The global economic burden of health anxiety/hypochondriasis- a systematic review.

BACKGROUND: Recent studies have shown a lifetime prevalence of 5.7% for health anxiety/hypochondriasis resulting in increased healthcare service utilisation and disability as consequences. To the best of our knowledge, there has been no systematic review examining the global costs of hypochondriasis, encompassing both direct and indirect costs. Our objective was to synthesize the available evidence on the economic burden of health anxiety and hypochondriasis to identify research gaps and provide guidance and insights for policymakers and future research. METHODS: A systematic literature search was conducted using PubMed, Web of Science, PsycInfo, EconLit, IBSS and Google Scholar without any time limit, up until April 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this search and the following article selection process. The included studies were systematically analysed and summarized using a predefined data extraction sheet. RESULTS: Of the 3044 articles identified; 10 publications met our inclusion criteria. The results displayed significant variance in the overall costs listed among the studies. The reported economic burden of hypochondriasis ranged from 857.19 to 21137.55 US$ per capita per year. Most of the investigated costs were direct costs, whereas the assessment of indirect costs was strongly underrepresented. CONCLUSION: This systematic review suggests that existing studies underestimate the costs of hypochondriasis due to missing information on indirect costs. Furthermore, there is no uniform data collection of the costs and definition of the disease, so that the few existing data are not comparable and difficult to evaluate. There is a need for standardised data collection and definition of hypochondriasis in future studies to identify major cost drivers as potential target point for interventions.

The COVID-19 pandemic and its prolonged impacts on food prices, food consumption and diet quality in sub-Saharan Africa

BackgroundSub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods, nutrition, and food security, with recovery slowed down by lagging vaccination progress. ObjectiveThis study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. MethodsWe conducted a repeated cross-sectional study and used a mobile platform to collect data. Data collected from round 1 (July-November, 2020) and round 2 (July-December, 2021) were considered. We assessed participants dietary intake of 20 food groups over the previous seven days. The studys primary outcome was the Prime Diet Quality Score (PDQS), with higher scores indicating better dietary quality. We used linear regression and generalized estimating equations to assess factors associated with diet quality during COVID-19. ResultsMost of the respondents were male and the mean age ({+/-}SD) was 42.4 ({+/-}12.5) years. Mean PDQS ({+/-}SD) was low at 19.1 ({+/-}3.8) before COVID-19, 18.6({+/-}3.4) in Round 1, and 19.4({+/-}3.8) in Round 2. A majority of respondents (80%) reported higher than expected prices for all food groups during the pandemic. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), older age (estimate: 30-39 years: 0.77, 95% CI: 0.35, 1.19, or 40 years or older: 0.72, 95% CI: 0.30, 1.13), and medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81) were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, - 0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) associated with lower PDQS. ConclusionDiet quality which had declined early in the pandemic had started to improve. However, consumption of healthy diets remained low, and food prices remained high. Efforts should continue to improve diet quality for sustained nutrition recovery through mitigation measures, including social protection.

Perceptions and predictors of COVID-19 vaccine hesitancy among health care providers across five countries in sub-Saharan Africa

The African continent has some of the worlds lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among health care providers (HCP) is another factor that could adversely affect efforts to control infections on the continent. We sought to understand the extent of COVID-19 vaccine hesitancy among HCP, and its contributing factors in Africa. We evaluated COVID-19 vaccine hesitancy among 1,499 HCP enrolled in a repeated cross-sectional telephone survey in Burkina Faso, Ethiopia, Nigeria, Tanzania and Ghana. We defined COVID-19 vaccine hesitancy among HCP as self-reported responses of definitely not, maybe, unsure, or undecided on whether to get the COVID-19 vaccine, compared to definitely getting the vaccine. We used Poisson regression models to evaluate factors influencing vaccine hesitancy among HCP. Approximately 65.6% were nurses and the mean age ({+/-}SD) of participants was 35.8 ({+/-}9.7) years. At least 67% of the HCP reported being vaccinated. Reasons for low COVID-19 vaccine uptake included concern about vaccine effectiveness, side effects and fear of receiving unsafe and experimental vaccines. COVID-19 vaccine hesitancy affected 45.7% of the HCP in Burkina Faso, 25.7% in Tanzania, 9.8% in Ethiopia, 9% in Ghana and 8.1% in Nigeria. Respondents reporting that COVID-19 vaccines are very effective (RR:0.21, 95% CI:0.08, 0.55), and older HCP (45 or older vs.20-29 years, RR:0.65, 95% CI: 0.44,0.95) were less likely to be vaccine-hesitant. Nurses were more likely to be vaccine-hesitant (RR 1.38, 95% CI: 1.00,1.89) compared to doctors. We found higher vaccine hesitancy among HCP in Burkina Faso and Tanzania. Information asymmetry among HCP, beliefs about vaccine effectiveness and the endorsement of vaccines by the public health institutions may be important. Efforts to address hesitancy should address information and knowledge gaps among different cadres of HCP and should be coupled with efforts to increase vaccine supply.

Levels and determinants of COVID-19 vaccine hesitancy among sub-Saharan African adolescents

COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the levels and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2803 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 15% in rural Kersa, 24% in rural Ibadan, 31% in rural Nouna, 33% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 64% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.61; 95% CI: 3.10, 4.22) and lack of effectiveness (aPR: 3.59; 95% CI: 3.09, 4.18) were associated with greater vaccine hesitancy. The levels of COVID-19 vaccine hesitancy among adolescents are alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.

Effects of Side-Effect Risk Framing Strategies on COVID-19 Vaccine Intentions in the United States and the United Kingdom: A Randomized Controlled Trial

Fear over side-effects is one of the main drivers of COVID-19 vaccine hesitancy. We conducted a pre-registered randomized controlled trial among 8998 individuals to examine the effects of different ways of framing and presenting vaccine side-effects on individuals willingness to get vaccinated. We found that adding a descriptive risk label ("very low risk") next to the numerical side-effect and providing a comparison to motor vehicle mortality increased participants willingness to take the COVID-19 vaccine by 3.0 percentage points (p = 0.003) and 2.4 percentage points (p = 0.049), respectively. These effects were independent and additive and combining both framing strategies increased willingness to receive the vaccine by 6.1 percentage points (p < 0.001). Mechanistically, we find evidence that these framing effects operate by increasing individuals perceptions of how safe the vaccine is. Our results reveal that low-cost side-effect framing strategies can meaningfully affect vaccine intentions at a population level.

COVID-19 transmission in educational institutions August to December 2020, Rhineland-Palatinate, Germany: a study of index cases and close contact cohorts

BackgroundThe lack of precise estimates on transmission risk hampers rational decisions on closure of educational institutions during the COVID-19 pandemic. MethodsSecondary attack rates (SARs) for schools and day-care centres were calculated using data from state-wide mandatory notification of SARS-CoV-2 index cases in educational institutions and information on routine contact tracing and PCR-testing. FindingsFrom August to December 2020, every sixth of overall 784 independent index cases caused a transmission in educational institutions (risk 0{middle dot}17, 95% CI 0{middle dot}14-0{middle dot}19). In a subgroup, monitoring of 14,594 institutional high-risk contacts (89% PCR-tested) of 441 index cases revealed 196 secondary cases (SAR 1{middle dot}34%, 1{middle dot}16-1{middle dot}54). Transmission was more likely from teachers than from students/children (incidence risk ratio [IRR] 3{middle dot}17, 1{middle dot}79-5{middle dot}59), and from index cases in day-care centres (IRR 3{middle dot}23, 1{middle dot}76-5{middle dot}91) than from those in secondary schools. In 748 index cases, teachers caused four times more secondary cases than children (1{middle dot}08 vs. 0{middle dot}25 secondary cases per index, IRR 4{middle dot}39, 2{middle dot}67-7{middle dot}21). This difference was mainly due to a large number of teacher-to-teacher transmissions in day-care centres (mean number of secondary cases 0.66) and a very low number of student/child-to-teacher transmissions in schools (mean number of secondary cases 0.004). InterpretationIn educational institutions, the risk of infection for contacts to a confirmed COVID-19 case is one percent, but varies depending on type of institution and index case. Hygiene measures and vaccination targeting the day-care setting and teacher-to-teacher transmission are priorities in reducing the burden of infection and may promote educational justice during the pandemic. FundingNo particular funding was received for this study. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed on Jan 27, 2021, without any language restrictions for all articles in which the title or abstract contained the search terms "COVID 19" or "corona", and "school", "education*", or "daycare", and "transmission", and "risk", "attack rate", or "SAR", and screened 175 results for original research or reviews on COVID-19 transmission risk in the educational setting. Following a similar strategy, we also searched Google Scholar, SSRN, medRxiv, and the reference lists of identified literature. We found five cohort studies on transmission risk looking at overall 171 index cases and their 6,910 contact persons in Australian, Italian, Irish, Singaporean, and German schools and reporting attack rates between 0% and 3% percent. These five studies were conducted before October 2020 and thus looked at COVID-19 transmission risk in schools before the second wave in Europe. A number of modelling studies from the first wave of COVID-19 provide inconclusive guidance to policy makers. While two publications, one from several countries and one from Switzerland, concluded that school closures contributed markedly to the reduction of SARS-CoV-2 transmission and individual mobility, two other studies, one using cross-country data and one from Japan rated school closures among the least effective measures to reduce COVID-19 incidence rates. Added value of this studyBased on a large data set that emerged from the current public health practice in Germany, which incorporates routine PCR-testing during active follow-up of asymptomatic high-risk contacts to index cases, this study provides a precise estimate of the true underlying SARS-CoV-2 transmission risk in schools and day-care centres. Its analysis also allows for a meaningful examination of differences in the risk of transmission with respect to the characteristics of the index case. We found that the individual risk of acquiring SARS-CoV-2 among high-risk contacts in the educational setting is 1.3%, but that this risk rises to 3.2% when the index case is a teacher and to 2.5% when the index case occurs in a day-care centre. Furthermore, we could show that, on average, teacher index cases produced about four times as many secondary cases as student/child index cases. Despite the relatively small proportion of teachers among index cases (20%), our study of transmission pathways revealed that the majority of all secondary cases (54%), and the overwhelming majority of secondary cases in teachers (78%) were caused by teacher index cases. Of note, most cases of teacher-to-teacher transmission (85%) occurred in day-care centres. Implications of all the available evidenceIn this setting, where preventative measures are in place and COVID-19 incidence rates were rising sharply in the population, we found a low and stable transmission risk in educational institutions over time, which provides evidence for the effectiveness of current preventative measures to control the spread of COVID-19 in schools. The identification of a substantial teacher-to-teacher transmission risk in day-care, but a clearly mitigated child/student-to-teacher transmission risk in schools, indicates the need to shift the focus to hygiene among day-care teachers, including infection prevention during staff-meetings and in break rooms. These findings also strongly support the re-prioritization of vaccination against SARS-CoV-2 to educational staff in day-care.

Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response

BackgroundSARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time to the healthcare facility. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km x 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA. MethodsWe assembled a unique dataset on healthcare facilities geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km x 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km x 1km grid using a cost-distance algorithm. Findings9.6% (95% CI: 5.2% - 16.9%) of adults aged [≥]60 years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged [≥]60 years had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged [≥]60 years with the longest travel times was 348 minutes (equal to 5.8 hours; IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (equal to 27.6 hours; IQR: 1065 - 2440 minutes) in Gabon. InterpretationOur high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases. FundingBill & Melinda Gates Foundation Research in context Evidence before this studyWe searched MEDLINE from January 1966 until May 2020 for studies with variations of the words physical access, distance, travel time, hospital, and healthcare facility in the title or abstract. To date, the only studies to systematically map physical access to healthcare facilities in sub-Saharan Africa at a high resolution examined access to emergency hospital care (with a focus on women of child-bearing age), access to care for children with fever, travel time to the nearest healthcare facility for specific populations at risk of viral haemorrhagic fevers, and travel time to the nearest regional- or district-level hospital. Added value of this studyThe added value of this study is threefold. First, we assembled a new dataset of GPS-tagged healthcare facilities, which combines two unique data sources for the geolocation of healthcare facilities across sub-Saharan Africa: one-based on crowd-sourced data from OpenStreetMap and one based on information from ministries of health, health management information systems, government statistical agencies, and international organizations. Second, this is the first study to comprehensively map both hospitals and primary healthcare facilities, and including both public- and private-sector facilities, across sub-Saharan Africa. Third, because the COVID-19 epidemic causes a far higher need for hospital services among older than younger population groups, we focus on physical access to healthcare for the population aged 60 years and older, which is a population group that is rarely studied in investigations of healthcare demand and supply in the region. As such, our maps can inform not only the health system response to COVID-19, but more generally to conditions that are common among older adults in the region, particularly chronic non-communicable diseases and their sequelae. Implications of all the available evidenceLow physical access to healthcare in sub-Saharan Africa will be a major barrier to receiving care for adults aged 60 years and older with COVID-19. However, there is a wide degree of variation in physical access to healthcare facilities for older adults in the region both between and within countries, which likely has an important bearing on the extent to which different population groups within countries are able to access care for COVID-19. Likewise, in those areas with a long travel time to the nearest healthcare facility of any type (which exist in most countries), symptomatic cases of COVID-19 are particularly unlikely to be reported to the healthcare system. Our high-resolution maps for each region and country in sub-Saharan Africa provide precise information about this geographic variation for local, national, and regional policymakers as well as non-governmental organizations.

COVID-19 and climate: global evidence from 117 countries

Visual inspection of world maps shows that coronavirus disease 2019 (COVID-19) is less prevalent in countries closer to the equator, where heat and humidity tend to be higher. Scientists disagree how to interpret this observation because the relationship between COVID-19 and climatic conditions may be confounded by many factors. We regress confirmed COVID-19 cases per million inhabitants in a country against the countrys distance from the equator, controlling key confounding factors: air travel, distance to Wuhan, testing intensity, cell phone usage, vehicle concentration, urbanization, and income. A one-degree increase in absolute latitude is associated with a 2.6% increase in cases per million inhabitants (p value < 0.001). The Northern hemisphere may see a decline in new COVID-19 cases during summer and a resurgence during winter. One Sentence SummaryAn increase in absolute latitude by one degree is associated with a 2.6% increase in COVID-19 cases per million inhabitants after controlling for several important factors.