Estimating Ro of The COVID-19 Virus Outbreak in Malawi: Opportunities and Challenges

COVID-19 remains a global concern such that social distancing, wearing of face masks and hand washing remain key prevention measures. Additionally, various types of vaccines have been developed and put to use. On the other hand, epidemiologists continue to monitor published COVID-19 data to analyse the dynamics of the disease including estimation of the reproduction number ( Ro). However, lack of continuous authenticated data defines a daunting task of estimating  Ro both locally and globally. This paper aimed at assessing the scope of COVID-19 in Malawi and extent of estimating Ro , existing challenges and opportunities. The assessment showed that for the past one year, COVID-19 data showed some cyclic pattern with a probable occurrence of third wave. But no traceable reasons of curve flattening were clearly met. In addition, we observed missing of some data which present an obstacle to the process of deriving various disease parameters including Ro .Nevertheless, based on the available dataset, a preliminary estimate of Ro=1.05 was obtained using method of generation interval. Thus, more effort should be spent on gathering and publishing clean and continuous data. Nonetheless, the available COVID-19 data, openly published by relevant authorities, sets a benchmark for possible estimation of Ro in Malawi. Keywords: COVID-19, Data, Reproduction number, Challenges, Opportunities, Malawi

Computer-Aided Pharmacoepidemiology in Drug Use and Safety: Examining the Intersection between Data Science and Medicines Research

Pharmacoepidemiology is a relatively new area of study that focuses on research aimed at producing data about drugs’ usage and safety in well-defined populations. Its significant impact on patient safety has translated into improving health care systems worldwide, where it has been widely adopted. This field has developed to an extent that policy and guidelines makers have started using its evidence alongside that produced from randomised controlled clinical trials. Although this significant improvement has been partly attributed to the adoption of statistics and computer-aided models into the way pharmacoepidemiology studies are designed and conducted, certain gaps still exist. This chapter reports some of the significant developments made, along with the gaps observed so far, in the adoption of statistics and computing into pharmacoepidemiology research. The goal is to highlight efforts that have led to the new pharmacoepidemiology developments, while examining the intersection between data science and pharmacology through research narrative reviews of computer-aided pharmacology. The chapter shows the significant number of initiatives that have been applied/adopted to improve pharmacoepidemiology research. Nonetheless, further developments in integrating pharmacoepidemiology with computers and statistics are needed in order to enhance the research agenda

On Average Distance of Neighborhood Graphs and Its Applications

Graph invariants such as distance have a wide application in life, in particular when networks represent scenarios in form of either a bipartite or non-bipartite graph. Average distance μ of a graph G is one of the well-studied graph invariants. The graph invariants are often used in studying efficiency and stability of networks. However, the concept of average distance in a neighborhood graph G′ and its application has been less studied. In this chapter, we have studied properties of neighborhood graph and its invariants and deduced propositions and proofs to compare radius and average distance measures between G and G′. Our results show that if G is a connected bipartite graph and G′ its neighborhood, then radG1′≤radG and radG2′≤radG whenever G1′ and G2′ are components of G′. In addition, we showed that radG′≤radG for all r≥1 whenever G is a connected non-bipartite graph and G′ its neighborhood. Further, we also proved that if G is a connected graph and G′ its neighborhood, then and μG1′≤μG and μG2′≤μG whenever G1′ and G2′ are components of G′. In order to make our claims substantial and determine graphs for which the bounds are best possible, we performed some experiments in MATLAB software. Simulation results agree very well with the propositions and proofs. Finally, we have described how our results may be applied in socio-epidemiology and ecology and then concluded with other proposed further research questions

Perceptions of pregnant women on antenatal care visit during their first trimester at area 25 health center in Lilongwe, Malawi – a qualitative study

Abstract Background Initiation of antenatal care during the first trimester is crucial for reducing maternal and neonatal morbidity and mortality. Unfortunately, only 24% of pregnant women in Malawi initiate antenatal care during this time with even lower rates of 15% at Area 25 Health Centre in Lilongwe. Despite such cases, there is little literature on obstacles that prevent women from accessing first-trimester antenatal care in Malawi. Aim To explore perceptions of pregnant women and how they influence antenatal care visits during the first trimester at Area 25 Health Centre in Lilongwe, Malawi. Methods We employed a qualitative exploratory study on 55 purposely identified participants. The participants were aged between 18 and 37 years with a gestational period of 36 weeks and below and attended antenatal care at Area 25 Health Centre in Lilongwe Urban, Malawi. Data were collected by MN and 2 data collectors from 19th March 2021 to 16th April 2021 through a total of 15 In-depth Interviews (IDIs) and four Focus Group Discussions (FGDs). Data were manually analysed using thematic analysis, which included categorization and deductive theme identification with reference to the study objectives and the Health Belief Model (HBM). Results Pregnant women perceived that the first-trimester antenatal care visits were only for those experiencing ill health conditions like backache, headache, and HIV/AIDS during pregnancy. First-trimester pregnancy was perceived as too small and not worthy of seeking antenatal care; the women placed a low value on it. The majority of those who initiated antenatal care in the first trimester had previously experienced disorders and complications such as previous cesarean sections and abortions. In addition to limited knowledge about the required total number of ANC visits, challenges such as long-distance, preoccupation with business, multiple antenatal visits, scheduling of antenatal care visits, negative attitude of health workers, adherence to COVID-19 containment measures, and inadequate partner support, were identified as barriers to seeking antenatal care during the first trimester. Conclusion The negative perceptions among pregnant women, coupled with various health systems, socio-economic and individual barriers, contributed to low attendance rates for first trimester antenatal care in Malawi. Addressing knowledge gaps and overcoming barriers related to economic, individual and health care delivery can improve women’s early antenatal care visits. Future research should consider the pregnant women from diverse socioeconomic backgrounds to gain a better understanding of these perceptions and barriers

Herbal medicine use during pregnancy and childbirth: perceptions of women living in Lilongwe rural, Malawi – a qualitative study

Abstract Background Globally, use of herbal medicine during pregnancy and labour is often associated with adverse obstetric outcomes such as uterine rupture and fetal distress. However, in rural Malawi, information on the perceptions of women about the use of herbal medicine during pregnancy and labour is underreported despite the practice. Understanding women’s views and perceptions on use of herbal medicine during pregnancy and labour is therefore critical for understanding the basis of their practice and for setting up maternal and neonatal health care interventions to alleviate any possible pregnancy and labour complications. Aims To explore the perceptions of women on the use of herbal medicine during pregnancy and labour in rural Malawi. Methods We employed a qualitative descriptive (QD) study on the purposively identified participants (women with parity $$\ge 2$$ ≥ 2 ), residing in four villages (Kagona, Champsinja, Mthupi and Manja) of Traditional Authority Malili, in Lilongwe rural district, Malawi. Qualitative data was collected through four Focus Groups of 6–8 women in each group that were conducted in each village. Data analysis was performed inductively, using reflexive thematic analysis approach. Results A total of 28 women of reproductive age 20 and above; 20–24 (32.14%), married (75%), average of 3 deliveries (57.14%), primary school education (75.0%), and Christians (92.86%) were recruited and interviewed. Two main themes emerged from the narratives: (1) perceived benefits of using herbal medicine: (i) hastens labour, (ii) prevents pregnancy complications and (iii) prevents and treats illnesses, and (2) perceived risks of using herbal medicine: (i) perceived maternal risks, (ii) perceived fetal risks. Conclusion In rural Malawi, the practice of using herbal medicine during pregnancy and labour is perceived as both risky and beneficial to women. These perceptions are shaped by the exposure to either personal or other people’s experiences, hence the continued practice. Therefore, inclusion of health education topics on maternal complications due to use of herbal medicine among women can help reduce maternal and neonatal mortality rates in rural Malawi. Further research is also warranted to explore accessibility and community pathway systems for herbal medicine use during pregnancy and labour among the pregnant women

COVID-19 transmission dynamics and the impact of vaccination:modelling, analysis and simulations

Despite the lifting of COVID-19 restrictions, the COVID-19 pandemic and its effects remain a global challenge including the sub-Saharan Africa (SSA) region. Knowledge of the COVID-19 dynamics and its potential trends amidst variations in COVID-19 vaccine coverage is therefore crucial for policy makers in the SSA region where vaccine uptake is generally lower than in high-income countries. Using a compartmental epidemiological model, this study aims to forecast the potential COVID-19 trends and determine how long a wave could be, taking into consideration the current vaccination rates. The model is calibrated using South African reported data for the first four waves of COVID-19, and the data for the fifth wave are used to test the validity of the model forecast. The model is qualitatively analysed by determining equilibria and their stability, calculating the basic reproduction number R0 and investigating the local and global sensitivity analysis with respect to R0. The impact of vaccination and control interventions are investigated via a series of numerical simulations. Based on the fitted data and simulations, we observed that massive vaccination would only be beneficial (deaths averting) if a highly effective vaccine is used, particularly in combination with non-pharmaceutical interventions. Furthermore, our forecasts demonstrate that increased vaccination coverage in SSA increases population immunity leading to low daily infection numbers in potential future waves. Our findings could be helpful in guiding policy makers and governments in designing vaccination strategies and the implementation of other COVID-19 mitigation strategies