Psychological impact of COVID- 19 outbreak on health care professionals working at the Pakistan institute of medical sciences, Islamabad

Objective:  To assess anxiety and depression in healthcare professionals who are at high risk of exposure during the corona virus outbreak. Methodology: A cross-sectional descriptive study was performed from April 21, 2020 to June 21, 2020 at Pakistan Institute of Medical Sciences Islamabad. The number of healthcare professionals was selected using a simple random sampling technique from medicine and allied and surgical and allied. Standard SOPs were followed by both researchers and participants as per WHO and MOH guidelines.Self administered questionnaire in which anxious thoughts regarding Covid 19 were assessed. Reliable and validated research tools were used which included: a) Hospital Anxiety and Depression Scale (HAD-S), for evaluating level of anxiety and depression, b) Bradford Somatic Inventory (BSI), this assesses the somatic symptoms associated with anxiety and depression.Results: The study results on the Hospital Anxiety and Depression Scale indicate that overall, 76.47 % of the respondents showed the positive symptoms of anxiety. Among them 25.73% were males and 50.73% were females.  Overall, 4.65 % of respondents were facing depression, in which 2.69% pare females whereas 1.96 % were males. Scores on Bradford Somatic Inventory reveal that 0ut of 119 females 97 were found to have somatic symptoms, while out of 289 males 103 had somatic complaints. A total of 200 participants were found positive for somatic symptoms.Conclusion: It is concluded that there is a need for developing guidelines for healthcare professionals about effectively dealing in a health emergency situation like outbreak of this pandemic

Global trends in typhoidal salmonellosis: A systematic review

Typhoid and paratyphoid fever continue to significantly contribute to global morbidity and mortality. Disease burden is higher in low-and middle-income settings where surveillance programs are rare and little systematic information exists at population level. This review evaluates national, regional, and global trends in the incidence of typhoid fever and of related morbidity and mortality. A literature search in Medline, Embase, and Web of Science was conducted in June 2016, followed by screening and data extraction in duplicate. Studies reporting blood culture estimates of typhoid or paratyphoid morbidity and mortality were included in the analysis. Five thousand five hundred sixty-three unique records were identified, of which 1978 were assessed for relevance with 219 records meeting the eligibility criteria. Salmonella enterica serotype Typhi was the most commonly reported organism (91%), with the occurrence of typhoidal Salmonella (either incidence or prevalence) being the most commonly reported outcome (78%), followed by typhoid fever mortality, ileal perforation morbidity, and perforation mortality, respectively. Fewer than 50% of studies stratified outcomes by age or urban/rural locality. Surveillance data were available from 29 countries and patient-focused studies were available from 32 countries. Our review presents a mixed picture with declines reported in many regions and settings but with large gaps in surveillance and published data. Regional trends show generally high incidence rates in South Asia, sub-Saharan Africa, and East Asia and Pacific where the disease is endemic in many countries. Significant increases have been reported in certain countries but should be explored in the context of long-term trends and underlying at-risk populations

Combined clinical audits and low-dose, high-frequency, in-service training of health care providers and community health workers to improve maternal and newborn health in Mali: Protocol for a pragmatic cluster randomized trial

Background: Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills.Objective: This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality.Methods: The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting.Results: The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol.Conclusions: The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings.Trial registration: ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237.International registered report identifier (irrid): DERR1-10.2196/28644