Disparate on-site access to water, sanitation, and food storage heighten the risk of COVID-19 spread in Sub-Saharan Africa.

COVID-19 is an active pandemic that likely poses an existential threat to humanity. Frequent handwashing, social distancing, and partial or total lockdowns are among the suite of measures prescribed by the World Health Organization (WHO) and being implemented across the world to contain the pandemic. However, existing inequalities in access to certain basic necessities of life (water, sanitation facility, and food storage) create layered vulnerabilities to COVID-19 and can render the preventive measures ineffective or simply counterproductive. We hypothesized that individuals in households without any of the named basic necessities of life are more likely to violate the preventive (especially lockdown) measures and thereby increase the risk of infection or aid the spread of COVID-19. Based on nationally-representative data for 25 sub-Saharan African (SSA) countries, multivariate statistical and geospatial analyses were used to investigate whether, and to what extent, household family structure is associated with in-house access to basic needs which, in turn, could reflect on a higher risk of COVID-19 infection. The results indicate that approximately 46% of the sampled households in these countries (except South Africa) did not have in-house access to any of the three basic needs and about 8% had access to all the three basic needs. Five countries had less than 2% of their households with in-house access to all three basic needs. Ten countries had over 50% of their households with no in-house access to all the three basic needs. There is a social gradient in in-house access between the rich and the poor, urban and rural richest, male- and female-headed households, among others. We conclude that SSA governments would need to infuse innovative gender- and age-sensitive support services (such as water supply, portable sanitation) to augment the preventive measures prescribed by the WHO. Short-, medium- and long-term interventions within and across countries should necessarily address the upstream, midstream and downstream determinants of in-house access and the full spectrum of layers of inequalities including individual, interpersonal, institutional, and population levels.

Corrigendum to "Organizational safety culture perceptions of healthcare workers in Ghana: A cross-sectional interview study".

[This corrects the article DOI: 10.1016/j.ijnsa.2021.100020.].

Organizational safety culture perceptions of healthcare workers in Ghana: A cross-sectional interview study.

Background: Evidence shows that routine occupational safety and health (OSH) training is critical for maintaining good safety culture at healthcare facilities. However, our understanding of how healthcare facility type and routine OSH training interactively influence the number of reported organizational safety culture perceptions is limited. Objectives: This study assesses the interactive effect of healthcare facility type and OSH training on the number of reported organizational safety culture perceptions of healthcare workers in Ghana, secondly it evaluates how the relationship was attenuated when theoretically relevant factors (compositional and contextual) were considered, and lastly examines the magnitude and order of association between the predictors and the number of reported organizational safety culture perceptions. Design: Cross-sectional interview study. Setting and participants: The researchers interviewed 500 healthcare workers in seventeen healthcare facilities in the Central region of Ghana. Methods: Negative binomial regression models were fitted to cross-sectional survey data on 500 healthcare workers in Ghana. Results: Healthcare workers who work in healthcare centers (24%, P<0.05) and hospitals (23%, P<0.05) where routine OSH training was conducted were more likely to report good organizational safety culture perceptions compared with their counterparts who work at healthcare centers where no routine OSH training was conducted. Individuals who were above 39 years (23%, P<0.05) were more likely to report good organizational safety culture perceptions compared with their counterparts in the 20-29-year category. Female healthcare workers (11%, P<0.05) were more likely to report good organizational safety culture perceptions compared with their male counterparts. Conclusions: These findings provide valuable information for policymakers and stakeholders in the healthcare sector to develop interventions necessary for improving safety culture at healthcare facilities.

Household cooking fuel type and childhood anaemia in sub-Saharan Africa: analysis of cross-sectional surveys of 123, 186 children from 29 countries.

OBJECTIVE: This study sought to investigate the joint effect of household cooking fuel type and urbanicity (rural-urban residency) on anaemia among children under the age of five in sub-Saharan Africa. DESIGN: We analysed cross-sectional data of 123, 186 children under the age of five from 29 sub-Saharan African countries gathered between 2010 and 2019 by the Demographic and Health Survey programme. Bivariate (χ2 test of independence) and multilevel logistic regression were used to examine the effect of urbanicity-household cooking fuel type on childhood anaemia. Results were reported as adjusted odds ratios (aORs) with 95% CIs at p<0.05. OUTCOME MEASURES: Anaemia status of children. RESULTS: More than half (64%) of children had anaemia. The percentage of children who suffered from anaemia was high in those born to mothers in Western Africa (75%) and low among those born in Southern Africa (54%). Children from rural households that depend on unclean cooking fuels (aOR=1.120; 95% CI 1.033 to 1.214) and rural households that depend on clean cooking fuels (aOR=1.256; 95% CI 1.080 to 1.460) were more likely to be anaemic as compared with children from urban households using clean cooking fuel. Child's age, sex of child, birth order, perceived birth size, age of mother, body mass index of mother, education, marital status, employment status, antenatal care, wealth quintile, household size, access to electricity, type of toilet facility, source of drinking water and geographic region had significant associations with childhood anaemia status. CONCLUSIONS: Our study has established a joint effect of type of household cooking fuel and urbanicity on anaemia among children under the age of five in sub-Saharan Africa. It is therefore critical to promote the usage of clean cooking fuels among households and women in rural areas. These should be done taking into consideration the significant child, maternal, household, and contextual factors identified in this study.

Assessing sub-regional-specific strengths of healthcare systems associated with COVID-19 prevalence, deaths and recoveries in Africa.

INTRODUCTION: The coronavirus 2019 (COVID-19) has overwhelmed the health systems of several countries, particularly those within the African region. Notwithstanding, the relationship between health systems and the magnitude of COVID-19 in African countries have not received research attention. In this study, we investigated the relationship between the pervasiveness of the pandemic across African countries and their Global Health Security Index (GHSI) scores. MATERIALS AND METHODS: The study included 54 countries in five regions viz Western (16); Eastern (18); Middle (8); Northern (7); and Southern (5) Africa. The outcome variables in this study were the total confirmed COVID-19 cases (per million); total recoveries (per million); and the total deaths (per million). The data were subjected to Spearman's rank-order (Spearman's rho) correlation to determine the monotonic relationship between each of the predictor variables and the outcome variables. The predictor variables that showed a monotonic relationship with the outcome were used to predict respective outcome variables using multiple regressions. The statistical analysis was conducted at a significance level of 0.05. RESULTS: Our results indicate that total number of COVID-19 cases (per million) has strong correlations (rs >0.5) with the median age; aged 65 older; aged 70 older; GDP per capita; number of hospital beds per thousand; Human Development Index (HDI); recoveries (per million); and the overall risk environment of a country. All these factors including the country's commitments to improving national capacity were related to the total number of deaths (per million). Also, strong correlations existed between the total recoveries (per million) and the total number of positive cases; total deaths (per million); median age; aged 70 older; GDP per capita; the number of hospital beds (per thousand); and HDI. The fitted regression models showed strong predictive powers (R-squared>99%) of the variances in the total number of COVID-19 cases (per million); total number of deaths (per million); and the total recoveries (per million). CONCLUSIONS: The findings from this study suggest that patient-level characteristics such as ageing population (i.e., 65+), poverty, underlying co-morbidities-cardiovascular disease (e.g., hypertension), and diabetes through unhealthy behaviours like smoking as well as hospital care (i.e., beds per thousand) can help explain COVID-19 confirmed cases and mortality rates in Africa. Aside from these, other determinants (e.g., population density, the ability of detection, prevention and control) also affect COVID-19 prevalence, deaths and recoveries within African countries and sub-regions.

Self-reported disease symptoms of stone quarry workers exposed to silica dust in Ghana.

BACKGROUND AND AIMS: Understanding the importance of using personal protective equipment (PPE) and the influence of work-post (working distance to main dust source-crusher) in stone quarries is vital for designing tailored interventions in minimizing workers' exposure to silica dust. Nonetheless, studies on silica dust and disease symptoms in Ghana are nascent. This study assessed how work-post and use of required PPE jointly influence exposure to silica dust and disease symptoms in Ghana. METHODS: Generalized linear models (complementary log-log regression) were fitted to cross-sectional survey data of 524 stone quarry workers in Ghana to assess the joint effect of work-post and PPE usage on self-reported disease symptoms while controlling for relevant compositional and contextual factors. RESULTS: Stone quarry workers who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 90% and 87% respectively less likely to report eye irritation compared with their counterparts who work between 1 and 100 m from the crusher without the required PPE. Individuals who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 94% and 95% respectively less likely to report breathing difficulty compared with the reference group. Workers who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 97% and 99% respectively less likely to report coughing compared with the reference group. Workers who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 93% and 97% respectively less likely to report common cold compared with their counterparts who work between 1 and 100 m from the crusher without the required PPE. CONCLUSION: There are adverse health implications for people who work in silica dust polluted environments, suggesting the need for a national safety and health policy to target them.

Access to improved water and sanitation in sub-Saharan Africa in a quarter century.

The realization of the scale, magnitude, and complexity of the water and sanitation problem at the global level has compelled international agencies and national governments to increase their resolve to face the challenge. There is extensive evidence on the independent effects of urbanicity (rural-urban environment) and wealth status on access to water and sanitation services in sub-Saharan Africa. However, our understanding of the joint effect of urbanicity and wealth on access to water and sanitation services across spatio-temporal scales is nascent. In this study, a pooled regression analysis of the compositional and contextual factors that systematically vary with access to water and sanitation services over a 25-year time period in fifteen countries across sub-Saharan Africa (SSA) was carried out. On the whole, substantial improvements have been made in providing access to improved water sources in SSA from 1990 to 2015 unlike access to sanitation facilities over the same period. Households were 28.2 percent and 125.2 percent more likely to have access to improved water sources in 2000-2005 and 2010-2015 respectively, than in 1990-1995. Urban rich households were 329 percent more likely to have access to improved water sources compared with the urban poor. Although access to improved sanitation facilities increased from 69 percent in 1990-1995 and 74 percent in 2000-2005 it declined significantly to 53 percent in 2010-2015. Urban rich households were 227 percent more likely to have access to improved sanitation facilities compared with urban poor households. These results were mediated and attenuated by biosocial, socio-cultural and contextual factors and underscore the fact that the challenge of access to water and sanitation in sub-Saharan Africa is not merely scientific and technical but interwoven with environment, culture, economics and human behaviour necessitating the need for interdisciplinary research and policy interventions.