Epidemiology of COVID-19 and Predictors of Recovery in the Republic of Korea.

BACKGROUND: The recent COVID-19 pandemic has emerged as a threat to global health. Though current evidence on the epidemiology of the disease is emerging, very little is known about the predictors of recovery. OBJECTIVES: To describe the epidemiology of confirmed COVID-19 patients in the Republic of Korea and identify predictors of recovery. MATERIALS AND METHODS: Using publicly available data for confirmed COVID-19 cases from the Korea Centers for Disease Control and Prevention from January 20, 2020, to April 30, 2020, we undertook descriptive analyses of cases stratified by sex, age group, place of exposure, date of confirmation, and province. Correlation was tested among all predictors (sex, age group, place of exposure, and province) with Pearson's correlation coefficient. Associations between recovery from COVID-19 and predictors were estimated using a multivariable logistic regression model. RESULTS: Majority of the confirmed cases were females (56%), 20-29 age group (24.3%), and primarily from three provinces-Gyeongsangbuk-do (36.9%), Gyeonggi-do (20.5%), and Seoul (17.1%). The case fatality ratio was 2.1%, and 41.6% cases recovered. Older patients, patients from provinces such as Daegu, Gyeonggi-do, Gyeongsangbuk-do, Jeju-do, Jeollabuk-do, and Jeollanam-do, and those contracting the disease from healthcare settings had lower recovery. CONCLUSIONS: Our study adds to the very limited evidence base on potential predictors of recovery among confirmed COVID-19 cases. We call additional research to explore the predictors of recovery and support development of policies to protect the vulnerable patient groups.

Household economic impact of an emerging disease in terms of catastrophic out-of-pocket health care expenditure and loss of productivity: investigation of an outbreak of chikungunya in Orissa, India.

BACKGROUND & OBJECTIVES: To examine the household economic impact of an outbreak of chikungunya in terms of out-of-pocket health care expenditure and income foregone due to loss of productive time in Orissa, India. METHODS: Structured interviews were conducted on 150 respondents, bread winners from the affected households of a village with maximum number of reported cases in the state, during August 2007. We looked at the economic profile, treatment history, and patient-side cost of care, loss of productivity and consequent income loss. RESULTS: The median out-of-pocket health care expenditure was US$ 84, of which the proportion of cost of diagnosis was the highest (US$ 77). One hundred and forty nine respondents incurred cost of care more than 10% of their monthly household income (catastrophic health expenditure). The median catastrophic health care expenditure was 37%. The respondents depended more on private health care providers (49%) and 31% of them accessed care from both public and private health care providers. The median work days lost was 35 with a consequent loss of income of US$ 75. INTERPRETATION & CONCLUSION: Outbreak of an emerging disease creates unforeseen catastrophic health care expenditure and reinforcing the poverty ill-health nexus. The priorities of tackling emerging diseases should include; discretionary public health spending, financial protection against the cost of illness and productivity with special emphasis on people living on daily wages with less financial reserves, and further research on therapeutic measures to reduce the duration of suffering and consequent economic loss.

Assessing community health workers' performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme.

OBJECTIVE: This study examined the performance motivation of community health workers (CHWs) and its determinants on India's Accredited Social Health Activist (ASHA) programme. DESIGN: Cross-sectional study employing mixed-methods approach involved survey and focus group discussions. SETTING: The state of Orissa. PARTICIPANTS: 386 CHWs representing 10% of the total CHWs in the chosen districts and from settings selected through a multi-stage stratified sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: The level of performance motivation among the CHWs, its determinants and their current status as per the perceptions of the CHWs. RESULTS: The level of performance motivation was the highest for the individual and the community level factors (mean score 5.94-4.06), while the health system factors scored the least (2.70-3.279). Those ASHAs who felt having more community and system-level recognition also had higher levels of earning as CHWs (p=0.040, 95% CI 0.06 to 0.12), a sense of social responsibility (p=0.0005, 95% CI 0.12 to 0.25) and a feeling of self-efficacy (p=0.000, 95% CI 0.38 to 0.54) on their responsibilities. There was no association established between their level of dissatisfaction on the incentives (p=0.385) and the extent of motivation. The inadequate healthcare delivery status and certain working modalities reduced their motivation. Gender mainstreaming in the community health approach, especially on the demand-side and community participation were the positive externalities of the CHW programme. CONCLUSIONS: The CHW programme could motivate and empower local lay women on community health largely. The desire to gain social recognition, a sense of social responsibility and self-efficacy motivated them to perform. The healthcare delivery system improvements might further motivate and enable them to gain the community trust. The CHW management needs amendments to ensure adequate supportive supervision, skill and knowledge enhancement and enabling working modalities.