Explore the vast range of titles available.

Modeling the impact of COVID-19-mitigation strategies on malarial case management and prevention by health services in sub-Saharan Africa predicts 81,000 additional deaths in Nigeria and 769,000 in sub-Saharan Africa in 2020.

Ebola virus continues to cause considerable disease in West Africa, with an initial 70% associated mortality. This report shows improving survival at one center in Sierra Leone. To the Editor: Schieffelin et al. (Nov. 27 issue) 1 reported on 106 patients with Ebola virus disease who were treated in Kenema, Sierra Leone, in May and June 2014. Here we report similar data on the 631 patients with Ebola virus disease, as confirmed by polymerase-chain-reaction assay, who were admitted to the Ebola treatment center at the Hastings Police Training School near Freetown, Sierra Leone, on or after September 20, 2014 (the date on which the first patients were admitted to that center). The 31% case fatality rate at Hastings is lower than the 74% rate reported by Schieffelin et . . .

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social–ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. However, the term ‘lockdown’ is not well-defined. Indeed, WHO’s reference to ‘so-called lockdown measures’ indicates the absence of a clear and universally accepted definition of the term ‘lockdown’. We propose a definition of ‘lockdown’ based on a two-by-two matrix that categorises different communicable disease measures based on whether they are compulsory or voluntary; and whether they are targeted at identifiable individuals or facilities, or whether they are applied indiscriminately to a general population or area. Using this definition, we describe the design, timing and implementation of lockdown measures in nine countries in sub-Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. While there were some commonalities in the implementation of lockdown across these countries, a more notable finding was the variation in the design, timing and implementation of lockdown measures. We also found that the number of reported cases is heavily dependent on the number of tests carried out, and that testing rates ranged from 2031 to 63 928 per million population up until 7 September 2020. The reported number of COVID-19 deaths per million population also varies (0.4 to 250 up until 7 September 2020), but is generally low when compared with countries in Europe and North America. While lockdown measures may have helped inhibit community transmission, the pattern and nature of the epidemic remains unclear. However, there are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic disruption.

Although research on the epidemiology and ecology of Ebola has expanded since the 2014–15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone’s Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola’s destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or ‘suffering with’patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms—and to prevent the spread of Ebola—researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings. Bien que la recherche sur l’épidémiologie et l’écologie du virus Ebola se soit développée depuis l’épidémie de 2014-15 en Afrique de l’Ouest, on accorde peu d’attention à ses répercussions sur la santé mentale et le contexte psychosocial de la maladie pour les prestataires travaillant dans les établissements de soins de santé primaires (plutôt que des unités chargées spécifiquement du traitement d’Ebola). La présente étude se fonde sur 54 entretiens qualitatifs avec 35 prestataires travaillant dans huit centres de santé périphériques des districts de Bo et Kenema en Sierra Leone. La collecte des données a commencé peu avant le climax de l’épidémie en décembre 2014 et a duré 1 mois. Les prestataires ont relaté les changements survenus dans leur vie professionnelle, personnelle et sociale puisqu’ils étaient devenus de facto les premiers intervenants dans la lutte contre l’épidémie. La destruction par Ebola, des liens sociaux et du sentiment de confiance au sein et au-delà des formations sanitaires, des communautés et des familles, est un thème récurrent lors des entrevues. Les prestataires ont raconté qu’ils se sentaient seuls, ostracisés, mal aimés, apeurés, attristés et qu’ils n’étaient plus respectés. Ils ont également discuté des restrictions sur les comportements qui améliorent l’adaptation, notamment assister aux enterrements et accepter les contacts physiques (embrassades, poignées de main, s’asseoir ou manger avec des collègues, des patients et des membres de la famille). Les prestataires ont décrit les mesures de prévention de l’infection comme étant nécessaires, mais controversées, parce que les cabines de dépistage et l’équipement de protection empêchaient l’instauration de liens affectifs ou « d’empathie » avec les patients. Pour atténuer les mécanismes de morbidité psychiatrique et d’inadaptation - et prévenir la propagation du virus Ebola -, les chercheurs et les planificateurs des programmes doivent tenir compte du contexte psychosocial de cette maladie et mettre en place des mécanismes permettant d’améliorer l’assistance psychologique à tous les prestataires de soins de santé, notamment dans les centres de santé périphériques. Aunque la investigación sobre la epidemiología y la ecología del Ébola se ha expandido desde la epidemia del 2014-15 en África occidental, se le ha prestado menos atención a las implicaciones para la salud mental y el contexto psicosocial de la enfermedad de los proveedores que trabajan en centros de atención primaria de salud (en lugar de unidades de tratamiento específicos para el Ébola). Este estudio se basa en 54 entrevistas cualitativas con 35 proveedores que trabajan en ocho unidades de salud periféricas de los distritos de Bo y Kenema de Sierra Leona. La recolección de datos se inició cerca del punto más alto de la epidemia en diciembre de 2014 y duró l mes. Los proveedores describieron los cambios en su vida profesional, personal y social, a medida que se convirtieron en los primeros en responder de facto a la epidemia. Un tema articulado a través de las entrevistas fue la destrucción de la conexión social y el sentido de la confianza dentro y fuera de los centros de salud, las comunidades y las familias causada por el Ébola. Los proveedores describieron sentirse solos, aislados, sin amor, con miedo, tristes y ya no respetados. También discutieron las restricciones sobre los comportamientos que mejoran el acople incluyendo asistir a los entierros y la participación en el contacto físico (abrazos, apretón de manos, sentarse cerca, o comer con colegas, pacientes y miembros de la familia). Los proveedores describieron las medidas de prevención de infecciones como necesarias pero divisivas ya que las cabinas de examinación y equipos de protección inhibieron el acercamiento o ’el sufrimiento con’ los pacientes. Para mitigar las morbilidades psiquiátricas y mecanismos inadecuados de acople- y para evitar la propagación del Ébola- los investigadores y planificadores de programas deben tener en cuenta el contexto psicosocial de esta enfermedad y los mecanismos para mejorar los primeros auxilios psicológicos a todos los proveedores de salud, incluyendo aquellos en centros de salud periféricos. 尽管关于埃博拉的流行和生态的研究已经解释了2014-2015年 间在西非的爆发, 却很少有人关注在初级医疗机构（不是专门 治疗埃博的机构）提供医疗服务的人员的精神健康心理。本 文使用的数据来自于对塞拉利昂Bo和Kenema地区8个周边医 疗单位工作的35个服务提供者进行的54个定性访谈。数据的 收集始于2014年12月, 大概是疾病爆发的高峰, 并持续了一个 月。这些人讲述了他们在疾病爆发中职业、个人和生活上的 变化。一个大家共同提到的主题是埃博拉破坏了社会连接和 机构中、社区中和家庭中大家的信任感。医疗服务提供者描 述自己感到孤单、排斥、不被爱、害怕、悲伤和不再受到尊 重。他们同时也提到了一个行为上的限制, 包括参加葬礼和身 体接触（拥抱, 握手, 坐的比较近, 与同事、病人和家庭成员 吃饭）。他们形容预防感染的措施是需要的, 但是造成了间 隔, 因为这些防御措施阻止了他们与病人之间的互动。为了抵 消精神创伤和心理应对机制——同时防止埃博拉的传染—— 研究人员和项目规划者应该疾病给医护人员带来的心理情境, 以及应对这种问题的机制。

Lassa fever (LF) virus (LASV) is endemic in Sierra Leone (SL) and poses a significant public health threat to the region; however, no risk factors for clinical LF have been reported in SL. The objective of this study was to identify the risk factors for clinical LF in an endemic community in SL. We conducted a case–control study by enrolling 37 laboratory-confirmed LF cases identified through the national LF surveillance system in SL and 140 controls resided within a one-kilometre radius of the case household. We performed a conditional multiple logistic regression analysis to identify the risk factors for clinical LF. Of the 37 cases enrolled, 23 died (62% case fatality rate). Cases were younger than controls (19.5 years vs 28.9 years, p < 0.05) and more frequently female (64.8% vs 52.8%). Compared to the controls, clinical LF cases had higher contact with rodents (rats or mice) in their households in the preceding three weeks (83.8% vs 47.8%). Households with a cat reported a lower presence of rodents (73% vs 38%, p < 0.01) and contributed to a lower rate of clinical LF (48.6% vs 55.7%) although not statistically significant (p = 0.56). The presence of rodents in the households (matched adjusted odds ratio (mAOR): 11.1) and younger age (mAOR: 0.99) were independently associated with clinical LF. Rodent access to households and younger age were independently associated with clinical LF. Rodent access to households is likely a key risk factor for clinical LF in rural SL and potentially in other countries within the West African region. Implementing measures to control rodents and their access to households could potentially decrease the number of clinical LF cases in rural SL and West Africa.

Lassa fever (LF) is prevalent in many West African countries, including Nigeria. Efforts to combat LF have primarily focused on rural areas where interactions between rodents and humans are common. However, recent studies indicate a shift in its occurrence from rural to urban areas. We analysed secondary data of reported LF outbreaks from 2017 to 2021 in Ondo State, Nigeria to identify the distribution pattern, ecological variations, and other determinants of disease spread from the ward level using nearest neighbour statistics and regression analysis. Data utilised include LF incidence, ecological variables involving population, nighttime light intensity, vegetation, temperature, market presence, road length, and building area coverage. ArcGIS Pro 3.0 software was employed for spatial analysis. Results revealed spatio-temporal clustering of LF incidents between 2017 and 2021, with an increasing trend followed by a decline in 2021. All wards in Owo Local Government Area were identified as LF hotspots. The ecological variables exhibited significant correlations with the number of LF cases in the wards, except for maximum temperature. Notably, these variables varied significantly between wards with confirmed LF and those without. Therefore, it is important to prioritise strategies for mitigating LF outbreaks in urban areas of Nigeria and other LF-endemic countries.

The seasonal outbreaks of Mpox continue in most parts of West and Central Africa. In the past year, Nigeria had the highest number of reported cases. Here, we used the PRISMA guidelines to carry out a systematic review and meta-analysis of available evidence on Mpox in Nigeria to assess the prevalence, transmission pattern, diagnostic approach, and other associated factors useful for mitigating the transmission of the disease. All relevant observational studies in PubMed/MEDLINE, Embase, AJOL, Web of Science, Scopus and Google Scholar on Mpox in Nigeria were assessed within the last fifty years (1972 to 2022). In all, 92 relevant articles were retrieved, out of which 23 were included in the final qualitative analysis. Notably, most of the cases of Mpox in Nigeria were from the southern part of the country. Our findings showed a progressive spread from the southern to the northern region of the country. We identified the following factors as important in the transmission of Mpox in Nigeria; poverty, lack of basic healthcare facilities, and risk of exposure through unsafe sexual practices. Our findings reiterate the need to strengthen and expand existing efforts as well as establish robust multi-sectoral collaboration to understand the dynamics of Mpox Nigeria.

Reporting two million human Lassa fever (LF) cases with around 10,000 associated annual mortality, the West African sub-region is endemic for Lassa fever virus (LASV). The true incidence of LF is difficult to determine because most LASV-infected individuals show no differentiating clinical signs and symptoms. We investigated the distribution of cases, post-hospitalization survival patterns, and evaluated factors contributing to infection and clinical course of the disease during an outbreak of LF in Ondo State, Nigeria, from 2017 to 2021. We extracted LF data from the Integrated Disease Surveillance and Response weekly report of the Nigerian Centre for Disease Control for 2017-2021. Kaplan-Meier estimate was used to describe the probability of survival among the LF cases. Also, a univariable binary logistic regression was used to explore factors associated with mortality among the study participants. Key informant was interviewed and environmental assessments were also done. LASV infection was confirmed in 1,115 (24.5%) of 4,551 cases with clinical signs suggestive of LF (age 35.24 ± 20.77) and case fatality rate of 25.5%. Hospitalized patients who did not recover within 17 days had less than 50% chance of survival. Age is a strong predictor of survival; hospitalized patients >40 years were significantly more likely than younger ones to experience mortality (Odds ratio:2.46; 95% CI = 1.67-3.62; p < 0.01). Similarly, male patients were significantly less likely than the females to survive beyond 10 days of hospitalization. Open sun drying of food items and congested urban residential settings with history of frequent rat sightings are possible factors for the increase of LF cases in the study area. Current case definition in Ondo State identified close to 25% of laboratory confirmed LASV infection. Human activities during the dry season (October-March) are associated with increased LF cases. We propose a One Health disease surveillance approach that synchronizes farming activities with educational campaigns as a mitigation strategy against LASV infection and mortality in Nigeria.