Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave: a cross-sectional survey.

OBJECTIVE: To estimate the prevalence of long COVID among Western Australian adults, a highly vaccinated population whose first major exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was during the 2022 Omicron wave, and to assess its impact on health service use and return to work or study. STUDY DESIGN: Follow-up survey (completed online or by telephone). SETTING, PARTICIPANTS: Adult Western Australians surveyed 90 days after positive SARS-CoV-2 test results (polymerase chain reaction or rapid antigen testing) during 16 July - 3 August 2022 who had consented to follow-up contact for research purposes. MAIN OUTCOME MEASURES: Proportion of respondents with long COVID (ie, reporting new or ongoing symptoms or health problems, 90 days after positive SARS-CoV-2 test result); proportion with long COVID who sought health care for long COVID-related symptoms two to three months after infection; proportion who reported not fully returning to previous work or study because of long COVID-related symptoms. RESULTS: Of the 70 876 adults with reported SARS-CoV-2 infections, 24 024 consented to contact (33.9%); after exclusions, 22 744 people were invited to complete the survey, of whom 11 697 (51.4%) provided complete responses. Our case definition for long COVID was satisfied by 2130 respondents (18.2%). The risk of long COVID was greater for women (v men: adjusted risk ratio [aRR], 1.5; 95% confidence interval [CI], 1.4-1.6) and for people aged 50-69 years (v 18-29 years: aRR, 1.6; 95% CI, 1.4-1.9) or with pre-existing health conditions (aRR, 1.5; 95% CI, 1.4-1.7), as well as for people who had received two or fewer COVID-19 vaccine doses (v four or more: aRR, 1.4; 95% CI, 1.2-1.8) or three doses (aRR, 1.3; 95% CI, 1.1-1.5). The symptoms most frequently reported by people with long COVID were fatigue (1504, 70.6%) and concentration difficulties (1267, 59.5%). In the month preceding the survey, 814 people had consulted general practitioners (38.2%) and 34 reported being hospitalised (1.6%) with long COVID. Of 1779 respondents with long COVID who had worked or studied before the infection, 318 reported reducing or discontinuing this activity (17.8%). CONCLUSION: Ninety days after infection with the Omicron SARS-CoV-2 variant, 18.2% of survey respondents reported symptoms consistent with long COVID, of whom 38.7% (7.1% of all survey respondents) sought health care for related health concerns two to three months after the acute infection.

Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy.

BACKGROUND: Indicators of reproductive health (RH) are expected to be both inter-related and associated with key social determinants. As the provision of RH services is usually integrated, the effort to improve one RH component should influence the other components. However, there is a lack of evidence-based models demonstrating the inter-relationships. The purpose of this study was to examine the inter-relationships among key RH indicators and their relationship with women's literacy in sub-Saharan Africa (SSA). METHODS: Data were sourced from the most recent demographic and health survey conducted between 2010 and 2016 in 391 provinces of 29 SSA countries. We examined seven RH indicators along with women's literacy. The unit of analysis was at the provincial level. Structural equation modelling was used to examine the strength of relationships among these indicators and with women's literacy, using the total standardized effect sizes. Significance tests and 95% confidence intervals (CIs) for these effects were calculated using a bias-corrected bootstrap method. RESULTS: RH indicators are strongly interrelated and are associated with women's literacy. The strongest relationship is observed between women's literacy rate and the contraception prevalence rate, with a total standardized effect size of 0.79 (95% CI 0.74-0.83). The model of inter-relationships developed in this study may guide the design, implementation and evaluation of RH policies and programmes. CONCLUSIONS: The key challenge in reducing fertility in SSA is to reduce people fertility desire. This could mainly be addressed by enhancing integrated approaches especially between the education and health sectors.

Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage.

Introduction: Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia. Methods: We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions. Results: We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high. Conclusion: There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.

Utilisation of Skilled Birth Attendant in Low- and Middle-Income Countries: Trajectories and Key Sociodemographic Factors.

Reducing the maternal mortality ratio (MMR) in low- and middle-income countries (LMICs) remains a huge challenge. Maternal mortality is mostly attributed to low coverage of maternal health services. This study investigated the trajectories and predictors of skilled birth attendant (SBA) service utilisation in LMIC over the past two decades. The data was sourced from standard demographic and health surveys which included four surveys on women with livebirth/s from selected countries from two regions with a pooled sample of 56,606 Indonesian and 63,924 Nigerian respondents. Generalised linear models with quasibinomial family of distributions were fitted to investigate the association between SBA utilisation and sociodemographic factors. Despite a significant improvement in the last two decades in both countries, the change was slower than hope for, and inconsistent. Women who received antenatal care were more likely to use an SBA service. SBA service utilisation was significantly more prevalent amongst literate women in Indonesia (AOR = 1.39, 95% CI: 1.24-1.54) and Nigeria (AOR = 1.41, 95% CI: 1.31-1.53) than their counterparts. The disparity based on geographic region and social factors remained significant over time. Given the significant disparities in SBA utilisation, there is a strong need to focus on community- and district-level interventions that aim at increasing SBA utilisation.

Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review.

OBJECTIVE: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa. DESIGN: A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa. DATA SOURCES: Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv. ELIGIBILITY CRITERIA: Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020. DATA EXTRACTION AND SYNTHESIS: We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form. RESULTS: Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and individuals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths. CONCLUSIONS: Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies.

Predictors of Success of Workplace Physical Activity Interventions: A Systematic Review.

BACKGROUND: Despite holding great potential for addressing concerns regarding public health, recent systematic reviews have found effect sizes for interventions targeting physical activity to be small. Before interventions can be improved, the factors influencing outcomes must be identified. This systematic review aimed to identify predictors of success, measured in terms of engagement (eg, involvement duration) and health behavior change (eg, increased step counts), of workplace interventions targeting physical activity. METHODS: A structured search of 3 databases (PubMed, PsycINFO, and Web of Science) was conducted to identify articles published between January 2000 and April 2017. For inclusion, articles needed to test a workplace intervention targeting physical activity and perform a quantitative analysis, identifying predictors of engagement or health behavior change. RESULTS: Twenty-two studies were identified for review (median quality score = 70%). Demographic variables (eg, gender, age) were inconsistent predictors of success. However, employees in better health and physically active at baseline were found to have a greater likelihood of success. CONCLUSIONS: It appears that achieving successful results among employees at high risk of poor health outcomes remains a significant challenge for interventions. It is hoped that program developers can use this information to create effective interventions particularly for more sedentary employees.

Determinants of antenatal care and skilled birth attendance in sub-Saharan Africa: A multilevel analysis.

OBJECTIVE: To determine individual- and country-level determinants of utilization of key maternal health services in sub-Saharan Africa (SSA). STUDY SETTING: We used the most recent standard demographic and health survey data from the period of 2005 to 2015 for 34 SSA countries. Predictors of key maternal health service indicators were determined using a sample of 245 178 women who had at least one live birth 5 years preceding the survey. STUDY DESIGN: We used a two-level hierarchical model, considering individual predictors at level one and country factors at level two of the hierarchy. PRINCIPAL FINDINGS: While the skilled birth attendance (SBA) utilization rate reached 53 percent during the study period, the recommended four or more antenatal care (ANC) coverage was commonly low with less significant differences among different groups of women and countries. Being in a middle-income country increased the individual-level association between ANC and SBA (OR = 2.34, 95% CI: 1.24, 4.44). Less privileged women with lower education level were less likely to receive maternal health services. CONCLUSIONS: This study reveals the existence of wide gaps between ANC and SBA coverage in SSA. Urgent policy attention is required to improve access, utilization, and quality of maternal health services.

Disparities in maternal health services in sub-Saharan Africa.

OBJECTIVES: To examine the progress of and disparities in the provision of key maternal health services in the sub-Saharan Africa (SSA) region. METHODS: A time-trend analysis of disparities in antenatal care (ANC) and skilled birth attendance (SBA) coverage in SSA over the last 25 years was conducted. The average values of each country's 5-year period data were used for analysis. Absolute and relative disparities were examined by time period, economic class, geographic group and clusters. Analysis of variance was used to compare progresses in coverage across time. RESULTS: Regional median ANC coverage and SBA increased by 8% points and 15% points, respectively, during the 25-year period. The rank score of SBA has shown significant improvement only in the recent period. A 33.3% disparity between ANC and SBA was observed in the most recent period. The relative disparity by economic class and cluster was higher for SBA than ANC coverage. CONCLUSIONS: The region showed improvement in both indicators across time. Regional disparity in ANC narrowed down while that of SBA remained high. These were mainly associated with economic class and cluster of countries.