[The impact of the COVID-19 pandemic on health service utilisation in the City of Niamey: a study conducted in 17 health care facilities from January to June 2020]. / Impact de la pandémie de la COVID-19 sur l'utilisation des services de santé dans la ville de Niamey: une analyse dans 17 formations sanitaires de janvier à juin 2020.

COVID-19 pandemic has posed huge challenges for the health system in Africa; however they haven´t been well quantified. The purpose of this study was to assess the impact of COVID-19 pandemic on curative and preventive activities in health care facilities at 17 integrated health centers in Niamey by comparing the first half of 2020 and the first half of 2019. The differences were more pronounced in the second quarter of 2020, with a 34% reduction (95% CI: -47% to -21%) for curative care, 61% (95% CI: -74% to -48%) for pentavalent vaccines 1 and 3 and 36% (95% CI: -49% to -23%) for VAR 1. A nearly zero gain of 1% (95% IC: -2% to 4%) was reported for prenatal care attendance, thus reversing the gains of the first quarter. The COVID-19 pandemic has had negative effects on service deliveries to the most vulnerable groups, such as women and children. New strategies, such as community engagement, are essential.

Implementing COVID-19 response within the context of the broader health system: a proposed framework for Africa´s policy makers.

Heads of government in Africa responded to the COVID-19 pandemic by setting up high-level task forces at continental and national levels to coordinate preparedness and response strategies, in a bid to mitigate the spread of this virus on the continent. However, the current strategy at both continental and national levels are narrowly focused on COVID-19 and this is not sustainable. This is because Africa has a high burden of communicable and non-communicable diseases and sustaining access to essential life-saving health services is also critical during this pandemic. Therefore, we call for a more holistic health systems-based model for COVID-19 outbreak response. We recommend that response strategies should be transitioned from vertical isolated programmes to a broad-based "time-bound" integrated health system intervention that links with existing health programmes as well as other government and non-governmental sectors.

Implementing COVID-19 response within the context of the broader health system: a proposed framework for Africa´s policy makers

Heads of government in Africa responded to the COVID-19 pandemic by setting up high-level task forces at continental and national levels to coordinate preparedness and response strategies, in a bid to mitigate the spread of this virus on the continent. However, the current strategy at both continental and national levels are narrowly focused on COVID-19 and this is not sustainable. This is because Africa has a high burden of communicable and non-communicable diseases and sustaining access to essential life-saving health services is also critical during this pandemic. Therefore, we call for a more holistic health systems-based model for COVID-19 outbreak response. We recommend that response strategies should be transitioned from vertical isolated programmes to a broad-based "time-bound" integrated health system intervention that links with existing health programmes as well as other government and non-governmental sectors

Developing vaccinology expertise for Africa: six years and counting.

There exists high quality evidence showing that interactive educational meetings and workshops can improve healthcare worker performance. This evidence formed the basis for establishing the annual African Vaccinology Course in 2005 at the University of Cape Town in South Africa. The course, which is designed to develop vaccinology expertise for Africa, covers relevant basic sciences pertaining to vaccine-preventable diseases such as epidemiology, immunology and microbiology; discusses specific vaccine-preventable diseases; provides information on vaccine safety, vaccination strategies and evaluation of vaccines; discusses new vaccines in the pipeline; and promotes vaccine advocacy. We hope that course alumni would become strong advocates for childhood immunisation in their respective countries. Such dedicated advocacy should contribute to reducing the time gap between the development of new vaccines and the formulation of policies enabling their introduction in African countries, as well as contributing to more equitable increase in immunisation coverage in our continent.

Vitamin A supplementation for reducing the risk of mother-to-child transmission of HIV infection.

BACKGROUND: Observational studies of pregnant women in sub-Saharan Africa have shown that low serum vitamin A levels are associated with an increased risk of mother-to-child transmission (MTCT) of HIV. Vitamin A is cheap and easily provided through existing health services in low-income settings. It is thus important to determine the effect of routine supplementation of HIV positive pregnant or breastfeeding women with this vitamin on the risk of MTCT of HIV, which currently results in more than 1000 new HIV infections each day world-wide. OBJECTIVES: We aimed to assess the effect of antenatal and or postpartum vitamin A supplementation on the risk of MTCT of HIV as well as infant and maternal mortality and morbidity. SEARCH STRATEGY: In June 2010 we searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, AIDS Education Global Information System, and WHO International Clinical Trials Registry Platform; and checked reference lists of identified articles for any studies published after the earlier version of this review was updated in 2008. SELECTION CRITERIA: We selected randomised controlled trials conducted in any setting that compared vitamin A supplementation with placebo in known HIV-infected pregnant or breastfeeding women. DATA COLLECTION AND ANALYSIS: At least two authors independently assessed trial eligibility and quality and extracted data. We calculated relative risks (RR) or mean differences (MD), with their 95% confidence intervals (CI) for each study. We conducted meta-analysis using a fixed-effects method (when there was no significant heterogeneity between study results, i.e. P>0.1) or the random-effects method (when there was significant heterogeneity), and report the Higgins' statistic for all pooled effect measures. MAIN RESULTS: Five randomised controlled trials which enrolled 7,528 HIV-infected women (either during pregnancy or the immediate postpartum period) met our inclusion criteria. These trials were conducted in Malawi, South Africa, Tanzania, and Zimbabwe between 1995 and 2005. We combined the results of these trials and found no evidence that vitamin A supplementation has an effect on the risk of MTCT of HIV (4 trials, 6517 women: RR 1.04, 95% CI 0.87 to 1.24; I(2)=68%). However, antenatal vitamin A supplementation significantly improved birth weight (3 trials, 1809 women: MD 89.78, 95%CI 84.73 to 94.83; I(2)=33.0%), but there was no evidence of an effect on preterm births (3 trials, 2110 women: RR 0.88, 95%CI 0.65 to 1.19; I(2)=58.1%), stillbirths (4 trials, 2855 women: RR 0.99, 95%CI 0.68 to 1.43; I(2)=0%), deaths by 24 months (2 trials, 1635 women: RR 1.03, 95%CI 0.88 to 1.20; I(2)=0%), postpartum CD4 levels (1 trial, 727 women: MD -4.00, 95% CI -51.06 to 43.06), and maternal death ( 1 trial, 728 women: RR 0.49, 95%CI 0.04 to 5.37). AUTHORS' CONCLUSIONS: Current best evidence shows that antenatal or postpartum vitamin A supplementation probably has little or no effect on mother-to-child transmission of HIV. According to the GRADE classification, the quality of this evidence is moderate; implying that the true effect of vitamin A supplementation on the risk of mother-to-child transmission of HIV is likely to be close to the findings of this review, but that there is also a possibility that it is substantially different.

A systematic review of randomized controlled trials of prenatal and postnatal vitamin A supplementation of HIV-infected women.

We searched the Cochrane Library, MEDLINE, EMBASE, AIDSearch, and Gateway to assess the effect of prenatal and/or postnatal vitamin A supplementation on the risk of mother-to-child transmission (MTCT) of HIV and other pregnancy outcomes. We included 5 trials totaling 7528 women (4 trials of prenatal and 1 trial of postnatal supplementation). Overall, there was no evidence of an effect of prenatal and/or postnatal vitamin A supplementation on the risk of MTCT of HIV (Relative Risk [RR] 1.06, 95% Confidence Interval [CI] 0.89-1.26). However, prenatal vitamin A supplementation significantly improved birth weight (weighted mean difference 89.78; 95% CI, 84.73-94.83), but there was no evidence of an effect on stillbirths (RR 0.99; 95% CI, 0.68-1.43), preterm births (RR 0.88; 95% CI, 0.65-1.19), death before 24 months among live births (RR 1.08; 95% CI, 0.91-1.29), and maternal death (RR 0.83; 95% CI, 0.59-1.17). The available evidence does not support vitamin A supplementation of HIV-infected pregnant and lactating women, despite improvement in birth weight.