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face of dwindling resources. Lebanon has moved over the past few months from a high-middle-income country to a country in survival mode where the hunt for necessities is a daily chore. The immediate plans are concentrated around how to endure the current crisis. 4,5 Since the roots of the problem are deeply entrenched in the political system and the matrix of the society, hoping for immediate and sustainable solutions seems far-fetched. Lebanese physicians must accommodate the awkward situation and perform what is expected of them under near catastrophic conditions.We declare no competing interests.

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Introduction Acute respiratory illness (ARI) is a leading cause of mortality in children under 5 (CU5) in Malawi and can be prevented with 3-dose pneumococcal conjugate vaccine (PCV). There has been no national study in Malawi that seeks to associate social economic factors leading to PCV vaccine uptake and reported acute respiratory infections (RARI). The objectives of our study were to do this. Methods We conducted a cross-sectional analysis of secondary data from the 2014 UNICEF Malawi Multiple Indicator Cluster Survey to construct mutlivariable logistic regression models for independent associations with PCV 1/2/3 immunisation and RARI. Results 56% of CU5 in Malawi RARI in the 2 week recall period of the survey. Independent associations with reduced odds of RARI were central region living (OR 0.82, 95%CI (0.71–0.93)) middle (OR 0.84, (0.73–0.97)) fourth (OR 0.79, (0.68–0.92)) and richest wealth quintiles (OR 0.73, (0.60–0.88)). Using straw/shrubs for fuel was associated with increased RARI (OR 3.13, (1.00–9.79)). Among 1–36 month olds, in 2014, 93.3% received PCV1, 86.8% PCV2 and 77.0% PCV3. Between 2011–2014, the average age in months for a child to receive PCV1/2/3 reduced by 26.6 for PCV1, 26.4 for PCV2, and 26.1 for PCV 3. Independent predicators for increased odds of all 3 PCV doses, relative to 0–5 age group, were age group 6–11 (OR 21.8, (18.2–26.1) 12–23 (OR 27.5, (23.5–32.2) 24–36 months (OR 9.09, (7.89–10.5), mothers having a secondary (OR 1.52, (1.25–1.84)) or higher education (OR 2.68, (1.43–5.04) when compared to no education, and children in the middle (OR 1.24, (1.07–1.43)) fourth (OR 1.27, (1.09–1.48)) richest (OR 1.54, (1.27–1.88)) wealth quintiles relative to the lowest. Children living with 4–6 other children was independently associated with reduced odds of receiving all 3 PCV doses (OR 0.56, (0.33–0.96). Conclusion We report nationally representative social economic associations with RARI and PCV vaccine uptake and coverage estimates. We found reductions in the average age a child receives all 3 PCV vaccine doses between 2011–2014.

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Introduction Conflict and other disasters such as earthquakes or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. Aims The primary aim of this scoping review was to synthesize the evidence on the preparedness of health systems in low- and middle-income countries to respond with rehabilitation services and assistive technology to the demand associated with conflict and disaster situations. A secondary aim was to summarize related recommendations identified in the gathered literature. Methodology A scoping review was conducted using the Arksey and O’Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search range was 2010–2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. Results Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review collected the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters. The most prominent recommendations were; the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response. Conclusion: The literature demonstrates that rehabilitation is poorly integrated into health systems disaster preparedness and response in low- and middle-income countries, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of evidence available hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.