Global pattern and determinants of coronavirus disease 2019(COVID-19)vaccine coverage and progression:a global ecological study

Background:Understanding and minimizing existing global coronavirus disease 2019(COVID-19)vaccination disparities is critical to global population health and eliminating health inequities.The study aims to investigate the disparities of vaccination coverage and progression and the associated economic and educational determinants to inform global COVID-19 vaccination strategies.Methods:COVID-19 vaccination coverage data from 206 countries used in the study were derived from“Our World in Data”website.After obtaining the vaccination coverage indicators,we fitted the progression indicators for vaccination.Correlation and multiple linear regression analysis were used to examine the effects of gross domestic product(GDP)per capita,Gini index,education,and their interactions on the coverage and progression of the COVID-19 vaccination.Results:The coverage of COVID-19 vaccination ranged from less than 30 doses to more than 150 doses per hun­dred people,from less than 15%to more than 75%for proportion of people vaccinated,from less than 15%to more than 60%for proportion of people fully vaccinated.Similarly,the progression of vaccination ranged from less than 0.1 to more than 0.6 for progression of total number of doses,from less than 0.1 to more than 0.3 for progression of proportion of people vaccinated,and from less than 0.1 to more than 0.4 for progression of propor­tion of people fully vaccinated.GDP per capita and education were positively associated with the coverage and progression,while Gini index was negatively associated with the coverage and progression.Negative interaction between GDP per capita and education was also observed for coverage(0=-0.012 to-0.011,P<0.05)and progression(0=-0.012 to-0.011,P<0.05).Conclusions:Substantial geographic disparities existed for the coverage and progression of COVID-19 vaccination.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

Optimum Threshold Estimation of Thorax CT Scan for COVID-19 Diagnosis in a Single Center in Cameroon

Objective: To evaluate the lung CT scan as a possible predictive diagnostic method for COVID-19 in the Cameroonian context. Methods: We designed a cross sectional study. Suspected cases of COVID-19 during the first wave at the national social insurance fund (NSIF) hospital were screened with both COVID-19 with lung CT scan and a PCR test. Univariate analysis was performed for sample description and multivariate analysis to assess the correlation between positive results for the PCR and other parameters. We estimated the optimum threshold of sensitivity/specificity, and area under curve using the empirical method and package. Results: A total of 62 suspected COVID-19 cases were recorded, predominantly males (Sex Ratio = 2.2) with a median age of 58.5 (IQR = 19.7). Among our 62 patients, 29 (46.8%) were confirmed COVID-19 cases with positive PCR results. All the patients had a thorax CT scan with a median impairment of 40% (IQR = 20%). The optimum threshold estimate for CT scan for COVID-19 infection diagnosis was 60% (95% CI = 25% - 80%). Overall, the sensitivity and specificity estimates were 0.30 (95% CI = 0.15 - 0.49) and 0.87 (95% CI = 0.70 - 0.96), respectively, leading to an Area Under Curve (AUC) estimate of 0.59 (95% CI = 0.46, 0.71). Conclusion: In this setting, lung CT scan was neither sensitive nor specific to predict COVID-19 disease.

Correlation between Transcutaneous Bilirubinemia and Blood Bilirubinemia in Screening Term Newborn for Neonatal Jaundice at the Essos Hospital Centre (EHC), Yaoundé, Cameroon

Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.

Returned Migrants,Family Capital and Entrepreneurship in Rural China

This paper introduces an interaction item conslstmg of migration experience and family capital into a rural labor employment selection model.It analyzes how migration experience helps eliminate resource constraints in rural areas and facilitates the participation of rural workers in entrepreneurship.We find that the length of time migrants work in migrant inflow areas exerts a significantly positive influence on the non-agricultural employment of returned migrants.We also find that those returned migrants who have worked in the service industry prefer to work for local enterprises.Furthermore,returned migrant workers with business experience tend to start their own businesses upon returning home.Compared with non-migrants,returned migrants are more capable of utilizing their rural family capital in the entrepreneurial process.These findings suggest that both migration experience and family capital promote local employment and entrepreneurship in rural areas,despite the fact that they are subject to the imperfect rural market mechanism and lack adequate social support.

Observed versus estimated actual trend of COVID-19 case numbers in Cameroon:A data-driven modelling

Controlling the COVID-19 outbreak remains a challenge for Cameroon,as it is for many other countries worldwide.The number of confirmed cases reported by health authorities in Cameroon is based on observational data,which is not nationally representative.The actual extent of the outbreak from the time when the first case was reported in the country to now remains unclear.This study aimed to estimate and model the actual trend in the number of COVID-19 new infections in Cameroon from March 05,2020 to May 31,2021 based on an observed disaggregated dataset.We used a large disaggregated dataset,and multilevel regression and poststratification model was applied prospectively for COVID-19 cases trend estimation in Cameroon from March 05,2020 to May 31,2021.Subsequently,seasonal autoregressive integrated moving average(SARIMA)modeling was used for forecasting purposes.Based on the prospective MRP modeling findings,a total of about 7450935(30%)of COVID-19 cases was estimated from March 05,2020 to May 31,2021 in Cameroon.Generally,the reported number of COVID-19 infection cases in Cameroon during this period underestimated the estimated actual number by about 94 times.The forecasting indicated a succession of two waves of the outbreak in the next two years following May 31,2021.If no action is taken,there could be many waves of the outbreak in the future.To avoid such situations which could be a threat to global health,public health Abbreviations:ACF,Autocorrelation Function;AIC,Akaike information criterion;COVID-19,Coronavirus Disease 2019;MAE,Mean Absolute Error;MAPE,Mean Absolute Percentage Error;MASE,Mean Absolute Scaled Error;ME,Mean Error;MPE,Mean Percentage Error;MRP,Multilevel Regression and Post-stratification;PACF,Partial Autocorrelation Function;PLACARD,Platform for Collecting,Analyzing and Reporting Data;SARIMA,Seasonal Autoregressive integrated moving average;SARS-CoV-2,Severe Acute Respiratory Syndrome Coronavirus 2.