Infection prevention and control for COVID-19 response in the Rohingya refugee camps in Bangladesh: an intra-action review.

BACKGROUND: Infection Prevention and Control (IPC) is critical in controlling the COVID-19 pandemic and is one of the pillars of the WHO COVID-19 Strategic Preparedness and Response Plan 2020. We conducted an Intra-Action Review (IAR) of IPC response efforts to the COVID-19 pandemic in Cox's Bazar, Bangladesh, to identify best practices, challenges, and recommendations for improvement of the current and future responses. METHODS: We conducted two meetings with 54 participants purposively selected from different organizations and agencies involved in the frontline implementation of IPC in Cox's Bazar district, Bangladesh. We used the IPC trigger questions from the WHO country COVID-19 IAR: trigger question database to guide the discussions. Meeting notes and transcripts were then analyzed manually using content analysis, and results were presented in text and quotes. RESULTS: Best practices included: assessments, a response plan, a working group, trainings, early case identification and isolation, hand hygiene in Health Facilities (HFs), monitoring and feedback, general masking in HFs, supportive supervision, design, infrastructure and environmental controls in Severe Acute Respiratory Infection Isolation and Treatment Centers (SARI ITCs) and HFs and waste management. Challenges included: frequent breakdown of incinerators, limited PPE supply, inconsistent adherence to IPC, lack of availability of uniforms for health workers, in particular cultural and gender appropriate uniforms and Personal Protective Equipment (PPE). Recommendations from the IAR were: (1) to promote the institutionalization of IPC, programs in HFs (2) establishment of IPC monitoring mechanisms in all HCFs, (3) strengthening IPC education and training in health care facilities, and (4) strengthen public health and social measures in communities. CONCLUSION: Establishing IPC programmes that include monitoring and continuous training are critical in promoting consistent and adaptive IPC practices. Response to a pandemic crisis combined with concurrent emergencies, such as protracted displacement of populations with many diverse actors, can only be successful with highly coordinated planning, leadership, resource mobilization, and close supervision.

The availability of global guidance for the promotion of women's, newborns', children's and adolescents' health and nutrition in conflicts.

BACKGROUND: Significant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be difficult unless conflict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conflicts. METHODS: We identified guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability. FINDINGS: We identified 105 conflict-relevant guidance documents from 75 organisations. Of these, nine were specific to conflicts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their 'scope and purpose' and 'clarity of presentation' and low for 'rigour of development' and 'editorial independence'. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insufficient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases. INTERPRETATION: Organisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conflicts specifically and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conflicts and other humanitarian settings is needed.

Helicopter Critical Care Retrieval in a Developing Country: A Trauma Case Series from Bhutan.

Background: The care of victims of traumatic injuries requires an organized system to achieve the best outcomes. Dispatch of specialist physicians, paramedics, and nurses to the patient by helicopter can reduce mortality. Countries in the developing world share the challenge of providing timely medical care to trauma victims, while facing others such as a higher trauma burden, poor infrastructure, inadequate government resources, organizational constraints, a lack of technical expertise, and prohibitive costs. These challenges can severely limit the provision of critical prehospital trauma care. Methods: We reviewed the prehospital trauma database to identify victims of trauma who required aeromedical evacuation as determined by the national triage system of Bhutan during the 4-month period after the establishment of the national Bhutan Emergency Aeromedical Retrieval (BEAR) team. We collected the patients' age and gender, description of injuries, mechanism of injury, interventions undertaken by the critical care retrieval team, and patient outcomes (alive vs. dead). Results: During the first 4 months of service, BEAR cared for 16 trauma patients. Fourteen patients survived to hospital discharge; two died after hospitalization. No patient died on scene or during transport. The team successfully treated several challenging casualties, including a patient gored by a water buffalo leading to traumatic cardiac arrest with successful resuscitation, victims of a compressed gas cylinder explosion, a bear mauling, and a penetrating arrow injury to the head. The team performed a variety of critical care interventions, including induction and maintenance of anesthesia, orotracheal intubation, mechanical ventilation, tube thoracostomy, administration of blood products, and successful management of traumatic cardiac arrest. Conclusion: A critical care helicopter retrieval team can deliver trauma care in a developing country, such as Bhutan, with favorable outcomes at low cost.