BackgroundEbola haemorrhagic fever (EHF) is infamous for its high case-fatality proportion (CFP) and the ease with which it spreads among contacts of the diseased. We describe the course of the EHF outbreak in Masindi, Uganda, in the year 2000, and report on response activities.MethodsWe analysed surveillance records, hospital statistics, and our own observations during response activities. We used Fisher's exact tests for differences in proportions, t-tests for differences in means, and logistic regression for multivariable analysis.ResultsThe response to the outbreak consisted of surveillance, case management, logistics and public mobilisation. Twenty-six EHF cases (24 laboratory confirmed, two probable) occurred between October 21st and December 22nd, 2000. CFP was 69% (18/26). Nosocomial transmission to the index case occurred in Lacor hospital in Gulu, outside the Ebola ward. After returning home to Masindi district the index case became the origin of a transmission chain within her own extended family (18 further cases), from index family members to health care workers (HCWs, 6 cases), and from HCWs to their household contacts (1 case). Five out of six occupational cases of EHF in HCWs occurred after the introduction of barrier nursing, probably due to breaches of barrier nursing principles. CFP was initially very high (76%) but decreased (20%) due to better case management after reinforcing the response team. The mobilisation of the community for the response efforts was challenging at the beginning, when fear, panic and mistrust had to be countered by the response team.ConclusionsLarge scale transmission in the community beyond the index family was prevented by early case identification and isolation as well as quarantine imposed by the community. The high number of occupational EHF after implementing barrier nursing points at the need to strengthen training and supervision of local HCWs. The difference in CFP before and after reinforcing the response team together with observations on the ward suggest a critical role for intensive supportive treatment. Collecting high quality clinical data is a priority for future outbreaks in order to identify the best possible FHF treatment regime under field conditions.

The World Health Organization (WHO) has collected information on policies on sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) over many years. Creating a global survey that works for every country context is a well-recognized challenge. A comprehensive SRMNCAH policy survey was conducted by WHO from August 2018 through May 2019. WHO regional and country offices coordinated with Ministries of Health and/or national institutions who completed the questionnaire. The survey was completed by 150 of 194 WHO Member States using an online platform that allowed for submission of national source documents. A validation of the responses for selected survey questions against content of the national source documents was conducted for 101 countries (67%) for the first time in the administration of the survey. Data validation draws attention to survey questions that may have been misunderstood or where there was a lot of missing data, but varying methods for validating survey responses against source documents and separate analysis of laws from policies and guidelines may have hindered the overall conclusions of this process. The SRMNCAH policy survey both provided a platform for countries to track their progress in adopting WHO recommendations in national SRMNCAH-related legislation, policies, guidelines and strategies and was used to create a global database and searchable document repository. The outputs of the SRMNCAH policy survey are resources whose importance will be enriched through policy dialogues and wide utilization. Lessons learned from the methodology used for this survey can help to improve future updates and inform similar efforts.

Audrey Prost and colleagues discuss how best to enable families and communities to improve child health

Background: As of May 2021 no ethiotropic treatment for COVID-19 demonstrated safety and efficacy. A number of clinical trials are underway to investigate candidate products, most of them are repurposed products. As new evidenced emerges, WHO updates its recommendations on clinical management to support Member States amending their treatment protocols. Hydroxychloroquine / Chloroquine (HCQ/CQ) and Lopinavir + Ritonavir arms of the Solidarity Trial were discontinued. There is strong recommendation against administrating these products to COVID-19 patients. In contrary, Corticosteroids were identified as lifesaving medicines, substantially reducing mortality for critically ill patients. This study aimed at checking the alignment of countries’ COVID-19 treatment protocols in the WHO African region with the WHO recommendations, and analyze their impact on supply chain and quality of care. Methods: In October-November 2020, country treatment protocols were collected, and data on therapeutics were summarized in an Excel Sheet to facilitate their comparison with the WHO recommendations. Results: From the thirty protocols collected, 50% were recommending HCQ/CQ for mild COVID-19. The proportion was quite similar for moderate and severe cases accounting 57% and 53 % of protocols respectively, while 27% were still recommending HCQ/CQ for critically ill patients. Antibiotics were recommended in 53% and 80 % of protocols for mild and moderate cases respectively. Only 47 % and 60% of protocols were recommending corticosteroids for severe and critical cases respectively. Convalescent Plasma was reflected in few protocols. Discussion: HCQ and CQ were the standard treatment of COVID-19 in most of countries, diverting resources from the supply chain for essential services. There is a serious risk of antibiotic misuse, which can potentially lead to antimicrobial resistance surge, the increased rates of morbidity, mortality, treatment costs and financial burden for patients and communities. Slow uptake of corticosteroids may compromise the quality of care for severe and critical cases.Conclusions: The COVID-19 pandemic has demonstrated that, in cases similar to COVID-19 without efficacious treatment, treatment protocols are handled as living documents to be timely amended. Proactive update of country protocols to reflect evolving scientific evidences is critical, to ensure that all patients benefit from high standard quality of care.