Maintaining essential child health services in Malawi

20 February, 2021

Dear CHIFA and HIFA colleagues,

Below are the citation and extracts of a new paper in Archives of Disease in Childhood, and a comment from me.

CITATION: Chaziya J, Freyne B, Lissauer S et al. COVID-19 in Malawi: lessons in pandemic preparedness from a tertiary children’s hospital. Archives of Disease in Childhood 2021;106:238-240.

https://adc.bmj.com/content/106/3/238

Queen Elizabeth Central Hospital (QECH) in Blantyre is the tertiary referral hospital for the Southern Region of Malawi. The pandemic heightened existing challenges related to limited human and material resources. Public fear and healthcare worker (HCW) sit-ins associated with concerns around inadequate personal protective equipment (PPE) disrupted services and contributed to delayed patient presentation...

Limited diagnostics led to a risk of inappropriate isolation, unnecessary exposure of high-risk children and guardians to COVID-19 and a reduced level of specialty care for acutely unwell children. We addressed this issue on two fronts. First, we collaborated with the district health team to provide paediatric training and consultation at the local isolation facility. Second, we developed a respiratory COVID zone in the emergency department (ED) where suspected cases could be stabilised...

In February, we faced the real threat of PPE shortage... We received cash donations to develop a reusable gown laundry service, PPE items, cloth masks, water sanitation and hygiene items and hand sanitiser from academic partners, local charities and religious groups...

We have documented a significant drop in both ED and outpatient department attendances. There was a simultaneous rise in the number of children who were pronounced dead on arrival to hospital and a spike of admissions to the ‘One Stop’ family centre for sexual assault at the time of school closures. This is powerful information to use in public health and advocacy...

Open communication, partnership and strong local leadership are free and can be fostered in any environment. Ultimately, these will be the most effective tools in mitigating the direct and indirect effects of COVID-19 in LMICs.

--

Comment (NPW): As we contiue our EHS-COVID exploration of what works and what doesn't to maintain essential health services, this paper presents a multi-faceted approach. Success is perhaps more dependent on planning and implementing basic public health measures, than on identifying innovative 'magic bullets'. The last comment is interesting: 'Open communication, partnership and strong local leadership are free and can be fostered in any environment.' This has become a truism in public health, and yet it is not straightforward to foster 'open communication, partnership and strong local leadership'. How can such an enabling environment be developed? I invite comment from CHIFA and HIFA members.

Join HIFA: www.hifa.org/joinhifa

Join CHIFA (child health and rights): http://www.hifa.org/joinchifa

Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19

https://www.hifa.org/projects/essential-health-services-and-covid-19

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org