PSBI Formative Research Study Group--------Wammanda, R.D.Hassan, L.Hassan, I.Anyebe, E.E.2024-05-032024-05-032022PSBI Formative Research Study Group: Barriers to optimal care and strategies to promote safe and optimal management of sick young infants during the COVID-19 pandemic: A multi-country formative research study. J Glob Health 2022;12:05023.12:05023.doi: 10.7189/jogh.12.05023https://uilspace.unilorin.edu.ng/handle/123456789/13293A 7-country paper on sick infants during a pandemic. Sick young infants are among the most vulnerable groups needing protection during the pandemic, so the findings provide valuable insights for policymakers and an urgent need for clear guidance for care of normal and sick young infants during the pandemic. The challenges of health systems in countries need to be flexible, including the need for adaptive and decentralised decision-making autonomy to mobilise resources for training and service provision, especially in times of emergency. Pragmatic solutions to optimise care are emphasisedBackground: Essential health and nutrition services for pregnant women, newborns, and children, particularly in low- and middle-income countries (LMICs), are disrupted by the COVID-19 pandemic. This formative research was conducted at five LMICs to understand the pandemic’s impact on barriers to and mitigation for strategies of care-seeking and managing possible serious bacterial infection (PSBI) in young infants. Methods: We used a convergent parallel mixed-method design to explore the possible factors influencing PSBI management, barriers, and facilitators at three levels: 1) national and local policy, 2) the health systems, public and private facilities, and 3) community and caregivers. We ascertained trends in service provision and utilisation across pre-lockdown, lockdown, and post-lockdown periods by examining facility records and community health worker registers. Results: The pandemic aggravated pre-existing challenges in the identification of young infants with PSBI; care-seeking, referral, and treatment due to several factors at the policy level (limited staff and resource reallocation), health facility level (staff quarantine, sub-optimal treatment in facilities, limited duration of service availability, lack of clear guidelines on the management of sick young infants, and inadequate supplies of protective kits and essential medicines) and at the community level (travel restrictions, lack of transportation, and fear of contracting the infection in hospitals). Care-seeking shifted to faith healers, traditional and informal private sources, or home remedies. However, caregivers were willing to admit their sick young infants to the hospital if advised by doctors. A review of facility records showed low attendance (<50%) of sick young infants in the OPD/emergencies during lockdowns in Bangladesh, India (both sites) and Pakistan, but it gradually increased as lockdowns eased. Stakeholders suggested aspirational and pragmatic mitigation strategies. Conclusions: We obtained useful insights on health system preparedness during catastrophes and strategies to strengthen services and improve utilisation re garding PSBI management. The current pandemic provides an opportunity for implementing various mitigation strategies at the policy, health system, and community levels to improve preparedness.enBarriersPossible serious bacterial infection (PSBI)Covid-19 pandemicYoung infantsOptimal careArticle