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BACKGROUND: Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi. METHODS: Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff. RESULTS: The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed. CONCLUSIONS: We have shown that it is possible to implement Appreciative ...

Background: Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi. Methods: Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff. Results: The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed. Conclusions: We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.

BACKGROUND: Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi. METHODS: Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff. RESULTS: The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed. CONCLUSIONS: We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.

There is conflicting evidence on the influence of weather on COVID-19 transmission. Our aim is to estimate weather-dependent signatures in the early phase of the pandemic, while controlling for socio-economic factors and non-pharmaceutical interventions. We identify a modest non-linear association between mean temperature and the effective reproduction number (Re) in 409 cities in 26 countries, with a decrease of 0.087 (95% CI: 0.025; 0.148) for a 10 °C increase. Early interventions have a greater effect on Re with a decrease of 0.285 (95% CI 0.223; 0.347) for a 5th - 95th percentile increase in the government response index. The variation in the effective reproduction number explained by government interventions is 6 times greater than for mean temperature. We find little evidence of meteorological conditions having influenced the early stages of local epidemics and conclude that population behaviour and government interventions are more important drivers of transmission. ; This work was generated using Copernicus Climate Change Service (C3S) and Copernicus Atmosphere Monitoring Service (CAMS) information [2020]. The authors would like to thank the European Centre for Medium-Range Weather Forecasts (ECMWF) that implements the C3S and CAMS on behalf of the European Union. D.R. was supported by a postdoctoral research fellowship of the Xunta de Galicia (Spain). A.G. was funded by the Medical Research Council-UK (Grant ID: MR/R013349/1), the Natural Environment Research Council UK (Grant ID: NE/R009384/1) and the European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655). R.L. was supported by a Royal Society Dorothy Hodgkin Fellowship. S.A. and S.M. were funded by the Wellcome Trust (grant 210758/Z/18/Z210758/Z/18/Z). The following funding sources are acknowledged as providing funding for the MCC Collaborative Research Network authors: J.K. and A.U. were supported by the Czech Science Foundation, project 18-22125S. S.T. was supported by the Shanghai Municipal Science and Technology Commission (Grant 18411951600). N.S. is supported by the NIEHS-funded HERCULES Center (P30ES019776). H.K. was supported by the National Research Foundation of Korea (BK21 Center for Integrative Response to Health Disasters, Graduate School of Public Health, Seoul National University). A.S., F.D.R. and S.R. were funded by the European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655). Each member of the CMMID COVID-19 Working Group contributed to processing, cleaning and interpretation of data, interpreted findings, contributed to the manuscript and approved the work for publication. The following funding sources are acknowledged as providing funding for the CMMID COVID-19 working group authors. This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: M.Q; INV-003174: K.P., M.J., Y.L., J.L.; NTD Modelling Consortium OPP1184344: C.A.B.P., G.M.; OPP1180644: S.R.P.; OPP1183986: E.S.N.). BMGF (OPP1157270: K.E.A.). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: C.A.B.P.). EDCTP2 (RIA2020EF-2983-CSIGN: H.P.G.). ERC Starting Grant (#757699: M.Q.). This project has received funding from the European Union's Horizon 2020 research and innovation programme—project EpiPose (101003688: K.P., M.J., P.K., R.C.B., W.J.E., Y.L.). This research was partly funded by the Global Challenges Research Fund (GCRF) project 'RECAP' managed through RCUK and ESRC (ES/P010873/1: A.G., C.I.J., T.J.). HDR UK (MR/S003975/1: R.M.E.). MRC (MR/N013638/1: N.R.W.; MR/V027956/1: W.W.). Nakajima Foundation (A.E.). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/136/46: B.J.Q.; 16/137/109: B.J.Q., F.Y.S., M.J., Y.L.; Health Protection Research Unit for Immunisation NIHR200929: N.G.D.; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: T.J.; NIHR200908: R.M.E.; NIHR200929: F.G.S., M.J.; PR-OD-1017-20002: A.R., W.J.E.). Royal Society (Dorothy Hodgkin Fellowship: R.L.; RP\EA\180004: P.K.). UK DHSC/UK Aid/NIHR (PR-OD-1017-20001: H.P.G.). UK MRC (MC_PC_19065—Covid 19: Understanding the dynamics and drivers of the COVID-19 epidemic using real-time outbreak analytics: A.G., N.G.D., R.M.E., S.C., T.J., W.J.E., Y.L.; MR/P014658/1: G.M.K.). Authors of this research receive funding from the UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (T.J.). Wellcome Trust (206250/Z/17/Z: A.J.K., T.W.R.; 206471/Z/17/Z: O.B.; 208812/Z/17/Z: S.C.; 210758/Z/18/Z: J.D.M., J.H., N.I.B.; UNS110424: F.K.). No funding (A.M.F., A.S., C.J.V.-A., D.C.T., J.W., K.E.A., Y.-W.D.C.). LSHTM, DHSC/UKRI COVID-19 Rapid Response Initiative (MR/V028456/1: Y.L.). Innovation Fund of the Joint Federal Committee (01VSF18015: F.K.). Foreign, Commonwealth and Development Office/Wellcome Trust (221303/Z/20/Z: M.K.). ; Peer reviewed

There is conflicting evidence on the influence of weather on COVID-19 transmission. Our aim is to estimate weather-dependent signatures in the early phase of the pandemic, while controlling for socio-economic factors and non-pharmaceutical interventions. We identify a modest non-linear association between mean temperature and the effective reproduction number (Re) in 409 cities in 26 countries, with a decrease of 0.087 (95% CI: 0.025; 0.148) for a 10 °C increase. Early interventions have a greater effect on Re with a decrease of 0.285 (95% CI 0.223; 0.347) for a 5th - 95th percentile increase in the government response index. The variation in the effective reproduction number explained by government interventions is 6 times greater than for mean temperature. We find little evidence of meteorological conditions having influenced the early stages of local epidemics and conclude that population behaviour and government interventions are more important drivers of transmission.

There is conflicting evidence on the influence of weather on COVID-19 transmission. Our aim is to estimate weather-dependent signatures in the early phase of the pandemic, while controlling for socio-economic factors and non-pharmaceutical interventions. We identify a modest non-linear association between mean temperature and the effective reproduction number (Re) in 409 cities in 26 countries, with a decrease of 0.087 (95% CI: 0.025; 0.148) for a 10 °C increase. Early interventions have a greater effect on Re with a decrease of 0.285 (95% CI 0.223; 0.347) for a 5th - 95th percentile increase in the government response index. The variation in the effective reproduction number explained by government interventions is 6 times greater than for mean temperature. We find little evidence of meteorological conditions having influenced the early stages of local epidemics and conclude that population behaviour and government interventions are more important drivers of transmission.