Background: Muslim majority countries have experienced a considerable burden of COVID-19 infection. However, there has been a relative lack of research comparing COVID-19 outbreaks and responses between Muslim-majority countries. Methods: We use a mixed-methods approach to describe the course of the COVID-19 pandemic throughout the Islamic world, highlight the range of non-pharmaceutical interventions used and the speed with which they were implemented, and investigate reasons behind the differing responses between Muslim-majority countries. The number of cases and deaths per million population, and the median time taken to implement a range of policies, were compared across the Islamic world. Cases per million population and the mean estimated doubling time for cases was compared between Muslim-majority countries on the basis of governance systems, rapidity of institution of mitigation strategies and conflict groups. We also evaluated pushback to implementation of measures within MMCs, especially from religious quarters. Results: Non-democratic regimes had much shorter doubling time of cases compared to functional democratic Muslim-majority countries (mean 33.9 versus 66.5 days, P = 0.002) and a significantly greater proportion of countries appeared to have flattened the curve by 1 June 2020 (43.8% versus 12.5%, P < 0.03). The doubling time was also significantly greater among countries who implemented lockdown and mitigation measures early (66.7 versus 16.7 days, P < 0.003). 1 / 13 WHO EMRO | Analysis of COVID-19 burden, epidemiology and mitigation strategies in Muslim majority co Conclusion: Our analysis indicates wide diversity in the COVID-19 response across Muslim majority countries with clear indication that functional democracies were able to contain the epidemic significantly better than nondemocratic regimes. Future analysis should focus on determination of sub-national differentials and risks as well as targeting of interventions.

Background We conducted a systematic review to assess whether measles humoral immunity wanes in previously infected or vaccinated populations in measles elimination settings. Methods After screening 16,822 citations, we identified nine articles from populations exposed to wild-type measles and 16 articles from vaccinated populations that met our inclusion criteria. Results Using linear regression, we found that geometric mean titers (GMTs) decreased significantly in individuals who received two doses of measles-containing vaccine (MCV) by 121.8 mIU/mL (95% CI -212.4, -31.1) per year since vaccination over one to five years, 53.7 mIU/mL (95% CI -95.3, -12.2) five to ten years, 33.2 mIU/mL (95% CI -62.6, -3.9) ten to 15 years, and 24.1 mIU/mL (95% CI -51.5,3.3) 15 to 20 years since vaccination. Decreases in GMT over time were not significant after one dose of MCV or after infection. Decreases in the proportion of seropositive individuals over time were not significant after one or two doses of MCV, or after infection. Conclusions Measles antibody waning in vaccinated populations should be considered in planning for measles elimination.

Background Uganda has achieved a considerable reduction in childhood stunting over the past two decades, though accelerated action will be needed to achieve 2030 targets. Objectives This study assessed the national, community, household, and individual-level drivers of stunting decline since 2000, along with direct and indirect nutrition policies and programs that have contributed to nutrition change in Uganda. Design This mixed-methods study used 4 different approaches to determine the drivers of stunting change over time: 1) a scoping literature review; 2) quantitative data analyses, including Oaxaca-Blinder decomposition and difference-in-difference multivariable hierarchical modeling; 3) national and community-level qualitative data collection and analysis; and 4) analysis of key direct and indirect nutrition policies, programs, and initiatives. Results Stunting prevalence declined by 14% points from 2000 to 2016, though geographical, wealth, urban/rural, and education-based inequalities persist. Child growth curves demonstrated substantial improvements in child height-for-age z-scores (HAZ) at birth, reflecting improved maternal nutrition and intrauterine growth. The decomposition analysis explained 82% of HAZ change, with increased coverage of insecticide-treated mosquito nets (ITNs; 35%), better maternal nutrition (19%), improved maternal education (14%), and improved maternal and newborn healthcare (11%) being the most critical factors. The qualitative analysis supported these findings, and also pointed to wealth, women's empowerment, cultural norms, water and sanitation, dietary intake/diversity, and childhood illness as important. The 2011 Uganda Nutrition Action Plan (UNAP) was an essential multi-sectoral strategy that shifted nutrition out of health and mainstreamed it across related sectors. Conclusions Uganda's success in stunting reduction was multi-factorial, but driven largely through indirect nutrition strategies delivered outside of health. To further improve stunting, it will be critical to prioritize malaria-control strategies, including ITN distribution campaigns and prevention/treatment approaches for mothers and children, and deliberately target the poor, least educated and rural populations along with high-burden northern and western districts.