ABSTRACT
IntroductionThe Covid-19 pandemic, and societal attempts to control it, have touched almost every aspect of peoples lives around the world, albeit in unequal ways. In particular, there is considerable concern about the way that stringent lockdowns, as implemented in Kenya and many other countries, affected young children, especially those living in informal settlements. However, to date, there has been little research attempting to unpack and understand how the pandemic has impacted on the care of young children. MethodsIn-depth telephone interviews were conducted with 21 parents/carers of children aged under five years living in three Nairobi slums between May and September 2021 exploring the ways in which covid-19, and policies to control the pandemic, impacted on their household and the care of their child/children. ResultsThe impacts of covid-19 control measures on the care of children have been widely felt, deep and multiple. The impact of economic hardship has been significant, reportedly undermining food security and access to services including healthcare and childcare. Respondents reported an associated increase in domestic and community violence. Many people relied on help from others; this was most commonly reported to be in the form of variable levels of flexibility from landlords and help from other community members. No direct harms from covid-19 disease were reported by respondents. ConclusionThe impacts of covid-19 control measures on the care of young children in informal settlements have been indirect but dramatic. Given the breadth and depth of these reported impacts, and the particular vulnerability of young children, deeper consideration ought to inform decisions about approaches to implementation of stringent disease control measures in future. In addition, these findings imply a need for both short- and long-term policy responses to ameliorate the impacts described. Key messages O_TEXTBOXO_LIYoung children living in slums, while at low direct risk from Covid-19, are highly vulnerable to early childhood adversity, so may be at great risk from economic and other hardships that are a likely side effect of blunt pandemic control measures like stringent lockdowns. C_LIO_LIParent/carers described a set of indirect impacts of covid-19 control efforts that were broad, deep and protracted. Core to these impacts was widespread economic hardship, with knock on effects on household food security, wellbeing and community safety. C_LIO_LIConsidering the particular risks and vulnerability that blunt pandemic control measures present to young children, especially those in slums, needs to be central to policy discussions about if and how to implement stringent disease-control measures. In addition, more research is required to quantify the issues identified in this qualitative inquiry. C_LI C_TEXTBOX
ABSTRACT
Objective:To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. Methods: A cluster-randomized; triple-blind; placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned; according to their cluster of residence; to receive oral vitamin A (7500 ?g) or placebo once a week. Randomization was blocked; with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks; fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians; who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat; based on cluster of residence; with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. Findings The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms.Conclusion: Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age
