BackgroundThe International Consortium for Health Outcomes Measurement (ICHOM) was founded in 2012 to propose consensus-based measurement tools and documentation for different conditions and populations.This article describes how the ICHOM Older Person Working Group followed a consensus-driven modified Delphi technique to develop multiple global outcome measures in older persons.The standard set of outcome measures developed by this group will support the ability of healthcare systems to improve their care pathways and quality of care. An additional benefit will be the opportunity to compare variations in outcomes which encourages and supports learning between different health care systems that drives quality improvement. These outcome measures were not developed for use in research. They are aimed at non researchers in healthcare provision and those who pay for these services.MethodsA modified Delphi technique utilising a value based healthcare framework was applied by an international panel to arrive at consensus decisions.To inform the panel meetings, information was sought from literature reviews, longitudinal ageing surveys and a focus group.ResultsThe outcome measures developed and recommended were participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death mapped to a three tier value based healthcare framework.ConclusionsThe first global health standard set of outcome measures in older persons has been developed to enable health care systems improve the quality of care provided to older persons.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0701-3) contains supplementary material, which is available to authorized users.

In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient–provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient’s trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient–provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.

Objective: To describe patterns of food consumption associated with overweight/ obesity (OW/OB) and their links to socio-economic status (SES) and urbanization. Design: A nationwide cross-sectional survey. Setting: Secondary schools in cities, towns and villages in Botswana, Africa. Subjects: A total of 746 adolescent schoolchildren. Results: OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P , 0?01) more daily servings of snack foods (1?55 v. 0?76) and fewer servings of traditional diet foods (0?99 v. 1?68) and also reported that they ate meals outside the home more often (90 % v. 72 %). Students in cities ate significantly (P , 0?01) more servings of snacks (1?69 v. 1?05 v. 0?51) and fewer servings of traditional foods (0?67 v. 1?52 v. 1?61) compared with those in urban and rural villages. The odds of OW/OB were increased 1?16-fold with a snack-food diet, a result that was diminished when controlled for SES. Conclusions: These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development. Keywords Snacks Traditional diet Food patterns Nutrition transitionThe worldwide obesity epidemic is evident in children belonging to economically developed countries, as well as in children belonging to countries undergoing such development. According to the International Obesity Taskforce, approximately 10 % of youth aged 5-17 years worldwide were overweight (OW) and 2-3 % were obese (OB) in the year 2000 (1) . In a nationwide sample of adolescent secondary-school students in Botswana, 16 % of adolescents were OW/OB, with three OW/OB adolescents for every underweight one (2) . In this sample, OW/OB prevalence was higher among adolescents having a higher socio-economic status (SES) and among those from cities than among those from rural villages. These data suggest that initial efforts to prevent further increase in the prevalence of OW/OB must consider environmental and behavioural factors associated with increasing SES and urbanization as economic development continues.The typical food intake patterns of adolescents in Botswana and whether these patterns have any relationship with OW/OB have not been published. In addition, the role that SES or urbanization plays in patterns of food consumption has not been examined in adolescents. It is critical to understand these behaviours as a first step towards designing interventions to prevent the expected further increases in OW/OB. Therefore, the purposes of the present study were:1. to characterize the patterns of food intake of adolescent schoolchildren and the relationship of these patterns with OW/OB; 2. to evaluate the associatio...