Situation Report-78 HIGHLIGHTS • One new country/territory/area reported cases of COVID-19 in the past 24 hours: São Tomé and Príncipe. • Today, 7 April, marks World Health Day and this year WHO pays tribute to the incredible contribution of all health workers, especially nurses and midwives. Nurses are the largest component of the health workforce and play a fundamental role in combatting COVID-19 and achieving Universal Health Coverage and the Sustainable Development Goals. WHO has published the first-ever report on the state of the world's nursing workforce, available here. It renews calls on governments to invest in nurses. 1 279 722 confirmed (68 766) 72 614 deaths (5020) Western Pacific Region 113 641 confirmed (1119) 3892 deaths (31) European Region 686 338 confirmed (30 999) 52 809 deaths (3330) SouthEast Asia Region 9132 confirmed (304) 362 deaths (18) Eastern Mediterranean Region 78 565 confirmed (4218) 4149 deaths (173) Region of the Americas 384 242 confirmed (31 650) 11 097 deaths (1417) African Region 7092 confirmed (476) 294 deaths (51)

Background: Bangladesh, one of the most densely populated countries in the world has been ranked 9th on the Climate Risk Index for 2017: the 10 most affected countries & 7th on the Long-Term Climate Risk Index: the 10 countries most affected from 1998 to 2017. Every year it is afflicted with various climatic disasters including floods, hurricanes and cyclones. Apart from the obvious devastation of lives and property, there is a huge increase in clinical diseases when these disasters occur. Mental health of affected persons after these disasters is a topic that is often neglected by local and national level. Methods: A qualitative case study was conducted on perceived need on mental health support & availability of such services in a cyclone affected area in rural Bangladesh. Ten (10) key informant interviews (KIIs) with different stakeholders and ten (10) in-depth interviews (IDIs) with affected people were taken. Findings: We found that cyclones had numerous psychosocial impacts on the population including acute stress disorder, sleep disorder, post-traumatic stress disorders (PTSDs), generalized anxiety disorders, suicidal ideation and depression. The survivors had specific needs for receiving support. Children, elderly and women were perceived to be more vulnerable. The government and NGOs had no specific action plans and initiatives to address these issues and support the mental health of affected population. There was a visible gap in finding effective ways to provide affected people with the required mental health & psycho-social services (MHPSS). Conclusion: Resilient, responsive and self-sustaining health systems for this vulnerable population are required. Implementation of effective mental health programs and strong mental health policies remain a challenge in Bangladesh where there is a cultural fatalistic acceptance of mental health issues.

The reduction of inequalities in access to quality care has been a central tenet of UK health policy. Ethnic minorities may experience additional inequalities because of language and other cultural barriers. This article reports interviewer reflections of conducting interviews with South Asian kidney patients about their experiences of end-of-life care. It explores themes which emerged from the analysis of a focus group held with eight bilingual research interviewers. The relevance of these themes to understanding inequalities and access to end-of-life care is discussed; together with the potential for the research process to contribute to service improvement.

ObjectivesWe aimed to investigate the socioeconomic inequalities in the burden of underweight and overweight among children in South Asia. We also examined other factors that were associated with these outcomes independently of household’s socioeconomic status.DesignNationally-representative surveys.SettingsDemographic and Health Surveys from Bangladesh, India, Pakistan, Maldives and Nepal, which were conducted between 2009 and 2016.ParticipantsChildren aged 24 to 59 months with valid measurement for height and weight (n=146 996).Primary exposure and outcome measuresPrimary exposures were household’s wealth index and level of education. Underweight and overweight were defined according to the WHO and International Obesity Task Force definitions, respectively.ResultsUnderweight prevalence was 37% in Bangladesh, 38% in India, 19% in Maldives, 29% in Nepal and 28% in Pakistan. Bangladesh, India and Nepal had similar overweight prevalence (between 2% and 4%) whereas Pakistan (7%) and Maldives (9%) had higher prevalence. Households with higher wealth index or education had lower odds of having underweight children. Adjusted ORs of underweight for richest versus poorest households were 0.4 (95% CI: 0.3 to 0.5), 0.5 (95% CI: 0.5 to 0.6), 0.5 (95% CI: 0.2 to 1.4), 0.5 (95% CI: 0.3 to 0.8) and 0.7 (95% CI: 0.5 to 1.1) for Bangladesh, India, Maldives, Nepal and Pakistan, respectively. Compared with poorest households, richest households were more likely to have overweight children in all countries except Pakistan, but such associations were not significant after adjustment for other factors. There were higher odds of having overweight children in households with higher education in Bangladesh (OR 2.1 (95% CI: 1.3 to 3.5)), India (OR 1.2 (95% CI: 1.2 to 1.3)) and Pakistan (OR 1.8 (95% CI: 1.1 to 2.9)) when compared with households with no education. Maternal nutritional status was consistently associated with children’s nutritional outcomes after adjustments for socioeconomic status.ConclusionsOur study provides evidence for socioeconomic inequalities for childhood underweight and overweight in South Asian countries, although the directions of associations for underweight and overweight might be different.

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