BMJ public health最新文献

{"title":"Securitising public health emergencies: a qualitative examination of the origins of military intervention in Sierra Leone’s Ebola Epidemic","authors":"S. Boland, S. Mayhew, D. Balabanova","doi":"10.1136/bmjph-2023-000236","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000236","url":null,"abstract":"The 2013–2016 West Africa Ebola Epidemic remains the largest recorded Ebola outbreak. In response to the escalating number of cases in Sierra Leone in the summer and early autumn of 2014, the British Armed Forces and Republic of Sierra Leone Armed Forces intervened in support of the outbreak response. Among other contributions, the militaries established and subsequently helped to lead a national network of bespoke (and inherently militarised) coordination centres, from which almost all formal Ebola response operations were organised. Their contributions were therefore central to the outbreak response. However, the decision and process by which these actors first intervened is not well documented.In order to examine the historical origin of the militaries’ intervention, 110 semistructured qualitative interviews with key stakeholders at the international, national and subnational level were conducted and analysed.Military support to Sierra Leone’s Ebola response was found to result from the advocacy and careful planning of a small number of individuals operating in Freetown, alongside closed-door negotiations occurring at the highest level of government in the UK.This has important implications for understanding elite decision-making related to the militarisation of aid and the wider securitisation agenda.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122803341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing disparity in the distribution of HIV and sexually transmitted infections in Australia: a retrospective cross-sectional study using Gini coefficients","authors":"Phyu Mon Latt, Nyi Nyi Soe, Xian-hui Xu, Rashidur Rahman, E. Chow, Jason J. Ong, C. Fairley, Lei Zhang","doi":"10.1136/bmjph-2023-000012","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000012","url":null,"abstract":"The risk of HIV and sexually transmitted infections (STIs) varies substantially across population groups in Australia. We examined this disparity in HIV/STI distribution using Gini coefficients, where scores closer to one indicate greater disparity.We used demographic and sexual behaviour data from the Melbourne Sexual Health Centre, between 2015 and 2018. We examined 88 642 HIV consultations, 92 291 syphilis consultations, 97 473 gonorrhoea consultations and 115 845 chlamydia consultations. We applied a machine learning-based risk assessment tool, MySTIRisk, to determine the risk scores. Based on individuals’ risk scores and HIV/STIs diagnoses, we calculated the Gini coefficients for these infections for different subgroups.Overall, Gini coefficients were highest for syphilis (0.60, 95% CI 0.57 to 0.64) followed by HIV (0.57, 95% CI 0.52 to 0.62), gonorrhoea (0.38, 95% CI 0.36 to 0.42) and chlamydia (0.31, 95% CI 0.28 to 0.35). Gay, bisexual and other men who have sex with men (GBMSM) had lower Gini coefficients compared with heterosexual men or women; HIV (0.54 vs 0.94 vs 0.96), syphilis (0.50 vs 0.86 vs 0.93), gonorrhoea (0.24 vs 0.57 vs 0.57) and chlamydia (0.23 vs 0.42 vs 0.40), respectively. The Gini coefficient was lower among 25–34 years than in other age groups for HIV (0.66 vs 0.83–0.90) and gonorrhoea (0.38 vs 0.43–0.47). For syphilis, the oldest age group (≥45 years) had a lower Gini coefficient than 18–24 years (0.61 vs 0.70).Our study demonstrated that HIV/STIs are more evenly distributed among GBMSM, suggesting widely disseminated interventions for GBMSM communities. In contrast, interventions for heterosexual men and women should be more targeted at individuals with higher risk scores.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117195383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between residential greenness and severe psychological distress and the moderating role of ‘stay-at-home’ status: a population-based cross-sectional study during the COVID-19 pandemic in Japan","authors":"Hisaaki Nishimura, N. Nawa, Yui Yamaoka, Y. Koyama, Jin Kuramochi, T. Fujiwara","doi":"10.1136/bmjph-2023-000093","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000093","url":null,"abstract":"There is a need for public health strategies to address the negative psychological consequences of the COVID-19 pandemic, and the role of residential green exposure has gained prominence, particularly in the context of the ‘new normal’ and the prevailing ‘stay-at-home’ policies. This study aimed to evaluate the association between residential greenness and severe psychological distress during the COVID-19 pandemic in Japan. We also investigated the association stratified by ‘stay-at-home’ status, a proxy for exposure to residential greenness.We used data from a population-based cohort study conducted in Utsunomiya City, Japan. Residential greenness was measured by the normalised difference vegetation index (NDVI) averaged over circular buffers around residence. Severe psychological distress was defined as a Kessler Psychological Distress Scale (K6) score ≥13. ‘Stay-at-home’ status was categorised as either ‘not stay-at-home’ (individuals working outside the home or self-employed) or ‘stay-at-home’ (working from home or not working), based on the working status. Logistic regression analysis was performed to examine the association between residential greenness and severe psychological distress.A total of 615 participants were analysed. Among the ‘stay-at-home’ group, an IQR increase in NDVI was inversely associated with severe psychological distress (100 m buffer: OR=0.27, 95% CI 0.10 to 0.77; 250 m buffer: OR=0.26, 95% CI 0.10 to 0.69; 500 m buffer: OR=0.33, 95% CI 0.11 to 0.95). However, no significant association was observed for the ‘not stay-at-home’ group.Residential greenness was a protective factor for severe psychological distress among the ‘stay-at-home’ group, who were assumed to have spent more time in their residence.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124616061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: a prospective cohort study","authors":"C. Bodinayake, A. Nagahawatte, V. Devasiri, Wasantha Kodikara Arachichi, R. Kurukulasooriya, T. Sheng, B. Nicholson, Truls Østbye, M. Reller, C. Woods, L. G. Tillekeratne","doi":"10.1136/bmjph-2023-000073","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000073","url":null,"abstract":"Acute febrile illness (AFI) is a common cause of hospital admissions in tropical settings. Identifying AFI aetiology is essential for guiding clinicians’ diagnoses and developing diagnostic and management guidelines. We used rigorous, gold-standard testing for diverse viral and bacterial pathogens to confirm the aetiology of AFI in southern Sri Lanka.We prospectively enrolled children and adults with AFI admitted to Teaching Hospital Karapitiya, Galle, the largest tertiary care hospital in Southern Province, Sri Lanka from June 2012 to May 2013. We obtained sociodemographic and clinical data, an acute blood sample, a nasopharyngeal sample, and a urine sample at enrolment and a convalescent blood sample 2–4 weeks later. Laboratory testing was conducted for dengue, respiratory viruses, leptospirosis, scrub typhus, spotted fever group (SFG) and typhus group (TG) rickettsioses and Q fever.A total of 976 patients were enrolled and a convalescent visit was completed in 878 (90.0%). Median age was 26.9 (14.2–41.4) years and the majority were male (628, 64.3%). A viral or bacterial aetiology was identified in 660 (67.6%). A viral aetiology was identified in 534 (54.7%), including 388 (39.8%) with dengue and 171 (17.5%) with respiratory viruses. Bacterial infection was found in 138 (14.1%) and included leptospirosis (79, 8.1%), SFG (17, 1.7%), TG (7, 0.7%), scrub typhus (53, 5.4%) and Q fever (5, 0.5%). Antibiotics were prescribed at enrolment for 45.5% with viral infections and 62.3% with bacterial infection. Overall, sensitivity of clinical diagnosis was low at approximately 50%.We identified an aetiology of AFI in two-thirds of patients in a setting where malaria is non-endemic. Sensitivity of clinical diagnosis was low, with overuse of antibiotics for viral infections and underuse of antibiotics for bacterial infections. Diagnostic algorithms for AFI may help improve clinical management in this and comparable settings with diverse AFI aetiologies.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128340861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did children’s symptoms and infections decline during the COVID-19 pandemic? A comparison of parental reports before and during the pandemic from a birth cohort study in New Hampshire, USA","authors":"J. Peacock, Susana Diaz-Coto, V. Sayarath, J. Madan, M. Karagas","doi":"10.1136/bmjph-2023-000069","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000069","url":null,"abstract":"Restrictive measures were widely introduced at the start of the COVID-19 pandemic to reduce the spread of the virus. These restrictions have been linked to reductions in laboratory-diagnosed infections and hospitalisations. It is unclear if the observed decreases reflect a reduction in health-seeking behaviour or results from fewer infections per se.We have explored trends in caregiver reports of respiratory infections and symptoms needing a doctor visit in children aged 0–11 years using data from the New Hampshire Birth Cohort Study in 2011–2021, comparing the prepandemic and pandemic periods. Generalized Estimating Equations were used to model pandemic/prepandemic risk ratios (RRs) with adjustment for maternal and child characteristics.The overall probability of a report of an upper respiratory tract infection (RTI) needing a doctor visit in children aged 0–11 years was 16.7%. There was strong evidence of a decline during the pandemic: 17.9% pre pandemic versus 8.19% in the pandemic period, adjusted RR 0.51 (95% CI: 0.42 to 0.64). Similar trends were seen for any lower RTI, any respiratory symptom and any other acute symptom with overall probabilities of 4.33%, 24.8% and 13.8%, respectively, and adjusted rate ratios 0.61 (0.41 to 0.91), 0.59 (0.51 to 0.68) and 0.72 (0.59 to 0.87), respectively. In contrast, respiratory syncytial virus and bronchiolitis remained steady.The steep decline in caregiver-reported infections and symptoms mirrored trends reported in laboratory-diagnosed infections and hospitalisations and suggests a real decrease in prevalence. Longer follow-up is needed to determine later consequences of the reduction in childhood infections.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126839146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is a sedentary lifestyle a leading causal factor of obesity and distress in type 2 diabetes? A cross-sectional study in low-socioeconomic areas of Karachi, Pakistan","authors":"Sana Sharif, H. Sharif, J. Rehman, Zoya Fatima","doi":"10.1136/bmjph-2023-000149","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000149","url":null,"abstract":"Worldwide, the burden of diabetes with obesity as comorbidity has intensely increased. Even though sedentary behaviour is not favourable for a healthy lifestyle, some people still live a sedentary lifestyle. There is a dire need to report cases of sedentary behaviour in people with diabetes and obesity in the slums of Karachi, Pakistan.To assess the association of obesity and distress with sedentary behaviour among individuals with diabetes in slums and the associated factors.This institutional-based cross-sectional study was conducted in 38 slums in Karachi, Pakistan, to determine the association of sedentary behaviour with poor glycaemic control and demographic factors. Data from August to September 2022 were analysed, and inferences were drawn.Among the studied population, out of 493 participants, 273 (55%) were female of age range 46–55 years 109 (22%) belonged to body mass index class-1 obesity 110 (22%), with hypertension 205 (42%), showed sedentary behaviour with low-socioeconomic settlements 299 (61%), and belong to Pathan ethnicity 153 (31%). More participants were married 337 (68%), had low-socioeconomic status 299 (61%) and had a positive family history of diabetes 242 (49%).This study found that sedentary behaviour is significantly associated with the sociodemographic and clinical profile of patients with type 2 diabetes. It causes a long turn effect that can only result in uncontrolled and poor glycaemic control in diabetes and metabolic imbalance. The study can promote a physical-induced work setup and spread awareness among illiterate people for awareness of disease complications.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125621609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing postacute care healthcare charges after hospitalisation due to influenza or COVID-19 infection in an all-payer administrative dataset in the USA: a retrospective cohort study","authors":"J. Bailey, S. Alexandria, Blair Hu, L. Wolfe, Leah J. Welty, J. Kruser, R. Kalhan","doi":"10.1136/bmjph-2023-000102","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000102","url":null,"abstract":"SARS-CoV-2 infection often causes a persistent syndrome of multiorgan dysfunction with symptoms that may be debilitating. Individuals seeking care for this syndrome are likely to generate significant healthcare utilisation and spending. It is unknown if healthcare costs after SARS-CoV-2 infection differ from those after influenza infection.We used an all-payer administrative dataset comprised coding and billing data from 446 hospitals in the USA that use a financial analytics platform by Strata Decision Technology. The deidentified analytical sample included patients aged 18 years or older who were admitted to a hospital between July 2018 and May 2021 with an International Classification of Disease-10 code for COVID-19 or influenza. Analyses were stratified by age (18–44, 45–64 and 65+) and need for ventilation during acute hospitalisation. Linear regression models were used to evaluate the relationship between infection type (COVID-19 or influenza) and cumulative charges between 1 and 5 months after hospitalisation. Independent variables included medical comorbidities, health system classification and prehospitalisation charges, among others.Of 110 381 patients included in our analysis, 94 927 (86.0%) were hospitalised for COVID-19 and 15 454 (14.0%) were hospitalised for influenza. Patients hospitalised for COVID-19 generated a median of US$5248 (inter-quartile range (IQR) US$25693) in postacute healthcare charges, whereas patients hospitalised for influenza generated a median of US$8463 (IQR US$41063). Compared with influenza, linear model results demonstrated no significant differences in postacute charges among patients hospitalised with COVID-19.Our findings suggest that individual healthcare expenditures after acute COVID-19 infection are not significantly different from those after influenza infection.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130013544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining barriers and facilitators of HPV vaccination in Nigeria, in the context of an innovative delivery model: a mixed-methods study","authors":"Odunayo Talabi, Hannah N Gilbert, M. C. Fawzi, R. Anorlu, Thomas Randall","doi":"10.1136/bmjph-2023-000003","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000003","url":null,"abstract":"More than 80% of cervical cancer cases diagnosed globally are in low-income and middle-income countries. In sub-Saharan Africa, where treatment facilities are widely unavailable, it is a leading cause of cancer deaths in women. Human papillomavirus (HPV) vaccination, which is known to prevent almost 90% of cases of cervical cancer, has low uptake in this region, and little is known about the behaviour of those who have been offered the HPV vaccine. This knowledge is critical to guide policy-makers in sub-Saharan Africa on how best to roll out the vaccine and ensure successful and sustainable HPV vaccination programmes.To better understand uptake of the HPV vaccine among schoolgirls in Nigeria, we designed a mixed-methods convergent study, with a case–control quantitative arm that recruited caregivers of adolescent schoolgirls as cases (those who accepted vaccination) and controls (those who did not accept vaccination). For the qualitative study, we conducted 10 focus group discussions with of caregivers and 6 in-depth interviews with school administrators, vaccination sponsors and policy-makers.Those with high awareness of HPV vaccination had three times the odds of uptake (adjusted OR (aOR) 2.6, 95% CI 1.54 to 4.31, p=0.002). Giving HPV vaccines in school was also associated with uptake (aOR 3.1, 95% CI 1.54 to 6.43, p=0.002). Being offered free HPV vaccination was significant in the bivariate analysis (aOR 1.67, 95% CI 1.03 to 2.70, p=0.039) but was marginally significant in the multivariate analysis (aOR 0.63, 95% CI 0.37 to 1.06, p=0.086). Qualitative themes supported these findings, demonstrating that effective awareness and convenience of vaccination could encourage uptake. Key barriers to uptake included lack of affordability and limited availability of vaccines.Effective awareness, administering HPV vaccines in school and subsidising HPV vaccination costs can improve uptake.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132411414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disability-adjusted life years due to COVID-19 in Sri Lanka: a retrospective cross-sectional study","authors":"A. R. Wickremasinghe, A. D. K. Ariyasena, Thushani Umesha Munasinghe, R. Perera","doi":"10.1136/bmjph-2023-000055","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000055","url":null,"abstract":"To estimate the health burden of COVID-19 in Sri Lanka using disability-adjusted life years (DALYs) and to investigate how the burden varies across age groups and sex.A retrospective study was conducted based on information obtained from the daily situation reports and monthly epidemiological reports issued by the Epidemiology Unit of the Ministry of Health, Sri Lanka. DALYs due to COVID-19 in Sri Lanka from 27 January 2020 to 30 June 2022 were estimated by age and sex. For the calculation, we also included the DALYs due to mild anxiety for the family members of the patients with COVID-19.The total number of COVID-19 cases reported during this time period was 664 123, of which, 54% were males. There were 16 521 deaths reported giving a case fatality rate of 2.48%, which was higher in females as compared with males. The total years of life lost during this period is estimated to be 77 679 for males and 115 065 for females. The estimate of DALYs due to COVID-19 in Sri Lanka was 269 606 corresponding to 12.2 per 1000 population.Compared with other countries, the burden of COVID-19 in Sri Lanka, as assessed by DALYs, was relatively low. This may be due to the country being an island and the strict rules imposed by the government to limit the spread of the disease. Assessing the impact of COVID-19 using only DALYs does not reflect the devastating economic and social consequences experienced by the country.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131393279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiagency approaches to preventing sudden unexpected death in infancy (SUDI): a review and analysis of UK policies","authors":"Helen L. Ball, Alice-Amber Keegan, Daniel R Whitehouse, Louise S Cooper, Sophie R Lovell-Kennedy, Laura M Murray, D. Newbury-Birch, N. Cleghorn, A. Healy","doi":"10.1136/bmjph-2023-000017","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000017","url":null,"abstract":"Recent reviews of sudden unexpected deaths in infancy (SUDI) in England recommend a multiagency working (MAW) approach to prevention but lack clear guidance around how this might be implemented.In England, local authorities commission and oversee public health services. This review examines how local authority policies address implementation of MAW for SUDI prevention to understand local variations and identify strengths and weaknesses.Using a comprehensive list of all metropolitan, county, unitary councils and London boroughs in England, we systematically searched local authority websites for relevant published documents and submitted freedom of information (FOI) requests where policies or guidance for SUDI prevention had not been sourced online. We extracted data from documents using a standardised form to summarise policy contents which were then collated, described and appraised.We searched the websites of 152 council and London boroughs, identifying 36 relevant policies and guidelines for staff. We submitted 116 FOI requests which yielded 64 responses including six valid documents: 45% (52/116) of local authorities did not respond. Seventeen councils shared the same guidance under safeguarding partnerships; removal of duplicates resulted in 26 unique documents. Only 15% (4/26) of the documents included a detailed plan for how MAW approaches were to be implemented despite 73% (19/26) of the documents mentioning the importance of engaging the MAW in raising awareness of safe sleep for babies with vulnerable families. Five areas of variation were identified across policies: (1) scope, (2) responsibilities, (3) training, (4) implementation and (5) evaluation.There are discrepancies between local authorities in England in whether and how MAW for SUDI prevention is carried out. Strengths and weaknesses of approaches are identified to inform future development of MAW for SUDI prevention.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122222927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}