Socioeconomic position and eye health outcomes: identifying inequality in rapid population-based surveys.

OBJECTIVE: Monitoring health outcomes disaggregated by socioeconomic position (SEP) is crucial to ensure no one is left behind in efforts to achieve universal health coverage. In eye health planning, rapid population surveys are most commonly implemented; these need an SEP measure that is feasible to collect within the constraints of a streamlined examination protocol. We aimed to assess whether each of four SEP measures identified inequality-an underserved group or socioeconomic gradient-in key eye health outcomes. DESIGN: Population-based cross-sectional survey. PARTICIPANTS: A subset of 4020 adults 50 years and older from a nationally representative sample of 9188 adults aged 35 years and older in The Gambia. OUTCOME MEASURES: Blindness (presenting visual acuity (PVA) <3/60), any vision impairment (VI) (PVA <6/12), cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) at two operable cataract thresholds (<6/12 and <6/60) analysed by one objective asset-based measure (EquityTool) and three subjective measures of relative SEP (a self-reported economic ladder question and self-reported household food adequacy and income sufficiency). RESULTS: Subjective household food adequacy and income sufficiency demonstrated a socioeconomic gradient (queuing pattern) in point estimates of any VI and CSC and eCSC at both operable cataract thresholds. Any VI, CSC <6/60 and eCSC <6/60 were worse among people who reported inadequate household food compared with those with just adequate food. Any VI and CSC <6/60 were worse among people who reported not enough household income compared with those with just enough income. Neither the subjective economic ladder question nor the objective asset-wealth measure demonstrated any socioeconomic gradient or pattern of inequality in any of the eye health outcomes. CONCLUSION: We recommend pilot-testing self-reported food adequacy and income sufficiency as SEP variables in vision and eye health surveys in other locations, including assessing the acceptability, reliability and repeatability of each question.

Genomic epidemiology of SARS-CoV-2 infections in The Gambia: an analysis of routinely collected surveillance data between March, 2020, and January, 2022.

BACKGROUND: COVID-19, caused by SARS-CoV-2, is one of the deadliest pandemics of the past 100 years. Genomic sequencing has an important role in monitoring of the evolution of the virus, including the detection of new viral variants. We aimed to describe the genomic epidemiology of SARS-CoV-2 infections in The Gambia. METHODS: Nasopharyngeal or oropharyngeal swabs collected from people with suspected cases of COVID-19 and international travellers were tested for SARS-CoV-2 with standard RT-PCR methods. SARS-CoV-2-positive samples were sequenced according to standard library preparation and sequencing protocols. Bioinformatic analysis was done using ARTIC pipelines and Pangolin was used to assign lineages. To construct phylogenetic trees, sequences were first stratified into different COVID-19 waves (waves 1-4) and aligned. Clustering analysis was done and phylogenetic trees constructed. FINDINGS: Between March, 2020, and January, 2022, 11 911 confirmed cases of COVID-19 were recorded in The Gambia, and 1638 SARS-CoV-2 genomes were sequenced. Cases were broadly distributed into four waves, with more cases during the waves that coincided with the rainy season (July-October). Each wave occurred after the introduction of new viral variants or lineages, or both, generally those already established in Europe or in other African countries. Local transmission was higher during the first and third waves (ie, those that corresponded with the rainy season), in which the B.1.416 lineage and delta (AY.34.1) were dominant, respectively. The second wave was driven by the alpha and eta variants and the B.1.1.420 lineage. The fourth wave was driven by the omicron variant and was predominantly associated with the BA.1.1 lineage. INTERPRETATION: More cases of SARS-CoV-2 infection were recorded in The Gambia during peaks of the pandemic that coincided with the rainy season, in line with transmission patterns for other respiratory viruses. The introduction of new lineages or variants preceded epidemic waves, highlighting the importance of implementing well structured genomic surveillance at a national level to detect and monitor emerging and circulating variants. FUNDING: Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, UK Research and Innovation, WHO.