. Our findings indicate a high circulation of SARS-CoV- 2 in N'Djamena, despite low mortality and morbidity after the first two COVID-19 pandemic waves. This high seroprevalence must be considered in Chad's vaccine policy.

Automatic Detection of Lung Ultrasound Artifacts using a Deep Neural Networks approach

The COVID-19 pandemic has challenged many of the healthcare systems around the world. Many patients who have been hospitalized due to this disease develop lung damage. In low and middle-income countries, people living in rural and remote areas have very limited access to adequate health care. Ultrasound is a safe, portable and accessible alternative;however, it has limitations such as being operator-dependent and requiring a trained professional. The use of lung ultrasound volume sweep imaging is a potential solution for this lack of physicians. In order to support this protocol, image processing together with machine learning is a potential methodology for an automatic lung damage screening system. In this paper we present an automatic detection of lung ultrasound artifacts using a Deep Neural Network, identifying clinical relevant artifacts such as pleural and A-lines contained in the ultrasound examination taken as part of the clinical screening in patients with suspected lung damage. The model achieved encouraging preliminary results such as sensitivity of 94%, specificity of 81%, and accuracy of 89% to identify the presence of A-lines. Finally, the present study could result in an alternative solution for an operator-independent lung damage screening in rural areas, leading to the integration of AI-based technology as a complementary tool for healthcare professionals. © 2023 SPIE.

Characteristics of COVID-19 patients and risk factors of mortality in the early times of pandemic, Herat-Afghanistan

Objective: Coronaviruses are a large family of viruses that cause different types of diseases. This study aims to evaluate the risk factors for mortality based on comorbidity and sociodemographic characteristics among COVID-19 patients. Methods: This cross-sectional study conducted in Herat, Afghanistan, from February 24 to July 5, 2020, used data provided by the public health department, including sociodemographics, symptoms, comorbidities, hospitalization, contact history, and COVID-19 test type. The Chi-square test was used to observe differences between categorical variables. In bivariate analysis, all independent variables with a significant p-value were put into the model. Odds ratios and 95% confidence intervals were calculated, and a p-value less than 0.05 was considered statistically significant. Results: The study analyzed 11,183 COVID-19 cases, with a 53.5% positivity rate. Recovery rates in the city and Herat province districts were 96.2% and 94.7%, respectively. Case-fatality rates varied with age, with 0.4% for those aged 1-29 and 33% for those aged 80-105. Mortality rates were highest for those with COPD and cancer, at 12.5% and 18.2%, respectively. In the logistic regression results, age, gender, and COPD were significant variables for COVID-19 mortality. Conclusion: By providing more health service facilities to people in risk groups, especially in rural areas, the mortality rate of COVID-19 and other diseases can be decreased.

Attitude and acceptance toward COVID-19 vaccines among Kabul city's residents: a cross sectional study

Objective: The present study aimed to assess the attitude and perception of Kabul city's residents toward COVID-19 vaccines hesitancy and acceptance. Methods: Applying a cross-sectional study design, the data was collected from 665 participants in Kabul city using a predesigned validated questionnaire. For statistical analysis, Spearman correlation, chi-square, and logistic regression techniques were used. Results: Although the vaccine availability was limited for the public during the survey period, 70.5% of the participants were willing to receive COVID-19 vaccines. Meanwhile, 49.2% participants were concerned about the COVID-19 vaccines side effects. The presence of positive COVID-19 cases among family members and friends (OR: 2.7), presence of fears during COVID-19 pandemic (OR: 4.4) and beliefs that vaccine has important and vital role in people's protection against COVID-19 (OR: 5.3), increase the likelihood of vaccine acceptance among the participants. On the other hand, participant's mistrust of the safety of COVID-19 vaccines (OR: 0.21) and disbelief on ministry of public health "MoPH" advice about COVID-19 vaccine safety and efficiency (OR: 0.27) decrease the odds of COVID-19 vaccine acceptance among the respondents. In addition, a strong correlation was found between vaccine attitude and vaccine acceptance scales (Spearman p=0.52, p<0.001). Conclusion: Although majority of the participants were willing to receive the COVID-19 vaccines, due to high level of participant's concerns about COVID-19 vaccines-related side effects, a great proportion of the respondents were hesitate to receive the COVID-19 vaccines. Accordingly, public awareness about COVID-19 vaccines must be increased to counteract incorrect and misleading propaganda about vaccination and immunization.

Factors associated with people's satisfaction with their sex life: a survey conducted in Kinshasa (Democratic Republic of Congo) during the COVID-19 pandemic

Background: COVID-19's restrictive measures have significantly affected our health, work and social relationships. As yet, less attention has been given to the changes in sex life. Aim: This study investigates people's satisfaction with sex life in Kinshasa in the Democratic Republic of Congo (DRC). Methods: A cross-sectional survey of the general population (18 years and over) was conducted, from 1st to 18th July 2020, in 17 municipalities in Kinshasa and several measures were used: Quality of life MANSA, EQ-5D-3L, UCLA Loneliness;PHQ-9;GAD-7. Prior to conducting data analysis, diagnostic tests for our data were performed to assess distribution, variance and multicollinearity. Descriptive statistics, bivariate correlation and multiple regression analysis were used. Results: Sex life satisfaction increases from young adults aged 18- 35 to those aged 36-55 and then there is a decrease from ages 56-69. After controlling for socio-demographic factors, sex life satisfaction was positively associated with the number and quality of people's friendships (B=0.30, p=0.01) and people's relationships with their families (B=0.32, p=0.03). People who feel lonely have lower sex life satisfaction (B=-0.15, p=0.01). Conclusion: People's quality of their friendships and family relationships are important for their sexual well-being. Healthcare providers and policymakers should consider people's quality of friendships and family relationships when planning to improve the sexual well-being of people in DRC.

Characterization of varieties biofortified in iron and zinc and local varieties of common bean

Iron and zinc are important minerals in humans in sub Saharan Africa, whose deficiency is known as "hidden hunger" due to the lack of recognised symptoms in the early stages. Although iron deficiency is the most prevalent, zinc is also involved in inhibition of replication of viruses, including the corona virus (COVID-19). In North Kivu and South Kivu provinces where more than 50% of common bean is produced and consumed in Democratic Republic of Congo, 36% and 47% of preschool children are anemic due to iron deficiency. This paradox is mainly due to insufficiency of iron-rich foods. The aim of this study is to characterise 59 iron and zinc biofortified varieties together with six local varieties of common bean for a potential selection programme in Butembo town in the Democratic Republic of Congo. We focused on 15 qualitative and five quantitative parameters. The qualitative parameters were helpful to distinguish the different morphotypes and for cluster analysis. In addition to the descriptive statistics, the quantitative data were used for Pearson correlation and for principal component analysis, PCA. Qualitative parameters enabled grouping of the study genotypes into 14 morphotypes according to the aspect and colour of the seed coat, the colour around the hilum and the size of seeds. Clustering grouped the 65 genotypes into 12 clusters with the most similar genotypes grouped in the same cluster. Quantitative parameters showed that the study genotypes were dissimilar (P=0.00). A positive correlation was obtained between the days to flowering and the days to maturity (P<0.05) and between the number of pods per plant and the days to flowering. A strong correlation was found between the number of pods per plant and seeds per pod (P<0.01). In contrast, a negative correlation was observed between the 100 seed weight and the number of seeds per pod. The PCA represented on two perpendicular axes showed 64.1% of the total variance of which the 42.3% is explained by the first axis and 21.8% by the second axis. Overall, the study genotypes are morphologically and quantitatively different and thus can be used in a selection programme.

COVID-19 SEIAR Model with Sensitivity Analysis

Beside the unexpected toll of mortality and morbidity caused by COVID-19 worldwide, low- and middle-income countries are more suffering from the devastating issues on economic and social life. This disease has fostered mathematical modelling. In this paper, a SEIAR mathematical model is presented to illustrate how policymakers may apply efficient strategies to end or at least to control the devastating wide spread of COVID-19. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States

Mental health needs and disparities are widespread and have been exacerbated by the COVID-19 pandemic, with the greatest burden being on marginalized individuals worldwide. The World Health Organization developed the Mental Health Gap Action Programme to address growing global mental health needs by promoting task sharing in the delivery of psychosocial and psychological interventions. However, little is known about the training needed for non-specialists to deliver these interventions with high levels of competence and fidelity. This article provides a brief conceptual overview of the evidence concerning the training of non-specialists carrying out task-sharing psychosocial and psychological interventions while utilizing illustrative case studies from Kenya, Ethiopia, and the United States to highlight findings from the literature. In this article, the authors discuss the importance of tailoring training to the skills and needs of the non-specialist providers and their roles in the delivery of an intervention. This narrative review with four case studies advocates for training that recognizes the expertise that non-specialist providers bring to intervention delivery, including how they promote culturally responsive care within their communities.Copyright © 2023 The Author(s).

Prevalence of antibiotics prescription amongst patients with and without COVID-19 in low- and middle-income countries: a systematic review and meta-analysis.

Antimicrobial resistance (AMR) poses a substantial risk to public health. In low-income and middle-income (LMICs) nations, the impact of AMR is significantly more severe. The absence of data from low-income countries (LMICs) causes this topic to be frequently overlooked. Additionally, the COVID-19 pandemic could make the AMR issue even worse. Earlier guidelines recommended antibiotic use in patients with COVID-19, even in those without bacterial coinfection. This study aims to investigate the proportion of antibiotic prescriptions in LMICs among patients with and without coronavirus disease-2019 (COVID-19), the proportion of inappropriate antibiotics, and multi-antibiotic prescribing. We followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). We retrieved data through online databases, including PubMed, Scopus, and ScienceDirect. Amongst COVID-19 patients, the meta-analytic estimate of antibiotic prescription was 0.80 (95% CI: 0.72-0.88), whereas antibiotic use among patients with non-COVID-19 infections was 0.54 (95% CI: 0.49-0.58). Half of those prescribed antibiotics (0.52, 95% CI: 0.32-0.72) are inappropriate prescriptions. In addition, we found that one-third of antibiotics prescriptions consisted of more than one antibiotic (0.32, 95% CI: 0.21-0.43). In conclusion, antibiotics are highly prescribed across LMICs, and their use is increased in patients with COVID-19. Amongst those prescriptions, inappropriate and multiple use was not uncommon. This study has several limitations, as it included two studies in an ambulatory setting, and some of the studies included in the analysis were conducted on a small scale. Nevertheless, our findings suggest that urgent action to improve prescribing practices is essential.

Harnessing technology, a step forward to become "der herr der welt" of neurosurgery

While neurosurgical advancement, both in operative and educational domains, have been rapid in the past few years, most of them were made by the countries who already have well established systems. A huge part of the world lacks such opportunities, and paradoxically they are most in need as they do not have enough learning opportunities, well-trained personnel, and available mentors for training purpose. Additionally, local field competitions leading to turf war, internal politics, red tape, and complex-ossified bureaucratic procedures also hinder the progress towards the technological advancement in these countries. The recent emergence of Covid-19 Global crisis with new recommendations for in-person activities and limitation of movement and educational activities has necessitated the implementation and development of unique tools to keep both the surgeries and education going as normally as during the pre-pandemic time. The word latest advances in management strategies and teaching methodology generally means acquisition of some new novel technology and surgical techniques. Most of them are in experimental phases and still evolving. In reality, this is a much deeper term to understand. It must include a thorough understanding of all the available techniques and application of the best ones in one's armamentarium that should lead to the best results while it is cost-effective and feasible for one's given circumstances. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Assessing vaccine safety during a pandemic: Recent experience and lessons learned for the future.

During the roll out of vaccines during a pandemic, questions regarding vaccine safety often arise. This was surely true during the SARS-CoV-2 pandemic. Different tools and capabilities exist during the pre-authorization phase and post introduction each with its strengths and limitations. Here we review the various tools and their strengths and limitations and discuss what functioned well in high income settings and the limitations that unequal vaccine safety pharmacovigilance capacity imposed upon middle and low income countries.

COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

Progressive realization of universal health coverage (UHC) requires health systems capacity to provide quality service and financial risk protection which supports access to services without financial hardship. Government health spending in low-income countries (LICs) has been low and heavily relied on external donor resources and out-of-pocket payment. This has resulted in high prevalence of catastrophic health spending or foregone care by those who cannot afford. Under fiscal constraints posed by pandemic, reforms in LICs should focus on efficiency through health resource waste reduction. Targeting the poor even with low level of health spending can make a significant health gain. Investment in primary healthcare and health workforce is the foundation for realizing UHC which cannot be postponed. Innovative tax on health hazardous products, conditional debt relief can increase fiscal space for health; while international collaboration to accelerate coronavirus disease 2019 (COVID-19) vaccine coverage can bring LICs out of acute phase of pandemic.

Schistosomiasis and soil-transmitted helminthiases: progress report, 2021

In 2021, the number of children who required PC for STH decreased for pre-SAC from 291.2 million to 260.6 million and for SAC from 732.3 million to 653.7 million (Figure 2). This change was mainly due to revision of the numbers of children who require PC for STH in India, which decreased from 103.5 to 80.7 million for pre-SAC and from 332.1 to 259.1 million for SAC. The decreases were based on impact assessment surveys conducted in the past few years, which changed the endemicity status of some districts. Globally, PC coverage of SAC increased from 47% in 2020 to 62.9% in 2021.The number of SAC reached with deworming increased almost to that before the COVID-19 pandemic (411 million in 2021, 344 million in 2020, 455.9 million in 2019), indicating that countries are recovering.

Improving the timeliness of health expenditure tracking in OECD and low-and middle-income countries

The COVID-19 pandemic has highlighted that access to timely health spending data is crucial for informed policy-making. This Health Working Paper summarises and compares the methodologies applied in around half of OECD countries to estimate public and private health spending for the most recent year (i.e. t-1) as well as the approaches taken by the OECD Secretariat to fill existing data gaps for the remaining OECD countries. For the first time, the paper also explores the feasibility of nowcasting health spending for the current year (i.e. t) and examines data sources that could be potentially useful in such an exercise. While this review should help OECD countries that do not yet have experience in estimating health spending for year t-1 to improve the timeliness in their data reporting, a special focus in this paper lies on testing the applicability of the methods in low- and middle-income countries (LMIC), using the WHO Western Pacific Region (WPRO) as an example. Generally, different data sources exist in many countries that would allow for a more timely estimation for health spending aggregates.

Smallholder views on Chinese agricultural investments in Mozambique and Tanzania in the context of VGGTs

Based on a case study in each country, this study documents the views of Mozambican and Tanzanian smallholders regarding Chinese agricultural investments and the extent to which investors abide by their legitimate land tenure rights as defined by the Voluntary Guidelines for the Responsible Governance of Tenure of Land, Forests and Fisheries in the Context of National Food Security (VGGTs). The VGGTs offer guidelines to government on how to protect the land tenure of rural communities when land is being acquired for large-scale land investments. The study also assessed the impact of the COVID-19 pandemic on smallholders. Due to COVID-19, instead of fieldwork, we conducted telephone interviews with 20 smallholders in Mozambique and 35 in Tanzania. The Mozambican case showed that even when land set aside for investors was not in dispute, smallholders still had unmet expectations, especially regarding investors' corporate social responsibility activities. In the Tanzanian case, even though the land leased by the Chinese investor had been designated as general land, it had laid fallow for a long period, and smallholders had moved back onto the land, only to be displaced in 2017. Although smallholders' views on the investment were mixed, the case underscored the need for government to assess current land use before allocating it to investors - regardless of how the land is classified and especially in areas where land shortages are creating conflict. The cases show that even if communities are consulted about proposed land investments, guidelines need to include clauses that allow for ongoing communications between investors, communities and government officials such that if communities are unsatisfied with the results of the investment, renegotiation is possible. Further, in the event of crises, such as COVID-19, investors should partner with communities and government to limit the extent of harm in communities as a result of the crisis.

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.

A retrospective evaluation of people with COVID-19 in Northwest Syria

Aim: In our study, in Northwest Syria, where healthcare is provided with humanitarian support, with investigating the demographic and clinical characteristics of people who has been detected Coronavirus disease-2019 (COVID-19), we investigated their situation in the pandemic. Materials and Methods: The demographic and clinical characteristics of people whose COVID-19 polymerase chain reaction (PCR) tests were studied and found positive in the World Health Organization supported assistance coordination unit laboratories in Northwest Syria, were retrospectively investigated. All patients except healthcare workers were included in the study between 01/05-22/12/2020. Results: 17,070 non-healthcare workers who were positive for COVID-19 PCR were included in the study. 6.368 (37.3%) of the participants were female and 10,702 (62.7%) were male. The average age of the participants was 37.7+or-16.4 years. The data obtained that there were 1.090 (6.4%) people hospitalized or undergoing isolation. When comorbid diseases were investigated, hypertension was found in 435 (2.5%), diabetes in 426 (2.5%), and heart disease in 139 (0.8%) people. When evaluated in terms of prognosis, 56% (n=9584) of the patients showed complete recovery, 41.8% (n=7141) recovered and their symptoms persist, but 345 (2%) patients died of COVID-19, including 106 of them are women (female crude death rate: 1.6%) and 239 of them are men (crude death rate: 2.23%). Conclusion: In our study, we presented a cross-sectional analysis of almost all people with COVID-19 in the last half of the 2020 by investigating the demographic and clinical characteristics of people with COVID-19 in Northwest Syria. COVID-19 diagnoses were evaluated according to the PCR test result.

Can 4C score predict mortality due to COVID-19 pneumonia in Syria? An observational study

INTRODUCTION: The aim of this study was to investigate the patients treated for COVID -19 in pandemic hospitals in northwestern Syria. METHODS: The study evaluated all patients hospitalized for COVID -19 by the pandemic emergency departments of hospitals in northwestern Syria between July 1, 2020 and December 01, 2020. Demographic, clinical, laboratory, and imaging characteristics, 4C mortality index scores treatments, and progressions of all patients hospitalized for COVID -19 were retrospectively reviewed. RESULTS: A total of 991 patients admitted to hospitals in northwestern Syria by pandemic emergency services for treatment and follow-up were included. 114 patients from Afrin Hospital, 251 from Al-Bab Hospital, 527 from Azez Vatan Hospital, and 99 from Jarablus Hospital were included in the study. When comparing the mortality and hospitalization rates of the patients according to the 4C Mortality Score, it was found that the patients with high-risk score in Azez and Jarabulus hospitals and those with very high-risk score in El Bab hospital had significantly higher mortality and hospitalization rates in the ICU (p<0.05). DISCUSSION AND CONCLUSION: The data that can be obtained from studies evaluating the approach to the COVID -19 epidemic in this and similar regions are important for the development of health services in disadvantaged regions. We believe that our study will make an important contribution to the literature, as it is the first and only data reflecting hospitalized patients with COVID -19 in this region.

Performance of the PanbioTM COVID-19 Ag rapid test in a health care setting in Ouagadougou, Burkina Faso

This study aimed to evaluate the performance of the PanbioTM Covid-19 Ag Rapid Test (Abbott) in a medical center in Ouagadougou. The PanbioTM COVID-19 Ag test was evaluated from January 26 to March 31, 2021 in symptomatic and asymptomatic patients in the medical Centre of Kossodo. A total of 268 individuals were tested by both SARS-CoV-2 RT-PCR, and antigen RDT. Of these 268 individuals, 52 were positive and 216 were negative for COVID-19 RT-PCR. The performance parameters of the test and its Kappa agreement with the RT-PCR were calculated according to the presence or absence of symptoms in the patients on one hand, and according to the time onset of symptoms on the other hand. The sensitivity of the PanbioTM COVID-19 Ag Rapid Test ranged from 29.63% (95% CI: 13.75 to 50.18) among COVID-19 asymptomatic patients, to 87.5% (95% CI: 52.91 to97.76) among symptomatic patients with symptom onset time of 1-5 days. Similarly, the PanbioTM COVID-19 Ag Rapid Test specificity was 97.3% (95% CI: 90.58 to 99.67) and 96.4% (95% CI: 91.81 to 98.82) in symptomatic and asymptomatic RT PCR negative patients. The PanbioTM COVID-19 Ag Rapid Test shows good performance in detecting COVID-19 cases in patients with a symptom onset time of less than seven (7) days. This performance is even better when the symptom onset is reduced to five (5) days. The results show that the antigen RDT is not suitable for COVID-19 detection among asymptomatic patients.