UNCTAD  [to 16 February 2014]
http://unctad.org/en/Pages/Home.aspx

12 Feb 2014
Global imports of information technology goods approach $2 trillion, UNCTAD figures show

12 Feb 2014
Job creation critical for durable economic progress in Nepal

USAID [to 16 February 2014]
http://www.usaid.gov/

USAID Highlights Progress on Wildlife Trafficking Crisis
February 13, 2014
This week, U.S. Agency for International Development Assistant Administrator Eric Postel will represent USAID at the London Conference on Illegal Wildlife Trade, which brings together more than 35 heads of state, foreign ministers, and other high-level government officials to bring global attention to the crisis of wildlife trafficking and discuss solutions for combating this pernicious illegal trade.

USAID awards contract to support countries in transition
February 12, 2014
Yesterday, the U.S. Agency for International Development (USAID)  awarded the Support Which Implements Fast Transitions IV (SWIFT) indefinite quantity contract. SWIFT is a five-year agreement with a potential of up to $2.5 billion. The contract will help advance peace and democracy in countries that are in transition. This is the fourth iteration of the SWIFT contract.

Through SWIFT, USAID is able to provide fast, short-term assistance to countries.  The program focuses on political transition and stabilization needs. Partners rapidly deploy initial start-up teams to countries in order to set up offices; hire local staff; develop, award, and administer small grants, primarily to local groups based on USAID guidance; and implement other activities to meet critical short-term needs in political and/or post-conflict transitions.

The nine SWIFT partners, which are all U.S. based companies, are: AECOM, Casals and Associates, Chemonics International, Creative Associates International, DAI, International Relief and Development (IRD), International Resources Group (IRG)/Engility, Management Systems International (MSI), and RTI International.

“SWIFT partners are critical to the success of USAID’s programs in transitioning countries. They are expected to overcome significant challenges posed by conflict affected areas or otherwise unstable transition countries where USAID’s operates,” said Nealin Parker, Acting Director of USAID’s Office of Transition Initiatives.

SWIFT supports a hands-on management and monitoring structure where USAID has daily oversight with implementing partners. Since it’s creation in 1994, SWIFT has helped USAID implement 25,000 activities in 40 countries worldwide

The American Journal of Bioethics
Volume 14, Issue 2, 2014
http://www.tandfonline.com/toc/uajb20/current#.Uv_UyrQt6F9

Connecting Health Systems Research Ethics to a Broader Health Equity Agenda
Bridget Pratta
pages 1-3
DOI: 10.1080/15265161.2014.881213
[No abstract]

Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration
Adnan A. Hydera, Abbas Rattania, Carleigh Krubinera, Abdulgafoor M. Bachania & Nhan T. Tranb
DOI: 10.1080/15265161.2013.868950
pages 28-37
http://www.tandfonline.com/doi/abs/10.1080/15265161.2013.868950#.Uv_VlrQt6F8
Abstract
Given that health systems research (HSR) involves different aims, approaches, and methodologies as compared to more traditional clinical trials, the ethical issues present in HSR may be unique or particularly nuanced. This article outlines eight pertinent ethical issues that are particularly salient in HSR and argues that the ethical review process should be better tailored to ensure more efficient and appropriate oversight of HSR with adequate human protections, especially in low- and middle-income countries. The eight ethical areas we discuss include the nature of intervention, types of research subjects, units of intervention and observation, informed consent, controls and comparisons, risk assessment, inclusion of vulnerable groups, and benefits of research. HSR involving human participants is necessary to ensure health systems strengthening and quality of care and to guide public policy intelligently. Health systems researchers must carefully define their intent and goals and openly clarify the values that may influence the premises and design of protocols. As new types of population-level research activities become more commonplace, it is critical that institutional review board (IRB) and research ethics committee (REC) review processes evolve to evaluate these research protocols in ways that address the nuanced features of these studies.

Vulnerability as a Concept for Health Systems Research
Margaret Meek Lange
pages 41-43

Ethical Review of Health Systems Research in Low- and Middle-Income Countries: Research–Treatment Distinction and Intercultural Issues
Shivam Gupta
pages 44-46

BMC Health Services Research
[PDF] Trends in the types and quality of childhood immunisation research output from Africa 1970-2010: mapping the evidence base
S Machingaidze, GD Hussey, CS Wiysonge -, 2014

Abstract
Background: Over the past four decades, extraordinary progress has been made in establishing and improving childhood immunization programmes around Africa. In order to ensure effective and sustainable positive growth of these childhood immunisations programmes, the development, adaptation and implementation of all interventions (programme activities, new vaccines, new strategies and policies) should be informed by the best available local evidence.

Methods: An assessment of the peer-reviewed literature on childhood immunization research published in English from 1970 to 2010 was conducted in PubMed and Africa-Wide databases. All study types were eligible for inclusion. A standard form was used to extract information from all studies identified as relevant and entered into a Microsoft Access database for analysis.

Results: Our initial search yielded 5,436 articles from the two databases, from which 848 full text articles were identified as relevant. Among studies classified as clinical research (417), 40% were clinical trials, 24% were burden of disease/epidemiology and 36% were other clinical studies. Among studies classified as operational research (431), 77% related to programme management, 18% were policy related and 5% were related to vaccine financing. Studies were conducted in 48 African countries with six countries (South Africa, The Gambia, Nigeria, Senegal, Guinea-Bissau and Kenya) accounting for 56% of the total research output. Studies were published in 152 different journals with impact factors ranging from 0.192 to 53.29; with a median impact factor of 3.572.

Conclusion: A similar proportion of clinical versus operational research output was found. However, an uneven distribution across Africa was observed with only six countries accounting for over half of the research output. The research conducted was of moderate to high quality, with 62% being published in journals with 2010 impact factors greater than two. Urgent attention should be given to the development of research capacity in low performing countries around Africa, with increased focus on the process of turning immunisations programme research evidence into policy and practice, as well as increased focus on issues relating to vaccine financing and sustainability in Africa.

Disaster Medicine and Public Health Preparedness
Volume  7  – Issue 06 – December 2013
http://journals.cambridge.org/action/displayIssue?jid=DMP&tab=currentissue

Commentary
The Promise and Pitfalls of Community Resilience
Lori Uscher-Pinesa1 c1, Anita Chandraa1 and Joie Acostaa1
a1 RAND Corporation, Arlington, Virginia

Abstract
An important shift in terminology has occurred in emergency preparedness, and the concept of community resilience has become ubiquitous. Although enhancing community resilience is broader than preparedness, and emphasizes a distinct set of activities and participants, the terms are often used interchangeably. The implications of this shift have not been fully explored. This commentary describes the potential promise and pitfalls of the concept of community resilience and recommends strategies to overcome its limitations. We believe that resilience has the power to dramatically change this field in immense, positive ways, but some important challenges such as confusion about definitions and lack of accountability must first be overcome. (Disaster Med Public Health Preparedness. 2013;7:603-606)

Globalization and Health
[Accessed 15 February 2014]
http://www.globalizationandhealth.com/

Research
Health systems performance assessment in low-income countries: learning from international experiences
Christine Kirunga Tashobya, Valéria Campos da Silveira, Freddie Ssengooba, Juliet Nabyonga-Orem, Jean Macq and Bart Criel
Author Affiliations
Globalization and Health 2014, 10:5  doi:10.1186/1744-8603-10-5
Published: 13 February 2014

Abstract (provisional)
Background
The study aimed at developing a set of attributes for a ‘good’ health system performance assessment (HSPA) framework from literature and experiences in different contexts and using the attributes for a structured approach to lesson learning for low-income countries (LICs).

Methods
Literature review to identify relevant attributes for a HSPA framework; attribute validation for LICs in general, and for Uganda in particular, via a high-level Ugandan expert group; and, finally, review of a selection of existing HSPA frameworks using these attributes.

Results
Literature review yielded six key attributes for a HSPA framework: an inclusive development process; its embedding in the health system’s conceptual model; its relation to the prevailing policy and organizational set-up and societal context; the presence of a concrete purpose, constitutive dimensions and indicators; an adequate institutional set-up; and, its capacity to provide mechanisms for eliciting change in the health system. The expert group contextualized these attributes and added one on the adaptability of the framework.

Lessons learnt from the review of a selection of HSPA frameworks using the attributes include: it is possible and beneficial to involve a range of stakeholders during the process of development of a framework; it is important to make HSPA frameworks explicit; policy context can be effectively reflected in the framework; there are marked differences between the structure and content of frameworks in high-income countries, and low- and middle-income countries; champions can contribute to put HSPA high on the agenda; and mechanisms for eliciting change in the health system should be developed alongside the framework.

Conclusion
It is possible for LICs to learn from literature and the experience of HSPA in other contexts, including HICs. In this study a structured approach to lesson learning included the development of a list of attributes for a ‘good’ HSPA framework. The attributes thus derived can be utilized by LICs like Uganda seeking to develop/adjust their HSPA frameworks as guidelines or a check list, while taking due consideration of the specific context. The review of frameworks from varied contexts, highlighted varied experiences which provide lessons for LICs.

Journal of Development Economics
Volume 108,   In Progress   (May 2014)
http://www.sciencedirect.com/science/journal/03043878/106

Labor coercion and the accumulation of human capital
Original Research Article
Pages 32-53
Gustavo J. Bobonis, Peter M. Morrow
Abstract
We estimate the impact of the income earned in the host country on return migration of labor migrants from developing countries. We use a three-state correlated competing risks model to account for the strong dependence of labor market status and the income earned. Our analysis is based on administrative panel data of recent labor immigrants from developing countries to The Netherlands. The empirical results show that intensities of return migration are U-shaped with respect to migrants’ income, implying a higher intensity in low- and high- income groups. Indeed, the lowest-income group has the highest probability of return. We also find that ignoring the interdependence of labor market status and the income earned leads to an overestimating the income effect on departure.

The Lancet  
Feb 15, 2014  Volume 383  Number 9917  p575 – 668  e12 – 14
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Protecting children in conflict
The Lancet

Preview |
The UN Convention on the Rights of the Child states that children have rights to protection, health, education, and fair treatment. For the children killed, tortured, raped, and abused in conflicts, these rights are far beyond reach.

Last week, a report of the UN Secretary-General on the situation of children and armed conflict in Syria detailed grave violations against children, committed by all parties. More than 10 000 children are estimated to have been killed since March, 2011, many more injured, and countless psychologically affected. The document contains reports of the imprisonment, torture, and murder of children, and their exposure to unthinkable cruelties. Sexual violence is used to harm, humiliate, and intimidate young victims and those forced to witness. Children have been recruited into warfare, abducted for ransom, and used as human shields. They have lost families, homes, schools, and health care.

Tragically, similar reports have surfaced from other nations gripped by conflict. Brutality against children in the Central African Republic is said to be at unprecedented levels; children are being beheaded and maimed amid widespread sexual violence, and an estimated 6000 are associated with armed groups. For children who escape conflict, the psychological scars from witnessing horrific events endure. In South Sudan, orphaned and displaced children will struggle to find their emotional needs met in a country battered by decades of civil war, many living in camps where their security and health are threatened. Children born as refugees might not have birth certificates, crucial to ensure they can access their rights.

By committing atrocities to children, fighters destroy their nation’s future. Damage to children’s health, education, and psychological wellbeing will delay a country’s recovery; without decisive action, a generation in every war zone could become the lasting casualties. Better protection of children is paramount. The Syrian Government has legislated greater child protection, but violations threaten to continue while war lasts. During the conflicts and the aftermath, international communities must seek to heal emotional wounds and safeguard children’s rights.

The Lancet  
Feb 15, 2014  Volume 383  Number 9917  p575 – 668  e12 – 14
http://www.thelancet.com/journals/lancet/issue/current

Comment
Protecting health: the global challenge for capitalism
Richard Horton a, Selina Lo a
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962712-9/fulltext

The quest to secure economic growth, after a financial crisis that raised serious questions about capitalism’s ability to protect and sustain the wellbeing of populations in rich and poor countries alike, is the overriding political priority for many governments today. And those prospects for growth seem good. The World Bank reported in January, 2014, that “advanced economies are turning the corner” and that “developing countries [will] regain strength after two weak years”.1 Specifically, global growth is expected to be 3·2% in 2014, rising to 3·5% by 2016. In high-income countries, growth is predicted to be 2·2% in 2014, rising to 2·4% in 2016. And for developing countries, the expectations are little short of spectacular: projected growth of 5·3% in 2014, rising to 5·7% in 2016. By 2015 it is projected that sub-Saharan Africa will host seven of the world’s fastest growing economies. The World Bank concludes that the world is “finally emerging from the global financial crisis”.

This change in economic fortune should be good news for health. It will mean more resources to invest not only in the health sector, but also in related sectors that shape and influence health, such as education and housing. However, there are disparities between regions. The World Bank1 estimates that China can expect growth of 7·7% in 2014. Sub-Saharan Africa’s growth will likely be 6·4%, excluding South Africa. South Asia should come in at 5·7%, with India at 6·2%. But Latin America and the Middle East are expected to deliver dismal 2·9% and 2·8% growth rates, respectively. Meanwhile, some countries will do less well than their neighbours. Pakistan, 3·4% growth. South Africa, 2·7%. Brazil, 2·4%. Egypt, 2·3%. Central and eastern Europe, 2·1%. Iran, 1%. These between-country disparities will be compounded by within-country inequalities. The World Bank has less to say on this issue. But the lack of inclusive growth within a nation—that is, the exclusion of sectors of the population from the overall benefits of economic growth which should include improved health—will deepen inequality in ways that headline gross domestic product figures fail to reveal.

Economic growth alone will not deliver good health to the most vulnerable sectors of society without addressing the intertwined global factors that challenge or destroy healthy lives. Beyond the economy, recent extreme weather events experienced across most parts of the world are tentative (and incompletely understood) signs that the effects of climate change are already with us. The effect that climate has on the agriculture sector and food security, and the likely impact on nutrition and health outcomes, requires further deep evaluation and cooperation between disciplines. The worsening conflict in Syria, and the continued violence in Iraq, Afghanistan, South Sudan, and the Central African Republic, show the frightening ability of violence to damage health and wellbeing, not only directly, but also indirectly through the social chaos violence inevitably causes. Recent episodes of civil strife in Turkey, Thailand, and Brazil prove that despite considerable health gains, the political systems within which those health gains have taken place are fragile and unstable—lessons that all societies need to relearn, no matter how secure they feel today.

These challenges can be addressed only by reaching beyond the health sector. This might seem an obvious notion but its common understanding and application in global policy debate is weak. Decisions made in different political domains rarely have health at the core of their thinking.

One great gap in thinking about the future of health and wellbeing are the arrangements we put in place to organise our international institutions and policies to sustain the fortunes of societies. These arrangements are inherently political, as Ole Petter Ottersen and his colleagues argue in the final report of The Lancet—University of Oslo Commission on Global Governance for Health.2 They are about power. They are about elites. And they are about a rigid consensus among these powerful elites that prevents most attempts to question the norms on which political decisions are made. Yet elites are only as powerful as the systems that support the status quo. And global systems, such as those in trade, investment, or security, should (but do not always) have mechanisms for civil society participation and links with international norms that already exist to protect health.

The Commission addresses seven political domains that shape health and contribute to inequity within populations: finance, intellectual property, trade and investment treaties, food, corporate activity, migration, and armed conflict. It examines the obstacles to effective global governance for health. And finally, it proposes mechanisms to improve the accountability of all those who influence health through these different sectors. Proposals that could better articulate a way in which civil society engages in global policy, together with ideas for how international institutions could be mandated to produce health equity impact assessments, are worthy of consideration and debate.

The Commission includes contributors from 13 countries, including India, Brazil, Thailand, Tanzania, Ghana, Namibia, South Africa, and the occupied Palestinian territory. They have provided an opportunity to pause and reflect on a problem of emerging and serious importance. The era after the Millennium Development Goals is one that will be substantially more complex than today. The link between poverty and sustainability is not simple. Exclusive anti-poverty measures will not solve some of the biggest health threats people face. Solutions will require specific input from different regions, countries, and individuals—and a more critical understanding than has hitherto been displayed by policy makers of the determinants of human survival and wellbeing. Success will demand courage and flexibility to challenge the consensus that so inhibits the changes needed to bring about greater equity. This Commission can, we hope, be a contribution to this need for greater critical understanding and challenge.

We would like to thank all of the Commissioners for their contributions to this project—and especially Professor Ole Petter Ottersen for leading this work—and are grateful for the support of the Commission from the Norwegian Agency for Development Cooperation, the Norwegian Ministry of Foreign Affairs, the Norwegian Ministry of Education and Research, the Board of the University of Oslo, the University of Oslo’s Institute of Health and Society and Centre for Development and the Environment, and the Harvard Global Health Institute.

References
1 The World Bank. Global economic prospects: coping with policy normalization in high-income countries. Washington, DC: The World Bank, 2014.
2 Ottersen OP, Dasgupta J, Blouin C, et al. The political origins of health inequity: prospects for change. Lancet 2014. published online Feb 11. http://dx.doi.org/10.1016/S0140-6736(13)62407-1.

The Lancet Commissions
-University of Oslo Commission on Global Governance for Health
The political origins of health inequity: prospects for change
Ole Petter Ottersen, Jashodhara Dasgupta, Chantal Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, Bience P Gawanas, Rita Giacaman, John Gyapong, Jennifer Leaning, Michael Marmot, Desmond McNeill, Gertrude I Mongella, Nkosana Moyo, Sigrun Møgedal, Ayanda Ntsaluba, Gorik Ooms, Espen Bjertness, Ann Louise Lie, Suerie Moon, Sidsel Roalkvam, Kristin I Sandberg, Inger B Scheel
Full Text | PDF

Executive summary
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. Although the health sector has a crucial role in addressing health inequalities, its efforts often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.

This is the starting point of The Lancet—University of Oslo Commission on Global Governance for Health. With globalisation, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power: states, transnational corporations, civil society, and others. The decisions, policies, and actions of such actors are, in turn, founded on global social norms. Their actions are not designed to harm health, but can have negative side-effects that create health inequities. The norms, policies, and practices that arise from global political interaction across all sectors that affect health are what we call global political determinants of health.

The Commission argues that global political determinants that unfavourably affect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works. There is an urgent need to understand how public health can be better protected and promoted in the realm of global governance, but this issue is a complex and politically sensitive one. Global governance processes involve the distribution of economic, intellectual, normative, and political resources, and to assess their effect on health requires an analysis of power.

This report examines power disparities and dynamics across a range of policy areas that affect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict. The case analyses show that in the contemporary global governance landscape, power asymmetries between actors with conflicting interests shape political determinants of health.

Key messages

:: The unacceptable health inequities within and between countries cannot be addressed within the health sector, by technical measures, or at the national level alone, but require global political solutions

:: Norms, policies, and practices that arise from transnational interaction should be understood as political determinants of health that cause and maintain health inequities

:: Power asymmetry and global social norms limit the range of choice and constrain action on health inequity; these limitations are reinforced by systemic global governance dysfunctions and require vigilance across all policy arenas

:: There should be independent monitoring of progress made in redressing health inequities, and in countering the global political forces that are detrimental to health

:: State and non-state stakeholders across global policy arenas must be better connected for transparent policy dialogue in decision-making processes that affect health

:: Global governance for health must be rooted in commitments to global solidarity and shared responsibility; sustainable and healthy development for all requires a global economic and political system that serves a global community of healthy people on a healthy planet

PLoS One
[Accessed 15 February 2014]
http://www.plosone.org/

Research Article
Essential Medicines Are More Available than Other Medicines around the Globe
Yaser T. Bazargani, Margaret Ewen, Anthonius de Boer, Hubert G. M. Leufkens, Aukje K. Mantel-Teeuwisse mail
Published: February 12, 2014
DOI: 10.1371/journal.pone.0087576
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0087576

Abstract
Background
The World Health Organization (WHO) promotes the development of national Essential Medicines Lists (EMLs) in order to improve the availability and use of medicines considered essential within health care systems. However, despite over 3 decades of international efforts, studies show an inconsistent pattern in the availability of essential medicines. We evaluated and compared the availability of essential medicines, and medicines not included in national EMLs, at global and regional levels.

Methods
Medicine availability in the public and private sector were calculated based on data obtained from national and provincial facility-based surveys undertaken in 23 countries using the WHO/HAI methodology. The medicines were grouped according to their inclusion (‘essential’) or exclusion (termed ‘non-essential’) in each country’s EML current at the time of the survey. Availability was calculated for originator brands, generics and any product type (originator brands or generics) and compared between the two groups. Results were aggregated by WHO regions, World Bank country income groups, a wealth inequality measure, and therapeutic groups.

Findings
Across all sectors and any product type, the median availability of essential medicines was suboptimal at 61·5% (IQR 20·6%–86·7%) but significantly higher than non-essential medicines at 27·3% (IQR 3·6%–70·0%). The median availability of essential medicines was 40·0% in the public sector and 78·1% in the private sector; compared to 6·6% and 57·1% for non-essential medicines respectively. A reverse trend between national income level categories and the availability of essential medicines was identified in the public sector.

Interpretation
EMLs have influenced the provision of medicines and have resulted in higher availability of essential medicines compared to non-essential medicines particularly in the public sector and in low and lower middle income countries. However, the availability of essential medicines, especially in the public sector does not ensure equitable access.

PLoS Neglected Tropical Diseases
January 2014
http://www.plosntds.org/article/browseIssue.action

Mass Vaccination with a New, Less Expensive Oral Cholera Vaccine Using Public Health Infrastructure in India: The Odisha Model
Shantanu K. Kar, Binod Sah mail, Bikash Patnaik, Yang Hee Kim, Anna S. Kerketta, Sunheang Shin, Shyam Bandhu Rath, Mohammad Ali, Vittal Mogasale, Hemant K. Khuntia, Anuj Bhattachan, Young Ae You, Mahesh K. Puri, Thomas F. Wierzba
http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002629#close

Abstract
Introduction
The substantial morbidity and mortality associated with recent cholera outbreaks in Haiti and Zimbabwe, as well as with cholera endemicity in countries throughout Asia and Africa, make a compelling case for supplementary cholera control measures in addition to existing interventions. Clinical trials conducted in Kolkata, India, have led to World Health Organization (WHO)-prequalification of Shanchol, an oral cholera vaccine (OCV) with a demonstrated 65% efficacy at 5 years post-vaccination. However, before this vaccine is widely used in endemic areas or in areas at risk of outbreaks, as recommended by the WHO, policymakers will require empirical evidence on its implementation and delivery costs in public health programs. The objective of the present report is to describe the organization, vaccine coverage, and delivery costs of mass vaccination with a new, less expensive OCV (Shanchol) using existing public health infrastructure in Odisha, India, as a model.

Methods
All healthy, non-pregnant residents aged 1 year and above residing in selected villages of the Satyabadi block (Puri district, Odisha, India) were invited to participate in a mass vaccination campaign using two doses of OCV. Prior to the campaign, a de jure census, micro-planning for vaccination and social mobilization activities were implemented. Vaccine coverage for each dose was ascertained as a percentage of the censused population. The direct vaccine delivery costs were estimated by reviewing project expenditure records and by interviewing key personnel.

Results
The mass vaccination was conducted during May and June, 2011, in two phases. In each phase, two vaccine doses were given 14 days apart. Sixty-two vaccination booths, staffed by 395 health workers/volunteers, were established in the community. For the censused population, 31,552 persons (61% of the target population) received the first dose and 23,751 (46%) of these completed their second dose, with a drop-out rate of 25% between the two doses. Higher coverage was observed among females and among 6–17 year-olds. Vaccine cost at market price (about US$1.85/dose) was the costliest item. The vaccine delivery cost was $0.49 per dose or $1.13 per fully vaccinated person.

Discussion
This is the first undertaken project to collect empirical evidence on the use of Shanchol within a mass vaccination campaign using existing public health program resources. Our findings suggest that mass vaccination is feasible but requires detailed micro-planning. The vaccine and delivery cost is affordable for resource poor countries. Given that the vaccine is now WHO pre-qualified, evidence from this study should encourage oral cholera vaccine use in countries where cholera remains a public health problem.

Author Summary
Cholera – an acute life-threatening diarrheal illness – continues to disrupt public health in resource poor countries. The devastating outbreaks in Haiti and Zimbabwe – to name just two of many occurrences – calls for the use of available oral cholera vaccines as an additional tool in the arsenal of cholera control measures. An oral cholera vaccine (Shanchol) has been licensed in India since 2009; however, there has only been limited use of this vaccine in government public health programs. A vaccination campaign using 2 doses of Shanchol was conducted in Odisha, India, during May and June, 2011, where 31,552 persons (61% of the target population) received the first dose and 23,751 of them completed their second dose. The vaccine delivery cost was $0.49 per dose. Through our findings and experience, we discuss the organization of the cholera vaccination campaign in Odisha, the challenges met for conducting the campaign and the strategies designed to overcome those challenges, and the delivery costs incurred in the use of this vaccine, the first of its kind, in a public health setting. We believe that evidence from this study is of significant interest and use to policymakers from countries where cholera remains a public health problem.

Prehospital & Disaster Medicine
Volume  29  – Issue 01 – February 2014
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Original Research
Médecins Sans Frontières Experience in Orthopedic Surgery in Postearthquake Haiti in 2010
Carrie Lee Teichera1 c1  id1, Kathryn Albertia1, Klaudia Portena1, Greg Eldera1, Emannuel Barona1 and Patrick Herarda1
a1 Médecins Sans Frontières/Doctors Without Borders, Epicentre/Medical Department, New York, New York USA
https://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9167457&fulltextType=RA&fileId=S1049023X13009278

Abstract
Introduction
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.

Problem
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.

Methods
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.

Results
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).

Conclusion
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.

CL Teicher, K Alberti, K Porten, G Elder, E Baron, P Herard. Médecins Sans Frontières experience in orthopedic surgery in postearthquake Haiti in 2010. Prehosp Disaster Med. 2014;29(1):1-6 .

Prehospital & Disaster Medicine
Volume  29  – Issue 01 – February 2014
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Comprehensive Review
Disaster Health After The 2011 Great East Japan Earthquake
Mayumi Kakoa1 c1, Paul Arbona1 and Satoko Mitania2
a1 Flinders University School of Nursing & Midwifery, Disaster Research Centre, Adelaide, Australia
a2 Kyoto University, School of Medicine, Unit for Livable Cities, Kyoto, Japan
https://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9167465&fulltextType=RV&fileId=S1049023X14000028

Abstract
Introduction
The March 11, 2011 disaster was unparalleled in the disaster history of Japan. There is still enormous effort required in order for Japan to recover from the damage, not only financially, but psychosocially. This paper is a review of the studies that have been undertaken since this disaster, from after the March 11th disaster in 2011 to the end of 2012, and will provide an overview of the disaster-health research literature published during this period.

Methods
The Japanese database Ichushi Ver. 5 was used to review the literature. This database is the most frequently used database in Japanese health-sciences research. The keywords used in the search were “Higashi Nihon Dai-shinsai” (The Great East Japan Earthquake).

Results
A total of 5,889 articles were found. Within this selection, 163 articles were categorized as original research (gencho ronbun). The articles were then sorted and the top four key categories were as follows: medicine (n = 98), mental health (n = 18), nursing (n = 13), and disaster management (n = 10). Additional categories were: nutrition (n = 4), public health (n = 3), radiology, preparedness, and pharmacology (n = 2 for each category). Nine articles appeared with only one category label and were grouped as “others.”

Conclusion
This review provides the current status of disaster-health research following the Great East Japan Earthquake. The research focus over the selected period was greatly directed towards medical considerations, especially vascular conditions and renal dialysis. Considering the compounding factors of the cold temperatures at the time of the disaster, the geography, the extensive dislocation of the population, and the demographics of an aging community, it is noteworthy that the immediate and acute impact of the March 11th disaster was substantial compared with other events and their studies on the impact of disaster on chronic and long-term illness. The complexity of damage caused by the earthquake event and the associated nuclear power plant event, which possibly affected people more psychologically than physically, might also need to be investigated with respect to long term objectives for improving disaster preparedness and management.

M Kako, P Arbon, S Mitani. Literature review on disaster health after the 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-6

Social Science & Medicine
Volume 106,   In Progress   (April 2014)
http://www.sciencedirect.com/science/journal/02779536/104

Poverty and mental health in Indonesia
Original Research Article
Pages 20-27
Gindo Tampubolon, Wulung Hanandita
Abstract
Community and facility studies in developing countries have generally demonstrated an inverse relationship between poverty and mental health. However, recent population-based studies contradict this. In India and Indonesia the poor and non-poor show no difference in mental health. We revisit the relationship between poverty and mental health using a validated measure of depressive symptoms (CES-D) and a new national sample from Indonesia – a country where widespread poverty and deep inequality meet with a neglected mental health service sector. Results from three-level overdispersed Poisson models show that a 1% decrease in per capita household expenditure was associated with a 0.05% increase in CES-D score (depressive symptoms), while using a different indicator (living on less than $2 a day) it was estimated that the poor had a 5% higher CES-D score than the better off. Individual social capital and religiosity were found to be positively associated with mental health while adverse events were negatively associated. These findings provide support for the established view regarding the deleterious association between poverty and mental health in developed and developing countries.

From Google Scholar+
Selected content from beyond the journals and sources covered above, aggregated from a range of Google Scholar monitoring algorithms and other monitoring strategies.

International Nursing Review
Volume 61, Issue 1, page 3, March 2014
Nursing and Health Policy Perspectives
Disaster training for nurses: a moral and humanitarian imperative
Professor Sue Turale DEd, RN, FACN, FACMHN Editor
Article first published online: 11 FEB 2014
DOI: 10.1111/inr.12093
http://onlinelibrary.wiley.com/doi/10.1111/inr.12093/full

I am sure you do not need reminding of the large-scale disasters that have plagued our planet in recent years. Global warming has played a large part in this with historic temperature variations occurring in many parts of the world, like recent snow on the pyramids of Giza, and increases in adverse weather events, such as heavy rains, floods, and typhoons. For example, the huge Typhoon Haiyan (Yolanda) hit the Philippines on 8 November 2013, eventually continuing its destructive path into Vietnam.

Typhoons seem to be growing in intensity in the Asia-Pacific region, and often hit areas where people are poor and local infrastructure is limited. This typhoon was the deadliest on record to affect the Philippines. As I write this editorial, bodies are still being found, and health systems are struggling to cope with the health needs of the population, especially as immediate international relief efforts wind down.

Of course there are many other types of disasters and nurses like all other health professionals need to be better equipped to deal with their aftermath. While it is not in our power to stop such terrible events in the natural world, it is in our power to be better prepared to help communities deal with losses and ongoing effects. We also can be better prepared to help ourselves, for nurses are victims of disaster, too. Although the awareness of nurses regarding disaster preparation has grown around the world over the last decade, most nurses are not yet prepared, educationally or psychologically, to respond to disasters, despite scientists warning us that such disasters will continue with possibly greater catastrophic events in the 21st century. Little is known about the numbers of nurses who were gravely affected by the typhoon, and needing direct assistance (Philippine Nurses Association 2013). This was truly a catastrophic event and while our hearts might go out to our colleagues in the Philippines and Vietnam, such sentiments are not enough. We must help nurses in these troubled areas to cope and be prepared for future disasters.

Unfortunately around the world we have only made very small inroads into providing nurses with appropriate disaster nursing education and training at undergraduate and graduate levels, and in courses offered within health systems. ‘Health systems and health care delivery in disaster situations are only successful when nurses have the fundamental disaster competencies or abilities to rapidly and effectively respond’ (World Health Organization and International Council of Nurses 2009, p. 6). Capacity building in nursing and midwifery is needed to help limit injury and death, and provide for the ongoing health and well being of communities long after the disaster event. For example, the psychological effects of disasters often last for many years, and nurses need to be trained in psychological first aid, just as they are trained in physical first aid. Nurses have a major role to play in risk assessment and in helping communities be better prepared for disasters, large or small.

I hope that everyone who reads this editorial will take steps to prepare nurses and midwives for disasters of the future, for these will pose serious and ongoing public health risks wherever they occur. We need to take urgent and critical action in all countries to ensure that nursing curricula contain some element of disaster nursing. The ICN Framework for Disaster Nursing Competencies (2009) will help in designing such courses. Specific courses for disaster nursing have been instigated in a number of countries, but often in more developed countries. Nurses need to make international efforts in this capacity building, and this involves advocating, policy-making, research, programme design and implementation. Since we are the largest group of health professionals globally, it is within our power to bring to the attention of politicians and policy-makers the urgent need to prepare nurses for disasters. After all if we don’t do it, who will?

The only certain thing about disasters is that they will happen in the future, so do your best to help nurses of the world be better prepared. I believe that this is one of our moral and humanitarian imperatives of the 21st Century.

Journal of Social Change
2014, Volume 6, Issue 1, Pages 15–26
[PDF] Health promotion and education among refugee women: a literature review
E Kimunai
The aims of this literature review were to (1) identify a comprehensive range of issues surrounding  female refugee physical health and (2) identify strategies addressing most of the critical physical health issues surrounding female refugee heath through dynamic and community-based approaches.

PhD Thesis – The right to humanitarian assistance in natural and human-made disasters: progress and challenges for an emerging international legal framework
Cubie, Douglas A.
University College Cork
https://cora.ucc.ie/handle/10468/1375
Abstract:
Natural and human-made disasters cause on average 120,000 deaths and over US$140 billion in damage to property and infrastructure every year, with national, regional and international actors consistently responding to the humanitarian imperative to alleviate suffering wherever it may be found. Despite various attempts to codify international disaster laws since the 1920s, a right to humanitarian assistance remains contested, reflecting concerns regarding the relative importance of state sovereignty vis-à-vis individual rights under international law. However, the evolving acquis humanitaire of binding and non-binding normative standards for responses to humanitarian crises highlights the increasing focus on rights and responsibilities applicable in disasters; although the International Law Commission has also noted the difficulty of identifying lex lata and lex ferenda regarding the protection of persons in the event of disasters due to the “amorphous state of the law relating to international disaster response.” Therefore, using the conceptual framework of transnational legal process, this thesis analyses the evolving normative frameworks and standards for rights-holders and duty-bearers in disasters. Determining the process whereby rights are created and evolve, and their potential internalisation into domestic law and policy, provides a powerful analytical framework for examining the progress and challenges of developing accountable responses to major disasters.

The Sustainable Neighborhoods for Happiness Index (SNHI): A metric for assessing a community’s sustainability and potential influence on happiness
S Cloutier, J Jambeck, N Scott – Ecological Indicators, 2014
… 2014. Highlights. • An index that simultaneously considers happiness and sustainable development was developed. • Context for the potential relationships between sustainable development and happiness are provided. • The …

Surgery
Available online 8 February 2014
Surgical Skills Needed for Humanitarian Missions in Resource-limited Settings: Common Operative Procedures Performed at Médecins Sans Frontières Facilities
Evan G. Wong, MD1, 2, 3, Miguel Trelles, MD, MPH, PhD4, Lynette Dominguez, MD4, Shailvi Gupta, MD2, 3, 5, Gilbert Burnham, MD, PhD2, Adam L. Kushner, MD, MPH2, 3, 6

Abstract
Background
Surgeons in high-income countries are increasingly expressing interest in global surgery and participating in humanitarian missions. Knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare such surgeons and plan for interventions.

Methods
A retrospective review of all surgical procedures performed at Médecins Sans Frontières (MSF) Brussels facilities from June 2008 to December 2012 was performed. Individual data points included: country of project; patient age and sex; and surgical indication and surgical procedure.

Results
Between June 2008 and December 2012, a total of 93,385 procedures were performed on 83,911 patients in 21 different countries. The most common surgical indication was for fetal-maternal pathologies, accounting for 25,548/65,373 (39.1%) of all cases. The most common procedure was a Cesarean section; a total of 24,182 or 25.9% of all procedures. Herniorrhaphies (9,873/93,385, 10.6%) and minor surgeries (11,332/93,385, 12.1%) including wound debridement, abscess drainage and circumcision were also common.

Conclusions
A basic skill set that includes the ability to provide surgical care for a wide variety of surgical morbidities is urgently needed to cope with the surgical need of humanitarian emergencies. This review of MSF’s operative procedures provides valuable insight into the types of operations that an aspiring volunteer surgeon should be familiar with

[PDF] MEASURING VIOLENCE AGAINST CHILDREN IN HUMANITARIAN SETTINGS – A scoping exercise of methods and tools.
Landis, D., Williamson, K., Fry, D. and Stark, L. (2013).
New York and London: Child Protection in Crisis (CPC) Network and Save the Children
UK.
Executive Summary [Excerpt]
From May–‐December 2013, the Child Protection in Crisis (CPC) Network and Save the Children conducted a scoping exercise in order to examine two child protection issues considered “hard to measure” in humanitarian settings: sexual violence against children and violence within the household. The goal of this exercise was to identify existing methodologies and tools to assess these issues, as well as to highlight gaps in current approaches and offer recommendations for further action…

WHO: 6 February: International Day of Zero Tolerance to Female Genital Mutilation

More than 125 million girls and woman alive today have been cut in the 29 countries in Africa and the Middle East where Female Genital Mutilation (FGM) is concentrated. Furthermore, due to migration, surprising numbers of cases of FGM are coming to light in other parts of the world as well.

There is a need to raise awareness of the prevalence of FGM among healthcare providers in these settings to offer appropriate care for women with FGM, and to eliminate this practice.
As part of the International Day of Zero Tolerance to FGM, we profile Dr. Jasmine Abdulcadir, a physician in a multidisciplinary group of healthcare providers offering services to women in Geneva who have been subjected to FGM.

:: Interview with Dr Jasmine Abdulcadir
:: Multidisciplinary care in Geneva for women who were subjected to FGM
:: Call of UN Secretary-General
:: “Preserve the Best in Culture and Leave Harm Behind”

Perspective: Today is a significant day in Mali
Molly Melching
Source: Skoll World Forum – Thu, 6 Feb 2014 03:12 PM

Today is a significant day in the West African country of Mali.

Just outside the capital city of Bamako, in the bustling suburb of Yirimadio (pop. 70,000), 14 neighborhoods have been preparing for a life-changing event.

Today, on the UN-recognized International Day promoting the abandonment of female genital cutting (FGC), these 14 neighborhoods have decided that they will no longer support the practices of female genital cutting and child/forced marriage. This public declaration marks a major change in community norms.

It will be a reference point people will use for generations to come marking the moment when they, as a collective group, agreed to protect the health and human rights of their daughters. Government ministers, traditional and religious leaders, hundreds of people from Yirimadio neighborhoods, project donors, Tostan International staff and Tostan’s implementing NGO partner, Muso, have all gathered at the Yirimadio community stadium to witness this celebratory event.

This is the second public declaration in Mali in the last eight months by communities who have participated in Tostan’s holistic human rights-based nonformal education program. In June of last year, 30 communities from the Koulikoro region in Mali made a similar pledge. At that event, community member Diarra Awa Sow said, “I know that I am not going to cut my daughters. I hope that my example will show others that they don’t need to do so either.”

Diarra’s example, and the example of thousands of others who have decided to abandon with their communities, have bolstered the confidence of the 14 neighborhoods declaring today. Rather than deciding silently on their own, they join the growing abandonment movement in West Africa. Since the first public declaration in 1997 by the women of Malicounda Bambara in Senegal, more than 7,000 communities in the African countries where Tostan  works have publicly announced their intention to abandon these harmful practices and have shown the way for the movement to grow and spread across community networks and country borders.

Reaching the point of a public declaration is not an easy process.  In fact, the 14 neighborhoods who are abandoning today discussed for many months whether or not they would declare, following the completion of their participation in Tostan’s three-year empowerment program.    They reached out to thousands in Yirimadio and met frequently to dialogue and debate what they had learned in their class sessions. The information, discussed  in their own local language, provided a framework for further learning and dialogue around areas relevant to these communities, such as democracy, human rights, problem-solving, hygiene and health , literacy, numeracy, project management, and environmental sustainability. Through this holistic education, they were better able to gauge which actions protect their human rights and ability to develop, or put them at risk.

It is within this context that taboo subjects like FGC could be safely discussed and questioned – in class sessions, community deliberations, intervillage meetings and beyond – until every member of a social network was consulted. This process of engagement enabled changes in attitude to take place, slowly and inclusively, until connected communities were ready to make public their decisions to choose positive change.

When communities participate in a public declaration, they are making an announcement in a public setting which reflects endorsement of the new social norm – no one will be ostracized for deciding not to engage in a practice when all have collectively agreed to stop it. Communities in West Africa are bound by the weight of their words and it is very important to bring together the whole community to abandon a practice.  Public declarations are essential in building a critical mass for abandonment through this collective and public support.

While we know that there is not 100 percent abandonment after a public declaration, these events support the social change process and can work hand in hand with other efforts to encourage abandonment. FGC scholar Dr. Bettina Shell-Duncan recently published an article studying the impact of the law in ending the practice of FGC in rural Senegal.  The study found that while many community members knew that there was a law against FGC, local rules most often took preference over rule of law. In order to illustrate this, she included an example of a community which had participated in the Tostan program and put in place an enforcement committee to ensure that families complied with the declaration to abandon FGC.  That committee then confronted and fined a family who had taken their daughter across the border into The Gambia to be cut.  This was thought to have deterred others from attempting to violate the new “community” law and no cases have been detected since.

This study supports Tostan’s conclusion from experience in hundreds of villages over the past 17 years that the abandonment of FGC must start at the grassroots, with community members who have been educated in their mother tongue and who then reach out to their extended social network to abandon the practice collectively.

Today we congratulate the communities gathered in Yirimadio, Mali who are doing just this, as well as all the other communities who have chosen to pursue a future for their children where health and human rights are respected and protected. The abandonment movement is growing, and now is the time to propel it further through partnership between organizations working to end this practice and with more support for the communities who are bravely taking this step.

Molly Melching is Founder and Executive Director of Tostan.

Media Release: EU and UNICEF boost their partnership to improve child and maternal health and to save more children

Excerpt
NEW YORK, 4 February 2014 – The European Union announced today that it has allocated €320 million ($431 million) through UNICEF to improve the health and nutrition of children and women in 15 developing countries and to help speed progress in meeting the Millennium Development Goals.
Funding will focus on tackling under-nutrition and infectious diseases, which are among the root causes of child mortality.  Multi-year programmes will focus on improving access to safe water, sanitation and hygiene facilities, as well as quality medical services, health care and adequate nutrition.
The amount represents a 350 per cent increase in development funding from the European Union to UNICEF since 2008.
“Today’s announcement shows what a difference we can make when we work together, and our partnership with UNICEF will help us reach even more of the people who most need our help,” European Commissioner for Development Andris Piebalgs told the UNICEF Executive Board in New York. “Much remains to be done before the 2015 deadline for achieving the MDGs and these projects will help us build on the achievements made so far.”
While child mortality rates have declined from an estimated 12.6 million in 1990 to approximately 6.6 million in 2012, around 18,000 children still die of preventable diseases each day.  At current trends, the world will not meet Millennium Development Goal 4 – to cut the rate of under-five mortality by two-thirds – until 2028.
The €320 million in funding agreements – signed with 15 UNICEF country offices in 2013 – is part of the EU’s MDG-initiative and the 10th European Development Fund, which aims to accelerate progress towards meeting the most off-track goals.  UNICEF and the EU, in cooperation with partner countries and civil societies, will scale up interventions that reduce child mortality and strengthen maternal and pre-natal health…

UN: Polio vaccination campaign begins at besieged Palestinian refugee camp in Syria

Excerpt
5 February 2014 – The United Nations agency assisting Palestinian refugees said today it has begun a large-scale polio vaccination campaign targeting thousands of children in the Yarmouk refugee camp in Damascus.

The UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and its partners have been attempting for months to take desperately needed aid, particularly food and medicines, to Yarmouk, whose 18,000 residents have been trapped for months amid the ongoing conflict in Syria.

“We are pleased to announce that UNRWA has secured the formal authorization for the transfer of 10,000 polio vaccines to Yarmouk Camp in Damascus,” said Chris Gunness, a spokesperson for the Agency.

“This process has been completed without incident and the vaccination of thousands children in the camp is now underway”…

WHO Media Note: Measles deaths reach record lows with fragile gains toward global elimination
6 February 2014

Excerpt
New mortality estimates from WHO show that annual measles deaths have reached historic lows, dropping 78% from more than 562,000 in 2000 to 122,000 in 2012. During this time period, “an estimated 13.8 million deaths have been prevented by measles vaccination” and surveillance data showed that reported cases declined 77% from 853,480 to 226,722.

These gains are a result of global routine measles immunization coverage holding steady at 84% and 145 countries having introduced a routine second dose of measles vaccine to ensure immunity and prevent outbreaks. In addition to routine immunization, countries vaccinated 145 million children during mass campaigns against measles in 2012 and reached more than 1 billion since 2000, with the support of the Measles & Rubella Initiative.

Despite the impressive gains made, progress towards measles elimination remains uneven with some populations still unprotected. Measles continues to be a global threat, with five of six WHO regions still experiencing large outbreaks and with the Region of the Americas responding to many importations of measles cases. The African, Eastern Mediterranean and European regions are not likely to meet their measles elimination targets on time. The Region of the Americas has achieved measles elimination and continues to maintain this status while the Western Pacific region is approaching its target.

Routine measles vaccination coverage is an important progress indicator towards meeting Millennium Development Goal Four3 because of its potential to reduce child mortality and widely recognized as a marker of access to children’s health services…
http://www.who.int/mediacentre/news/notes/2014/measles-20140206/en/index.html