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Ndawana E. The City of Harare's response to COVID-19: A case for international co-operation and solidarity. PHYSICS AND CHEMISTRY OF THE EARTH (2002) 2022; 128:103221. [PMID: 36059916 PMCID: PMC9420206 DOI: 10.1016/j.pce.2022.103221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/18/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
This article uses the case of the City of Harare to offer insights into how the coronavirus pandemic shaped paradiplomacy in Zimbabwe. It argues that the City of Harare's international partnerships played a nominal role in helping its response to COVID-19. There is strong evidence that the coronavirus pandemic undermined the significance of international co-operation and solidarity by African subnational governments in pursuit of their development and service delivery mandates. Better leveraging of the City of Harare's international partnerships had the potential to transform many of the challenges it faced in fighting the pandemic. The absence of a robust international dimension in the city's handling of the COVID-19 pandemic was one of the main factors that resulted in most of its responses being ineffective. The article concludes that the City of Harare's experience offers important lessons to, among others, African governments on the need to integrate decentralised responses and city-to-city co-operation into their future national disaster and economic response, recovery and resilience strategies.
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Affiliation(s)
- Enock Ndawana
- Department of Politics and International Relations, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Peace Security and Society, Faculty of Arts and Humanities, University of Zimbabwe, Harare, Zimbabwe
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Burt JF, Ouma J, Lubyayi L, Amone A, Aol L, Sekikubo M, Nakimuli A, Nakabembe E, Mboizi R, Musoke P, Kyohere M, Namara Lugolobi E, Khalil A, Le Doare K. Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda. BMJ Glob Health 2021; 6:bmjgh-2021-006102. [PMID: 34452941 PMCID: PMC8406460 DOI: 10.1136/bmjgh-2021-006102] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background COVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services. Methods An observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020). Results Between 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks. During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown. Conclusion The Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
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Affiliation(s)
- Jessica Florence Burt
- School of Medicine, University of Leeds, Leeds, UK.,Makerere University Johns Hopkins University, Kampala, Uganda
| | - Joseph Ouma
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Lawrence Lubyayi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Alexander Amone
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Lorna Aol
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Musa Sekikubo
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Annettee Nakimuli
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Eve Nakabembe
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Robert Mboizi
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Philippa Musoke
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Mary Kyohere
- Makerere University Johns Hopkins University, Kampala, Uganda
| | | | - Asma Khalil
- Infection and Immunity, St. George's, University of London, London, UK
| | - Kirsty Le Doare
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda .,Infection and Immunity, St. George's, University of London, London, UK
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Ortega E, Corcoy R, Gratacòs M, Cos Claramunt FX, Mata-Cases M, Puig-Treserra R, Real J, Vlacho B, Castelblanco E, Domingo P, Khunti K, Franch-Nadal J, Mauricio D. Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study. BMJ Open 2021; 11:e051237. [PMID: 34301668 PMCID: PMC8300551 DOI: 10.1136/bmjopen-2021-051237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIM This study's objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM). DESIGN This was a cross-sectional study. SETTINGS We used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain. OUTCOME MEASURES Multiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes. RESULTS Overall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value. CONCLUSION The results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.
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Affiliation(s)
- Emilio Ortega
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Francesc Xavier Cos Claramunt
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Innovation office, Institut Català de la Salut, Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ramon Puig-Treserra
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Esmeralda Castelblanco
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pere Domingo
- Infectious Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Institut de Recerca Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Didac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
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