The importance of community health workers as frontline responders during the COVID-19 pandemic, Somalia, 2020-2021.

Introduction: We examined the contribution of community health workers as frontline responders for the community-based surveillance in Somalia during the first year of the COVID-19 pandemic for detection of COVID-19 cases and identification of contacts. Methods: We retrieved COVID-19 surveillance data from 16 March 2020 to 31 March 2021 from the health ministry's central database. These data were collected through community health workers, health facilities or at the points of entry. We compared the number of suspected COVID-19 cases detected by the three surveillance systems and the proportion that tested positive using the chi-squared test. We used logistic regression analysis to assess association between COVID-19 infection and selected variables. Results: During the study period, 154,004 suspected cases of COVID-19 were detected and tested, of which 10,182 (6.6%) were positive. Of the notified cases, 32.7% were identified through the community-based surveillance system, 54.0% through the facility-based surveillance system, and 13.2% at points of entry. The positivity rate of cases detected by the community health workers was higher than that among those detected at health facilities (8.6% versus 6.4%; p < 0.001). The community health workers also identified more contacts than those identified through the facility-based surveillance (13,279 versus 1,937; p < 0.001). The odds of COVID-19 detection generally increased by age. Community-based surveillance and health facility-based surveillance had similar odds of detecting COVID-19 cases compared with the points-of-entry surveillance (aOR: 7.0 (95% CI: 6.4, 7.8) and aOR: 7.5 (95% CI: 6.8, 8.3), respectively). Conclusion: The community health workers proved their value as first responders to COVID-19. They can be effective in countries with weak health systems for targeted community surveillance in rural and remote areas which are not covered by the facility-based surveillance system.

Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: a stepped wedge cluster randomised trial.

INTRODUCTION: Iron deficiency is the most prevalent micronutrient deficiency in pregnancy globally responsible for nearly 120 000 maternal deaths per year and a fifth of maternal mortality. Over 46% of pregnant women in Africa and 62% of pregnant women in Kenya are anaemic. Anaemia has severe economic and health consequences. Daily iron and folic acid supplementation (IFAS) is an efficacious strategy recommended in pregnancy to reduce the risk of anaemia and improve maternal and neonatal survival. However, most pregnant women do not consume IFAS as recommended. Limited knowledge on IFAS, its benefits and its connection with anaemia, and mitigation of its side effects lead to poor consumption. The main objective of this trial is to determine the effectiveness of public health education on uptake of antenatal IFAS. METHODS AND ANALYSIS: A stepped wedge cluster randomised trial with antenatal clinics as units of randomisation. Twelve clusters will be randomised to receive the intervention and levels of IFAS uptake compared with preintervention period. The 9-month trial will enrol 1205 pregnant women. The primary outcome will be the proportion of pregnant women effectively taking up IFAS measured through self-reports, residual pill count and inspection of pill reminder cards. Routine clinical data on haemoglobin counts and fetal growth monitoring will also be used. Descriptive and bivariate analysis will be conducted in Stata using Pearson's χ2 test for association, and multivariate logistic regression to identify determinants of uptake. The potential public health benefits will be estimated using the number needed to treat and the preventable fraction. ETHICS AND DISSEMINATION: Ethical approval was granted by Kenyatta University Ethics Review Committee (PKU/2443/11575). The research permit is obtained from Kenya National Commission for Science, Technology and Innovation (NACOSTI/P/22/16168). Findings will be disseminated through peer-reviewed publications and public health conferences. TRIAL REGISTRATION NUMBER: PACTR202202775997127.

Water, Sanitation and Hygiene Situation in Kenya's Urban Slums.

Kenya has undergone rapid urbanization as people migrate to the cities in search of economic opportunities. This has given rise to informal settlements characterized by overcrowding, poor infrastructure, and inadequate social amenities. A cross-sectional study on water, sanitation, and hygiene (WASH) status was carried out in Mathare, an informal settlement in Nairobi. A random sample of 380 households was used. The average household size was five people, and 26% of the household heads had completed secondary or higher level of education. The main source of income (70%) was self-employment with 41% of the households living on less than 1.5 USD per day. The WASH situation in the urban slums is below the minimum standard recommended by the World Health Organization (WHO). There is need to improve the situation by improving and installing basic infrastructure including water, sanitation, and solid waste collection.

Community-Led Total Sanitation, Open Defecation Free Status, and Ebola Virus Disease in Lofa County, Liberia.

The Ebola virus disease (EVD) epidemic entered Liberia through Lofa County in February 2014 and spread to two health districts where the nongovernmental organization Global Communities had been implementing community-led total sanitation (CLTS) since 2012. By December 2014 the county had 928 Ebola cases (422 of them confirmed) and 648 deaths. Before the epidemic, CLTS was triggered in 155 communities, and 98 communities were certified as Open Defecation Free (ODF). Using mixed quantitative and qualitative methods, we determined that no cases of EVD were found in ODF communities and in only one CLTS community that had not reached ODF status. No differences were found between EVD and non-EVD communities in tribe, religion, ethnic group, or major sources of Ebola information. Radio was the most common source of information for all communities, but health workers were the most trusted information sources. CLTS ODF communities attributed their avoidance of EVD to Water, Sanitation, and Hygiene behaviors, especially hand washing with soap and disposal of feces that they learned from CLTS prior to the epidemic. Communities that got EVD blamed their strong initial resistance to Ebola response messages on their distrust that Ebola was real and their reliance on friends and family for advice. A strong inverse correlation between EVD and CLTS with or without ODF emerged from the regression analysis (R = -.6).

Community based health insurance schemes: lessons from rural Kenya.

BACKGROUND: Health care costs are often a hindrance to seeking health care. Community-based health care insurance schemes (CBHIS) is a suitable alternative to conventional health insurance schemes which are often beyond the budget of majority of rural residents in Africa. Following establishment of a model CBHIS in the Samburu district in northern Kenya in 1988, initial membership rose from 12 to 218 households within 18 months but dropped to below 50 households by end of the 18th year. Samburu residents are mainly semi-nomadic pastoralist people dispersed into small nomadic communities across vast stretches of difficult terrain. OBJECTIVE: The objective of the survey was to assess Samburu CBHIS and give recommendations on how to rejuvenate the scheme. DESIGN: A cross-sectional study was conducted using qualitative and quantitative methods. RESULTS: The community has a poor understanding of the mechanism of CBHIS; little trust for scheme; and believes the scheme is expensive. CONCLUSIONS: There is need to create awareness on the operations of a health insurance scheme and engage community in redesigning of the scheme.

Geophagy during pregnancy in Africa: a literature review.

INTRODUCTION: Geophagy is a form of pica characterized by craving and eating of soil. The main materials ingested include anthill soils and soft stone. In this review, our objectives were to study the prevalence of geophagy in pregnancy (GiP), establish the risk factors for GiP, assess the effects of GiP on pregnancy outcomes, and recommend possible interventions for reducing GiP. PREVALENCE: Geophagy among pregnant women is common in many cultures. In some African countries, GiP prevalence of up to 84% has been observed. In Nigeria, the most populous country in Africa, the prevalence of GiP is estimated at 50%. The practice has been associated with religious practice, culture, and famine. RISKS: It is postulated that GiP is due to micronutrient deficiencies, cultural influences, and gastrointestinal upsets. Despite their potential to supply micronutrients, soils interfere with bioavailability of micronutrients leading to micronutrient deficiency and can also act as a pathway for ingestion of geohelminths and heavy metals, putting woman and fetus at risk. GAPS: Despite its association with anemia, pregnancy, and micronutrients, many antenatal care guidelines or National guidelines on micronutrient deficiency control are silent on GiP. The guidelines generally recommend iron supplementation and deworming of pregnant women as anemia control measures. However, not all women seek antenatal services; hence, there is need for more innovative ways of addressing micronutrient deficiencies in pregnancy. RECOMMENDATIONS: It is imperative to enquire whether pregnant women are geophagous and discourage geophagy, strengthen and expand the existing supplementation programs, and mandate flour fortification to enhance population-wide iron supply and safer pregnancies. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to analyze the prevalence of GiP, identify the risk factors for GiP, and assess the effects of GiP on pregnancy outcomes. In addition to propose remedial interventions for reducing GiP.