Population-Based Assessment of the Burden of COVID-19 Infection in African Countries: A First-Year Report Card and Public Health Implications

BACKGROUND: The COVID-19 pandemic constitutes a global health threat and poses a major burden on the African continent. We assessed the real-world burden of COVID-19 infection in African Union (AU) member states to determine the distributional patterns of epidemiological measures during the first 1 year of the pandemic. METHODS: This retrospective cross-sectional study utilized COVID-19 data from publicly available data repositories of the African Center for Disease Control and Prevention and RESULTS: A total of 3.21 million cases were reported during the 1-year period, with 2.6 million recoveries, 536,784 cases remaining active, and 77,486 deaths. Most countries (49.1%, CONCLUSION: Understanding the true burden of the disease in AU countries is important for establishing the impact of the pandemic in the African continent and for intervention planning, preparedness, and deployment of resources during COVID-19 surges and future pandemics

Comparative Effectiveness of Smoking Cessation Medications among Schizophrenic Smokers

Objective: To examine which medication could lead to a higher short and long term smoking abstinence in patients with schizophrenia. Methods: A retrospective cohort study was conducted using General Electric (GE) medical records database (1995 – 2011). The cohort consisted of adult smokers with diagnosis of schizophrenia newly initiating cessation medication. Short term and long term outcomes of cessation were measured at 3 weeks and 1 year. Descriptive and chi-square analyses were used to determine the frequencies and associations of patient characteristics with the abstinence outcomes. Logistic regression models were carried out to determine the predictors of short term and long term abstinence. Results: The cohort consisted of 3,976 patients. Abstinence rate was highest for Varenicline, followed by Bupropion, NRT, and lastly combination at week 12. At one year, abstinence rate was highest for Varenicline, followed by combination, NRT, and lastly Bupropion. Age, race, household locations and receiving counseling were associated with abstinence. No significant differences were found between cessation medications. Conclusions: There were no statistically significant differences in quitting with type of cessation medication. Predictors of better abstinence identified included older age, white race, western household location. These factors should be considered when designing future interventions for schizophrenic population as this minority population may need more tailored approaches to achieve a successful cessation outcome

Public Opinion Regarding Government Response to COVID-19: Case Study of a Large Commercial City in Nigeria

Introduction: government measures to contain the COVID-19 pandemic cannot be effective without widespread compliance by the public. A greater understanding of citizens\u27 perceptions of these measures can help government agencies adapt their strategies to boost compliance. We examined citizens\u27 perceptions of government\u27s measures to contain the COVID-19 pandemic and its implications on compliance using data from Onitsha city, Anambra State Nigeria. Methods: data was obtained through in-person interviews of 140 consenting adults in March 2020. Descriptive and inferential statistics were used to summarize the data. Results: most participants (84.7%) doubted government\u27s ability to manage the COVID-19 outbreak, raising concerns about ineffective governance (25.7%) and inadequate health facilities (20.7%). However, participants expressed a favorable perception of school closures (92.3%) and a ban on large gatherings (83.9%), driven mostly by the need to contain the COVID-19 and avoid its spread. But, they were generally indifferent about the closure of the markets and workplaces due to concerns for food insecurity and lack of government\u27s relief programs. Participants who had a positive perception of the ban on large gatherings were more likely to have high knowledge and to adopt good COVID-19 preventive practices. Conclusion: the study showed a lack of public\u27s confidence in the government\u27s ability to manage the pandemic. This provides an opportunity for the city government and the public to reflect on the existing relationships, build mutual trust, and devise collaborative engagement that will boost compliance and help contain the devastating impact of COVID-19 pandemic

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient\u27s HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites. The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients. The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment

COVID-19 Infection among People with HIV/AIDS in Africa: Knowledge Gaps, Public Health Preparedness and Research Priorities

The emergence of novel virus SARS-CoV-2 that causes COVID-19 has complicated Africa’s public health challenges, especially with the pre-existing epidemics such as HIV/AIDS. We highlight the known evidence related to COVID-19 infections among people with HIV (PWH) with specific reference to Africa. The knowledge gaps, level of public health preparedness and the potential research priorities are also outlined. Although the epidemiology and clinical course of COVID-19 in HIV patients are evolving, existing evidence indicate that the disease outcomes are comparable to that of the general population. However, PWH with low CD4 cell counts may have worse outcomes than individuals with restored immunity, whereas old age and co-morbidities such as obesity, hypertension and diabetes can further increase their overall risk. While there may be slight disruption of HIV service delivery in selected African countries, the resilience and resourcefulness of others have helped to sustain HIV service delivery and enhanced the level of public health preparedness and fight against the pandemic. The paucity of data and research studies on HIV-COVID-19 coinfection in Africa, call for concerted efforts to address these limitations. Keywords: • COVID-19 • SARS-CoV-2 • HIV • PWH • Public Health • Research • Africa   Copyright © 2021 Essien, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited

Connaissance et utilisation de la partographie chez les sages-femmes dans la région de Niger Delta du Nigéria

This cross-sectional study assessed knowledge and utilization of the partograph among midwives in two tertiary health facilities in the Niger Delta Region of Nigeria. A descriptive survey design was utilized, using a structured questionnaire administered to 165 midwives purposively selected from the Federal Medical Center (FMC) (79) and Niger Delta University Teaching Hospital (NDUTH) (86). Results revealed that 84% of midwives knew what the partograph was and 92.7% indicated that the use of the partograph reduces maternal and child mortality. About 50.6% midwives in FMC and 98.8% in NDUTH indicated that it was routinely utilized in their centers. Assessment of utilized partograph charts revealed that only 18_ (37.5%) out of 48 in FMC and 17_ (32.6%) out of 52 in NDUTH were properly filled. Factors in the utilization of the partograph were:-non-availability of the partograph (30.3%), shortage of staff (19.4%), little or no knowledge in the use of the partograph (22.2%), and 8.6 percent indicated it was time consuming. A significant relationship existed between knowledge of the partograph and its utilization (χ2 = 32.298. Df = 1; P <0.05) and between midwives years of experience and its utilization (χ2=4.818, Df = 4; P <0.05). However, this study also showed that despite midwives good knowledge of the partograph, there was poor utilization in labor monitoring in both centers. Training of midwives on the use of the partograph with periodic workshops and seminars and a mandatory hospital policy are recommended and vital to the safety of women in labor in the Niger Delta region of Nigeria (Afr J Reprod Health 2012; 16[1]:125-132).Cette étude transversale a évalué la connaissance et l’utilisation de la partographie chez les sages-femmes dans deux établissements de santé tertiaires dans la région de Niger Delta du Nigéria. Nous nous sommes servis du modèle de l’enquête descriptive à l’aide d’un questionnaire administré auprès de 165 sages-femmes délibérément sélectionnées à Federal Medical Centre (FMC) et au Centre Hospitalier Universitaire de l’Université de Niger Delta (NDUTH) (86). Les résultats ont révélé que 84% des sages-femmes connaissent la pantographie et 92,7% ont déclaré que l’utilisation de la partographie réduit la mortalité maternelle et infantile. Environ 50,6% sages-femmes dans le FMC et 98,8% dans NDUTH ont dit qu’elle est utilisé de routine dans leurs centres. L’évaluation des chartes de la partographie ont révélé que seulement 18 (37,5%) sur 48 dans le FMC et 17 (32,6%) sur 52 dans la NDUTH étaient bien remplies. Les facteurs dans l’utilisation de la partographie étaient la non-disponibilité de la partographie (30,3%), le maque de personnel (19,4%) peu ou pas de connaissance du tout à l’égard de l’utilisation de la partographie (22,2%) et 8,6 pourcent ont déclaré que cela prend beaucoup de temps. Il existait un rapport significatif entre la connaissance et son utilisation (χ2 =32, 298. Df =1 ; P <0,05) et entre les années d’expérience des sages-femmes et ses utilisations (χ2 = 4,818, Df = 4 ; < 0,05). Néanmoins, cette étude a également montré que malgré la bonne connaissance qu’ont les sages-femmes de la partographie, il y avait une faible surveillance du travail dans les deux Centres. Nous recommandons que les sages-femmes apprennent à utiliser la partographie à travers des ateliers périodiques et des séminaires et à travers une politique hospitalière obligatoire, ce que nous considérons comme étant essentiel pour la sécurité des femmes pendant le travail dans la région du Niger Delta du Nigéria (Afr J Reprod Health 2012; 16[1]:125-132)

La caractérisation épidemiologique et comportementale de la connaissance de l&apos;usage du préservatif et du modelage chez le personnel militaire

How accurately condoms are being used vary across populations and knowledge of the factors determining its proper use remains unclear. Knowledge of such differentials and determinants would aid in evaluating the contributions of condom use to HIV epidemic reduction. Baseline data from the Situationally Focused Individual HIV/AIDS intervention to promote HIV protective behavior among 2,213 Nigerian Military Personnel were analyzed. Educational status as a predictor variable was assessed using univariable and multivariable logistic regression model. Compared to those with less than high school education, those with high school and some college education were two times more likely to demonstrate knowledge of condom use and modeling, prevalence odds ratio (POR), 2.32, 95% Confidence Interval (CI)=1.60-3.37. After adjustment for the relevant covariates, higher education attainment was associated with nonsignificant 62% increase in knowledge and modeling, POR, 1.62, 95% CI=0.78-3.38. This study is indicative of low knowledge of condom use and modeling among the Nigerian military personnel; as well as a direct correlation between education attainment and knowledge of condom use and modeling.La caractérisation épidemiologique et comportementale de la connaissance de l&apos;usage du préservatif et du modelage chez le personnel militaire. La façon efficace dont l&apos; on utilise les préservatifs varie à travers les populations et la connaissance des facteurs qui déterminant son bon usage n&apos;est pas claire. Une connaissance des tels différentiels et déterminants aiderait à évaluer des contributions du bon usage des préservatifs en vue de la réduction de l&apos;épidémie du VIH. Les données initiales de base qui ont été obtenues à partir de l&apos;intervention du VIH/SID par rapport à l&apos;individu sur qui on a concentré de manière situationnelle afin de promouvoir le comportement protecteur du VIH chez 2,213 personnel militaire nigérian ont été analysées. A l&apos;aide de la cote composite des six démarches pour la connaissance de l&apos;usage du préservatif et le modelage comme le variable de conséquence, nous avons examiné le niveau d&apos;éducation comme un variable de l&apos; indice, le modelage avec un univariable non-conditionnel et la régressive logistique multivariable. Quand on compare ceux qui n&apos;ont pas eu l&apos;éducation secondaire à ceux qui l&apos;ont eu, les derniers avaient deux fois plus la possibilité de démontrer la connaissancede l&apos;usage du préservatif et du modelage; le rapport de prévalence, 2,2,95% l&apos;interval de Confiance IC= 1,60 - 3,37. Pourtant, l&apos;association qui a été significative statistiquement n&apos;a pas persisté après l&apos;ajustement pour les co-variables; la prévalence du rapport, 1,62,95%IC=0,78 - 3,38. Cette étude montre une faible connaissance de l&apos;usage du préservatif et du modelage parmi le personnel militaire nigérian; elle montre aussi l&apos;influence des autres caractérisques en ce qui concerne le rôle de l&apos;acquis de l&apos;éducation dans la connaissance de l&apos;usage du préservatif et du modelage

Comparison of Cardiovascular Risks following Smoking Cessation Treatments Using Varenicline vs. NRT among Schizophrenic Smokers

Background: Schizophrenic patients have a lot higher smoking rates when compared to people in the general population. A variety of pharmaceutical cessation aids are available, which include nicotine replacement therapy (NRT), Bupropion SR, and Varenicline. Our objective was to assess which cessation medication would have lower risks in developing risk factors of cardiovascular diseases. Methods: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (1995-2011). The cohort consisted of patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-9 code 295.00-295.99) and who had newly initiated use of any smoking cessation medication. We excluded our cohort who (1) were not prescribed atypical antipsychotics and (2) already had diagnosis of diabetes, hyperlipidemia or hypertension prior to index date. Follow up period was from 12 weeks onwards index date up to one year. The hazard ratio of developing cardiovascular risks was assessed using Cox proportional hazards regression model after controlling for other covariates. Results: A total of 580 patients were included in our cohort. Among those, nearly half (n=276, 47.59%) developed one or more criteria of the metabolic syndromes. We found that smokers who were prescribed NRT were less likely to develop metabolic syndromes as compared to those who were prescribed Varenicline. Conclusions: Physicians are advised to carefully weigh the risks against the benefits before prescribing cessation medications since risks for metabolic syndromes were found to be very high. Healthcare providers should monitor patients&rsquo; lab data regularly as this minority population is under higher risks

Population-based assessment of the burden of COVID-19 infection in African countries: a first-year report card and public health implications

Background: The COVID-19 pandemic constitutes a global health threat and poses a major burden on the African continent. We assessed the real-world burden of COVID-19 infection in African Union (AU) member states to determine the distributional patterns of epidemiological measures during the first 1 year of the pandemic. Methods: This retrospective cross-sectional study utilized COVID-19 data from publicly available data repositories of the African Center for Disease Control and Prevention and Our World in Data for the period February 2020 to January 2021. AU member states were classified into low, medium, and high burdens based on COVID-19 morbidity. We conducted descriptive and inferential analyses of COVID-19-reported cases, deaths, recoveries, active cases, COVID-19 tests, and epidemiological measures that included morbidity and mortality rates, case fatality rate (CFR), and case ratios. Results: A total of 3.21 million cases were reported during the 1-year period, with 2.6 million recoveries, 536,784 cases remaining active, and 77,486 deaths. Most countries (49.1%, n  = 26) in AU experienced a low burden of COVID-19 infection compared to 28.3% ( n  = 15) with medium burden and 22.6% ( n  = 12) with high burden. AU nations with a high burden of the disease were mainly in the northern and southern regions. South Africa recorded the highest number of cases (1.31 million), followed by Morocco with 457,625 and Tunisia with 175,065 cases. Correspondently, death tolls for these countries were 36,467, 7888, and 5528 deaths, respectively. Of the total COVID-19 tests performed (83.8 million) during the first 1 year, 62.43% were from high-burden countries. The least testing occurred in the medium-burden (18.42%) countries. The overall CFR of AU was 2.21%. A morbidity rate of 327.52/10 5 population and mortality rate of 5.96/10 5 population were recorded during the first 1-year period with significant variations ( p  < 0.0001) across burden levels. Continental morbidity and mortality rates of 17,359/10 5 and 315.933/10 5 populations were recorded with significant correlation ( r  = 0.863, p  < 0.0001) between them and variations across selected epidemiological measures by COVID-19 burden levels. Conclusion: Understanding the true burden of the disease in AU countries is important for establishing the impact of the pandemic in the African continent and for intervention planning, preparedness, and deployment of resources during COVID-19 surges and future pandemics