Non-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana: a mixed-methods study.

BACKGROUND: The World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection. METHODS: In August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted. RESULTS: A total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake. CONCLUSIONS: A relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.

Using Andersen's model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey.

BACKGROUND: This study aimed to investigate, using Andersen's model of health care utilization, factors associated with COVID-19 testing among adults in nine low- and middle- income countries. METHODS: In between 10 December 2020 and 9 February 2021, an online survey was organized in nine low- and middle-income countries. In total 10,183 adults (median age 45 years, interquartile range 33-57 years, range 18-93 years), including 6470 from Brazil, 1738 Malaysia, 1124 Thailand, 230 Bangladesh, 219 DR Congo, 159 Benin, 107 Uganda, 81 Malawi and 55 from Mali participated in the study. COVID-19 testing/infection status was assessed by self-report. RESULTS: Of the 10,183 participants, 40.3% had ever tested for COVID-19, 7.3% tested positive, and 33.0% tested negative. In an adjusted logistic regression model, predisposing factors (residing in Brazil, postgraduate education), enabling/disabling factors (urban residence, higher perceived economic status, being a student or worker in the health care sector, and moderate or severe psychological distress), and need factors (having at least one chronic condition) increased the odds of COVID-19 testing. Among those who were tested, participants residing in Bangladesh, those who had moderate to severe psychological distress were positively associated with COVID-19 positive diagnosis. Participants who are residing in Malaysia and Thailand, and those who had higher education were negatively associated with a COVID-19 positive diagnosis. Considering all participants, higher perceived economic status, being a student or worker in the health sector, and moderate or severe psychological distress were positively associated with a COVID-19 positive diagnosis, and residing in Malaysia, Thailand or five African countries was negatively associated with a COVID-19 positive diagnosis. CONCLUSION: A high rate of COVID-19 testing among adults was reported in nine low-and middle-income countries. However, access to testing needs to be increased in Africa. Moreover, COVID-19 testing programmes need to target persons of lower economic status and education level who are less tested but most at risk for COVID-19 infection.

Violence and discrimination among Ugandan residents during the COVID-19 lockdown.

BACKGROUND: In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub-Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems, and mass gatherings to minimize spread. Social control measures for COVID-19 are reported to increase violence and discrimination globally, including in Uganda as some may be difficult to implement resulting in the heavy deployment of law enforcement. Media reports indicated that cases of violence and discrimination had increased in Uganda's communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures. METHODS: In April 2020, we conducted a secondary analysis of cross-sectional data under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants' characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination. RESULTS: Of the 1726 ICP study participants, 1051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement officer. Factors associated with experiencing violence or discrimination were: being male (AOR = 1.60 CI:1.10-2.33), having attended work physically for more than 3 days in the past week (AOR = 1.52 CI:1.03-2.23), and inability to access social or essential health services since the epidemic started (AOR = 3.10 CI:2.14-4.50). CONCLUSION: A substantial proportion of Ugandan residents experienced violence and/or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. We recommend mitigation of the collateral impact of lockdowns with interventions that focus on improving policing quality, ensuring continuity of essential services, and strengthening support systems for vulnerable groups including males.

Prevalence of epilepsy in the onchocerciasis endemic middle belt of Ghana after 27 years of mass drug administration with ivermectin.

BACKGROUND: In onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission, a high prevalence of epilepsy has been reported. This study aimed to determine the prevalence and clinical characteristics of epilepsy in the Bono Region of Ghana following 27 years of implementation of ivermectin mass drug administration (MDA). METHODS: Between October 2020 and August 2021, cross-sectional surveys were conducted in nine communities in the Tain District and Wenchi Municipality of the Bono Region of Ghana. In the first stage, a random door-to-door approach was used to screen the population for epilepsy using a pre-tested questionnaire. Persons suspected of having epilepsy were invited for a second-stage neurological examination for case verification. Community O. volvulus microfilarial infection status and Ov16 seropositivity were also determined. Ninety-five confidence intervals (95% CI) for prevalence values were calculated using the Wilson Score Interval. RESULTS: Of the 971 participants, 500 (51.5%) were females, and the median age (interquartile range) was 26 (15‒43) years. Fourteen participants (1.4%, 95% CI: 1.0‒2.0) were diagnosed as having epilepsy with generalized seizures being the most frequent seizure type (85.7%, 12/14). The overall microfilarial prevalence of O. volvulus was 10.3% (November 2020) and 9.9% (August 2021); the Ov16 seroprevalence was 22.2% (June 2021). Only 63.2% took ivermectin in the last round of MDA distribution in March 2021. CONCLUSIONS: The 1.4% prevalence of epilepsy in the Bono region is similar to the median epilepsy prevalence in sub-Saharan Africa. However, the persistent microfilarial prevalence and low ivermectin study coverage call for the Ghana Onchocerciasis Elimination Programme to step up its efforts to ensure that the gains achieved are consolidated and improved to achieve the elimination of onchocerciasis by 2030.

Assessment of adherence to public health measures and their impact on the COVID-19 outbreak in Benin Republic, West Africa.

INTRODUCTION: following the global COVID-19 outbreak, the government of Benin implemented preventive measures to stall viral transmission. We sought to evaluate adherence of the Beninese people to these preventive measures, in order to identify predictors of poor adherence and adapt the national response to COVID-19. METHODS: two consecutive online surveys were conducted between May and August 2020. Four hundred and sixty two and 507 adult participants aged 18 years and above responded to the first and second survey respectively, with >70% being males. RESULTS: more than 98% of respondents reported wearing face masks. A five-point adherence score was constituted by scoring observance to key preventive measures (mask use, physical distancing, hand hygiene, coughing hygiene and avoiding to touch one´s face). We observed that the mean adherence scores were fairly stable over time, respectively 4.08 and 4.03 during the first and second survey (p=0.439). Increasing age (aOR=1.043, 95% CI: 1.026 - 1.061; p<0.001) and obtaining COVID-19 information from official sources (aOR=1.628, 95% CI: 1.275 - 2.081; p<0.001) were significantly associated with higher adherence scores in a multivariable model. CONCLUSION: these findings suggest that a wide dissemination of adequate information about COVID-19 would increase adherence, and that targeted efforts should be directed towards increasing the compliance to preventive measures among the younger age groups.

Adherence to COVID-19 Preventive Measures in Mozambique: Two Consecutive Online Surveys.

We assessed adherence to government recommendations implemented shortly after the introduction of COVID-19 in Mozambique in March 2020, through two online cross-sectional surveys in April and June 2020. We quantified adherence to preventive measures by a composite score comprising of five measures: physical distancing, face mask use, hand hygiene, cough hygiene, and avoidance of touching the face. 3770 and 1115 persons participated in the first and second round respectively. Wearing face masks, regular handwashing and cough hygiene all reached compliance rates of over 90% while physical distancing and avoiding to touch the face reached a compliance rate of 80-90%. A multivariable model investigating factors associated with adherence found that being older, more educated, and belonging to the healthcare sector increased the odds for higher adherence. Private workers and retired people, respondents receiving COVID-19 information through social media, and those who reported flu-like symptoms were less likely to adhere. 6% of respondents reported flu-like symptoms which aligned with the WHO clinical definition of COVID-19, suggesting low level community transmission. In conclusion, most respondents in this online survey in Mozambique complied well with strategies to prevent COVID-19. Whether the good preventive behaviour explains the low grade COVID-19 transmission requires further study.

Well-Being of Healthcare Workers and the General Public during the COVID-19 Pandemic in Vietnam: An Online Survey.

The COVID-19 pandemic and associated restrictive measures implemented may considerably affect people's lives. This study aimed to assess the well-being of Vietnamese people after COVID-19 lockdown measures were lifted and life gradually returned to normal. An online survey was organized from 21 to 25 April 2020 among Vietnamese residents aged 18 and over. The survey was launched by the Hue University of Medicine and Pharmacy. The WHO-5 Well-Being Index (scored 0-25) was used to score participants' well-being. A multivariate logistic regression model was used to determine the predictors of well-being. A total of 1922 responses were analyzed (mean age: 31 years; 30.5% male; 88.2% health professionals or students in the health sector). The mean well-being score was 17.35 ± 4.97. Determinants of a high well-being score (≥13) included older age, eating healthy food, practicing physical exercise, working from home, and adhering to the COVID-19 preventive measures. Female participants, persons worried about their relatives' health, and smokers were more likely to have a low well-being score. In conclusion, after the lockdown measures were lifted, the Vietnamese have people continued to follow COVID-19 preventive measures, and most of them scored high on the well-being scale. Waiting to achieve large-scale COVID-19 vaccine coverage, promoting preventive COVID-19 measures remains important, together with strategies to guarantee the well-being of the Vietnamese people.

COVID-19 Vaccine Acceptability and Its Determinants in Mozambique: An Online Survey.

A high worldwide SARS-CoV-2 vaccine coverage must be attained to stop the COVID-19 pandemic. In this study, we assessed the level of willingness of Mozambicans to be vaccinated against COVID-19. Data were collected between 11 and 20 March 2021, through a self-administered online survey. Of the 1878 respondents, 30.1% were healthcare workers, 58.3% were aged between 18 and 35 years, 60% were male, and 38.5% were single. Up to 43% had been tested for COVID-19 and 29% had tested positive. Overall vaccine acceptability was 71.4% (86.6% among healthcare workers, 64.8% among other respondents; p < 0.001). Reasons for vaccine hesitancy included: fear of vaccine side effects (29.6%) and the belief that the vaccine is not effective (52%). The acceptability of the SARS-CoV-2 vaccine increased with increasing vaccine efficacy. Using logistic regression, determinants for acceptability of the vaccine were: older age, a past COVID-19 test, a concern of becoming (re)infected by COVID-19, having a chronic disease, and considering vaccination important for personal and community health. In conclusion, vaccine acceptability in Mozambique was relatively high among healthcare workers but significantly lower in the rest of the population. This suggests that there is a need to educate the general population about SARS-CoV-2 vaccination and its importance.

Effect of Ivermectin Treatment on the Frequency of Seizures in Persons with Epilepsy Infected with Onchocerca volvulus.

A clinical trial performed in the Democratic Republic of Congo (DRC), among persons with epilepsy (PWE) infected with Onchocerca volvulus treated with anti-seizure medication suggested that ivermectin reduces the seizure frequency. We assessed the effect of ivermectin treatment on seizure frequency in PWE with and without anti-seizure medication in three onchocerciasis endemic areas (Maridi, South Sudan; Aketi, DRC; and Mahenge, Tanzania). Pre- and 3-5 months post-ivermectin microfilariae densities in skin snips and seizure frequency were assessed. After ivermectin, the median (IQR) percentage reduction in seizure frequency in the study sites ranged from 73.4% (26.0-90.0) to 100% (50.0-100.0). A negative binomial mixed model showed that ivermectin significantly reduced the seizure frequency, with a larger decrease in PWE with a high baseline seizure frequency. Mediation analysis showed that ivermectin reduced the seizure frequencies indirectly through reduction in microfilariae densities but also that ivermectin may have a direct anti-seizure effect. However, given the short half-life of ivermectin and the fact that ivermectin does not penetrate the healthy brain, such a direct anti-seizure effect is unlikely. A randomized controlled trial assessing the ivermectin effect in people infected with O. volvulus who are also PWE on a stable anti-seizure regimen may be needed to clarify the causal relationship between ivermectin and seizure frequency.

Persons with onchocerciasis-associated epilepsy and nodding seizures have a more severe form of epilepsy with more cognitive impairment and higher levels of Onchocerca volvulus infection.

Following previous reports of very high epilepsy prevalence in the onchocerciasis-endemic villages in Maridi County, South Sudan, a study was conducted to investigate the association between the level of Onchocerca volvulus infection, epilepsy, and related outcomes. In December 2018, persons with epilepsy (PWE) were recruited from villages where an epilepsy prevalence of 4.4% (range: 3.5-11.9%) was documented. We enrolled 318 participants from whom two skin snips were taken for microscopic detection of O. volvulus microfilariae (mf). Seizure history was obtained for all PWE and their degree of disability assessed using the modified Rankin scale. Almost all (84.9%) PWE had detectable mf in their skin snips. Onchocerciasis-infected PWE experienced nodding seizures more often than uninfected PWE (p=0.034). Moreover, persons with nodding seizures had more frequent seizures (p<0.001) and higher disability scores (p<0.001), and were more often cognitively impaired and younger at the time of their first epileptic seizure (nine years vs 12 years, p<0.001) compared to PWE without nodding seizures. Based on multivariate models, nodding seizures were associated with higher mf densities (aOR: 1.022; 95% CI: 1.005-1.041). Epilepsy onset at a younger age was associated with a worse outcome. Higher frequency of seizures, longer duration of epilepsy and younger age were associated with increased disability. Regular antiepileptic drug use was associated with better cognitive and disability outcomes. PWE with nodding seizures have a more severe form of onchocerciasis-associated epilepsy, with earlier seizure onset and higher levels of O. volvulus infection. Younger PWE were prone to worse epilepsy outcomes, which would be prevented with regular antiepileptic treatment.