Problems of dual vulnerability in nutrition: A qualitative study of older persons caring for under 5-year-olds in post-disaster Haiti.

SITUATION: Malnutrition plays a significant role in under-five mortality rates following disasters. Older people play an important role in childcare in non-Western societies, which often increases in displacement contexts. Until now, policy, in general, and nutrition programmes, in particular, have focused on the mother-child dyad. AIM: To gather information on possible barriers to older carers accessing nutritional services for the children they care for and explore ways to overcome these obstacles. METHOD: A qualitative approach was taken to explore the experiences of the carers themselves. Focus group discussions provided data, which were analysed using grounded theory. RESULTS: Data collected showed older people have similar needs to other caregivers in emergency settings, needs that are often amplified by age. Moreover, many barriers to accessing services were elicited, including targeting and advertising of nutritional programmes, alongside physical and psychosocial barriers to assessing existing support. Participants generated potential solutions to each identified barrier. CONCLUSION: As older people in Haiti were often the sole carers of under-fives, there is a need to recognise their importance in this role and support them within. More generally, in any emergency setting, organisations need take into account all stakeholders in child nutrition when planning and implementing programmes.

Exploring the third delay: an audit evaluating obstetric triage at Mulago National Referral Hospital.

BACKGROUND: Mulago National Referral Hospital has the largest maternity unit in sub-Saharan Africa. It is situated in Uganda, where the maternal mortality ratio is 310 per 100,000 live births. In 2010 a 'Traffic Light System' was set up to rapidly triage the vast number of patients who present to the hospital every day. The aim of this study was to evaluate the effectiveness of the obstetric department's triage system at Mulago Hospital with regard to time spent in admissions and to identify urgent cases and factors adversely affecting the system. METHODS: A prospective audit of the obstetric admissions department was carried out at the Mulago Hospital. Data were obtained from tagged patient journeys using two data collection tools and compiled using Microsoft Excel. StatsDirect was used to compose graphs to illustrate the results. RESULTS: Informal triage was occurring 46 % of the time at the first checkpoint in a woman's journey, but the 'Traffic Light System' was not being used and many of the patient's vital signs were not being recorded. CONCLUSIONS: It is hypothesised that the 'Traffic Light System' is not being used due to its focus on examination finding and diagnosis, implying that it is not suitable for an early stage in the patient's journey. Replacing it with a simple algorithm to categorise women into the urgency with which they need to be seen could rectify this.

Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP).

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk. Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder. Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission. Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93-0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample. Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.