Coordination and Management of COVID-19 in Africa through Health Operations and Technical Expertise Pillar: A Case Study from WHO AFRO One Year into Response

Abstract: Background: following the importation of the first Coronavirus disease 2019 (COVID-19) case into Africa on 14 February 2020 in Egypt, the World Health Organisation (WHO) regional office for Africa (AFRO) activated a three-level incident management support team (IMST), with technical pillars, to coordinate planning, implementing, supervision, and monitoring of the situation and progress of implementation as well as response to the pandemic in the region. At WHO AFRO, one of the pillars was the health operations and technical expertise (HOTE) pillar with five sub-pillars: case management, infection prevention and control, risk communication and community engagement, laboratory, and emergency medical team (EMT). This paper documents the learnings (both positive and negative for consideration of change) from the activities of the HOTE pillar and recommends future actions for improving its coordination for future emergencies, especially for multi-country outbreaks or pandemic emergency responses. Method: we conducted a document review of the HOTE pillar coordination meetings’ minutes, reports, policy and strategy documents of the activities, and outcomes and feedback on updates on the HOTE pillar given at regular intervals to the Regional IMST. In addition, key informant interviews were conducted with 14 members of the HOTE sub pillar. Key Learnings: the pandemic response revealed that shared decision making, collaborative coordination, and planning have been significant in the COVID-19 response in Africa. The HOTE pillar’s response structure contributed to attaining the IMST objectives in the African region and translated to timely support for the WHO AFRO and the member states. However, while the coordination mechanism appeared robust, some challenges included duplication of coordination efforts, communication, documentation, and information management. Recommendations: we recommend streamlining the flow of information to better understand the challenges that countries face. There is a need to define the role and responsibilities of sub-pillar team members and provide new team members with information briefs to guide them on where and how to access internal information and work under the pillar. A unified documentation system is important and could help to strengthen intra-pillar collaboration and communication. Various indicators should be developed to constantly monitor the HOTE team’s deliverables, performance and its members

Prevalence and risk factors of acute respiratory infection by human respiratory syncytial virus in children at Provincial General Hospital of Bukavu, Democratic Republic of the Congo

Thesis (MMedSc)--Stellenbosch University, 2017.ENGLISH ABSTRACT : Human Respiratory Syncytial Virus (HRSV) is the major cause of acute respiratory infection in children (ARI) and it is responsible for substantial morbidity and mortality, especially in younger children. The present study had two main objectives. The first one was to determine the prevalence of HRSV and non-HRSV ARI in children under the age of 5 years at the Provincial General Hospital of Bukavu (PGHB). The second objective was to analyse factors associated with the risk of ARI to be diagnosed as lower respiratory tract infection (LRTI). A total of 146 children under 5 years visiting the PGHB for ARI between August and December 2016 were recruited. A clinical examination was made and a questionnaire was completed by the parent or the guardian after which a nasopharyngeal swab was performed to collect respiratory fluid. The sample was analysed by a multiplex reverse transcriptase polymerase chain reaction for the detection of 15 different viruses, among which HRSV A and B, Influenza A and B, human Rhinovirus (HRV) A/B/C, Parainfluenza (PIV) viruses 1, 2, 3 and 4, Adenovirus (ADV), Bocavirus, Coronavirus OC43 and 229E/NL63, Enterovirus and human Metapneumovirus. Of 146 samples collected, 84 (57.5%) displayed a positive result of at least one of the 15 viruses. The overall prevalence of HRSV was 21.2%. HRSV A (30, 20.5%) was the virus the most detected, followed by HRV (24, 16.4%), PIV3 (20, 16.6) and ADV (7, 4.79%). The other viruses were detected in three or less cases. There were only 11 (7.5%) of co-infection. In bivariate analyses, HRSV infection, malnutrition, younger age, rural settings, low income and mother illiteracy were associated with the risk of ARI to be diagnosed as LRTI. However, in multivariate analyses, only HRSV infection and younger age predicted LRTI. Children with HRSV infection had 6.45 times higher odds to exhibit LRTI when compared to children without HRSV infection. Older children (by one month) had 6% lower odds of LRTI than younger children (adjusted odds ratio = 0.94, 95% CI: 0.90 – 0.97, p-value = 0.004).AFRIKAANSE OPSOMMING : Respiratoriese sinsitiale virus (RSV) is die hoofoorsaak van akute respiratoriese infeksie (ARI) by kinders en dit is verantwoordelik vir erge morbiditeit en mortaliteit, veral by jonger kinders. Die huidige studie het twee hoofdoelwitte gehad. Die eerste een was om die voorkoms van RSV en nie-RSV ARI in kinders onder die ouderdom van 5 jaar by die Provinsiale Algemene Hospitaal van Bukavu (PGHB) te bepaal. Die tweede doel was om faktore te analiseer wat verband hou met die risiko dat ARI gediagnoseer word as lae lugweginfeksie. 'n Totaal van 146 kinders onder 5 jaar wat die PGHB vir ARI besoek het tussen Augustus en Desember 2016 is gewerf vir die studie. 'n Kliniese ondersoek is gedoen en 'n vraelys is deur die ouer of voog voltooi, waarna respiratoriese vloeistof met behulp van 'n nasofaringeale depper versamel is. Die monster is geanaliseer met behulp van 'n multiplex-omgekeerde transkriptase-polimerase kettingreaksie vir die opsporing van 15 verskillende virusse, waaronder RSV A en B, Influenza A en B, menslike Rhinovirus (HRV) A / B / C, Parainfluenza virus (PIV) 2, 3 en 4, Adenovirus (ADV), Bocavirus, Coronavirus OC43 en 229E / NL63, Enterovirus en menslike Metapneumovirus. Van 146 monsters wat versamel is, is minstens een van die 15 virusse bevestig in 84 (57.5%) gevalle. Die algehele voorkoms van RSV was 21.2%. RSV A (30, 20.5%) was die virus wat die meeste bespeur is, gevolg deur HRV (24, 16.4%), PIV3 (20,16.6) en ADV (7, 4.79%). Die ander virusse is slegs in drie of minder gevalle bevestig. Daar was slegs 11 (7.5%) ko-infeksie. In ʼn twee-veranderlike analise is RSV-infeksie, wanvoeding, jonger ouderdom, landelike woongebiede, lae inkomste en ongeletterdheid in moeders geassosieer met die risiko dat ARI gediagnoseer word as lae lugweginfeksie. In ʼn meer-veranderlike analise het slegs RSV-infeksie en jonger ouderdom lae lugweginfeksie voorspel. Kinders met RSV-infeksie het ʼn 6.45 keer hoër kans gehad om lae lugweginfeksie te vertoon in vergelyking met kinders sonder RSV-infeksie. Ouer kinders (met een maand) het ʼn 6% laer kans gehad op lae lugweginfeksie as jonger kinders (aangepaste kansverhouding = 0.94, 95% CI: 0.90 – 0.97, p-waarde = 0.004)