The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (>80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population.

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018–2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated growing political commitment to HHSDGs, with augmentation of multisectoral institutional arrangements, strengthening of monitoring systems and engagement of development partners. On the other hand, there has been limited involvement of civic society representatives and academia, relatively few capacity development initiatives were in place, a well-crafted communication strategy was missing, and there is limited evidence of additional domestic financing for implementing HHSDGs. While the momentum towards universal health coverage is notable, explicit linkages with non-health SDGs and integrated multisectoral implementation strategies are lacking. The study offers messages to LMICs that would allow for a full decade of accelerated implementation of HHSDGs, and points to the need for more implementation research in each domain and for testing interventions that are likely to work before scale-up.

PurposeThe purpose of this research is to focus on work-based problems catalysed by the COVID-19 global pandemic, based on a case study of a multi-continental, multi-campus university distributed across Kenya, Tanzania, Uganda and Pakistan. Higher education institutions (HEIs) in developing countries lacked pre-existing infrastructure to support online education and/or policy and regulatory frameworks during the pandemic. The university's programmes in Pakistan and East Africa provide lessons to other developing countries' HEIs. The university's focus on teaching and learning and staff development has had a transformational organisational effect.Design/methodology/approachCase study with participatory approaches aimed at co-production of responsive systems and co-creation of effective curriculum and faculty training is used.FindingsSystems and processes developed across the university in the effort to ensure educational continuity. From the disruption to all educational programmes and the disarray of regulatory bodies' responses, collaboration emerged as a key driver of positive change. The findings reiterate the value of trust and provision of opportunities for those with the requisite competencies to lead in a participatory and distributive manner whilst addressing limited human and financial resources. The findings reflect on previous work respecting organisational change recast in the digital age.Originality/valueThis paper reflects the authors' work in real-time as they led and managed changes encountered during the COVID-19 pandemic. The paper will be of value to management and leadership cadres, particularly in developing contexts, responsible for recovery and sustainability of the higher education sector.