Digital psychiatry in low-and-middle-income countries:New developments and the way forward

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

Breast cancer awareness in reproductive women in the low-and middle-income countries:a scoping review

Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.

Overcoming geographical and socioeconomic limitations in colorectal cancer screening

Despite colorectal cancer’s(CRC)high global incidence,residents of low-and middle-income countries,as well as low-income minorities in advanced economies have low screening rates.Observational studies demonstrate that in these groups higher incidence of CRC is observed,yet screening rates remain low for consistent reasons.Low income,low educational background,and lack of awareness in combination with inadequate social security of certain population groups impede access and compliance rates to CRC screening.On the other hand,despite the global availability of multiple screening approaches(colonoscopy,sigmoidoscopy,faecal occult blood test,faecal immunochemical test,computed tomography-colonography,etc.)with proven diagnostic validity,many low-income countries still lack established screening programs.The absence of screening guidelines in these countries along with the heterogeneity of guidelines in the rest of the world,demonstrate the need for global measures to tackle this issue comprehensively.An essential step forward is to develop a global approach that will link specific elements of screening with the incidence and available resources in each country,to ensure the achievement of at least a minimum screening program in low-income countries.Utilizing cheaper,cost-effective techniques,which can be carried out by less specialized healthcare providers,might not be equivalent to endoscopy for CRC screening but seems more realistic for areas with fewer resources.Awareness has been highlighted as the most pivotal element for the effective implementation of any screening program concerning CRC.Moreover,multiple studies have demonstrated that outreach strategies and community-based educational programs are associated with encouraging outcomes,yet a centrally coordinated expansion of these programs could provide more consistent results.Additionally,patient navigator programs,wherever implemented,have increased CRC screening and improved follow-up.Therefore,global coordination and patient education seem to be the main areas on which policy making needs to focus.

Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

Development of low-and non-waste technologies in China

Water pollution is one of the most serious environmental problems in China. In order to reduce the discharge of waste water per RMB 1000 Yuan of the industrial output value, the author offered a proposal on the development of low-and non-waste technologies as follows: 1. Changing distribution and structures of industrial production; 2. Innovation in techniques and eliminating industrial wastewater in the process of manufacture; 3. Comprehensive utilization of wastes and wastewater; 4. Strengthening environmental management and supervision of industrial enterprises.

Lessons from the coronavirus disease 2019(COVID-19)pandemic response in China,Italy,and the U.S.:a guide for Africa and low-and middle-income countries

Africa can be"left behind"after other advanced continents recover from the coronavirus disease 2019(COVID-19)pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially adaptable,effective and innovative strategies from China,Italy,and the U.S.The purpose is to help African countries with weaker healthcare systems better respond to the COVID-19 pandemic.China,being the first to report COVID-19 infection swiftly swung into anti-epidemic actions by the use of innovative risk communication and epidemic containment strategies.Italy and U.S.,the next rapidly hit countries after China,however,experienced sustained infections and deaths due to delayed and ineffective response.Many African countries responded poorly to the COVID-19 pandemic as evidenced by the limited capacity for public health surveillance,poor leadership,low education and socioeconomic status,among others.Experience from China,Italy and U.S.suggests that a better response to the COVID-19 pandemic in Mrica needs a strong public health leadership,proactive strategies,innovative risk communication about the pandemic,massive tests and isolation,and scaling-up community engagement.Lastly,African countries must collaborate with other countries to facilitate real-time information and experience exchange with other countries to avoid being left behind.

Aero-Hydrodynamic Coupled Dynamic Characteristics of Semi-Submersible Floating Offshore Wind Turbines Under Inflow Turbulence

In this study,the frequency characteristics of the turbulent wind and the effects of wind-wave coupling on the low-and high-frequency responses of semi-submersible floating offshore wind turbines(FOWT)are investigated.Various wave load components,such as first-order wave loads,combined first-and second-order difference-frequency wave loads,combined first-and second-order sum-frequency wave loads,and first-and complete second-order wave loads are taken into consideration,while different turbulent environments are considered in aerodynamic loads.The com-parison is based on time histories and frequency spectra of platform motions and structural load responses and statistical values.The findings indicate that the second-order difference-frequency wave loads will significantly increase the natural frequency of low-frequency motion in the responses of the platform motion and structure load of the semi-submersible platform,which will cause structural fatigue damage.Under the action of turbulent wind,the influences of second-order wave loads on the platform motion and structural load response cannot be ignored,especially under extreme sea conditions.Therefore,in order to evaluate the dynamic responses of semi-submersible FOWT more accurately,the actual environment should be simulated more realistically.

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.

Knowledge translation for public health in low-and middle-income countries:a critical interpretive synthesis

Background:Effective knowledge translation allows the optimisation of access to and utilisation of research knowledge in order to inform and enhance public health policy and practice.In low-and middle-income countries,there are substantial complexities that affect the way in which research can be utilised for public health action.This review attempts to draw out concepts in the literature that contribute to defining some of the complexities and contextual factors that influence knowledge translation for public health in low-and middle-income countries.Methods:A Critical Interpretive Synthesis was undertaken,a method of analysis which allows a critical review of a wide range of heterogeneous evidence,through incorporating systematic review methods with qualitative enquiry techniques.A search for peer-reviewed articles published between 2000 and 2016 on the topic of knowledge translation for public health in low-and middle-income countries was carried out,and 85 articles were reviewed and analysed using this method.Results:Four main concepts were identified:1)tension between‘global’and‘local’health research,2)complexities in creating and accessing evidence,3)contextualising knowledge translation strategies for low-and middle-income countries,and 4)the unique role of non-government organisations in the knowledge translation process.Conclusion:This method of review has enabled the identification of key concepts that may inform practice or further research in the field of knowledge translation in low-and middle-income countries.

Cervical cancer screening in developing countries at a crossroad:Emerging technologies and policy choices

Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.

Management of neuroblastoma in limited-resource settings

BACKGROUND Neuroblastoma(NB)is a heterogeneous disease with variable outcomes among countries.Little is known about NB in low-and middle-income countries(LMICs).AIM The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries(HICs).METHODS PubMed,Global Health,Embase,SciELO,African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB,LMICs and outcomes.Only English language manuscripts and abstracts were included.A descriptive review was done,and tables illustrating the findings were constructed.RESULTS Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available.The disease characteristics varied among countries for the following variables:sex,age at presentation,MYCN amplification,stage and outcome.LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs.Implementation of evidence-based treatment protocols was still a barrier to care.Many socioeconomic variables also influenced the diagnosis,management and followup of patients with NB.CONCLUSION Patients presented at a later age with more advanced disease in LMICs.Management was limited by the lack of resources and genetic studies for improved NB classification.Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources.

Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal

To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of m Health for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.

Continuity of cancer care in the era of COVID-19 pandemic: Role of social media in low- and middle-income countries

A novel coronavirus(severe acute respiratory syndrome coronavirus 2)first detected in Wuhan,China,has spread rapidly since December 2019,causing more than 1.4 million confirmed infections and 15000 fatalities(as of April 9,2020).The outbreak was declared a pandemic by the World Health Organization on March 11,2020.Isolation,quarantine,social distancing,and community containment measures were rapidly implemented in China,which helped in containing the disease.However,other low-and middle-income countries lack such extensive infrastructural capacities and resources.Cancer patients are particularly at high risk of infection and mortality due to immunosuppression.Hence self-quarantine is recommended for them.Additionally,it is becoming impossible to maintain the continuity of care when cancer patients have to avoid physical visits.Social media applications,e.g.,Facebook and WhatsApp,can provide educational group program and psychosocial support to these patients while maintain social distancing.We have analyzed their use in this review article and how it could change the follow-up of cancer patients during this pandemic.

Value of multi-quadrants biopsy:Pooled analysis of 11 population-based cervical cancer screening studies

Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.

Association between Active School Travel and Depressive Symptoms among 51,702 Adolescents in 26 Low- and Middle-Income Countries

Little is known about the role of active school travel(AST)on mental health among adolescents.Thus,this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low-and middle-income countries(LMICs).Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3%boys).Both depressive symptoms and AST were assessed by a single question self-reported measure,respectively.Participants who reported having 5 days or above were considered as AST.Multivariable logistic regression analysis(accounting for sampling weights)was performed while controlling for gender,age,physical activity,sedentary behavior,and food insecurity,and a countrywide meta-analysis was undertaken.The prevalence of depressive symptoms and AST were 30.1%and 37.0%,respectively.Compared with those not having AST,adolescents with AST were less likely to have self-reported depressive symptoms(OR=0.88,95%CI:0.85-0.93)regardless of gender.Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12%lower odds for depressive symptoms(OR=0.88;95%CI:0.82-0.94)but with a moderate between-country heterogeneity(I^(2)=59.0%).Based on large samples of adolescents from LMICs,it would be expected that AST may play a critical role in preventing adolescent depression worldwide.However,it is necessary to consider more country-specific factors when implementing AST-related mental health interventions.Future studies should adopt the solid study design to confirm or negate our researchfindings.

Environmental health perspectives for low- and middle-income countries

In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramatically. Common global environmental issues, such as air pollution and noise pollution, are associated with lasting impacts on health and contribute significantly to the overall burden of disease. Moreover, a global disparity exists between the burden of such environmental health issues and the global resources available to address this issue. To alleviate the environmental health impacts and ensure a sustainable future for human beings, China has made an important contribution to improving access to ecological protection, environmental governance, patriotic health campaigns, smart city construction, and so on. Experiences gained in China may be useful for some other countries, particularly the low- and middle-income countries with limited sources.

A Review of Sensorless Control Methods for AC Motor Drives

In recent years,the application of sensorless AC motor drives is expanding in areas ranging from industrial applications to household electrical appliances.As is well known,the advantages of sensorless motor drives include lower cost,increased reliability,reduced hardware complexity,better noise immunity,and less maintenance requirements.With the development of modern industrial automation,more advanced sensorless control strategies are needed to meet the requirements of applications.For sensorless motor drives at low-and zero-speed operation,inverter nonlinearities and motor parameter variation have significant impact on the stability of control system.Meanwhile,high observer’s bandwidth is required in high-speed region.This paper introduces the state of art of recent progress in sensorless AC motor drives.In addition,this paper presents the sensorless control strategies we investigated for practical industrial and household applications.Both advanced sensorless drives of induction motor(IM)and permanent magnet synchronous motor(PMSM)are presented in this paper.

Modeling vaccination strategies with limited early COVID-19 vaccine access in low-and middle-income countries:A case study of Thailand

Low-and middle-income countries faced significant challenges in accessing COVID-19 vaccines during the early stages of the pandemic.In this study,we utilized an agestructured modeling approach to examine the implications of various vaccination strategies,vaccine prioritization,and vaccine rollout speeds in Thailand,an upper-middleincome country experiencing vaccine shortages during the early stages of the pandemic.The model directly compares the effectiveness of several vaccination strategies,including the heterologous vaccination where CoronaVac(CV)vaccine was administered as the first dose,followed by ChAdOx1 nCoV-19(AZ)vaccine as the second dose,under varying disease transmission dynamics.We found that the traditional AZ homologous vaccination was more effective than the CV homologous vaccination,regardless of disease transmission dynamics.However,combining CV and AZ vaccines via either parallel homologous or heterologous vaccinations was more effective than relying solely on AZ homologous vaccination.Additionally,prioritizing vaccination for the elderly aged 60 years and above was the most effective way to reduce mortality when community transmission is wellcontrolled.On the other hand,prioritizing workers aged 20e59 was most effective in lowering COVID-19 cases,irrespective of the transmission dynamics.Lastly,despite the vaccine prioritization strategy,rapid vaccine rollout speeds were crucial in reducing COVID-19 infections and deaths.These findings suggested that in low-and middle-income countries where early access to high-efficacy vaccines might be limited,obtaining any accessible vaccines as early as possible and using them in parallel with other higherefficacy vaccines might be a better strategy than waiting for and relying solely on higher-efficacy vaccines.

Can health technology assessments assist the global campaign against poverty?

Although a key tenant of the Sustainable Development Goals is to achieve universal health coverage,the global drug gap persists-cver a third of the global population lack access to essential medicines.Without access to affordable drugs,people have worse health outcomes,higher medical expenses,and productivity loss,pushing them into poverty.Health technology assessments(HTAs)offer an opportunity to decrease the global drug gap and increase access to essential medicines by overcoming barriers to medicine access.These barriers include drug procurement,drug affordability for payers and patients,a patienfs ability to obtain essential medicines,and health system capacity.Using HTAs can therefore close the global drug gap by increasing access to affordable essential medicines.In turn,people have better health outcomes,spend less money on medical care,and can have better productivity.Ultimately,use of HTAs can lift the population out of poverty and force fewer people into poverty by creating better health outcomes at affordable prices.

Digital Social and Emotional Literacy Intervention for Vulnerable Children in Brazil:Participants’Experiences

Social emotional literacy(SEL)interventions are widely implemented through schools,with growing evidence for a range of positive child outcomes.Increasingly,such interventions are delivered on online platforms.To date,there is limited evidence about digital SEL interventions in low-and middle-income countries(LMIC).The aim of this study was to explore the perceptions and experiences of children,parents and facilitator of the potential value of addressing SEL via tailored digital intervention.The intervention was designed to help children,in Brazil,to cope during the first COVID-19 pandemic lockdown.The intervention was delivered via a digital platform to groups of three children for 45 min per week for nine.Thirteen children,nine parents and nine facilitators were interviewed following the completion of the intervention.The data was analysed through a codebook thematic approach,which led to three themes:empowerment,participatory aspects of the intervention and digital adaptation.Overall,children’s SEL development was reported to be supported during the COVID-19 pandemic,by the application of new skills outside the sessions.Children reported a number of empowering factors such as being heard and belonging.A range of useful participatory tools were identified including storytelling,games,drawings and videos.Blended SEL interventions involving both face-to-face and web-based facilitation could be developed within a tiered model of universal mental health promotion and targeted prevention.Access to online platforms would increase reach to large numbers of children in LMIC,especially in contexts of disadvantage.