Showing papers in "Journal of Global Health in 2020"

Knowledge, attitudes and practices of COVID-19 among income-poor households in the Philippines: A cross-sectional study.

Abstract: Background The presence of COVID-19 in low- and middle-income countries (LMICs) is raising important concerns about effective pandemic response and preparedness in the context of fragile health systems and the pervasiveness of misinformation. The objective of this study was to gain an understanding of how COVID-19 was perceived by households experiencing extreme poverty in the Philippines. Methods This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO) that runs a poverty-alleviation program called Transform targeted towards extreme low-income households. We integrated knowledge, attitudes, and practices (KAP) questions into ICM's cross-sectional program monitoring and evaluation systems from February 20 through March 13, 2020. Frequencies and proportions were calculated to describe the respondents' responses, and the Kruskal-Wallis test and binomial logistic regression were undertaken to determine the socio-demographic characteristics associated with COVID-19 KAPs. Results In total, 2224 respondents from 166 communities in rural, urban and coastal settings were surveyed. Although the survey was administered during the earlier stages of the pandemic, 94.0% of respondents had already heard of COVID-19. Traditional media sources such as television (85.5%) and radio (56.1%) were reported as the main sources of information about the virus. Coughing and sneezing were identified as a transmission route by 89.5% of respondents, while indirect hand contact was the least commonly identified transmission route, recognized by 72.6% of respondents. Handwashing was identified by 82.2% of respondents as a preventive measure against the virus, but social distancing and avoiding crowds were only identified by 32.4% and 40.6%, respectively. Handwashing was the most common preventive practice in response to COVID-19, adopted by 89.9% of respondents. A greater number of preventive measures were taken by those with more knowledge of potential transmission routes. Conclusions There is a need for targeted health education as a response strategy to COVID-19 in low-income settings, and it is important that strategies are contextually relevant. Understanding KAPs among populations experiencing extreme poverty will be important as tailored guidance for public health response and communication strategies are developed for LMICs.

The role of children in transmission of SARS-CoV-2: A rapid review.

Abstract: Background Understanding the role of children in the transmission of SARS-CoV-2 is urgently required given its policy implications in relation to the reopening of schools and intergenerational contacts.

Saving the frontline health workforce amidst the COVID-19 crisis: Challenges and recommendations.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010345 1 June 2020 • Vol. 10 No. 1 • 010345 Healthcare workers are toiling countless number of hours since the global outbreak of COVID-19 (caused by the SARS CoV-2 and also known as the novel coronavirus) which has been recently declared as a pandemic by the World Health Organisation [1]. Healthcare systems across developed and developing nations are being put to the ultimate test and are under tremendous pressure to limit the spread of the novel coronavirus and majority of this responsibility is being shouldered by frontline health care workers effortlessly putting their lives on the line in order to do so. Through this article, we attempt to highlight some of the dire challenges currently being faced by frontline health workers and propose certain recommendations to reduce the encumbrance being imposed on them in order to ensure the provision of rapid, well-equipped, efficient health care services.

Effects of underlying morbidities on the occurrence of deaths in COVID-19 patients: A systematic review and meta-analysis.

Abstract: Background: Coronavirus disease 2019 (COVID-19), the most hectic pandemic of the era, is increasing exponentially and taking thousands of lives worldwide. This study aimed to assess the prevalence of pre-existing comorbidities among COVID-19 patients and their mortality risks with each category of pre-existing comorbidity. Methods: To conduct this systematic review and meta-analysis, Medline, Web of Science, Scopus, and CINAHL databases were searched using pre-specified search strategies. Further searches were conducted using the reference list of the selected studies, renowned preprint servers (eg, medRxiv, bioRxiv, SSRN), and relevant journals' websites. Studies written in the English language included if those were conducted among COVID-19 patients with and without comorbidities and presented survivor vs non-survivor counts or hazard/odds of deaths or survivors with types of pre-existing comorbidities. Comorbidities reported in the selected studies were grouped into eight categories. The pooled likelihoods of deaths in each category were estimated using a fixed or random-effect model, based on the heterogeneity assessment. Publication bias was assessed by visual inspection of the funnel plot asymmetry and Egger's regression test. Trim and Fill method was used if there any publication bias was found. Results: A total of 41 studies included in this study comprised of 27 670 samples. The most common pre-existing comorbidities in COVID-19 patients were hypertension (39.5%), cardiovascular disease (12.4%), and diabetes (25.2%). The higher likelihood of deaths was found among COVID-19 patients who had pre-existing cardiovascular diseases (odds ratio (OR) = 3.42, 95% confidence interval (CI) = 2.86-4.09), immune and metabolic disorders (OR = 2.46, 95% CI = 2.03-2.85), respiratory diseases (OR = 1.94, 95% CI = 1.72-2.19), cerebrovascular diseases (OR = 4.12, 95% CI = 3.04-5.58), any types of cancers (OR = 2.22, 95% CI = 1.63-3.03), renal (OR = 3.02, 95% CI = 2.60-3.51), and liver diseases (OR = 2.35, 95% CI = 1.50-3.69). Conclusions: This study provides evidence that COVID-19 patients with pre-existing comorbidities had a higher likelihood of death. These findings could potentially help health care providers to sort out the most susceptible COVID-19 patients by comorbidities, take precautionary measures during hospitalization, assess susceptibility to death, and prioritize their treatment, which could potentially reduce the number of fatalities in COVID-19.

Reopening schools after the COVID-19 lockdown.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010376 1 June 2020 • Vol. 10 No. 1 • 010376 With nationwide school closures currently operating in 191 countries, the United Nations Educational, Scientific and Cultural Organization (UNESCO) has estimated that 1.6 billion (90.2%) students are currently out of primary, secondary and tertiary education (henceforth schools) as a result of the global COVID-19 lockdown [1]. These restrictions have been introduced to help maintain physical distancing and have contributed to the stabilising incidence of SARS-CoV-2 infections and resulting COVID-19 hospitalizations and deaths now being witnessed in many parts of the world. These measures have the potential however – particularly if prolonged – to result in major detrimental effects on the health and well-being of children and adolescents. In the absence of a robust evidence base on lockdown exit strategies, we consider the range of options being taken globally to reopen schools with a view to informing the formulation of national plans.

Nigeria's public health response to the COVID-19 pandemic: January to May 2020.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.020399 1 December 2020 • Vol. 10 No. 2 • 020399 1 Nigeria Centre for Disease Control, Abuja, Nigeria 2 African Field Epidemiology Network, Abuja, Nigeria 3 Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria 4 Center for Global Health, Centers for Disease Control and Prevention, FCT Abuja, Nigeria 5 School of Public Health, University of the Western Cape, Cape Town, South Africa 6 World Health Organisation, Abuja, Nigeria 7 Resolve to Save Lives Resolve to Save Lives (Vital Strategies), Abuja, Nigeria 8 World Bank, Nigeria Country Office, Abuja, Nigeria 9 Tony Blair Institute, Tony Blair Institute for Global Change, London, UK 10 George Town University Center for Global Health Practice and Impact, Abuja, Nigeria 11 Public Health England International Health Regulations (IHR) Strengthening Project, British High Commission, Abuja, Nigeria 12 Nigeria Port Health Services, Federal Ministry of Health Abuja, Nigeria 13 ECOWAS Regional Center for Disease Surveillance and Control, Abuja-Nigeria 14 Africa Centers for Disease Control and Prevention, African Union Commission, Addis Ababa Ethiopia 15 Department of Hospital Services, Federal Ministry of Health Abuja, Federal Secretariat Abuja, Nigeria 16 Lagos State Ministry of Health Ikeja, Lagos, Nigeria 17 College of Medicine, University of Lagos Teaching Hospital Lagos, Nigeria 18 Health and Human Services Secretariat Federal, Capital Territory Administration, Abuja, Nigeria 19 Kano State Ministry of Health, Kano, Nigeria 20 Ogun State Ministry of Health Abeokuta, Nigeria 21 Federal Ministry of Agriculture and Rural Development, Federal Secretariat Abuja, Nigeria 22 National Veterinary Research Institute Vom, Plateau State, Nigeria 23 Nigerian Institute of Medical Research, Lagos, Nigeria 24 Institute of Global Health, University College London, London, UK 25 Department of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK © 2020 The Author(s) JoGH © 2020 ISGH

A cascade of causes that led to the COVID-19 tragedy in Italy and in other European Union countries.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010335 1 June 2020 • Vol. 10 No. 1 • 010335 The perception of the COVID-19 pandemic in my homeland Croatia has been based on two main sources of information over the past three weeks. On the one hand, our Civil Protection Headquarters, as well as all of the experts and scientists to whom media space has been provided, called for caution, but without any panic. They emphasized that this was not a cataclysm, but an epidemic involving a serious respiratory infectious disease. The cause of this disease is the new coronavirus, for which we do not have a vaccine. Therefore, it can be expected that the disease will be very dangerous for the elderly and to those who are already ill. So, it was an unknown danger worthy of caution, but our epidemiologists remained calm. They knew that they would be able to estimate the epidemic’s development using data and then control the situation with anti-epidemic measures, and through several lines of defence [1].

Regularizing daily routines for mental health during and after the COVID-19 pandemic.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.020315 1 December 2020 • Vol. 10 No. 2 • 020315 The SARS-Cov-2 (COVID-19) pandemic, though far from concluded, has already had an enormous psychological [1] and economic [2] impact on over half of the world’s countries and regions. Everyday life can actually be seen as the fundamental context for resilience during trauma and chronic stress [3]. In response to the pandemic, different forms of lockdown, quarantine, and social/physical distancing have restricted interactions both within and across regions and countries. This has threatened basic livelihoods and mobility, reduced interpersonal interactions, and led to new workforce patterns and the suspension of schools and higher education. These changes in major life domains resemble the functional impairment consequential to mental disorders such as depression and place a large number of people at greater risk of poor mental health. In the latest published guidelines on mental health and psychological aspects of COVID-19, the World Health Organization (WHO) [4] suggests regular activities for children confined at home and new routines for vulnerable adults, including those who are older and /or with chronic health conditions. This advice is reflected in advice by Governments in the UK (PHE), the US (CDC), and elsewhere.

Early psychological impact of the 2019 coronavirus disease (COVID-19) pandemic and lockdown in a large Spanish sample.

Abstract: Background: Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD). Methods: An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21 207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors. Results: We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD = 40.9%, PMD = 51.9%, CMD = 74.4%, F = 1011.459, P < 0.001). Risk factors were female sex and classification as a case in any psychological domain. Protective factors were younger age and ability to enjoy free time. Variables related to COVID-19 had almost no impact except for having COVID-19 symptoms, which was a risk factor for anxiety in all three groups. Conclusions: Our results can help develop coping strategies addressing modifiable risk and protective factors for each mental status for early implementation in future outbreaks.

Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for COVID-19 responses.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010354 1 June 2020 • Vol. 10 No. 1 • 010354 Since the first COVID-19 case importation on January 23, Vietnam is now the only country in the world contain the epidemic with 268 confirmed cases (52 active and 216 recovered) with no deaths over the past three months. Being proactive in contact tracing and restrict quarantine of multiple clusters early are common policies that helped Vietnam efficiently control the spread of COVID-19. However, they are resource-intensive while the country has a limited capacity for massive testing. How to ensure surveillance and detection at the grassroots level, especially in rural and remote areas, is a critical question that is challenging not only Vietnam but also other lowand middleincome countries. In this viewpoint, we first summarize the roles and responsibilities of the network of village health workers over its long history of development in Vietnam. Thereafter, we discuss the functionalities of this informal taskforce in monitoring COVID-19 epidemic and delivering packages of interventions, especially in disadvantaged settings.

The COVID-19 containment in Vietnam: What are we doing?

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010338 1 June 2020 • Vol. 10 No. 1 • 010338 This viewpoint provides an explanation from the public health policies of Vietnamese government to contain the contagious disease with regard to COVID-19 pandemic. A combination of an early lockdown, increase in “virality” of the health information, encouragement in health declaration, regulation for wearing mask in the public, and country’s unity have been the effective ways to cope with this deadly virus in Vietnam, a developing country, which became the first country to halt the SARS spread successfully in 2003.

The COVID-19 outbreak in Iran.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010365 1 June 2020 • Vol. 10 No. 1 • 010365 According to the World Health Organization, as of April 21, 2020, 2 397 217 cases of coronavirus disease 2019 (COVID-19), including 162 956 deaths, have been reported worldwide [1]. The outbreak began in Iran after the detection of the first death associated with COVID-19, on Feb 19, 2020 in Qom, a holy city in central Iran. After a short period, COVID-19 has widely spread in all other provinces in Iran. As of April 21, 2020, of 330 137 tested patients, 80 868 people have been infected with COVID-19. Of them, 55 987 people have recovered, 3513 people are critically ill and 5031 people have died [2].

What is the evidence for transmission of COVID-19 by children in schools? A living systematic review.

Abstract: Background It is of paramount importance to understand the transmission of SARS-CoV-2 in schools, which could support the decision-making about educational facilities closure or re-opening with effective prevention and control measures in place. Methods We conducted a systematic review and meta-analysis to investigate the extent of SARS-CoV-2 transmission in schools. We performed risk of bias evaluation of all included studies using the Newcastle-Ottawa Scale (NOS). Results 2178 articles were retrieved and 11 studies were included. Five cohort studies reported a combined 22 student and 21 staff index cases that exposed 3345 contacts with 18 transmissions (overall infection attack rate (IAR): 0.08%, 95% confidence interval (CI) = 0.00%-0.86%). IARs for students and school staff were 0.15% (95% CI = 0.00%-0.93%) and 0.70% (95% CI = 0.00%-3.56%) respectively. Six cross-sectional studies reported 639 SARS-CoV-2 positive cases in 6682 study participants tested [overall SARS-CoV-2 positivity rate: 8.00% (95% CI = 2.17%-16.95%). SARS-CoV-2 positivity rate was estimated to be 8.74% (95% CI = 2.34%-18.53%) among students, compared to 13.68% (95% CI = 1.68%-33.89%) among school staff. Gender differences were not found for secondary infection (OR = 1.44, 95% CI = 0.50-4.14, P = 0.49) and SARS-CoV-2 positivity (OR = 0.90, 95% CI = 0.72-1.13, P = 0.36) in schools. Fever, cough, dyspnea, ageusia, anosmia, rhinitis, sore throat, headache, myalgia, asthenia, and diarrhoea were all associated with the detection of SARS-CoV-2 antibodies (based on two studies). Overall, study quality was judged to be poor with risk of performance and attrition bias, limiting the confidence in the results. Conclusions There is limited high-quality evidence available to quantify the extent of SARS-CoV-2 transmission in schools or to compare it to community transmission. Emerging evidence suggests lower IAR and SARS-CoV-2 positivity rate in students compared to school staff. Future prospective and adequately controlled cohort studies are necessary to confirm this finding.

Containing the spread of COVID-19 in Ethiopia.

Abstract: Ethiopia has a low although rising number of confirmed COVID-19 cases Despite these low figures, stringent measures have been implemented since mid-March In this viewpoint we describe the prevention and preparation measures taken in Ethiopia and comment on the consequences, challenges and strengths of the measures, keeping in mind the Ethiopian context

More effective strategies are required to strengthen public awareness of COVID-19: Evidence from Google Trends.

Abstract: Background: The outbreak of coronavirus disease 2019 (COVID-19) has posed stress on the health and well-being of both Chinese people and the public worldwide. Global public interest in this new issue largely reflects people's attention to COVID-19 and their willingness to take precautionary actions. This study aimed to examine global public awareness of COVID-19 using Google Trends. Methods: Using Google Trends, we retrieved public query data for terms of "2019-nCoV + SARS-CoV-2 + novel coronavirus + new coronavirus + COVID-19 + Corona Virus Disease 2019" between the 31st December 2019 and the 24th February 2020 in six major English-speaking countries, including the USA, the UK, Canada, Ireland, Australia, and New Zealand. Dynamic series analysis demonstrates the overall change trend of relative search volume (RSV) for the topic on COVID-19. We compared the top-ranking related queries and sub-regions distribution of RSV about COVID-19 across different countries. The correlation between daily search volumes on the topic related to COVID-19 and the daily number of people infected with SARS-CoV-2 was analyzed. Results: The overall search trend of RSV regarding COVID-19 increased during the early period of observing time and reached the first apex on 31st January 2020. A shorter response time and a longer duration of public attention to COVID-19 was observed in public from the USA, the UK, Australia, and Canada, than that in Ireland and New Zealand. A slightly positive correlation between daily RSV about COVID-19 and the daily number of confirmed cases was observed (P < 0.05). People across countries presented a various interest to the RSV on COVID-19, and public awareness of COVID-19 was different in various sub-regions within countries. Conclusions: The results suggest that public response time to COVID-19 was different across countries, and the overall duration of public attention was short. The current study reminds us that governments should strengthen the publicity of COVID-19 nationally, strengthen the public's vigilance and sensitivity to COVID-19, inform public the importance of protecting themselves with enough precautionary measures, and finally control the spread of COVID-19 globally.

Risk factors for Epstein Barr virus-associated cancers: a systematic review, critical appraisal, and mapping of the epidemiological evidence.

Abstract: Background Epstein Barr Virus (EBV) infects 90%-95% of all adults globally and causes ~ 1% of all cancers. Differing proportions of Burkitt's lymphoma (BL), gastric carcinoma (GC), Hodgkin's lymphoma (HL) and nasopharyngeal carcinoma (NPC) are associated with EBV. We sought to systematically review the global epidemiological evidence for risk factors that (in addition to EBV) contribute to the development of the EBV-associated forms of these cancers, assess the quality of the evidence, and compare and contrast the cancers. Methods MEDLINE, Embase and Web of Science were searched for studies of risk factors for EBV-associated BL, GC, HL and NPC without language or temporal restrictions. Studies were excluded if there was no cancer-free comparator group or where analyses of risk factors were inadequately documented. After screening and reference list searching, data were extracted into standardised spreadsheets and quality assessed. Due to heterogeneity, a narrative synthesis was undertaken. Results 9916 hits were retrieved. 271 papers were retained: two BL, 24 HL, one GC and 244 NPC. The majority of studies were from China, North America and Western Europe. Risk factors were categorised as dietary, environmental/non-dietary, human genetic, and infection and clinical. Anti-EBV antibody load was associated with EBV-associated GC and BL. Although the evidence could be inconsistent, HLA-A alleles, smoking, infectious mononucleosis and potentially other infections were risk factors for EBV-associated HL. Rancid dairy products; anti-EBV antibody and EBV DNA load; history of chronic ear, nose and/or throat conditions; herbal medicine use; family history; and human genetics were risk factors for NPC. Fresh fruit and vegetable and tea consumption may be protective against NPC. Conclusions Many epidemiological studies of risk factors in addition to EBV for the EBV-associated forms of BL, GC, HL and NPC have been undertaken, but there is a dearth of evidence for GC and BL. Available evidence is of variable quality. The aetiology of EBV-associated cancers likely results from a complex intersection of genetic, clinical, environmental and dietary factors, which is difficult to assess with observational studies. Large, carefully designed, studies need to be strategically undertaken to harmonise and clarify the evidence. Registration PROSPERO CRD42017059806.

COVID-19 pandemic: The African paradox.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.020348 1 December 2020 • Vol. 10 No. 2 • 020348 Since COVID-19 became a pandemic, projection models were developed for Africa, with the assumption that SARS-CoV-2 has an exponential pattern of transmission. Crowded social life and poor personal hygiene in Africa can be conducive for COVID-19 spread. However, as of July 20, 2020, only about 9691 COVID-19 deaths have been reported from African continent among a population of 1.34 billion (compared to 143 000/328.2 million in the US alone). Although the number of infected subjects increased considerably during mid-July 2020 reaching about 597223 confirmed cases, the case fatality remained remarkably low in Africa [1]. According to the WHO, COVID-19 in Africa will likely “smoulder” ie, spread from hotspots at a slow, but steady pace rather than exponentially as elsewhere worldwide (https://www.afro.who.int/news/new-who-estimates-190-000-people-could-die-COVID-19africa-if-not-controlled; last accessed July 21, 2020). Whether this paradox is due to genetics and immunity, comparatively young population, lower rates of comorbidities or just due to limited testing and late arriver of the pathogen in the continent, the low COVID-19 morbidity in African countries, with its fragile health care system, continues to puzzle experts. Herein, we outlined current concepts about potential players behind this low COVID-19 related mortality in Africa.

Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010332 1 June 2020 • Vol. 10 No. 1 • 010332 Post-hoc secondary analysis of data from our recent Edinburgh and Lothians Viral Intervention Study (ELVIS) pilot randomised controlled trial (RCT) indicates that hypertonic saline nasal irrigation and gargling (HSNIG) reduced the duration of coronavirus upper respiratory tract infection (URTI) by an average of two-and-a-half days. As such, it may offer a potentially safe, effective and scalable intervention in those with Coronavirus Disease-19 (COVID-19) following infection with the betacoronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1].

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices.

Abstract: Background In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, Results A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P Conclusions This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration Registered in ClinicalTrials.gov: NCT04344197.

Early childhood suspected developmental delay in 63 low- and middle-income countries: Large within- and between-country inequalities documented using national health surveys.

Abstract: 2Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. Background The Sustainable Development Goals call for inclusive, equitable and quality learning opportunities for all. This is especially important for children, to ensure they all develop to their full potential. We studied the prevalence and inequalities of suspected delay in child development in 63 low- and middle-income countries. Methods We used the early child development module from national health surveys, which covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track. We calculated the age-adjusted prevalence of suspected delay at the country level and stratifying by wealth, urban/rural residence, sex of the child and maternal education. We also calculated measures of absolute and relative inequality. Results We studied 330 613 children from 63 countries. Prevalence of suspected delay for the ECDI ranged from 3% in Barbados to 67% in Chad. For all countries together, 25% of the children were suspected of developmental delay. At regional level, prevalence of delay ranged from 10% in Europe and Central Asia to 42% in West and Central Africa. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large inequalities, and most markedly for the literacy-numeracy domain. Conclusions To date, our study presents the most comprehensive analysis of child development using an instrument especially developed for national health surveys. With a quarter of the children globally suspected of developmental delay, we face an immense challenge. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving these children behind.

Combination of CT and RT-PCR in the screening or diagnosis of COVID-19.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010347 1 June 2020 • Vol. 10 No. 1 • 010347 Coronavirus Disease 2019 (COVID-19), emerged in Wuhan, China, in December 2019. As of 10 March 2020, COVID-19 cases have been reported in 114 countries from all Continents except Antarctica, with accumulative 80 932 cases in China and 29 432 in other countries [1]. The transmission potential of COVID-19, determined by reproduction number (R0) of 3.28, is much higher that of severe acute respiratory syndrome (SARS) [2]. Bold measures taken by China have effectively curbed the rapid spread of this new respiratory disease source and changed the dangerous process of rapid spread of the epidemic [3]. The world is not yet ready to organize and implement the measures that have been proved to be efficient and effective by China to block or minimize the spread of new coronavirus [3]. The crude case-fatality rate (CFR) of COVID-19 is reported to be 2.3% in all patients [4], while higher to be 61.5% in critically ill patients [5]. Therefore, early screening and quarantining mild or asymptomatic cases and early diagnosis of sever patients for intensive treatment are urgent to avoid the pandemic of COVID-19.

When will the battle against novel coronavirus end in Wuhan: A SEIR modeling analysis.

Abstract: Background: Recent outbreak of 2019-nCoV in Wuhan raised serious public health concerns. By February 15, 2020 in Wuhan, the total number of confirmed infection cases has reached 37 914, and the number of deaths has reached 1123, accounting for 56.9% of the total confirmed cases and 73.7% of the total deaths in China. People are eager to know when the epidemic will be completely controlled and when people's work and life will be on the right track. Method: In this study we analyzed the epidemic dynamics and trend of 2019-nCoV in Wuhan by using the data after the closure of Wuhan city till February 12, 2020 based on the SEIR modeling method. Results: The optimal parameters were estimated as R0 = 1.44 (interquartile range: 1.40-1.47), TI = 14 (interquartile range = 14-14) and TE = 3.0 (interquartile range = 2.8-3.1). Based on these parameters, the number of infected individuals in Wuhan city may reach the peak around February 19 at about 47 000 people. Once entering March, the epidemic would gradually decline, and end around the late March. It is worth noting that the above prediction is based on the assumption that the number of susceptible population N = 200 000 will not increase. If the epidemic situation is not properly controlled, the peak of infected number can be further increased and the peak time will be a little postponed. It was expected that the epidemic would subside in early March, and disappear gradually towards the late March. Conclusions: The epidemic situation of 2019-nCoV in Wuhan was effectively controlled after the closure of the city, and the disease transmission index also decreased significantly. It is expected that the peak of epidemic situation would be reached in late February and end in March.

The operational readiness capacities of the grassroots health system in responses to epidemics: Implications for COVID-19 control in Vietnam.

Abstract: Background There is a paucity of data on the operational readiness capacities of the grassroots health system in Vietnam while it plays a vital role as a first-line defense against health emergencies, including the coronavirus disease (COVID-19). This study, therefore, aims to assess the operational readiness capacities of the grassroots health system in response to epidemics and provides implications for controlling COVID-19 in Vietnam. Methods An online cross-sectional study using the respondent-driven sampling technique was conducted with 6029 health professionals and medical students in Vietnam from December 2019 to February 2020. The operational readiness capacities of the health system were assessed by the sufficiency of health professionals, administrative and logistics staffs, equipment and facilities, and general capacity of health professionals. Kruskal-Wallis test, Fisher exact test and χ2 test were employed to identify the differences among variables. Tobit and censored regression models were operated to determine associated factors. Results The operational readiness capacities of the grassroots health system for four assessed criteria were at moderate levels, ranging from 6.3 to 6.8 over 10. In Vietnam, the grassroots health system in rural areas, in the South, and at the district level were more likely to be vulnerable compared to their counterparts. Conclusions According to empirical data, this study reveals the vulnerability of the grassroots health system in Vietnam and provides the rationality of prompt and vigorous actions of the Vietnamese Government against COVID-19. Findings also offer useful insights for effective strategies to strengthen the grassroots health system in the long term. In the short term, practicing precautionary measures and mobilizing human resources, as well as medical equipment, are needed to successfully contain COVID-19 in Vietnam.

The role of children in the transmission of SARS-CoV2: updated rapid review.

Abstract: Background: Understanding carriage and transmission potential of SARS-CoV-2 in children is of paramount importance to understand the spread of virus in school and community settings. Methods: We performed an updated rapid review to investigate the role of children in the transmission of SARS-CoV-2. We synthesized evidence for five categories and results are reported narratively. Results: A total of 33 new studies were included for this review. We did not identify additional studies that reported documented cases of SARS-CoV-2 transmission by children. We identified 15 new studies that demonstrate children's susceptibility and transmission risk of SARS-CoV-2 with evidence provided on the chance of being index or secondary cases, the potential of faecal-oral transmission, and the possibility of asymptomatic transmission. There is little data on the transmission of SARS-CoV-2 in schools. There were three studies reporting COVID-19 school outbreaks in France (Oise), Australia (New South Wales) and Israel. The remaining four studies found that all reported cases did not infect any other pupils or staff. With data from seven studies and governmental websites, the proportion of children among all confirmed COVID-19 patients was estimated for 29 countries, varying from 0.3% (lowest in Spain) up to 13.8% (highest in Argentina). Lastly, we identified seven studies reporting on PIMS-TS linked to COVID-19 among paediatric patients. Conclusions: There is somewhat limited evidence available for quantifying the extent to which children may contribute to overall transmission, but the balance of evidence so far suggests that children and schools play only a limited role in overall transmission.

Treatment delays in oncology patients during COVID-19 pandemic: A perspective.

Abstract: www.jogh.org • doi: 10.7189/jogh.10.010367 1 June 2020 • Vol. 10 No. 1 • 010367 Ever since the emergence of novel coronavirus disease 2019 (COVID-19) in Wuhan, China, it has impacted mankind globally. WHO declared it a public health emergency since March 11, 2020 [1]. A major effect of it has been seen in the health sector worldwide, due to the unpreparedness for such an event. Lockdown and social distancing, though necessary non-pharmacological measures to flatten the transmission curve, have further aggravated the interruption of health care services to the needy. Worse survival has been reported in oncology patients during the COVID crisis, due to their compromised immunity, which could be disease or anticancer treatment-related. As a considerable fraction of patients visiting the health care institute are oncology patients, interruption of health care services during the crisis might delay treatment in these patients.

Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries.

Abstract: Background The 2016 World Health Organization (WHO) guidelines for antenatal care (ANC) shift the recommended minimum number of ANC contacts from four to eight, specifying the first contact to occur within the first trimester of pregnancy. We quantify the likelihood of meeting this recommendation in 54 Countdown to 2030 priority countries and identify the characteristics of women being left behind. Methods Using 54 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) since 2012, we reported the proportion of women with timely ANC initiation and those who received 8-10 contacts by coverage levels of ANC4+ and by Sustainable Development Goal (SDG) regions. We identified demographic, socio-economic and health systems characteristics of timely ANC initiation and achievement of ANC8+. We ran four multiple regression models to quantify the associations between timing of first ANC and the number and content of ANC received. Results Overall, 49.9% of women with ANC1+ and 44.3% of all women had timely ANC initiation; 11.3% achieved ANC8+ and 11.2% received no ANC. Women with timely ANC initiation had 5.2 (95% confidence interval (CI) = 5.0-5.5) and 4.7 (95% CI = 4.4-5.0) times higher odds of receiving four and eight ANC contacts, respectively (P < 0.001), and were more likely to receive a higher content of ANC than women with delayed ANC initiation. Regionally, women in Central and Southern Asia had the best performance of timely ANC initiation; Latin America and Caribbean had the highest proportion of women achieving ANC8+. Women who did not initiate ANC in the first trimester or did not achieve 8 contacts were generally poor, single women, with low education, living in rural areas, larger households, having short birth intervals, higher parity, and not giving birth in a health facility nor with a skilled attendant. Conclusions Timely ANC initiation is likely to be a major driving force towards meeting the 2016 WHO guidelines for a positive pregnancy experience.

Tackling COVID-19: Can the African continent play the long game?

Abstract: Events have progressed with dizzying rapidity since the World Health Organization (WHO) was first alerted to cases of severe pneumonia in the Wuhan City of China on December 31st 2019. The novel SARS-CoV-2 coronavirus disease (COVID-19) was declared a pandemic on March 11th 2020. As of April 7th, a total of 1.38 million cases of COVID-19 had been diagnosed globally with over 78 000 deaths attributable to the disease [1]. Comparisons have been drawn between COVID-19 and other deadly pandemics such as the 1918 Spanish flu that infected about one-third of the world’s population, killed 40-50 million people and changed the course of history [2]. While it is premature to judge the final death toll of COVID-19, the global response to the pandemic will determine how bad it becomes.

Early epidemiological indicators, outcomes, and interventions of COVID-19 pandemic: A systematic review.

Abstract: Background: Coronavirus disease-2019 (COVID-19), a pandemic that brought the whole world to a standstill, has led to financial and health care burden. We aimed to evaluate epidemiological characteristics, needs of resources, outcomes, and global burden of the disease. Methods: Systematic review was performed searching PubMed from December 1, 2019, to March 25, 2020, for full-text observational studies that described epidemiological characteristics, following MOOSE protocol. Global data were collected from the JHU-Corona Virus Resource Center, WHO-COVID-2019 situation reports, KFF.org, and Worldometers.info until March 31, 2020. The prevalence percentages were calculated. The global data were plotted in excel to calculate case fatality rate (CFR), predicted CFR, COVID-19 specific mortality rate, and doubling time for cases and deaths. CFR was predicted using Pearson correlation, regression models, and coefficient of determination. Results: From 21 studies of 2747 patients, 8.4% of patients died, 20.4% recovered, 15.4% were admitted to ICU and 14.9% required ventilation. COVID-19 was more prevalent in patients with hypertension (19.3%), smoking (11.3%), diabetes mellitus (10%), and cardiovascular diseases (7.4%). Common complications were pneumonia (82%), cardiac complications (26.4%), acute respiratory distress syndrome (15.7%), secondary infection (11.2%), and septic shock (4.3%). Though CFR and COVID-19 specific death rates are dynamic, they were consistently high for Italy, Spain, and Iran. Polynomial growth models were best fit for all countries for predicting CFR. Though many interventions have been implemented, stern measures like nationwide lockdown and school closure occurred after very high infection rates (>10cases per 100 000population) prevailed. Given the trend of government measures and decline of new cases in China and South Korea, most countries will reach the peak between April 1-20, if interventions are followed. Conclusions: A collective approach undertaken by a responsible government, wise strategy implementation and a receptive population may help contain the spread of COVID-19 outbreak. Close monitoring of predictive models of such indicators in the highly affected countries would help to evaluate the potential fatality if the second wave of pandemic occurs. The future studies should be focused on identifying accurate indicators to mitigate the effect of underestimation or overestimation of COVID-19 burden.