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Open accessJournal ArticleDOI: 10.1093/TRSTMH/TRAB033

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study.

05 Mar 2021-Transactions of The Royal Society of Tropical Medicine and Hygiene (Oxford University Press)-Vol. 115, Iss: 10, pp 1174-1183
Abstract: Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures.

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5 results found


Open accessJournal ArticleDOI: 10.1007/S13337-021-00708-0
25 Jun 2021-
Abstract: Control of coronavirus disease through vaccination is not merely dependent on vaccine efficacy and safety. Professional and general public acceptance is vital for the successful control of the virus. This study aimed (1) to assess health professionals' attitude towards COVID-19 vaccine acceptance; (2) to identify factors associated with health professional’s attitude towards COVID-19 vaccine acceptance. An Institutional based cross-sectional study was conducted on health professionals working at Debre Tabor Comprehensive Specialized Hospital. A structured questionnaire containing 16 items was used to assess the attitude of health professionals on vaccine acceptance. Bivariable and multivariable logistic analysis was done to identify factors associated with the attitude of health professionals. In this study, 42.3% [95% CI (36.7–47.6)] participants had positive attitude to COVID-19 vaccine acceptance. Age 30–39 years [AOR 2.23; (CI 1.23–4.04)] and ≥ 40 years [AOR 5.51; (CI 2.47–12.30)] of respondents have positive attitude than their counterparts. Also physicians [AOR 3.67; (CI 1.90–7.09)], pharmacists [AOR 4.27; (CI 1.39–13.09)] and laboratory professionals [AOR 4.56; (CI 1.34–15.39)] have higher attitude to COVID vaccine acceptance than nurses. In conclusion, the attitude level of health professionals on COVID-19 vaccine acceptance was poor. Age and profession were factors significantly associated with the attitude level of health professionals for COVID-19 vaccine acceptance.

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Topics: Vaccine efficacy (55%)

5 Citations


Open accessJournal ArticleDOI: 10.1016/J.JMH.2021.100040
Jo Vearey1, Thea de Gruchy1, Nicholas Maple1Institutions (1)
01 Jan 2021-
Abstract: The Covid-19 pandemic provides a stark reminder of the political tensions associated with the field of immigration and health, highlighting the central role that nationalism, racism and xenophobia play in determining responses to communicable diseases. The blurring of global health, immigration governance, and the global health security agendas has long been recognised. However, an improved understanding of the politics influencing these entanglements, specifically within the context of the Covid-19 response in low- and middle-income country contexts, is urgently needed. This includes – but is not limited to – the immediate concerns surrounding inclusive social, political and medical responses to Covid-19; vaccine nationalism – at both global and national levels; and calls for ‘vaccine passports’. To this end, we draw on the Southern African Development Community (SADC) context – one associated with high levels of diverse population movements and a large burden of communicable diseases – to explore responses to Covid-19. We unpack tensions surrounding the management of migration and the ways in which sovereignty impacts attempts at building regional, coordinated responses to migration and health, and consider how this affects progress towards global health targets. With an initial focus on South Africa, we build on previous work exploring the blurring of global health, immigration governance, and the global health security agendas in SADC, and draw from ongoing research on the governance of migration and health within the region. This includes current and evolving research exploring migration and Covid-19, initiated in March 2020 when the first cases of Covid-19 were identified in Southern Africa. The aim is for these findings to catalyse a new and evolving researh agenda to inform the development and implementation of appropriate pandemic responses in a region associated with some of the highest levels of inequality globally. To this end, an evolving research agenda should be responsive to current needs. We suggest that, in SADC, priority research should focus on improving our understanding of (1) the political factors influencing the (dis)connections between migration and health governance structures in the context of Covid-19, and how to overcome these in the context of a pandemic; and (2) the motivations for and implications of a ‘vaccine passport’ system on movement within and beyond the SADC region. This requires a reactive, cross-disciplinary, regional research network. In a context where funding for research is increasingly inaccessible, this requires innovative, informal, collaborative engagement.

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Topics: Global health (57%), Immigration (51%), Context (language use) (51%) ... show more

4 Citations


Open accessJournal ArticleDOI: 10.1136/BMJ-2021-068302
Stella Talic1, Shivangi Shah1, Holly Wild1, Danijela Gasevic1  +13 moreInstitutions (3)
18 Nov 2021-BMJ
Abstract: Objective To review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. Design Systematic review and meta-analysis. Data sources Medline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints). Eligibility criteria for study selection Observational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. Main outcome measures The main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality. Data synthesis DerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran’s Q test and the I2 metrics, with two tailed P values. Results 72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a “package of interventions.” Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I2=12%), mask wearing (0.47, 0.29 to 0.75, I2=84%), and physical distancing (0.75, 0.59 to 0.95, I2=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively. Conclusions This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination. Systematic review registration PROSPERO CRD42020178692.

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Topics: Public health (58%), Community health (58%), Global health (54%) ... show more

3 Citations


Open accessJournal ArticleDOI: 10.12688/HRBOPENRES.13263.2
Rakesh Ahmed1, Peter M. May1Institutions (1)
06 Sep 2021-
Abstract: Background : Coronavirus disease 2019 (COVID-19) has necessitated public health responses on an unprecedented scale. Controlling infectious diseases requires understanding of the conditions that increase spread. Prior studies have identified sociodemographic, epidemiological and geographic associations. Ireland offers an unusual opportunity to quantify how high infection rates in one country impacted cases in a neighbouring country. Methods : We analysed official statistics on confirmed COVID-19 cases on the island of Ireland for 52 weeks from March 2020. Our main research question was: Did higher cases in Northern Ireland (NI) impact the number of cases in the Republic of Ireland (ROI)? We used least squares regression to compare confirmed cases in ROI counties that border NI with the rest of the state. We included in our model sociodemographic, epidemiological and geographic factors. We employed the latitude of each county town as an instrumental variable to isolate a quasi-experimental estimate of the cross-border spread. Results : In the quasi-experimental framework, and controlling for population density, age distribution and circulatory disease prevalence, border counties had an extra 21.0 (95%CI: 8.4-33.6) confirmed COVID-19 cases per 1000 people. This equates to an estimated 9,611 additional cases in ROI, or 4% of the national total in the first year of the pandemic. Our results were substantively similar in non-experimental frameworks, with alternative additional predictors, and in sensitivity analyses. Additionally, population density in ROI counties was positively associated with confirmed cases and higher proportions of residents in the professional classes was negatively associated. Conclusion : On the island of Ireland during the first year of the COVID-19 pandemic, high infection rates in NI increased cases in the neighbouring ROI. Maximising co-ordination of pandemic responses among neighbouring countries is essential to minimising disease spread, and its associated disruptions to society and the economy. Socioeconomic disadvantage appeared to confer significant additional risk of spread.

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Open accessJournal ArticleDOI: 10.3390/ENGPROC2021005008
25 Jun 2021-
Abstract: This study compares the effectiveness of COVID-19 control policies on the virus’s spread and on the change of the infection dynamics in China, Germany, Austria, and the USA relying on a regression discontinuity in time and ‘earlyR’ epidemic models. The effectiveness of policies is measured by real-time reproduction number and cases counts. Comparison between the two lockdowns within each country showed the importance of people's risk perception for the effectiveness of the measures. Results suggest that restrictions applied for a long period or reintroduced later may cause at-tenuated effect on the circulation of the virus and the number of casualties.

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22 results found


Open accessJournal ArticleDOI: 10.7326/M20-0504
Stephen A. Lauer1, Kyra H. Grantz1, Qifang Bi1, Forrest K. Jones1  +5 moreInstitutions (2)
Abstract: Using news reports and press releases from provinces, regions, and countries outside Wuhan, Hubei province, China, this analysis estimates the length of the incubation period of COVID-19 and its pu...

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3,940 Citations


Open accessJournal ArticleDOI: 10.1126/SCIENCE.ABA9757
Matteo Chinazzi1, Jessica T. Davis1, Marco Ajelli2, Corrado Gioannini3  +14 moreInstitutions (8)
06 Mar 2020-Science
Abstract: Motivated by the rapid spread of coronavirus disease 2019 (COVID-19) in mainland China, we use a global metapopulation disease transmission model to project the impact of travel limitations on the national and international spread of the epidemic. The model is calibrated on the basis of internationally reported cases and shows that, at the start of the travel ban from Wuhan on 23 January 2020, most Chinese cities had already received many infected travelers. The travel quarantine of Wuhan delayed the overall epidemic progression by only 3 to 5 days in mainland China but had a more marked effect on the international scale, where case importations were reduced by nearly 80% until mid-February. Modeling results also indicate that sustained 90% travel restrictions to and from mainland China only modestly affect the epidemic trajectory unless combined with a 50% or higher reduction of transmission in the community.

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Topics: Mainland China (53%)

2,084 Citations


Open access
01 Jan 2020-
Abstract: Globally, as of 10:47am CEST, 28 May 2020, there have been 5,556,679 confirmed cases of COVID-19, including 351,866 deaths, reported to WHO

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Topics: Coronavirus (58%)

1,791 Citations


Open accessJournal ArticleDOI: 10.1093/IJE/DYW098
Abstract: Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.

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1,161 Citations


Open accessJournal ArticleDOI: 10.1016/S0140-6736(20)30411-6
Marius Gilbert1, Giulia Pullano2, Francesco Pinotti2, Eugenio Valdano3  +12 moreInstitutions (9)
14 Mar 2020-The Lancet
Abstract: Summary Background The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Local cycles of transmission have already occurred in 12 countries after case importation. In Africa, Egypt has so far confirmed one case. The management and control of COVID-19 importations heavily rely on a country's health capacity. Here we evaluate the preparedness and vulnerability of African countries against their risk of importation of COVID-19. Methods We used data on the volume of air travel departing from airports in the infected provinces in China and directed to Africa to estimate the risk of importation per country. We determined the country's capacity to detect and respond to cases with two indicators: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Countries were clustered according to the Chinese regions contributing most to their risk. Findings Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (ie, Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable capacity and high vulnerability. We identified three clusters of countries that share the same exposure to the risk originating from the provinces of Guangdong, Fujian, and the city of Beijing, respectively. Interpretation Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission. Funding EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche.

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Topics: Preparedness (55%), Vulnerability index (53%), Vulnerability (51%) ... show more

711 Citations


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