Autonomic Nervous System Dysregulation in Young People with a History of COVID-19

**Impact of Health Spoken Tutorials, IIT-B, on Effective Breastfeeding Practices on Prevention and Treatment of Undernutrition at Three Months: Preliminary Findings of a Case-Control Study from the Dept. of Health, Govt of Banaskantha, Gujarat, India**

**Milindkumar Ukey2 , Manishkumar Fancy1 , Rupal Dalal1,2,3, Marian Abraham2,3, Apoorva Nambiar2,3, Thirumal Reddy2,3, and Satish Agnihotri2,3** <sup>1</sup> Department of Health, Government of Gujarat <sup>2</sup> CTARA, IIT-Bombay

Breastfeeding, the most important source of nutrition in infants and young children, even if exclusive, can be sub-optimal if the technical skills and practices are not appropriate, resulting in poor milk transfer to the baby. Community-based interventions that involve training mothers and caregivers on skills can be an important approach to preventing weight faltering. The current study evaluates the impact of counseling on breastfeeding skills during ANC/PNC and growth monitoring on the nutritional status of infants under six months of age. The study is an experimental (case-control) study that compares the outcomes of the Standard Care Group (n=270) and Intervention Group (n=288). The research was conducted within the existing public health infrastructure of Banaskantha district, Gujarat, India. The study respondents were pregnant women who were enrolled in the last trimester of pregnancy. Women in standard care received home visits from female community health workers post-delivery up to six months of delivery, whereas women in the intervention group received the same in addition to education on effective breastfeeding practices (e.g., cross cradle hold) during ANC/PNC periods. The counseling was delivered mainly through health-spoken tutorials created at IIT-Bombay in the local language. Descriptive statistics were obtained, and statistical tests were applied to check for the efficacy of the intervention. Preliminary analysis of data at three months suggests that there was a significant impact of counseling on effective breastfeeding practices during the ANC/PNC period in reducing underweight prevalence among babies at three months. The mean weight gain (gm/day) at three months was higher in the intervention group (32.2±5.7) as compared to the standard care group (28.2±7), and the differences were statistically significant (p<0.001). 89.6% achieved weight gain of more than 25 gm/day in the intervention group compared to 65.9% in standard care. Also, in this group, underweight prevalence was nearly three times that of the intervention group at three months. In the context of COVID-19, where nutrition program delivery has become constrained, there is also a greater need for low-cost community interventions that adopt dynamic counseling methodologies to carry out impactful behavior change.

Milindkumar Ukey2, Manishkumar Fancy1, Rupal Dalal1,2,3, Marian Abraham2,3, Apoorva Nambiar2,3, Thirumal Reddy2,3, and Satish Agnihotri2,3

<sup>1</sup> Department of Health, Government of Gujarat <sup>2</sup> CTARA, IIT-Bombay 3SMDT

#### Background

Breastfeeding is the most important source of nutrition in infants and young children, but even if used exclusively it can be sub-optimal if the technical skills and practices are not appropriate, resulting in poor milk transfer to the baby. In this context, community-based interventions that involve training mothers and caregivers on skills can be an important approach to prevent weight faltering.

#### Objective

To evaluate the impact of a nutrition education intervention (counselling on effective breastfeeding practices) using Health Spoken Tutorials (HST, developed at IIT Bombay) during the ANC/PNC period and systematic growth monitoring on the nutritional status of an infant at three months of age.

#### Methodology

#### Results

The mean weight gain (gm/day) at 3 months was higher in the

intervention group (32.2±5.7) compared to the standard care group (28.2±7), and the difference was observed to be statistically significant (p<0.001). In total, 89.6% achieved a weight gain of more than 25 gm/day in the intervention group compared to 65.9% receiving standard care.



**Standard Cre**

In the context of COVID-19, where nutrition program delivery has become constrained, there is also a greater need for low-cost community interventions that adopt dynamic counselling methodologies to carry out impactful behavior change. The Health Spoken Tutorials have potential for uptake by various countries.

**Study**

**Groups**

Impact of Health Spoken Tutorials, IIT-B, on Effective Breastfeeding Practices on the Prevention and Treatment of Undernutrition at Three Months: Preliminary Findings of a Case-Control Study from the Dept. of Health, Govt of Banaskantha, Gujarat, India

### **The World Needs Pandemic Preparedness Goals**

**Anne-Mieke Vandamme1,2 and Jan-Peter Sandler3,4 on behalf of the Coronavirus Pandemic Preparedness Team5**

1 KU Leuven, Dept Microbiology, Immunology and Transplantation, Rega Institute, Clinical and Epidemiological Virology, Institute for the Future, Leuven, Belgium

<sup>2</sup> Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal

<sup>3</sup> KU Leuven, Honours Programme Transdisciplinary Insights, Institute for the Future, Leuven,

Belgium

4 KU Leuven, Master's of Philosophy, Leuven, Belgium

<sup>5</sup> https://rega.kuleuven.be/if/pandemicpreparedness/learningteam

In February 2020, KU Leuven Institute for the Future gathered a transdisciplinary learning team to consider pandemic preparedness as a wicked problem, observe the COVID-19 pandemic, and draw lessons for the future. We found pandemic preparedness in Belgium and worldwide needs improvement. Taking inspiration from the SDGs, we suggest developing Pandemic Preparedness Goals (PPGs) before the next pandemic hits to help policymakers and society implement lessons from the past for better preparedness for the next pandemic. We propose 7 PPGs. **PPG1** Prepare to limit the spread of a pandemic pathogen. **PPG2** Improve healthcare to include the entire human being, body, mind, and social relations. **PPG3** Equip governments to meet a pandemic challenge. **PPG4** Prepare to maintain societal values during a pandemic. **PPG5** Prepare to maintain societal functions during a pandemic. **PPG6** Improve and professionalize crisis communication. **PPG7** Equip citizens and institutions with adaptive capacity through fostering transdisciplinary learning and education. This list serves to initiate a process whereby PPGs with associated targets and indicators can be developed together with the many layers of society, both internationally and locally. The process itself will rebuild trust between politicians, scientists, and citizens, an essential prerequisite to pandemic preparedness. It will also contribute to increasing societal resilience, another essential quality in any crisis. Setting international goals is working for SDGs that are currently mobilizing entire societies.

We need to use the momentum of the COVID-19 pandemic to start the process. We cannot change the past, but we can reshape the future.

Anne-Mieke Vandamme1,2 and Jan-Peter Sandler3,4 on behalf of the Coronavirus Pandemic Preparedness Team5

1 KU Leuven, Dept Microbiology, Immunology and Transplantation, Rega Institute, Clinical and Epidemiological Virology, Institute for the Future, Leuven, Belgium


*Table 1. A list of 7 pandemic preparedness goals (PPGs) with associated targets, as cocreated with Belgian stakeholders, inspired by SDGs.* 

*(https://rega.kuleuven.be/if/pandemicpreparedness/potential-pandemic-preparedness-*

*goals-targets-and.pdf.*

PPG1: Prepare to limit the spread of a pandemic pathogen. Targets: improve surveillance, prepare containment and mitigation strategies, improve

host resistance. Rapid development of diagnostics is possible, broad-spectrum therapeutics are available, prepare for rapid availability of vaccines.

PPG2: Improve healthcare to include the entire human being. Targets: optimize surge capacity, improve health literacy, protection of vulnerable groups, integrate mental health into health care, integrate care for social relations into health care, set up a reflection board to evaluate cost and benefit to the integrated health of implemented measures.

PPG3: Equip governments to meet a pandemic challenge. Targets: fast and clear decision making, restrictions on rights and freedoms are legally determined, install transdisciplinary advice boards, provide a framework for consulting stakeholders, provide a framework for the enforcement of necessary measures, ensure evidence-based governance, participate in international strategies, install government alertness.

PPG4: Prepare to maintain societal values during a pandemic. Targets: protect democratic values, maintain a broad societal view, reduce health inequality, establish ethical reflection boards.

PPG5: Prepare to maintain societal functions during a pandemic. Targets: business, government and education continuity plans are in place, supply chain risks are mitigated, continuity plans exist for the self-employed, reserve funds are available.

PPG6: Improve and professionalize crisis communication. Targets: transparency about objectives, reach out to all layers of society, address the infodemic, combat spread of fake news, invest in good communication, invest in transdisciplinary consultation and communication.

PPG7: Equip citizens and institutions with creative and adaptive capacity through fostering learning and educating.Targets: establish a transdisciplinary learning culture, implement society-wide evaluation exercises, implement lessons learned to improve pandemic preparedness, include transdisciplinary skill sets in all education plans, train decision makers, advisers, media and the general population in pandemic literacy.

Conclusions: The need to improve pandemic preparedness is high, in Belgium and worldwide. The pandemic is still raging, and we need to continue to learn. Taking inspiration from the Sustainable Development Goals, or SDGs, the team has argued that the world needs Pandemic Preparedness Goals, or PPGs, and proposes a list of seven PPGs. The transdisciplinary process of developing such goals before the next pandemic hits, with clear targets and specific indicators, will help policy makers and society at large to remember the lessons from the past, to better prepare for the next pandemic, and by doing so to increase trust. Setting international goals has worked for UN SDGs that are currently mobilizing entire societies. We also need it to work for PPGs, using the momentum of the COVID-19 pandemic. We cannot change the past but we can reshape the future.

#### Acknowledgements:

Funding: King Baudouin Foundation, Department of Economy Science & Innovation, Flanders, Doctoral School of Humanities and Social Sciences. Partners: Institute of Tropical Medicine, Antwerp, Vrije Universiteit, Brussels.

Stakeholders: https://rega.kuleuven.be/if/pandemicpreparedness/stakeholder\_advisory\_group.

Interviewees: Ritva Halila, Laurette Hieber Girardet, Katelyn Jetelina, Michael Jordan, Heidi Larson, Laurence Lwoff, John Nkengasong, Peter Piot, Maria Van Kerhove, Jean-Pascal van Ypersele.

Background: In February 2020, the Institute for the Future at KU Leuven established a learning team with the explicit task of learning from the current pandemic in Belgium in order to be better prepared for a future pandemic. The purpose was to observe the current pandemic and to reflect on what went well and what could be done better in future.

Methodology: The team used the Designing Feasible Futures Framework (DF3), which iteratively cycles through four types of transdisciplinary activities to co-create systems knowledge, target knowledge and transformation knowledge (Figure 1).

#### Results

Iteration 1: systems knowledge = a list of gaps in Belgium's pandemic preparedness (Figure 2); desirable future = better societal resilience.

Iteration 2: systems knowledge = 27 lessons learned; desirable future

= pandemic preparedness goals (PPGs) (https://rega.kuleuven.be/if/ pandemicpreparedness/introducing-pandemic-preparedness-goals).

Iteration 3: systems knowledge = a list of seven potential PPGs and associated


targets (Table 1); desirable future = co- creation of those seven PPGs and their targets and indicators within all levels of society.

Currently at Iteration 4: systems knowledge = a methodology on how to locally cocreate PPGs, targets and indicators, in order to better fit to the local situation. The team's current view of a desirable future = the continuous process of co-creation builds trust among and between scientists, politicians and citizens.
