Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda.

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload

Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: retrospective cohort study

Objective: Despite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria. Design Retrospective cohort study. Setting: COVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control. Participants: Individuals who were investigated for SARSCoV-2 using real-time PCR testing during the study period 27 February–8 June 2020. Methods: COVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs. Results: A total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trend<0.0001), male sex (aOR 1.11, 95%CI 1.04 to 1.18) and the following presenting symptoms: cough (aOR 1.23, 95% CI 1.13 to 1.32), fever (aOR 1.45, 95% CI 1.45 to 1.71), loss of smell (aOR 7.78, 95% CI 5.19 to 11.66) and loss of taste (aOR 2.50, 95% CI 1.60 to 3.90). An increased risk of mortality following COVID-19 was observed in those aged ≥51 years, patients in farming occupation (aOR 7.56, 95% CI 1.70 to 33.53) and those presenting with cough (aOR 2.06, 95% CI 1.41 to 3.01), breathing difficulties (aOR 5.68, 95% CI 3.77 to 8.58) and vomiting (aOR 2.54, 95% CI 1.33 to 4.84). Conclusion: The significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals

Influence of pesticide information sources on citrus farmer's knowledge, perception and practices in pest management, Mekong Delta, Vietnam

In 1998-99, about 150 citrus farmers and 120 pesticide sellers were interviewed in Can Tho and Dong Thap province, Mekong Delta, Vietnam. Media, pesticide sellers and extension staff had different influences on farmers' pest perception and management practices depending on the region and intensity of the cropping system. Pesticide sellers were notified by about 95% of the farmers about their major pest problems, and the type of pesticides sold in their shop was primarily based on farmers' demand (87%) and then on company promotion (56%). Those farmers relying on pesticide sellers used more of the banned insecticide methyl parathion. Probably for fear of being accused of illegal practices, none of the pesticide sellers mentioned that they recommended this product or that farmers asked for it. In the intensive Tieu mandarin cropping system, media and extension activities increased farmers' knowledge of difficult-to-observe pests such as the citrus red mite Panonychus citri and thrips, Thrips sp. and Scirtothrips sp. Since extension was weak in sweet orange, those farmers exposed to media only reported the damage symptom of mites, not knowing the causal agent. Media alone seemingly did not suffice to acquaint farmers with these small organisms. Farmers getting advice from the media advertisements applied more different pesticide products and sprayed insecticides more frequently, whereas the extension has stimulated the use of acaricides and increased the number of both insecticide and fungicide sprays. The traditional practice of biological control with the ant Oecophylla smaragdina might be endangered with growing media influence and when extension activities remain confined to chemical pest control. Constraints and potentials of different information sources are discussed in relation to developing IPM programmes for citru