Defining and identifying critical elements of, and lessons learned from addressing, 'operational readiness' for public health emergency events, including COVID-19: a scoping review protocol

INTRODUCTION

Much is known around public health preparedness and response phases. However, between the two phases is operational readiness that comprises the immediate actions needed to respond to a developing risk or hazard. Currently, emergency readiness is embedded in multiple frameworks and policy documents related to the health emergency cycle. However, knowledge about operational readiness' critical readiness components and actions required by countries to respond to public health eminent threat is not well known. Therefore, we aim to define and identify the critical elements of 'operational readiness' for public health emergencies, including COVID-19, and identify lessons learnt from addressing it, to inform the WHO Operational Readiness Framework.

METHODS AND ANALYSIS

This is a scoping review following the Joanna Briggs Institute guidance. Reporting will be according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. MEDLINE, Embase and Web of Science databases and grey literature will be searched and exported into an online systematic review software (eg, Rayyan in this case) for review. The review team, which apart from scoping review methodological experts include content experts in health systems and public health and emergency medicine, prepared an a priori study protocol in consultation with WHO representatives. ATLAS.ti V.9 will be used to conduct thematic data analysis as well as store, organise and retrieve data. Data analysis and presentation will be carried out by five reviewers.

ETHICS AND DISSEMINATION

This review will reveal new insights, knowledge and lessons learnt that will translate into an operational framework for readiness actions. In consultation with WHO, findings will be disseminated as appropriate (eg, through professional bodies, conferences and research papers). No ethics approvals are required as no humans will be involved in data collection.

PROTOCOL REGISTRATION

This rapid scoping review has been registered on Open Science Framework (doi:10.17605/OSF.IO/6SYAH).

User assessments and the use of information from MomConnect, a mobile phone text-based information service, by pregnant women and new mothers in South Africa

MomConnect was designed to provide crucial health information to mothers during pregnancy and in the early years of child rearing in South Africa. The design drew on the success of the Mobile Alliance for Maternal Action’s programme in South Africa, as well as a growing list of mobile health (mHealth) interventions implemented internationally. Services such as MomConnect are dependent on user acceptability as all engagements are voluntary, meaning that tools have to be easy to use and useful to be successful. This paper describes the evaluation of the tool by pregnant women and new mothers using the tool. A purposive sample of 32 individual semistructured interviews and 7 focus groups were conducted, across five provinces in South Africa. All the sessions were transcribed and then analysed using a contextualised interpretative approach, with the assistance of Atlas.ti. The women were consistently positive about MomConnect, attaching high value to the content of the messages and the medium in which they were delivered. The system was found to work well, with minor problems in some language translations. Respondents were enthusiastic about the messages, stating that the information was of great use and made them feel empowered in their role as a mother, with some saving the messages to use as a resource or to share with others. The most significant problems related to network coverage. There was strong support for this intervention to continue. Given the user acceptability of mHealth interventions, MomConnect appeared to meet the target of identifying and responding to the recipient’s needs.

Public sector antiretroviral treatment programme in South Africa: health care workers' attention to mental health problems

Although there is a high prevalence of anxiety and depression amongst people receiving antiretroviral treatment (ART), many patients are not screened, diagnosed or referred for mental health problems. This study aims to determine whether public sector health care workers in South Africa observe, screen, diagnose and refer ART patients that show symptoms of common mental disorders. It also aims to ascertain the extent of mental health training received by public sector health care workers working in ART. The study was cross-sectional in design. Self-administered questionnaires were completed by 40 nurses and structured interviews were conducted with 23 lay workers across the five districts in the Free State between July 2009 and October 2009. STATA version 12 was used to perform statistical data analysis. The health care workers reported observing a high frequency of symptoms of common mental disorders among public sector ART patients. While 70% of nurses screened and diagnosed, only 40% of lay workers screened and diagnosed patients on ART for a mental disorder. Health care workers who had received training in mental health were more likely to screen or diagnose a mental disorder, but only 14% of the workers had received such training. We recommend that health care workers should receive task-specific training to screen and/or diagnose patients on ART for common mental disorders using the guidelines of the South African HIV Clinicians Society. A positive diagnosis should be referred to a health care practitioner for appropriate evidence-based treatment in the form of medication or psychotherapy.

Housing conditions and mental health of orphans in South Africa

Literature from the developed world suggests that poor housing conditions and housing environments contribute to poor mental health outcomes, although research results are mixed. This study investigates the relationship between housing conditions and the socio-emotional health of orphans and vulnerable children (OVC) in South Africa. The results of the study are mainly inconclusive, although it is suggested that methodological considerations play a vital role in explaining the mixed results. However, a positive relationship was found between living in informal settlements and better socio-emotional health of the OVC. We speculate that the historical context of informal settlement formation in South Africa helps to explain this unexpected result.

Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study

Background

HIV/AIDS and depression are projected to be the two leading causes of disability by 2030. HIV/AIDS and anxiety/depression are interlinked. People suffering from depression may be more likely to engage in risky sexual behaviour, and therefore at greater risk of contracting HIV. An HIV + diagnosis may trigger symptoms of anxiety and depression, which may in turn result in risky sexual behaviour and the spread of HIV. This study explores correlates of anxiety and depression in patients enrolled in a public sector ART programme in South Africa.

Methods

Interviews were conducted with 716 patients initiating ART at twelve public health care facilities in the Free State. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). An 8+ cut-off was used to identify possible cases of anxiety and depression. Multivariate logistic regression analysis, using STATA Version 11, was performed to identify correlates of anxiety and depression.

Results

The prevalence of symptoms of respectively anxiety and depression amongst this study population in the Free State was 30.6% and 25.4%. The multivariate logistic regression analyses identified five correlates of symptoms of anxiety and depression. Disruptive side effects (OR = 3.62, CI 1.95-6.74) and avoidant coping (OR = 1.42, CI 1.22-1.65) were associated with a greater number of symptoms of anxiety. Stigma was associated with an increase in symptoms of anxiety (OR = 1.14, CI 1.07-1.21) and of depression (OR = 1.13, CI 1.06-1.20), while being a widow (OR = 0.30, CI 0.13-0.69) and participating in a support group (OR = 0.21, CI 0.05-0.99) were associated with decreased symptoms of depression.

Conclusions

The findings from the study provide valuable insights into the psychosocial aspects of the Free State public-sector ART programme. Combined with the literature on the intricate link between mental health problems and treatment outcomes our results emphasise firstly, the necessity that resources be allocated for both screening and treating mental health problems and, secondly, the need for interventions that will encourage support-group participation, address ART side effects, reduce maladaptive coping styles, and minimise the stigma associated with symptoms of anxiety and/or depression.