Community interventions in Low—And Middle-Income Countries to inform COVID-19 control implementation decisions in Kenya: A rapid systematic review

Abstract

Globally, public health measures like face masks, hand hygiene and maintaining social distancing have been implemented to delay and reduce local transmission of COVID-19. To date there is emerging evidence to provide effectiveness and compliance to intervention measures on COVID-19 due to rapid spread of the disease. We synthesized evidence of community interventions and innovative practices to mitigate COVID-19 as well as previous respiratory outbreak infections which may share some aspects of transmission dynamics with COVID-19. In the study, we systematically searched the literature on community interventions to mitigate COVID-19, SARS (severe acute respiratory syndrome), H1N1 Influenza and MERS (middle east respiratory syndrome) epidemics in PubMed, Google Scholar, World Health Organization (WHO), MEDRXIV and Google from their inception until May 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO (CRD42020183064). Of 41,138 papers found, 17 studies met the inclusion criteria in various settings in Low- and Middle-Income Countries (LMICs). One of the papers from LMICs originated from Africa (Madagascar) with the rest from Asia 9 (China 5, Bangladesh 2, Thailand 2); South America 5 (Mexico 3, Peru 2) and Europe 2 (Serbia and Romania). Following five studies on the use of face masks, the risk of contracting SARS and Influenza was reduced OR 0.78 and 95% CI = 0.36–1.67. Equally, six studies on hand hygiene practices reported a reduced risk of contracting SARS and Influenza OR 0.95 and 95% CI = 0.83–1.08. Further two studies that looked at combined use of face masks and hand hygiene interventions showed the effectiveness in controlling the transmission of influenza OR 0.94 and 95% CI = 0.58–1.54. Nine studies on social distancing intervention demonstrated the importance of physical distance through closure of learning institutions on the transmission dynamics of disease. The evidence confirms the use of face masks, good hand hygiene and social distancing as community interventions are effective to control the spread of SARS and influenza in LMICs. However, the effectiveness of community interventions in LMICs should be informed by adherence of the mitigation measures and contextual factors taking into account the best practices. The study has shown gaps in adherence/compliance of the interventions, hence a need for robust intervention studies to better inform the evidence on compliance of the interventions. Nevertheless, this rapid review of currently best available evidence might inform interim guidance on similar respiratory infectious diseases like Covid-19 in Kenya and similar LMIC context.

How the nations should gear up for future pandemics?

“…Pro-active communication would be the most important tool in managing risk, which would allow public to embrace protective conduct, alleviate enhanced disease surveillance, bring down confusion and promote effective use of resources, all of which are requisite for an efficacious response[ 8 ]. Investment in digital technology and attaining universal health coverage may not be feasible for low and middle-income countries; while, evidences suggest that usage of face mask, maintaining social distancing, and hand hygiene practices were efficient norms in halting the spread of current pandemic [ 9 ]. However, all these required public support and it wouldn’t be possible without gaining public trust in the government, which in turn is possible through transparent communication of the facts.…”

Implementing Public Health Strategies—The Need for Educational Initiatives: A Systematic Review

“…Technical requirements that include opt-in measures are necessary to grant contact tracing app users the ability to return to their normal lives in an achievable time, provided they use the app and respect other important public health measures. This would comply with the European Data Protection Board (EDPB)'s statement that restrictions of freedom during the pandemic or any other emergency during a strictly limited period are acceptable [31,32]. A solely Bluetooth-enabled app would operate on a system of individual anonymous codes, which enables the exchange of codes through a decentralized system.…”

“…A future public health emergency may not facilitate any option to adopt such mass surveillance measures [32]. It is, thus, crucial to ensure that policies, mathematical models, and technological measures are developed and in place to protect the collected and used data and promote transparency in how data can help contain the spread of disease while protecting and ensuring civil liberties [31].…”

“…Adequate knowledge about incidents, their etiology, and the available management options enables recognition of the threats and acceptance of necessary strategies during public health emergencies. Consequently, community preparedness and mental readiness seem to be some of the most important elements in successful policy implementation [20,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. It is therefore evident that investing in local empowerment by establishing educational initiatives, proper communication, and timely information are all necessary steps to counteract misinformation and to promote successful implementation of public health strategies, which will further attenuate the pandemic.…”

La edad y la resiliencia en el personal de salud que atiende pacientes con Covid-19. Caso de la ciudad de Ambato.

“…Las técnicas de control básicas que los países a nivel mundial emplearon desde su inicio derivaron en el del rastreo de casos, el aislamiento de los infectados y cuarentenas obligatorias. Este impedimento de trabajo presencial en los trabajos tradicionales ocasionó un quebrantamiento en el sistema financiero (Abdullahi et al 2020), pero el sector sanitario no paró y se acomodó a este ambiente agresivo de trabajo generando posibles situaciones de exposición a elementos estresantes por el www.anatomiadigital.org manejo directo de pacientes e indirecto de los sitios contaminados por este virus mortífero (Yin et al 2020).…”