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COVID-19 in Low and Middle Income Countries

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 39636

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Dr. Robert Colebunders

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Global Health Institute, University of Antwerp, Antwerp, Belgium
Interests: onchocerciasis; epilepsy; epidemiology; public health; infectious and tropical diseases
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Prof. Dr. Jacob Souopgui

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Laboratory of Embryology & Biotechnology, Université Libre de Bruxelles, Gosselies, Belgium
Interests: onchocerciasis; parasite biology; nematodes
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Dear Colleagues,

The COVID-19 pandemic is expected to increasingly spread in low and middle income countries (LMIC). In the absence of effective treatments or vaccines, the WHO strongly recommends that countries implement interventions to curb the rapid spread of COVID-19, through minimizing contact between infected and uninfected persons. Suggested measures include lockdowns, closing schools and public places, prohibition of social gatherings, and stringent personal methods of physical distancing, wearing face masks and hand hygiene.

Most governments in LMICs, in an early phase of the epidemic, have implemented lockdown measurements. Such interventions were typically modelled on the COVID-19 outbreaks in high-income countries. Concerns have, however, been raised that the pandemic follows very different trajectories in different contexts, and that a “one size fits all” approach for non-pharmaceutical interventions may not be appropriate, as the risk–benefit balance of such interventions may be very different in different settings. Although the early implementation of lockdown measures for COVID-19 control may have contributed to the (initially) low mortality observed in several LMICs, the collateral damage resulting from this strategy is becoming increasingly apparent. Moreover, lockdown measures are more detrimental to those with the least resources.

Since many LMIC countries are now easing lockdown measures, the number of COVID-19 cases is likely to increase rapidly. We have already learnt a lot about COVID-19, but there are still many unknowns: the one constant feature of the COVID-19 pandemic is its unpredictability. The main operational as well as research question for LMIC is how to reduce COVID-19 transmission and COVID-related mortality, with minimal collateral damage to the economy, the wellbeing of people, and the prevention and control of other diseases.

With this Special Issue, we hope to learn from LMICs, to identify the most effective combination of measures to reduce the incidence of severe COVID-19 disease. We invite you to submit research articles, review articles, short notes about the epidemiology of COVID-19 in LMICs, innovative ways to prevent and treat COVID-19 infection in settings with limited resources, adherence to preventive measures, the impact of COVID-19 on both the physiological and psychological wellbeing of people and the health system, host–pathogen interactions, COVID-19 diagnostics, host immune responses, and vaccine development.

The “COVID-19 in Low and Middle Income Countries” Special Issue is jointly organized between “Pathogens” and “International Journal of Environmental Research and Public Health” journals. You may choose our Joint Special Issue in Pathogens.

We look forward to your contribution.

Prof. Dr. Robert Colebunders
Prof. Dr. Jacob Souopgui
Guest Editors

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Keywords

COVID-19
epidemiology
prevention
diagnosis
treatment
pathogenesis
immunology
low and middle income countries

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Related Special Issue

COVID-19 in Low and Middle Income Countries in Pathogens (6 articles)

Published Papers (10 papers)

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Research

12 pages, 701 KiB

Open AccessArticle

Adherence to COVID-19 Preventive Measures among Dental Care Workers in Vietnam: An Online Cross-Sectional Survey

by Tai Tan Tran, Thang Van Vo, Tuyen Dinh Hoang, Minh Vu Hoang, Nhu Thi Quynh Tran and Robert Colebunders

Int. J. Environ. Res. Public Health 2022, 19(1), 481; https://doi.org/10.3390/ijerph19010481 - 2 Jan 2022

Cited by 6 | Viewed by 4526

Abstract

An online cross-sectional survey using a “snowball” sampling method was carried out to assess the adherence to COVID-19 preventive measures among dental care workers (DCWs) during the pandemic. Six questions concerning the COVID-19 preventive guidelines issued by the Vietnam Ministry of Health were used to evaluate DCWs’ adherence to preventive measures at dental care clinics. The quality of life of DCWs was assessed using the WHO-5 questionnaire and was defined as low if the total score was less than 13 points. Factors relating to adherence to COVID-19 prevention measures of DCWs were determined by multivariate linear regression analysis. In total, 514 DCWs completed the questionnaire. A total of 37% DCWs rated their quality of life as low. Regression analysis suggested that older age, a better quality of life, living in an urban area, and training on COVID-19 prevention were associated with better adherence to COVID-19 preventive measures, while being a dentist and lack of personal protective equipment was associated with less adherence to COVID-19 preventive measures. The pandemic had a significant negative impact on the physical and mental health of DCWs. Therefore, specific national guidelines for the prevention and control of the spread of COVID-19 in dental facilities should be issued. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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14 pages, 1324 KiB

Open AccessArticle

Demographic and Clinical Factors Associated with Reactivity of Anti-SARS-CoV-2 Antibodies in Serbian Convalescent Plasma Donors

by Jasmina Grujić, Nevenka Bujandrić, Zorana Budakov-Obradović, Vladimir Dolinaj, Damir Bogdan, Nebojša Savić, Alejandro Cabezas-Cruz, Dragana Mijatović, Verica Simin, Nikola Anđelić and Pavle Banović

Int. J. Environ. Res. Public Health 2022, 19(1), 42; https://doi.org/10.3390/ijerph19010042 - 21 Dec 2021

Cited by 6 | Viewed by 2921

Abstract

Passive immunotherapy with convalescent COVID-19 plasma (CCP) is used as a therapeutic procedure in many countries, including Serbia. In this study, we analyzed the association between demographic factors, COVID-19 severity and the reactivity of anti-SARS-CoV-2 antibodies (Abs) in Serbian CCP donors. Individuals (n = 468) recovered from confirmed SARS-CoV-2 infection, and who were willing to donate their plasma for passive immunization of COVID-19 patients were enrolled in the study. Plasma samples were tested for the presence of IgG reactive to SARS-CoV-2 spike glycoprotein (S1) and nucleocapsid antigens. Individuals were characterized according to age, gender, comorbidities, COVID-19 severity, ABO blood type and RhD factor. Total of 420 candidates (420/468; 89.74%) reached the levels of anti-SARS-CoV-2 IgG that qualified them for inclusion in CCP donation program. Further statistical analysis showed that male individuals (p = 0.034), older age groups (p < 0.001), existence of hypertension (p = 0.008), and severe COVID-19 (p = 0.000) are linked with higher levels of anti-SARS-CoV-2 Abs. These findings will guide the selection of CCP donors in Serbia. Further studies need to be conducted to assess the neutralization potency and clinical efficiency of CCP collected from Serbian donors with high anti-SARS-CoV-2 IgG reactivity. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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13 pages, 437 KiB

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Repercussions of the COVID-19 Response in Pregnant Women in Western Uganda: Knowledge, Behavior, and Emotional State after the First Lockdown in 2020

by Stefanie Theuring, Agnes Kengonzi, Lorena Hafermann, Carolin Herrmann, Steven Ndugwa Kabwama and John Rubaihayo

Int. J. Environ. Res. Public Health 2021, 18(15), 7817; https://doi.org/10.3390/ijerph18157817 - 23 Jul 2021

Cited by 5 | Viewed by 2653

Abstract

Limited research exists on pregnant women’s knowledge, attitudes, and behavior concerning COVID-19 in sub-Saharan Africa. We performed a cross-sectional study among 648 pregnant women in Fort Portal, Uganda, after the first lockdown starting in June 2020. Structured interviews were conducted at three different facilities during routine antenatal care, assessing sociodemographic background, knowledge of COVID-19, prevention behavior adherence, and psycho-emotional stress levels. We performed descriptive analyses and examined associated factors using multivariable logistic regression. In Fort Portal Region, 32.8% of pregnant women had a higher knowledge regarding the COVID-19 pandemic, while all women at least heard of COVID-19. 88.6% of the women showed low self-reported prevention behavior adherence. More than one third of the pregnant women experienced high psycho-emotional stress related to the pandemic (39.8%). The odds for psycho-emotional stress were increased among the age group 21–30 years (AOR 1.97; 95% CI 1.18–3.35) compared to women under the age of 21, and decreased in single or divorced women compared to women in partnerships (AOR 0.42; 0.22–0.77) and in women having less COVID-19-related knowledge (AOR 0.40; 0.27–0.58). In conclusion, prevention behavior adherence seemed challenging, and psycho-emotional stress was ubiquitous among our cohort. To avoid adverse consequences in maternal and neonatal health, campaigns for hygiene but also women’s emotional state should be a major focus of community healthcare in exceptional times such as the SARS-CoV-2 pandemic. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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12 pages, 1156 KiB

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Impact of COVID-19 on Healthcare Workers in Brazil between August and November 2020: A Cross-Sectional Survey

by Edlaine Faria de Moura Villela, Izadora Rodrigues da Cunha, Joseph Nelson Siewe Fodjo, Michael Obimpeh, Robert Colebunders and Stijn Van Hees

Int. J. Environ. Res. Public Health 2021, 18(12), 6511; https://doi.org/10.3390/ijerph18126511 - 17 Jun 2021

Cited by 12 | Viewed by 3049

Abstract

During the COVID-19 pandemic, healthcare workers (HCW) have been subjected to greater workloads. We conducted a cross-sectional online survey to assess the impact of the COVID-19 pandemic on Brazilian HCW. Data were collected between 11 August and 1 November 2020. Of the 295 respondents, 95 (32.2%) were medical doctors, 82 (27.8%) administrative staff, 53 (18.0%) nurses, 27 (9.2%) laboratory staff, and 38 (12.9%) were other staff. COVID-19-related restructuring at the health facilities was reported by 207 (70.2%) respondents, and 69 (23.4%) had their tasks changed. Preventive measures were well respected when seeing suspected patients. Overall, 167 (56.6%) HCW screened positive for anxiety and 137 (46.4%) for depression; 109 (36.9%) screened positive for both conditions. Of the 217 (73.6%) HCW who had been tested for COVID-19, at least one positive result was reported in 49 (22.6%). Following a positive COVID-19 test, 45/49 (91.8%) stopped working and stayed home. In conclusion, we found a high incidence of COVID-19 infection among Brazilian HCW with high rates of anxiety and depression despite a good self-reported adherence to COVID-19 preventive measures. As such, our study highlights the urgent need for interventions to mitigate the psychosocial risks HCW in Brazil encounter during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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13 pages, 317 KiB

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MAROCOVID: Snapshot Monitoring of Knowledge and Perceptions of Safety Behaviors during the COVID-19 Outbreak in Morocco

by Imane Berni, Aziza Menouni, Younes Filali Zegzouti, Marie-Paule Kestemont, Lode Godderis and Samir El Jaafari

Int. J. Environ. Res. Public Health 2021, 18(11), 5745; https://doi.org/10.3390/ijerph18115745 - 27 May 2021

Cited by 5 | Viewed by 3113

Abstract

To assess whether knowledge, attitude, and perceptions of the COVID-19 pandemic predicted changes in behaviors among the general Moroccan population, a cross-sectional online survey was conducted between 30 March and 20 April involving a total of 14,157 participants. The statistical analysis of the data included univariate and multivariate logistic regression analysis. Our results suggest that less than ten days after the Moroccan government announced “Health state of Emergency” response to the COVID-19 outbreak, public knowledge, attitude and responses to the pandemic were relatively high. More than half the respondents (63.2%) reported that they complied with more than five of nine recommended safety measures, including avoiding going out (93.2%), and frequent handwashing with soap and water (78.2%). Factors associated with an increased likelihood to adopt safety measures included perceptions that COVID-19 was a human health risk, the pandemic will continue for a long time, availability of clear information, and a lack of medicine. The largest predictor of safety behavior change was age; participants older than 55 were more likely to adopt recommended safety behaviors. Although knowledge and perception among the general public was reasonable, more encouragement from government via health education programs is needed to maintain appropriate behaviors. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

10 pages, 3492 KiB

Open AccessArticle

Well-Being of Healthcare Workers and the General Public during the COVID-19 Pandemic in Vietnam: An Online Survey

by Tuyen Dinh Hoang, Robert Colebunders, Joseph Nelson Siewe Fodjo, Nhan Phuc Thanh Nguyen, Trung Dinh Tran and Thang Van Vo

Int. J. Environ. Res. Public Health 2021, 18(9), 4737; https://doi.org/10.3390/ijerph18094737 - 29 Apr 2021

Cited by 17 | Viewed by 4468

Abstract

The COVID-19 pandemic and associated restrictive measures implemented may considerably affect people’s lives. This study aimed to assess the well-being of Vietnamese people after COVID-19 lockdown measures were lifted and life gradually returned to normal. An online survey was organized from 21 to 25 April 2020 among Vietnamese residents aged 18 and over. The survey was launched by the Hue University of Medicine and Pharmacy. The WHO-5 Well-Being Index (scored 0–25) was used to score participants’ well-being. A multivariate logistic regression model was used to determine the predictors of well-being. A total of 1922 responses were analyzed (mean age: 31 years; 30.5% male; 88.2% health professionals or students in the health sector). The mean well-being score was 17.35 ± 4.97. Determinants of a high well-being score (≥13) included older age, eating healthy food, practicing physical exercise, working from home, and adhering to the COVID-19 preventive measures. Female participants, persons worried about their relatives’ health, and smokers were more likely to have a low well-being score. In conclusion, after the lockdown measures were lifted, the Vietnamese have people continued to follow COVID-19 preventive measures, and most of them scored high on the well-being scale. Waiting to achieve large-scale COVID-19 vaccine coverage, promoting preventive COVID-19 measures remains important, together with strategies to guarantee the well-being of the Vietnamese people. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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12 pages, 2368 KiB

Open AccessArticle

Seroprevalence of SARS-CoV-2 Infection and Adherence to Preventive Measures in Cuenca, Ecuador, October 2020, a Cross-Sectional Study

by David Acurio-Páez, Bernardo Vega, Daniel Orellana, Ricardo Charry, Andrea Gómez, Michael Obimpeh, Veronique Verhoeven and Robert Colebunders

Int. J. Environ. Res. Public Health 2021, 18(9), 4657; https://doi.org/10.3390/ijerph18094657 - 27 Apr 2021

Cited by 13 | Viewed by 3660

Abstract

A door-to-door survey was organised in Cuenca, Ecuador, to determine the prevalence of COVID-19 infection and adherence of the population to COVID-19 preventive measures. A total of 2457 persons participated in the study; 584 (23.7%) reported having experienced at least one flu-like symptom since the onset of the pandemic. The maximum SARS-CoV-2 seroprevalence in Cuenca was 13.2% (CI: 12–14.6%) (IgM or IgG positive). Considering PCR confirmed infections, the prevalence was 11% (CI: 10–12.4%). There was no significant difference in seroprevalence between rural and urban areas. Participants aged 35–49 years old, living with a COVID-19 positive person, at least six people in a household, physical contact with someone outside the household, a contact with a person outside the home with flu-like symptoms, using public transport, and not having enough resources for living, significantly increased the odds for SARS-CoV-2 seropositivity. Overall, there was good adherence to COVID-19 preventive measures. Having known someone who tested positive for COVID-19, having a primary or secondary level of education, and having enough resources for living, significantly increased the odds for higher adherence. In conclusion, despite good overall adherence of the population of Cuenca with COVID-19 preventive measures, our study suggests high ongoing COVID-19 transmission in Cuenca, particularly in certain parishes. Prevention should not only focus on behavioural change, but on intensified testing strategies in demographical risk groups. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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12 pages, 560 KiB

Open AccessArticle

COVID-19 Preventive Behaviours in Cameroon: A Six-Month Online National Survey

by Joseph Nelson Siewe Fodjo, Leonard Ngarka, Wepnyu Y. Njamnshi, Leonard N. Nfor, Michel K. Mengnjo, Edwige L. Mendo, Samuel A. Angwafor, Jonas Guy Atchou Basseguin, Cyrille Nkouonlack, Edith N. Njit, Nene Ahidjo, Eric Samuel Chokote, Fidèle Dema, Julius Y. Fonsah, Godwin Y. Tatah, Nancy Palmer, Paul F. Seke Etet, Dennis Palmer, Dickson S. Nsagha, Daniel E. Etya’ale, Stephen Perrig, Roman Sztajzel, Jean-Marie Annoni, Anne-Cécile Zoung-Kanyi Bissek, Rose G. F. Leke, Marie-Thérèse Abena Ondoa Obama, John N. Nkengasong, Robert Colebunders and Alfred K. Njamnshi Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(5), 2554; https://doi.org/10.3390/ijerph18052554 - 4 Mar 2021

Cited by 16 | Viewed by 4558

Abstract

Since March 2020, the Cameroonian government implemented nationwide measures to stall COVID-19 transmission. However, little is known about how well these unprecedented measures are being observed as the pandemic evolves. We conducted a six-month online survey to assess the preventive behaviour of Cameroonian adults during the COVID-19 outbreak. A five-point adherence score was constructed based on self-reported observance of the following preventive measures: physical distancing, face mask use, hand hygiene, not touching one’s face, and covering the mouth when coughing or sneezing. Predictors of adherence were investigated using ordinal logistic regression models. Of the 7381 responses received from all ten regions, 73.3% were from male respondents and overall mean age was 32.8 ± 10.8 years. Overall mean adherence score was 3.96 ± 1.11 on a scale of 0–5. Mean weekly adherence scores were initially high, but gradually decreased over time accompanied by increasing incidence of COVID-19 during the last study weeks. Predictors for higher adherence included higher age, receiving COVID-19 information from health personnel, and agreeing with the necessity of lockdown measures. Meanwhile, experiencing flu-like symptoms was associated with poor adherence. Continuous observance of preventive measures should be encouraged among Cameroonians in the medium- to long-term to avoid a resurgence in COVID-19 infections. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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9 pages, 482 KiB

Open AccessArticle

Adherence to COVID-19 Preventive Measures in Mozambique: Two Consecutive Online Surveys

by António Júnior, Janeth Dula, Sérgio Mahumane, Olivier Koole, Sónia Enosse, Joseph Nelson Siewe Fodjo and Robert Colebunders

Int. J. Environ. Res. Public Health 2021, 18(3), 1091; https://doi.org/10.3390/ijerph18031091 - 26 Jan 2021

Cited by 32 | Viewed by 4531

Abstract

We assessed adherence to government recommendations implemented shortly after the introduction of COVID-19 in Mozambique in March 2020, through two online cross-sectional surveys in April and June 2020. We quantified adherence to preventive measures by a composite score comprising of five measures: physical distancing, face mask use, hand hygiene, cough hygiene, and avoidance of touching the face. 3770 and 1115 persons participated in the first and second round respectively. Wearing face masks, regular handwashing and cough hygiene all reached compliance rates of over 90% while physical distancing and avoiding to touch the face reached a compliance rate of 80–90%. A multivariable model investigating factors associated with adherence found that being older, more educated, and belonging to the healthcare sector increased the odds for higher adherence. Private workers and retired people, respondents receiving COVID-19 information through social media, and those who reported flu-like symptoms were less likely to adhere. 6% of respondents reported flu-like symptoms which aligned with the WHO clinical definition of COVID-19, suggesting low level community transmission. In conclusion, most respondents in this online survey in Mozambique complied well with strategies to prevent COVID-19. Whether the good preventive behaviour explains the low grade COVID-19 transmission requires further study. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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14 pages, 305 KiB

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Level and Determinants of Adherence to COVID-19 Preventive Measures in the First Stage of the Outbreak in Uganda

by Bob O. Amodan, Lilian Bulage, Elizabeth Katana, Alex R. Ario, Joseph N. Siewe Fodjo, Robert Colebunders and Rhoda K. Wanyenze

Int. J. Environ. Res. Public Health 2020, 17(23), 8810; https://doi.org/10.3390/ijerph17238810 - 27 Nov 2020

Cited by 36 | Viewed by 3755

Abstract

We conducted an online survey in the first two months of the Coronavirus Disease 2019 (COVID-19) epidemic in Uganda to assess the level and determinants of adherence to and satisfaction with the COVID-19 preventive measures recommended by the government. We generated Likert scales for adherence and satisfaction outcome variables and measured them with four preventive measures, including handwashing, wearing face masks, physical distancing, and coughing/sneezing hygiene. Of 1726 respondents (mean age: 36 years; range: 12–72), 59% were males, 495 (29%) were adherent to, and 545 (32%) were extremely satisfied with all four preventive measures. Adherence to all four measures was associated with living in Kampala City Centre (AOR: 1.7, 95% CI: 1.1–2.6) and receiving COVID-19 information from health workers (AOR: 1.2, 95% CI: 1.01–1.5) or village leaders (AOR: 1.4, 95% CI: 1.02–1.9). Persons who lived with younger siblings had reduced odds of adherence to all four measures (AOR: 0.75, 95% CI: 0.61–0.93). Extreme satisfaction with all four measures was associated with being female (AOR: 1.3, 95% CI: 1.1–1.6) and health worker (AOR: 1.2, 95% CI: 1.0–1.5). Experiencing violence at home (AOR: 0.25, 95% CI: 0.09–0.67) was associated with lower satisfaction. Following reported poor adherence and satisfaction with preventive measures, behavior change programs using health workers should be expanded throughout, with emphasis on men. Full article

(This article belongs to the Special Issue COVID-19 in Low and Middle Income Countries)

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