Resilience of mental health services amidst Ebola disease outbreaks in Africa.

Introduction: Health systems including mental health (MH) systems are resilient if they protect human life and produce better health outcomes for all during disease outbreaks or epidemics like Ebola disease and their aftermaths. We explored the resilience of MH services amidst Ebola disease outbreaks in Africa; specifically, to (i) describe the pre-, during-, and post-Ebola disease outbreak MH systems in African countries that have experienced Ebola disease outbreaks, (ii) determine the prevalence of three high burden MH disorders and how those prevalences interact with Ebola disease outbreaks, and, (iii) describe the resilience of MH systems in the context of these outbreaks. Methods: This was a scoping review employing an adapted PRISMA statement. We conducted a five-step Boolean strategy with both free text and Medical Subject Headings (MeSH) to search 9 electronic databases and also searched WHO MINDbank and MH Atlas. Results: The literature search yielded 1,230 publications. Twenty-five studies were included involving 13,449 participants. By 2023, 13 African nations had encountered a total of 35 Ebola outbreak events. None of these countries had a metric recorded in MH Atlas to assess the inclusion of MH in emergency plans. The three highest-burden outbreak-associated MH disorders under the MH and Psychosocial Support (MHPSS) framework were depression, post-traumatic stress disorder (PTSD), and anxiety with prevalence ranges of 1.4-7%, 2-90%, and 1.3-88%, respectively. Furthermore, our analysis revealed a concerning lack of resilience within the MH systems, as evidenced by the absence of pre-existing metrics to gauge MH preparedness in emergency plans. Additionally, none of the studies evaluated the resilience of MH services for individuals with pre-existing needs or examined potential post-outbreak degradation in core MH services. Discussion: Our findings revealed an insufficiency of resilience, with no evaluation of services for individuals with pre-existing needs or post-outbreak degradation in core MH services. Strengthening MH resilience guided by evidence-based frameworks must be a priority to mitigate the long-term impacts of epidemics on mental well-being.

Modeling the Lassa fever outbreak synchronously occurring with cholera and COVID-19 outbreaks in Nigeria 2021: A threat to Global Health Security.

Nigeria struggles with seasonal outbreaks of Lassa fever (LF), with 70 to 100% of its states affected annually. Since 2018, the seasonal dynamics have changed with a stark increase in infections, though the pattern in 2021 differed from the other years. Nigeria had three outbreaks of Lassa Fever in 2021. In that year, Nigeria also experienced substantial burdens from COVID-19 and Cholera. There is potential that these three outbreak events interacted with each other. This may have been from community disruption and so changes in how people access the health system, how the health system responds, or overlapping biological interactions, misclassification, social factors, misinformation, and pre-existing disparities and vulnerabilities. We assessed the syndemic potential of Lassa Fever, COVID-19, and Cholera through modeling their interactions across the 2021 calendar year employing a Poisson regression model. We included the number of states affected and the month of the year. We used these predictors to forecast the progression of the outbreak using a Seasonal Autoregressive Integrated Moving Average (SARIMA) model. The Poisson model prediction for the confirmed number of Lassa fever cases was significantly dependent on the number of confirmed COVID-19 cases, the number of states affected, and the month of the year (p-value < 0.001), and the SARIMA model was a good fit, accounting for 48% of the change in the number of cases of Lassa fever (p-value < 0.001) with parameters ARIMA (6, 1, 3) (5, 0, 3). Lassa Fever, COVID-19, and Cholera 2021 case curves have mirrored dynamics and likely interact. Further research into common, intervenable aspects of those interactions should be performed.

An epidemiological synthesis of emerging and re-emerging zoonotic disease threats in Cameroon, 2000-2022: a systematic review.

Introduction: Population factors such as urbanization, socio-economic, and environmental factors are driving forces for emerging/re-emerging zoonotic diseases in Cameroon. To inform preparedness and prioritization efforts, this study mapped out epidemiological data (including prevalence) of zoonotic diseases occurring in Cameroon between 2000 and 2022 by demographic factors. Methods: Following the PRISMA guidelines, a protocol was registered in the PROSPERO database (CRD42022333059). Independent reviewers searched the PubMed, Embase, CINAHL, Cochrane, and Scopus databases on May 30, 2022 for relevant articles; duplicates were removed, and the titles, abstracts, and full texts were screened to identify eligible articles. Results: Out of 4142 articles identified, 64 eligible articles were retrieved in the database search and an additional 12 from the cited literature (N = 76). Thirty-five unique zoonoses (viral, bacterial, and parasitic) were indexed, including Cameroon priority zoonoses: anthrax, bovine tuberculosis, Ebola and Marburg virus disease, highly pathogenic avian influenza, and rabies. The number of studies varied by region, ranging from 12 in the Far North to 32 in the Centre Region. The most reported were as follows: brucellosis (random-effects pooled estimate proportion (effect size), ES 0.05%, 95% confidence interval (CI) 0.03-0.07; n = 6), dengue (ES 0.13%, 95% CI 0.06-0.22; n = 12), avian and swine influenza virus (ES 0.10%, 95% CI 0.04-0.20; n = 8), and toxoplasmosis (ES 0.49%, 95% CI 0.35-0.63; n = 11), although I 2 values were greater than 75%, thus there was high inter-study heterogeneity (P < 0.01). Conclusions: This understanding of the distribution of emerging and re-emerging zoonotic threats in Cameroon is vital to effective preventive and resource prioritization measures.