Readiness of health facilities to manage individuals infected with COVID-19, Uganda, June 2021.

BACKGROUND: The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19. METHODS: Referral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery points. We used an observational checklist to evaluate capacity in infection prevention, medicines, personal protective equipment (PPE), and CTU surge capacity. We used the "ReadyScore" criteria to classify readiness levels as > 80% ('ready'), 40-80% ('work to do'), and < 40% ('not ready') and tailored the assessments to the health facility level. Scores for the lower-level health facilities were weighted to approximate representativeness for their health facility type in Uganda. RESULTS: The median (interquartile range (IQR)) readiness scores were: 39% (IQR: 30, 51%) for all health facilities, 63% (IQR: 56, 75%) for referral hospitals, and 32% (IQR: 24, 37%) for lower-level facilities. Of 17 referral facilities, two (12%) were 'ready' and 15 (88%) were in the "work to do" category. Fourteen (82%) had an inadequate supply of medicines, 12 (71%) lacked adequate supply of oxygen, and 11 (65%) lacked space to expand their CTU. Fifty-five (77%) lower-level health facilities were "not ready," and 16 (23%) were in the "work to do" category. Seventy (99%) lower-level health facilities lacked medicines, 65 (92%) lacked PPE, and 53 (73%) lacked an emergency plan for COVID-19. CONCLUSION: Few health facilities were ready to manage the second wave of COVID-19 in Uganda during June 2021. Significant gaps existed for essential medicines, PPE, oxygen, and space to expand CTUs. The Uganda Ministry of Health utilized our findings to set up additional COVID-19 wards in hospitals and deliver medicines and PPE to referral hospitals. Adequate readiness for future waves of COVID-19 requires additional support and action in Uganda.

Intensity of malaria transmission and the spread of Plasmodium falciparum resistant malaria: a review of epidemiologic field evidence.

Malaria transmission intensity has been proposed, based on theoretical models, as an important factor for the spread of falciparum-resistant malaria, but the predictions obtained vary according to the assumptions inherent in the model used. We summarized the available field data on transmission intensity and the prevalence of malaria drug resistance. Resistance to chloroquine and sulphadoxine-pyrimethamine monotherapy was invariably higher where transmission was intense. Vector control interventions were associated with a better chloroquine and sulfadoxine-pyrimethamine efficacy. However, high resistance to chloroquine and also to combination therapy (chloroquine plus sulphadoxine-pyrimethamine and amodiaquine plus sulfadoxine-pyrimethamine) was also observed in very low transmission areas. Reducing transmission intensity is likely to slow the spread of drug resistance. Nevertheless, where transmission is extremely low, to limit the unnecessary use of antimalarials and a consequent paradoxical acceleration of the spread of resistance, patients should be treated only after laboratory confirmation of malaria.