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Kabwama SN, Wanyenze RK, Razaz N, Ssenkusu JM, Alfvén T, Lindgren H. How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: a case-study of Wakiso District, Uganda. Glob Health Action 2024; 17:2314345. [PMID: 38381458 PMCID: PMC10883101 DOI: 10.1080/16549716.2024.2314345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response. METHODS This was a descriptive case study conducted in Wakiso District in central Uganda. It included 21 nurses and midwives as key informants and 32 mothers in three focus group discussions. Data were collected using an interview guide following the Systems Engineering Initiative for Patient Safety theoretical framework for service delivery. RESULTS Maternal and child health service delivery during the pandemic involved service provision without changes, service delivery with temporary changes and outcomes, and service delivery that resulted into sustained changes and outcomes. Temporary changes included patient schedule adjustments, community service delivery and negative outcomes such as increased workload and stigma against health workers. Sustained changes that strengthened service delivery included new infrastructure and supplies such as ambulances and equipment, new roles involving infection prevention and control, increased role of community health workers and outcomes such as improved workplace safety and teamwork. CONCLUSIONS In spite of the negative impact the COVID-19 pandemic had on health systems, it created the impetus to invest in system improvements. Investments such as new facility infrastructure and emergency medical services were leveraged to improve maternal and child health services delivery. The inter-departmental collaboration during the response to the COVID-19 pandemic resulted into an improved intra-hospital environment for other service delivery. However, there is a need to evaluate lessons beyond health facilities and whether these learnings are deliberately integrated into service delivery. Future responses should also address the psychological and physical impacts suffered by health workers to maintain service delivery.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Neda Razaz
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Public Health Department, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
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Amanya G, Washington ML, Kadobera D, Richard M, Ndyabakiira A, Harris J. Cost effectiveness and decision analysis for national airport screening options to reduce risk of COVID-19 introduction in Uganda, 2020. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:40. [PMID: 38735961 PMCID: PMC11089758 DOI: 10.1186/s12962-024-00548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Early during the COVID-19 outbreak, various approaches were utilized to prevent COVID-19 introductions from incoming airport travellers. However, the costs and effectiveness of airport-specific interventions have not been evaluated. METHODS We evaluated policy options for COVID-19-specific interventions at Entebbe International Airport for costs and impact on COVID-19 case counts, we took the government payer perspective. Policy options included; (1)no screening, testing, or mandatory quarantine for any incoming traveller; (2)mandatory symptom screening for all incoming travellers with RT-PCR testing only for the symptomatic and isolation of positives; and (3)mandatory 14-day quarantine and one-time testing for all, with 10-day isolation of persons testing positive. We calculated incremental cost-effectiveness ratios (ICERs) in US$ per additional case averted. RESULTS Expected costs per incoming traveller were $0 (Option 1), $19 (Option 2), and $766 (Option 3). ICERs per case averted were $257 for Option 2 (which averted 4,948 cases), and $10,139 for Option 3 (which averted 5,097 cases) compared with Option I. Two-week costs were $0 for Option 1, $1,271,431 Option 2, and $51,684,999 Option 3. The per-case ICER decreased with increase in prevalence. The cost-effectiveness of our interventions was modestly sensitive to the prevalence of COVID-19, diagnostic test sensitivity, and testing costs. CONCLUSION Screening all incoming travellers, testing symptomatic persons, and isolating positives (Option 2) was the most cost-effective option. A higher COVID-19 prevalence among incoming travellers increased cost-effectiveness of airport-specific interventions. This model could be used to evaluate prevention options at the airport for COVID-19 and other infectious diseases with similar requirements for control.
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Affiliation(s)
- Geofrey Amanya
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Michael L Washington
- Division of Preparedness and Emerging Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Migisha Richard
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Alex Ndyabakiira
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Julie Harris
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Kampala, Uganda
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Nakireka S, Mukunya D, Tumuhaise C, Olum R, Namulema E, Napyo A, Serwanja Q, Ingabire PM, Muyinda A, Bongomin F, Musaba M, Mutaki V, Nantale R, Akunguru P, Ainembabazi R, Nomujuni D, Olwit W, Nakawunde A, Nyiramugisha S, Aol PM, Rujumba J, Munabi I, Kiguli S. "I thought I was going to die": Experiences of COVID-19 patients managed at home in Uganda. PLoS One 2023; 18:e0295113. [PMID: 38085728 PMCID: PMC10715664 DOI: 10.1371/journal.pone.0295113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In Uganda, approximately 170,000 confirmed COVID-19 cases and 3,630 deaths have been reported as of January 2023. At the start of the second COVID-19 wave, the Ugandan health system was overwhelmed with a sudden increase in the number of COVID-19 patients who needed care, and the Ministry of Health resorted to home-based isolation and care for patients with mild to moderate disease. Before its rollout, the COVID-19 home-based care strategy had neither been piloted nor tested in Uganda. OBJECTIVE To explore the experiences of COVID-19 patients managed at home in Uganda. METHODS This was a qualitative study that was conducted to explore the lived experiences of COVID-19 patients managed at home. The study was carried out among patients who presented to three hospitals that were designated for treating COVID-19 patients in Uganda. COVID-19 patients diagnosed at these hospitals and managed at home were followed up and contacted for in-depth telephone interviews. The data were analysed using thematic content analysis with the aid of NVIVO 12.0.0 (QRS International, Cambridge, MA). RESULTS Participants experienced feelings of fear and anxiety: fear of death, fear of losing jobs, fear of infecting loved ones and fear of adverse events such as loss of libido. Participants also reported feelings of loneliness, hopelessness and depression on top of the debilitating and sometimes worsening symptoms. In addition to conventional medicines, participants took various kinds of home remedies and herbal concoctions to alleviate their symptoms. Furthermore, COVID-19 care resulted in a high economic burden, which persisted after the COVID-19 illness. Stigma was a major theme reported by participants. Participants recommended that COVID-19 care should include counselling before testing and during and after the illness to combat the fear and stigma associated with the diagnosis. Another recommendation was that health workers should carry out home visits to patients undergoing home-based care and that COVID-19 treatment should be free of charge. CONCLUSION COVID-19 home-based care was associated with fear, anxiety, loneliness, depression, economic loss and stigma. Policymakers should consider various home-based follow-up strategies and strengthen counselling of COVID-19 patients at all stages of care.
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Affiliation(s)
- Susan Nakireka
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
- Department of Internal Medicine, Uganda Christian University, School of Medicine, Mukono, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Crescent Tumuhaise
- Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Mpigi, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Edith Namulema
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
- Department of Internal Medicine, Uganda Christian University, School of Medicine, Mukono, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Public Health, Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | | | | | - Asad Muyinda
- Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Milton Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Vivian Mutaki
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | | | | | | | - William Olwit
- Department of Radiology, Uganda Cancer Institute, Kampala, Uganda
| | - Aisha Nakawunde
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | | | | | - Joseph Rujumba
- Department of Pediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Ian Munabi
- Department of Anatomy, School of Medicine, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
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Khazaee-Pool M, Moradi M, Pashaei T, Ponnet K. Psychosocial status and risk perception among Iranian healthcare workers during the fifth wave of the COVID-19 pandemic. HUMAN RESOURCES FOR HEALTH 2023; 21:76. [PMID: 37723512 PMCID: PMC10506218 DOI: 10.1186/s12960-023-00862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are essential resources, and their health and wellbeing are key not only for offering constant and useful care facilities to clients, but also for maintaining the safety of the workforce and patients. The risk of severe mental health problems among HCWs may have increased during large outbreaks of COVID-19. To evaluate the psychosocial status and risk perception of HCWs who participated in treating COVID-19 patients in Northern Iran, we performed a web-based cross-sectional study. METHODS The web-based cross-sectional design was applied between June 27 and September 2, 2021. Using convenience sampling, 637 HCWs were recruited from hospitals in Northern Iran (Mazandaran). The HCWs completed self-report questionnaires that included a sociodemographic information form, the 12-item General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception Questionnaire, and Anxiety Stress Scale-21. The data were analyzed via descriptive and inferential statistics and univariate/multivariate logistic regression to assess the risk factors linked to each psychosocial consequence. RESULTS The results reveal that the COVID-19 pandemic had an adverse psychosocial influence on HCWs, which was already apparent 1.5 years after the crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported having anxiety, depression, and stress symptoms, respectively, since the outbreak of this disease. The logistic regression models displayed that marital status, having children, and working hours with patients were all risk factors of psychosocial impairment. CONCLUSIONS The outbreak of COVID-19 can be considered an important experience of a bio-disaster resulting in a significant rate of psychiatric problems in HCWs. There is a need for designing and promoting supportive programs to help HCWs cope and to improve their psychosocial state, and the present study has detected for whom psychosocial support may be effective and practical 1.5 years after the primary outbreak. Moreover, detecting and managing concerns and reducing infection-related embarrassment/stigma are essential for improving HCWs' mental health.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Masoud Moradi
- Department of Biostatistics and Epidemiology, School of Health, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Nansumba H, Nambuya P, Wafula J, Laiton N, Kadam R, Akinwusi O, Suleiman K, Akugizibwe P, Ssewanyana I. Uptake and effectiveness of a mobile application for real-time reporting and quality assurance of decentralized SARS-CoV-2 testing in Uganda. Front Public Health 2023; 11:1053544. [PMID: 37325307 PMCID: PMC10267314 DOI: 10.3389/fpubh.2023.1053544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
Background Effective management of the COVID-19 pandemic required rapid expansion of diagnosis. The introduction of antigen tests presented an opportunity to decentralize testing, but raised challenges with ensuring accurate and timely reporting of testing data, which is essential to guide the response. Digital solutions can help address this challenge and provide more efficient means of monitoring and quality assurance. Methods Uganda's existing laboratory investigation form was digitized in the form of an Android-based application, eLIF, which was developed by the Central Public Health Laboratory and implemented in 11 high-volume facilities between December 2021 and May 2022. The app enabled healthcare workers to report testing data via mobile phone or tablet. Uptake of the tool was monitored through a dashboard that enabled real-time visibility into data being transmitted from sites, as well as qualitative insights from site visits and online questionnaires. Results and discussion A total of 15,351 tests were conducted at the 11 health facilities during the study period. Of these, 65% were reported through eLIF, while 12% were reported through preexisting Excel-based tools. However, 23% of tests were only captured in paper registers and not transmitted to the national database, illustrating the need for increased uptake of digital tools to ensure real-time data reporting. While data captured through eLIF were transmitted to the national database within 0-3 days (min, max), data transmitted through Excel were transmitted in within 0-37 days (min, max), and data for paper-based reporting took up to 3 months. The majority of healthcare workers interviewed in an endpoint questionnaire responded that eLIF improved timeliness of patient management, and reduced reporting time. However, some functions of the app were not successfully implemented, such as providing random selections of samples for external quality assurance and enabling seamless linkage of these data. Challenges arose from broader operational complexities, such as staff workload, frequent task-shifting and unexpected changes to facility workflows, which limited adherence to the envisioned study procedures. Ongoing improvements are needed to adjust to these realities, to strengthen the technology and support to healthcare workers using it, to optimize the impact of this digital intervention.
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Affiliation(s)
- Hellen Nansumba
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Proscovia Nambuya
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Jackson Wafula
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Namutebi Laiton
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Rigveda Kadam
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Olukunle Akinwusi
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | | | - Paula Akugizibwe
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Isaac Ssewanyana
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
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Kyagambiddwa T, Kintu TM, Miiro E, Nabalamba F, Asiimwe GS, Namutebi AM, Abeya FC, Lumori BA, Ijuka I, Muhindo RK, Mutekanga A, Musinguzi R, Natuhwera F, Ngonzi J, Nuwagira E. Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study. Infect Drug Resist 2023; 16:2923-2932. [PMID: 37197696 PMCID: PMC10184892 DOI: 10.2147/idr.s405256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
Background There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda. Methods We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation <94%, lung infiltrates >50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance. Results Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32-6.82; p = 0.009) and altered mental state (GCS <15) (HR: 6.89, 95% CI: 1.48-32.08, p = 0.014) were significant predictors of 30-day mortality. Conclusion There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.
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Affiliation(s)
- Tonny Kyagambiddwa
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Timothy Mwanje Kintu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Miiro
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Franchesca Nabalamba
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gloria Suubi Asiimwe
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Fardous C Abeya
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Boniface A Lumori
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rose K Muhindo
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Mutekanga
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Joseph Ngonzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda
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Kok MO, Terra T, Tweheyo R, van der Hoeven M, Ponce MC, van Furth MT, Rutebemberwa E. Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study. BMC Health Serv Res 2023; 23:284. [PMID: 36973681 PMCID: PMC10040915 DOI: 10.1186/s12913-023-09217-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/23/2023] [Indexed: 03/28/2023] Open
Abstract
Background At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic. Methods For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis. Results Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products. Conclusions The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.
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Affiliation(s)
- Maarten Olivier Kok
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Tosca Terra
- Healthy Entrepreneurs Foundation, Kampala, Uganda
| | - Raymond Tweheyo
- grid.11194.3c0000 0004 0620 0548Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
| | - Marinka van der Hoeven
- grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maiza Campos Ponce
- grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marceline Tutu van Furth
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Vrije Universiteit Amsterdam Infectious Diseases, Amsterdam, The Netherlands
| | - Elizeus Rutebemberwa
- grid.11194.3c0000 0004 0620 0548Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
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Olivieri-Mui B, Hoeppner SS, Tong Y, Kohrt E, Quach LT, Saylor D, Seeley J, Tsai AC, Reynolds Z, Okello S, Asiimwe S, Flavia A, Sentongo R, Tindimwebwa E, Meyer AC, Nakasujja N, Paul R, Ritchie C, Greene M, Siedner MJ. Associations of the COVID-19 pandemic with quality of life: A cross-sectional study of older-age people with and without HIV in rural Uganda. J Glob Health 2023; 13:06003. [PMID: 36655920 PMCID: PMC9850875 DOI: 10.7189/jogh.13.06003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background COVID-19-related lockdowns and other public health measures may have differentially affected the quality of life (QOL) of older people with and without human immunodeficiency virus (HIV) in rural Uganda. Methods The Quality of Life and Aging with HIV in Rural Uganda study enrolled people with and without HIV aged over 49 from October 2020 to October 2021. We collected data on COVID-19-related stressors (behavior changes, concerns, interruptions in health care, income, and food) and the participants' QOL. We used linear regression to estimate the associations between COVID-19-related stressors and QOL, adjusting for demographic characteristics, mental and physical health, and time before vs after the lockdown during the second COVID-19 wave in Uganda. Interaction between HIV and COVID-19-related stressors evaluated effect modification. Results We analyzed complete data from 562 participants. Mean age was 58 (standard deviation (SD) = 7); 265 (47%) participants were female, 386 (69%) were married, 279 (50%) had HIV, and 400 (71%) were farmers. Those making ≥5 COVID-19-related behavior changes compared to those making ≤2 had worse general QOL (estimated linear regression coefficient (b) = - 4.77; 95% confidence interval (CI) = -6.61, -2.94) and health-related QOL (b = -4.60; 95% CI = -8.69, -0.51). Having access to sufficient food after the start of the COVID-19 pandemic (b = 3.10, 95% CI = 1.54, 4.66) and being interviewed after the start of the second lockdown (b = 2.79, 95% CI = 1.30, 4.28) were associated with better general QOL. Having HIV was associated with better health-related QOL (b = 5.67, 95% CI = 2.91,8.42). HIV was not associated with, nor did it modify the association of COVID-19-related stressors with general QOL. Conclusions In the context of the COVID-19 pandemic in an HIV-endemic, low-resource setting, there was reduced QOL among older Ugandans making multiple COVID-19 related behavioral changes. Nonetheless, good QOL during the second COVID-19 wave may suggest resilience among older Ugandans.
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Affiliation(s)
- Brianne Olivieri-Mui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Susanne S Hoeppner
- College of Science and Mathematics, University of Massachusetts Boston, Boston, USA,Harvard Medical School, Boston, USA,Department of Psychiatry, Massachusetts, General Hospital, Boston, USA
| | - Yao Tong
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Emma Kohrt
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Lien T Quach
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexander C Tsai
- Harvard Medical School, Boston, USA,Department of Psychiatry, Massachusetts, General Hospital, Boston, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Zahra Reynolds
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Samson Okello
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA,Mbarara University of Science and Technology
| | - Stephen Asiimwe
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA,Mbarara University of Science and Technology,Kabwohe Clinical Research Centre, Kabwohe Town, Uganda
| | | | | | | | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri-St Louis, St. Louis, USA
| | - Christine Ritchie
- Harvard Medical School, Boston, USA,Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA,Center for Aging and Serious Illness, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, USA,Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA,Mbarara University of Science and Technology
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Olal E, Mukunya D, Oloya JN, Baguma S, Okot C, Alema NO, Acullu D, Ochula DO, Atim PO, Odong PO, Okot GS, Pebolo FP, Oyat FWD, Ikoona EN, Aloyo J, Kitara DL. Prevalence and Factors Associated With Compliance With COVID-19 Presidential Lockdown Measures: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231201258. [PMID: 37803931 PMCID: PMC10559722 DOI: 10.1177/00469580231201258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is one of the most severe global health uncertainties to date. Although significant global effort has been put into implementing COVID-19 pandemic control measures such as lockdowns, travel restrictions, and hygiene precautions, the transmission is expected to resurface once these efforts are discontinued. We aimed to determine the prevalence and factors associated with compliance with presidential 53-day lockdown measures in June-July 2021 in northern Uganda. In this cross-sectional study, 587 adult participants (≥18 years old) from northern Uganda were selected using a systematic sampling method. Data collection involved interviewer-administered questionnaires with an internal validity of Cronbach's α = .72. Socio-demographic characteristics of participants were described, and multivariable modified Poisson regressions were performed to assess prevalence ratios between dependent and selected independent variables, with respective P values at 95% confidence intervals. All analyses were conducted using Stata 17.0. Participants' compliance with the presidential lockdown directives was high at 88%(95% CI: 85%-90%). Compliance with the presidential directives was more likely among participants who agreed to the lockdown measures [adjusted Prevalence Ratio, aPR = 1.28 (95% CI: 1.10-1.49; P = .001)] compared to those who did not, and more likely among those who were afraid of death from COVID-19 [aPR = 1.08 (95% CI: 1.01-1.15; P = .023)] than those who did not. However, compliance was less likely among males [aPR = 0.91 (95% CI: 0.86-0.97; P = .002)] compared to females, those aged 35 to 44 years [aPR = 0.87 (95% CI: 0.79-0.97; P = .013)] compared to those less 25 years; and unmarried [aPR = 0.89 (95% CI: 0.82-0.97; P = .011)] compared to the married. Compliance with the COVID-19 presidential lockdown measures in northern Uganda was high. The factors associated with compliance were the fear of death and agreement with presidential lockdown measures. However, compliance was less likely among males, unmarried persons, and persons aged 35 to 44. The authors recommend more community engagements, participation, sensitization, mobilization, and simultaneous application of multiple public health approaches to improve compliance and control of COVID-19.
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Affiliation(s)
- Emmanuel Olal
- Yotkom Medical Centre, Kitgum, Uganda
- Uganda Medical Association, Gulu City, Uganda
| | - David Mukunya
- Busitema University, Mbale, Uganda
- Nikao Medical Center, Kampala, Uganda
| | - Johnson Nyeko Oloya
- Uganda Medical Association, Gulu City, Uganda
- Moroto Regional Referral Hospital, Moroto, Uganda
| | - Steven Baguma
- Uganda Medical Association, Gulu City, Uganda
- Gulu Regional Referral Hospital, Gulu City, Uganda
| | - Christopher Okot
- Uganda Medical Association, Gulu City, Uganda
- Gulu Regional Referral Hospital, Gulu City, Uganda
| | | | - Denis Acullu
- Uganda Medical Association, Gulu City, Uganda
- Aga Khan Hospital, Mombasa, Kenya
| | - Denish Omoya Ochula
- Uganda Medical Association, Gulu City, Uganda
- Lamwo District Local Government, District Health Office, Padibe, Uganda
| | - Pamela Okot Atim
- Uganda Medical Association, Gulu City, Uganda
- St. Joseph’s Hospital, Kitgum District, Uganda
| | - Patrick Olwedo Odong
- Uganda Medical Association, Gulu City, Uganda
- Amuru District Local Government, District Health Office, Amuru, Uganda
| | - Godfrey Smart Okot
- Uganda Medical Association, Gulu City, Uganda
- Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda
| | | | | | | | - Judith Aloyo
- Uganda Medical Association, Gulu City, Uganda
- Rhites-N, Acholi, Gulu City, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association, Gulu City, Uganda
- Gulu University, Gulu City, Uganda
- Gulu Centre for Advanced Medical Diagnostics, Research, Trainings, and Innovations (GRUDI BIONTECH), Gulu, Uganda
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Amanya G, Elyanu P, Migisha R, Kadobera D, Ario AR, Harris JR. Individual and household risk factors for COVID-19 infection among household members of COVID-19 patients in home-based care in western Uganda, 2020. IJID REGIONS 2022; 5:183-190. [PMID: 36407852 PMCID: PMC9650255 DOI: 10.1016/j.ijregi.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate factors associated with COVID-19 among household members of patients in home-based care (HBC) in western Uganda. METHODS We conducted a case-control and cohort study. Cases were reverse transcriptase-polymerase chain reaction-confirmed SARS-CoV-2 diagnosed 1-30 November 2020 among persons in HBC in Kasese or Kabarole districts. We compared 78 case-households (≥1 secondary case) with 59 control-households (no secondary cases). The cohort included all case-household members. Data were captured by in-person questionnaire. We used bivariate regression to calculate odds and risk ratios. RESULTS Case-households were larger than control-households (mean 5.8 vs 4.3 members, P<0.0001). Having ≥1 household member per room (adjusted odds ratio (aOR)=4.5, 95% CI 2.0-9.9), symptom development (aOR=2.3, 95% CI 1.1-5.0), or interaction with primary case-patient (aOR=4.6, 95% CI 1.4-14.7) increased odds of case-household status. Households assessed for suitability for HBC reduced odds of case-household status (aOR=0.4, 95% CI=0.2-0.8). Interacting with a primary case-patient increased the risk of individual infection among household members (adjusted risk ratio=1.7, 95% CI 1.1-2.8). CONCLUSION Household and individual factors influence secondary infection risk in HBC. Decisions about HBC should be made with these in mind.
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Key Words
- ABHR, Alcohol Based Hand Rub
- AFENET, The African Field Epidemiology Network
- CDC, Centers for Diseases Control and Prevention
- COVID-19
- COVID-19, Corono Virus Disease 2019
- HBC, Home Based Care
- HH, Household
- MoH, Ministry of Health
- PEPFAR, President's Emergency Plan for AIDS Relief
- RT-PCR, Reverse Tanscription Polymerase Chain Reaction
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SES, Social Economic Status
- Screening
- TB, Tuberculosis
- Uganda
- home-based care (HBC)
- household contacts
- pandemic
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Affiliation(s)
- Geofrey Amanya
- Uganda Public Health Fellowship Program, Infectious Diseases Institute
| | | | - Richard Migisha
- National Institute of Public Health, Ministry of Health, Kampala, Uganda
| | - Daniel Kadobera
- National Institute of Public Health, Ministry of Health, Kampala, Uganda
| | - Alex Riolexus Ario
- National Institute of Public Health, Ministry of Health, Kampala, Uganda
| | - Julie R. Harris
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Kampala, Uganda
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Najjuka SM, Ngabirano TD, Balizzakiwa T, Nabadda R, Kaggwa MM, Kateete DP, Kalungi S, Beyeza-Kashesya J, Kiguli S. Health Care Workers' Perceived Self-Efficacy to Manage COVID-19 Patients in Central Uganda: A Cross-Sectional Study. Healthc Policy 2022; 15:1253-1270. [PMID: 35769499 PMCID: PMC9234180 DOI: 10.2147/rmhp.s356410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background The novel coronavirus disease 2019 (COVID-19) pandemic placed health workers at the frontline of the emergency task force response; a duty that requires professional expertise and confidence to rapidly identify and treat patients with COVID-19. This study explored perceived self-efficacy (PSE) of health care workers (HCWs) in the management of patients with COVID-19 and associated factors in central Uganda. Methods We recruited 418 HCWs from four national referral hospitals in Uganda. Multivariate linear regression analysis was utilized to determine factors associated with PSE. A p-value > 0.05 was considered statistically significant. Results Majority of the participants were female, about half were nurses/midwives, and had 10 years of work experience on average. Overall, HCWs reported moderate PSE in managing COVID-19 patients which reduced with increasing severity of the COVID-19 illness. Having a PhD, being a medical doctor, agreeing or completely agreeing that one has knowledge about COVID-19 management, and having COVID-19 management training were significantly associated with increase in one’s level of PSE. Conclusion This study highlights an unsatisfactory, moderate level of PSE among HCWs in the management of patients with COVID-19 in central Uganda. The health sector should focus on improving HCWs’ self-efficacy through continuous training of all HCWs in the clinical management of especially the severe and critically ill cases of COVID-19. Non-doctor HCWs should be given priority as they scored lower levels of PSE; yet they are the corner stone of the primary health care system and make majority of the health human resource in low- and middle-income countries. Interventions towards creating a safe working environment for HCWs through provision of adequate infection prevention and control strategies are essential in boosting HCWs confidence to manage COVID-19 patients.
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Affiliation(s)
| | - Tom Denis Ngabirano
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Rebecca Nabadda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, College of Health Sciences Makerere University, Kampala, Uganda
| | - Samuel Kalungi
- Department of Pathology, Mulago National Referral Hospital, Kampala, Uganda
| | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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12
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Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: Update of a living systematic review and meta-analysis. PLoS Med 2022; 19:e1003987. [PMID: 35617363 PMCID: PMC9135333 DOI: 10.1371/journal.pmed.1003987] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Debate about the level of asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection continues. The amount of evidence is increasing and study designs have changed over time. We updated a living systematic review to address 3 questions: (1) Among people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) What is the infectiousness of asymptomatic and presymptomatic, compared with symptomatic, SARS-CoV-2 infection? (3) What proportion of SARS-CoV-2 transmission in a population is accounted for by people who are asymptomatic or presymptomatic? METHODS AND FINDINGS The protocol was first published on 1 April 2020 and last updated on 18 June 2021. We searched PubMed, Embase, bioRxiv, and medRxiv, aggregated in a database of SARS-CoV-2 literature, most recently on 6 July 2021. Studies of people with PCR-diagnosed SARS-CoV-2, which documented symptom status at the beginning and end of follow-up, or mathematical modelling studies were included. Studies restricted to people already diagnosed, of single individuals or families, or without sufficient follow-up were excluded. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with a bespoke checklist and modelling studies with a published checklist. All data syntheses were done using random effects models. Review question (1): We included 130 studies. Heterogeneity was high so we did not estimate a mean proportion of asymptomatic infections overall (interquartile range (IQR) 14% to 50%, prediction interval 2% to 90%), or in 84 studies based on screening of defined populations (IQR 20% to 65%, prediction interval 4% to 94%). In 46 studies based on contact or outbreak investigations, the summary proportion asymptomatic was 19% (95% confidence interval (CI) 15% to 25%, prediction interval 2% to 70%). (2) The secondary attack rate in contacts of people with asymptomatic infection compared with symptomatic infection was 0.32 (95% CI 0.16 to 0.64, prediction interval 0.11 to 0.95, 8 studies). (3) In 13 modelling studies fit to data, the proportion of all SARS-CoV-2 transmission from presymptomatic individuals was higher than from asymptomatic individuals. Limitations of the evidence include high heterogeneity and high risks of selection and information bias in studies that were not designed to measure persistently asymptomatic infection, and limited information about variants of concern or in people who have been vaccinated. CONCLUSIONS Based on studies published up to July 2021, most SARS-CoV-2 infections were not persistently asymptomatic, and asymptomatic infections were less infectious than symptomatic infections. Summary estimates from meta-analysis may be misleading when variability between studies is extreme and prediction intervals should be presented. Future studies should determine the asymptomatic proportion of SARS-CoV-2 infections caused by variants of concern and in people with immunity following vaccination or previous infection. Without prospective longitudinal studies with methods that minimise selection and measurement biases, further updates with the study types included in this living systematic review are unlikely to be able to provide a reliable summary estimate of the proportion of asymptomatic infections caused by SARS-CoV-2. REVIEW PROTOCOL Open Science Framework (https://osf.io/9ewys/).
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13
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Oyelade T, Alqahtani JS, Hjazi AM, Li A, Kamila A, Raya RP. Global and Regional Prevalence and Outcomes of COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7020022. [PMID: 35202217 PMCID: PMC8880028 DOI: 10.3390/tropicalmed7020022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The relationship between HIV (human immunodeficiency virus) and COVID-19 clinical outcome is uncertain, with conflicting data and hypotheses. We aimed to assess the prevalence of people living with HIV (PLWH) among COVID-19 cases and whether HIV infection affects the risk of severe COVID-19 or related death at the global and continental level. Methods: Electronic databases were systematically searched in July 2021. In total, 966 studies were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Narratives were synthesised and data pooled for the global and continental prevalence of HIV–SARS-CoV-2 coinfection. The relative risks of severity and mortality in HIV-infected COVID-19 patients were computed using a random-effect model. Risk of bias was assessed using the Newcastle–Ottawa score and Egger’s test, and presented as funnel plots. Results: In total, 43 studies were included involving 692,032 COVID-19 cases, of whom 9097 (1.3%) were PLWH. The global prevalence of PLWH among COVID-19 cases was 2% (95% CI = 1.7–2.3%), with the highest prevalence observed in sub-Saharan Africa. The relative risk (RR) of severe COVID-19 in PLWH was significant only in Africa (RR = 1.14, 95% CI = 1.05–1.24), while the relative risk of mortality was 1.5 (95% CI = 1.45–2.03) globally. The calculated global risk showed that HIV infection may be linked with increased COVID-19 death. The between-study heterogeneity was significantly high, while the risk of publication bias was not significant. Conclusions: Although there is a low prevalence of PLWH among COVID-19 cases, HIV infection may increase the severity of COVID-19 in Africa and increase the risk of death globally.
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Affiliation(s)
- Tope Oyelade
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London NW3 2PF, UK
- Correspondence: ; Tel.: +44(0)-20-7679-5203
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia;
| | - Ahmed M. Hjazi
- Centre for Haematology, Department of Inflammatory and Inflammation, College of Medicine, Imperial College London, London W12 0NN, UK;
| | - Amy Li
- Division of Surgery and Interventional Science, University College London, London NW3 2PS, UK;
| | - Ami Kamila
- Faculty of Science, Universitas ‘Aisyiyah Bandung, Bandung 40264, Indonesia; (A.K.); (R.P.R.)
| | - Reynie Purnama Raya
- Faculty of Science, Universitas ‘Aisyiyah Bandung, Bandung 40264, Indonesia; (A.K.); (R.P.R.)
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London NW3 2PF, UK
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14
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Migisha R, Ario AR, Kwesiga B, Bulage L, Kadobera D, Kabwama SN, Katana E, Ndyabakira A, Wadunde I, Byaruhanga A, Amanya G, Harris JR, Fitzmaurice AG. Risk perception and psychological state of healthcare workers in referral hospitals during the early phase of the COVID-19 pandemic, Uganda. BMC Psychol 2021; 9:195. [PMID: 34920763 PMCID: PMC8678424 DOI: 10.1186/s40359-021-00706-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
Background Safeguarding the psychological well-being of healthcare workers (HCWs) is crucial to ensuring sustainability and quality of healthcare services. During the COVID-19 pandemic, HCWs may be subject to excessive mental stress. We assessed the risk perception and immediate psychological state of HCWs early in the pandemic in referral hospitals involved in the management of COVID-19 patients in Uganda. Methods We conducted a cross-sectional survey in five referral hospitals from April 20–May 22, 2020. During this time, we distributed paper-based, self-administered questionnaires to all consenting HCWs on day shifts. The questionnaire included questions on socio-demographics, occupational behaviors, potential perceived risks, and psychological distress. We assessed risk perception towards COVID-19 using 27 concern statements with a four-point Likert scale. We defined psychological distress as a total score > 12 from the 12-item Goldberg’s General Health Questionnaire (GHQ-12). We used modified Poisson regression to identify factors associated with psychological distress. Results Among 335 HCWs who received questionnaires, 328 (98%) responded. Respondents’ mean age was 36 (range 18–59) years; 172 (52%) were male. The median duration of professional experience was eight (range 1–35) years; 208 (63%) worked more than 40 h per week; 116 (35%) were nurses, 52 (14%) doctors, 30 (9%) clinical officers, and 86 (26%) support staff. One hundred and forty-four (44%) had a GHQ-12 score > 12. The most common concerns reported included fear of infection at the workplace (81%), stigma from colleagues (79%), lack of workplace support (63%), and inadequate availability of personal protective equipment (PPE) (56%). In multivariable analysis, moderate (adjusted prevalence ratio, [aPR] = 2.2, 95% confidence interval [CI] 1.2–4.0) and high (aPR = 3.8, 95% CI 2.0–7.0) risk perception towards COVID-19 (compared with low-risk perception) were associated with psychological distress. Conclusions Forty-four percent of HCWs surveyed in hospitals treating COVID-19 patients during the early COVID-19 epidemic in Uganda reported psychological distress related to fear of infection, stigma, and inadequate PPE. Higher perceived personal risk towards COVID-19 was associated with increased psychological distress. To optimize patient care during the pandemic and future outbreaks, workplace management may consider identifying and addressing HCW concerns, ensuring sufficient PPE and training, and reducing infection-associated stigma.
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Affiliation(s)
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda.,Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | | | | | | | | | | | - Geofrey Amanya
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Julie R Harris
- COVID-19 Response International Task Force, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Arthur G Fitzmaurice
- COVID-19 Response International Task Force, US Centers for Disease Control and Prevention, Kampala, Uganda
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15
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Nshakira-Rukundo E, Whitehead A. Changing perceptions about COVID-19 risk and adherence to preventive strategies in Uganda: Evidence from an online mixed-methods survey. SCIENTIFIC AFRICAN 2021; 14:e01049. [PMID: 34805650 PMCID: PMC8592851 DOI: 10.1016/j.sciaf.2021.e01049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/18/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022] Open
Abstract
Since the COVID-19 pandemic started, countries have enacted a series of non-clinical preventive mechanisms aimed at slowing the rate of spread. However, these mechanisms can be effective only when they are correctly followed and only when individuals believe the risk of COVID-19 is high enough to warrant following them. As risk perceptions decline, individuals are more likely to relax following preventive measures and the rate of spread might increase. This study assesses the determinants of changes in perceptions of COVID-19 risk and the determinants of adherence to preventive measures in Uganda. Logistic regression results show that age, access to information and being supportive of preventive measures strongly predicts keeping higher risk perceptions and adhering to preventive actions. Qualitative results show that risk perceptions are also influenced by economic stress, citizens’ level of confidence in the government, local political climate and the extent of proliferation of misinformation about COVID-19.
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Affiliation(s)
- Emmanuel Nshakira-Rukundo
- Institute for Food and Resource Economics, University of Bonn, Nußallee 19-21, Bonn 53117, Germany.,Apata Insights, Kampala Uganda
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16
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Extent of compliance with COVID-19 prevention and control guidelines among supermarkets in Kampala Capital City and Mukono Municipality, Uganda. PLoS One 2021; 16:e0258840. [PMID: 34710126 PMCID: PMC8553093 DOI: 10.1371/journal.pone.0258840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. Methods A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. Results Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. Conclusion This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures.
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17
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Sah P, Fitzpatrick MC, Zimmer CF, Abdollahi E, Juden-Kelly L, Moghadas SM, Singer BH, Galvani AP. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A 2021; 118:e2109229118. [PMID: 34376550 PMCID: PMC8403749 DOI: 10.1073/pnas.2109229118] [Citation(s) in RCA: 247] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.
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Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Charlotte F Zimmer
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
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Nsekuye O, Rwagasore E, Muhimpundu MA, El-Khatib Z, Ntabanganyimana D, Kamayirese EN, Ruyange L, Umutoni A, Adeline AK, Ntaganira J, Nsazimana S, Omolo J. Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137018. [PMID: 34209123 PMCID: PMC8297211 DOI: 10.3390/ijerph18137018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022]
Abstract
We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was a person with laboratory confirmation of SARS-CoV-2 infection (PCR) while a contact was any person who had contact with a SARS-CoV-2 confirmed case within 72 h prior, to 14 days after symptom onset; or 14 days before collection of the laboratory-positive sample for asymptomatic cases. High risk contacts were those who had come into unprotected face-to-face contact or had been in a closed environment with a SARS-CoV-2 case for >15 min. Forty cases were reported from four clusters by 22 April 2020, accounting for 61% of locally transmitted cases within six weeks. Clusters A, B, C and D were associated with two nightclubs, one house party, and different families or households living in the same compound (multi-family dwelling). Thirty-six of the 1035 contacts tested were positive (secondary attack rate: 3.5%). Positivity rates were highest among the high-risk contacts compared to low-risk contacts (10% vs. 2.2%). Index cases in three of the clusters were imported through international travelling. Fifteen of the 40 cases (38%) were asymptomatic while 13/25 (52%) and 8/25 (32%) of symptomatic cases had a cough and fever respectively. Gatherings in closed spaces were the main early drivers of transmission. Systematic case-investigations contact tracing and testing likely contributed to the early containment of SARS-CoV-2 in Rwanda.
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Affiliation(s)
- Olivier Nsekuye
- Blood Transfusion Division, Rwanda Biomedical Center (RBC), Kigali 7162, Rwanda
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali 3286, Rwanda; (D.N.); (E.N.K.); (L.R.); (J.N.); (J.O.)
- Correspondence:
| | - Edson Rwagasore
- Public Health Surveillance and Epidemic, Rwanda Biomedical Center (RBC), Kigali 7162, Rwanda; (E.R.); (M.A.M.); (A.U.); (A.K.A.)
| | - Marie Aime Muhimpundu
- Public Health Surveillance and Epidemic, Rwanda Biomedical Center (RBC), Kigali 7162, Rwanda; (E.R.); (M.A.M.); (A.U.); (A.K.A.)
| | - Ziad El-Khatib
- Bill and Joyce Cumming Institute of Global Health, University of Global Health Equity, Kigali 6955, Rwanda;
- Department of Global Public Health, Karolinska Institutet, 17177 Solna, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada
| | - Daniel Ntabanganyimana
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali 3286, Rwanda; (D.N.); (E.N.K.); (L.R.); (J.N.); (J.O.)
| | - Eric Noël Kamayirese
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali 3286, Rwanda; (D.N.); (E.N.K.); (L.R.); (J.N.); (J.O.)
| | - Laurent Ruyange
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali 3286, Rwanda; (D.N.); (E.N.K.); (L.R.); (J.N.); (J.O.)
- Public Health Surveillance and Epidemic, Rwanda Biomedical Center (RBC), Kigali 7162, Rwanda; (E.R.); (M.A.M.); (A.U.); (A.K.A.)
| | - Angela Umutoni
- Public Health Surveillance and Epidemic, Rwanda Biomedical Center (RBC), Kigali 7162, Rwanda; (E.R.); (M.A.M.); (A.U.); (A.K.A.)
| | - Adeline Kabeja Adeline
- Public Health Surveillance and Epidemic, Rwanda Biomedical Center (RBC), Kigali 7162, Rwanda; (E.R.); (M.A.M.); (A.U.); (A.K.A.)
| | - Joseph Ntaganira
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali 3286, Rwanda; (D.N.); (E.N.K.); (L.R.); (J.N.); (J.O.)
| | | | - Jared Omolo
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali 3286, Rwanda; (D.N.); (E.N.K.); (L.R.); (J.N.); (J.O.)
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Mugisha JYT, Ssebuliba J, Nakakawa JN, Kikawa CR, Ssematimba A. Mathematical modeling of COVID-19 transmission dynamics in Uganda: Implications of complacency and early easing of lockdown. PLoS One 2021; 16:e0247456. [PMID: 33617579 PMCID: PMC7899325 DOI: 10.1371/journal.pone.0247456] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Uganda has a unique set up comprised of resource-constrained economy, social-economic challenges, politically diverse regional neighborhood and home to long-standing refuge crisis that comes from long and protracted conflicts of the great lakes. The devastation of the on-going global pandemic outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to be escalated by these circumstances with expectations of the impact of the disease being severe. MATERIALS AND METHODS In this study, we formulate a mathematical model that incorporates the currently known disease characteristics and tracks various intervention measures that the government of Uganda has implemented since the reporting of the first case in March 2020. We then evaluate these measures to understand levels of responsiveness and adherence to standard operating procedures and quantify their impact on the disease burden. Novel in this model was the unique aspect of modeling the trace-and-isolate protocol in which some of the latently infected individuals tested positive while in strict isolation centers thereby reducing their infectious period. RESULTS The study findings show that even with elimination of all imported cases at any given time it would take up to nine months to rid Uganda of the disease. The findings also show that the optimal timing of easing of lockdowns while mitigating the possibility of re-emergence of a second epidemic wave requires avoiding the scenario of releasing too-many-too-soon. It is even more worrying that enhancing contact tracing would only affect the magnitude and timing of the second wave but cannot prevent it altogether. CONCLUSION We conclude that, given the prevailing circumstances, a phased-out lifting of lockdown measures, minimization of COVID-19 transmissibility within hospital settings, elimination of recruitment of infected individuals as well as enhanced contact tracing would be key to preventing overwhelming of the healthcare system that would come with dire consequences.
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Affiliation(s)
- Joseph Y. T. Mugisha
- Department of Mathematics, College of Natural Sciences, Makerere University, Kampala, Uganda
| | - Joseph Ssebuliba
- Department of Mathematics, College of Natural Sciences, Makerere University, Kampala, Uganda
| | - Juliet N. Nakakawa
- Department of Mathematics, College of Natural Sciences, Makerere University, Kampala, Uganda
| | - Cliff R. Kikawa
- Department of Economics and Statistics, Faculty of Economics and Management Sciences, Kabale University, Kabale, Uganda
| | - Amos Ssematimba
- Department of Mathematics, Faculty of Science, Gulu University, Gulu, Uganda
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