From Surviving to Thriving: Evaluation of the International Diabetes Federation Life for a Child Program

IDF-LFAC aims to provide: (1) insulin and syringes; (2) blood glucose monitoring (BGM) equipment; (3) appropriate clinical care; (4) HbA1c testing; (5) diabetes education; and (6) technical support and training for health professionals, as well as 7) facilitating relevant clinical research, and where possible 8) assisting with capacity building. IDF-LFAC receives financial and in-kind support from private foundations, individuals, and corporations. Insulin and blood glucose monitoring equipment distribution is made possible by donations of insulin and the purchase of blood glucose monitors and strips at a reduced price from large pharmaceutical companies.The goal of this evaluation is to assess IDF-LFAC's organizational structure, strategic framework, processes, program impact, and potential to catalyze longterm sustainable improvements to T1D care delivery systems in its partner countries. LSHTM were commissioned to undertake the evaluation in 2014 when IDF-LFAC had active programs in 45 countries

Lassa fever outbreak in Nigeria: How prepared are we?

Despite the discovery of Lassa fever nearly five decades ago, the disease is still endemic in West Africa. The Nigerian Centre for Disease Control’s (NCDC) weekly epidemiological report for the first 10 weeks in the year 2018 shows that there were 157 confirmed cases and 56 deaths from Lassa fever outbreak and an upward trend in the case fatality rate in the last three years. This study aims to identify gaps in disease preparedness and propose recommendations in the event of future outbreaks. Some of the notable challenges impeding on preparedness include the annual repeated morbidity and mortality among healthcare workers who cater for infected patients. Furthermore, there is an observed occurrence of epidemics in regions with rocky terrains and environments with rocky terrains. Recommendations for stronger political commitment and the adoption of a one health approach among others were also proposed in order to avert a possible pandemic

Zika: structuring the European research response

Studies are needed to assess #Zika virus risks and to develop diagnostic tests http://ow.ly/ZaOZw

Short-term and medium-term clinical outcomes of multisystem inflammatory syndrome in children: a prospective observational cohort study

Background Even though the incidence of Multisystem Inflammatory Syndrome in children (MIS-C) is decreasing cases are still reported across the world. Studying the consequences of MIS-C enhances our understanding of the disease’s prognosis. The objective of this study was to assess short- and medium-term clinical outcomes of MIS-C. Methods Prospective observational cohort study at Municipal Children’s Hospital Morozovskaya, Moscow, Russia. All children meeting the Royal College of Paediatrics and Child Health (RCPCH), Centers for Disease Control and Prevention (CDC), or the World Health Organization (WHO) MIS-C case definition admitted to the hospital between 17 May and 26 October 2020 were included in the study. All survivors were invited to attend a clinic at 2 and 6 weeks after hospital discharge. Results 37 children median age 6 years (interquartile range [IQR] 3.3–9.4), 59.5% (22/37) boys were included in the study. 48.6% (18/37) of patients required ICU care. One child died. All children had increased levels of systemic inflammatory markers during the acute event. Echocardiographic investigations identified abnormal findings in 35.1% (13/37) of children. 5.6% (2/36) of children were presenting with any symptoms six weeks after discharge. By six weeks the inflammatory markers were within the reference norms in all children. The echocardiographic evaluation showed persistent coronary dilatation in one child. Conclusions Despite the severity of their acute MIS-C, the majority of children in our cohort fully recovered with none having elevated laboratory markers of inflammation at 6 weeks, few

COVID-19: Preparing for the future: looking ahead to winter 2021/22 and beyond

Despite a highly successful vaccination campaign in the UK, the coronavirus disease 2019 (COVID-19) pandemic is not over, and we are currently seeing rapidly rising infection rates. While there is an understandable and intense desire for ‘normality’ to return, we need to sustain our efforts to limit the transmission and impacts of the virus, particularly for the most vulnerable, for the longer term. To prepare for the winter period and beyond, the priorities over the summer period must be to: Maximise the speed and uptake of COVID-19 vaccination in all eligible age groups, and prepare for possible booster vaccines in priority groups and vaccination against influenza later in the year. Increase the ability of people with COVID-19 to self-isolate through financial and other support, with a particular focus on those in areas of persistent transmission and in the lowest socio-economic groups. Boost capacity in the NHS (staff and beds) to: build resilience against future outbreaks of COVID-19 and other infectious diseases, including through improving infection prevention and control (IPC), increasing vaccination and testing capacity for COVID-19 and influenza, adequately resourcing primary care, and reducing the backlog of non-COVID-19 care. Provide clear guidance about environmental and behavioural precautions (such as the use of face coverings, ventilation and physical distancing) that individuals and organisations can take to protect themselves and others, especially those who are most vulnerable from infection

Involve those, who are managing these outbreaks – Identifying barriers and facilitators to the implementation of clinical management guidelines for High-Consequence Infectious Diseases in Uganda

Prior research highlighting the complexity of clinical management guidelines (CMG) implementation, has suggested that limited access to treatments and equipment [1] and substantial issues regarding availability, inclusivity, quality, and applicability [2–6] hinder the implementation of CMGs in Low- and Middle-Income Countries (LMICs). This in-depth case study of Uganda – coincidentally occurring during the 2022 Sudan Virus Disease outbreak – aimed to explore contextual and supplementary factors which hinder or facilitate CMG development and implementation. Using thematic network analysis [7–9] the research describes five thematic topics, that emerged from interviews with 43 healthcare personnel, as barriers to the implementation of CMGs in Uganda, namely: (1) deficient content and slow updates of CMGs; (2) limited pandemic preparedness and response infrastructure; (3) slow dissemination and lack of training; (4) scarce resources and healthcare disparities and (5) patient outcomes. The study displays how insufficient training, patchy dissemination and slow updating exacerbate many of the underlying difficulties in LMIC contexts, by illustrating how these issues are related to resource constraints, healthcare disparities, and limited surveillance and referral infrastructure. Key recommendations to enhance CMG implementation are provided, underscoring the necessity of integrating local stakeholders to ensure guidelines are reflective of the reality of the local health system, applicable and inclusive of resource-constrained settings, available as “living guidance” that is disseminated widely and supported by cascading hands-on training. Findings offer valuable insights for LMICs to improve high consequence infectious disease outbreak responses and for organizations involved in guideline development and funding

‘Involve those who are managing these outbreaks’: stakeholders’ perspectives on the barriers and facilitators to the implementation of clinical management guidelines for high-consequence infectious diseases in Uganda—a thematic network analysis

Introduction: Prior research highlighting the complexity of clinical management guidelines’ (CMGs) implementation during high consequence infectious disease (HCID) outbreaks has suggested that limited access to treatments and equipment and substantial issues regarding availability, inclusivity, quality and applicability hinders the implementation of CMGs in low- and middle-income countries (LMICs). This in-depth case study of Uganda—coincidentally occurring during the 2022 Sudan virus disease outbreak—aimed to explore contextual and supplementary factors which hinder or facilitate CMG development and implementation. Methods: Between August and December 2022, 43 interviews were conducted with medical personnel, consultant physicians, case managers and Uganda Ministry of Health officials. Interviews were analysed using a thematic network analysis approach to visualise thematic codes in qualitative data and highlight inherent relationships between codes. Results: Six thematic topics emerged as the main barriers to the implementation of CMGs during HCID outbreaks in Uganda: (1) deficient content and slow updates of CMGs; (2) scarce resources and healthcare disparities; (3) slow dissemination and limited access to guidelines; (4) improvisation of patient care (5) lack of training for healthcare workers (HCWs); and (6) limited pandemic preparedness and response infrastructure. Codes most strongly linked to facilitators and suggestions included: (1) HCW training in CMG implementation; (2) adequate resourcing; (3) involvement of personnel with prior HCID response experience in CMG development and (4) improvements in access to CMGs. Conclusions: By illustrating linkages to resource constraints, healthcare disparities, and limited surveillance and referral infrastructure, our study displays how insufficient training, patchy dissemination and slow updating exacerbate many of the underlying difficulties for CMG implementation in LMIC contexts. Findings offer valuable insights for LMICs to improve HCID outbreak responses and inform implementation of CMGs in future HCID outbreaks, where evidence is often initially limited. Recommendations to enhance CMG implementation are provided

Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study.

Background The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty. Methods This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group—robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)—at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107. Findings Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered. Interpretation Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required. Funding UK Research and Innovation and National Institute for Health Research