IntroductionPeople with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia.Methods and analysisWe will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder scale (GAD-7)) and health-related quality of life (EQ-5D-5L). We will measure blood pressure, height, weight and waist circumference according to WHO guidelines. We will also measure glycated haemoglobin, lipid profile, thyroid function, liver function, creatinine and haemoglobin. Prevalence rates of physical health conditions and health-risk behaviours will be presented and compared with the WHO STEPS survey findings in the general population. Regression analyses will explore the association between health-risk behaviours, mental and physical health conditions.Ethics and disseminationThe study has been approved by the ethics committees of the Department of Health Sciences University of York (UK), Centre for Injury Prevention and Rehabilitation (Bangladesh), Health Ministry Screening Committee and Indian Council of Medical Research (India) and National Bioethics Committee (Pakistan). Findings will be disseminated in peer-reviewed articles, in local and international conferences and as reports for policymakers and stakeholders in the countries involved.Trial registration numberISRCTN88485933; 3 June 2019.

Growth monitoring is an essential element of child health care. Children’s healthy growth and development, and detection of variations from typical growth can be confirmed by proper growth monitoring. Objective This study aimed to evaluate detection and referral processes of cases of stunting among a sample of children aged less than 5 years attending maternal and child Healthcare centers in Cairo. Methods a quality of performance study carried out to observe children aged less than 5 years attending two primary healthcare centers during their growth monitoring process to assess the quality of documentation (14 items), body measurements (Anthropometric Measurements – 11 items for height and 8 for weight measurements), plotting (3 items), interpretation (4 items) and referral of detected cases (2 items) using observational checklist. Interviewing questionnaire for healthcare workers to assess their knowledge and skills in the process of detection of stunting. Results Observed growth monitoring process was undertaken for 300 children, 51% boys and 49% girls, 44% were breastfed. Out of the sample 27 (9.3%) were < -2 Z-score height for age, 5 (1.7%) were < -2 Z-score weight for age, 5 (1.7%) were < -2 Z-score weight for height and 4 (1.3%) were < -2 Z-score body mass index for age. By Observational checklist results for growth monitoring process for documentation (28.5%) of items were not done, (53.7%) were good done and (17.8%) were satisfactory done. For measuring height (9%) of items were not done, (45.5%) were poor done, (9%) were satisfactory done and (36.5%) were good done. For measuring weight (25%) of items were not done, (6.2%) were poorly done, (12.5%) were satisfactory done and (56.3%) were good done. For plotting on growth chart (66.7%) of items were not done and (33.3%) were good done. For Interpretation of the growth pattern and referral (100%) of items not done. Conclusion Growth monitoring shows areas in need for improvement as the detection process including documentation and follow standardized anthropometric measurements, up-to-date and periodic staff training. Developing formal and well organized referral of detected stunted is a mandate.

BackgroundPeople with severe mental illness (SMI) die earlier than the general population, primarily due to physical disorders. There is limited information on physical illnesses and health-risk behaviours in people with SMI in low and middle-income countries.MethodsWe conducted a cross-sectional survey in adults with SMI attending specialist mental health services in Bangladesh and Pakistan. Data were collected on non-communicable diseases (NCDs), their risk factors, health-risk behaviours, treatments and health risk modification advice (using questions from the WHO STEPwise approach to Surveillance of NCDs (STEPS)) and on common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis, and compared weighted prevalence for these variables in our survey with prevalence for the general population in the STEPS reports from Bangladesh and Pakistan.ResultsWe recruited 2,344 participants with bipolar disorder (36.7%), non-affective psychosis (42.2%), and depression with psychosis (21.1%). Eight percent had diabetes, 24.7% hypertension and 3.1% tuberculosis. 43.4% were overweight or obese, and half had hypercholesterolemia. Most participants with diabetes, hypertension and hypercholesterolemia were previously undiagnosed; of those diagnosed only around half were receiving treatment. Fifty-four percent of men and 17.2% of women used tobacco; 46.9% and 87.1% did not meet WHO recommendations for physical activity and fruit and vegetable intake respectively. Compared with the general population, people with SMI were more likely to have diabetes (O.R.=1.56,95%C.I.=1.30 to 1.88 Bangladesh), hypercholesterolemia (O.R.=2.35,95%C.I.=2.08 to 2.65 Bangladesh) and overweight or obesity (O.R.=1.97, 95%C.I.=1.75 to 2.22 Bangladesh; O.R.=1.61,95%C.I.=1.40 to 1.86 Pakistan). They were less likely to receive tobacco cessation (O.R.=0.33,95%C.I.=0.26 to 0.42 Bangladesh; O.R.=0.42,95%C.I.=0.31 to 0.55 Pakistan), and weight management advice (O.R.=0.51,95%C.I.=0.41 to 0.63 Bangladesh; and O.R.=0.65,95%C.I.=0.51 to 0.82 Pakistan).ConclusionDespite the high prevalence we found significant gaps in detection, prevention and treatment of NCDs and their risk factors in people with SMI.RegistrationISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933

Background: The rollout of the COVID-19 vaccine represented more than logistical challenges. Lebanon, despite benefitting from the COVAX initiative that made vaccines more accessible to everyone residing in the country, faced considerable challenges encouraging the Syrian refugee population to register for a vaccine. The reasons behind refugees’ reluctance to get vaccinated were mainly behavioral in nature: fear of side effects, doubts about the vaccine’s effectiveness, and even the belief that the vaccine was unnecessary. Methods: An RCT was conducted in order to test the impact of dissonance induction on the level of willingness of Syrian refugee survey respondents who had not been vaccinated (n=1,569). The survey also collected data on refugees’ knowledge, attitudes, and practices regarding the vaccine. Results: Results revealed that dissonance induction significantly reduced vaccine hesitancy, with more pronounced effects detected among women, middle aged adults. Conclusion: These findings have important implications on rethinking the behavioral aspect of the delivery of public health services to the refugee population in Lebanon and vulnerable populations elsewhere.