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The COVID-19 pandemic and its multiple lockdowns disrupted city life, while restrictions on physical distancing and urban activities highlighted the importance of our living environment and its links to our well-being. As part of the COVINFORM research project, this case study uses a micro-political lens to explore the specific spatial challenges which migrants faced in two of the more socially deprived neighbourhoods in Antwerp, Antwerpen-Noord and Borgerhout. This study aims to understand the specific spatial challenges migrants encountered during the pandemic and examine how they navigated and asserted agency within the confines of their living situation during this period. We combine participant observation with 25 semi-structured interviews with migrants living in two neighbourhoods in Antwerp (Flanders, Belgium), namely Borgerhout and Antwerpen-Noord. Findings show that the COVID-19 pandemic reinforced urban spatial disparities, where people’s strategies of adaptation were suddenly disrupted. Lower-income migrants were particularly affected, living in crowded housing without access to private open space. Access to public and green spaces, as well as facilities and public transport links, became more important during the pandemic, especially for those in poorer housing conditions. Within this context of spatial inequalities, migrants deployed their agency through claiming access to the city, shifting dwelling practices, and leveraging neighbourhood and community networks.

The COVID-19 pandemic has highlighted the need for structurally informed mental health services that are sensitive to social inequalities and cultural differences. Community-level services and organisations are often referred to as having the potential to play a key role in providing such services to migrants, yet not many studies have documented how these types of services have been experienced during the pandemic. The objective of our case study in Antwerp's districts of Borgerhout and Antwerpen-Noord (Belgium) was to explore how community-level responses to the mental health impact of the COVID-19 crisis were organised and experienced by first-generation migrants and members of community-level organisations. Our findings highlight the complex drivers of migrants' mental health and the unique value and indispensability of local-level services and organisations in providing mental-health related services, particularly in a crisis context like the COVID-19 pandemic. Qualities that emerged to be particularly important included organisations' awareness of local needs; their flexible nature which allows them to address bottlenecks and fill gaps left by other services; their capacity to respond holistically to a broad spectrum of needs; their ability to offer culturally sensitive care and support; and their physical accessibility. Our findings also demonstrate the fragility and fragmentation of these local-level services and initiatives. In the face of the COVID-19 crisis, this related to serious challenges to the necessary physical accessibility of organisations' services; services and initiatives becoming overloaded; and widespread fragmentation and lack of oversight of the available services forming a barrier for both service users and providers.

BACKGROUND: More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania.METHODS: A prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI].RESULTS: A stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13-5.98), caesarean section [CS] (OR 5.19, CI 2.32-11.62), previous CS (OR 2.63, CI 1.05-6.59), preeclampsia (OR 21.54, CI 5.28-87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06-5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23-27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS.CONCLUSIONS: The stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan's goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.

Background: Perinatal mental distress poses a heavy burden in low- A nd middle-income countries (LMICs). This study investigated perceptions and experiences of perinatal mental distress among women in a rural Ethiopian community, in an effort to advance understanding of cross-cultural experiences of perinatal mental distress. Methods: We employed a sequential explanatory study design. From a population-based cohort study of 1065 perinatal women in the Butajira Health and Demographic Surveillance Site, we purposively selected 22 women according to their scores on a culturally validated assessment of perinatal mental distress (the Self-Reporting Questionnaire). We examined concordance and discordance between qualitative semi-structured interview data ('emic' perspective) and the layperson-administered fully-structured questionnaire data ('etic' perspective) of perinatal mental distress. We analysed the questionnaire data using summary statistics and we carried out a thematic analysis of the qualitative data. Results: Most women in this setting recognised the existence of perinatal mental distress states, but did not typically label such distress as a discrete illness. Instead, perinatal mental distress states were mostly seen as non-pathological reactions to difficult circumstances. The dominant explanatory model of perinatal mental distress was as a response to poverty, associated with inadequate food, isolation, and hopelessness. Support from family and friends, both emotional and instrumental support, was regarded as vital in protecting against mental distress. Although some women considered their distress amenable to biomedical solution, many thought medical help-seeking was inappropriate. Integration of perspectives from the questionnaire and semi-structured interviews highlighted the important role of somatic symptoms and nutritional status. It also demonstrated the differential likelihood of endorsement of symptoms when screening tools versus in-depth interv