COVID-19 and informal settlements - implications for water, sanitation and health in India and Indonesia.

Informal settlements are home to over 1 billion people worldwide and are characterised by high population densities and poor environmental conditions. The authors identify the impact of COVID-19 on existing water and sanitation practices and potential pathways for the transmission of COVID-19 in informal settlements in India and Indonesia. In the short term, there is an urgent need for mobile and contactless hand washing, washing/bathing facilities and toilets. In the long term, COVID-19 provides an opportunity to invest in centralised water and sanitation networked solutions appropriate for high-density settings to integrate those settlements into cities and improve environmental conditions and health in these cities.

COVID-19 & informal settlements: is 'Stay Home' safe?

The disproportional burden of coronavirus (COVID-19) and vulnerability to containment measures in informal settlements have been recognised; however, the role of poor housing conditions in propagating these remains neglected. Poor housing conditions makes it difficult to effectively implement social distancing measures. With increased time spent in cramped, dark and uncomfortable indoor environments, water and sanitation outside the home, and no outdoor space, higher exposure to existing health hazards and high levels of stress, with women and children being most vulnerable, are anticipated. Through this commentary paper, we reflect on these interconnections and recommend immediate measures and the long-term need for adequate housing for health and well-being.

Parental help-seeking behaviour for, and care of, a sick or injured child during the COVID-19 pandemic: a European online survey.

BACKGROUND: Globally, the COVID-19 pandemic had a huge impact on patients and healthcare systems. A decline in paediatric visits to healthcare settings was observed, which might have been due to lower incidence of injury and infectious illness, changes in healthcare services and parental concern. The aim of our study was to examine parental experiences of help-seeking for, and care of, a sick or injured child during COVID-19 lockdown periods in five European countries with different healthcare systems in place. METHODS: An online survey for parents with a child with any kind or illness of injury during COVID-19 lockdowns was circulated through social media in five European countries: Italy, Spain, Sweden, the Netherlands, and the United Kingdom. Parents living in one of these countries with self-identification of a sick or injured child during COVID-19 lockdown periods were eligible to fill in the survey. Descriptive statistics were used for the level of restrictions per country, children's characteristics, family characteristics and reported help-seeking behaviour of parents prior to the lockdown and their real experience during the lockdown. The free text data was subjected to thematic analysis. RESULTS: The survey was fully completed by 598 parents, ranging from 50 to 198 parents per country, during varying lockdown periods from March 2020 until May 2022. Parents who completed the survey were not deterred from seeking medical help for their sick or injured child during the COVID-19 pandemic. This finding was comparable in five European countries with different healthcare systems in place. Thematic analysis identified three main areas: parental experiences of access to healthcare, changes in parents' help-seeking behaviours for a sick or injured child during lockdowns, and the impact of caring for a sick or injured child during the lockdowns. Parents reported limited access to non-urgent care services and were anxious about either their child or themselves catching COVID-19. CONCLUSION: This insight into parental perspectives of help-seeking behaviour and care for a sick or injured child during COVID-19 lockdowns could inform future strategies to improve access to healthcare, and to provide parents with adequate information concerning when and where to seek help and support during pandemics.

How Does Living in Temporary Accommodation and the COVID-19 Pandemic Impact under 5s' Healthcare Access and Health Outcomes? A Qualitative Study of Key Professionals in a Socially and Ethnically Diverse and Deprived Area of London.

Background: Children < 5 years living in temporary accommodation (U5TA) are vulnerable to poor health outcomes. Few qualitative studies have examined service provider perspectives in family homelessness; none have focused on U5TA with a cross-sector approach. This study explored professionals' perspectives of the barriers and facilitators, including pandemic-related challenges, experienced by U5TA in accessing healthcare and optimising health outcomes, and their experiences in delivering services. Methods: Sixteen semi-structured online interviews were conducted. Professionals working in Newham (London) with U5TA families were recruited from non-profit organisations, the health sector, and Local Authority. A thematic analysis was conducted. Findings: Professionals described barriers including poor parental mental health; unsuitable housing; no social support; mistrust of services; immigration administration; and financial insecurity. Digital poverty, language discordance, and the inability to register and track U5TA made them even less visible to services. Professionals tried to mitigate barriers with improved communication, and through community facilitators. Adverse pandemic effects on U5TA health included delay and regression in developmental milestones and behaviours. In-person services were reduced, exacerbating pre-existing barriers. Interpretation: COVID-19 further reduced the ability of professionals to deliver care to U5TA and significantly impacted the lives of U5TA with potential life-long risks. Innovative and tailored cross-sector strategies are needed, including co-production of public health services and policies focusing on early development, mental health support, employment training, and opportunities for parents/carers.

The double impact of the pandemic on BAME young people’s mental and emotional wellbeing: the effects of racial inequality and COVID-19

AimsThe combined impact of race discrimination and COVID-19 on the everyday lives of Black Asian and minority ethnic families and communities has drawn to the fore the glaring inequalities that exist in British society today. Drawing from a socioecological framework this ongoing research focuses on the emotional and mental wellbeing and resilience of Black and South Asian young people and how they have been differently impacted by the pandemic. With Black and Asian families already disproportionately impacted by the health and economic disparities, children and young people have been doubly exposed to emotional and psycho-social trauma. The aim of the research has been to examine the factors that impact the health, well-being and resilience of Black and Asian minority ethnic families and children during the pandemic.MethodsStarting from a critical race theory perspective, the qualitative research design uses a wellbeing and resilience framework and socioecological approach, to connect micro-meso-macro social processes. Semi-structured interviews, focus groups and creative workshops have provided insight into the combined impact of COVID-19 and racial discrimination on Black and South Asian young peoples’ everyday life, and how they navigated change. Data was collated in 2021 through purposive and snowballing techniques including from a community groups and schools, with a total of 53 participants, aged between 12–19 who identified as Black, Asian or mixed Black/Asian heritage. A youth engagement panel was also set up to aid meaningful engagement and involvement with youth participants.ResultsFindings based on a thematic analysis, provide insight into the interconnectedness of young people’s relationships with family, peers, teachers, and community support workers for maintaining mental wellbeing. Isolation, anxiety, experiences of bereavement, separation from school and friends, conducting their lives online and the impact of social media, influenced their concerns about inconsistencies in the policing of ‘lockdown’ rules, education, health, mental health support, within the context of being young and from Black or Asian backgrounds. The prominence of BLM movement and amplification of racial injustices during the pandemic, encouraged participants to speak candidly about identity, racialization, belonging, friendships and highlight local, national and global processes of change necessary for tackling systemic racial discrimination.Although many communicated through social media, being at home and separated from peers/friends made them more introspective and reflective on their relationships and friendships.ConclusionFor Black and Asian young people already experiencing the adverse effects of structural inequalities, the pandemic has added some extra challenges in relation to maintaining their wellbeing. Their perspectives provide important insights into the complex multiplicity of factors that must be understood to build resilience post-COVID-19 - from new coping strategies, family connections, accessing support services, the importance and reliance on peer support and peer power, and the need for more culturally-responsive policies for young people;changes that respond sensitively to the emotional and mental wellbeing of Black and Asian young people.

Giving children in rural India a voice during the Covid-19 pandemic: using drawing activities to understand children’s experiences and encourage global discussion

AimsRural communities and children are underrepresented in research. It is imperative that researchers engage with these populations, whether it be to disseminate findings or inform the research agenda. Post-pandemic, ensuring these communities are not forgotten is even more essential. Children may have more resistance to the virus but have had to endure the economic and social impact of the lockdowns. Art is used as a pressure-free way to engage children and elicit their experiences, feelings, and concerns.1 Therefore, we conducted a drawing activity with children living in rural areas to explore the pandemic from the child’s perspective. This examines how we worked with communities to use the arts to allow children who experience marginalisation to voice their feelings/opinions.MethodsPartnerships were built with local Indian community researchers and charities before commencing the work. The researchers understood the local context and spoke the primary local language. With the help of local teachers, the community researchers recruited 20 children from rural villages in Dungarpur to take part in the activity in a school hall. Trained community researchers explained the activity in the regional language, with translators who could speak the local dialect where necessary. Written consent was taken from both the parents and children, with agreement that the drawings could be freely used as part of exhibitions and presentations. Everyone wore masks and kept a minimum of 1 metre apart (the local guidance at the time) and hand sanitizer was readily available. Children were briefed on the project and, after some ice-breaker games, were asked to depict their experiences of the pandemic. The pictures were collected, scanned, and uploaded to our website as part of a global virtual exhibition on the arts and public health. The online event included talks from international scientists, artists, NGOs, and journalists.ResultsThe children’s drawings illustrated that they were worried about the global impact of the pandemic;felt isolated;feared for their parents’ job security;concerned about getting behind at school;and showed understanding of COVID safety precautions. Some depicted experiences of food insecurity. Others took a more positive approach, illustrating how happy they were about spending more time with their families. Presenting these images at the online exhibition raised awareness of the topic and stimulated discussion, potentially encouraging the multidisciplinary and influential attendees to pursue the research further or translate our approach to a different subject area. Additionally, it gave rural Indian communities a platform to voice their concernsConclusionThe engagement exercise allowed us to gauge the concerns of a marginalised community during the pandemic. Local partnerships and community collaborations were key to conducting this work. It allowed us to conduct an engagement activity that could be tailored to other contexts and which gave us a much-needed insight into the challenges that children in rural India have faced during the pandemic. This helped set research priorities and inform the discussion with policymakers, funders, and academics about key issues we need to address for children to rebuild their lives post pandemic.ReferenceChildren in Focus, J. Boyden.

The impact of the pandemic on children under 11 with Down Syndrome

AimsThe UK has faced 3 major lockdowns since March 2020 due to the pandemic, affecting access to education, healthcare provision and social activities. Children with Down Syndrome are more likely to have chronic health conditions and require developmental support, therefore are more likely to be impacted by healthcare delays and the move to remote services. Childhood is a crucial time for social, physical, and emotional development so 2 years of disrupted support will have had life-long consequences. This survey aimed to determine the impact of the pandemic on children under 11 with DS in the UK.MethodsThe survey was split into 6 categories: Demographics, Education, Healthcare provision, Physical health, Mental health, and Behaviour. Parents/carers gave feedback during the survey development. The questions were inputted into REDCap survey software on a secure server and all data was anonymously submitted. The survey was circulated using a digital snowballing technique through social media and email. Charities and support groups were contacted and asked to share the survey. Valid response percentages for each item were calculated and presented below.ResultsThere were 241 responses from caregivers across the UK between 25thOctober 2021 and 14th February 2022 (England 79.5%;Scotland 18.5%;Wales 2.9%;NI 2.1%). The children were primarily White (n=215) and male (Male: n=124;Female: n=117).Parents believed that remote learning had a negative impact on children with DS. 51% (n=53) of parents of children who continued school online felt that their child did not progress with their learning and 83.8% (n=88) felt they were missing out on key learning activities. 84.3% (n=129) believed that missing out on after-school activities had a moderate-large impact on their child and 59.8% (n=143) of parents believe that the lockdown has caused their child’s social skills to deteriorate.Healthcare/therapy provision was a large concern;89.8% (n=211) had appointments delayed and/or cancelled, while 43.6% (n=17) of those awaiting surgeries had them cancelled due to COVID and another 43.6% (n=17) were delayed. 57.1% (n=20) of those parents were worried about their child’s health as a result and 34.2% (n=78) of parents saw a direct increase in health issues.Parents saw a change in their child’s mental health and behaviour. 68.7% (n=161) of parents believe that their child’s emotional wellbeing had deteriorated, with the number of children presenting with signs of aggression often/almost always increasing from 4.3% (n=10) to 20.9% (n=48) and those crying often/almost always increasing from 2.5% (n=6) to 19.9% (n=47). As such, 77.8% (n=159) said the pandemic made the family dynamic more strained/stressful.ConclusionDespite parents reporting that 58.2% (n=139) of their children were ‘seemingly unaware’ of the pandemic, it has nonetheless had a clear negative impact on their health, development and quality of life. Conducting qualitative interviews with families would provide a deeper insight into the lived experiences of the children during the pandemic and help to develop a tailored and targeted approach to support parents/carers and their children moving forward.

Parental mental health and associations between living in temporary accommodation and socio-political determinants during the COVID-19 pandemic

576 Figure 1Is the adjusted odds ratio (OR) plot showing the odds of an increased rank of depression severity with living in Temporary Accommodation as the main exposure and each predictior variable given all the other variables were held constant in the model[Figure omitted. See PDF] 576 Figure 2Is the adjusted odds ratio (OR) plot showing the odds of an increased rank of anxiety severity with living in temporary accommodation as the main exposure and each predictior variable given all the other variables were held constant in the model[Figure omitted. See PDF]22.9% and 20.0% of TA parents/caregivers had severe anxiety and moderate anxiety compared to 4.0% and 25.0% of non-TA parents/caregivers, respectively. For parents/caregivers living in TA, the odds of a more severe anxiety rank were 2.46 times higher (95%CI:1.27–4.75). Other significant factors for anxiety were: Very Low Food Security (OR 4.45, 95%CI:3.26–6.08);families ‘finding it very difficult’ financially (OR 1.62, 95%CI:0.96–2.73). [Figure 2]ConclusionFamilies living in TA had a greater odds of poor parental mental health outcomes, which was further compounded by factors including NRPF status, financial insecurity, food insecurity and poor housing environments. Poor parental mental health is an adverse childhood experience (ACE) directly impacting both the health and wellbeing of the parent and child throughout the life course. Targeted policies and tailored community-based mental health strategies, including the co-location of mental health and housing support within settings already accessed by TA families with under 5s, are vitally needed, since this vulnerable group is at higher risk of poorer parental mental health and a higher ACE count, which is exacerbated by the unsuit ble and unsafe TA environment.

Socio-political determinants of health inequalities during the COVID-19 pandemic: Under 5s and their families living in temporary accommodation in a socially diverse and deprived population—Newham, East London

605 Figure 1Comparisons Between TA and Non-TA Families: Socio-political Determinants[Figure omitted. See PDF] 605 Table 1Health care access: comparison of non-TA and TA families n (%)ConclusionTA children were increasingly disadvantaged among multiple domains: socio-demographics, food insecurity, inadequate/poor housing, health service access. Therefore, the need is urgent to minimise the potential lifelong health impacts of these socio-political determinants of health experienced by this vulnerable group in addition to tackling the immediate risks arising from issues such as digital exclusion and poor housing conditions, which were likely exacerbated during the pandemic. The future of the pandemic is uncertain and future lockdowns are possible, so all families must have digital access now that many vital health services and schooling are online, even some exclusively. The time families spend in TA must be reduced, and the co-production of interim solutions and future policies to ensure a minimum set of housing standards for TA should be made a priority to address these inequalities and inequities.

Differences in clinical presentation, severity, and treatment of COVID-19 among individuals with Down syndrome from India and high-income countries: Data from the Trisomy 21 Research Society survey.

Background: People with Down syndrome (DS) are one of the highest risk groups for mortality associated with COVID-19, but outcomes may differ across countries due to different co-morbidity profiles, exposures, and societal practices, which could have implications for disease management. This study is designed to identify differences in clinical presentation, severity, and treatment of COVID-19 between India and several high-income countries (HICs). Methods: We used data from an international survey to examine the differences in disease manifestation and management for COVID-19 patients with DS from India vs HIC. De-identified survey data collected from April 2020 to August 2021 were analysed. Results: COVID-19 patients with DS from India were on average nine years younger than those from HICs. Comorbidities associated with a higher risk for severe COVID-19 were more frequent among the patients from India than from HICs. Hospitalizations were more frequent among patients from India as were COVID-19-related medical complications. Treatment strategies differed between India and HICs, with more frequent use of antibiotics in India. The average severity score of 3.31 was recorded for Indian DS in contrast to 2.3 for European and 2.04 for US cases. Conclusions: Presentation and outcomes of COVID-19 among individuals with DS were more severe for patients from India than for those from HIC. Global efforts should especially target vaccination campaigns and other risk-reducing interventions for individuals with DS from low-income countries.

COVID-19 Vaccination of Individuals with Down Syndrome-Data from the Trisomy 21 Research Society Survey on Safety, Efficacy, and Factors Associated with the Decision to Be Vaccinated.

Individuals with Down syndrome (DS) are among the groups with the highest risk for severe COVID-19. Better understanding of the efficacy and risks of COVID-19 vaccines for individuals with DS may help improve uptake of vaccination. The T21RS COVID-19 Initiative launched an international survey to obtain information on safety and efficacy of COVID-19 vaccines for individuals with DS. De-identified survey data collected between March and December 2021 were analyzed. Of 2172 individuals with DS, 1973 (91%) had received at least one vaccine dose (57% BNT162b2), 107 (5%) were unvaccinated by choice, and 92 (4%) were unvaccinated for other reasons. Most participants had either no side effects (54%) or mild ones such as pain at the injection site (29%), fatigue (12%), and fever (7%). Severe side effects occurred in <0.5% of participants. About 1% of the vaccinated individuals with DS contracted COVID-19 after vaccination, and all recovered. Individuals with DS who were unvaccinated by choice were more likely to be younger, previously recovered from COVID-19, and also unvaccinated against other recommended vaccines. COVID-19 vaccines have been shown to be safe for individuals with DS and effective in terms of resulting in minimal breakthrough infections and milder disease outcomes among fully vaccinated individuals with DS.

Parents' experiences with a sick or injured child during the COVID-19 lockdown: an online survey in the Netherlands.

OBJECTIVE: To assess the impact of the COVID-19 lockdown on parents' health-seeking behaviour and care for a sick or injured child in the Netherlands. DESIGN AND SETTING: An online survey on parents' experiences with a sick or injured child during the COVID-19 lockdown periods was disseminated through social media. PARTICIPANTS: Parents living in the Netherlands with a sick or injured child during the lockdown periods from March to June 2020 and from December 2020 to February 2021 were eligible to participate. OUTCOME MEASURES: Descriptive statistics and thematic analysis were used to analyse family and children's characteristics, parents' response to a sick or injured child, and the perceived impact of the lockdown on child's severity of illness and treatment reported by parents. Analyses were stratified for children with and without chronic conditions. RESULTS: Of the 105 parents who completed the survey, 83% reported they would have sought medical help before lockdown compared with 88% who did seek help during lockdown for the same specific medical problem. Parents reported that changes in health services affected their child's severity of illness (31%) and their treatment (39%), especially for children with chronic conditions. These changes included less availability of healthcare services and long waiting lists, which mostly led to worsening of the child's illness. During lockdown, there was no change in health-seeking behaviour by parents of children with a chronic condition (N=51) compared with parents of children without a chronic condition. CONCLUSION: Parents in the Netherlands who completed the survey were not deterred from seeking medical help for their sick or injured child during the COVID-19 lockdown periods. However, changes in health services affected child's severity of illness and treatment, especially for children with chronic conditions.

Mitigating the severity of child homelessness in the UK: a global mixed-methods systematic review

Background In 2019, 585 000 children in England were homeless or at risk of becoming homeless. The pressure of the COVID-19 pandemic on the health-care delivery system has amplified the inequalities faced by marginalised children. Although the UK has had a series of successful health sector reforms, few have designed or implemented strategies that target reach, access, and use of public health services for marginalised children. This project aims to identify such strategies by exploring solutions used in low-income and middle-income countries (LMICs), through reverse-innovation. Methods We undertook a systematic review of the literature published in English from PubMed, MEDLINE, and SCOPUS between Jan 1, 2010, and March 31, 2021. We explored the literature focusing on policy, strategy, intervention, and services, using keywords and Medical Subject Headings corresponding to the target population, and medical, health, and nutrition services including preventive and immunisation services, and outcomes. Our target population included homeless and marginalised children. We defined marginality in terms of social distances following Braun and Gatzweiler (2013). We included in our search homelessness, temporary accommodation (eg, makeshift accommodation, emergency shelter, and feral), the conditions that put a child at risk of homelessness (eg, war, battle, conflict, refugee, displaced, and migrant), and the general conditions of social distances (eg, poverty, and financial catastrophe) that do not belong to discrimination. We used the Arksey O'Malley framework with Levene's extension in the aforementioned databases and Google Scholar to improve inclusivity. The primary outcomes included access, coverage, and utilisation of child health and nutrition services. The impact measurements included morbidity, mortality, and economic outcomes (return on investment, cost, and efficiency). We applied natural language processing for thematic analysis of qualitative evidence. The analysis was assisted by Python (v3.7.12). Findings We found 53 final articles (47 quantitative and six qualitative) from LMICs. Community-focused and financial interventions were successful in different settings. Financial interventions such as user-fee removal increased health care and service use between 15–309%. Cash transfers increased immunisation coverage, financial security, and nutrition. Mobile health services and the individualised tactics of community midwives and volunteers improved the coverage and use of child health and nutrition services. Community-based savings groups, user-fee removal, and cash transfer policies improved access and utilisation. mHealth applications and capacity building of health workforce increased coverage and quality of these services and improved clinic attendance. Interpretation UK policy makers could adapt and adopt targeted and conditional cash transfer policies to provide greater financial security to homeless families and make child health care more affordable and inclusive. Volunteer and mobile-clinic-based community services would increase access and use of these services in the COVID-19 recovery phase. Our review may have missed matured strategies published before 2010. We were unable to estimate a pooled effect. Funding ESRC, UK Research and Innovation rapid response COVID 19.

COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey.

Adults with Down Syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19) than the general population, but evidence is required to understand the risks for children with DS, which is necessary to inform COVID-19 shielding advice and vaccination priorities. We aimed to determine the epidemiological and clinical characteristics of COVID-19 in children with DS. Using data from an international survey obtained from a range of countries and control data from the United States, we compared the prevalence of symptoms and medical complications and risk factors for severe outcomes between DS and non-DS paediatric populations with COVID-19. Hospitalised COVID-19 patients <18 years with DS had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than control patients without DS <18 years. Older age, obesity, and epilepsy were significant risk factors for hospitalisation among paediatric COVID-19 patients with DS, and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. Mortality rates were low in all paediatric COVID-19 patients (with and without DS), contrasting with previous findings in adults with DS (who exhibit higher mortality than those without DS). Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population and to identify children with DS who present comorbidities that pose a risk for a severe course of COVID-19. Our results emphasize the importance of vaccinating children with DS as soon as they become eligible.

Admissions to a low-resource neonatal unit in Malawi using a mobile app and dashboard: a one year digital perinatal outcome audit

BackgroundNeonatal deaths still account for a large proportion of child deaths. Understanding the extent and characteristics of neonatal deaths in Sub-Saharan Africa is a significant challenge with poor quality, inaccurate record-keeping in these settings. The process of audit is considered the foundation of quality improvement. With mHealth gaining prominence in many hospital departments, the NeoTree data collection and quality improvement system is a digital innovation deployed at Kamuzu Central Hospital (KCH), Neonatal Unit, Malawi, from April 2019, facilitating automated, real-time, prospective audit via a data dashboard.ObjectivesTo describe the pattern of admissions and outcomes in a Malawian neonatal unit over a one-year period via a prototype data dashboard, using a bedside electronic data collection and quality improvement system: NeoTree.MethodsAn electronic audit of admissions to KCH, Neonatal Unit (1st May 2019 to 31st April 2020) was carried out. Data were collected prospectively by nursing staff at the point of care, using electronic forms in the NeoTree app on tablet devices. Admission and outcome forms contained embedded reminders, education and training regarding newborn care according to national and international guidelines. Data were exported from the tablets to a cloud database. The data were then reviewed, visualised, and retrieved via a Microsoft Power BI dashboard. Data cleaning and descriptive statistics were executed using R.ResultsA total of 2732 neonates were admitted and 2413 (88.3%) had an outcome recorded electronically using the NeoTree app. Of 2413 whose outcome was known, 1899 (78.7%) were discharged alive, 12 (0.5%) were referred to another hospital and 10 (0.4%) left the hospital before being discharged. One fifth (n=492) infants died, giving an overall case fatality rate of 204/1000 admissions. Of 492 deaths, the commonest causes of death were prematurity with respiratory distress (n=252, 51%), neonatal sepsis (n=116, 23%), and neonatal encephalopathy (n=80, 16%). Almost half (45%) of deaths occurred within the first 72 hours of admission. The most common perceived modifiable factors around deaths were inadequate monitoring of vital signs and management of sepsis. Monthly trends were tracked in relation to a change in admission criteria and the COVID-19 pandemic. 202 (8.1%) neonates were HIV exposed and 143 (70.8%) of these received nevirapine as prophylaxis leaving 59 (29.2%) vulnerable to vertical infection. Data collected on the NeoTree app were on average 96% complete across all data fields and coverage of admissions, discharges and deaths was 97%, 99% and 91% respectively when compared with the ward logbook.ConclusionsThis is the first electronic, point-of-care audit of neonatal admissions and outcomes to a neonatal unit, collected by health professionals using a mobile app, reported via a data dashboard. This system achieved high coverage and completeness of data over a one-year period suggesting that M-health quality improvement systems such as the NeoTree can provide and improve quality of data for audit, timely reporting, and effective decision making regarding neonatal care in low resource settings, even during significant external stresses such as the COVID-19 pandemic. A larger scale evaluation of impact on quality of care and case fatality rate is planned.

Identifying housing-level barriers to optimal health for Under5s experiencing homelessness: a citizen science approach

BackgroundThe first five years of life are critical for optimal growth, health and cognitive development during which ~90% of brain development occurs. However, many children experience poverty and/or homelessness. Data from 2019 suggested there could be more than 210,000 homeless children in temporary accommodation (TA) or sofa surfing, and ~585,000 who are either homeless or at risk of becoming homeless in England.ObjectivesTo explore the housing environmental barriers to optimal health for children under the age of five (U5s) experiencing homelessness and living in TA.MethodsThe study employed a mixed-methods, participatory design integrating citizen science to identify housing-level barriers to achieving optimal health. Participants were mothers of U5s living in TA, and conveniently sampled at a local charity providing support to U5s experiencing homelessness in Newham, London. Newham has the highest number of children in TA in England (1 in 12 children are homeless) and 1 in 2 children live in poverty. The study had two parts(i) Housing Survey and (ii) House Visits.A housing survey utilised citizen science methodology to collect data including mobile phone images and free text captions to describe the TA housing conditions including those which participants considered as barriers to their child’s health. The survey was first piloted over two weeks on five participants, following refinement based on collaborative feedback and dialogue between the doctoral researcher and study participants. To compliment the housing survey, the doctoral researcher visited the participants’ TA and took observational notes with an audio-recorder and digital photos.A thematic analysis was conducted to triangulate themes across the data. Kingfisher’s Unfit Housing UK Research Report guided the categories for the results. Specific factors explored within these data included ease of access to the property, safety risks, disrepairs, visible structural problems, poor ventilation, temperature control, space (e.g., for a baby to crawl).ResultsIn the Housing Survey, fifteen participants collected data over a period of one month at the end of 2019. In 2019–2020, four House Visits were completed (Pre-COVID), but further visits were cancelled due to the pandemic.Several themes were prominent and overlapped across the Housing Surveys and House Visits, which were noted as risks to child health and development. Thematic categories included (i) overcrowding, (ii) dampness/mould growth, (iii) poor/inadequate kitchen/toilet facilities, (iv) infestations/vermin, (v) structural problems/disrepair, (vi) unsafe electrics, (vii) excessively cold/warm due to inadequate temperature regulation and (viii) unsafe surfaces that risk causing trips or falls.ConclusionsThe Early Years is a short, yet vital period to ensure to the next generation have the best start in life, however U5s in TA face numerous barriers in the housing environment which have significant short- and long-term health impacts. Despite a small sample size, findings are consistent with the Children’s Commissioner ‘Bleak houses’ report and likely to be generalisable across other similar families experiencing homelessness in England.Policy should be enacted to regulate the conditions of TA across England with greater monitoring of and accountability for the safety and regulations to ensure that these environments promote optimal growth and development for U5s.

Caring for a sick or injured child during the COVID-19 pandemic lockdown in 2020 in the UK: An online survey of parents' experiences.

BACKGROUND: During the COVID-19 pandemic, the first UK lockdown (March to May 2020) witnessed a dramatic reduction in children presenting to primary/emergency care, creating concern that fear of the virus was resulting in children presenting late. METHODS: An online survey was co-developed with UK parents to understand the impact of the lockdown on parents' help-seeking for, and care of, their sick/injured child(ren). The survey was advertised through social media and snowballing to parents whose children had been ill/injured during the lockdown. Analysis used descriptive statistics, SPSSv25 and thematic analysis. RESULTS: The survey was fully completed by 198 UK parents. The majority asked for help (144/198): from their family doctor (78), national helplines (48) or an Emergency Department (23). Most reported that their decision-making had not changed, although how they sought help had changed. A few parents reported that the severity and duration of illness had increased because of uncertainty about and/or difficulty accessing services. Parents did not always report seeking help for symptoms rated red or amber by the Royal College of Paediatrics and Child Health. Parents reported accessing information through the internet or using information that they already had. PARENT CONTRIBUTION: This was a collaboration with parents from survey development to dissemination, with two parents being integral members of our research team. CONCLUSIONS: Our questionnaire was completed by parents who were not deterred from seeking help for their sick or injured children. Even for these parents, the lockdown changes to services created uncertainty about, and barriers to, accessing medical help for their children.

Medical vulnerability of individuals with Down syndrome to severe COVID-19-data from the Trisomy 21 Research Society and the UK ISARIC4C survey.

BACKGROUND: Health conditions, immune dysfunction, and premature aging associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19. METHODS: The T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers on patients with COVID-19 and DS. Data collected between April and October 2020 (N=1046) were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS. FINDINGS: The mean age of COVID-19 patients with DS in the T21RS survey was 29 years (SD = 18). Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Joint/muscle pain and vomiting or nausea were less frequent (p < 0.01), whereas altered consciousness/confusion were more frequent (p < 0.01). Risk factors for hospitalization and mortality were similar to the general population with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher in patients with DS (T21RS DS versus non-DS patients: risk ratio (RR) = 3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus non-DS patients: RR = 2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality. INTERPRETATION: Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of medical complications and mortality, especially from age 40. FUNDING: Down Syndrome Affiliates in Action, DSMIG-USA, GiGi's Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, The Matthew Foundation, NDSS, National Task Group on Intellectual Disabilities and Dementia Practices.