Risk as catalyst for positive change: lessons learnt from public health readiness for cholera in Jordan.

This case study highlights how a looming health crisis was leveraged as drivers for positive change for the health sector, in line with the health security agenda. In Jordan, several authorities are mandated by law to manage health emergencies. Following the declaration of outbreaks of cholera in Iraq, Lebanon and Syria, health authorities in Jordan called for a series of emergency meetings during September 2022 to discuss implications around travel and trade as well as shared waters. WHO was part of the consultations and provided guidance on the application of the International Health Regulations 2005. As the risk for cholera importation persisted, the Ministry of Health assumed its leadership role for the overall health sector response while the Jordanian Center for Disease Control assumed a coordinating function. Roles and responsibilities were enshrined in the National Cholera Preparedness and Response Plan. In consideration of the vulnerability of refugee camps and settlements towards Cholera, the existing Jordan humanitarian coordination platforms such as the Health Sector Working Group were used to share information and to coordinate activities. A whole-of-government risk assessment during December 2022 was complemented by a field visit at Zaatari refugee camp. This helped assess the risk and readiness for a cholera outbreak in Jordan and informed priority activities, such as the establishment of a national risk communication and community engagement working group as well as training on case management.

The risk of perinatal mortality following short inter-pregnancy intervals-insights from 692 402 pregnancies in 113 Demographic and Health Surveys from 46 countries: a population-based analysis.

BACKGROUND: Inter-pregnancy interval has been identified as a potentially modifiable risk factor to improve perinatal outcomes. We examined the WHO recommended interval of at least 24 months after a livebirth to next pregnancy, and its recommendation of waiting for at least 6 months after a pregnancy loss to improve subsequent pregnancy outcomes. We aimed to estimate the association between inter-pregnancy interval and perinatal mortality using the Demographic and Health Survey reproductive and contraceptive calendar. METHODS: For this population-based analysis, we extracted data for pregnancies with gestational age and pregnancy outcomes from 113 publicly available Demographic and Health Surveys conducted between 2000 and 2022 in 46 countries that included a reproductive or contraceptive calendar module. The primary outcome was perinatal mortality (stillbirth and early neonatal death) while the inter-pregnancy interval was the exposure of interest, grouped into categories of less than 6 months, 6-11 months, 12-17 months, 18-23 months, and 24-59 months. The analysis was stratified by preceding pregnancy outcome (livebirths, stillbirths, or abortions). The Kaplan-Meier method and Cox proportional hazard model were used to calculate the cumulative probability of perinatal mortality and the hazard ratios (HRs). FINDINGS: The analysis sample comprised of 692 402 pregnancies contributed by 570 145 women with a mean age of 28·4 years (SD 5·96). The overall HR of perinatal death was 2·72 (95% CI 2·52-2·93) times higher for an inter-pregnancy interval of less than 6 months compared with the WHO recommended optimal waiting time of 18-23 months following a livebirth. Overall HRs followed a context-related pattern, with the highest ratio of 2·95 (95% CI 2·67-3·25) in sub-Saharan Africa and the lowest of 1·98 (1·47-2·66) in north Africa, west Asia, and Europe. Inter-pregnancy intervals of less than 3 months, 6 months, and 12 months following stillbirth or abortion (spontaneous or induced) do not pose a higher risk for perinatal death in subsequent pregnancy. INTERPRETATION: Our study reaffirms the WHO recommendation on optimal interval between the last livebirth and the next pregnancy of at least 24 months and avoiding pregnancy before 18 months. However, our analysis does not support the WHO recommendation of delaying the next pregnancy for at least 6 months after a pregnancy loss for improved perinatal survival. FUNDING: None.

Participatory Mathematical Modeling Approach for Policymaking during the First Year of the COVID-19 Crisis, Jordan.

We engaged in a participatory modeling approach with health sector stakeholders in Jordan to support government decision-making regarding implementing public health measures to mitigate COVID-19 disease burden. We considered the effect of 4 physical distancing strategies on reducing COVID-19 transmission and mortality in Jordan during March 2020-January 2021: no physical distancing; intermittent physical distancing where all but essential services are closed once a week; intermittent physical distancing where all but essential services are closed twice a week; and a permanent physical distancing intervention. Modeling showed that the fourth strategy would be most effective in reducing cases and deaths; however, this approach was only marginally beneficial to reducing COVID-19 disease compared with an intermittently enforced physical distancing intervention. Scenario-based model influenced policy-making and the evolution of the pandemic in Jordan confirmed the forecasting provided by the modeling exercise and helped confirm the effectiveness of the policy adopted by the government of Jordan.

Supportive public health leadership for COVID-19 response in Jordan.

Background: The WHO Regional Office for the Eastern Mediterranean and the United Nations System Staff College (UNSSC) implemented a leadership programme on epidemic and pandemic preparedness and response, specific to the COVID-19 pandemic, during the second half of 2021. Aims: To highlight the leadership role played by the WHO Jordan Country Office during the COVID-19 pandemic in collaboration with UNSSC. Programme: The WHO Jordan country office successfully leveraged the expertise of UNSSC to implement a leadership training to prepare key stakeholders in Jordan for the response to COVID-19 and similar pandemics or outbreaks. The training curriculum included several modules such as leadership in times of crisis, strategic thinking and planning, emotional resilience, preparedness, adopting a system approach to response, and multisectoral partnership-building for pandemic response. The training helped strengthen the generation of evidence for policymaking and promotion of equitable access to health during the COVID-19 pandemic. Conclusion: Leadership capacity strengthening of national counterparts by WHO and partners can help advance efforts at national level to increase the use of evidence for policymaking and response to pandemics and disease outbreaks.

Maintaining Cross-Border Cargo Movements Between Jordan and Saudi Arabia During the COVID-19 Pandemic.

One of Jordan's essential border crossings, the Al-Omari border crossing, is 1 of 3 land crossings between Jordan and Saudi Arabia and is located 160 km west of the capital city of Amman. Given its economic importance and essential role in the functioning of food supply networks across the region, Jordan undertook evidence-driven actions to keep the border crossing safely open during the initial phase of the COVID-19 pandemic. Cross-border coordination and collaboration, specifically with international contact tracing and case management, have been critical elements of Jordan's response. While several bottlenecks and delays led to documented clusters of infections among truck drivers, this case study illustrates the use of evidence to mitigate disease exposure and spread. Plans to manage public health threats need to consider sustainable strengthened surveillance and laboratory capacities coupled with efficient cross-border communication and coordination plans implemented across multiple sectors engaged in cross-country health.

Measuring stillbirth and perinatal mortality rates through household surveys: a population-based analysis using an integrated approach to data quality assessment and adjustment with 157 surveys from 53 countries.

BACKGROUND: In most low-income and middle-income countries (LMICs), national surveys are the main data source for stillbirths and perinatal mortality. Data quality issues such as under-reporting and misreporting have greatly limited the usefulness of such data. We aimed to enhance the use of mortality data in surveys by proposing data quality metrics and exploring adjustment procedures to obtain the best possible measure of perinatal mortality. METHODS: We performed a population-based analysis of data from 157 demographic and health surveys (DHSs) from 1990 to 2020, with reproductive calendar and birth history data from 53 LMICs. Pregnancies terminated before 7 months' gestation were excluded. We examined data quality and compared survey values with reference values obtained from a literature review to assess misreporting of the age at early neonatal death, omission and transference of stillbirths, and very early neonatal deaths. Real cohort life-table rates of stillbirth, early neonatal, and perinatal mortality per 1000 births were calculated. The underlying risks of stillbirth and daily deaths were modelled using modified Gompertz-Makeham models. FINDINGS: Data for 2 008 807 pregnancies of ≥7 months' gestational age were extracted from the reproductive calendar for the analysis period. Age heaping at day 7 occurred in most surveys. The median value for the heaping index of deaths at day 7 was 2·05 (IQR 1·36-2·87). The median ratio of stillbirths to deaths on days 0-1 was 1·15 (0·86-1·51). Of the 157 surveys, 23 (15%) were considered to have plausible ratios, 71 (45%) had probable ratios, and 63 (40%) had improbable ratios. The ratio of deaths on days 0-1 to deaths on days 2-6 varied considerably between surveys and 119 surveys (76%) had ratios of less than 2·4, indicative of under-reporting of very early neonatal deaths in most surveys. The fully adjusted model increased the median stillbirth rates from 12·2 (9·4-15·9) to 25·6 (18·0-33·4) per 1000 births, with a median relative increase of 95·0% (56·6-136·6). The median perinatal mortality rate also increased from 32·6 (23·6-38·3) to 44·8 (32·8-58·0) per 1000 births, with a median relative increase of 47·8% (6·9-61·0). INTERPRETATION: A simultaneous focus on stillbirths and early neonatal mortality facilitates a comprehensive assessment of inaccurate reporting in household surveys and allows for better use of surveys in planning and monitoring of efforts to reduce stillbirths and early neonatal mortality. FUNDING: None.

Supporting the Aspecific Physiological Defenses of Upper Airways against Emerging SARS-CoV-2 Variants.

The rapid rollout of COVID-19 vaccines in 2021 sparked general optimism toward controlling the severe form of the disease, preventing hospitalizations and COVID-19-associated mortality, and the transmissibility of SARS-CoV-2 infection [...].

COVID-19 and non-communicable diseases in complex vulnerable populations: evidence from Jordan.

More than three in 10 people living in Jordan are immigrants, with the majority being Palestinian and Syrian refugees, who have a very similar non-communicable diseases (NCDs) profile to the hosting Jordanian community. We conducted a rapid review of the literature of studies, reports, and documents on the evidence of the impact of COVID-19 on vulnerable populations in Jordan with regard to NCD during the first year of the pandemic. COVID-19-related mobility constraints and often lack of awareness of NCDs put additional burden on vulnerable populations like refugees and migrants, in particular on non-registered migrants. COVID-19 pandemic and associated mitigation measures led to disruption in routine health services, significantly impacting people living with NCDs. Ensuring to deliver a people-centered and inclusive approach that works well during COVID-19 is of paramount importance toward Universal Health Coverage (all people have access to the health services they need, when and where they need them, without financial hardship).

Migrant health during public health emergencies: The Ebola crisis in Uganda.

The Ebola virus diseases (EVD) declared in Uganda in September 22, 2022, has spread to seven districts by early November, with a total of 131 confirmed cases and 48 deaths. Public health emergency response in Uganda deserves a specific and tailored approach due to the current population composition, which accounts to around 1.4 million refugees and asylum seekers. Indeed, Uganda is a potential example of how increased international connectivity has resulted in forced migration with profound impacts on global health. In consideration of the vulnerability of refugees and migrants due to poor living, housing, and working conditions, inclusive policies are even more critical during public health emergencies. Inclusivity lessons learned from COVID-19 in several settings, such as access to treatment and vaccination for all individuals regardless of nationality, residence, and legal status, would be critical to ensure wellbeing of migrants, refugees and host communities.