@article{Rice2020.07.23.20161208,

title = {High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa},

author = {Benjamin L. Rice and Akshaya Annapragada and Rachel E. Baker and Marjolein Bruijning and Winfred Dotse-Gborgbortsi and Keitly Mensah and Ian F. Miller and Nkengafac Villyen Motaze and Antso Raherinandrasana and Malavika Rajeev and Julio Rakotonirina and Tanjona Ramiadantsoa and Fidisoa Rasambainarivo and Weiyu Yu and Bryan T. Grenfell and Andrew J. Tatem and C. Jessica E. Metcalf},

url = {https://www.medrxiv.org/content/early/2020/07/29/2020.07.23.20161208},

doi = {10.1101/2020.07.23.20161208},

year  = {2020},

date = {2020-01-01},

journal = {medRxiv},

publisher = {Cold Spring Harbor Laboratory Press},

abstract = {A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments1, younger populations2–4) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ‘slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.Competing Interest StatementThe authors have declared no competing interest.Funding StatementREB is supported by the Cooperative Institute for Modeling the Earth System (CIMES). AA acknowledges support from the NIH Medical Scientist Training Program 1T32GM136577. AJT is funded by the BMGF (OPP1182425, OPP1134076 and INV-002697). MB is funded by NWO Rubicon grant 019.192EN.017.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:NAAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData and code have been deposited into a publicly available GitHub repository: https://github.com/labmetcalf/SSA-SARS-CoV-2 High resolution maps and further visualizations of the risk indicators and simulations studied here can be accessed online through an interactive tool: https://labmetcalf.shinyapps.io/covid19-burden-africa/ https://labmetcalf.shinyapps.io/covid19-burden-africa/},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Dotse-Gborgbortsie002020,

title = {The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana},

author = {Winfred Dotse-Gborgbortsi and Duah Dwomoh and Victor Alegana and Allan Hill and Andrew J Tatem and Jim Wright},

url = {https://gh.bmj.com/content/4/Suppl_5/e002020},

doi = {10.1136/bmjgh-2019-002020},

year  = {2020},

date = {2020-01-01},

journal = {BMJ Global Health},

volume = {4},

number = {Suppl 5},

publisher = {BMJ Specialist Journals},

abstract = {Objectives Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.Methods We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.Results A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.Conclusion This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence-based information for improving maternal health service provision by targeting specific communities and health facilities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{https://doi.org/10.1016/j.ijgo.2015.11.004,

title = {Spatial distribution of emergency obstetric and newborn care services in Ghana: Using the evidence to plan interventions},

author = {Samuel Bosomprah and Andrew J. Tatem and Winfred Dotse-Gborgbortsi and Patrick Aboagye and Zoe Matthews},

url = {https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2015.11.004},

doi = {https://doi.org/10.1016/j.ijgo.2015.11.004},

year  = {2016},

date = {2016-01-01},

journal = {International Journal of Gynecology & Obstetrics},

volume = {132},

number = {1},

pages = {130-134},

abstract = {Abstract Objective To provide clear policy directions for gaps in the provision of signal function services and sub-regions requiring priority attention using data from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey. Methods Using 2010 survey data, the fraction of facilities with only one or two signal functions missing was calculated for each facility type and EmONC designation. Thematic maps were used to provide insight into inequities in service provision. Results Of 1159 maternity facilities, 89 provided all the necessary basic or comprehensive EmONC signal functions 3 months prior to the 2010 survey. Only 21% of facility-based births were in fully functioning EmONC facilities, but an additional 30% occurred in facilities missing one or two basic signal functions—most often assisted vaginal delivery and removal of retained products. Tackling these missing signal functions would extend births taking place in fully functioning facilities to over 50%. Subnational analyses based on estimated total pregnancies in each district revealed a pattern of inequity in service provision across the country. Conclusion Upgrading facilities missing only one or two signal functions will allow Ghana to meet international standards for availability of EmONC services. Reducing maternal deaths will require high national priority given to addressing inequities in the distribution of EmONC services.},

keywords = {Emergency obstetric and newborn care (EmONC), Geospatial analysis, Ghana, Maternal mortality, Needs assessment, Signal functions},

pubstate = {published},

tppubtype = {article}

}