Search

Background: Worldwide, health systems have been challenged by the overwhelming demands of the COVID-19 pandemic. In Ethiopia, maintaining essential health services during the COVID-19 pandemic is critical to preventing severe outcomes and protecting the gains made over the past years in the health sector. This project aims to explore the health system's response to maintaining essential healthcare services in Addis Ababa, Ethiopia., Methods: A total of 60 key informant interviews were conducted by purposively selecting key stakeholders from Federal Ministry of Health, Addis Ababa Regional Health Bureau, Sub-city Health Offices, and frontline healthcare providers. Interviews were transcribed verbatim and coded using Open Code. Thematic analysis was employed to analyze the data., Result: COVID-19 affected the delivery of essential health services in several ways, namely: decline in health service utilization, fear of infection among healthcare providers, stigma towards healthcare providers, and perceived decrease in quality-of-service provision. However, the health system actors made efforts to sustain services while responding to the pandemic by enacting changes in the service delivery modality. The most significant service delivery changes included repurposing health centers and prolonged prescriptions (multi-month medication dispensing). The primary challenges encountered were burnout of the health workforce and a shortage of personal protective equipment., Conclusion: COVID-19 has affected the delivery of essential health services in multifaceted ways. System actors have accordingly made efforts to sustain services while responding to the pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fenta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia., Methods: A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level., Results: Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (β: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (β: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (β: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (β: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (β: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (β: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia., Conclusion: Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Abera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

With a remarkable increase in industrialization among fast-developing countries, air pollution is rising at an alarming rate and has become a public health concern. The study aims to examine the effect of air pollution on patient's hospital visits for respiratory diseases, particularly Acute Respiratory Infections (ARI). Outpatient hospital visits, air pollution and meteorological parameters were collected from March 2018 to October 2021. Eight machine learning algorithms (Random Forest model, K-Nearest Neighbors regression model, Linear regression model, LASSO regression model, Decision Tree Regressor, Support Vector Regression, X.G. Boost and Deep Neural Network with 5-layers) were applied for the analysis of daily air pollutants and outpatient visits for ARI. The evaluation was done by using 5-cross-fold confirmations. The data was randomly divided into test and training data sets at a scale of 1:2, respectively. Results show that among the studied eight machine learning models, the Random Forest model has given the best performance with R 2 = 0.606, 0.608 without lag and 1-day lag respectively on ARI patients and R 2 = 0.872, 0.871 without lag and 1-day lag respectively on total patients. All eight models did not perform well with the lag effect on the ARI patient dataset but performed better on the total patient dataset. Thus, the study did not find any significant association between ARI patients and ambient air pollution due to the intermittent availability of data during the COVID-19 period. This study gives insight into developing machine learning programs for risk prediction that can be used to predict analytics for several other diseases apart from ARI, such as heart disease and other respiratory diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The COVID-19 lockdown resulted in improved air quality in many cities across the world. With the objective of what could be the new learning from the COVID-19 pandemic and subsequent lockdowns for better air quality and human health, a critical synthesis of the available evidence concerning air pollution reduction, the population at risk and natural versus anthropogenic emissions was conducted. Can the new societal norms adopted during pandemics, such as the use of face cover, awareness regarding respiratory hand hygiene, and physical distancing, help in reducing disease burden in the future? The use of masks will be more socially acceptable during the high air pollution episodes in lower and middle-income countries, which could help to reduce air pollution exposure. Although post-pandemic, some air pollution reduction strategies may be affected, such as car-pooling and the use of mass transit systems for commuting to avoid exposure to airborne infections like coronavirus. However, promoting non-motorized modes of transportation such as cycling and walking within cities as currently being enabled in Europe and other countries could overshadow such losses. This demand focus on increasing walkability in a town for all ages and populations, including for a differently-abled community. The study highlighted that for better health and sustainability there. is also a need to promote other measures such as work-from-home, technological infrastructure, the extension of smart cities, and the use of information technology., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The seasonal burning of crop residue significantly affects the environment, leading to poor air quality over Indo-Gangetic Plain (IGP) in India. Hence, there have been significant efforts to minimize crop residue burning through policy, innovations, and awareness measures. However, an abrupt increase in paddy residue burning was observed over IGP during 2020. Hence, the study explores the factors leading to this sharp rise. The business as usual trends analysis revealed that paddy crop residue burning activities increased significantly (60%) in 2020 compared to the previous year. The massive increase in crop residue burning consequently seems to be linked with the COVID-19 pandemic, which affected the farmer's income, including the poor compliance by the regulatory authorities. The study also highlights the issues and prospects for sustainable crop residue management and explores the solutions to minimize crop residue burning. There are few crops in India that have guaranteed minimum sale price and are also subsidized. These provisions encourage farmers to grow those particular crops, resulting in the generation of large amounts of crop residue from these specific crops. There have been several efforts by the Indian government, including based on recent court intervention. Still, there is no respite from burning activities and the occurrence of Delhi winter smog every year. Hence, the study emphasizes a need to adopt integrated approaches having in situ eco-friendly solutions, which enhances the farmer's income and focuses on employability, capacity building, awareness generation, and in situ economically viable solutions., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This global study, which has been coordinated by the World Meteorological Organization Global Atmospheric Watch (WMO/GAW) programme, aims to understand the behaviour of key air pollutant species during the COVID-19 pandemic period of exceptionally low emissions across the globe. We investigated the effects of the differences in both emissions and regional and local meteorology in 2020 compared with the period 2015-2019. By adopting a globally consistent approach, this comprehensive observational analysis focuses on changes in air quality in and around cities across the globe for the following air pollutants PM 2.5 , PM 10 , PMC (coarse fraction of PM), NO 2 , SO 2 , NOx, CO, O 3 and the total gaseous oxidant (OX = NO 2  + O 3 ) during the pre-lockdown, partial lockdown, full lockdown and two relaxation periods spanning from January to September 2020. The analysis is based on in situ ground-based air quality observations at over 540 traffic, background and rural stations, from 63 cities and covering 25 countries over seven geographical regions of the world. Anomalies in the air pollutant concentrations (increases or decreases during 2020 periods compared to equivalent 2015-2019 periods) were calculated and the possible effects of meteorological conditions were analysed by computing anomalies from ERA5 reanalyses and local observations for these periods. We observed a positive correlation between the reductions in NO 2 and NOx concentrations and peoples' mobility for most cities. A correlation between PMC and mobility changes was also seen for some Asian and South American cities. A clear signal was not observed for other pollutants, suggesting that sources besides vehicular emissions also substantially contributed to the change in air quality. As a global and regional overview of the changes in ambient concentrations of key air quality species, we observed decreases of up to about 70% in mean NO 2 and between 30% and 40% in mean PM 2.5 concentrations over 2020 full lockdown compared to the same period in 2015-2019. However, PM 2.5 exhibited complex signals, even within the same region, with increases in some Spanish cities, attributed mainly to the long-range transport of African dust and/or biomass burning (corroborated with the analysis of NO 2 /CO ratio). Some Chinese cities showed similar increases in PM 2.5 during the lockdown periods, but in this case, it was likely due to secondary PM formation. Changes in O 3 concentrations were highly heterogeneous, with no overall change or small increases (as in the case of Europe), and positive anomalies of 25% and 30% in East Asia and South America, respectively, with Colombia showing the largest positive anomaly of ~70%. The SO 2 anomalies were negative for 2020 compared to 2015-2019 (between ~25 to 60%) for all regions. For CO, negative anomalies were observed for all regions with the largest decrease for South America of up to ~40%. The NO 2 /CO ratio indicated that specific sites (such as those in Spanish cities) were affected by biomass burning plumes, which outweighed the NO 2 decrease due to the general reduction in mobility (ratio of ~60%). Analysis of the total oxidant (OX = NO 2  + O 3 ) showed that primary NO 2 emissions at urban locations were greater than the O 3 production, whereas at background sites, OX was mostly driven by the regional contributions rather than local NO 2 and O 3 concentrations. The present study clearly highlights the importance of meteorology and episodic contributions (e.g., from dust, domestic, agricultural biomass burning and crop fertilizing) when analysing air quality in and around cities even during large emissions reductions. There is still the need to better understand how the chemical responses of secondary pollutants to emission change under complex meteorological conditions, along with climate change and socio-economic drivers may affect future air quality. The implications for regional and global policies are also significant, as our study clearly indicates that PM 2.5 concentrations would not likely meet the World Health Organization guidelines in many parts of the world, despite the drastic reductions in mobility. Consequently, revisions of air quality regulation (e.g., the Gothenburg Protocol) with more ambitious targets that are specific to the different regions of the world may well be required., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The impact of restrictions during various phases of COVID-19 lockdown on daily mean PM 2.5 concentration in five Indian megacities (New Delhi, Chennai, Kolkata, Mumbai, and Hyderabad) was studied. The impact was studied for pre-lockdown (1st Mar-24th Mar 2020), lockdown (25th Mar-31st May 2020), and unlocking (1st Jun-31st Aug 2020) phases. The lockdown period comprises 4 lockdown phases with distinct measures, whereas the unlocking period had 3 phases. PM 2.5 concentration reduced significantly in all megacities and met the national standards during the lockdown period. The maximum reduction in PM 2.5 level was observed in Kolkata (62%), followed by Mumbai (49%), Chennai (34%), and New Delhi (26%) during the lockdown period. Comparatively, Hyderabad exhibited a smaller reduction in PM 2.5 concentration, i.e., 10%. The average PM 2.5 levels during the lockdown in the peak hour (i.e., 07:00-11:00 h) in New Delhi, Chennai, Kolkata, Mumbai, and Hyderabad decreased by 21.3%, 48.5%, 63.4%, 56.4%, and 23.8%, respectively, compared to those before lockdown period. During the unlocking period, except for Chennai, all megacities showed a reduction in average PM 2.5 levels compared to concentrations in the lockdown period, but these reductions were mainly linked with monsoon rains in India. The current study provided an opportunity to study air pollution in the absence of major anthropogenic activities and during limited activities in monsoon season having an ecological design. The study reports a new baseline of PM 2.5 , except for monsoon, and explores this knowledge to plan future air pollution reduction strategies. The study also discusses how this new learning of knowledge could strengthen air pollution control policies for better air quality and sustainability.Graphical abstract.

Clean cooking energy strategies are critical for reducing air pollution, improving health, and achieving related Sustainable Development Goals. The recent COVID-19 lockdowns may impact the transition towards clean cooking fuels. The nationwide lockdown is likely to affect key factors such as energy access, income, transportation, etc., that play a role in decisions influencing household fuel use. The rural population already bears the burden of poverty and may not be able to afford and access clean cooking fuels during the lockdown. They are thus vulnerable to reversion to their traditional cooking methods using solid biomass fuels. The household air pollution caused due to the use of polluting fuels increases their susceptibility to non-communicable diseases, and thus may intensify the risk and severity of COVID-19 infection. Hence, there is an urgent need to expand sustainable energy solutions worldwide. The present study applies the DPSIR modeling framework to establish a set of comprehensive indicators for addressing the transition towards clean cooking fuels during the COVID-19 pandemic. The study also provides insights on various strategies adopted in India in response to the COVID-19 pandemic for maintaining continuity of delivering benefits under a clean cookstove program. The study offers future directions to ensure the transition towards cleaner fuels and sustainability., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The variation in ambient air quality during COVID-19 lockdown was studied in Chandigarh, located in the Indo-Gangetic plain of India. Total 14 air pollutants, including particulate matter (PM 10 , PM 2.5 ), trace gases (NO 2 , NO, NO x , SO 2 , O 3 , NH 3 , CO) and VOC's (benzene, toluene, o-xylene, m,p-xylene, ethylbenzene) were examined along with meteorological parameters. The study duration was divided into four parts, i.e., a) 21 days of before lockdown b) 21 days of the first phase of lockdown c) 19 days of the second phase of lockdown d) 14 days of the third phase of lockdown. The results showed significant reductions during the first and second phases for all pollutants. However, concentrations increased during the third phase. The concentrations of SO 2 , O 3, and m,p-xylene kept on increasing throughout the study period, except for benzene, which continuously decreased. The percentage decrease in the concentrations during consecutive periods of lockdown were 28.8%, 23.4% and 1.1% for PM 2.5 and 36.8%, 22.8% and 2.4% for PM 10 respectively. The Principal Component Analysis (PCA) and characteristic ratios identified vehicular pollution as a primary source during different phases of lockdown. During the lockdown, residential sources showed a significant adverse impact on the air quality of the city. Regional atmospheric transfer of pollutants from coal-burning and stubble burning were identified as secondary sources of air pollution. The findings of the study offer the potential to plan air pollution reduction strategies in the extreme pollution episodes such as during crop residue burning period over Indo-Gangetic plain., Competing Interests: Declaration of competing interest Authors confirm that there’s no financial/personal interest or belief that could affect the objectivity. All authors read the paper and approved it., (Copyright © 2020 Elsevier Ltd. All rights reserved.)