Background COVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. Objective The aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. Methods We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. Results A total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42). Conclusions Being pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial Registration PROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011.

In an effort to mitigate the outbreak of COVID-19, many countries have imposed drastic lockdown, movement control, or shelter-in-place orders on their residents. The effectiveness of these mitigation measures is highly dependent on the cooperation and compliance of all members of society. The knowledge, attitudes, and practices people hold toward the disease play an integral role in determining a society’s readiness to accept behavioral change measures from health authorities. Urban informal settlements are characterized by large populations occupying a small land area. Housing in informal settlements is close to each other with most households making do with poor quality and erratic water supply. How challenges of sanitation in slum dwellings in Kenya affect the spread of COVID-19 is not known. Social distancing, wearing masks and hand washing among other measures are known to reduce the spread of COVID-19. Although access to hand-washing facilities with soap and water is nearly universal in high-income countries, the same is not true for low-income countries. The purpose of this survey was to assess the challenges of hand washing as a COVID-19 prevention measure among urban slum populations in Kenya. Key information of practices on hand-washing practices among this sub-population will inform the ministry of health, its collaborators, and interested health sectors, on areas of improvement. A descriptive cross-sectional survey for quantitative data was used. Solvins formula for the calculation of sample size was used. A properly designed data collection tool was used in collecting the primary data on hand washing to prevent transmission of COVID-19 with a combination of face-to-face interviews. A pre-test of the data collection tool prior to pilot data collection was performed to ascertain validity and reliability. Data was analyzed using descriptive statistics such as frequencies, mean and standard deviation and displayed using tables and figures. Inferential statistics for predictive associations between variables was performed. In the analysis, data was combined to allow reporting on an array of issues. The results indicate salient challenges on hand-washing and show an acceptable level of knowledge in mitigating COVID-19 through hand-washing and hygiene and, highlight the importance of consistent messaging from local health authorities and the government as well as the need for tailored community health education and sensitization programs to improve levels of knowledge, attitudes, and practices mostly on handwashing as this pandemic may be there for some time or there could be a possible upsurge in future.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0202/a.php" alt="Hit counter" /></p>

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Background: Post-COVID-19 sequalae involves a variety of new, returning or ongoing symptoms that people experience more than four weeks after getting COVID-19. The aims of this meta-analysis were to assess the prevalence of Post-Acute COVID-19 sequalae and estimate the average time to its diagnosis; and meta-regress for possible moderators. Methods: A standard search strategy was used in PubMed, and then later modified according to each specific database. Search terms included; long COVID-19 or post-acute COVID-19 syndrome/sequalae. The criteria for inclusion were published clinical articles reporting the long COVID-19, further, the average time to diagnosis of post-acute COVID-19 sequelae among primary infected patients with COVID-19. Random-effects model was used. Rank Correlation and Eggers tests were used to ascertain publication bias. Sub-group, sensitivity and meta-regression analysis were conducted. A 95% confidence intervals were presented and a p-value < 0.05 was considered statistically significant. Review Manager 5.4 and comprehensive meta-analysis version 4 (CMA V4) were used for the analysis. The trial was PROSPERO registered (CRD42022328509). Results: Prevalence of post-acute COVID-19 sequalae was 42.5% (95% confidence interval (CI) 36 % to 49.3%). The PACS event rates range was 25 % at four months and 66 % at two months and mostly, signs and symptoms of PASC were experienced at three (54.3%, P < 0.0001) to six months (57%, P < 0.0001), further increasing at 12 months (57.9%, P= 0.0148). At an average of two months, however with the highest event rate (66%), it was not significantly associated with PACS diagnosis (P=0.08). On meta-regression, comorbidities collectively contributed to 14% of PACS with a non-significant correlation (Q = 7.05, df = 8, p = 0.5313) (R-squared analog = 0.14). A cardiovascular disorder especially hypertension as a stand-alone, showed an event rate of 32% and significantly associated with PACS, 0.322 (95% CI 0.166, 0.532) (P < 0.001). Chronic obstructive pulmonary disorder (COPD) and abnormal basal metabolic index (BMI) had higher event rates of PACS (59.8 % and 55.9 %) respectively, with a non-significant correlation (P > 0.05). With a significant association, hospital re-admission contributed to 17% (Q = 8.70, df = 1, p = 0.0032) (R-squared analog= 0.17) and the study design 26% (Q = 14.32, df = 3, p = 0.0025) (R-squared analog= 0.26). All the covariates explained at least some of the variance in effect size on PACS at 53% (Q = 38.81, df = 19, p = 0.0047) (R-squared analog = 0.53). Conclusion: The prevalence of PACS in general population was 42.5%, of which cardiovascular disorders were highly linked with it with COPD and abnormal BMI also being possible conditions found in patients with PACS. Hospital re-admission predicted highly, an experience of PACS as well as prospective study design. Clinical and methodological characteristics in a specific study contributed to over 50% of PACS events. The PACS event rates ranged between 25 % at four months and 66 % at two months with most signs and symptoms experienced between three to six months increasing at 12 months.

IntroductionEstablished predictors for COVID 19 related mortalities are diverse. The impact of these several risk factors on coronavirus mortality have been previously reported in several meta-analyses limited by small sample sizes and premature data. The objective of this systematic review and meta-analysis coupled with meta-regression was to evaluate the updated evidence on the risk of COVID 19 related mortality by HIV serostatus using published data, and account for possible moderators.MethodElectronic databases including Google Scholar, Cochrane Library, Web of Sciences (WOS), EMBASE, Medline/PubMed, COVID 19 Research Database, and Scopus, were systematically searched till 30th February, 2022. All human studies were included irrespective of publication date or region. Twenty-two studies with a total of 19,783,097 patients detailing COVID 19 related mortality were included. To pool the estimate, a random effects model with risk ratio as the effect measure was used. Moreover, publication bias and sensitivity analysis were evaluated followed by meta-regression. The trial was registered (CRD42021264761) on the PROSPERO register.ResultsThe findings were consistent in stating the contribution of HIV infection for COVID-19 related mortality. The cumulative COVID-19 related mortality was 110270 (0.6%) and 48863 (2.4%) with total events of 2010 (3.6%), 108260 (0.5%) among HIV-positive and negative persons respectively. HIV infection showed an increased risk of COVID-19 related mortality [RR=1.19, 95% CI (1.02, 1.39) (P=0.00001)] with substantial heterogeneity (I squared > 80%). The true effects size in 95% of all the comparable populations fell between 0.64 to 2.22. Multiple Centre studies and COVID-19 mortality with HIV infection showed a significant association [RR = 1.305, 95% CI (1.092, 1.559) (P = 0.003)], similar to studies conducted in America (RR=1.422, 95% CI 1.233, 1.639) and South Africa (RR=202;1.123, 95% CI 1.052, 1.198). HIV infection showed a risk for ICU admission [(P=0.00001) (I squared = 0%)] and mechanical ventilation [(P=0.04) (I squared = 0%)] which are predictors of COVID-19 severity prior to death. Furthermore, risk of COVID 19 related mortality is influenced by the region of study (R squared = 0.60). The variance proportion explained by covariates was significant (I squared = 87.5%, Q = 168.02, df = 21, p = 0.0000) (R squared = 0.67).ConclusionOur updated meta-analysis indicated that HIV infection was significantly associated with an increased risk for both COVID 19 mortality, which might be modulated by the regions. We believe the updated data further will contribute to more substantiation of the findings reported by similar earlier studies (Dong et al., 2021; K. W. Lee et al., 2021; Massarvva, 2021; Mellor et al., 2021; Ssentongo et al., 2021)

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Background: With enhanced rollout of anti-retroviral therapy (ART) following prevention of mother to child transmission (PMTCT) and the associated burden of opportunistic infections in developing countries, human immunodeficiency virus-immune reconstitution inflammatory syndrome (HIV-IRIS) may remain a public health area of major concern especially, in pregnancy. Ascertaining the association between maternal HIV infection and adverse maternal and birth related outcomes could be conflicted by the relationship between maternal-HIV- IRIS and the adverse pregnancy-fetal outcomes (APFOs) in HIV-infected mothers. We sought to estimate the incidence and determine possible predictors for adverse pregnancy-fetal outcomes with maternal-HIV-IRIS in ART naïve HIV infected pregnant women. Methodology: Subjects grouped in to IRIS exposed and non-IRIS exposed were followed from the end of first trimester for six and half months. Chi-square test was used to establish the association between the variables at p-value < 0.05. Regression analysis was performed to identify independent predictors of APFOs. Adjusted Relative Risk at 95% confidence interval was determined. Results: The IRIS exposed pregnant women, had a 26.47% adverse pregnancy-fetal outcomes cumulative incidence compared to 10.78% among IRIS non-exposed women. The APFO incidence rate estimate was 0.012 and 0.0045 per person’s week respectively. IRIS cases had 2.46 times the risk of experiencing an APFO compared to those who did not [OR=3; 95%CI: 1.4-6.4; P=.004], at bivariate analysis, not sustained at the multivariate analysis [AOR=1.6; 95%CI: 0.4-5.8; P = .508]. Multiple logistic regression dropped maternal HIV-IRIS and revealed; HIV-RNA viral load at baseline of above 50 copies/ml [AOR=2.7; 95%CI: 1.2-6.3; P=.017], Maternal placental syndrome(MPS) characterized by hypertensive event [AOR=0.1; 95%CI:0.0-1.0; P = .052] and mother’s general health during delivery [AOR= 4; 95%CI: 4.0:1.8-9.1;P=.001] as independent predictors of APFOs. Conclusion: There is a higher incidence of APFOs among maternal HIV-IRIS diagnosed pregnant women as compared to non-HIV maternal IRIS diagnosed pregnant women. In particular, MPS characterized by an hypertensive event, HIV-RNA viral load at baseline of above 50 copies/ml and mother’s general health during delivery are key predictors of an adverse pregnancy outcome. Interventions to reduce the associated risk predictors identified in this analysis should be studied for their effects on reducing APFOs.

Background. Long COVID is a wide range of new, returning, or ongoing health problems experienced after primary COVID-19 infection, with a possibility of broad adverse outcomes. The aim of this study was to determine the case fatality of of post-acute sequelae of COVID-19 (PASC) and assess possible covariates. Population and Methods. We conducted a systematic review and meta-analysis from 43 studies (367,236 patients), (June, 2020 - August, 2022). PASC mortality was assessed from six studies. With random-effects model, the pooled case fatality was measured. Publication bias was ascertained and meta-regression analysis done on predetermined covariates. Results. The estimated prevalence of PASC was 42.5% (95% CI = 36.0 % - 49.3%).  The pooled case fatality was 7.4% (95% CI = 7.4% to 11.2%). The funnel plot suggested the presence of publication bias. Hospital re-admission (P = 0.0034) (R² = 1.00) and the year 2021 (P = 0.0309) (R² = 0.55) were associated with fatalities from PASC. Discussion. PASC increased the case-fatality of  COVID-19, particularly during the year 2021, reflecting a longer follow-up of patients and with hospital re-admission. It is recommended to monitor patients re-admitted to hospital post index COVID-19 closely monitor specific clinical parameters that may increase the risk of death.