The effects of the SARS-CoV-2 pandemic on the delivery of maternal and child health services in South Africa.

OBJECTIVE: The COVID-19 pandemic severely interrupted the functioning of healthcare systems, negatively affecting the global provision of maternal and child health (MCH) services. This study aims to specify the effects of COVID-19 on these services in the Gauteng province (South Africa) and to put forward context-specific recommendations aimed at augmenting them and ensuring ongoing uninterrupted coverage, even and especially during pandemics. METHODS: In this quantitative study, a retrospective review of District Health Information System data routinely collected between February 2019 and March 2021 was conducted, comparing performance of the relevant indicators across the two-year span. The data were analyzed using Stata 16 statistical software (StataCorp). The two sample t-test with equal variance and the Mann-Whitney test were applied to evaluate the equality of the indicators. RESULTS: Routine MCH services were negatively impacted, with marked declines in all relevant indicators from the onset of the pandemic. There was a statistically significant decline in cervical cancer coverage and maternal postnatal visits within six days of delivery. While declines in the other critical indicators were likewise observed, they were not statistically significant. CONCLUSION: The South African response to the pandemic had negative repercussions on all MCH services in the Gauteng province. The lessons to be drawn from the pandemic experience should help to strengthen health system capacities, boost service provision, and mitigate future damage to the healthcare system.

Defining and identifying the critical elements of operational readiness for public health emergency events: a rapid scoping review.

INTRODUCTION: COVID-19 showed that countries must strengthen their operational readiness (OPR) capabilities to respond to an imminent pandemic threat rapidly and proactively. We conducted a rapid scoping evidence review to understand the definition and critical elements of OPR against five core sub-systems of a new framework to strengthen the global architecture for Health Emergency Preparedness Response and Resilience (HEPR). METHODS: We searched MEDLINE, Embase, and Web of Science, targeted repositories, websites, and grey literature databases for publications between 1 January 2010 and 29 September 2021 in English, German, French or Afrikaans. Included sources were of any study design, reporting OPR, defined as immediate actions taken in the presence of an imminent threat, from groups who led or responded to a specified health emergency. We used prespecified and tested methods to screen and select sources, extract data, assess credibility and analyse results against the HEPR framework. RESULTS: Of 7005 sources reviewed, 79 met the eligibility criteria, including 54 peer-reviewed publications. The majority were descriptive reports (28%) and qualitative analyses (30%) from early stages of the COVID-19 pandemic. Definitions of OPR varied while nine articles explicitly used the term 'readiness', others classified OPR as part of preparedness or response. Applying our working OPR definition across all sources, we identified OPR actions within all five HEPR subsystems. These included resource prepositioning for early detection, data sharing, tailored communication and interventions, augmented staffing, timely supply procurement, availability and strategic dissemination of medical countermeasures, leadership, comprehensive risk assessment and resource allocation supported by relevant legislation. We identified gaps related to OPR for research and technology-enabled manufacturing platforms. CONCLUSIONS: OPR is in an early stage of adoption. Establishing a consistent and explicit framework for OPRs within the context of existing global legal and policy frameworks can foster coherence and guide evidence-based policy and practice improvements in health emergency management.

COVID-19 pandemic in Malawi: Did public sociopolitical events gatherings contribute to its first-wave local transmission?

INTRODUCTION: The COVID-19 pandemic in Malawi emerged amidst widespread anti-government demonstrations and subsequent mass gatherings. This paper describes the incidence and factors associated with the spread of the COVID-19 pandemic in Malawi. METHODOLOGY: This was a retrospective study of public data analysing geopolitical and immigration activities that occurred between 02 April and 08 September 2020. The Chi-square test of independence was used to tabulate sex and age-related fatality ratios among deaths due to COVID-19-related complications. RESULTS: The drivers for COVID-19 spread were mass gatherings secondary to the country's political landscape and repatriation of citizens from high-risk areas coupled with minimum use of public health interventions. The prevalence was higher in people aged 50-59 years, males and in urban areas. Men had an increased risk of COVID-19-related deaths (Case Fatality Ratio: 1.58 (95% CI 1.11-2.22) compared with women. Furthermore, men and women aged ≥40 years were 16.1 times and 7.1 times more likely to die of COVID-related complications, respectively. Men aged ≥40 years had a 62% increased risk of deaths compared with women of the same age group. CONCLUSION: Mass political gatherings and cross-border immigration from high-risk areas were drivers for infection. Males, older age and urban residence were associated with increased COVID-19 morbidity and mortality. To control the spread of COVID-19 there is a need to regulate mass gatherings and repatriation of citizens, and strengthen the use of preventive health interventions. Men, the older age groups and urban areas should be prioritised for COVID-19 prevention strategies.