Health Movement Research Articles

Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis.

Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model. Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors. An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study. Women with late-stillbirth (cases, n=851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n=2257). Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables. Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth. After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86). Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.

Health and care system assessment aimed at cultural adaptation of MhGAP modules

IntroductionAs part of the Global Mental Health (GMH) movement, WHO launched the Mental Health Gap Action Program (mhGAP). One of the key initiatives of the MhGAP is to train lay health professionals to meet the mental health needs of populations, particularly in low- and middle-income countries (LMICs) where the need far exceeds the availability and quality of services. Training modules are standardized and designed for use in many countries and settings. In practice, there is often a stereotyped reproduction of modules without consideration of specific cultural adaptation needs.ObjectivesAs part of a psychosocial support program in two provinces of the eastern Democratic Republic of Congo (Ituri and North Kivu), the NGO Action contre la Faim proposed a health and care system assessment aimed at adapting MhGAP modules for health center staff. The objective was to know the local practices in terms of psychic care as well as to identify the competences already existing to reinforce them, but also to contextualize the tools and the contents of the trainings.MethodsThe methodology used was mixed.A questionnaire based on the WHO situation analysis tools was revised, simplified and adapted to the zone, allowing us to obtain quantitative data on the health centers, the care provided, referrals and supervision. Health care workers were interviewed using the questionnaire from ACF’s “Strengthening the Health Care System” guide, focusing on care methods, knowledge of mental health and the most frequently encountered symptoms. Focus Group Discussions with the Community Relais in the area allowed for the collection of information on the level of knowledge of the population in terms of mental health, their awareness on this subject, their cultural vision and the means of care.ResultsThe data collected from 9 health centers in the two provinces allowed us to learn about:- Poor knowledge of mental health and school readiness- Identification of barriers to access to care- Beliefs around mental health, mental suffering and care- Details about the different pathologies and symptoms as well as the issues related to the therapeutic framework.ConclusionsThe evaluation was fundamental to have a better knowledge of the context, which made it possible to adapt the content of the MhGap training modules les, to design tools more adherent to reality. The data collected may also be the subject of advocacy aimed at mobilizing the country’s policies in terms of mental health, as well as raising awareness in the international community.Disclosure of InterestNone Declared

Adjusting intervention of trade war subjective feelings: An analysis of the relationship between psychological characteristics and mental health of foreign trade workers

BackgroundWith the development of the economy and society and the further increase of social competition pressure, people often encounter some difficulties or pressure in academics, employment, economy, interpersonal relationship, marriage and other aspects. Mental health problems occur frequently. The burden of illness caused by mental health is growing. In recent years, it has had the greatest impact on our country’s foreign trade industry. The most profound social event is the China–United States trade war. On March 22, 2018, the US announced an additional 25 percent tariff on $60 billion of Chinese goods. On March 23, China retaliated by imposing additional tariffs on $3 billion of imported goods from the US, marking the official start of the “China–United States trade war”. Mental health is an important part of people’s health. Without a healthy mind, there will be no healthy life. In recent years, with the rapid development of the global mental health movement, the attention of all walks of life to mental health has reached a new height. The researchers investigated or studied the mental health status of teachers, school students, police officers, medical personnel, workers, left-behind children, sailors and supervised personnel from various perspectives. Based on the above, the study analyzes the impact of the trade war on the psychological characteristics and mental health of foreign trade employees and the relationship between them, in order to improve the anxiety of foreign trade employees.Subjects and MethodsThe research data was obtained through a questionnaire survey. At the beginning of the questionnaire, unified guidance is used to introduce the nature, purpose and filling method of the survey. The respondents are asked to select the corresponding answer for each item in a secret way according to their actual situation. The questionnaire is distributed centrally and filled out separately. The original data obtained from the questionnaire contains 438 samples, some of which have problems such as the mission of question filling, inconsistency of key information, and continuous selection of the same options in each question of the same scale, which need to be excluded. After pretreatment, the sample size was 354, and the sample effective rate was 81%. Stata16.0 software and SPSS22.0 software were used for the calculation and statistics of relevant data.Figure 1.Scores of index of Well-Being scale before and after the interventionResultsAs shown in Figure 1, under the psychological intervention of trade war subjective perception adjustment for foreign trade practitioners, scores of all index of Well-Being scales were significantly higher than before the intervention (P < 0.01).ConclusionsThe results of this study show that after the intervention mechanism of trade war subjective perception regulation, all the scores of indexes of Well-Being scale are significantly higher than before the intervention (P < 0.01), indicating that the trade war subjective perception regulation mechanism is intervening in the psychology of foreign trade practitioners, which can improve the work happiness of foreign trade practitioners. Avoiding social events such as the China–United States trade war may aggravate their psychological symptoms and reduce their mental health.

Contact Tracing and Epidemic Intervention via Deep Reinforcement Learning

The recent outbreak of COVID-19 poses a serious threat to people’s lives. Epidemic control strategies have also caused damage to the economy by cutting off humans’ daily commute. In this article, we develop an Individual-based Reinforcement Learning Epidemic Control Agent (IDRLECA) to search for smart epidemic control strategies that can simultaneously minimize infections and the cost of mobility intervention. IDRLECA first hires an infection probability model to calculate the current infection probability of each individual. Then, the infection probabilities together with individuals’ health status and movement information are fed to a novel GNN to estimate the spread of the virus through human contacts. The estimated risks are used to further support an RL agent to select individual-level epidemic-control actions. The training of IDRLECA is guided by a specially designed reward function considering both the cost of mobility intervention and the effectiveness of epidemic control. Moreover, we design a constraint for control-action selection that eases its difficulty and further improve exploring efficiency. Extensive experimental results demonstrate that IDRLECA can suppress infections at a very low level and retain more than 95% of human mobility.

The new World Mental Health Report: Believing impossible things.

We examine whether the recent World Health Organization (WHO) report on global mental health uses severity of illness as a criterion in priority setting for resource allocation. The WHO does not prioritise severity in the recent landmark World Mental Health Report. It recommends instead the insuperable task of scaling-up interventions for broadly defined mental health conditions, including milder distress, amongst over a billion people, with the majority living in low- and middle-income countries. Schizophrenia, the most severe and disabling of all psychiatric illnesses, is relatively neglected in the WHO report, and the disability associated with bipolar disorder is underestimated. This is inconsistent with the ethical principle of vertical equity, where the most severe illnesses should receive the greatest priority. The global mental health movement must refocus on deinstitutionalisation, and ensure adequate community and general hospital treatment for severe illnesses, especially the 24 million people with schizophrenia.

HUNDRED YEARS OF THE PSYCHOANALYTIC PROGRESSIVE MENTAL HEALTH MOVEMENT.

Beginning in 1920 and in keeping with Freud's sustained encouragement, the first two generations of European psychoanalysts initiated a progressive mental health movement by offering very low cost and free psychoanalytic services that were in harmony with Austrian social democratic and socialist political leaders' commitment to societal reforms in light of the economic and social inequities after the First World War. This synthesis of biographical and autobiographical accounts of early Freudian, Ego Psychology and Neo-Freudian theorists' contributions highlights their consideration of the effects of social injustice as central challenges to the development of psychological growth.

Structural competency, Latin American social medicine, and collective health: Exploring shared lessons through the work of Jaime Breilh

ABSTRACT Structural competency is a recent framework for understanding and addressing the structural drivers of disease. Latin American Social Medicine and Collective Health is a decades-long movement similarly concerned with the study and transformation of social structures to achieve health equity. In this paper, we put insights from Latin American Social Medicine and Collective Health into conversation with the developing structural competency framework. We focus specifically on insights from Jaime Breilh’s new article summarising his theoretical work on medical ethics and rights in this special issue and his new book, Critical Epidemiology and the People’s Health. This paper is comprised of three parts. Part 1 provides an introduction to the structural competency framework. Part 2 provides an overview of the Latin American Social Medicine and Collective Health movement, along with a summary of the social determination of health paradigm. Part 3 places insights from these works into conversation with structural competency and considers ways in which Latin American Social Medicine and Collective Health might inform the further development of structural competency, and potentially vice versa. The paper closes by calling for greater attention to Latin American Social Medicine and Collective Health among those committed to health equity within the anglophone world.

About the Contributors

About the Contributors

An Analysis of the Popular Identity and Contemporary Implications of the Patriotic Health Movement at the Early Stage of the Founding of New China

In the early years of the founding of New China, the patriotic health movement was launched nationwide to consolidate the new regime, improve national health, improve medical and health care, and respond to American germ warfare. The patriotic health movement achieved the purpose of universal participation in the patriotic health movement by realizing the political identity, national and ethnic identity, master identity, and new moral identity of the people. The Organization's leadership, effective mobilization and propaganda, the central position of the people, and the popularization of scientific health knowledge were fully reflected in this process. The patriotic health movement in the early days of the founding of the nation has brought profound inspiration to the contemporary patriotic health movement and the popular identity of a healthy China, namely, the need to take national emotions as an opportunity, combine national and popular interests, scientific guidance and the power of exemplary role models to achieve popular identity, to internalize it in the heart and externalize it in practice.

Developing Midwives, Delivering Development

ABSTRACT The United Nations Population Fund publications in 2011 and 2014, The State of the World’s Midwifery, both argue that midwives in poor countries need to be professionalized for the good of their countries and of women and children worldwide. These narratives of professionalization as the road to stability, health, respect, and women’s welfare are tangled within broader narratives of neoliberalism. These broader narratives borrow familiar commonplaces from the feminist health movement and colonial reasoning to limit global midwifery’s scope to a neoliberal system of value within a neocolonial development agenda. Using definition as a grounding commonplace to argue for the professionalization of midwives in poorer nations, these reports potentially disenfranchise many birthing people and their attendants in these nations who do not fall under the professionalized definition of midwife.

The Spread of Hygiene Concepts and the Making of Public Health Discourse in Modern East Asia.

If public health can be defined as "all activities to ensure universal medical use of the people and protect and promote health," it can be said that public health emerged in the process of developing the concept of hygiene in East Asia. While traditional hygiene emphasized individual curing and longevity, modern hygiene was the state in charge of individual body and discipline. East Asian countries had to practice modern tasks in the field of hygiene and medical care in line with the construction of modern countries, and it was considered legitimate for modern countries to intervene in individual bodies. As the demand for modern national construction became stronger, interest in public health rather than personal hygiene increased. In East Asia, a new interpretation of the concept of hygiene began in Japan. Sensai Nagayo(1838-1902) newly defined the concept of 'sanitation' to justify the physical intervention of the modern state in Meiji period. The concept of 'public health' began to be used in earnest in 1890, when Ogai Mori(1862-1922) translated Western-style health protection measures for the public as public health. Since then, public health has evolved into a universal social discourse in Japan. Japan's public health expanded to colonial Joseon, Taiwan, and China. Japan's victory in the Sino-Japanese War led East Asian countries to believe that hygiene was the root of the Japanese nation's power. In the early 20th century, the government of the Republic of China began to imitate the case of Japan while promoting modern education reform and institutional reform. Japanese-style 'public health' was transplanted into various hygiene laws and sanitary equipment. In Korea, modern hygiene was introduced and spread from the end of the 19th century to the first half of the 20th century, and the concept of 'public health' in Japan was mainly spreading. Public health in Japan was vaguely defined as an activity to protect and promote the health of the people, but in practice, it was focused on improving quarantine and environmental infrastructure. In response, the concept of American-style public health, which values prevention and treatment at the same time, has already begun to emerge under the Japanese colonial rule. In East Asia in the 1920s and 1930s, Japanese-style public health and American-style public health discourse competed, and measures to solve medical inequality were discussed in earnest. Interestingly, in common in East Asian countries, Actual Medical Expenses Campaigns to improve medical access at low cost and social medicine to universally provide prevention and treatment to the people have drawn attention. This was also a phenomenon caused by intensifying medical inequality as rapid urbanization and industrialization progressed in East Asian countries in the first half of the 20th century. Although it was impossible to resolve social contradictions or move toward fundamental reform of the national medical system due to the nature of the private movement, the actual medical movement further imprinted the need for public health care in the country and society. Social medicine studied the effects and relationships of the social environment on diseases and health, and studied ways to promote public health by using preventive medicine and therapeutic medicine. If social medicine was supported by state power, it was possible to go forward with practice such as State Medicine like China, otherwise it would only be a civilian movement such as the People's Health Movement, as in colonial Korea. Liberation and the Korean War were a dramatic turning point in American-style health that led to Japanese-style hygiene. Immediately after Liberation, there was a discussion between the left and right camps over medical nationalization to enhance the publicity of medical care. The medical community was sympathetic to the nationalization of medical care, but due to the lack of medical personnel and financial resources, specific alternatives could not be proposed. As American-style health studies gradually expanded their influence after the Korean War, American-style public health, which emphasized prevention and treatment activities, became established, and efforts were made to establish a health center system.

FAKTOR-FAKTOR YANG MEMPENGARUHI PENERAPAN PERILAKU HIDUP BERSIH DAN SEHAT (PHBS) PADA IBU RUMAH TANGGA DI WILAYAH KERJA PUSKESMAS PETALING KECAMATAN MENDO BARAT KABUPATEN BANGKA

PHBS in the household is an effort to empower household members to know, be willing and able to carry out clean and healthy living behaviors and play an active role in the health movement in the community. Based on data from the Petaling Health Center, the PHBS coverage in the Petaling Health Center work area in 2019 was 69.87%, in 2020 it decreased by 51.82% and in 2021 it increased by 60.76%. This study aims to determine the factors that influence the application of Clean and Healthy Living Behavior (PHBS) to housewives in the working area of ??Petaling Health Center, Mendo Barat District, Bangka Regency in 2022. The type of research used in this research is analytic with survey method and cross sectional study approach. This research was conducted in the working area of ??the Petaling Public Health Center, Mendo Barat District, Bangka Regency in August 2022. The population in this study were housewives in the working area of ??the Petaling Health Center which amounted to 10,468 households, with a total sample of 109 respondents. Analysis of the data used includes univariate and bivariate analysis using the Chi Square test. The results showed that there was an influence of Knowledge (p=0.000, POR=13,789), Attitude (p=0.011, POR=3.508), Family Income (p=0.026, POR=6349), Infrastructure (p=0.000, POR= 27.491), Family Support (p=0.000, POR=12.364), and the Role of Health Officers (p=0.031, POR=0.262) on the implementation of PHBS in housewives. The key can be that infrastructure is the dominant factor influencing the application of clean and healthy living behavior (PHBS) to housewives. Health workers are expected to be extra and innovative in conducting counseling on clean and healthy living behavior (PHBS).

EXCHANGE AND COORDINATION: CHALLENGES OF THE GLOBAL ONE HEALTH MOVEMENT

Current economic, social, and environmental trajectories within most world regions are unsustainable. Interaction between bottom-up initiatives and top-down good governance is essential to change them. The One Health movement, made up of many organizations, groups, and individuals from diverse backgrounds and disciplines, seeks to redress the present trajectories but has lacked coordination and cooperation, limiting its effectiveness to date. We take a snapshot of groups/organizations working to promote One Health, explore options to increase cooperation and coordination among global One Health stakeholders, and propose systemic strategies that could positively impact animals, people, the planet, plants, and politics.Methods: Through a review of the compilation of Who’s Who in One Health organizations on the One Health Commission’s (OHC) website and the list of organizations that have pledged support for One Health listed on the One Health Initiative (OHI) website, 289 organizations were identified (as of 29 July 2022: 126 Civil Society Organizations, 133 academic and 30 governmental organizations). A stratified sampling approach and MAXQDA 2022 were used in a mixed-methods analysis to select a sample (N=50) of organizations to evaluate with 10 questions on purpose & focus, structure & transparency, cooperation & implementation, and publications. Results: The words “One Health” appeared in the organizations’ names on 62.0% (N=31) of websites examined, most often those in academic settings (78.2%). As regards transparency of the organizational structures, membership was defined in 70.0% (N=35), again most often by academic organizations (82.6%). Members of the governing structures were named on 34.0% of organizational websites. Projects led in the last two years were described on 32.0%, and cooperation with other organizations was indicated on 64.0% of websites examined. Relevant publications and annual reports were listed on 46.0% and 24.0% of probed websites, respectively. Ranking the number of positive findings for each of the 50 organizations examined revealed that full information for all ten questions was provided by only 4 academic and 1 governmental organization.The OHC website was used as a starting point and thus was not included in the N=50 samples. It was therefore examined as an example of a Non-Profit / CSO working to support bottom-up One Health leadership. Since 2014 the OHC has supported a Global One Health Community listserv of individuals from around the globe. The analysis revealed a dominance of Directors from the US and a high proportion of organizations included on the OHC Who’s Who in One Health organizations webpage were located in North America. The social sciences - sociology and economics in particular – were underrepresented among in its leadership. Conclusion: These 10 questions may not have been fully appropriate for all organizations examined in academic or government settings versus stand-alone non-profit or civil society organizations. However, an examination of the 50 selected websites of organizations working to implement One Health and/or framing their projects and purpose in One Health revealed the global One Health movement to be fragmented and uncoordinated. The authors propose to form a more unified voice for One Health across the international One Health movement, a fully networked, informal global One Health alliance or community of practice that can coordinate sharing of information among the networks and with the general public, and that is able to seek synergies and joining of hands in collective/collaborative actions to effectively and efficiently promote and support bottom-up efforts.

Embodied, embedded and educated: How everyday heroes strive to save lives during a pandemic

Drawing on an ethnographic study of the HIV/AIDS pandemic, we explore how ordinary people make extraordinary efforts to convince others to comply with health authorities’ advice to change their behaviour. Theories of heroism and embodied health movements inform our typology consisting of four distinct types of everyday heroes. Everyday heroes adopt a variety of actions, uniquely drawing on their embodiment of the illness and embeddedness in the local context. The ‘national role model’ builds a personal brand promoting beauty with a purpose, while the ‘national entrepreneur’ assembles resources and builds support networks and institutions. The ‘local caregiver’ offers face-to-face support to the diseased and afflicted, while the ‘local entrepreneur’ creates non-risky health practices to replace risky ones. A significant finding is the heroes’ courage and creative self-educational work, through which they find their own ways to translate medical knowledge into the local vernacular and practice.

ACADEMIC MENTAL HEALTH GALA: BRIDGING THE GAP

According to a BBC report published in 2016, around 15 million people in Pakistan are struggling with psychiatric disorders of any cause. The irony of the fact is that the psychiatric patients of Pakistan are still in search of rights to treat as patients, chained or tied, swinging like a rolling stone between ancient cultural beliefs and modern psychiatric management (mhGAP). Department of Psychiatry & Behavioral Sciences (MH Rana), Sheikh Zayed Medical College/Hospital (SZMCH), Rahim Yar Khan has been a strong advocate of providing effective treatment to the mentally ailing community. As a part of efforts, Academic Mental Health Gala: Bridging the Gap was organized in Rahim Yar Khan on 06-07th March 2022. The academic mental health gala was organized by the Department of Psychiatry & Behavioral Sciences SZMCH in collaboration with the World Psychiatric Association, Pakistan Psychiatric Society, The Islamia University of Bahawalpur (RYK campus), Enabling Center IUB, Mind Health Movement, and Al-Mustafa Mental, Addiction, and Behavioral Health Services.

Decolonizing the decolonization movement in global health: A perspective from global surgery

There has been a recent increase in dialogs around decolonization in global health. We present a perspective from global surgery emphasizing personal experiences around equity in barriers to education and surgical missions, citing specific personal challenges and local perceptions that we have experienced as well as potential solutions. We also cite fundamental challenges to the movement to decolonize global surgery, including donor-directed priorities and the creation of partnerships based in genuine bilateral exchange. We cite several models of current programs aiming to address some of these challenges.

Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries

Context/Objective Excess weight has the potential to carry a substantial physical and emotional burden. A better understanding of perceived consequences of excess weight may facilitate the development of patient-centered programs and interventions to promote weight management efforts in persons with spinal cord injury (SCI). The study objective was to describe consequences of excess weight from the personal perspectives of individuals with SCI. Design Descriptive qualitative design using in-depth semi-structured interviews and thematic analysis. Setting Veterans Health Administration (VHA) SCI System of Care. Participants Individuals with SCI (n-33). Outcome measures Key themes from thematic analysis. Results Participants were male (61%), ranged from 29 to 84 years of age, and about half had tetraplegia (55%). Five themes were identified that demonstrate negative consequences of excess weight experienced by individuals with SCI, including: (1) physical health conditions (including chronic conditions and SCI secondary conditions), (2) physical symptoms (such as pain, discomfort, and fatigue), (3) movement challenges, (4) appearance-related concerns, and (5) emotional impacts. Conclusions Carrying excess weight is concerning to individuals with SCI and in terms of consequences such onset or exacerbation of chronic conditions, SCI secondary conditions, physical symptoms, e.g. pain, movement impairment (including hampered mobility, difficult transfers and self-care), image/appearance concerns (e.g. body image, clothing misfit), and negative emotions (e.g. unhappy, sad, depressed). Our findings may inform SCI healthcare providers about the consequences of excess weight as experienced by individuals with SCI, highlighting what matters most to persons with SCI and guiding a patient-centered approach to weight management in this population.

Mental health law, policy & program in India – A fragmented narrative of change, contradictions and possibilities

There has been a long-standing history of over 150 years of mental health legislation in the Indian sub-continent. India formulated its National Mental Health Program (NMHP) in 1982 and National Mental Health Policy (MHP) only in 2014. In this paper we mark significant influences on the evolution of mental health law, policy and program in India starting from colonial laws. We suggest that discursive continuities from these colonial laws have existed for a few decades in post-independence India. International influences of deinstitutionalization and growth in community psychiatry took root in India by the late 1970s and considerably shaped mental health program thinking. The decade of 2000s with two major international developments, the UN Convention on Rights of Persons with Disabilities (CRPD) as well as Movement for Global Mental Health (MGMH) have had a significant impact on the mental health sector in India. We comment on a disjuncture between the progressive frames of the current mental health law and policy framework on the one hand and the national and district mental health programs in the country on the other. We then focus on technology assisted solutions for mental health care and their promise as widely promoted by the state and the market and what these mean for a country like India. Throughout the paper, we raise critical questions regarding dominance of western bio medical psychiatry as the epistemic frame guiding policy imagination at the cost of diverse, community resources and practices.

Effect of COVID-19 Pandemic on Maternal and Child Health Services and Strategies for Effective Service Implementation in Ethiopia.

The COVID-19 pandemic is a global burden to the Health sector of developing countries. However, the effect of COVID-19 on maternal and child health services is scarce and no evidence was documented in the Ethiopian context. Hence, this particular study aimed to examine the effect of the pAndemic and to identify effective strategies in Ethiopia. Both quantitative and qualitative approaches were applied. For the qualitative, 74 study participants were considered. Study participants were selected purposively and interview guide was used to collect data. Finally audio records were transcribed verbatim, coded and analyzed thematically. For the quantitative, data were extracted from the DHIS2 reports to assess the trend over time. The qualitative findings indicated that the pandemic affected the MNCH services to be inaccessible and low quality. The trend analysis also showed that the COVID-19 has disrupted MNCH services particularly in the first two months Of the pandemic. Health workers also faced a scarcity of personal protective equipment, work overload and shortage Of resources during the pandemic. As a cope up strategy, the Health system at all levels has established a COVID-19 task force supported by a working guideline. There is also a media prevention program, establishment of quarantine at home, resource mobilization, active surveillance, availing extra ambulances and strong follow-up. Multiple interventions applied to curb the pandemic have lowered MNCH service utilization. The low commitment of health workers, resources shortage and movement restrictions had a an impact on the uptake of MCH services. There should be a balance in resource utilization to COVID and other essential Health services and the government should avail the necessary supplies during the COVID era. Regionally tailored adaptive interventions are also required to improve MNCH service uptake. Extensive media advocacy and HEWs active involvement for community mobilization are also recommended.

Public health and military health.

This paper summarizes the role of Public Health specialists within the UK Defence Medical Services (DMS). The armed forces have a need for expert advice on health improvement, health protection and healthcare public health. The first professor of military hygiene, Dr Edmund Parkes, was a leading pioneer in the public health movement of the late 19th century. Since then, the armed forces have evolved the term 'hygiene', though 'health', to 'well-being'. Military doctors with an interest in medical administration and the health of populations have longstanding links with their civilian peers, through the Society of Medical Officers of Health and its successor the Faculty of Public Health. The specialty of Public Health in the armed forces is multidisciplinary, following the same educational pathway as civilian peers. The speciality has made important contributions during global health emergencies including the Ebola outbreak in 2014 and the recent COVID-19 pandemic. Although a small cadre, within the DMS and in the UK Public Health workforce, they have an important role in keeping our armed forces ready for operations. We celebrate the 50th anniversary of the Faculty of Public Health and expect that the DMS will contribute to the further development of the specialty.