Background The rapid spread of COVID-19 globally has prompted policymakers to evaluate the capacity of health care infrastructure in their communities. Many hard-hit localities have witnessed a large influx of severe cases that strained existing hospitals. As COVID-19 spreads in India, it is essential to evaluate the country's capacity to treat severe cases. Methods We combined data on public and private sector hospitals in India to produce state level estimates of hospital beds, ICU beds, and mechanical ventilators. Based on the number of public sector hospitals from the 2019 National Health Profile (NHP) of India and the relative proportions of public and private health care facilities from the National Sample Survey (NSS) 75th round (2017-2018), we estimated capacity in each Indian state and union territory (UT). We assumed that 5% of all hospital beds were ICU beds and that 50% of ICU beds were equipped with ventilators. Results We estimated that India has approximately 1.9 million hospital beds, 95,000 ICU beds and 48,000 ventilators. Nationally, resources are concentrated in the private sector (hospital beds: 1,185,242 private vs 713,986 public; ICU beds: 59,262 private vs 35,699 public; ventilators: 29,631 private vs. 17,850 public). Our findings suggest substantial variation in available resources across states and UTs. Conclusion Some projections shave suggested a potential need for approximately 270,000 ICU beds in an optimistic scenario, over 2.8 times the estimated number of total available ICU beds in India. Additional resources will likely be required to accommodate patients with severe COVID-19 infections in India.

Background The coronavirus disease (COVID-19) pandemic is an emerging threat across the African continent where national critical care capacity is underdeveloped or unknown. In this paper, we compile data on critical care capacity -- including number of ICU beds, number of ventilators, and number of physician and non-physician anesthesia providers -- for 54 African countries. Methods Data was compiled from a variety of resources including World Bank databases, local and international news media, government reports, local healthcare workers, and published scientific literature. Results Overall, data on number of ICU beds were available for 49 (91%) countries and on number of ventilators for 46 (85%) countries, respectively. Data on physician anesthesia providers and non-physician providers was available for 47 (87%) and 37 (69%) of the 54 African countries. Conclusion Most low and lower middle-income African countries have limited critical care capacity available to cope with potential surges in critical care demand due to COVID-19 outbreaks. Keywords: COVID-19, SARS-CoV-2, critical care capacity, ICU, ventilators, Africa

ObjectivesAs of 13 January 2021, there have been 3 113 963 confirmed cases of SARS-CoV-2 and 74 619 deaths across the African continent. Despite relatively lower numbers of cases initially, many African countries are now experiencing an exponential increase in case numbers. Estimates of the progression of disease and potential impact of different interventions are needed to inform policymaking decisions. Herein, we model the possible trajectory of SARS-CoV-2 in 52 African countries under different intervention scenarios.DesignWe developed a compartmental model of SARS-CoV-2 transmission to estimate the COVID-19 case burden for all African countries while considering four scenarios: no intervention, moderate lockdown, hard lockdown and hard lockdown with continued restrictions once lockdown is lifted. We further analysed the potential impact of COVID-19 on vulnerable populations affected by HIV/AIDS and tuberculosis (TB).ResultsIn the absence of an intervention, the most populous countries had the highest peaks in active projected number of infections with Nigeria having an estimated 645 081 severe infections. The scenario with a hard lockdown and continued post-lockdown interventions to reduce transmission was the most efficacious strategy for delaying the time to the peak and reducing the number of cases. In South Africa, projected peak severe infections increase from 162 977 to 2 03 261, when vulnerable populations with HIV/AIDS and TB are included in the analysis.ConclusionThe COVID-19 pandemic is rapidly spreading across the African continent. Estimates of the potential impact of interventions and burden of disease are essential for policymakers to make evidence-based decisions on the distribution of limited resources and to balance the economic costs of interventions with the potential for saving lives.

Pastoral livelihoods are evolving rapidly. The emergence of globalized markets and the integration of globalized production in developing countries have forced many pastoralists, along with the rest of the world's consumers, to shift their economic strategies of production to accommodate these evolving markets. The objective of this paper is to illustrate the relationship between globalization and apparent transformations in pastoralist behaviour in recent years. We specifically focus on the links among climate, land use, and herding in rural northern Kenya. To do this, we use a novel conceptual framework that incorporates both traditional interactions between pastoral ecology and resource generation and modern opportunities by linking pastoral families via their pastoral production and other economic activities to the cash economy, modern diets and nutritional status (health), and public and private assistance and programmes (such as food aid).

Objectives As of August 24th 2020, there have been 1,084,904 confirmed cases of SARS-CoV-2 and 24,683 deaths across the African continent. Despite relatively lower numbers of cases initially, many African countries are now experiencing an exponential increase in case numbers. Estimates of the progression of disease and potential impact of different interventions are needed to inform policy making decisions. Herein, we model the possible trajectory of SARS-CoV-2 in 52 African countries under different intervention scenarios. Design We developed a compartmental model of SARS-CoV-2 transmission to estimate the COVID-19 case burden for all African countries while considering four scenarios: no intervention, moderate lockdown, hard lockdown, and hard lockdown with continued restrictions once lockdown is lifted. We further analyzed the potential impact of COVID-19 on vulnerable populations affected by HIV/AIDS and TB. Results In the absence of an intervention, the most populous countries had the highest peaks in active projected number of infections with Nigeria having an estimated 645,081 severe infections. The scenario with a hard lockdown and continued post-lockdown interventions to reduce transmission was the most efficacious strategy for delaying the time to the peak and reducing the number of cases. In South Africa projected peak severe infections increase from 162,977 to 203,261, when vulnerable populations with HIV/AIDS and TB are included in the analysis. Conclusion The COVID-19 pandemic is rapidly spreading across the African continent. Estimates of the potential impact of interventions and burden of disease are essential for policy makers to make evidence-based decisions on the distribution of limited resources and to balance the economic costs of interventions with the potential for saving lives.

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AimsInfection remains the leading cause of neonatal mortality in developing countries. In Kenya, about 20% of neonatal deaths are attributable to sepsis. We aim to look at the epidemiological pattern of neonatal sepsis in a county referral hospital in Kenya.MethodRetrospective data was collected for all admissions to the Newborn unit between 2011 to 2014 in a county referral hospital in central Kenya. We calculated monthly rates of neonatal sepsis cases, mortalities, and case fatality rates for all admissions. We then plotted a monthly time series of sepsis cases and mortalities to determine if there was a seasonal trend over the four-year period. The epidemic time series was plotted and smoothed using a seasonal moving average estimator in Stata 12.1. The study was carried out during a Global Links RCPCH placement.ResultsThere were 1262 admissions to the Newborn Unit during the 4 year period. 23.9% of admissions had a diagnosis of neonatal sepsis. The overall mortality rate of admissions was 24.7%, whereas mortality attributed to sepsis was 18.2%. We observed a strong biannual peak in sepsis cases, with peaks in July 2012 and July 2014. Case fatality rates were highest in March 2012 (66.6%), July 2012 (50%), July 2014 (50%) and August 2014 (50%).ConclusionThe overall rate of neonatal mortality due to sepsis in this hospital is comparable to the national average. Our study indicates that sepsis cases correspond to a strong bi-annual pattern rather than a yearly one, with intermediate years yielding few sepsis cases. From this, we predict low sepsis rates in 2015, with a peak of cases in July 2016. This is the first time a bi-annual trend has been demonstrated for neonatal sepsis. We suggest further work should be done to analyse possible causes, including socio-political factors, for this bi-annual pattern for neonatal sepsis and mortality, and whether the same pattern can also be seen in other areas of Kenya over the same time period.

Acute respiratory infections (ARIs) are a leading cause of under-five mortality globally. In Kenya, the reported prevalence of respiratory syncytial virus (RSV) infections in single-centre studies has varied widely. Our study sought to determine the prevalence of RSV infection in children admitted with ARI fulfilling the WHO criteria for bronchiolitis. This was a prospective cross-sectional prevalence study in five hospitals across central and highland Kenya from April to June 2015. Two hundred and thirty-four participants were enrolled. The overall RSV positive rate was 8.1%, which is lower than in previous Kenyan studies. RSV-positive cases were on average 5 months younger than RSV-negative cases.