Postemergency health services for refugee and host populations in Uganda, 1999-2002

Since 1990, Uganda has hosted an estimated 200?000 refugees in postemergency settlements interspersed within host communities. We investigated the extent to which obstetric needs were met in the refugee and host populations during 1999-2002. Between September and December, 2000, we retrospectively collected data from 1999 and 2000 on major obstetric interventions for absolute maternal indications from all five hospitals in Arua, Adjumani, and Moyo districts, Uganda. The same data were collected prospectively for 2001. We did community-based maternal mortality surveys on refugee and host populations in Adjumani district in 2002. Rates of major obstetric interventions were significantly higher for refugees than for the host population who live in the same rural areas as refugees (1.01% [95% CI 0.77-1.25] vs 0.45% [0.38-0.52]; p<0.0001). Rates of major obstetric interventions were also significantly higher for refugees than for the host population who live in rural areas without refugees (1.01% [0.77-1.25] vs 0.40% [0.36-0.44]; p<0.0001). Maternal mortality was 2.5 times higher in the host population than in refugees in the Adjumani district (322 per 100000 births [247-396] vs 130 [81-179]. Refugees had better access to health services than did the rural host population in the northern Ugandan communities that we surveyed.     

Costs and coverage of reproductive health interventions in three rural refugee-affected districts, Uganda

BACKGROUND: Uganda has hosted an estimated 200,000 refugees in post-emergency phase settlements interspersed within host communities since 1990. However, refugee health service runs parallel to host in most refugee-affected districts. The process of integration of health services began in 1999. OBJECTIVE: To estimate and compare the costs and coverage of reproductive health (RH) interventions in refugee and host populations in three rural West Nile refugee-affected districts of Uganda. METHODS: Data on costs of RH interventions were collected through a survey in 38/116 (33%) health facilities (3 public hospitals and 35 health centres). Data on coverage of RH interventions were collected from all 116 health facilities in the three rural refugee-affected districts for 2 years, 2003 and 2004. RESULTS: The costs and coverage of RH interventions significantly varied between population categories and among levels of refugee and host health facilities. Per capita cost of health care is 2.7 times higher for the refugee than the host population (US$13.12 vs. US$4.85). The cost per RH intervention is higher in the refugee than in the host health system (US$3.02 vs. US$2.73). Significantly more refugees attend antenatal care [99.4% (95% CI, 97.5-100) vs. 53.5% (53.22-53.78); P < 0.0001]. The proportion of births in health facilities was significantly greater among refugees [37.3% (36.12-38.48) vs. 15.2% (15.01-15.39); P < 0.05]. Major obstetrical interventions for absolute maternal indications were significantly more frequent among refugees than the host population living in the same region [1.02% (0.79-1.25) vs. 0.85% (0.80-0.90); P < 0.05]. CONCLUSIONS: Our study has shown higher costs and coverage in refugee than host health services. The findings suggest policy recommendations for improving the capacity, financing, organization and the performance of host health system in the refugee-affected settings.     

The better the worse: risk factors for HIV infection among women in Kenya and Uganda: demographic and health survey

The objective of the study was to investigate socio-economic status (SES) factors as risk factors for HIV among women in Kenya and Uganda. Individual data from cross-sectional, population based 2003-Kenya Demographic and Health Survey (KDHS) and 2004-Uganda AIDS Indicator Survey (AIS) were used and the probability of being HIV-positive was analysed. Contrary to the public health literature, women of high SES were also vulnerable to HIV risk. Both Ugandan and Kenyan women had similar SES risk factors to HIV and harmonising policies in the two countries to deal with the disadvantages of the social and cultural roles of women would help reduce vulnerability to HIV for women. Policies in both countries need to be broad based to cut across all socio-economic groups and deal with the complexity of HIV/AIDS. Nyanza region needs exceptional policies to deal with the high HIV prevalence and reduce risk through cultural practices like widow inheritance.     

AIDS communications through social networks: catalyst for behaviour changes in Uganda

Objective: To investigate distinctive communications through social networks which may be associated with population behaviour changes and HIV prevalence declines in Uganda compared to other countries.

Methods: We undertook a comparative analysis of demographic and HIV behavioural data collected in Demographic and Health Surveys (DHS III) in Uganda, Kenya, Tanzania, Malawi, Zambia and Zimbabwe as well as Knowledge, Attitudes and Behaviours (KABP) surveys in Uganda in 1989 and 1995. AIDS behaviours, social communications and channels for communication about AIDS and people with AIDS were analysed by age, sex and country. Modelling was developed to investigate at what stage of the epidemic a majority of people will know someone with AIDS, given differing communication patterns through social networks. Finally AIDS reporting and Voluntary Counselling and Testing (VCT) trends were analysed to assess if the impact of social communications worked through clinical services and interventions or more directly at the population level in community contexts.

Results: Uganda showed unique patterns of communications through social networks including a shift from mass and institutional to personal channels for communicating about AIDS, 1989–1995. This was associated with higher levels of knowing someone with AIDS through social networks and, in turn, positive risk ratios for behaviour change including reducing casual sex and condom use. Youth had distinctively high levels of knowing someone with AIDS in Uganda, suggesting widespread community communication across age groups. Patterns of disclosure, AIDS diagnosis and reporting were influential on social communications about AIDS. Over 90%, 45% or under 20% of people know someone with AIDS at peak HIV incidence and high AIDS mortality, depending on whether communications through social networks are extensive or restricted.

Conclusion: There are distinctive patterns for communicating through social networks about AIDS and people with AIDS in Uganda. They appear to work directly at population level rather than in response to clinical interventions and testing and may be important in the uptake of the latter services. This communication response provides an important basis for HIV prevention if it is to be scaled to the population level. Vertical prevention (and even treatment) interventions need to engage more closely with local, horizontal communication and behavioural responses to AIDS. Communication programmes have to take root at the level of social networks working though local networks of meetings, chiefs, churches and health personnel as well as the media. Mobilising basic social communications may be a necessary resource (as much as services and finance) to scale HIV prevention and treatment to the population level.     

A community perspective on young people's knowledge of HIV/AIDS in three African countries

Individual, household and community-level influences on young people's (15–24) knowledge of HIV/AIDS in three African countries (Burkina Faso, Ghana and Zambia) are explored. The focus of the analysis is on the roles of demographic, economic and behavioral dimensions of the community environment in shaping knowledge of HIV/AIDS. Data from Demographic and Health Surveys, collected independently for males and females in each of the countries, are analyzed. There are clear pathways through which the community environment shapes knowledge, and the community influences on knowledge vary greatly by country and gender. For young women, residences in communities with demographic and behavioral patterns that are indicative of greater opportunities are associated with increased knowledge of HIV/AIDS. The results highlight community-level factors that can be harnessed in the development of community-based interventions to improve knowledge of HIV/AIDS among young people, and reinforce the need to focus on the community environment in designing behavioral change interventions.     

The intersection of antiretroviral therapy,peer support programmes,and economic empowerment with HIV stigma among HIV-positive women in West Nile Uganda

HIV stigma remains a major problem of the AIDS epidemic in sub-Saharan Africa. Women fear impending social stigma including blame, isolation and abuse. HIV infection and HIV stigma interact cyclically, creating and reinforcing economic and social exclusion for individuals living with HIV. Evidence suggests that interventions for people living with HIV infection that include, in combination, antiretroviral therapy (ART), peer support and economic empowerment are likely to be more effective than if used alone. We report a qualitative study in West Nile Uganda that explored perceptions of HIV stigma among fifty-four HIV-positive women who had similar access to ART and HIV peer support programmes, but varying levels of participation (full-time, intermittent, none) in economic empowerment programmes. Our study found that access to ART, peer support groups, and economic empowerment programmes helped to curb perceptions of deep-seated HIV stigma for participants. More expressions of usefulness, hope and psychological well-being prevailed with participants who had increased participation in economic empowerment programmes. Our findings underscore the value of HIV outreach programmes which combine ART, peer support and economic empowerment to alleviate HIV stigma. Further research to quantify the interaction of these factors is warranted.     

Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya

Due to heightened vulnerability to HIV from frequent engagement in sex work and overlapping drug-using and sexual networks, women who inject drugs should be a high priority population for pre-exposure prophylaxis (PrEP) and other biomedical HIV prevention tools. Kenya is one of the first African countries to approve oral PrEP for HIV prevention among “key populations,” including people who inject drugs and sex workers. The objective of this study was to explore preferences and perceived challenges to PrEP adoption among women who inject drugs in Kisumu, Kenya. We conducted qualitative interviews with nine HIV-uninfected women who inject drugs to assess their perceptions of biomedical HIV interventions, including oral PrEP, microbicide gels, and intravaginal rings. Despite their high risk and multiple biomedical studies in the region, only two women had ever heard of any of these methods. All women were interested in trying at least one biomedical prevention method, primarily to protect themselves from partners who were believed to have multiple other sexual partners. Although women shared concerns about side effects and product efficacy, they did not perceive drug use as a significant deterrent to adopting or adhering to biomedical prevention methods. Beginning immediately and continuing throughout Kenya’s planned PrEP rollout, efforts are urgently needed to include the perspectives of high risk women who use drugs in biomedical HIV prevention research and programing.     

在流动人口中开展预防艾滋病工作初探

目的了解流动人口对艾滋病相关知识的知晓情况,尝试如何在流动人口中开展艾滋病预防教育工作.方法对云南省某建筑工地18名建筑工人(均为男性)进行了2小时的艾滋病基本知识培训,培训采用讲解、示教和参与相结合的方法,培训内容注重实用性.结果培训后,培训对象有关艾滋病的知识知晓率明显上升,对艾滋病的警觉性有所提高.结论建议在流动人口中开展灵活多样的艾滋病预防教育工作.     

The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS

Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.     

HIV type 1 subtypes in circulation in northern Kenya

The genetic subtypes of HIV-1 circulating in northern Kenya have not been characterized. Here we report the partial sequencing and analysis of samples collected in the years 2003 and 2004 from 72 HIV-1-positive patients in northern Kenya, which borders Ethiopia, Somalia, and Sudan. From the analysis of partial env sequences, it was determined that 50% were subtype A, 39% subtype C, and 11% subtype D. This shows that in the northern border region of Kenya subtypes A and C are the dominant HIV-1 subtypes in circulation. Ethiopia is dominated mainly by HIV-1 subtype C, which incidentally is the dominant subtype in the town of Moyale, which borders Ethiopia. These results show that cross-border movements play an important role in the circulation of subtypes in Northern Kenya.     

Ethics and the AIDS pandemic in the developing world

Traditional ethics provide insight, but often fall short of guiding the complex biomedical ethical concerns of research conducted in developing countries. The need to create research within a framework that is appropriate to the social, medical, and political context of developing countries is examined through the current AIDS pandemic in sub-Saharan Africa. A specific case study focuses on this issue. Over 70 percent of the 40 million people with HIV/AIDS live in sub-Saharan Africa. With at least one in five African adults infected with the disease, sub-Saharan Africa is now acknowledged as the epicenter of HIV/AIDS. The scale and scope of the disease in the environment of a developing economy presents unique issues that challenge the role and practices of traditional ethics in healthcare research programs. Medical research within developing countries, particularly for HIV/AIDS, requires a distinctive approach. For these populations, investigators must incorporate new thinking into traditional biomedical research ethics which will address the role of innovation; access to treatment; the impact of fear, stigma, and denial; concerns around autonomy for vulnerable populations; capacity building; and sustainable care to communities. Since May 1999, Secure the Future, a philanthropic program that focuses on care and support for women and children infected and affected by HIV/AIDS, has attempted to fulfill these ethical concepts in its processes. The program is a public and private sector partnership between governments, communities, practitioners, academia, and Bristol-Myers Squibb Company to respond to AIDS in five countries in sub-Saharan African countries: Botswana, Lesotho, Namibia, South Africa, and Swaziland. To ensure symmetry between ethical principles and local context, collaborative projects undergo a comprehensive review process. This includes review and approval by a national secretariat to ensure projects support objectives of national policies and local communities; approval by an ethics committee comprised of participating institutions; blinded peer review; and an examination by an external advisory board comprised of local and international medical experts, persons living with AIDS (PLWA), religious communities, governments, and nongovernmental organizations (NGOs). An independent monitor also oversees the approved programs. Cost-effective and practical interventions against HIV/AIDS must encompass ethical approaches appropriate to the contexts of the respective developing countries. Lessons learned to date are to focus on innovation; establish unassailable ethical standards that are sensitive to local contexts; ensure transparent communications among partners and the broader community; and build sustainable capacity.     

Traditional male circumcision practices among the Kurya of North-eastern Tanzania and implications for national programmes

The World Health Organisation and the Joint United Nations Programme on AIDS recommend male circumcision (MC) as an additional intervention against HIV infection. Various sub-Saharan African countries are at different stages of rolling out MC programmes. Despite initial fears, studies conducted among traditionally non-circumcising communities in Africa have shown that MC is widely accepted as a biomedical intervention. However, little is known on how traditionally circumcising communities where MC carries considerable social meaning and significance would respond to such programmes. This study was conducted among a traditionally circumcising community in Tarime district in Tanzania as part of a national situation analysis prior to initiating a national MC programme. It employed key informant interviews and focus group discussions for data collection. Results show that the Kurya ethnic group practice MC as a rite of passage from childhood to adulthood. Each clan organises its own circumcision ceremony, which takes place every even numbered years. Clan leaders and traditional circumcisers are central to its organisation. Among the Kurya, there is high regard for traditional MC as it is perceived as upholding cultural practice and identity. It also embodies notions of bravery since anaesthetics are not used. On the other hand, medical MC is not viewed as prestigious since anaesthetics are used to suppress pain. Social pressure for traditional MC is applied through ridiculing of those uncircumcised or circumcised at health facilities. In general, there are positive attitudes towards MC as it is perceived as enhancing personal hygiene and having a protective effect against sexually transmitted infections. For the success of nation-wide MC programmes, there is need to develop programmes that incorporate both clinical and sociocultural interests.     

Social Perceptions of HIV/AIDS among the Wayuu of Colombia

Understanding how Indigenous populations perceive HIV/AIDS is of high relevance for the implementation of culturally appropriate interventions. The study analyzed the ways in which Indigenous Wayuu communities of Colombia socially perceive and respond to HIV/AIDS from their sociocultural realities and their knowledge of the illness. It analyzed qualitative data from 9 focus groups and 29 semi-structured interviews. The Wayuu think of HIV/AIDS as “the illness”, that it is incurable, fatal, transmitted from alijunas (non Wayuu), and beyond their understanding. They seem to perceive HIV/AIDS similarly to the ways Western societies perceived unknown or misunderstood epidemics in the past.     

Spatially explicit Schistosoma infection risk in eastern Africa using Bayesian geostatistical modelling

Schistosomiasis remains one of the most prevalent parasitic diseases in the tropics and subtropics, but current statistics are outdated due to demographic and ecological transformations and ongoing control efforts. Reliable risk estimates are important to plan and evaluate interventions in a spatially explicit and cost-effective manner. We analysed a large ensemble of georeferenced survey data derived from an open-access neglected tropical diseases database to create smooth empirical prevalence maps for Schistosoma mansoni and Schistosoma haematobium for a total of 13 countries of eastern Africa. Bayesian geostatistical models based on climatic and other environmental data were used to account for potential spatial clustering in spatially structured exposures. Geostatistical variable selection was employed to reduce the set of covariates. Alignment factors were implemented to combine surveys on different age-groups and to acquire separate estimates for individuals aged ≤20 years and entire communities. Prevalence estimates were combined with population statistics to obtain country-specific numbers of Schistosoma infections. We estimate that 122 million individuals in eastern Africa are currently infected with either S. mansoni, or S. haematobium, or both species concurrently. Country-specific population-adjusted prevalence estimates range between 12.9% (Uganda) and 34.5% (Mozambique) for S. mansoni and between 11.9% (Djibouti) and 40.9% (Mozambique) for S. haematobium. Our models revealed that infection risk in Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Somalia and Sudan might be considerably higher than previously reported, while in Mozambique and Tanzania, the risk might be lower than current estimates suggest. Our empirical, large-scale, high-resolution infection risk estimates for S. mansoni and S. haematobium in eastern Africa can guide future control interventions and provide a benchmark for subsequent monitoring and evaluation activities.     

Social and economic consequences of HIV and AIDS on children: case study of a high-density community in Harare,Zimbabwe

We present results from a household-based survey that was conducted in Mabvuku, a high-density community in Zimbabwe. The objective of the study was to improve understanding of social and economic consequences of HIV and AIDS on children. Children affected by HIV and AIDS (CABA) formed the treatment group while those not affected by HIV and AIDS (non-CABA) were the control group. We found that many of the differences in the socio-economic indicators that we studied between CABA and non-CABA were not significant. Therefore our results indicate a gloomy scenario for all the children. These results are consistent with existing literature which indicates that the impact of HIV and AIDS is exacerbated by poverty. Based on evidence from this paper, we conclude that programmes and interventions targeted at children should encompass both CABA and non-CABA within a framework of sustained commitment to improving the lives of these children. We hope that our findings will be used in the formulation of interventions and strategies to improve the situation of children affected by HIV and AIDS and/or living in impoverished communities.     

HIV, injecting drug use and harm reduction: a public health response

Injecting drug use is driving HIV epidemics in many countries around the world. There is evidence that such epidemics can be averted, halted and reversed if comprehensive HIV programmes targeting drug users are put into place. The term 'harm reduction' is used widely to describe the goals, policies and interventions of such programmes. However, despite its rapidly expanding use, the term has no universally accepted definition. This paper aims to describe the evolution and branding of the term 'harm reduction' and the adoption of the concept across a wide range of countries. It highlights a range of issues that remain controversial in the harm reduction discourse related to HIV and injecting drug use, including: the definition of 'harm reduction' and related terms; the scope of harm reduction; the promotion of a public health versus drug control dichotomy; the feasibility and appropriateness of harm reduction in low- and middle-income countries; and the strength of evidence on harm reduction interventions. The paper argues that harm reduction should be a core element of a public health response to HIV/AIDS where injecting drug use exists. The effectiveness of policies and programmes targeting drug users should be measured against public health outcomes. This requires the alignment of drug control measures with public health goals. A 'model package' for harm reduction is proposed, which provides guidance to countries on the selection of evidence-based policies and interventions, including: interventions for reducing HIV transmission; treatment of HIV/AIDS and associated comorbidities; appropriate models of service delivery; creation of supportive policy, legal and social environments; and strengthening of strategic information systems to better guide responses.     

HIV-prevention knowledge among illiterate and low-literate women in rural Amhara,Ethiopia

More than 85% of Ethiopia's population lives in rural areas and literacy levels in the country are relatively low. Despite this, little is known about levels of knowledge in regard to HIV/AIDS and condom use among illiterate and low-literate rural individuals. We conducted a cross-sectional study among 200 illiterate to semi-literate women, ages 13 to 24, from two rural communities in the Amhara region of northwestern Ethiopia. Nearly all the women had heard about HIV and AIDS. Among the illiterate individuals (n = 54), 24% did not know that HIV was the cause of AIDS and 48% did not know that HIV could be transmitted by sexual intercourse without a condom with an HIV-infected person. Among the same group, 59% did not know what a condom is. Literacy had a strong positive association with knowledge of HIV transmission and condoms. Thus, due to a generally higher level of literacy (grade 5-8 attainment), very young women (ages 13-20) had better knowledge of HIV transmission and condoms than did women ages 21-24 who by comparison were less literate. Given poor knowledge of HIV transmission and condoms among illiterate and low-literate women in Amhara, targeted HIV-prevention interventions are needed in this region.     

Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators

There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected NGOs can adapt the proposed generic outcomes and indicators based on the settings of their programmes. A collaborative approach by all stakeholders is required, from international organisations, funders, governments, NGOs and communities to strengthening monitoring and evaluation of sport-based HIV/AIDS awareness programmes including other development programmes. This will assist the NGOs that use sport for development to be able to reflect accurately the information about their HIV/AIDS activities and also be able to contribute to on-going monitoring activities at a national and global level as well as to the Sustainable Development Goals.     

Evaluating the effects of community-based organization engagement on HIV and AIDS-related risk behavior in Kenya

International donors have increasingly shifted AIDS funding directly to community-based organizations (CBOs) with the assumption that responding to the epidemic is best achieved at the community level. The World Bank, ICF Macro, and the National Council for Population and Development in Kenya, conducted a study to evaluate the community response in Kenya. The study used a quasi-experimental design comparing seven study communities and seven comparison communities in Nyanza Province and Western Province. We examined the impact of CBO activity on individual and community-level outcomes, including HIV knowledge, awareness and perceptions, sexual risk behavior, and social transformation (gender ideology and social capital). The study consisted of two components: a household survey conducted in all 14 communities, and qualitative data collected in a subset of communities. Individuals in communities with higher CBO engagement were significantly more likely to have reported consistent condom use. Higher CBO engagement was associated with some measures of social capital, including participation in local and national elections, and participation in electoral campaigns. CBOs provide added value in addressing the HIV and AIDS epidemic in very targeted and specific ways that are closely tied to the services they provide (e.g., prevention education); thus, increasing CBO engagement can be an effective measure in scaling up prevention efforts in those areas.     

Code blue! Implementing a COVID-19 emergency response,supported by an HIV community program: Communities without borders,a Spanish-Speaking intervention in Toronto,Canada

Abstract

COVID-19 a new infections agent took the world by surprise. Governments, medical systems, communities, and individuals soon would become familiar with many new terms and many new prevention measurements to avoid infection. To this day, it is unknown what would be the final consequences and impact in populations in the world, how those came to be a “new normal” in our daily lives. Also, it is unknown the number of victims, and economical after-effects result from the new pandemic. This article aims to establish a para parallel in relation to the early days of HIV/AIDS in the world. Keeping in mind the slow governmental, and even irresponsible response in different countries, both cases (HIV/AIDS-COVID-19), present a dimension that shows intermediately from HIV/AIDS organizations response to help communities. The article argues that is precise because we have learned as marginalized communities that reacted at the beginning of the AIDS early days, that HIV/AIDS educators adapted very fast interventions, programs, and counseling to alleviate societal effect pandemic against COVID-19 new infections.