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Background: : While climate change and migration are separately recognised as public health challenges, the combination of the two - climate change-induced migration which is predicted to increase through this century - requires further research to ensure population health needs are met. As such, this paper aims to identify initial gaps and opportunities in the nexus of climate change, migration and health research. Methods: : We conducted a questionnaire based study of academics and practitioners working in the fields of climate change, migration and health. Open-ended responses were thematically analysed. Results: : Responses from 72 practitioners collected in October 2021 were categorised into a thematic framework encompassing i) gaps and opportunities: across health care and outcomes, impact pathways between climate change and migration, most at risk groups (specific actors) and regions, and longitudinal perspectives on migrant journeys; alongside ii) methodological challenges; iii) ethical challenges, and iv) advancing research with better funding and collaboration. Broadly, findings suggested that research must clarify the interlinkages and drivers between climate change, migration, health (systems), and intersecting factors including the broader determinants of health. Study of the dynamics of migration needs to extend beyond the current focus of rural-urban migration and international migration into high income countries, to include internal displacement and immobile/ trapped populations. Research could better include considerations of vulnerable groups currently underrepresented, people with specific health needs, and focus more on most at-risk regions. Research methodology could be strengthened through better data and definitions, clear ethical guidelines, and increased funding and collaboration. Conclusion: : This study describes gaps, challenges and needs within research on the nexus of climate change, migration and health, in acknowledgement of the complexity of studying across multiple intersecting factors. Working with complexity can be supported by using the framework and findings to support researchers grappling with these intersecting themes.
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BACKGROUND: Patients who develop severe illness due to COVID-19 are more likely to be admitted to hospital and acquire bacterial co-infections, therefore the WHO recommends empiric treatment with antibiotics. Few reports have addressed the impact of COVID-19 management on emergence of nosocomial antimicrobial resistance (AMR) in resource constrained settings. This study aimed to ascertain whether being admitted to a COVID-19 ward (with COVID-19 infection) compared to a non-COVID-19 ward (as a COVID-19 negative patient) was associated with a change in the prevalence of bacterial hospital acquired infection (HAI) species or resistance patterns, and whether there were differences in antimicrobial stewardship (AMS) and infection prevention and control (IPC) guidelines between COVID-19 and non-COVID-19 wards. The study was conducted in Sudan and Zambia, two resource constrained settings with differing country-wide responses to COVID-19. METHODS: Patients suspected of having hospital acquired infections were recruited from COVID-19 wards and non-COVID-19 wards. Bacteria were isolated from clinical samples using culture and molecular methods and species identified. Phenotypic and genotypic resistance patterns were determined by antibiotic disc diffusion and whole genome sequencing. Infection prevention and control guidelines were analysed for COVID-19 and non-COVID-19 wards to identify potential differences. RESULTS: 109 and 66 isolates were collected from Sudan and Zambia respectively. Phenotypic testing revealed significantly more multi-drug resistant isolates on COVID-19 wards in both countries (Sudan p = 0.0087, Zambia p = 0.0154). The total number of patients with hospital acquired infections (both susceptible and resistant) increased significantly on COVID-19 wards in Sudan, but the opposite was observed in Zambia (both p = ≤ 0.0001). Genotypic analysis showed significantly more ß-lactam genes per isolate on COVID-19 wards (Sudan p = 0.0192, Zambia p = ≤ 0.0001). CONCLUSIONS: Changes in hospital acquired infections and AMR patterns were seen in COVID-19 patients on COVID-19 wards compared to COVID-19 negative patients on non-COVID-19 wards in Sudan and Zambia. These are likely due to a potentially complex combination of causes, including patient factors, but differing emphases on infection prevention and control, and antimicrobial stewardship policies on COVID-19 wards were highlighted.
