Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A posthoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5•9 months (IQR 4•9-6•5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments w...
The objective of this formative research was to assess the acceptability of a micronutrient powder (Sprinkles ® ) and a lipid-based nutrient supplement (Nutributter ® ), and to explore people's willingness to pay for these products in a resource-poor context like Niger. In four sites, 84 focus group discussions among mothers, fathers and grandmothers of children 6-23 months were conducted, as well as 80 key informant interviews of mothers who participated in a home study where their children 6-23 months were given either Sprinkles ® or Nutributter ® to use either for a period of 4 weeks, or they were given both products over the 4-week period, i.e. Sprinkles ® for 2 weeks and Nutributter ® for an additional 2 weeks. The mothers understood how to use the products and generally used the products correctly. Both products were highly acceptable to adults and most children. In Niamey, where the 4-week home study used both products for 2 weeks each, the mothers tended to prefer Nutributter ® . The mothers who used either product were pleased with the improvements they saw in their children's health, including increased appetite, weight gain and increased energy and activity. A few mothers were concerned with how they would be able to provide for their child's increased appetite. Most participants across all four sites reported that they would be willing and able to afford to buy a single sachet of either Sprinkles ® at a cost of US$0.03 or Nutributter ® at a cost of US$0.08 several times a week. This study provides evidence that both of these products were are highly acceptable in different settings in Niger and suggests that delivery of Nutributter ® or Sprinkles ® at a low or subsidized cost through a market-based system may be possible in Niger, if an appropriate distribution system can be identified.
Background Micronutrient powders (MNP) reduce anemia and improve iron status in children aged 6 to 23 months. Little is known about home fortification interventions in low-income and middle-income countries. Objective To describe highlights of the Global Assessment of Home Fortification Interventions 2011, new directions, and needed policy and programmatic guidance. Methods A cross-sectional survey of home fortification interventions was conducted. Staff at UNICEF and regional focal points at Home Fortification Technical Advisory Group partner agencies sent questionnaires to representatives in 152 low-income and middle-income countries. Included interventions met the following criteria: they were for prevention and used MNP, lipid-based nutrient supplements (LNS), or complementary food supplements (CFS); one recommended mode of use was mixing into food; they were implemented or planning to start within 12 months; and research interventions were directly linked to programs. Results This study identified 63 implemented interventions (36 countries) and 28 planned interventions (21 countries), including 34 implemented interventions (22 countries) and 25 planned interventions (20 countries) that used MNP. These interventions were expected to reach 17.2 million people in 2011, including 14.1 million participants in MNP interventions. Among implemented interventions, 16% distributed nationally. Most interventions used integrated approaches targeting young children. Recently, there was increasing expansion of interventions in Africa. The main challenges identified were monitoring and evaluation, adherence, product funding, and procurement. Conclusions Home fortification interventions, especially those that use MNP, are increasing and scaling up rapidly in regions with widespread problems of micronutrient deficiencies and stunting. Home fortification interventions contribute to global initiatives to reduce undernutrition.
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