Reliability of Early Estimates of the Basic Reproduction Number of COVID-19: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review estimated the pooled R0 for early COVID-19 outbreaks and identified the impact of study-related factors such as methods, study location and study period on the estimated R0. METHODS: We searched electronic databases for human studies published in English between 1 December 2019 and 30 September 2020 with no restriction on country/region. Two investigators independently performed the data extraction of the studies selected for inclusion during full-text screening. The primary outcome, R0, was analysed by random-effects meta-analysis using the restricted maximum likelihood method. RESULTS: We identified 26,425 studies through our search and included 151 articles in the systematic review, among which 81 were included in the meta-analysis. The estimates of R0 from studies included in the meta-analysis ranged from 0.4 to 12.58. The pooled R0 for COVID-19 was estimated to be 2.66 (95% CI, 2.41-2.94). The results showed heterogeneity among studies and strong evidence of a small-study effect. CONCLUSIONS: The high heterogeneity in studies makes the use of the R0 for basic epidemic planning difficult and presents a huge problem for risk assessment and data synthesis. Consensus on the use of R0 for outbreak assessment is needed, and its use for assessing epidemic risk is not recommended.

Breastfeeding support through wet nursing during nutritional emergency: A cross sectional study from Rohingya refugee camps in Bangladesh.

BACKGROUND/OBJECTIVES: This study examined the best practices with regard to infant and young child feeding in emergency (IYCF-E) program. This was done by observing a breastfeeding support scenario through wet nursing in Rohingya refugee camps in Cox's Bazar, Bangladesh. METHODS: Information on demographics, IYCF-E knowledge, wet nursing support, type of constraints faced, and possible ways to overcome such constraints was collected through face-to-face interviews with 24 conveniently selected wet nurses. Linear regression was used to analyze the associations. RESULTS: Mean age of wet nurses was 21.6 years; 16.67% had adequate knowledge about IYCF-E; and 29.17% had prior knowledge about wet nursing. Mean age of supported infants was 1.29 months, and 58.33% had a familial relationship with the wet nurses. Duration of breastfeeding support was significantly associated with the wet nurse's age, age of the wet nurses' youngest children, familial relationship with infants, knowledge about IYCF-E, and follow-ups from community nutrition workers (Ps <0.05). The status of facing problems (58.33%) was negatively correlated with duration of wet nursing, although this association was not statistically significant. The most extensively reported problems were as follows: misunderstandings with the infant's family (85.71%), family workload and time limitations (21.43%), household distance (42.86%), and family members' poor compliance (21.43%). Counseling from community nutrition workers (64.29%) and mediation by community leaders (57.14%) played key roles in mitigating such problems. Self-satisfaction (37.50%), counseling (62.50%), and religious inspiration (58.33%) were key motivators behind dedicated breastfeeding support. CONCLUSION: Wet nursing in the Rohingya refugee camps in Cox's Bazaar, Bangladesh, was associated with several factors involving both supply and demand. The present findings may help design better IYCF-E programs in similar context.