Implementing the Practice of Birth Companion in Labor During the COVID-19 Pandemic: A Quality Improvement Endeavor in India.

Objective We aim to implement the practice of birth companions (BC) (from 0% to 90%) during labor to provide respectful maternity care (RMC) during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a prospective quality improvement (QI) study conducted in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences (AIIMS), Rishikesh, India. The methodology given by the World Health Organization (WHO)'s Point of Care Continuous Quality Improvement (POCQI) manual was followed, and standard tools of quality improvement were used to attain the objective. Results The QI team conducted a cause and effect analysis to understand the reasons why birth companions were not allowed during childbirth. The Pareto principle derived at three most important causes of the problem: absence of a defined policy, ignorance of guidelines promoting BC even during the pandemic, and relatives could enter wards only after a negative reverse transcriptase polymerase chain reaction (RTPCR) report, which could take up to 48 hours. Multiple change ideas were tested by means of Plan-Do-Study-Act (PDSA) cycles that were successful in bringing about desired change and improvement in the delivery of quality healthcare. Conclusion QI methodology was effective in promoting and achieving more than 90% birth companionship in labor and thus helpful in providing respectful maternity care even during the COVID-19 pandemic.

COVID-19 lockdown-driven changes in the Ganga River ecosystem in response to human perturbations.

We examined 10 subsurface water, 5 benthic water and 19 sediment (02 cm) samples along a 518 km of the middle segment of the Ganga River to assess the possible improvements that resulted from the industrial shutdown during the COVID-19 pandemic. The sites included the main stem river, tributary confluences, and two point sources, one of which releases metal-rich effluents and the other flushes municipal sewage. We found significant declines in the carbon, nutrient and metal concentrations in both the water and sediment. Even the most polluted zones did not show hypoxia (dissolve oxygen; DO < 2.0 mg L-1) that had been observed in the previous year. Despite a significant decline in carbon and nitrogen as substrates, the activities of extracellular enzymes (EEs), such as ß-D-glucosidase, FDAase and protease in sediment (0-2 cm depth), increased significantly (p < 0.05) in response to the declining metal concentrations resulting from the industrial shutdown. We found strong negative correlations between EE activity and the concentrations of metal pollutants measured in 2019, but the correlations between these variables appeared poor in 2020 (lockdown period). Also, we found large variances (low stability coefficients) during the period of strong anthropogenic effects (2019). The study indicates that industrial sources are important contributors of metal pollution in the Ganga River and has relevance exploring river ecosystem recovery windows for management decisions.

Effects of COVID-19 lockdown on water quality, microbial extracellular enzyme activity, and sediment-P release in the Ganga River, India.

This study investigates possible improvement in water quality and ecosystem functions in the Ganga River as influenced by COVID-19 lockdown in India. A total of 132 samples were collected during summer-2020 low flow (coinciding COVID-19 lockdown) for water (sub-surface and sediment-water interface) and 132 samples separately for sediment (river bottom and land-water interface) considering 518-km main river stem including three-point sources (one releases urban sewage and the other two add metal-rich industrial effluents) and a pollution-impacted tributary. Parameters such as dissolved oxygen deficit and the concentrations of carbon, nutrients (N and P), and heavy metals were measured in water. Sediment P-release was measured in bottom sediment whereas extracellular enzymes (EE; alkaline phosphatase, FDAase, protease, and ß-D-glucosidase) and CO2 emission were measured at land-water interface to evaluate changes in water quality and ecosystem functions. The data comparisons were made with preceding year (2019) measurements. Sediment-P release and the concentrations of carbon, nutrients, and heavy metals declined significantly (p<0.05) in 2020 compared to those recorded in 2019. Unlike the preceding year, we did not observe benthic hypoxia (DO <2.0 mg L-1) in 2020 even at the most polluted site. The EE activities, which declined sharply in the year 2019, showed improvement during the 2020. The stability coefficient and correlative evidences also showed a large improvement in the water quality and functional variables. Positive changes in functional attributes indicated a transient recovery when human perturbations withdrawn. The study suggests that timing the ecosystem recovery windows, as observed here, may help taking management decision to design mitigation actions for rivers to recover from anthropogenic perturbations.