Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda

Funding: CARE: COVID-19 and Antimicrobial Resistance in East Africa – impact and response is a Global Effort on COVID-19 (GECO) Health Research Award (MR/V036157/1) funded by UK Research and Innovation (Medical Research Council) and the Department of Health and Social Care (National Institute for Health Research).Background There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania. Methods In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as ‘pre-COVID-19 phase’ (February 2019 to February 2020), ‘COVID-19 phase 1’ (March 2020 to April 2020), and ‘COVID-19 phase 2’ (July 2021 to February 2022). Results In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda. Conclusions There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance.Publisher PDFPeer reviewe

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

Mapping of Lineament Structures from Aeromagnetic and Landsat Data Over Ankpa Area of Lower Benue Trough, Nigeria

Structural analysis of aeromagnetic and Landsat data over Ankpa area, Benue state was carried out to delineate the basement topography, hydrocarbon potentials, groundwater availability and the structures that control basin formation. The Landsat imagery generated from this study was further processed using Geomatica software (version 9.0). The results obtained revealed that the drainage pattern is dendritic which could be associated to the lithological, structural and topographic differences. Also, this may indicate the presence of alluvial rocks, typically of the same geology, mainly of sedimentary rocks. This present study is in good agreement with the areas in the lineament map of high-density structures. The observation showed that the study area constitutes densely lineaments that cut across each other, which may be attributed to groundwater availability and upward migration of hydrocarbon-bearing formation. The structural trend is predominantly in the NE-SW direction and agrees with the Landsat data structural trends. Significantly, this NE-SW trend is in agreement with the trend of Benue Trough (NE –SW) and could be that they have the same structural control

Dispersion of gamma dose rates and natural radionuclides in the coastal environments of the Unumherin community in Niger Delta

AbstractThe outdoor gamma dose rates and the activity concentrations of potassium-40, uranium-238, and thorium-232 within the study area were carried out using calibrated hand-held gamma detector (RS-125 gamma spectrometer) and NaI(Tl) gamma spectroscopy. The in-situ measurement results of the gamma dose rate indicate that the hotspot is at location 4 with a value of 100 nGyh-1. The results from the NaI(Tl) gamma detector revealed the highest activity concentrations of potassium-40, uranium-238, and thorium-232 to be 288.09, 96.49, and 136.12 Bqkg−1 for sediments and 257.31, 66.93, and 96.57 Bqkg for water, respectively. The highest mean activity concentration of potassium-40 and uranium-238 was observed in Catfish with values of 151.87 and 38.00 Bqkg−1, whereas the highest value for the activity of thorium-232 was observed in Tilo Fish with a value of 89.02 Bqkg-1. In comparison, all the observed values are higher than the population-weighted average of 420.00, 32.00, and 45.00 Bqkg−1 for potassium-40, uranium-238, and thorium-232 according to UNSCEAR. Geologically, this may be attributed to the marine incursion of regional tectonic subsidence during transgression. Statistically, the correlation results confirmed that the enhanced outdoor dose rates at the coastline environment were caused mainly by uranium-238, followed by thorium-232 and then potassium-40 in magnitude. The mean hazard indices calculated for the samples were also observed to be within the global average values recommended by ICRP