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ObjectiveOur aim was to assess Siaya county COVID-19 preparedness at community and health facility levels and measure baseline household prevalences of fever and cough. DesignThere was retrospective and prospective data collection using standard tools. We determined the prevalence of fever and cough in households. We evaluated household knowledge about COVID-19 prevention and adherence to preventive measures. We evaluated the presence of a workforce, essential infrastructure and equipment needed for COVID-19 case management, and the availability of essential maternal and child health services in health facilities. SettingSiaya in rural Western Kenya Participantshouseholds and health facilities in Siaya ResultsWe visited 19474 households and assessed 152 facilities. The prevalences of fever and cough ranged from 1.4% to 4.3% and 0.2 to 0.8% respectively; 97% and 98% of households had not received a guest from nor travelled outside Siaya respectively; 97% knew about frequent handwashing, 66% knew about keeping distance, and 80% knew about wearing a mask; 63% washed their hands countless times; 53% remained home; and 74% used a mask when out in public. The health facility assessment showed: 93.6% were dispensaries and health centers; 90.4% had nurses; 40.5% had oxygen capacity; 13.5% had pulse oximeters; and 2 ventilators were available; 94.2% of facilities did not have COVID-19 testing kits; 94% and 91% of facilities continued to provide antenatal care and immunization services respectively. Health care worker training in COVID-19 had been planned. ConclusionsHousehold prevalence of fever and cough was low suggesting Siaya had not entered the active community transmission phase in June 2020. Our assessment revealed a need for training in COVID-19 case management, and a need for basic equipment and supplies including pulse oximeters and oxygen. Future interventions should address these gaps. Strengths and limitationsO_LIThis study provides an example of how to successfully carry out an integrated rural health system baseline assessment of COVID-19 preparedness; an approach that would be useful for any country experiencing COVID-19 with a significant rural population. C_LIO_LISome of our data were retrospective in nature and therefore vulnerable to multiple sources of bias including: recall bias and misclassification. C_LI Clinical Trial registrationClinicaltrials.gov NCT04501458 5/8/2020 ProtocolThe full protocol has been accepted for publication: Kaseje N, Kaseje D, Oruenjo K, Milambo J and Kaseje M: Engaging community health workers, technology, and youth in the COVID-19 response with concurrent critical care capacity building: A protocol for an integrated community and health system intervention to reduce mortality related to COVID-19 infection in Western Kenya. Wellcome Open Research. Ethical review approvalsreceived from the University of Nairobi Ethics Review Committee and Jaramogi Oginga Odinga Teaching and Referral Hospital Ethics Review Committee (approval number IERC/JOOTR/219/20)
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BACKGROUND: Tanzania HIV/AIDS management follows WHO clinical staging which requires CD4 counts as complement. Lacking CD4 counts facilities in rural health facilities remains a challenge. Simplified and sensitive clinical staging based on local clinical patterns is useful to ensure effective care without CD4 counts. OBJECTIVES: To assess whether local HIV clinical manifestations can be used to guide HIV management in settings with limited access to CD4 counts in Tanzania. METHODS: A Cross-sectional study conducted at Tumbi and Chalinze health facilities documented clinical manifestations and CD4 counts in 360 HIV/AIDS patients. Simplified management groups comprised of severe and moderate disease were formed based on clinical manifestations and CD4 counts results. Symptoms with high frequency were used to predict severe disease. RESULTS: A Weight loss (48.3%) and chronic cough (40.8 %) were the most reported manifestations in the study population. More than 50% of patients presented with CD4≤200. Most symptoms were found to be highly sensitive (71% to 93%) in predicting severe immunosuppression using CD4<200 cut-off point as a 'Gold standard'. Chronic diarrhoea presented in 10.6%, and predicted well severe immunosuppression either alone (OR 1.95, 95%CI, 0.95-4.22) or in combination (OR 4.21, 95%CI 0.92-19.33) with other symptoms. Basing strictly on WHO clinical staging 30.8% of patients were detected to be severely immunosuppressed (Stage 4). While using our proposed management categories of severe and moderate immunosuppression 70% of patients were put into the severe immunosuppression group, consistent with CD4 cut-off count of≤350. CONCLUSIONS: HIV/AIDS clinics managing large cohorts should develop validated site specific guidelines based on local experiences. Simplified guidelines are useful for resource constrained settings without CD4 counting facilities.
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<p><b>OBJECTIVE</b>To identify Oncomelania hupensis snail habitats and areas with high transmission potential by GIS/RS.</p><p><b>METHODS</b>Marshland areas near high endemic villages of schistosomiasis in the Poyang Lake region were selected. Corresponding map was digitized and (Landsat 5 TM) image was corrected according to the digital map. The image in dry seasons was calculated by both normalized difference vegetation index (NDVI) and tasseled cap model.</p><p><b>RESULTS</b>Result showed that snails spots were distributed in class 6, 7 and 8. Farther analysis of both NDVI and tasseled cap model showed that the snail habitats were mainly distributed in the areas where NDVI value was more than 110, and in tasseled cap wetness value between -10 to 3 with correction rate 94.93%.</p><p><b>CONCLUSION</b>First step was to use unsupervised classification to define the class 6, 7 and 8 snail habitat environment. Second step was to extract the value by NDVI model, and to define a healthy vegetation as snail suspicious habitat when NDVI value was more than 110. Then the third step was to use tasseled cap wetness model to define the areas as snail habitats which value was between -10 to 3.</p>
