Towards defining core principles of public health emergency preparedness: scoping review and Delphi consultation among European Union country experts

Expert Opinions on an Optimal Infant Feeding Quantitative Data Framework: A Mixed Methods Delphi-Style Study in the UK

BACKGROUND

This study aimed to explore how expert stakeholders involved in research, policy and practice would define an ideal dataset for collecting infant feeding data, to better align efforts to monitor and evaluate breastfeeding across the UK four nations.

METHODOLOGY

Using the Delphi method, two phases of consultation were completed with a total of 42 stakeholders. First, qualitative (Round 1) and quantitative (Round 2) surveys were distributed to an interdisciplinary panel of experts, to identify individual-level agreement for key terms and timepoints for data collection relevant to infant age. Second, policy-led stakeholders discussed outcomes from Phase 1, before contributing to a written consultation response for their nation to indicate group-level agreement.

RESULTS

Across Phase 1 surveys, 13 of 15 indicators reached consensus for definitions, and 11 of 13 reached consensus for timepoints. During Phase 2, 5 of 7 indicators reached a level of final agreement. Data collection was suggested to focus on the intention to breastfeed (around birth), and the early initiation of feeding (from birth to 10 days). Monitoring of 'exclusive' breastfeeding from 0 to 6 months, 'any' breastfeeding from 0 to 24 months, and complementary feeding at 6 and 12 months, were identified as key touchpoints.

PRINCIPAL CONCLUSIONS

To support the feasibility of data reforms across UK nations, these results identify consensus for a shortlist of shared data indicators (see Supplementary Figure 1), highlighting opportunities for data collection that close the gap with international standards, and align with existing monitoring frameworks and healthcare practice.

Identifying essential resource parameters for pandemic preparedness and response: an international Delphi study within the EU PANDEM-2 project

OBJECTIVE

The COVID-19 pandemic highlighted the crucial role of healthcare and public health resource management, where scarcity impairs pandemic response resulting in increased disease transmission, delayed patient care and poorer health outcomes. In the EU PANDEM-2 project, we aimed to identify essential resource parameters for pandemic preparedness and response in the context of an emerging viral respiratory illness.

DESIGN

After performing a systematic literature review, we conducted a Delphi study consisting of a structured questionnaire and consensus round with two separate panels of European public health experts (PHEs) and clinicians, respectively. Resources were categorised as material (n=23), human (n=18) or pharmaceutical (n=12). Data were analysed descriptively for both panels.

RESULTS

Participants were 17 PHEs and 16 clinicians from nine countries. Consensus between the two panels was found on 40 resource parameters (17 material, 14 human, 9 pharmaceutical; 33 accepted and 7 rejected). Notably, clinicians selected three home care resources while PHEs did not, and PHEs selected two pharmaceutical resources which clinicians did not. No consensus was observed on 13 resources. Eleven additional resources were suggested and included (five for PHE and six for clinicians) among which were personal protective equipment for mobile teams, resources for primary care and resources related to mechanical ventilation.

CONCLUSIONS

The high level of consensus between the two expert panels indicates common goals in pandemic resource planning. The disagreement on 13 resource parameters reflects the different priorities between PHEs and clinicians in pandemic planning. This study has demonstrated the core components of resource modelling required for pandemic preparedness planning and shows the importance of consulting experts with both public health and clinical backgrounds. Including our proposed resources in pandemic models allows for more enhanced planning and training activities for future pandemics.

Designing a competency-based curriculum for an advanced training program in public health emergency management: a stepwise, mixed method approach, 2023

INTRODUCTION

Combating the several public health threats on the African continent requires trained and equipped workforce. The establishment of the 6-month Africa CDC Public Health Emergency Management (PHEM) fellowship provides a pathway for developing a cadre of workforce that is capable of initiating and leading emergency management programs in Africa.

OBJECTIVE

We present the process undertaken to draw up a competency-based curriculum for the first continental advanced training program in PHEM.  METHOD: A multi-step, mixed methodology was employed in this study. Systematic review process was triangulated with case reviews of similar training programs to provide the first draft of competencies. Through subsequent consultations with experts and technical iterations, the program's competencies and curriculum were developed.

RESULT

Through four iterative revisions, the competencies framework evolved with input from each stage, resulting in a final structure of three competency domains and 10 sub-domains. These informed the development of an 11-course syllabus with corresponding learning objectives, outline and content.

CONCLUSION

A curriculum that reflects the foundational skills desirable of professionals engaged in the practice, education, and research in public health emergency management in Africa was developed utilizing mixed methods. Although this exercise was designed for the advanced PHEM Fellowship program at Africa CDC, the process, emerging competencies and curriculum could benchmark competency-based emergency management training across the African continent.

A systematic literature review on public health and healthcare resources for pandemic preparedness planning

BACKGROUND

Generating insights into resource demands during outbreaks is an important aspect of pandemic preparedness. The EU PANDEM-2 project used resource modelling to explore the demand profile for key resources during pandemic scenarios. This review aimed to identify public health and healthcare resources needed to respond to pandemic threats and the ranges of parameter values on the use of these resources for pandemic influenza (including the novel influenza A(H1N1)pdm09 pandemic) and the COVID-19 pandemic, to support modelling activities.

METHODS

We conducted a systematic literature review and searched Embase and Medline databases (1995 - June 2023) for articles that included a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example personal protective equipment (PPE) usage, length of stay (LoS) in intensive care unit (ICU), or vaccine efficacy. Papers with data on resource parameters from all countries were included.

RESULTS

We identified 2754 articles of which 147 were included in the final review. Forty-six different resource parameters with values related to non-ICU beds (n = 43 articles), ICU beds (n = 57), mechanical ventilation (n = 39), healthcare workers (n = 12), pharmaceuticals (n = 21), PPE (n = 8), vaccines (n = 26), and testing and tracing (n = 19). Differences between resource types related to pandemic influenza and COVID-19 were observed, for example on mechanical ventilation (mostly for COVID-19) and testing & tracing (all for COVID-19).

CONCLUSION

This review provides an overview of public health and healthcare resources with associated parameters in the context of pandemic influenza and the COVID-19 pandemic. Providing insight into the ranges of plausible parameter values on the use of public health and healthcare resources improves the accuracy of results of modelling different scenarios, and thus decision-making by policy makers and hospital planners. This review also highlights a scarcity of published data on important public health resources.

COVID-19 related barriers to institutional childbirth during the early phase of the pandemic in rural Arsi zone, Ethiopia, 2022: A qualitative study

Introduction

Global, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020-June 20/2020) in the rural Arsi zone of Ethiopia.

Methods

A community-based Phenomenological study was conducted from January 10-25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020-June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version.

Results

Four major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth.

Conclusions

COVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Identifying the preparedness components in COVID-19: Systematic literature review

In 2019, the COVID-19 pandemic posed a major challenge to the world. Since the world is constantly exposed to communicable diseases, comprehensive preparedness of countries is required. Therefore, the present systematic review is aimed at identifying the preparedness components in COVID-19. In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Science Direct, Iran Medex, Magiran, and Scientific Information Database were searched from 2019 to 2021 to identify preparedness components in COVID-19. Thematic content analysis method was employed for data analysis. Out of 11,126 journals retrieved from searches, 45 studies were included for data analysis. Based on the findings, the components of COVID-19 preparedness were identified and discussed in three categories: governance with three subcategories of characteristics, responsibilities, and rules and regulations; society with two subcategories of culture and resilience; and services with three subcategories of managed services, advanced technology, and prepared health services. Among these, the governance and its subcategories had the highest frequency in studies. Considering the need to prepare for the next pandemic, countries should create clear and coherent structures and responsibilities for crisis preparedness through legal mechanisms, strengthening the infrastructure of the health system, coordination between organizations through analysis and identification of stakeholders, culture building and attracting social participation, and service management for an effective response.

Identifying the sectors involved in the European public health emergency preparedness and response: a systematic review

OBJECTIVES

A systematic review was conducted with the aims of identifying sectors mentioned in the public health emergency preparedness and response (PHEPR) literature and mapping the involvement of those sectors in the seven PHEPR cycle domains.

SETTING

A detailed search strategy was conducted in Embase and Scopus, covering the period between 1 January 2005 and 1 January 2020.

METHODS

Published articles focusing on preparedness for and/or response to public health emergencies of multiple origins on the European continent were included. The frequency with which predetermined sectors were mentioned when describing collaboration during the preparedness and response cycle was determined.

RESULTS

The results show that description of the involvement of sectors in PHEPR in general and collaboration during PHEPR is predominantly confined to a limited number of sectors, namely 'Governmental institutions', 'Human health industry', 'Experts' and 'Civil Society'. Description is also limited to only three domains of the PHEPR cycle, namely 'Risk and crisis management', 'Pre-event preparations and governance' and 'Surveillance'.

CONCLUSIONS

Optimal preparedness and response require predefined collaboration with a broader scope of partners than currently seems to be the case based on this literature review. We recommend considering these outcomes when planning multisectoral collaboration during preparedness and response, as well as the need to further operationalise the term 'multisectoral collaboration' during PHEPRs.

PROSPERO REGISTRATION NUMBER

PROSPERO with registration number 176 331.

A scoping review of strategies to support public health recovery in the transition to a "new normal" in the age of COVID-19

BACKGROUND

During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pandemic, public health systems need to re-start the delivery of core public health programming alongside COVID-19 activities. The purpose of this scoping review was to identify strategies that support the re-integration of core public health programming alongside ongoing pandemic or emergency response.

METHODS

The Joanna Briggs Institute methodology for scoping reviews was used to guide this study. A comprehensive search was conducted using: a) online databases, b) grey literature, c) content experts to identify additional references, and d) searching reference lists of pertinent studies. All references were screened by two team members. References were included that met the following criteria: a) involved public health organizations (local, regional, national, and international); b) provided descriptions of strategies to support adaptation or delivery of routine public health measures alongside disaster response; and c) quantitative, qualitative, or descriptive designs. No restrictions were placed on language, publication status, publication date, or outcomes. Data on study characteristics, intervention/strategy, and key findings were independently extracted by two team members. Emergent themes were established through independent inductive analysis by two team members.

RESULTS

Of 44,087 records identified, 17 studies were included in the review. Study designs of included studies varied: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Included studies were from North America (n = 10), Africa (n = 4), and Asia (n = 3) and addressed various public health disasters including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1). Five emergent themes were identified on strategies to support the re-integration of core public health services: a) community engagement, b) community assessment, c) collaborative partnerships and coordination, d) workforce capacity development and allocation, and e) funding/resource enhancement.

CONCLUSION

Emergent themes from this study can be used by public health organizations as a beginning understanding of strategies that can support the re-introduction of essential public health services and programs in COVID-19 recovery.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations

The Sendai Framework for Disaster Risk Reduction 2015–2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

Emergency preparedness for public health threats, surveillance, modelling & forecasting

In the interconnected world, safeguarding global health security is vital for maintaining public health and economic upliftment of any nation. Emergency preparedness is considered as the key to control the emerging public health challenges at both national as well as international levels. Further, the predictive information systems based on routine surveillance, disease modelling and forecasting play a pivotal role in both policy building and community participation to detect, prevent and respond to potential health threats. Therefore, reliable and timely forecasts of these untoward events could mobilize swift and effective public health responses and mitigation efforts. The present review focuses on the various aspects of emergency preparedness with special emphasis on public health surveillance, epidemiological modelling and capacity building approaches. Global coordination and capacity building, funding and commitment at the national and international levels, under the One Health framework, are crucial in combating global public health threats in a holistic manner.