Leveraging digital platforms for disseminating health and nutrition information during COVID-19: reflections from Project Samvad in India

Countries around the globe, including India, are making strides to combat maternal and child health issues. To support these efforts, Digital Green implemented Project Samvad, a USAID-funded reproductive, maternal, newborn, and child health (RMNCH) project working across six states in India. The project used a human-mediated community video approach to improve maternal and child health outcomes. In early 2020, due to mobility-related restrictions and norms related to physical distancing resulting from the COVID-19 pandemic, Project Samvad's field activities stalled. This descriptive study highlights the project's pivot to the use of digital tools to reach beneficiaries during the COVID-19 pandemic. The project delivered COVID-19 related information by layering it on the existing RMNCH messages. It used WhatsApp and Interactive Voice Response System to reach out to the community and frontline workers. The content of the messages was locally relevant, culturally appropriate, and addressed the concerns of the local community concerning their immediate needs related to RMNCH and COVID-19. The project recorded a listenership of 85,199 and a content viewership of 283,866 in three months. The initiative also oriented 918 frontline workers virtually on their roles and responsibilities during COVID-19. The insights from the adaptation of our approach in the context of COVID-19 can help project managers and policymakers address communication issues during the pandemic or any other emergency, using digital dissemination for reaching beneficiaries, building the capacities of partners, engaging community members and frontline workers for improved learning, and dealing with process-related challenges.

Keeping the endoscopy ship afloat against the first wave of covid-19-the utilisation of a private institution to bolster mmuh gi services during covid-19

Aims During COVID-19, guidelines for performance of endoscopy meant procedure numbers were significantly curtailed.From April-June 2020, the Health Authorities in Ireland procured private hospitals for public use. The aims of this study were 1. to determine if additional private hospital capacity was utilised effectively for endoscopy, as this model is oftenemployed to deal with long waiting lists in Ireland. 2. to compare pathology and follow up rates between the two institutions. Methods We analysed all documentation relating to 242 endoscopy procedures outsourced to the private institution (MPH). For the period of June 2020 we compared indications, follow up rates and pathology for outpatient endoscopy proceduresperformed in our public institution, MMUH (n = 111) and MPH (n = 104). Results 197/242 (81.4 %) procedures in 167 patients were completed. Non-completion was due to refusal or failure toattend (32) and illness (6). 102 patients (61 %) were subsequently discharged to the GP and 39 % of patients requiredhospital follow up. There was no significant difference between indications in both institutions (p = 0.843). As shown in Table 1, rates ofsignificant pathology in MPH vs MMUH were not statistically significant, 4 % vs 7 %;p = 0.315. There was no difference infollow up rates in MPH vs MMUH, 62 % vs 51 %, p = 0.849. Conclusions The use of private capacity in MPH during the first wave of COVID19 significantly reduced the burden on thepublic system for GI procedures. However arranging the necessary follow up for the 39 % of patients from the MPHgenerated a substantial clinical and administrative workload on the public system. Although the endoscopy procedures performed in both institutions were deemed 'urgent', significant pathology was rare, between 4-7 %, suggesting more stringent criteria for endoscopy should be considered in the future.

Improving adherence to endoscopy guidelines for triage and surveillance in a singleendoscopy unit

Aims Encouraging adherence to agreed triage guidelines is a critical facet of endoscopy waiting list management,particularly in the current climate of COVID-19. Unfortunately, few such guidelines exist and there is considerable variabilityin their application. The aim of this study was to determine if the use of locally developed flowsheets, created using existing guidelines, couldaid in standardisation of endoscopy triage and surveillance in a single endoscopy unit. Methods Existing international (BSG) and national (NICE, NCSS and HIQA) guidelines were reviewed. Simple flowsheetswere devised to address upper and lower GI endoscopy triage, polyp and Barretts surveillance, family history of colorectalcancer. A baseline quiz involving clinical scenarios was devised and endoscopy users were invited to participate. The quizwas then retaken after reviewing the relevant flowsheets. Results 20 endoscopy users took part. The mean number of correct answers increased significantly after reviewingflowsheets (45±11 % v 71±12 %;p=<0.0001). Similar improvements were noted across both the triage and surveillancesections (25±15 % v 25±18 %;p=0.8368), and between nursing and medical staff (24±18 % v 27±15 %;p=0.7075).Consultants had more correct answers than nurses at initial assessment (56±5 % v 42±12 %;p=0.054) but there was nosignificant difference after reviewing the flowsheets (71±10 % v 66±14 %;p=0.5566). Conclusions We have shown a significant improvement in triage accuracy after reviewing appropriate guideline flowsheets among medical and nursing staff. While medical staff performed better at initial assessment, there was no significant difference between medical and nursing staff scores after reviewing the guidelines. We conclude that all staff should refer to guidelines when triaging clinical requests. In addition it reassures us that nurses, with appropriate guidelines as reference, can be utilised to support or replace doctor-led triage. (Table Presented).