Coronavirus disease 2019 (COVID 19) has had serious social, economic, and health effects globally. The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), which was first announced in December 2019 has resulted in more than 24 million infections. There is paucity of knowledge on the role of risk perception in the adoption of public health interventions needed to control the spread of COVID 19 infections within communities. This was a scoping review and documents how risk perception may be a major challenge for populations to adopt and implement different behavioral changes recommended to curtail the spread COVID- 19 pandemic in sub-Saharan Africa; and seeks to proffer solutions on how the identified challenges can be addressed drawing from lessons learnt from previous epidemics within the region. Database search of Google Scholar, PubMed, Research Gate among others were performed using related keywords to identify relevant journals and lists of primary articles. Culture, religious beliefs and poverty may influence how populations respond to infectious disease outbreaks. Risk strategies that focus only on biomedical approaches to control the COVID-19 pandemic may not mobilize the needed behavioral change. Lessons learnt from HIV and Ebola epidemics showed that involvement of communities could help transform weak adoption of public health measures when measures were framed in the relevant cultural context. An understanding of the factors influencing risk perception is needed to design appropriate risk communication strategies. Community engagement and reliance on local communication networks could promote mutual trust and increase the uptake of public-health interventions.

Background Long-term care facilities (LTCFs) including assisted living facilities (ALFs) are hubs for high transmission and poor prognosis of COVID-19 among the residents who are more susceptible due to old age and comorbidities. Aim Houston Health Department conducted assessments of ALFs within the City of Houston to determine preparedness and existing preventive measures at the facilities. Methods Onsite assessments were conducted at ALFs using a modified CDC Infection Control Assessment and Response (ICAR) Tool. Data was obtained on IPC measures, training, testing, vaccination etc. Data was analyzed, frequencies generated, and bivariate associations determined. Results A total of 118 facilities were assessed and categorized into small scale 46 (39%), medium scale 47 (40%), and large scale 25 (21%). The facilities had 2431 residents and 2290 staff. Thirty-one (26%) facilities reported an outbreak in 2020, while 14 (12%) had an ongoing outbreak. Twenty-three (97%) large-scale and 12 (26%) small-scale facilities had COVID-19 testing program. Vaccination coverage among residents ranged from 99% in large-scale to 40% in small-scale facilities but was smaller among staff at 748 (45%) in large scale, 71 (36%) in small scale, and 193 (45%) in medium scale. While 24 (96%) large-scale and 34 (77%) of small-scale facilities conducted staff training staff on IPC practices, 22 (92%) of large-scale and 19 (56%) of small-scale facility staff demonstrated capacity ( p = 0.01), respectively. Visitor screening was done at 100% of large-scale and 80% of small-scale and the medium-scale ALFs. Discussion Assisted living facilities within the city of Houston are at various levels of preparedness and interventions with respect to COVID-19 response.

Background Vaccine hesitancy threatens a reversal of progress made in tackling vaccine-preventable diseases. The Houston, Texas, Health Department assessed COVID-19 vaccine availability and uptake in these facilities after the emergency use authorization of the COVID-19 vaccines in United States. Population and Methods A facility-based cross-sectional study was conducted using a structured interviewer-administered questionnaire to elicit data on facility demographics, vaccine availability, residents and staff vaccine uptake at time of assessment. The unit of inquiry was the facility. We calculated frequencies and assessed association with facility type. Facilities were classified as: small-scale facilities (SSF) ≤ 10 beds, medium scale (MSF) 11-50 beds, and large-scale (LSF) > 50 beds. Results A total of 118 facilities were enrolled, with 2,431 residents and 2,290 staff. Twenty-five (14.5%) of the facilities were LSF, 47 (39.8%) MSF, and 46 (39.0%) SSF. Overall, 70 (59.3%) facilities had COVID-19 vaccine available. The staff of these facilities were four-times as likely as the patients to be unvaccinated (prevalence ratio= 4.1; 95% CI= 3.7, 4.6) since the vast majority of residents, (86.5%), were vaccinated but less than half of staff (44.2%) were (P < 0.0001). Reasons provided for vaccine hesitancy included fear of side effects from a new vaccine, need to wait and see what happens to others, government distrust, religious beliefs, conspiracy theories among other things.    Discussion The findings supported highlighted a preventable gap in the protection of the elderly in these facilities and prompted a health education campaign tackling vaccine hesitancy and encourage vaccine uptake.

Introduction: Rational use of Drugs is the prescription and dispensation of drugs to the appropriate patients in appropriate doses, for required period and at lowest cost to them and their community. Irrational use refers to inappropriate use of drugs which include prescription and dispensation of too many drugs (polypharmacy), unnecessary and overuse of antibiotics and use of injection where oral drug suffices. A step towards preventing irrational drug use is to document it in a study such as this, so that appropriate corrective steps can be taken. Methods: This was a cross sectional cohort analysis of the prescribing records of primary health care workers from eight primary health care facilities. Result & Discussion: There were 513 prescriptions of 2, 590 drugs from the eight facilities;206 (40%) from a cohort of two comprehensive health centres and 307(60%) from a cohort of six basic health clinics. 206(40%) was diagnosis-based prescriptions, while 307(60%) was not based on diagnosis. About 426(83%) contain antibiotics prescriptions, while 87(17%) had no antibiotic prescriptions. About 395(77%) prescriptions contained injectable drugs while 118(23%) did not contain any injectable drug. Conclusion: The average of number drugs per prescription and the proportions of antibiotics and injectables prescriptions in this study were higher than the WHO recommendations. These values were equally higher than values in many studies. Healthcare workers at the basic health clinics did more diagnosis-based prescriptions, prescribed more antibiotics and more injectable than their counterparts at the comprehensive health centers.

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