A comparison of postural and diurnal variations in intraocular pressure using the iCare rebound tonometer and Perkins applanation tonometer in admitted adults in Kenya

Background: Elevated intraocular pressure (IOP) remained the most important known risk factor for glaucoma. Aim: To compare the postural and diurnal IOP variations using the iCare rebound tonometer (RT) and Perkins applanation tonometer (PAT). Setting: Kakamega County Hospital, Kenya. Methods: Elevated intraocular pressure measurements were taken by two (masked) examiners with two devices in the morning (06:00–09:00), midday (12:00–15:00) and evening (18:00–21:00), in the sitting followed by supine positions in one randomly selected eye of 24 oculo-visual healthy hospital-admitted patients. Effects of the time of the day and position of the body within and between devices were analysed with the Statistical Package for Social Sciences. Results: The mean IOP measured by the RT ranged from 6 mmHg to 24 millimetres of mercury (mmHg) in the sitting position and from 10 mmHg to 26 mmHg in the supine position. The mean IOP measured using PAT ranged from 6 mmHg to 21 mmHg in the sitting position and from 8 mmHg to 24 mmHg in the supine position. The IOP measured by both devices significantly varied with position (p < 0.05). Perkins applanation tonometer on average gave a significantly higher IOP (1.7 mmHg [p = 0.003] and 1.3 mmHg [p = 0.034]) at 06:00 compared to that at 12:00 and 18:00, respectively. The IOP readings with the RT were on average 2.2 mmHg and 3.0 mmHg higher at 06:00 compared to that at 12:00 and 18:00, respectively (p < 0.0005). Conclusion: Significant reductions were observed in postural and diurnal IOPs in the sitting positions and in the afternoon, respectively. Diurnal IOP variations were slightly higher when measured by RT compared to when measured by PAT

Factors affecting willingness to comply with public health measures during the pandemic among sub-Sahara Africans

Background: The unprecedented outbreak of coronavirus disease (COVID-19) drastically spread worldwide, resulting in extraordinary measures put in place in various countries including Sub Saharan Africa (SSA) countries. Objective: To assess the factors associated with compliance with the public health measures imposed by various SSA countries. Method: Cross sectional study using self-administered surveys distributed on social media platforms between April 18th and May 16th, 2020, corresponding with the mandatory lockdown period in most SSA countries. Multivariate analysis examined the associated factors. Results: The prevalence of hand hygiene, quarantine, self isolation practices, wearing of face mask and attending large gatherings during COVID-19 were 94%, 39%, 31%, 64% and 14%, respectively. In multivariate models, older age 49+ years: adjusted OR 2.13, 95%CI 1.22,3.71), females (OR 1.41,95%CI 1.03,1.93), Central African countries (OR 3.73,95%CI 2.02,6.87) were associated with wearing face mask. Living alone (aOR 1.52,95%CI 1.04,2.24) during the lockdown was associated with avoiding large gatherings including religious events. Female respondents (aOR 1.61, 95%CI 1.30, 2.00), married (aOR 1.71,95%CI 1.33,2.21) and unemployed (aOR 1.62,95%CI 1.25,2.09) SSAs were more likely to practice self-quarantine measures. Conclusion: The low prevalence of mitigation practices suggest the need for targeted education campaign programs to sensitise the population

Public awareness and perception towards COVID-19 in sub-saharan African countries during the lockdown

Background: The coronavirus disease (COVID-19) outbreak has caused a universal health crisis resulting in significant morbidities and mortalities particularly among high-risk groups. This study sought to determine regional factors associated with knowledge and attitude towards COVID-19 mitigation practices and risk perception of contracting the disease in Sub-Saharan African (SSA) countries. Methods: A cross-sectional anonymous online study was conducted among 1970 participants between April and May 2020, during the lockdown in many SSA countries. Recruitment of participants was via WhatsApp, Facebook and emails using authors’ networks. The outcome variables were KAP (knowledge, attitudes and practice) of COVID-19 and analysis of variance (ANOVA) with post hoc test was run to assess the level of KAP by four regions in SSA. Simple and multiple linear regression (MLR) analyses were performed to examine factors associated with the outcome measures in the four SSA regions. Results: Mean knowledge (P=0.707) and risk perception (P=0.904) scores by four regions in SSA did not differ significantly. However, the mean attitude score was higher among West Africans compared with Southern (P=0.019) and Central Africans (P=0.003). MLR analysis revealed that among those living in West (adjusted coefficient β=-0.83 95% CI: -1.19, -0.48) and Southern Africa (β=-0.91 95% CI: -1.42, -0.40), having a primary or secondary education was associated with a decrease in knowledge scores while not being worried about COVID-19 decreased risk perception scores across the four SSA regions(West [β=-6.57, 95% CI: -7.53, -5.62], East [β=-6.24: 95% CI: -8.34,-4.15], Central [β=-6.51, 95% CI: -8.70, -4.31], and Southern Africa [β=-6.06: 95% CI: -7.51, -4.60]). Except among Southern Africans, participants who practiced self-isolation had positive attitude towards COVID-19. Conclusion: Future research on health education regarding COVID-19 or a future related pandemic in SSA should target people with lower education, those who do not self-isolate, those living in Southern and Western Africa and not worried about contracting COVID-19

COVID-19 in Sub-Saharan African countries : association between compliance and public opinion

Background: The outbreak of coronavirus disease (COVID-19) has created a global public health crisis and non-compliance with public health measures to contain the infection poses a challenge to Sub-Saharan African governments. This study investigated the associations between compliance and public opinion on COVID-19 public health containment measures across selected SSA countries. Method: Anonymous online cross-sectional survey was administered to 1779 adults (18 years and older) during the mandatory lockdown period in most African countries (April 18 - May 16, 2020). Respondents were recruited via Facebook, WhatsApp, and authors' networks. Data on participants’ socio-demographics, their opinions regarding the precautionary measures against COVID-19, and their compliance with preventive measures were collected. Multiple logistic regression analysis was used to examine the association between compliance and public opinions about COVID-19. Results: Respondents who did not think that public health authorities in their countries were doing enough to control the C0VID-19 outbreak were more likely to attend crowded places (aOR 1.75, 95% CI 1.30-2.35). Those who thought COVID-19 would not remain in their countries (aOR 0.48, 95% CI 0.24 - 0.96) and those who thought self-isolation is not needed during the pandemic (aOR 0.29, 95% CI 0.13 - 0.65) were less likely to encourage others to comply with the strategies put in place to prevent the spread of the disease. Participants who thought the COVID-19 outbreak was dangerous and those wearing medical masks were found to wash their hands with soap under running water. Conclusion: The study showed that public opinion influenced the compliance of individuals to public health measures for containment and mitigation of COVID-19. There is a need to improve compliance by the public

Differences in perceived risk of contracting SARS-CoV-2 during and after the lockdown in Sub-Saharan African countries

This study investigated risk perception of contracting and dying of SARS-CoV-2 in sub-Sahara Africa during and after the lockdown periods. Two online surveys were conducted one year apart, with participants 18 years and above living in sub-Sahara Africa or the diaspora. Each survey took four weeks. The first survey was taken from 18 April to 16 May 2020, i.e., during the lockdown. The second survey was taken from 14 April to 14 May 2021, i.e., after the lockdown. A cross-sectional study using adopted and modified questionnaires for both surveys were distributed through online platforms. Question about risks perception of contracting and dying of SARS-CoV-2 were asked. The Helsinki declaration was applied, and ethical approvals were obtained. Total responses for both surveys, i.e., both during and after the lockdown, was 4605. The mean age was similar in both surveys (18–28 years). The mean risk perception scores were higher after lockdown by 3.59%. Factors associated with risk perception of COVID-19 were survey period, age group, region of residence, and occupation. Non-health care workers had a lower risk perception of COVID-19. This first comparative study on the level of risk perception of Africans during and after the lockdown shows that one in every three and every four persons in sub-Sahara Africa felt at high risk of contracting COVID-19 and thought they could die from contracting the same, respectively

Analysis of perception, reasons, and motivations for COVID-19 vaccination in people with diabetes across Sub-Saharan Africa : a mixed-method approach

Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assesses COVID-19 vaccine acceptance and hesitancy in people with DM, and explores the reasons for not being vaccinated. This was a web-based cross-sectional survey using a mixed-method approach conducted in March–May 2021, corresponding to most sub-Saharan African (SSA) countries’ early vaccine rollout period. Participants were those aged ≥18 years with self-reported DM in 11 Sub-Saharan African (SSA) countries. Responses to comments on the reasons for vaccine hesitancy and facilitators for vaccine uptake were analyzed. Of the 73 participants with DM, 65.8% were males, older than 35 years (86.3%), had postsecondary education (90%), and a significant proportion were from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). At the time of this study, 64.4% experienced COVID-19 symptoms, 46.6% were tested for COVID-19, of which 19.2% tested positive. Few participants (6.8%) had received a COVID-19 vaccination, 65.8% were willing to take the vaccine when it becomes available in their country, while 26.0% either refused or remained hesitant towards taking the vaccine. The main identified reasons for not taking the vaccine were: advice from religious leaders; concerns about the safety, effects, and efficacy of the vaccines; mistrust of the pharmaceutical companies producing the vaccines and the process of production; the conspiracy theories around the vaccines; and the personal belief of the participants regarding vaccination. However, participants stated they would take the vaccine if they were more educated about it, received positive feedback from those vaccinated, were rewarded for taking the vaccine, or if vaccination became a condition for travel and employment. In conclusion, this study shows that the uptake of the COVID-19 vaccine was very low in this high-risk group. Efforts to increase the uptake of COVID-19 vaccines among people with diabetes are imperative, such as the provision of education and relevant information

Prevalence and factors associated with mental and emotional health outcomes among africans during the COVID-19 lockdown period—A web-based cross-sectional study

Mental health and emotional responses to the effects of COVID-19 lockdown in sub-Saharan Africa (SSA) are of serious public health concern and may negatively affect the mental health status of people. Hence, this study assessed the prevalence of mental health symptoms as well as emotional reactions among sub-Saharan Africans (SSAs) and associated factors among SSAs during the COVID19 lockdown period. This was a web-based cross-sectional study on mental health and emotional features from 2005 respondents in seven SSA countries. This study was conducted between 17 April and 17 May 2020 corresponding to the lockdown period in most SSA countries. Respondents aged 18 years and above and the self-reported symptoms were feeling anxious, being worried, angry, bored and frustrated. These were the main outcomes and were treated as dichotomous variables. Univariate and multivariate logistic regression analyses were used to identify the factors associated with these symptoms. We found that over half (52.2%) of the participants reported any of the mental health symptoms and the prevalence of feeling bored was 70.5% followed by feeling anxious (59.1%), being worried (57.5%), frustrated (51.5%) and angry (22.3%) during the COVID-19 pandemic. Multivariate analysis revealed that males, those aged >28 years, those who lived in Central and Southern Africa, those who were not married, the unemployed, those living with more than six persons in a household, had higher odds of mental health and emotional symptoms. Similarly, people who perceived low risk of contracting the infection, and those who thought the pandemic would not continue after the lockdown had higher odds of mental health and emotional symptoms. Health care workers had lower odds for feeling angry than non-healthcare workers. During the COVID-19 lockdown periods in SSA, about one in two participants reported mental health and emotional symptoms. Public health measures can be effectively used to identify target groups for prevention and treatment of mental health and emotional symptoms. Such interventions should be an integral component of SSA governments’ response and recovery strategies of any future pandemic

Misinformation About COVID-19 in Sub-Saharan Africa: Evidence from a Cross-Sectional Survey

Misinformation about coronavirus disease 2019 (COVID-19) is a significant threat to global public health because it can inadvertently exacerbate public health challenges by promoting spread of the disease. This study used a convenience sampling technique to examine factors associated with misinformation about COVID-19 in sub-Saharan Africa using an online cross-sectional survey. A link to the online self-administered questionnaire was distributed to 1,969 participants through social media platforms and the authors' email networks. Four false statements—informed by results from a pilot study—were included in the survey. The participants' responses were classified as “Agree,” “Neutral,” and “Disagree.” A multinomial logistic regression was used to examine associated factors. Among those who responded to the survey, 19.3% believed that COVID-19 was designed to reduce world population, 22.2% thought the ability to hold your breath for 10 seconds meant that you do not have COVID-19, 27.8% believed drinking hot water flushes down the virus, and 13.9% thought that COVID-19 had little effect on Blacks compared with Whites. An average of 33.7% were unsure whether the 4 false statements were true. Multivariate analysis revealed that those who thought COVID-19 was unlikely to continue in their countries reported higher odds of believing in these 4 false statements. Other significant factors associated with belief in misinformation were age (older adults), employment status (unemployed), gender (female), education (bachelor's degree), and knowledge about the main clinical symptoms of COVID-19. Strategies to reduce the spread of false information about COVID-19 and other future pandemics should target these subpopulations, especially those with limited education. This will also enhance compliance with public health measures to reduce spread of further outbreaks

International research collaboration during the pandemic: Team formation, challenges, strategies and achievements of the African Translational Research Group

This paper discusses multidisciplinary international research collaboration team formation during the COVID-19 pandemic, challenges faced, strategies adopted, achievements and dynamics in the implementation of research on Coronavirus disease-2019 (COVID-19), by the African Translational Research Group (ATReG). The paper also discusses the lessons learnt and future opportunities for global collaborative research. In-depth virtual interviews were conducted with consenting members of ATReG. Questions were designed to provide rich, deep, and insightful opinions, lived experiences and perspectives of ATReG group members on group formation, challenges, strategies and achievements. Interview data was transcribed and analysed thematically, and the results were presented with important quotations presented. The ATReG consisted of English (n = 13) and French (n = 1) speaking sub-Saharan African (SSA) researchers who specialise in public health, epidemiology, optometry, information technology, supply chain management, psychiatry, community health, general medical practice, nutrition and biostatistics. Most members of the group reported an informal but well-coordinated structure of the group. Formed during the pandemic, all group meetings were held online, and many members are yet to meet each other in person. The group collected data from Africans and published 10 peer reviewed journal articles on COVID-19 within two years. It presented in international conferences, engaged with the media and the public and was awarded a national competitive funding in Nigeria all of which which contributed to career progression and academic promotion of some members. There have been challenges in sustaining the research collaboration and maintaining productivity. Challenges include difficulties meeting deadlines and obtaining funding for research activities. However, these challenges have been addressed through a collaborative problem-solving approach. The study found the need for operational and methodological flexibility, centralised coordination, and established funding sources as being essential for long term sustainability and performance of the group. The ATReG’s objective of providing useful data on COVID-19 and generating useful knowledge about COVID-19 in SSA has been achieved. In such a multi-disciplinary international collaborative team relaiant on the online medium to operate, the experiences and challenges can be a model for learning for researchers intending to form international multidisciplinary collaborative groups. Nonetheless, there are still many important areas of research which ATReG will continue to pursue

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa

Background Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA). Methods A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded ‘not sure’ or ‘no’ to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of ‘vaccine hesitancy’ and ‘vaccine resistance’, respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes. Results The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper. Conclusion We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health