Limited Early Warnings and Public Attention to Coronavirus Disease 2019 in China, January–February, 2020: A Longitudinal Cohort of Randomly Sampled Weibo Users

Objective: Awareness and attentiveness have implications for the acceptance and adoption of disease prevention and control measures. Social media posts provide a record of the public’s attention to an outbreak. To measure the attention of Chinese netizens to coronavirus disease 2019 (COVID-19), a pre-established nationally representative cohort of Weibo users was searched for COVID-19-related key words in their posts. Methods: COVID-19-related posts (N = 1101) were retrieved from a longitudinal cohort of 52 268 randomly sampled Weibo accounts (December 31, 2019–February 12, 2020). Results: Attention to COVID-19 was limited prior to China openly acknowledging human-to-human transmission on January 20. Following this date, attention quickly increased and has remained high over time. Particularly high levels of social media traffic appeared around when Wuhan was first placed in quarantine (January 23–24, 8–9% of the overall posts), when a scandal associated with the Red Cross Society of China occurred (February 1, 8%), and, following the death of Dr Li Wenliang (February 6–7, 11%), one of the whistleblowers who was reprimanded by the Chinese police in early January for discussing this outbreak online. Conclusion: Limited early warnings represent missed opportunities to engage citizens earlier in the outbreak. Governments should more proactively communicate early warnings to the public in a transparent manner

Domestic burdens amid COVID-19 and women's mental health in middle-income Africa

This article analyzes two longitudinal datasets (October – December 2020; April 2021) of 1,000 and 900 women in Kenya and Nigeria, respectively, alongside in-depth qualitative interviews with women at risk of changes to time use, to study two pandemic issues: women’s substitution of paid for unpaid work and how these shifts compromise their mental health. Women devote more time to domestic care (30–38 percent), less time to employment (29–46 percent), and become unemployed (12–17 percent). A rise in domestic work is correlated with depressive (Nigeria) and anxiety symptoms (Kenya and Nigeria). Women with greater agency (Kenya) and fewer children (Nigeria) are less likely to report a domestic burden or loss in paid activities. Social protection programs may fill the void of assistance traditionally provided by informal networks in the short term, while campaigns shifting norms around household work may preserve women’s economic participation in the long term

Allocating external financing for health: a discrete choice experiment of stakeholder preferences

Most donors of external financing for health use allocation policies to determine which countries are eligible to receive financial support and how much support each should receive. Currently, most of these policies place a great deal of weight on income per capita as a determinant of aid allocation but there is increasing interest in putting more weight on other country characteristics in the design of such policies. It is unclear, however, how much weight should be placed on other country characteristics. Using an online discrete choice experiment designed to elicit preferences over country characteristics to guide decisions about the allocation of external financing for health, we find that stakeholders assign a great deal of importance to health inequalities and the burden of disease but put very little weight on income per capita. We also find considerable variation in preferences across stakeholders, with people from low- and middle-income countries putting more weight on the burden of disease and people from high-income countries putting more weight on health inequalities. These findings suggest that stakeholders put more weight on burden of disease and health inequalities than on income per capita in evaluating which countries should received external financing for health and that that people living in aid recipient may have different preferences than people living in donor countries. Donors may wish to take these differences in preferences in mind if they are reconsidering their aid allocation policies

Reconceptualizing successful pandemic preparedness and response: a feminist perspective

Pandemic preparedness and COVID-19 response indicators focus on public health outcomes (such as infections, case fatalities, and vaccination rates), health system capacity, and/or the effects of the pandemic on the economy, yet this avoids more political questions regarding how responses were mobilized. Pandemic preparedness country rankings have been called into question due to their inability to predict COVID-19 response and outcomes, and COVID-19 response indicators have ignored one of the most well documented secondary effects of the pandemic – its disproportionate effects on women. This paper analyzes pandemic preparedness and response indicators from a feminist perspective to understand how indicators might consider the secondary effects of the pandemic on women and other equity deserving groups. Following a discussion of the tensions that exist between feminist methodologies and the reliance on indicators by policymakers in preparing and responding to health emergencies, we assess the strengths and weakness of current pandemic preparedness and COVID-19 response indicators. The risk with existing pandemic preparedness and response indicators is that they give only limited attention to secondary effects of pandemics and inequities in terms of who is disproportionately affected. There is an urgent need to reconceptualize what ‘successful’ pandemic preparedness and response entails, moving beyond epidemiological and economic measurements. We suggest how efforts to design COVID response indicators on gender inclusion could inform pandemic preparedness and associated indicators

Managing Borders During Public Health Emergencies of International Concern: A Proposed Typology of Cross-Border Health Measures

Background The near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. Results Based on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – policy goal, type of movement (travel and trade), adopted by public or private sector, level of jurisdiction applied, stage of journey, and degree of restrictiveness. These categories are then brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. Addressing the current gaps in evidence about travel measures, including how different jurisdictions apply such measures with varying effects, in turn, enhances the potential for evidence-informed decision-making based on fuller understanding of policy trade-offs and externalities. Finally, through the adoption of standardized terminology and creation of an agreed evidentiary base recognized across jurisdictions, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). Conclusions The widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice

Measuring service quality and assessing its relationship to contraceptive discontinuation: A prospective cohort study in Pakistan and Uganda

Background: The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality measures based on these tools were consistently associated with contraceptive discontinuation.Methods: We linked existing, routinely collected facility audit data from social franchise clinics in Pakistan and Uganda with client data. Clients were women aged 15-49 who initiated a modern, reversible contraceptive method from a sampled clinic. Consented participants completed an exit interview and were contacted 3, 6, and 12 months later. We collapsed indicators into quality domains using theory-based categorization, created summative quality domain scores, and used Cox proportional hazards models to estimate the relationship between these quality domains and discontinuation while in need of contraception.Results: The 12-month all-modern method discontinuation rate was 12.5% among the 813 enrolled women in Pakistan and 5.1% among the 1,185 women in Uganda. We did not observe similar associations between facility-level quality measures and discontinuation across these 2 settings. In Pakistan, an increase in the structural privacy domain was associated with a 60% lower risk of discontinuation, adjusting for age and baseline method (PP=.005).Conclusions: We were not able to leverage existing, widely used quality measurement tools to create quality domains that were consistently associated with discontinuation in 2 study settings. Given the importance of contraceptive service quality and recent advances in indicator standardization in other areas, we recommend further effort to harmonize and simplify measurement tools to measure and improve contraceptive quality of care for all

#WuhanDiary and #WuhanLockdown: gendered posting patterns and behaviours on Weibo during the COVID-19 pandemic

Social media can be both a source of information and misinformation during health emergencies. During the COVID-19 pandemic, social media became a ubiquitous tool for people to communicate and represents a rich source of data researchers can use to analyse users' experiences, knowledge and sentiments. Research on social media posts during COVID-19 has identified, to date, the perpetuity of traditional gendered norms and experiences. Yet these studies are mostly based on Western social media platforms. Little is known about gendered experiences of lockdown communicated on non-Western social media platforms. Using data from Weibo, China's leading social media platform, we examine gendered user patterns and sentiment during the first wave of the pandemic between 1 January 2020 and 1 July 2020. We find that Weibo posts by self-identified women and men conformed with some gendered norms identified on other social media platforms during the COVID-19 pandemic (posting patterns and keyword usage) but not all (sentiment). This insight may be important for targeted public health messaging on social media during future health emergencies

Effect of community health clubs on child diarrhoea in western Rwanda: cluster-randomised controlled trial

Background Community health clubs are multi-session village-level gatherings led by trained facilitators and designed to promote healthy behaviours mainly related to water, sanitation, and hygiene. They have been implemented in several African and Asian countries but have never been evaluated rigorously. We aimed to evaluate the effect of two versions of the community health club model on child health and nutrition outcomes. Methods We did a cluster-randomised trial in Rusizi district, western Rwanda. We defined villages as clusters. We assessed villages for eligibility then randomly selected 150 for the study using a simple random sampling routine in Stata. We stratified villages by wealth index and by the proportion of children younger than 2 years with caregiverreported diarrhoea within the past 7 days. We randomly allocated these villages to three study groups: no intervention (control; n=50), eight community health club sessions (Lite intervention; n=50), or 20 community health club sessions (Classic intervention; n=50). Households in these villages were enrolled in 2013 for a baseline survey, then re-enrolled in 2015 for an endline survey. The primary outcome was caregiver-reported diarrhoea within the previous 7 days in children younger than 5 years. Analysis was by intention to treat and per protocol. This trial is registered with ClinicalTrials.gov, number NCT01836731. Findings At the baseline survey undertaken between May, 2013, and August, 2013, 8734 households with children younger than 5 years of age were enrolled. At the endline survey undertaken between Sept 21, 2015, and Dec 22, 2015, 7934 (91%) of the households were re-enrolled. Among children younger than 5 years, the prevalence of caregiver-reported diarrhoea in the previous 7 days was 514 (14%) of 3616 assigned the control, 453 (14%) of 3196 allocated the Lite intervention (prevalence ratio compared with control 0·97, 95% CI 0·81–1·16; p=0·74), and 495 (14%) of 3464 assigned the Classic intervention (prevalence ratio compared with control 0·99, 0·85–1·15; p=0·87). Interpretation Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reported diarrhoea among children younger than 5 years. Our results question the value of implementing this intervention at scale for the aim of achieving health gains

Child diarrhoea and nutritional status in rural Rwanda: a cross-sectional study to explore contributing environmental and demographic factors.

OBJECTIVE: To explore associations of environmental and demographic factors with diarrhoea and nutritional status among children in Rusizi district, Rwanda. METHODS: We obtained cross-sectional data from 8847 households in May-August 2013 from a baseline survey conducted for an evaluation of an integrated health intervention. We collected data on diarrhoea, water quality, and environmental and demographic factors from households with children <5, and anthropometry from children <2. We conducted log-binomial regression using diarrhoea, stunting and wasting as dependent variables. RESULTS: Among children <5, 8.7% reported diarrhoea in the previous 7 days. Among children <2, stunting prevalence was 34.9% and wasting prevalence was 2.1%. Drinking water treatment (any method) was inversely associated with caregiver-reported diarrhoea in the previous 7 days (PR = 0.79, 95% CI: 0.68-0.91). Improved source of drinking water (PR = 0.80, 95% CI: 0.73-0.87), appropriate treatment of drinking water (PR = 0.88, 95% CI: 0.80-0.96), improved sanitation facility (PR = 0.90, 95% CI: 0.82-0.97), and complete structure (having walls, floor and roof) of the sanitation facility (PR = 0.65, 95% CI: 0.50-0.84) were inversely associated with stunting. None of the exposure variables were associated with wasting. A microbiological indicator of water quality was not associated with diarrhoea or stunting. CONCLUSIONS: Our findings suggest that in Rusizi district, appropriate treatment of drinking water may be an important factor in diarrhoea in children <5, while improved source and appropriate treatment of drinking water as well as improved type and structure of sanitation facility may be important for linear growth in children <2. We did not detect an association with water quality