Prevalence of comorbid disease and associated risk factors among homeless people living in temporary shelters during the COVID-19 lockdown in Tshwane, South Africa.

BACKGROUND: People experiencing homelessness are among the most socially and medically vulnerable populations. OBJECTIVES: To assess the prevalence of comorbid disease and associated risk factors among homeless people admitted to temporary shelters in the City of Tshwane during levels 4 and 5 of the COVID-19 national lockdown in South Africa. METHODS: A descriptive cross-sectional study design was used. The sample was drawn from secondary data on all individuals placed in temporary shelters constructed by Tshwane during levels 4 and 5 of the COVID-19 lockdown (26 March - 31 May 2020). Descriptive statistics were used to summarise data, and a multivariable logistic regression model was applied to determine factors associated with comorbid disease. RESULTS: The overall prevalence of comorbid disease among homeless people in temporary shelters in Tshwane was 28.8% (95% confidence interval (CI) 26.9 - 30.8). There was no significant difference in the prevalence of comorbid disease by illicit substance use (29.9% for users v. 29.5% for non-users; p=0.871). In adjusted analyses, being South African (adjusted odds ratio (aOR) 2.06; 95% CI 1.10 - 3.88; p=0.024), being female (aOR 3.73; 95% CI 1.85 - 7.53; p<0.001), being black (aOR 3.43; 95% CI 1.12 - 10.54; p=0.031) or white (aOR 6.11; 95% CI 1.55 - 24.0; p=0.01), and injecting substances (aOR 1.68; 95% CI 1.19 - 2.37; p=0.003) were significantly associated with having comorbid disease. CONCLUSION: The study found a 28.8% prevalence of comorbid disease among homeless people placed in temporary shelters in Tshwane. In adjusted analysis, being South African, being female, black and white race, and injecting substances were associated with having comorbid disease. Strengthening of public health interventions such as needle and syringe exchange programmes, family planning and access to primary care with health education could improve the healthcare of people experiencing homelessness.

The FAST-M complex intervention for the detection and management of maternal sepsis in low-resource settings: a multi-site evaluation.

OBJECTIVE: To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting. DESIGN: A before-and-after design. SETTING: Fifteen government healthcare facilities in Malawi. POPULATION: Women suspected of having maternal sepsis. METHODS: The FAST-M complex intervention consisted of the following components: the FAST-M maternal sepsis treatment bundle and the FAST-M implementation programme. Performance of selected process outcomes was compared between a 2-month baseline phase and 6-month intervention phase with compliance used as a proxy measure of feasibility. MAIN OUTCOME RESULT: Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle. RESULTS: Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis. CONCLUSION: Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi. TWEETABLE ABSTRACT: Implementation of a sepsis care bundle for low-resources improved recognition & management of maternal sepsis.

In depth analysis of patients with severe SARS-CoV-2 in sub-Saharan Africa demonstrates distinct clinical and immunological profiles.

Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we comprehensively characterise patients hospitalised with suspected or confirmed COVID-19, and healthy community controls. PCR-confirmed COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-/IgG+ and PCR-/IgG-participants. PCR-/IgG+ participants exhibited a nasal and systemic cytokine signature analogous to PCR-confirmed COVID-19 participants, but increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. We did not find evidence that HIV co-infection in COVID-19 participants was associated with mortality or altered cytokine responses. The nasal immune signature in PCR-/IgG+ and PCR-confirmed COVID-19 participants was distinct and predominated by chemokines and neutrophils. In addition, PCR-/IgG+ individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies.

Early onset myasthenia gravis in a Malawian woman: Challenges in managing myasthenia gravis in a low-resource setting.

Myasthenia gravis is a rare autoimmune disease, which presents with ocular or generalised symptoms. Few publications describe its prevalence in African populations. We describe a young woman who was diagnosed with myasthenia gravis in a Malawian public hospital and outline the challenges encountered in managing this condition in a low-resource setting.

The Incursion and Spread of Highly Pathogenic Avian Influenza H5N8 Clade 2.3.4.4 Within South Africa.

The report of a mass die-off of white-winged terns (Chlidonias leucopterus) along the shores of Lake Victoria in Uganda in January 2017 was a warning that highly pathogenic avian influenza (HPAI) H5N8 clade 2.3.4.4 had entered the avian populations of the African Rift Valley. In early June 2017, Zimbabwe reported an outbreak of the virus in commercial breeder chickens near Harare, and on June 19, 2017, the first case of HPAI H5N8 was confirmed in a broiler breeder operation near Villiers, Mpumalanga Province, South Africa, representing the first ever notifiable influenza in gallinaceous poultry in South Africa. Forty viruses were isolated from wild birds, backyard hobby fowl, zoo collections, commercial chickens, and commercial ostriches over the course of the outbreak and full genomes were sequenced and compared to determine the epidemiologic events in the introduction and spread of clade 2.3.4.4 H5N8 across the country. We found that multiple virus variants were involved in the primary outbreaks in the north-central regions of South Africa, but that a single variant affected the southernmost regions of the continent. By November 2017 only two of the nine provinces in South Africa remained unaffected, and the layer chicken industry in Western Cape Province was all but decimated. Two distinct variants, suggesting independent introductions, were responsible for the first two index cases and were not directly related to the virus involved in the Zimbabwe outbreak. The role of wild birds in the incursion and spread was demonstrated by shared recent common ancestors with H5N8 viruses from West Africa and earlier South African aquatic bird low pathogenicity avian influenza viruses. Improved wild bird surveillance will play a more critical role in the future as an early warning system.

Incursión y propagación del virus de la influenza aviar altamente patógena H5N8 clado 2.3.4.4 en Sudáfrica. El informe de una muerte masiva de fumareles aliblancos (Chlidonias leucopterus) a lo largo de las orillas del lago Victoria en Uganda en enero del 2017 fue una advertencia de que la influenza aviar de alta patogenicidad (HPAI) H5N8, clado 2.3.4.4 había ingresado en las poblaciones de aves del Valle del Rift Africano. A principios de junio del 2017, Zimbabwe reportó un brote del virus en pollos reproductores comerciales cerca de Harare, y el 19 de junio del 2017, el primer caso de influenza aviar de alta patogenicidad H5N8 se confirmó en una operación de pollos de engorde en la provincia de Mpumalanga cerca de Villiers, Sudáfrica, que representa el primer caso de influenza notificable en aves gallináceas en Sudáfrica. Se aislaron cuarenta virus de aves silvestres, aves de traspatio, colecciones de zoológicos, pollos comerciales y avestruces comerciales durante el transcurso del brote. Se secuenciaron los genomas completos y se compararon para determinar los eventos epidemiológicos en la introducción y propagación del subtipo H5N8 clado 2.3.4.4 a través del país. Se encontró que múltiples variantes del virus estaban involucradas en los brotes primarios en las regiones centro y norte de Sudáfrica, pero que una sola variante afectaba a las regiones más al sur del continente. En noviembre de 2017, solo dos de las nueve provincias de Sudáfrica permanecían sin afectarse y la industria de pollos en la Provincia de Cabo Occidental resultó casi diezmada. Dos variantes distintas, que sugieren introducciones independientes, fueron responsables de los dos primeros casos índices y no estuvieron directamente relacionados con el virus involucrado en el brote de Zimbabwe. El papel de las aves silvestres en la incursión y diseminación fue demostrado por los ancestros comunes compartidos con los virus H5N8 de África Occidental y los virus de la influenza aviar de baja patogenicidad de aves acuáticas de Sudáfrica detectados anteriormente. La mejora de la vigilancia de aves silvestres jugará un papel más crítico en el futuro como un sistema de alerta temprana.

Strategies developed and implemented by women's groups to improve mother and infant health and reduce mortality in rural Malawi.

We evaluated the strategies to tackle maternal and infant health problems developed by women's groups in rural Malawi. Quantitative data were analyzed on strategies developed by 184 groups at two of the meetings in the community action cycle (attended by 3365 and 3047 women). Data on strategies implemented was collected through a survey of the 197 groups active in January 2010. Qualitative data on the identification and implementation of strategies was collected through 17 focus group discussions and 12 interviews with men and women. To address the maternal and child health problems identified the five most common strategies identified were: health education sessions, bicycle ambulances, training of traditional birth attendants, wetland vegetable garden (dimba garden) cultivation and distribution of insecticide treated bednets (ITNs). The five most common strategies actually implemented were: dimba garden cultivation, health education sessions, ITN distribution, health programme radio listening clubs and clearing house surroundings. The rationale behind the strategies and the factors facilitating and hindering implementation are presented. The potential impact of the strategies on health is discussed. Women's groups help communities to take control of their health issues and have the potential to reduce neonatal, infant and maternal mortality and morbidity in the longer term.