Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care

Background: In an effort to prevent infants being infected with SARS-CoV-2, some governments, professional organisations, and health facilities are instituting policies that isolate newborns from their mothers and otherwise prevent or impede breastfeeding. Weighing of risks is necessary in policy development: Such policies are risky as was shown in the early response to the HIV pandemic where efforts to prevent mother to child transmission by replacing breastfeeding with infant formula feeding ultimately resulted in more infant deaths. In the COVID-19 pandemic, the risk of maternal SARS-CoV-2 transmission needs to be weighed against the protection skin-to-skin contact, maternal proximity, and breastfeeding affords infants. Conclusion: Policy makers and practitioners need to learn from the mistakes of the HIV pandemic and not undermine breastfeeding in the COVID-19 pandemic. It is clear that in order to maximise infant health and wellbeing, COVID-19 policies should support skin-to-skin contact, maternal proximity, and breastfeeding

Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016-2018.

BACKGROUND: Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies. METHODS: We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management; malnutrition; water, sanitation and hygiene (WASH); vaccination; coordination and insecurity. We undertook a literature review of global and Yemen-specific cholera guidance, examined surveillance data from the first and second waves (28 September 2016-12 March 2018) and reviewed reports on airstrikes on water systems and health facilities (April 2015-December 2017). We used the Global Task Force on Cholera Control's framework to examine intervention strategies and thematic analysis to understand decision making. RESULTS: Yemen is water scarce, and repeated airstrikes damaged water systems, risking widespread infection. Since a cholera preparedness and response plan was absent, on detection, the humanitarian cluster system rapidly developed response plans. The initial plans did not prioritise key actions including community-directed WASH to reduce transmission, epidemiological analysis and laboratory monitoring. Coordination was not harmonised across the crisis-focused clusters and epidemic-focused incident management system. The health strategy was crisis focused and was centralised on functional health facilities, underemphasising less accessible areas. As vaccination was not incorporated into preparedness, consensus on its use remained slow. At the second wave peak, key actions including data management, community-directed WASH and oral rehydration and vaccination were scaled-up. CONCLUSION: Despite endemicity and conflict, Yemen was not prepared for the epidemic. To contain outbreaks, conflict-affected states, humanitarian agencies, and donors must emphasise preparedness planning and community-directed responses

A public health approach for deciding policy on infant feeding and mother-infant contact in the context of COVID-19

The COVID-19 pandemic has raised concern about the possibility and effects of mother-infant transmission of SARS-CoV-2 through breastfeeding and close contact. The insufficient available evidence has resulted in differing recommendations by health professional associations and national health authorities. We present an approach for deciding public health policy on infant feeding and mother-infant contact in the context of COVID-19, or for future emerging viruses, that balances the risks that are associated with viral infection against child survival, lifelong health, and development, and also maternal health. Using the Lives Saved Tool, we used available data to show how different public health approaches might affect infant mortality. Based on existing evidence, including population and survival estimates, the number of infant deaths in low-income and middle-income countries due to COVID-19 (2020-21) might range between 1800 and 2800. By contrast, if mothers with confirmed SARS-CoV-2 infection are recommended to separate from their newborn babies and avoid or stop breastfeeding, additional deaths among infants would range between 188 000 and 273 000

Occurrence and overlap of natural disasters, complex emergencies and epidemics during the past decade (1995–2004)

BACKGROUND: The fields of expertise of natural disasters and complex emergencies (CEs) are quite distinct, with different tools for mitigation and response as well as different types of competent organizations and qualified professionals who respond. However, natural disasters and CEs can occur concurrently in the same geographic location, and epidemics can occur during or following either event. The occurrence and overlap of these three types of events have not been well studied. METHODS: All natural disasters, CEs and epidemics occurring within the past decade (1995–2004) that met the inclusion criteria were included. The largest 30 events in each category were based on the total number of deaths recorded. The main databases used were the Emergency Events Database for natural disasters, the Uppsala Conflict Database Program for CEs and the World Health Organization outbreaks archive for epidemics. ANALYSIS: During the past decade, 63% of the largest CEs had ≥1 epidemic compared with 23% of the largest natural disasters. Twenty-seven percent of the largest natural disasters occurred in areas with ≥1 ongoing CE while 87% of the largest CEs had ≥1 natural disaster. CONCLUSION: Epidemics commonly occur during CEs. The data presented in this article do not support the often-repeated assertion that epidemics, especially large-scale epidemics, commonly occur following large-scale natural disasters. This observation has important policy and programmatic implications when preparing and responding to epidemics. There is an important and previously unrecognized overlap between natural disasters and CEs. Training and tools are needed to help bridge the gap between the different type of organizations and professionals who respond to natural disasters and CEs to ensure an integrated and coordinated response

A comparison of total cost estimates between exclusive breast-feeding and breast milk substitute usage in humanitarian contexts

Abstract Objective: Using a model-based analysis, we calculated the total costs associated with the exclusive breast-feeding (EBF) and breast milk substitute (BMS) usage for one infant for six months within select humanitarian contexts to (a) determine if there is a notable difference in costs and (b) use these results to inform future creation of data-informed humanitarian response standard operating procedures. Design: The inputs and costing data were drawn from a mixture of local e-commerce vendors, peer-reviewed literature and personal communications with field-based humanitarian responders. To account for cost fluctuations, each input’s costs along with low and high parameters are presented. All costs are presented in 2021 United States Dollars. Setting: Humanitarian responses within Indonesia and Jordan. Participants: Not applicable. Results: There was a notable difference in the total cost of care in both selected locations across the study arms (Indonesia: $542; Jordan:$892). Conclusions: Given the reality of limited funding for comprehensive humanitarian response around the world and the necessity of prioritising certain interventions, humanitarian response organisations should consider the notable cost difference between EBF and BMS usage (along with the proven health benefits of EBF). This difference should play a role in informing the future creation of standard operating procedures while also ensuring that all infants within a humanitarian crisis receive appropriate feeding