Public Health Professionals Research Articles

PERFIL DOS ATENDIMENTOS POR EMERGÊNCIAS PSIQUIÁTRICAS EM UM PRONTO SOCORRO GERAL

Objective: This study investigates the occurrence and nature of psychiatric emergencies in a general emergency department. Location: Palmas General Hospital (HGPP), State of Tocantins, Brazil. Methods: From November 2022 to July 2023, through an observational analysis of patient records, the frequency of visits, demographic data and clinical assessments are evaluated to build an epidemiological profile, which will assist in the development of improved management protocols and the dissemination of knowledge. Results: In this sample of 24,697 emergency room visits over 9 months, 6.4% of the cases were psychiatric emergencies. These cases were more frequent among young adults and women. The most common situations involved suicide risk, psychotic symptoms and psychomotor agitation, and the most frequent diagnoses were psychotic disorders, substance use disorders and depressive disorder. The data was similar to other studies, with some differences. Conclusion: Future studies with larger and more detailed samples will not only be able to profile psychiatric emergencies but also predict the most frequent cases, which is essential for planning public policies and training health professionals.

The Impact of Ecological Footprint, Urbanization, Education, Health Expenditure, and Industrialization on Child Mortality: Insights for Environment and Public Health in Eastern Europe.

The purpose of this study is to examine the connection between child mortality in Eastern Europe and ecological footprint, urbanization, education, health expenditure, and industrialization. The study acknowledges the significance of understanding how these factors influence the infant mortality rates in this region from 1993 to 2022. The Grossman Health Outcome (H-O) model investigates the theoretical framework. For the existence of the cross-sectional dependency, mixed-order unit root, and cointegration problem, the famous Cross-Sectional Autoregressive Distributed Lag (CS-ARDL) approach is applied. The research also used the Augmented Mean Group (AMG) and Common Correlated Effects Mean Group (CCEMG) to check robustness. The findings illustrated that health expenditure and education lessen the infant mortality rate in Eastern European countries. But ecological footprint, industrialization and unemployment raise the infant mortality rate. According to the CS-ARDL findings, expenditure on healthcare significantly reduces child mortality. Still, the ecological footprint significantly impacts increasing child mortality. However, the AMG and CCEMG models demonstrate that investing in education is the most effective strategy for reducing child mortality. Therefore, the government of Eastern European countries should provide more priorities in the sustainable urbanization, health expenditure, and education sectors. The robustness of the AMG and CCEMG also demonstrated the strength of the CS-ARDL findings. This research paper contributes to SDG 3 by examining the environmental and health factors that influence child mortality in Eastern Europe. Policymakers, public health professionals, and other stakeholders can use the findings to inform the development and implementation of programs that specifically target the identified causes of child mortality.

Interpretation of Guidelines for Diagnosis, Management, and Prevention of Pertussis in China (2024 Edition)

Abstract The resurgence of pertussis in China has recently attracted much attention. The incidence and burden of pertussis are largely underestimated in China owing to the lack of active pertussis surveillance and insufficient laboratory diagnosis. The high prevalence of macrolide-resistant Bordetella pertussis imposes a major challenge for the management of pertussis cases. To address a series of practice issues regarding pertussis diagnosis, treatment, and prevention, especially immunization practices, a multidisciplinary guideline development group (GDG) consisting of experts in the fields of infectious diseases, pediatric critical care medicine, clinical microbiology, epidemiology, and immunization planning jointly developed the first clinical practice guidelines for pertussis in China. Utilizing the Grading of Recommendations Assessment, Development and Evaluation Evidence-to-Decision framework recommended by the World Health Organization, the GDG formulated corresponding recommendations and suggestions. Good Practice Statements were created for issues not suitable for conventional evidence rating through the presentation of evidence and expert experience. The implementation suggestions for the 12 priority clinical questions given in this paper fully considered Chinese and international experiences as well as the national situation and policy. The primary target audience of these guidelines includes clinicians, microbiology laboratory staff, public health professionals, and policymakers.

External Factors Influencing the Implementation of Policy, System, and Environmental Change Strategies Within Cooperative Extension.

Introduction. Multilevel approaches are important to promote the adoption of healthier practices at the individual and community levels. Cooperative Extension pairs policy, systems, and environmental (PSE) change approaches with direct education programs focused on individual and community health. This study sought to understand Family and Consumer Sciences (FCS) Extension agents' perceptions of PSE change supports, benefits for their communities, and resources and partnerships important for implementation. Method. The Consolidated Framework for Implementation Research was used to develop a survey to assess outer setting domains related to PSE work. In addition to close-ended questions, the survey included several open-ended, qualitative questions exploring the benefits, resources, and relationships required to implement PSE changes. The surveys were collected online from FCS agents in two states. Descriptive statistics were calculated, open responses were coded, and key themes were established. Results. FCS agents (n=116) indicated high levels of agreement about having necessary support from state-level specialists (71%) and the overall Extension organization (64%). The largest gaps in support were reported as grant or external funding sources, time, and county programming funds. Half of the sample agreed that PSE training was adequate, but only 38.5% reported previously participating in PSE-specific training. Open-ended question responses revealed diverse relationships and numerous benefits of PSE work, including more sustainable health behavior changes and greater local Extension visibility. Discussion. Our findings corroborate previous work and identify potential gaps that future interventions can address to better support Extension and public health professionals when implementing PSE work at the community level.

Anti-Science Populism Versus Brazil's Covid-19 Vaccination Program: A Tale of Two Pandemic Stories

Can civil servants protect the administrative state from illiberal populism? We argue that bureaucratic success in fending off illiberal populism necessitates both a supportive institutional environment and overcoming populist rhetoric meant to undermine public confidence in policy expertise. The Covid-19 pandemic in Brazil is a case study of populist antipathy toward a professional public health service. Brazil's public health officials were able to defy Jair Bolsonaro's obstruction of a Covid-19 mass vaccination program thanks to institutions characterised by insulation from executive reprisal, decentralised health care provision, and an independent judiciary. However, civil servant resistance was less effective in nullifying Bolsonaro's anti-vaccine rhetoric: Even as most Brazilians received Covid-19 vaccines, vaccination rates remained associated with electoral support for Bolsonaro and overall vaccine hesitancy increased. The Brazilian case suggests the power of populist rhetoric to undermine pluralist public administration by attacking its epistemic foundation, even in a context favorable to bureaucratic resistance.

Use of large language models as a scalable approach to understanding public health discourse.

Online public health discourse is becoming more and more important in shaping public health dynamics. Large Language Models (LLMs) offer a scalable solution for analysing the vast amounts of unstructured text found on online platforms. Here, we explore the effectiveness of Large Language Models (LLMs), including GPT models and open-source alternatives, for extracting public stances towards vaccination from social media posts. Using an expert-annotated dataset of social media posts related to vaccination, we applied various LLMs and a rule-based sentiment analysis tool to classify the stance towards vaccination. We assessed the accuracy of these methods through comparisons with expert annotations and annotations obtained through crowdsourcing. Our results demonstrate that few-shot prompting of best-in-class LLMs are the best performing methods, and that all alternatives have significant risks of substantial misclassification. The study highlights the potential of LLMs as a scalable tool for public health professionals to quickly gauge public opinion on health policies and interventions, offering an efficient alternative to traditional data analysis methods. With the continuous advancement in LLM development, the integration of these models into public health surveillance systems could substantially improve our ability to monitor and respond to changing public health attitudes.

Comprehensive guide to tobacco control policy implementation

Background: Tobacco use remains one of the leading causes of preventable death and disease worldwide. Effective tobacco control policies are essential in mitigating these health risks. The Framework Convention on Tobacco Control (FCTC), adopted by the World Health Organization (WHO) in 2003, provides a comprehensive framework for implementing evidence-based tobacco control measures globally. This project aims to develop and implement robust tobacco control policies to reduce tobacco consumption and its associated health risks. Methods and Materials: The project involved a comprehensive review of existing tobacco control policies, data collection on tobacco use and related health outcomes, and the development of a multi-sectoral task force. Key strategies included setting clear goals, stakeholder engagement, public awareness campaigns, and the drafting of legislative and policy documents. Implementation mechanisms such as enforcement and evaluation systems were also established to ensure compliance and measure the policy's impact. Results: The implementation of the tobacco control policies resulted in a significant reduction in smoking prevalence and exposure to secondhand smoke. Public awareness of the health risks associated with tobacco use increased, and there was enhanced support for smoking cessation services. The project also identified best practices and strategies that can be adopted by other regions to achieve similar outcomes. Conclusion: This project highlights the importance of comprehensive research, effective coordination, and well-planned implementation in developing and executing tobacco control policies. The findings and recommendations presented serve as a valuable resource for policymakers and public health professionals aiming to reduce smoking rates and protect public health. Continued collaboration and adaptation of these strategies are essential for sustaining the progress made in tobacco control.

Debate: Bridging the gap - role of nonspecialists in child and adolescent mental health care.

The first point of contact for patients and families seeking professional help for health problems is often in nonspecialist community healthcare settings that vary widely across the countries in funding sources, resources and support from specialist services. They typically involve general practitioners, family physicians, general and community paediatricians, and nonphysician health workers such as nurses, social workers and public health professionals. This article discusses the role of nonspecialists in addressing the challenges of limited resources in Child and Adolescent Mental Health (CAMH) care services as healthcare systems struggle to meet the high demand. Stakeholders and decision-makers need to reconsider traditional healthcare models and service delivery. Integrating nonspecialist community care can be a potential solution but is beset with ethical, geopolitical, practical and economic challenges. The urgency and complexity of the issue are highlighted, emphasising the need for global discussion around CAMH care.

Training on animal hoarding disorder for public health professionals

Animal Hoarding Disorder (AHD) is a phenomenon little known in a structured way by professionals who work with the hoarding theme. This study aimed to evaluate a training course offered to professionals working in the public service of the State of Rio Grande do Sul, Brazil, with people who hoarded animals. Thus, 82 individuals aged between 18 and 65 years participated (M = 39.68; SD = 10.89). A questionnaire of sociodemographic data and an instrument for assessing knowledge about AHD (pre- and post-training) were applied. It was observed the knowledge regarding AHD improved significantly in the evaluation performed after the training. Finally, evidence of the effectiveness of training on AHD demonstrates the importance of developing and offering continuing education activities as tools for the qualification of professionals who work with the theme.

Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

A Toolkit to Facilitate the Selection and Measurement of Health Equity Indicators for Cardiovascular Disease.

Cardiovascular disease (CVD) is the leading cause of illness and death in the US and is substantially affected by social determinants of health, such as social, economic, and environmental factors. CVD disproportionately affects groups that have been economically and socially marginalized, yet health care and public health professionals often lack tools for collecting and using data to understand and address CVD inequities among their populations of focus. The Health Equity Indicators for Cardiovascular Disease Toolkit (HEI for CVD Toolkit) seeks to address this gap by providing metrics, measurement guidance, and resources to support users collecting, measuring, and analyzing data relevant to their CVD work. The toolkit includes a conceptual framework (a visual model for understanding health inequities in CVD); a comprehensive list of health equity indicators (metrics of inequities that influence CVD prevention, care, and management); guidance in definitions, measures, and data sources; lessons learned and examples of HEI implementation; and other resources to support health equity measurement. To develop this toolkit, we performed literature scans to identify primary topics and themes relevant to addressing inequities in CVD, engaged with subject matter experts in health equity and CVD, and conducted pilot studies to understand the feasibility of gathering and analyzing data on the social determinants of health in various settings. This comprehensive development process resulted in a toolkit that can help users understand the drivers of inequities in their communities or patient populations, assess progress, evaluate intervention outcomes, and guide actions to address CVD disparities.

Health risk assessment of lead and cadmium exposure from food and snuff in Pakistani population

BackgroundSmokeless tobacco (SLT) is a tobacco-based product consumed without burning or smoking. Snuff, commonly known as naswar, is a widely used SLT product in Pakistan. This study is designed to investigate the concentrations of lead (Pb) and cadmium (Cd) in snuff and their associated health risks to consumers. MethodsBlood samples from snuff consumers and non-consumers were analyzed for Pb and Cd concentrations. Additionally, samples of drinking water and wheat flour were also analyzed for Pb and Cd. Health risk assessments were calculated using hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) for Pb and Cd. ResultsSnuff consumers had significantly higher blood-Pb and blood-Cd levels compared to non-consumers. Approximately 38.5 % of snuff consumers were found to exceed blood-Pb levels from the safe limits (10 µg dL⁻¹) of the World Health Organization (WHO), while 48.9 % of snuff consumers were found to exceed blood-Cd levels from the WHO safe range of 0.03–0.12 µg dL⁻¹. Snuff samples contained Pb and Cd concentrations ranging from 5.3 to 22.4 µg g⁻¹ and 0.5–2.2 µg g⁻¹, respectively. Drinking water and wheat flour samples were found within the safe limits for Pb and Cd concentration, suggesting snuff as the primary source of exposure. Health risk assessments indicated elevated HQ values, for Pb (38.9 %) and Cd (14.3 %) detected in snuff, surpassing the safe HQ threshold of 1. Concerning ILCR from snuff, values for Pb were within the acceptable range, but alarmingly 100 % of samples for Cd exceeded the safe limits of USEPA (1.0×10⁻⁴), indicating a significant cancer risk in snuff users. ConclusionThis study highlights the exceeded Pb and Cd concentrations in snuff as well as also reporting significant carcinogenic and non-carcinogenic health risks to consumers. These findings emphasized the urgent need for regulatory bodies to ensure the safety of snuff before selling in the market. Public Health Professionals should also initiate educational campaigns to raise awareness among consumers and manufacturers about various health risks associated with the snuff.

Gender differences in the health workforce in China: an analysis of national data.

Gender differences in the health workforce matter for women's health and healthcare, and is also crucial for both health and economic development. Drawing on limited national gender data from China over the last 10 years, during which the country was undergoing a healthcare reform, this study dissects gender-related issues to identify existing problems, monitor progress, and develop strategies to promote change. Although women constituted the majority of health workers, they are predominantly engaged in service-oriented occupations. The gender distribution substantially differed between urban and rural primary health institutions. Moreover, significant differences in gender distribution among professional public health institutions were observed. The gender distribution of administrators varied in different types of health institutions. Women had lighter workloads because of the imbalanced distribution of specialties. Academicians comprised very few female scientists. To promote a more balanced gender distribution, policies should be developed to encourage a more reasonable division of family responsibilities. Further, equal higher education opportunities should be ensured for girls, especially in rural areas. Solutions to free more women from work-marriage-childcare conflicts and to decrease turnover rates deserve further discussion. Gender data should be highlighted and optimized to further advance gender differences among the health workforce and for women's health in China.

Methodological Insights About Photovoice as a Pedagogical Tool From Implementation With Graduate Students as Co-Researcher-Participants

Experiential learning is important in preparing the next generation of public health professionals to address health inequities. Students who aspire to work in community health must learn to engage with communities and advocate for change that aligns with community priorities. Learning about Community-Based Participatory Research (CBPR) and related methodologies can facilitate students’ understanding of community engagement and community organizing. Photovoice, a CBPR methodology, provides a unique opportunity to understand the lived experiences of participants while identifying community-led solutions to address public health challenges. Photovoice has been used as a pedagogical tool to engage students as participants in reflection, critical thinking, discussion, and experiential learning. However, the peer-reviewed literature often lacks detailed accounts of methodology, and barriers and facilitators to engaging participants in photovoice. We provide a detailed account of our methodology as we co-learned with 23 graduate students as co-researcher-participants in a photovoice experiential learning project as part of a CBPR course at the University of Illinois Chicago School of Public Health. Students reflected on their experience with the methodology by completing a series of fieldnotes while participating in photovoice. Fieldnotes were analyzed using an iterative inductive coding process. We present five themes from student reflections that convey barriers and facilitators to engaging in photovoice, and share related recommendations for using photovoice as a pedagogical tool to prepare the next generation of public health professions.

COVID Just-in-Time Extension for Community Health Outcomes: A Collaborative Information-Sharing Platform for a School Health Community.

The COVID-19 pandemic challenged school health professionals to navigate a dynamic public health emergency and to stay aware of changing recommendations. This study aimed to determine the value of the COVID Just-in-Time ECHO (Extension for Community Health Outcomes) Learning Series for Schools among participating school health personnel and to describe their ongoing information needs during the pandemic. School health, public health, and education professionals across Colorado participated in this ECHO series. Participants attended 1-hour sessions every 2 to 4 weeks from March 2020 through December 2021 for a total of 34 sessions. Data collection included postsession and postseries surveys assessing what participants found most valuable and what additional information they needed. School nurses represented 113 of 224 participants (50%). ECHO content noted as being the most valuable included epidemiology updates and special topics as chosen by participant input. Postseries surveys identified the value of experiencing shared knowledge among Just-in-Time ECHO participants. Participants identified ongoing needs for information about COVID-19 guidance and risk mitigation in schools throughout the sessions. In postseries surveys, participants reported additional ongoing information needs related to COVID-19 outside schools. This ECHO series delivered reliable and time-sensitive information for school health personnel and school leaders and may provide a useful model for information sharing among education and public health professionals.

Electronic cigarettes and their impact on oral health - review

Nowadays, the popularity of e-cigarettes is growing rapidly. Manufacturers of e-cigarettes advertise them as a less harmful option than traditional cigarettes, suggesting that their use can help reduce nicotine dependence and reduce the risk of smoking-related diseases. However, studies indicate that inhaling the chemicals in liquids can carry serious health consequences, particularly concerning the oral cavity Many of these preparations contain substances about whose effects we do not yet know enough, which raises concerns among public health professionals. The aim of this study was to provide an overview of e-cigarettes, including their popularity, the origins of their development, the substances they contain and the impact they have on oral health, which is most at risk from the harmful effects of e-cigarettes.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment

BackgroundA minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment.MethodsPWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels.ResultsA quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care.ConclusionsPWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

Psychosocial determinants of handwashing and physical distancing behaviour during the COVID-19 pandemic in the Netherlands: A longitudinal analysis.

Physical distancing and handwashing can be important infection prevention measures during an infectious disease outbreak such as the COVID-19 pandemic. To stimulate these behaviours, knowledge of psychosocial determinants as well as contextual factors is vital. We present longitudinal, within-person analyses of the impact of contextual and psychosocial factors on handwashing and distancing behaviour. We used individual-level data (186,490 participants completing 971,899 surveys) from the Corona Behavioural Unit COVID-19 Cohort, a dynamic cohort study conducted during 26 months of the COVID-19 pandemic in the Netherlands. Fixed-effects models were employed to estimate within-person associations between psychosocial factors and behaviour, combined with main and moderating effects of contextual factors. Pandemic severity was associated with more handwashing and distancing behaviour, while the duration of the pandemic had little effect. Within-person changes in response efficacy were most relevant for changes in both handwashing and distancing behaviour, while self-efficacy, descriptive norms and perceived severity of infecting others affected behaviour indirectly. These effects were stable over time. Associations were larger in cross-sectional models, indicating that such models tend to overestimate effects. Our study highlights the importance of longitudinal data and within-person models to detect possible causal associations. The results suggest that during an outbreak, government and public health professionals should clearly communicate the severity of the pandemic (e.g., hospitalization rates) and the effectiveness of recommended prevention measures in reducing that risk; and seek to improve people's capabilities and opportunities to adhere to guidelines, for example, by modifying the environment.

Effects of racial teasing on adolescent marijuana use and nicotine vaping: An analysis of the Virginia Youth Risk Behavior Surveillance System

BackgroundDespite adverse effects of tobacco and marijuana use on the adolescent brain, its use among youth remains high. Previous research shows associations between bullying and risks of substance use; less is known about racial teasing. This study examines associations of racial teasing, marijuana and/or electronic vapor products (EVP) use among adolescents, using 2021 Virginia Youth Risk Behavior Surveillance System (VYRBSS). MethodsVYRBSS is a self-reported survey which collects information on experiences with racial teasing and substance use. This analysis included 3,083 high school students ≥ 12 years old. Descriptive analysis and logistic regression models were performed for categorical variables. Multivariable models were adjusted for confounders. ResultsRacial teasing was associated with marijuana (AOR 1.89; CI 1.43–2.48) and EVP use (AOR 2.52; CI 1.91–3.31). Compared to Whites; Asians, Blacks, and Latinos were more likely to report racial teasing. Older heterosexual females reported higher use of marijuana and EVP. Blacks reported greater use of marijuana, whereas Whites were more likely to use EVP. EVP use was higher in females (AOR 1.73, CI 1.34–2.23), bisexual youth (AOR 1.68, CI 1.23, 2.30) and poor mental health (AOR 1.49, CI 1.16, 1.92). Marijuana use was associated with bisexuality (AOR 1.75, CI 1.28–2.39) and poor mental health (AOR 1.62, CI 1.27–2.07) as well. ConclusionsEvery effort should be made by public health professionals in Virginia to prevent racial teasing among adolescents because it increases the odds of substance use, particularly in older females, youth who identify as bisexual, and those reporting poor mental health.

"Kuteteza": A community-engaged COVID-19 Prevention and Protection Initiative in Southern Malawi.

The COVID-19 epidemic in Malawi involved almost 90,000 recorded cases and 2,638 deaths. In response to early concerns about vulnerable older people in rural areas, we developed 'Kuteteza': a COVID-19 mitigation response project. Clinicians, public health professionals, and researchers collaborated with government and district-level staff in two Southern Malawi districts. Interventions included supported 'shielding' of older people - minimising social mixing whilst having their daily needs supported. Additional mitigation strategies included provision of masks, handwashing stations, and soap. Government partnerships allowed additional support for vulnerable groups. We present the findings of a realist project evaluation, assessing the feasibility of this approach. We collated anonymised descriptive data on Kuteteza procedures and conducted qualitative structured observations in villages involved in the initiative. We carried out three focus groups involving community members, frontline health staff, and volunteers in each setting. These provided deeper insights into experiences of the pandemic and impacts of the intervention, including suggested opportunities during future outbreaks. The project involved 25 villages across two districts, with 1,087 people over the age of 60 voluntarily participating in 'shielding'. Supplies of food, water, and cooking fuel were mostly arranged within the family. In Kuteteza villages, the handwashing stations and soap were widely used, and there was awareness and some observance of COVID-19 prevention measures. The project, including the provision of supplies, was greatly appreciated by communities, but wider contextual constraints - namely widespread economic insecurity - presented persisting challenges. Suggestions for improvement largely concerned project enhancements and extensions. Through effective stakeholder engagement and contribution to national response strategy, the Kuteteza project helped raise COVID-19 awareness and supported populations at a critical time in the pandemic. Kuteteza approaches were welcomed locally and may be incorporated in future epidemic responses. Supported 'shielding' should be paired with government-led measures to mitigate economic hardship.