Public-private partnership to rapidly strengthen and scale COVID-19 response in Western Kenya.

Introduction: In Africa almost half of healthcare services are delivered through private sector providers. These are often underused in national public health responses. To support and accelerate the public sector's COVID-19 response, we facilitated recruitment of additional private sector capacity by initiating a public-private partnership (PPP) in Kisumu County, Kenya. In this manuscript we demonstrate this PPP's performance. Methods: COVID-19 diagnostic testing formed the basis for a PPP between Kenyan Medical Research Institute (KEMRI), Department of Health Kisumu County, PharmAccess Foundation, and local faith-based and private healthcare facilities: COVID-Dx. First phase COVID-Dx was implemented from June 01, 2020, to March 31, 2021 in Kisumu County, Kenya. Trained laboratory technologists in participating healthcare facilities collected nasopharyngeal and oropharyngeal samples from patients meeting the Kenyan MoH COVID-19 case definition. Healthcare workers in participating facilities collected patient clinical data using a digitized MoH COVID-19 Case Identification Form. We shared aggregated results from these data via (semi-) live dashboards with all relevant stakeholders through their mobile phones and tablets. Statistical analyses were performed using Stata 16 to inform project processes. Results: Nine private facilities participated in the project. A patient trajectory was developed from case identification to result reporting, all steps supported by a semi-real time digital dashboard. A total of 4,324 PCR tests for SARS-CoV-2 were added to the public response, identifying 425 positives, accounting for 16% of all COVID-19 tests performed in the County over the given time-period. Geo-mapped and time-tagged information on incident cases was depicted on Google maps through PowerBI-dashboards and fed back to policymakers for informed rapid decision making. Preferential COVID-19 testing was performed on health workers at risk, with 1,009 tests performed (up to 43% of all County health workforce). Conclusion: We demonstrate feasibility of rapidly increasing the public health sector COVID-19 response through coordinated private sector efforts in an African setting. Our PPP intervention in Kisumu, Kenya was based on a joint testing strategy and demonstrated that semi-real time digitalization of patient trajectories can gain significant efficiencies, linking public and private healthcare efforts, increasing transparency, support better quality health services and informing policy makers to target interventions.

Capacity assessment to secure COVID-19 waste treatment in Vietnam.

The accelerated generation of COVID-19 waste under the Delta-fuelled outbreak placed a sudden burden on waste disposal in Vietnam. To secure the treatment of COVID-19 waste amid the pandemic uncertainty, treatment capacity was assessed by determining treatment occupancy rate-the ratio of estimated demand to calculated capacity-both nationally and in Ho Chi Minh City. At the general occupancy rate for COVID-19 waste treatment of 7.4%, the country was capable of handling COVID-19 waste, with a capacity to treat 62 191 t month-1. However, Ho Chi Minh City became overwhelmed, indicated by a treatment occupancy rate of up to 780% during the Delta outbreak, as the unanticipated growth of demand for COVID-19 waste treatment caused waste to back up. The assessment results, in addition to current legislation, support collaboration in waste treatment as a solution to using existing resources to address the acute shortage of treatment capacity, so as to secure COVID-19 waste treatment. The findings could be used by other developing countries to tackle the waste problem in the pandemic era. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-022-01529-z.

Retrospective Analysis of C - Reactive Protein, Haematological Biomarkers and Coagulation Profile in Patients of SARS-Cov-2 in a Tertiary Care Hospital of Eastern India

Introduction: Blood tests play an important role in the early detection of disease given that they provide doctors with information about inflammatory processes. A complete blood count (CBC) is easy and inexpensive to perform. These parameters can be used alone as markers of inflammation. Their mutual ratio is also an indicator of early inflammation.4 In light of previous studies, the use of circulating biomarkers instead of inflammation and immune system has been considered a prognostic indicator for COVID-19 positive patients. Aims/ objective: To examines the role of biomarkers from peripheral blood samples in the diagnosis of hospitalized COVID-19 patients with a history of fever. Materials and Method: Haematological biomarkers and coagulation profile was compared between RT-PCR positive and negative patients. Systemic inflammatory index (SII) was calculated by multiplying thrombocyte count with neutrophil count and dividing the value by lymphocyte count. Neutrophil lymphocyte ratio (NLR) was calculated by dividing absolute neutrophil count by absolute lymphocyte count. Platelet lymphocyte ratio (PLR) was calculated by dividing absolute platelet by absolute lymphocyte count. Fisher exact test and unpaired t-test were used to compare categorical and continuous data respectively. Results: Analysis was done on 57 retrospective cases of RT-PCR positive patients and 61 RT-PCR negative patients with history of fever. COVID-19 positive patients showed leukopenia, neutropenia, thrombocytopenia, and lymphocytosis. SII and NLR decreased and PLR increased. PT and APTT were generally within normal limits in most of the patients. There was significant difference between two groups with respect to lymphocyte counts and PLR. Conclusion: The most standardized non-invasive and inexpensive tests such as CBC, coagulation and biochemical tests are available to assess disease severity for wise allocation of medical resources in developing countries such as India where resources and care are limited.

Characteristics, outcomes, and risk factors for in-hospital mortality of COVID-19 patients: A retrospective study in Thailand.

Introduction: Data on the characteristics and outcomes of patients hospitalized for Coronavirus Disease 2019 (COVID-19) in Thailand are limited. Objective: To determine characteristics and outcomes and identify risk factors for hospital mortality for hospitalized patients with COVID-19. Methods: We retrospectively reviewed the medical records of patients who had COVID-19 infection and were admitted to the cohort ward or ICUs at Siriraj Hospital between January 2020 and December 2021. Results: Of the 2,430 patients included in this study, 229 (9.4%) died; the mean age was 54 years, 40% were men, 81% had at least one comorbidity, and 13% required intensive care unit (ICU). Favipiravir (86%) was the main antiviral treatment. Corticosteroids and rescue anti-inflammatory therapy were used in 74 and 6%, respectively. Admission to the ICU was the only factor associated with reduced mortality [odds ratio (OR) 0.01, 95% confidence interval (CI) 0.01-0.05, P < 0.001], whereas older age (OR 14.3, 95%CI 5.76-35.54, P < 0.001), high flow nasal cannula (HFNC; OR 9.2, 95% CI 3.9-21.6, P < 0.001), mechanical ventilation (OR 269.39, 95%CI 3.6-2173.63, P < 0.001), septic shock (OR 7.79, 95%CI, 2.01-30.18, P = 0.003), and hydrocortisone treatment (OR 27.01, 95%CI 5.29-138.31, P < 0.001) were factors associated with in-hospital mortality. Conclusion: The overall mortality of hospitalized patients with COVID-19 was 9%. The only factor associated with reduced mortality was admission to the ICU. Therefore, appropriate selection of patients for admission to the ICU, strategies to limit disease progression and prevent intubation, and early detection and prompt treatment of nosocomial infection can improve survival in these patients.

Teacher Resilience During COVID-19: Comparing Teachers' Shift to Online Learning in South Africa and the United States.

The Covid-19 pandemic created the largest global disruption of education in recorded history. This unique qualitative study examined teacher resilience as they taught remotely with technology during the pandemic, and the experiences of teachers with a comparison across a developed country (US) with a developing country (South Africa). Data from a teacher resilience survey was gathered to explore factors of teacher resilience and interview data provided insight into teacher experiences. A grounded coding methodology was used to analyze the content. Within the examination of the extant literature, a Socio-Ecological Technology Integration framework (SETI) was developed and presented as a lens to conceptualize the full extent of all the socio-ecological factors involved in teacher technology integration including those in the school, district, and nationally. The findings reveal that teachers in South African reported less support and resources and greater challenges, yet overall reported themselves as more resilient than teachers in the US. From the findings, six factors emerged that impacted teachers' experiences during ERT: self-efficacy, growth, motivation, resources, support, and teacher challenges. The major challenges from both countries were: time management, student issues, isolation, anxiety, meeting student needs, technology, and student engagement.

Online interviews for qualitative health research in Africa: a scoping review.

Online interviews can be powerful tools in global health research. In this article, we review the literature on the use of and challenges associated with online interviews in health research in Africa and make recommendations for future online qualitative studies. The scoping review methodology was used. We searched on Medline and Embase in March 2022 for qualitative articles that used internet-based interviews as a data collection method. Following full-text reviews, we included nine articles. We found that online interviews were typically conducted via Microsoft Teams, Zoom, Skype, WhatsApp, Facebook Messaging and E-mail chats. Online interviews were used in Africa because of the restrictions imposed by the coronavirus disease 2019 pandemic and the need to sample participants across multiple countries or communities. Recruitment for online interviews occurred online, interviews were characterised by inaudible sounds, the inability to use video options and the challenges of including people with low income and education. We recommend that researchers critically evaluate the feasibility of online interviews within a particular African locality before fully implementing this data collection approach. Researchers may also collaborate with community-based organisations to help recruit a more socioeconomically diverse sample because of the potential of excluding participants with limited internet access.

Relations between indoor rehabilitation and basic health services in a developing country.

Background: and Introduction: Physical rehabilitation is vital for patients to regain maximum function. Approximately 80% of people with a disability live in developing countries, where they face multiple challenges in rehabilitation. The goal of the study was to conduct an analysis of indoor rehabilitation programs based on the demographics and medical conditions of the admitted patients and to relate to the available basic health and rehabilitation facilities. Methods: This was a mixed method study conducted in an inpatient rehabilitation ward of a tertiary level academic university hospital in a developing country. All admitted patients who stayed for a period of minimum two weeks were included in the study. Demographic and clinical data were obtained by means of a retrospective medical record review utilizing a standardized data extraction form. The study was further strengthened by an online literature search for the available documents for analysis, relation, and discussion. Results: Among the 1,309 admitted patients was male- female ratio was 10:7, with the majority (31.4%) cases falling between the ages of 46 and 60yrs. Rehabilitation outpatient department was the principal mode of admission (78%), and musculoskeletal and neurological conditions represented the maximum number (79.8%). Majority of patients (60.8%) were discharged home on completion of the rehabilitation program with a large number of patients who were absconded. Poor health budget allocation and lack of prioritization of the rehabilitation sector face multiple challenges, including the rehabilitation team functioning resources, space crisis for expansion which was further impacted by the COVID-19 pandemic. Conclusions: The country's current health-related rehabilitation process and socio-demographic variables have a negative relationship. There was a large number of missing data in the medical records and many patients were lost prematurely from the indoor rehabilitation program. Musculoskeletal disorders were common, and the majority of patients were discharged home once the program was completed.

Microfluidic device for detection of COVID-19 detection in hospitals and medical labs

Background: COVID-19 is the current most prominent global health problem. Rapid and accurate diagnosis of disease is one of the most important factors in eliminating the spread of the virus;developing countries are currently facing many problems related to the high cost of PCR tests for COVID-19. Purpose(s): To develop a fast, accurate and low-cost method for making a PCR test for COVID-19. Method(s): The method was based on the use of the RPA (Recombinase Polymerase Amplification) method. By making a microfluidic device including restored (RPA) Mixture and immobilised probes designed for the RPA reaction to take place inside. The experiments were conducted on 20 clinical samples, and conducted at the Faculty of Pharmacy, Tanta University. Result(s): The results were identical in approximately 90% of the samples used and results were available after 30 minutes at normal room temperature. The results were read by measuring the level of the precipitate of the RPA reaction products resulting from the interaction of the reaction mixture with the Viral RNA. Conclusion(s): This method is considered one of the fastest ways to detect COVID19 infection and it is the least expensive and can be used in developing countries and as point-of-care testing.

Universal COVID-19 pre-procedural swabs in children in a developing country: A comparison of findings over two transmission waves

Aim: The Coronavirus disease (COVID-19) pandemic has strained healthcare systems worldwide. Some institutions have implemented additional precautionary measures such as pre-procedural swabbing (PPS) to reduce transmission in patients and healthcare workers. We evaluate our experience with universal pre-procedural screening for COVID-19 in low-risk pediatric patients. Method(s): We performed a retrospective review of patients aged 18 years and below who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay swabs in our center over two waves (1st May 2020 to 31st July 2020 and 1st April 2021 to 30th June 2021). We included patients who underwent rRT-PCR for SARS-CoV-2 prior to any procedures requiring general anesthesia and were deemed low risk for COVID-19 according to our institutional screening criteria. All study patients were followed up for 14 days post-procedure. Result(s): Of 2065 swabs done for patients aged 18 years and below during the study period, 645 (31.2%) were pre-procedural swabs. Patients were aged 4.2 years (median, interquartile range: 1.6 years-9.8 years). Two patients (0.3%) tested positive for COVID-19 by PPS, detected during Period 2 - both had risk criteria which were overlooked by healthcare workers. Within 14 days post-procedure, 10 patients had unscheduled readmissions and 15 required repeat rRT-PCR, all of which were negative. Conclusion(s): In patients deemed low risk for COVID-19 infection according to our screening criteria, routine pre-procedural swabbing returns a low positive rate. Our findings can guide screening protocols at institutions that provide surgical services during the COVID-19 pandemic. Copyright © The Author(s) 2022.

Ecological aspects of online learning in higher education: a qualitative multi-level exploration in a developing country.

Using 22 undergraduate business students' online learning experiences during the COVID-19 lockdown in Pakistan (as the pandemic was the only time these students were enrolled as online students in Pakistan), this study demonstrates that online learning is a multi-level phenomenon and a practice situated within the environment. Despite online learning being a heavily researched area, research has under-examined the interaction of the Community of Inquiry (CoI) framework with the context. By adopting an ecological perspective, and by examining the interaction of micro, meso, and macro levels, this qualitative research provides useful insights into the interaction of the individual (micro-level) captured through the CoI framework, with the broader environment in which learners are located (meso and macro levels). It contributes to research on online learning broadly, and the CoI framework specifically, by revealing that each element of the CoI framework (micro-level), is influenced by macro (developing country), as well as meso (institutional policies and institutional preparedness) levels. It also spotlights the negotiated relationship between the individual and the systemic forces. The findings of this study are particularly relevant given that online education has the potential to become a norm in higher education in developing countries.