We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, 2020–September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.
Background: The Scanning Ears for Child Health (SEARCH) system is a biometric patient identification tool which uses a pattern recognition algorithm to translate an image of the ear into a unique identifier. If integrated into an electronic medical records (EMR) system, it would provide a patient identification solution that replaces unreliable paper, under-five card (UFC), or number-based identifiers. This study aims to understand the relative advantage of the biometric system, the sociocultural and pragmatic compatibility, and the extent of UFC deterioration over time. Methods: Interviews on impressions of the novel biometric patient identification tool were conducted in urban and rural settings in Zambia. Focus group discussions included 59 participants and key informant interviews included 5 healthcare workers and 2 government officials. Transcripts were coded into thematic categories for analysis. We sought to understand 1) the perceived relative advantage of a biometric system over the traditional UFCs among Zambian mothers, 2) the perceived sociocultural compatibility of a biometric system in the healthcare setting, and 3) pragmatic compatibility of the proposed system. Results: We found that the current UFC system presents issues for continuity of care and quality of data management, therefore posing disadvantages relative to the proposed system. Sociocultural and pragmatic barriers to acceptance included the existing fear of Satanism and electrical power issues throughout Zambia. Mothers and healthcare workers expressed that adoption of the biometric system could be successful given efforts to sensitize the community. Conclusions: Switching to an EMR backed by biometric identification would fill a critical gap in Zambian healthcare information systems and has numerous perceived advantages in both urban and rural settings. We determine that strategies for implementation should be localized, context informed, and conducted by trusted community members with knowledge of best approaches to diffusing information and a deep understanding of the novel biometric system.
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