Community engagement and compliance monitoring of COVID-19 safety protocols: innovative approach combining indigenous practice and GIS technology in Oyo State, Nigeria

Background: One of the major challenges that has driven the spread of Coronavirus Disease 2019 (COVID-19) worldwide is the burden of enforcing the preventive measures required to contain the pandemic. Enforcement of COVID-19 precautionary behaviour should not be homogenous; every country needs to be creative to ensure that humane considerations guide all decisions during the extraordinary experience that COVID-19 pandemic portends. The model of self-policing is acceptable and maintained principally because the citizens of any communities operate, recognize, and accept them as preferred alternatives to the official models of policing for enforcement. Hence the approach presented in this paper, which deployed existing indigenous alternative systems in ensuring compliance with COVID-19 precautionary behaviour. This article therefore documents the unique approach deployed for the containment of COVID-19 in Oyo State, Nigeria. Objective: This intervention was designed to explore established indigenous alternative systems and models of control, justice, law, security, and enforcement in Nigeria. Additionally, geographic information system (GIS) technology and investigative journalism was used to monitor and evaluate the effectiveness of the intervention. Method: The method employed was community conversation; a method of increasing inclusive, community-based engagement harnessing the expertise and motivation of key stakeholders. The community conversations were convened after the pattern of a traditional Town-hall meeting. Community conversations were organized as a qualitative framework focusing on deploying the indigenous practice of self-policing associated with Nigerias trade unions and aims to inform COVID-19 preventive behaviour at the community level. Geographical information system technology was used to develop COVID-19 Containment Compliance Citizens Reporter App. The App was developed using ESRI ArcGIS online platform to crowd source public feedback on compliance or contravention of COVID-19 protocols. Social media platforms were also deployed for monitoring and evaluation of the intervention post townhall meeting. Results: The establishment of a State-wide Containment response network provided the required inroad for advocacy and deployment of state-wide community conversation framework in the different communities comprising diverse ethnic groups, religious leaders, market leaders, National Union of Road Transport Workers (NURTW), and so on. Testimonials from the various communities showed that the people have embraced the self-policing strategy and the network system was effective with good outcomes in terms of response to decontamination, containment, and advocacy. The COVID-19 Containment Compliance Citizens Reporter App, investigative reporting by mass media were highly effective tools for monitoring and evaluation of the outcome of the intervention as well as possible evidence for melting out incentive and disincentive measures as necessary. This approach is a template, which could be adapted and replicated in other parts of Nigeria and other African societies with similar structures, demographics, and indigenous practices

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effectiveness of electrical stimulation and low-intensity laser therapy on diabetic neuropathy: A systematic review

Diabetes mellitus (DM) is a group of metabolic diseases which typically presents with frequent urination, increased thirst and increased hunger. DM be classified into three main types: type I (insulin-dependent DM), type-II (non-insulin dependent DM) and type III (gestational DM). Diabetes is a group of diseases of global health significance as 382 million people worldwide had diabetes in the year 2013 and this was projected to increase to an estimated 415 million in 2015. Damage to the nerves of the body (diabetic neuropathy) is the most common complication of diabetes. The signs and symptoms of diabetic neuropathy include numbness, diminished sensation, pain etc. Various types of electrotherapy, such as transcutaneous electrical nerve stimulation (TENS), pulsed-dose electrical stimulation, frequency-modulated electromagnetic neural stimulation, have been reported effective in managing diabetic neuropathy. This study is a systematic review of the evidence to enable the determination of the effectiveness of electrical stimulation and low-intensity laser therapy (LILT), and also aid their recommendation if proven to be effective. The outcome of this study was that TENS and other forms of electrical stimulation reviewed in this study may be effective and safe non-pharmacological treatment modalities in relieving the symptoms associated with diabetic neuropathy. The effectiveness of LILT couldn’t be determined due to the different parameters used to evaluate patients’ outcome and limited number of studies. Authors recommend that further randomized controlled trials with similar methodological parameters and studies with higher quality of evidences are needed to establish the true effectiveness of these modalities in diabetic neuropathy

Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Background: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially