IntroductionThe COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs).MethodsWe used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt.ResultsWe describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency.ConclusionsGuideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.

Two years into the covid-19 pandemic, footage from isolation centres in Shanghai showing unrest have raised questions about the safety, utility, and appropriate use of such facilities. 1 Confining people infected with a pathogen in a dedicated facility is not a new idea, nor are debates about the ethical basis or how such policies should be implemented while also safeguarding human rights. 2 3 Historical examples of isolation include patients with tuberculosis, those with influenza in the 1918 pandemic, and typhoid carriers. The use of isolation to limit community spread of infectious diseases has not, however, been consigned to history. Isolation facilities were used in the 2003 severe acute respiratory syndrome (SARS) outbreak, and, on a larger scale, Ebola treatment centres were extensively used in West Africa in 2014-15 to break the chains of Ebola transmission. 4 Governments revisited the idea of isolation facilities in response to covid-19 (box 1), especially in the early stages of the pandemic before vaccines became available, when predominant viral strains were less infectious and generally present in settings with low transmission. 6 One abiding image from early 2020 was the construction of massive health facilities in Wuhan, China, to house, treat and isolate people with covid-19 during the first wave. Other countries followed suit by refurbishing hospitals, re-purposing existing large-scale facilities or expanding capacity at pre-existing purpose-built infectious disease facilities (table 1). Box 1: Isolation facilities for covid-19An isolation facility is a dedicated place where people who test positive for covid-19 receive essential care and are provided with daily necessities, such as food, safe drinking water, and toiletries, as they recover. 5 "Mandatory" isolation means that everyone who meets certain criteria-typically a positive test within a defined period, even if asymptomatic or with mild clinical symptoms that do not require hospital admission-must be confined until they meet the criteria for discharge, are referred to other facilities, or die. This is different from quarantine (which isolates, temporarily, those considered at risk of spreading infection but not known to be infected), but both functions might sometimes be combined, as in New Zealand with its facilities for "managed isolation and quarantine."

Introduction: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. Objectives: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha Methods: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer-and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75 th percentile value was considered to differentiate 'good' knowledge from 'poor' knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. Conclusions: Majority of the caregivers' knowledge on asthma was poor. The caregivers' low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.