COVID-19 vaccine hesitancy in Africa:a scoping review

Background:Vaccination against the novel coronavirus is one of the most effective strategies for combating the global Coronavirus disease(COVID-19)pandemic.However,vaccine hesitancy has emerged as a major obstacle in several regions of the world,including Africa.The objective of this rapid review was to summarize the literature on COVID-19 vaccine hesitancy in Africa.Methods:We searched Scopus,Web of Science,African Index Medicus,and OVID Medline for studies published from January 1,2020,to March 8,2022,examining acceptance or hesitancy towards the COVID-19 vaccine in Africa.Study characteristics and reasons for COVID-19 vaccine acceptance were extracted from the included articles.Results:A total of 71 articles met the eligibility criteria and were included in the review.Majority(n=25,35%)of the studies were conducted in Ethiopia.Studies conducted in Botswana,Cameroun,Cote D’Ivoire,DR Congo,Ghana,Kenya,Morocco,Mozambique,Nigeria,Somalia,South Africa,Sudan,Togo,Uganda,Zambia,Zimbabwe were also included in the review.The vaccine acceptance rate ranged from 6.9 to 97.9%.The major reasons for vaccine hesitancy were concerns with vaccine safety and side effects,lack of trust for pharmaceutical industries and misinformation or conflicting information from the media.Factors associated with positive attitudes towards the vaccine included being male,having a higher level of education,and fear of contracting the virus.Conclusions:Our review demonstrated the contextualized and multifaceted reasons inhibiting or encouraging vaccine uptake in African countries.This evidence is key to operationalizing interventions based on facts as opposed to assumptions.Our paper provided important considerations for addressing the challenge of COVID-19 vaccine hesitancy and blunting the impact of the pandemic in Africa.

Assessment and validation of the Community Maternal Danger Score algorithm

Background:High rates of maternal mortality in low-and-middle-income countries(LMICs)are associated with the lack of skilled birth attendants(SBAs)at delivery.Risk analysis tools may be useful to identify pregnant women who are at risk of mortality in LMICs.We sought to develop and validate a low-cost maternal risk tool,the Community Maternal Danger Score(CMDS),which is designed to identify pregnant women who need an SBA at delivery.Methods:To design the CMDS algorithm,an initial scoping review was conducted to identify predictors of the need for an SBA.Medical records of women who delivered at the Federal Medical Centre in Makurdi,Nigeria(2019-2020)were examined for predictors identified from the literature review.Outcomes associated with the need for an SBA were recorded:caesarean section,postpartum hemorrhage,eclampsia,and sepsis.A maternal mortality ratio(MMR)was determined.Multivariate logistic regression analysis and area under the curve(AUC)were used to assess the predictive ability of the CMDS algorithm.Results:Seven factors from the literature predicted the need for an SBA:age(under 20 years of age or 35 and older),parity(nulliparity or grand-multiparity),BMI(underweight or overweight),fundal height(less than 35 cm or 40 cm and over),adverse obstetrical history,signs of pre-eclampsia,and co-existing medical conditions.These factors were recorded in 589 women of whom 67%required an SBA(n=396)and 1%died(n=7).The MMR was 1189 per 100,000(95%CI 478-2449).Signs of pre-eclampsia,obstetrical history,and co-existing conditions were associated with the need for an SBA.Age was found to interact with parity,suggesting that the CMDS requires adjustment to indicate higher risk among younger multigravida and older primigravida women.The CMDS algorithm had an AUC of 0.73(95%CI 0.69-0.77)for predicting whether women required an SBA,and an AUC of 0.85(95%CI 0.67-1.00)for in-hospital mortality.Conclusions:The CMDS is a low-cost evidence-based tool that uses 7 risk factors assessed on 589 women from Makurdi.Non-specialist health workers can use the CMDS to standardize assessment and encourage pregnant women to seek an SBA in preparation for delivery,thus improving care in countries with high rates of maternal mortality.