Lessons from Nigeria's Adaptation of Global Health Initiatives during the COVID-19 Pandemic

Scoping review of countries' practices missed by health emergency preparedness and response quantitative tools: COVID-19 and Ebola response experiences

Introduction

After the COVID-19 pandemic and previous disease outbreaks, it is critical to continuously examine the preparedness measurement tools and level of country preparedness for future health emergencies. Existing preparedness quantitative tools, such as the 2021 Global Health Security Index (GHSI) and Joint External Evaluation (JEE) second edition, may not fully reflect the country's actual practices during an outbreak. This scoping review profiles countries' practices, actions and experiences during Ebola and COVID-19 pandemics missed by these tools but critical to a successful response.

Methods

Using the PRISMA checklist for scoping reviews, we documented country practices during health emergence responses. Our search strategy keywords included "actions/practices," "preparedness/response," "Ebola/COVID-19," and "successes/experiences/challenges," across PubMed, Medline, CINAHL, Embase, Google Scholar and WHO IRIS. English peer-reviewed articles published between January 2004 and October 2020 for Ebola and between January 2020 and December 2022 for COVID-19 were included. Articles were independently assessed for inclusion and discordant decisions were agreed on by consensus. A qualitative thematic analysis was conducted and findings were presented by a disease outbreak.

Results

Out of 1913 studies screened, 36 were included. The COVID-19 and Ebola response practices, actions, and experiences not included in the GHSI 2021 and JEE second edition tools included; use of previous outbreaks lessons, cushioning the populations and putting in place mechanisms to support businesses, protection of vulnerable populations, leveraging the trust in leadership and role models, and innovative ways of engaging the public through use of technology.

Conclusion

Countries' outbreak response strategies depend on the available resources, the outbreak characteristics, its effects and how other countries are responding. This study suggests incorporating capacities of these response actions into existing tools and countries should make detailed plans on how they can leverage existing trust, protect the vulnerable, cushion citizens and businesses from epidemic effects, and innovatively use technology to engage the public in epidemic responses.

Why cost-effectiveness thresholds for global health donors should differ from thresholds for Ministries of Health (and why it matters)

Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision-makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.

Trends of the Global, Regional and National Incidence, Mortality, and Disability-Adjusted Life Years of Malaria, 1990-2019: An Analysis of the Global Burden of Disease Study 2019

BACKGROUND

Malaria remains a substantial concern in the realm of public health on a worldwide level. Using information from the global burden of disease (GBD) 2019 for 204 countries and territories between 1990 and 2019, we assessed the burden of malaria.

METHODS

Data on malaria were derived from the GBD 2019 study between 1990 and 2019. We evaluated the number of incidence, deaths, disability-adjusted life years (DALYs), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR), examining them across variables such as age, year, gender, country, region, and socio-demographic index (SDI).

RESULTS

The burden of malaria decreased globally between 1990 and 2019. There were 2313.57×105 incident cases and 6.43×105 deaths in 2019, contributing to 464.38×105 DALYs. Largest incident cases were observed in Western Sub-Saharan Africa [1151.72 (95% UI: 890.01-1527.17)] ×105 in 2019. The only region where deaths increased between 1990 and 2019 was Western Sub-Saharan Africa. ASRs of malaria are distributed heterogeneously in different regions. The highest ASIR was observed in Central Sub-Saharan Africa [21,557.65 (95% UI: 16,639.4-27,491.48)] in 2019. From 1990 to 2019, the ASMR of malaria declined. Compared to other age cohorts, the ASIR, ASMR, and ASDR for children aged between 1 to 4 years were found to be higher. Worst-affected regions by malaria infection were the low-middle SDI region and low SDI region.

CONCLUSION

Malaria threatens global public health, especially in Central Sub-Saharan Africa and Western Sub-Saharan Africa. Children 1-4 years old continue to bear the most significant burden of malaria. The study's results will guide efforts to reduce malaria's impact on the global population.

Impact of the COVID-19 Pandemic on Malaria Control in Africa: A Preliminary Analysis

Malaria remains a significant public health concern in Africa, and the emerging coronavirus disease 2019 (COVID-19) pandemic may have negatively impacted malaria control. Here, we conducted a descriptive epidemiological analysis of malaria globally, and preliminarily explored the impact of COVID-19 on the malaria elimination program in regions of Africa (AFR). The present analysis found that there was a vast heterogeneity of incidence of deaths caused by malaria globally in different continents, and the highest malaria burden was observed in AFR. In 2020, there was an obviously increasing trend in the malaria epidemic in AFR, while the other four continents exhibited stable and declining patterns. Historically, malaria has been largely concentrated in high-malaria-burden regions, such as West Africa, and there has been an obvious increasing trend in Nigeria. These data suggest that dynamic changes in the malaria epidemic situation worldwide have primarily originated from AFR, and West Africa has played an important role in the global malaria increase in recent years. Under the coercion of COVID-19, multiple factors have co-driven the increase in malaria in AFR, including insufficient financial investments, a high native malaria burden, weak surveillance systems, limited medical resources, and low socioeconomic development levels. In addition, the shift of medical resources (e.g., health workers and personal protective equipment (PPE), the manufacturing of diagnostic reagents, and drugs) from malaria control to emergency COVID-19 response in the pandemic's early stage caused disruptions, reductions, and delays in pillar malaria control measures, leading to a significant negative impact on malaria control. In particular, a funding shortfall at both the international and domestic levels led to a "significant threat," resulting in vast gaps in access to proven malaria control tools. Although there has been a declining trend in malaria control over time due to COVID-19, the effect still cannot be ignored. Hence, we recommend the implementation of medical and technical resource assistance as a priority strategy to support Africa (West Africa) in order to curb further transmission.