Modelling COVID-19 in Senegal and China with count autoregressive models.

COVID-19 is a global health burden. We propose to model the dynamics of COVID-19 in Senegal and in China by count time series following generalized linear models. One of the main properties of these models is that they can detect potentials trends on the contagion dynamics within a given country. In particular, we fit the daily new infections in both countries by a Poisson autoregressive model and a negative binomial autoregressive model. In the case of Senegal, we include covariates in the models contrary to the Chinese case where the fitted models are without covariates. The short-term predictions of the daily new cases in both countries from both models are graphically illustrated. The results show that the predictions given by the negative binomial autoregressive model are more accurate than those given by the Poisson autoregressive model.

Impact of Infective Immigrants on COVID-19 Dynamics.

The COVID-19 epidemic is an unprecedented and major social and economic challenge worldwide due to the various restrictions. Inflow of infective immigrants have not been given prominence in several mathematical and epidemiological models. To investigate the impact of imported infection on the number of deaths, cumulative infected and cumulative asymptomatic, we formulate a mathematical model with infective immigrants and considering vaccination. The basic reproduction number of the special case of the model without immigration of infective people is derived. We varied two key factors that affect the transmission of COVID-19, namely the immigration and vaccination rates. In addition, we considered two different SARS-CoV-2 transmissibilities in order to account for new more contagious variants such as Omicron. Numerical simulations using initial conditions approximating the situation in the US when the vaccination program was starting show that increasing the vaccination rate significantly improves the outcomes regarding the number of deaths, cumulative infected and cumulative asymptomatic. Other factors are the natural recovery rates of infected and asymptomatic individuals, the waning rate of the vaccine and the vaccination rate. When the immigration rate is increased significantly, the number of deaths, cumulative infected and cumulative asymptomatic increase. Consequently, accounting for the level of inflow of infective immigrants may help health policy/decision-makers to formulate policies for public health prevention programs, especially with respect to the implementation of the stringent preventive lock down measure.

Oxytocin via Uniject (a prefilled single-use injection) versus oral misoprostol for prevention of postpartum haemorrhage at the community level: a cluster-randomised controlled trial.

BACKGROUND: Access to injectable uterotonics for management of postpartum haemorrhage remains limited in Senegal outside health facilities, and misoprostol and oxytocin delivered via Uniject have been deemed viable alternatives in community settings. We aimed to compare the efficacy of these drugs when delivered by auxiliary midwives at maternity huts. METHODS: We did an unmasked cluster-randomised controlled trial at maternity huts in three districts in Senegal. Maternity huts with auxiliary midwives located 3-21 km from the closest referral centre were randomly assigned (1:1; via a computer-generated random allocation overseen by Gynuity Health Projects) to either 600 µg oral misoprostol or 10 IU oxytocin in Uniject (intramuscular), stratified by reported previous year clinic volume (deliveries) and geographical location (inland or coastal). Maternity huts that had been included in a previous study of misoprostol for prevention of postpartum haemorrhage were excluded to prevent contamination. Pregnant women in their third trimester were screened for eligibility either during community outreach or at home-based prenatal visits. Only women delivered by the auxiliary midwives in the maternity huts were eligible for the study. Women with known allergies to prostaglandins or pregnancy complications were excluded. The primary outcome was mean change in haemoglobin concentration measured during the third trimester and after delivery. This study was registered with ClinicalTrials.gov, number NCT01713153. FINDINGS: 28 maternity hut clusters were randomly assigned-14 to the misoprostol group and 14 to the oxytocin group. Between June 6, 2012, and Sept 21, 2013, 1820 women were recruited. 647 women in the misoprostol group and 402 in the oxytocin group received study drug and had recorded pre-delivery and post-delivery haemoglobin concentrations, and overall 1412 women delivered in the study maternity huts. The mean change in haemoglobin concentrations was 3·5 g/L (SD 16·1) in the misoprostol group and 2·7 g/L (SD 17·8) in the oxytocin group. When adjusted for cluster design, the mean difference in haemoglobin decreases between groups was not significant (0·3 g/L, 95% CI -8·26 to 8·92, p=0·71). Both drugs were well tolerated. Shivering was common in the misoprostol group, and nausea in the oxytocin group. Postpartum haemorrhage was diagnosed in one woman allocated to oxytocin, who was referred and transferred to a higher-level facility for additional care, and fully recovered. No other women were transferred. INTERPRETATION: In terms of effects on haemoglobin concentrations, neither oxytocin nor misoprostol was significantly better than the other, and both drugs were safe and efficacious when delivered by auxiliary midwives. The programmatic limitations of oxytocin, including short shelf life outside the cold chain, mean that misoprostol could be more appropriate for community-level prophylaxis of postpartum haemorrhage. FUNDING: Bill & Melinda Gates Foundation.

Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change.

The vast majority of community nutrition/health programs in developing countries focus on women of reproductive age (WRA) and a few explicitly involve senior women, or grandmothers. In Senegal, as in many other places, older, experienced women play an influential role in household maternal and child health (MCH) matters. Formative research in Serer villages revealed their importance and this was taken into account in an action research nutrition education (NE) project in which grandmothers were encouraged to promote improved nutritional practices related to pregnancy (e.g. decreased work and improved diet) and infant feeding (e.g. breastfeeding and complementary feeding). A participatory communication/empowerment education approach was used involving songs, stories and group discussion. Quantitative and qualitative data were collected to both document and evaluate the intervention. Triangulation of the evaluation data suggests that 12 months after the intervention was initiated there were significant improvements in grandmothers' nutritional knowledge, in their advice to WRA, and in the nutrition-related practices of these younger women associated both with pregnancy and infant feeding. For example, in the pre-test only 20% of grandmothers stated that they advise pregnant women to decrease their workload whereas in the post-test 87% reported giving this advice. At the same time, 91% of WRA in villages with the grandmother strategy reported having decreased their workload during their last pregnancy whereas in villages with NE activities for WRA but not with grandmothers, only 34% of younger women reported having done so. These findings provide evidence of grandmothers' ability to learn, to integrate new information into their practices and to positively influence the practices of WRA. These results support the need for future MCH programs, in different cultural contexts, to involve grandmothers and in so doing to build on their intrinsic commitment to family well-being.