World Trade Organisation [to 10 May 2014]
http://www.wto.org/english/news_e/news13_e/news13_e.htm

Azevêdo to push for trade role in future sustainable development goals
Director-General Roberto Azevêdo, in opening the WTO “Geneva Week” on 5 May 2014 for non-resident missions and observers, said that “trade has played a central role in lifting millions of people out of poverty in recent years”. He said that he would work “to ensure that the power of trade to support sustainable development is recognized” in the current discussions on the post-2015 development agenda.
> Speech

The Sphere Project [to 10 May 2014]
http://www.sphereproject.org/news/

UNICEF to offer Sphere elearning course to staff
09 May 2014 | Sphere Project
The United Nations Children’s Fund (UNICEF) will integrate the Sphere Handbook in Action e-learning course into its new learning platform.
As of next month, UNICEF staff across the world will be able to take the Sphere course on humanitarian principles and standards within their own online learning platform. The course will be available in English, Arabic, French and Spanish…

American Journal of Public Health
Volume 104, Issue 5 (May 2014)
http://ajph.aphapublications.org/toc/ajph/current

Noncommunicable Diseases and Human Rights: A Promising Synergy
Sofia Gruskin, JD, MIA, Laura Ferguson, PhD, MSc, MA, Daniel Tarantola, MD, and Robert Beaglehole, DSc
Sofia Gruskin and Laura Ferguson are with the Program on Global Health and Human Rights, Institute for Global Health, University of Southern California, Los Angeles. Daniel Tarantola is a global health consultant, Ferney-Voltaire, France. Robert Beaglehole is an emeritus professor, University of Auckland, Auckland, New Zealand.
Abstract
Noncommunicable diseases (NCDs) have finally emerged onto the global health and development agenda. Despite the increasingly important role human rights play in other areas of global health, their contribution to NCD prevention and control remains nascent.
The recently adopted Global Action Plan for the Prevention and Control of NCDs 2013–2020 is an important step forward, but the lack of concrete attention to human rights is a missed opportunity.
With practical implications for policy development, priority setting, and strategic design, human rights offer a logical, robust set of norms and standards; define the legal obligations of governments; and provide accountability mechanisms that can be used to enhance current approaches to NCD prevention and control. Harnessing the power of human rights can strengthen action for NCDs at the local, national, and global levels.

American Journal of Tropical Medicine and Hygiene
May 2014; 90 (5)
http://www.ajtmh.org/content/current

Special Section on Neglected Parasitic Infections
Neglected Parasitic Infections in the United States: Needs and Opportunities
Monica E. Parise*, Peter J. Hotez and Laurence Slutsker
Author Affiliations
Division of Parasitic Diseases and Malaria, Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
Initial text
Parasitic infections are a major global health burden. The impact of debilitating diseases caused by parasites is greatest among those who struggle to meet their daily basic needs and access basic health care services in low-income countries. However, persons who have or are at risk for parasitic infections are present in every income and social strata, and residents of the United States and other developed nations are not unaffected. For some persons living in the United States, these parasitic infections are acquired in their own immediate environment; for example, exposure to feces from domestic dogs or cats puts children at risk for toxocariasis and toxoplasmosis. For others, chronic parasitic infections acquired years ago in other areas of the world can manifest with severe illness later in life, such as neurocysticercosis leading to adult–onset epilepsy or Chagas disease leading to severe cardiomyopathy requiring heart transplant. We know much less than we should about the health and economic burden and impact of parasitic diseases in developed countries, including the United States (Table 1).1
This issue of the American Journal of Tropical Medicine and Hygiene features brief reviews of five parasitic infections that remain a significant health problem in the United States: Chagas disease, cysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis.2–6 These five diseases, which are among those that Centers for Disease Control and Prevention (CDC) refers to as neglected parasitic infections (NPIs) in the United States, have different epidemiologic profiles and modes of transmission and require tailored prevention and control strategies…

Early Phase Clinical Trials with Human Immunodeficiency Virus-1 and Malaria Vectored Vaccines in The Gambia: Frontline Challenges in Study Design and Implementation
Muhammed O. Afolabi*, Jane U. Adetifa, Egeruan B. Imoukhuede, Nicola K. Viebig, Beate Kampmann and Kalifa Bojang
Author Affiliations
Vaccinology Theme, Medical Research Council Unit, The Gambia; The Jenner Institute, University of Oxford, United Kingdom; European Vaccine Initiative, Germany; Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia Abstract.
Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and malaria are among the most important infectious diseases in developing countries. Existing control strategies are unlikely to curtail these diseases in the absence of efficacious vaccines. Testing of HIV and malaria vaccines candidates start with early phase trials that are increasingly being conducted in developing countries where the burden of the diseases is high. Unique challenges, which affect planning and implementation of vaccine trials according to internationally accepted standards have thus been identified. In this review, we highlight specific challenges encountered during two early phase trials of novel HIV-1 and malaria vectored vaccine candidates conducted in The Gambia and how some of these issues were pragmatically addressed. We hope our experience will be useful for key study personnel involved in day-to-day running of similar clinical trials. It may also guide future design and implementation of vaccine trials in resource-constrained settings.

BMC Health Services Research
(Accessed 10 May 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Improvements in pandemic preparedness in 8 Central American countries, 2008 – 2012
Lucinda EA Johnson, Wilfrido Clará, Manoj Gambhir, Rafael Chacón- Fuentes, Carlos Marín-Correa, Jorge Jara, Percy Minaya, David Rodríguez, Natalia Blanco, Naomi Iihoshi, Maribel Orozco, Carmen Lange, Sergio Vinicio Pérez, Nydia Amador, Marc-Alain Widdowson, Ann C Moen and Eduardo Azziz-Baumgartner
Author Affiliations
BMC Health Services Research 2014, 14:209 doi:10.1186/1472-6963-14-209
Published: 9 May 2014
Abstract (provisional)
Background
In view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012.
Methods
Eight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student’s t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting.
Results
All countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01).
Conclusions
Central America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries’ response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 10 May 2014]

Research
Need for a gender-sensitive human security framework: results of a quantitative study of human security and sexual violence in Djohong District, Cameroon
Open Access
Parmar PK, Agrawal P, Goyal R, Scott J and Greenough PG Conflict and Health 2014, 8:6 (7 May 2014)
Abstract (provisional)
Background
Human security shifts traditional concepts of security from interstate conflict and the absence of war to the security of the individual. Broad definitions of human security include livelihoods and food security, health, psychosocial well-being, enjoyment of civil and political rights and freedom from oppression, and personal safety, in addition to absence of conflict.
Methods
In March 2010, we undertook a population-based health and livelihood study of female refugees from conflict-affected Central African Republic living in Djohong District, Cameroon and their female counterparts within the Cameroonian host community. Embedded within the survey instrument were indicators of human security derived from the Leaning-Arie model that defined three domains of psychosocial stability suggesting individuals and communities are most stable when their core attachments to home, community and the future are intact.
Results
While the female refugee human security outcomes describe a population successfully assimilated and thriving in their new environments based on these three domains, the ability of human security indicators to predict the presence or absence of lifetime and six-month sexual violence was inadequate. Using receiver operating characteristic (ROC) analysis, the study demonstrates that common human security indicators do not uncover either lifetime or recent prevalence of sexual violence.
Conclusions
These data suggest that current gender-blind approaches of describing human security are missing serious threats to the safety of one half of the population and that efforts to develop robust human security indicators should include those that specifically measure violence against women.

Research
After abduction: exploring access to reintegration programs and mental health status among young female abductees in Northern Uganda
Muldoon KA, Muzaaya G, Betancourt TS, Ajok M, Akello M, Petruf Z, Nguyen P, Baines EK et al. Conflict and Health 2014, 8:5 (7 May 2014)
Abstract (provisional)
Background
Reintegration programs are commonly offered to former combatants and abductees to acquire civilian status and support services to reintegrate into post-conflict society. Among a group of young female abductees in northern Uganda, this study examined access to post-abduction reintegration programming and tested for between group differences in mental health status among young women who had accessed reintegration programming compared to those who self-reintegrated.
Methods
This cross-sectional study analysed interviews from 129 young women who had previously been abducted by the Lords Resistance Army (LRA). Data was collected between June 2011-January 2012. Interviews collected information on abduction-related experiences including age and year of abduction, manner of departure, and reintegration status. Participants were coded as ‘reintegrated’ if they reported >=1 of the following reintegration programs: traditional cleansing ceremony, received an amnesty certificate, reinsertion package, or had gone to a reception centre.
A t-test was used to measure mean differences in depression and anxiety measured by the Acholi Psychosocial Assessment Instrument (APAI) to determine if abductees who participated in a reintegration program had different mental status from those who self-reintegrated.
Results
From 129 young abductees, 56 (43.4%) had participated in a reintegration program. Participants had been abducted between 1988-2010 for an average length of one year, the median age of abduction was 13 years (IQR:11-14) with escaping (76.6%), being released (15.6%), and rescued (7.0%) being the most common manner of departure from the LRA. Traditional cleansing ceremonies (67.8%) were the most commonly accessed support followed by receiving amnesty (37.5%), going to a reception centre (28.6%) or receiving a reinsertion package (12.5%). Between group comparisons indicated that the mental health status of abductees who accessed >=1 reintegration program were not significantly different from those who self-reintegrated (p > 0.05).
Conclusions
Over 40% of female abductees in this sample had accessed a reintegration program, however significant differences in mental health were not observed between those who accessed a reintegration program and those who self-reintegrated. The successful reintegration of combatants and abductees into their recipient community is a complex process and these results support the need for gender-specific services and ongoing evaluation of reintegration programming.

Health Policy and Planning
Volume 29 Issue 3 May 2014
http://heapol.oxfordjournals.org/content/current

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme
Emmanuel Ankrah Odame1,*, Patricia Akweongo2, Ben Yankah3, Francis Asenso-Boadi3 and Irene Agyepong2
Author Affiliations
1Public Health Unit, Ridge Regional Hospital, Ghana Health Service, Box 473, Accra, Ghana, 2School of Public Health, University of Ghana, Box LG13, Legon-Accra, Ghana and 3National Health Insurance Authority, No. 36-6th Avenue, Ridge Residential Area, Private Mail Bag Ministries, Accra, Ghana
Accepted February 28, 2013.
Abstract
Objective: Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes.
Methods: Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective.
Findings: A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme—without a commensurate growth on the amounts generated annually—is an increasing threat to the sustainability of the fund.
Conclusions: Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

10 best resources on … mixed methods research in health systems
Sachiko Ozawa1,* and Krit Pongpirul1,2,3,4
Author Affiliations
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA, 2Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Thailand Research Center for Health Services System, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and 4Chula Clinical Research Center (ChulaCRC), Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10600, Thailand
Accepted March 8, 2013.
Abstract
Mixed methods research has become increasingly popular in health systems. Qualitative approaches are often used to explain quantitative results and help to develop interventions or survey instruments. Mixed methods research is especially important in low- and middle-income country (LMIC) settings, where understanding social, economic and cultural contexts are essential to assess health systems performance. To provide researchers and programme managers with a guide to mixed methods research in health systems, we review the best resources with a focus on LMICs. We selected 10 best resources (eight peer-reviewed articles and two textbooks) based on their importance and frequency of use (number of citations), comprehensiveness of content, usefulness to readers and relevance to health systems research in resource-limited contexts. We start with an overview on mixed methods research and discuss resources that are useful for a better understanding of the design and conduct of mixed methods research. To illustrate its practical applications, we provide examples from various countries (China, Vietnam, Kenya, Tanzania, Zambia and India) across different health topics (tuberculosis, malaria, HIV testing and healthcare costs). We conclude with some toolkits which suggest what to do when mixed methods findings conflict and provide guidelines for evaluating the quality of mixed methods research.

Integrating family planning messages into immunization services: a cluster-randomized trial in Ghana and Zambia
Gwyneth Vance1,*, Barbara Janowitz1, Mario Chen1, Brooke Boyer1, Prisca Kasonde1, Gloria Asare2, Beatrice Kafulubiti3 and John Stanback1
Author Affiliations
1FHI 360 – Program Sciences, Durham, NC, USA, 2Ghana Health Service, Accra, Ghana and 3Zambia Ministry of Health, Kabwe, Zambia
Accepted March 15, 2013.
Abstract
Objective To determine whether integrating family planning (FP) messages and referrals into facility-based, child immunization services increase contraceptive uptake in the 9- to 12-month post-partum period.
Methods A cluster-randomized trial was used to test an intervention where vaccinators were trained to provide individualized FP messages and referrals to women presenting their child for immunization services. In each of 2 countries, Ghana and Zambia, 10 public sector health facilities were randomized to control or intervention groups. Shortly after the introduction of the intervention, exit interviews were conducted with women 9–12 months postpartum to assess contraceptive use and related factors before and after the introduction of the intervention. In total, there were 8892 participants (Control Group Ghana, 1634; Intervention Group Ghana, 1129; Control Group Zambia, 3751; Intervention Group Zambia, 2468). Intervention effects were evaluated using logistic mixed models that accounted for clustering in data. In addition, in-depth interviews were conducted with vaccinators, and a process assessment was completed mid-way through the implementation of the intervention.
Results In both countries, there was no significant effect on non-condom FP method use (Zambia, P = 0.56 and Ghana, P = 0.86). Reported referrals to FP services did not improve nor did women’s knowledge of factors related to return of fecundity. Some providers reported having made modifications to the intervention; they generally provided FP information in group talks and not individually as they had been trained to do.
Conclusion Rigorous evidence of the success of integrated immunization services in resource poor settings remains weak.

Journal of Infectious Diseases
Volume 209 Issue 11 June 1, 2014
http://jid.oxfordjournals.org/content/current

Protecting the Family to Protect the Child: Vaccination Strategy Guided by RSV Transmission Dynamics
Barney S. Graham
Author Affiliations – Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Respiratory syncytial virus (RSV) is the most important respiratory pathogen of childhood and also contributes to substantial morbidity and mortality in the elderly. It was recently estimated that as a single infectious agent, RSV is second only to malaria as a cause of death in children between 1 month and 1 year of age [1]. In addition, the global impact as an adult pathogen has a comparable level of morbidity and mortality as influenza in the frail elderly [2, 3]. Further demonstration that RSV is a ubiquitous global pathogen is now reported in the prospective family cohort study performed by Munywoki et al and reported in this issue of the Journal of Infectious Diseases [4]. More than 80% of households with children experienced an RSV infection within the 6-month surveillance period, and RSV was detected in 64% of study infants (defined as <1 year of age). In about 50% of households, more than one person was infected, and repeat infections in the same individual from homologous or heterologous RSV subtypes within the same season were documented. Thus, transmission within family units is common, and natural infection with RSV, especially in very young infants, does not provide solid immunity against reinfection. These data that were collected in rural Kenya are consistent with another household study performed more than 40 years ago in Rochester, New York, that reported 2 months of surveillance data [5]. Although it would be useful to have more data from different geographic and climatic settings, the congruity of these 2 studies suggests the likelihood that these results are a realistic reflection of how RSV is transmitted within family units globally. Importantly, the current study was prospective, employed active …

The Source of Respiratory Syncytial Virus Infection In Infants: A Household Cohort Study In Rural Kenya
Patrick K. Munywoki1, Dorothy C. Koech1, Charles N. Agoti1, Clement Lewa1, Patricia A. Cane2, Graham F. Medley2 and D. J. Nokes1,2
Author Affiliations
1KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
2School of Life Sciences and WIDER, University of Warwick, Coventry, United Kingdom

Community Circulation Patterns of Oral Polio Vaccine Serotypes 1, 2, and 3 After Mexican National Immunization Weeks
Stephanie B. Troy1,a, Leticia Ferreyra-Reyes2,a, ChunHong Huang3, Clea Sarnquist3, Sergio Canizales-Quintero2, Christine Nelson1, Renata Báez-Saldaña2, Marisa Holubar3, Elizabeth erreira-Guerrero2, Lourdes García-García2 and Yvonne A. Maldonado3
Author Affiliations
1Eastern Virginia Medical School, Norfolk, Virginia
2Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
3Stanford University School of Medicine, Stanford, California
Abstract
Background With wild poliovirus nearing eradication, preventing circulating vaccine-derived poliovirus (cVDPV) by understanding oral polio vaccine (OPV) community circulation is increasingly important. Mexico, where OPV is given only during biannual national immunization weeks (NIWs) but where children receive inactivated polio vaccine (IPV) as part of their primary regimen, provides a natural setting to study OPV community circulation.
Methods In total, 216 children and household contacts in Veracruz, Mexico, were enrolled, and monthly stool samples and questionnaires collected for 1 year; 2501 stool samples underwent RNA extraction, reverse transcription, and real-time polymerase chain reaction (PCR) to detect OPV serotypes 1, 2, and 3.
Results OPV was detected up to 7 months after an NIW, but not at 8 months. In total, 35% of samples collected from children vaccinated the prior month, but only 4% of other samples, contained OPV. Although each serotype was detected in similar proportions among OPV strains shed as a result of direct vaccination, 87% of OPV acquired through community spread was serotype 2 (P < .0001).
Conclusion Serotype 2 circulates longer and is transmitted more readily than serotypes 1 or 3 after NIWs in a Mexican community primarily vaccinated with IPV. This may be part of the reason why most isolated cVDPV has been serotype 2.

Journal of International Development
May 2014 Volume 26, Issue 4 Pages 409–566
http://onlinelibrary.wiley.com/doi/10.1002/jid.v26.3/issuetoc

Research Article
BRAZILIAN LAND TENURE CONFLICTS: A SPATIAL ANALYSIS
Carlos Pestana Barros1, João Ricardo Faria2,* and Ari Francisco de Araujo Jr.3
Abstract
This paper analyses land occupation involving landless peasants in Brazil for the period 2000–2008. It is the first study to be undertaken at the national level, with a contemporary data span, using spatial analysis. Land occupation in Brazil is a state-based phenomenon and mainly a political issue. Our results show that land occupation grows with left-wing political violence and left-wing government’s support through public agencies. The view that land invasion is caused by poverty does not apply to the Brazilian case.

Research Article
SELF-HELP GROUPS AND EMPOWERMENT OF WOMEN: SELF-SELECTION, OR ACTUAL BENEFITS?
Zakir Husain1,*, Diganta Mukerjee2 and Mousumi Dutta3
Abstract
Researchers argue that programmes promoting SHGs often attract women already active in the public domain (‘self-selection effect’), excluding those most in need of assistance. This exaggerates estimates of the effects of the programme (‘programme effects’). This paper attempts to test the significance of the programme effect of SHGs by comparing empowerment levels of newly inducted and older members of SHGs, based on a survey conducted in six municipalities in West Bengal, India. Results indicate that programme effects operated only to reduce tolerance of domestic violence and enhance status of members within the household.

Research Article
MAKING POVERTY INTO A FINANCIAL PROBLEM: FROM GLOBAL POVERTY LINES TO KIVA.ORG
Anke F. Schwittay*
Abstract
This paper presents the financialization of poverty as a conceptual addition to the literature on microfinance. It argues that for microfinance to be seen as a solution to poverty alleviation, poverty has been made into a financial problem. This is exemplified by the World Bank’s global poverty line and leads to the constitution of poor people as financial subjects. In addition, thinking of poverty in financial terms enables Northern publics’ engagement with poverty. Recent initiatives like Live Below the Line and Kiva.org are presented as examples of how poverty is made manageable for Northern supporters of microfinance.

Journal of Public Health Policy
Volume 35, Issue 2 (May 2014)
http://www.palgrave-journals.com/jphp/journal/v35/n2/index.html

Editorial
Lessons from cholera in Haiti
6 March 2014
Anthony Robbins, Co-Editor
[Full text]
Following the cholera outbreak in Haiti is a little like recapitulating the history of public health. The earliest public health interventions that protected lives were really very simple to understand, if not to implement: keeping food and drinking water clean, reducing crowding in housing, and managing disposal of human waste. Almost two centuries ago, reformers in Europe, then in North America, found that these measures to combat filth were effective. Thus, health improved even before vaccines and antibiotics arrived.

Late in the nineteenth century came scientific knowledge of causal agents, making it possible to blame carriers, often the very same people who lived with filth. The focus for interventions shifted from communities to individuals, from cleaning up environments and creating infrastructure to vaccines and antibiotics.

Where does Haiti fit in this picture? The country has always lacked clean water and proper sewers and then the earthquake of 2010 further damaged the already scant infrastructure. An outbreak in Haiti awaited only the introduction of a communicable pathogen, in this case Vibrio cholerae, rather like a parched landscape awaiting a lit match.

What followed was an outbreak that has taken over 8000 lives and infected almost 700 000 more Haitians. How did cholera get to Haiti? In the old days, the health authorities might have found the physical source, like the Broad Street pump, but today, more could be learned. Genetic typing made it possible to recognize that the strain of cholera afflicting Haiti came from Asia, most likely brought to the island by Nepalese soldiers working with the United Nations emergency response for the earthquake.

Very interesting, a triumph for laboratory methods that typed the pathogen! But how cholera got to Haiti offered little help in ending the outbreak or preventing future ones once the disease was spreading. The source didn’t much matter. Haiti’s abysmal sanitation infrastructure meant that Vibrio cholerae introduced from almost any source could have caused an epidemic. To their credit, the Haitian Ministry of Health and the National Directorate for Water Supply and Sanitation, understood how to control and prevent cholera. As stated in 2011 by the United Nations’ Independent Panel. To prevent the spread of cholera, the United Nations and the Government of Haiti should prioritize investment in piped, treated drinking water supplies and improved sanitation throughout Haiti. Until such time as water supply and sanitation infrastructure is established:
:: Programs to treat water at the household or community level with chlorine or other effective systems, hand washing with soap, and safe disposal of fecal waste should be developed and/or expanded; and,
:: Safe drinking water supplies should continue to be delivered and fecal waste should be collected and safely disposed of in areas of high population density, such as the spontaneous settlement camps.

As far as we can see, the key lesson from Haiti is that populations around the world that live without potable water and proper management of human fecal waste remain vulnerable. The fact that there had been no cholera in Haiti for over 100 years should have been no comfort – especially to those in public health who (should) know that protection depends on infrastructure.

In 1991, Dr Robert Knouss, who was serving as the Deputy Director General of the Pan American Health Organization, appeared before a committee of the US Congress to testify about the cholera epidemic in Peru. ‘What would it cost to eliminate cholera in the Americas?’ he was asked. He had not prepared for just that question, but his answer was quick if not precise: ‘$25 billion. Enough to build modern drinking water and sewage systems for every major city in the region that lacks one today’. (The number would be far larger in today’s dollars.)

We urge the United Nations and programs that contribute money to build infrastructure to learn a lesson from Haiti and think as the late Dr Knouss did. Invest now before you can be ‘surprised’ by an epidemic of cholera or other waterborne disease from any source.

Journal of Public Health Policy
Volume 35, Issue 2 (May 2014)
http://www.palgrave-journals.com/jphp/journal/v35/n2/index.html

Original Article
A quiet revolution in global public health: The World Health Organization’s Prequalification of Medicines Programme
Ellen F M ‘t Hoena, Hans V Hogerzeilb, Jonathan D Quickc, and Hiiti B Sillod
aIndependent Consultant, Medicines Law and Policy, Paris, 75011, France
bUniversity of Groningen, 9713 AV Groningen, The Netherlands
cManagement Sciences for Health, Cambridge, Massachusetts 02139, USA
dTanzania Food and Drugs Authority (TFDA), P. O. Box 77150, Dar es Salaam, Tanzania
Abstract
Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP’s greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain.

The Lancet
May 10, 2014 Volume 383 Number 9929 p1609 – 1692
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Economic austerity, food poverty, and health
The Lancet
Preview
A century ago, the Scottish physician John Boyd-Orr saw first-hand how poverty and malnutrition lay at the heart of appalling health, especially among children in the slums of Glasgow, many of whom had rickets—the subject of a Seminar by Charlotte Elder and Nicholas Bishop in today’s Lancet, which details how this disease of the past is increasing in some parts of the UK. Later, Boyd-Orr’s vision and activism for improved population health through the delivery of equitable nutrition programmes helped establish the UK’s food policy during the austere years of World War 2 and beyond.

Human rights violations in Sri Lanka
The Lancet
Preview
5 years after the end of the 26 year long civil war, Sri Lanka has yet to secure its future stability. A World Report in this week’s issue describes torture, rape, detentions, and summary executions perpetrated by the Sri Lankan Government against people suspected of involvement in the defeated Liberation Tigers of Tamil Eelam (LTTE) and government critics. Evidence suggests a state-sanctioned campaign rather than isolated incidents and, because of a culture of impunity for the perpetrators (mainly Sri Lankan army, security forces, police officers) and fear of reporting by victims, the true scale of abuse is unknown.

Comment
Influenza vaccine in pregnancy: policy and research strategies
Preview
Mark C Steinhoff, Noni MacDonald, Dina Pfeifer, Louis J Muglia
Influenza vaccination in pregnancy reduces maternal illness, improves fetal outcomes, prevents influenza in the infant up to 6 months of age, and potentially improves long-term adult outcomes for the infant (table 1). These effects on four life stages are not widely known by policy makers, and we provide a summary with recommendations for policy and needed research.

Data, children’s rights, and the new development agenda
Preview
Tessa Wardlaw, Abid Aslam, David Anthony, Céline Little, Claudia Cappa
The coming year will mark the 25th anniversary of the Convention on the Rights of the Child1 and the culmination of the Millennium Development Goals (MDGs). As people look to the future of human wellbeing, data will play an increasingly important part in identifying inequities and in informing and evaluating interventions so these are responsive and accountable to the world’s 2•2 billion children, especially those so far excluded from the benefits of development.

Worldwide prevalence of non-partner sexual violence: a systematic review
Prof Naeemah Abrahams PhD a, Karen Devries PhD b, Prof Charlotte Watts PhD b, Christina Pallitto PhD c, Prof Max Petzold PhD d, Simukai Shamu PhD a e, Claudia García-Moreno MD c
Summary
Background
Several highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence.
Methods
We searched for articles published from Jan 1, 1998, to Dec 31, 2011, and manually search reference lists and contacted experts to identify population-based data on the prevalence of women’s reported experiences of sexual violence from age 15 years onwards, by anyone except intimate partners. We used random effects meta-regression to calculate adjusted and unadjusted prevalence for regions, which we weighted by population size to calculate the worldwide estimate.
Findings
We identified 7231 studies from which we obtained 412 estimates covering 56 countries. In 2010 7•2% (95% CI 5•2—9•1) of women worldwide had ever experienced non-partner sexual violence. The highest estimates were in sub-Saharan Africa, central (21%, 95% CI 4•5—37•5) and sub-Saharan Africa, southern (17•4%, 11•4—23•3). The lowest prevalence was for Asia, south (3•3%, 0—8•3). Limited data were available from sub-Saharan Africa, central, North Africa/Middle East, Europe, eastern, and Asia Pacific, high income.
Interpretation
Sexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, our findings indicate a pressing health and human rights concern.
Funding
South African Medical Research Council, Sigrid Rausing Trust, WHO.

Seminar
Rickets
Charlotte Jane Elder, Nicholas J Bishop
Rickets, historically referred to as “the English disease”, is common worldwide. Absence of phosphate at the growth plate and mineralising bone surfaces due to inadequate vitamin D supply either from sunlight exposure or diet is the main cause. Inherited disorders causing hypophosphataemia have shown the intricacies of phosphate metabolism. Present advice about the provision of vitamin D to young infants needs to be clarified; the existing guidance is fragmentary and contradictory, and will not help to eradicate the disease.

Viewpoint
Global Health Service Partnership: building health professional leadership
Vanessa B Kerry, Fitzhugh Mullan
Shortages of nurses, doctors, and health professionals in resource-poor countries challenge the success of many health initiatives and health-system strengthening. In many of these countries, medical and nursing schools are few and severely short of faculty, limiting their capacity to scale-up and increase the number of skilled graduates and professionals to support the health system. In an effort to address this problem, the US Peace Corps has partnered with Seed Global Health, a non-profit organisation with expertise in education for health professions, to launch an innovative new programme that sends faculty to medical and nursing schools in under-resourced settings.

New England Journal of Medicine
May 8, 2014 Vol. 370 No. 19
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Parasite Burden and Severity of Malaria in Tanzanian Children
Bronner P. Gonçalves, M.D., Chiung-Yu Huang, Ph.D., Robert Morrison, M.Sc., Sarah Holte, Ph.D., Edward Kabyemela, M.D., Ph.D., D. Rebecca Prevots, Ph.D., Michal Fried, Ph.D., and Patrick E. Duffy, M.D.
DOI: 10.1056/NEJMoa1303944
Abstract
Background
Severe Plasmodium falciparum malaria is a major cause of death in children. The contribution of the parasite burden to the pathogenesis of severe malaria has been controversial.

Methods
We documented P. falciparum infection and disease in Tanzanian children followed from birth for an average of 2 years and for as long as 4 years.

Results
Of the 882 children in our study, 102 had severe malaria, but only 3 had more than two episodes. More than half of first episodes of severe malaria occurred after a second infection. Although parasite levels were higher on average when children had severe rather than mild disease, most children (67 of 102) had high-density infection (>2500 parasites per 200 white cells) with only mild symptoms before severe malaria, after severe malaria, or both. The incidence of severe malaria decreased considerably after infancy, whereas the incidence of high-density infection was similar among all age groups. Infections before and after episodes of severe malaria were associated with similar parasite densities. Nonuse of bed nets, placental malaria at the time of a woman’s second or subsequent delivery, high-transmission season, and absence of the sickle cell trait increased severe-malaria risk and parasite density during infections.

Conclusions
Resistance to severe malaria was not acquired after one or two mild infections. Although the parasite burden was higher on average during episodes of severe malaria, a high parasite burden was often insufficient to cause severe malaria even in children who later were susceptible. The diverging rates of severe disease and high-density infection after infancy, as well as the similar parasite burdens before and after severe malaria, indicate that naturally acquired resistance to severe malaria is not explained by improved control of parasite density. (Funded by the National Institute of Allergy and Infectious Diseases and others.)

OMICS: A Journal of Integrative Biology
May 2014, 18(5)
http://online.liebertpub.com/toc/omi/18/5

Glaucomics: A Call for Systems Diagnostics for 21st Century Ophthalmology and Personalized Visual Health
Online Ahead of Print: April 14, 2014
Full Text PDF (168.6 KB)
Author information
Kıvanç Güngör,1 Peter J. Hotez,2,3,4 Vural Özdemir,5,6,7,8,9 and Şükrü Aynacıoğlu10
1Department of Ophthalmology, Faculty of Medicine, University Hospital, Gaziantep University, Gaziantep, Turkey.
2National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
3Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston, Texas.
4James A. Baker III Institute for Public Policy, Rice University, Houston, Texas.
5Office of the President, Global Technology and Innovation Policy, Gaziantep University, Gaziantep, Turkey.
6School of Journalism, Faculty of Communications, Gaziantep University, Gaziantep, Turkey.
7Department of Industrial Engineering, Faculty of Engineering, and the Technology Transfer Office (TARGET-TTO), Gaziantep University, Gaziantep, Turkey.
8School of Biotechnology, Amrita University, Amritapuri Campus, Kerala, India.
9Data-Enabled Life Sciences Alliance (DELSA Global), Seattle, Washington.
10Department of Medical Pharmacology, Faculty of Medicine, University Hospital, Gaziantep University, Gaziantep, Turkey.
ABSTRACT
This article analyzes and theorizes the current knowledge silos at the intersection of omics science, ophthalmology, personalized medicine, and global visual health. Visual disorders represent one of the largest health care expenditures in the United States, costing $139 billion per year. In middle-income and industrialized countries, glaucoma is a World Health Organization priority category eye disease, known for difficulties in its early diagnosis, chronic progressive nature, and large person-to-person differences in drug efficacy and safety. A complex disease, glaucoma is best conceptualized as a syndrome displaying an ostensibly common clinical end-point, but with vastly heterogeneous molecular underpinnings and host–environment interactions. About 12% of all global blindness is attributable to glaucoma. Glaucomics is a term that we coin here so as to introduce omics science and systems diagnostics to ophthalmology, a field that can benefit enormously from personalized medicine, and which has sadly lagged behind in systems diagnostics compared to fields such as oncology. We define glaucomics as the integrated use of multi-omics and systems science approaches towards rational discovery, development, and tandem applications of diagnostics and therapeutics, for glaucoma specifically, and for personalized visual health, more broadly. We propose that glaucoma is one of the neglected lowest hanging fruits and actionable targets for omics and systems diagnostics in 21st century ophthalmology for the salient reasons we describe here. Additionally, we offer an analysis on two of the most pertinent neglected tropical diseases (NTDs), trachoma and river blindness, which continue to plague visual health in developing countries. We conclude with a call for research on omics applications in glaucoma and personalized visual health.

The Pediatric Infectious Disease Journal
May 2014 – Volume 33 – Issue 5 pp: 431-548,e121-e134
http://journals.lww.com/pidj/pages/currenttoc.aspx

A Household-based Study of Acute Viral Respiratory Illnesses in Andean Children
Budge, Philip J.; Griffin, Marie R.; Edwards, Kathryn M.; More
Abstract
Background: Few community studies have measured the incidence, severity and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings.
Methods: We conducted active, household-based ARI surveillance among children aged ❤ years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections if tachypnea, wheezing, grunting, stridor or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time, reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression.
Results: During 755.1 child-years of observation among 892 children in 58 communities, 4475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% confidence interval: 5.9–6.5). Families sought medical care for 24% of ARI, 4% were classified as lower respiratory tract infections and 1% led to hospitalization. Of 5 deaths among cohort children, 2 were attributed to ARI. One or more respiratory viruses were detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30 and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus and parainfluenza virus 1–3 comprised a disproportionate share of lower respiratory tract infections compared with other etiologies.
Conclusions: In this high-altitude rural setting with low-population density, ARI in young children were common, frequently severe and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed.

PLoS One
[Accessed 10 May 2014]
http://www.plosone.org/

Research Article
Natural Hazards in a Changing World: A Case for Ecosystem-Based Management
Jeanne L. Nel mail, David C. Le Maitre, Deon C. Nel, Belinda Reyers, Sally Archibald, Brian W. van Wilgen, Greg G. Forsyth, Andre K. Theron, Patrick J. O’Farrell, Jean-Marc Mwenge Kahinda,
Francois A. Engelbrecht, Evison Kapangaziwiri, Lara van Niekerk, Laurie Barwell
Published: May 07, 2014
DOI: 10.1371/journal.pone.0095942
Abstract
Communities worldwide are increasingly affected by natural hazards such as floods, droughts, wildfires and storm-waves. However, the causes of these increases remain underexplored, often attributed to climate changes or changes in the patterns of human exposure. This paper aims to quantify the effect of climate change, as well as land cover change, on a suite of natural hazards. Changes to four natural hazards (floods, droughts, wildfires and storm-waves) were investigated through scenario-based models using land cover and climate change drivers as inputs. Findings showed that human-induced land cover changes are likely to increase natural hazards, in some cases quite substantially. Of the drivers explored, the uncontrolled spread of invasive alien trees was estimated to halve the monthly flows experienced during extremely dry periods, and also to double fire intensities. Changes to plantation forestry management shifted the 1:100 year flood event to a 1:80 year return period in the most extreme scenario. Severe 1:100 year storm-waves were estimated to occur on an annual basis with only modest human-induced coastal hardening, predominantly from removal of coastal foredunes and infrastructure development. This study suggests that through appropriate land use management (e.g. clearing invasive alien trees, re-vegetating clear-felled forests, and restoring coastal foredunes), it would be possible to reduce the impacts of natural hazards to a large degree. It also highlights the value of intact and well-managed landscapes and their role in reducing the probabilities and impacts of extreme climate events.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 10 May 2014)

Research Article
Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data
Tini Garske, Maria D. Van Kerkhove, Sergio Yactayo, Olivier Ronveaux, Rosamund F. Lewis, J. Erin Staples, William Perea, Neil M. Ferguson mail, for the Yellow Fever Expert Committee
Published: May 06, 2014
DOI: 10.1371/journal.pmed.1001638
Abstract
Background
Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods.
Methods and Findings
Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone.
The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000–380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000–180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%–31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys.
Conclusions
With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns.
Please see later in the article for the Editors’ Summary

Editors’ Summary
Background
Yellow fever is a flavivirus infection that is transmitted to people and to non-human primates through the bites of infected mosquitoes. This serious viral disease affects people living in and visiting tropical regions of Africa and Central and South America. In rural areas next to forests, the virus typically causes sporadic cases or even small-scale epidemics (outbreaks) but, if it is introduced into urban areas, it can cause large explosive epidemics that are hard to control. Although many people who contract yellow fever do not develop any symptoms, some have mild flu-like symptoms, and others develop a high fever with jaundice (yellowing of the skin and eyes) or hemorrhaging (bleeding) from the mouth, nose, eyes, or stomach. Half of patients who develop these severe symptoms die. Because of this wide spectrum of symptoms, which overlap with those of other tropical diseases, it is hard to diagnose yellow fever from symptoms alone. However, serological tests that detect antibodies to the virus in the blood can help in diagnosis. There is no specific antiviral treatment for yellow fever but its symptoms can be treated.
Why Was This Study Done?
Eradication of yellow fever is not feasible because of the wildlife reservoir for the virus but there is a safe, affordable, and highly effective vaccine against the disease. Large-scale vaccination efforts during the 1940s, 1950s, and 1960s reduced the yellow fever burden for several decades but, after a period of low vaccination coverage, the number of cases rebounded. In 2005, the Yellow Fever Initiative—a collaboration between the World Health Organization (WHO) and the United Nations Children Fund supported by the Global Alliance for Vaccines and Immunization (GAVI Alliance)—was launched to create a vaccine stockpile for use in epidemics and to implement preventive mass vaccination campaigns in the 12 most affected countries in West Africa. Campaigns have now been implemented in all these countries except Nigeria. However, without an estimate of the current yellow fever burden, it is hard to determine the impact of these campaigns. Here, the researchers use recent yellow fever occurrence data, serological survey data, and improved estimation methods to update estimates of the yellow fever burden and to determine the impact of mass vaccination on this burden.
What Did the Researchers Do and Find?
The researchers developed a generalized linear statistical model and used data on the locations where yellow fever was reported between 1987 and 2011 in Africa, force of infection estimates for a limited set of locations where serological surveys were available (the force of infection is the rate at which susceptible individuals acquire a disease), data on vaccination coverage, and demographic and environmental data for their calculations. They estimate that about 130,000 yellow fever cases with fever and jaundice or hemorrhage occurred in Africa in 2013 and that about 78,000 people died from the disease. By evaluating the difference between this estimate, which takes into account the current vaccination coverage, and a hypothetical scenario that excluded the mass vaccination campaigns, the researchers estimate that these campaigns have reduced the burden of disease by 27% across Africa and by up to 82% in the countries targeted by the campaigns (an overall reduction of 57% in the 12 targeted countries).
What Do These Findings Mean?
These findings provide a contemporary estimate of the burden of yellow fever in Africa. This estimate is broadly similar to the historic estimate of 200,000 cases and 30,000 deaths annually, which was based on serological survey data obtained from children in Nigeria between 1945 and 1971. Notably, both disease burden estimates are several hundred-fold higher than the average number of yellow fever cases reported annually to WHO, which reflects the difficulties associated with the diagnosis of yellow fever. Importantly, these findings also provide an estimate of the impact of recent mass vaccination campaigns. All these findings have a high level of uncertainty, however, because of the lack of data from both surveillance and serological surveys. Other assumptions incorporated in the researchers’ model may also affect the accuracy of these findings. Nevertheless, the framework for burden estimation developed here provides essential new information about the yellow fever burden and the impact of vaccination campaigns and should help the partners of the Yellow Fever Initiative estimate the potential impact of future vaccination campaigns and ensure the efficient allocation of resources for yellow fever control.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 10 May 2014)

Research Article
Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Robert Bain mail, Ryan Cronk, Jim Wright, Hong Yang, Tom Slaymaker, Jamie Bartram mail
Published: May 06, 2014
DOI: 10.1371/journal.pmed.1001644
Abstract
Background
Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator “use of an improved source,” which does not account for water quality measurements. Our objectives were to determine whether water from “improved” sources is less likely to contain fecal contamination than “unimproved” sources and to assess the extent to which contamination varies by source type and setting.
Methods and Findings
Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for “improved” sources than “unimproved” sources (odds ratio [OR] = 0.15 [0.10–0.21], I2 = 80.3% [72.9–85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52–3.71]; p<0.001) and rural areas (OR = 2.37 [1.47–3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption.
Conclusion
Access to an “improved source” provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.
Please see later in the article for the Editors’ Summary

Editors’ Summary
Background
Access to clean water is fundamental to human health. The importance of water to human health and wellbeing is encapsulated in the Human Right to Water, reaffirmed by the United Nations in 2010, which entitles everyone to “sufficient, safe, acceptable and physically accessible and affordable water for personal and domestic uses.” A step towards such universal access to water is Millennium Development Goal (MDG) target 7c that aims to halve the proportion of the population without sustainable access to safe drinking-water. One of the indicators to help monitor progress towards this target used by the Joint Monitoring Project (JMP—an initiative of the World Health Organization and UNICEF) is “use of an improved source.” Improved sources include piped water into a dwelling, yard, or plot, or a standpipe, borehole, and protected dug well. Unimproved sources are those that do not protect water from outside contamination, such as unprotected wells, unprotected springs, and surface waters.
Why Was This Study Done?
While this simple categorization may reflect established principles of sanitary protection, this indicator has been criticized for not adequately reflecting safety, suggesting that reported access to safe water might be overestimated by billions of people by not accounting for microbial water safety or more fully accounting for sanitary status. So the researchers conducted a systematic review and meta-analysis to investigate whether water from improved sources is less likely to exceed health-based guidelines for microbial water quality than water from unimproved sources and to what extent microbial contamination varies between source types, between countries, and between rural and urban areas.
What Did the Researchers Do and Find?
The researchers comprehensively searched the literature to find appropriate studies that investigated fecal contamination of all types of drinking-water in low and middle-income countries. The researchers included studies that contained extractable data on Escherichia coli or thermotolerant coliform (the WHO recommended indicators of fecal contamination) collected by appropriate techniques. The authors also assessed studies for bias and quality and used a statistical method (random effects meta-regression) to investigate risk factors and settings where fecal contamination of water sources was most common.
Using these methods, the authors included 319 studies reporting on 96,737 water samples. Most studies were from sub-Saharan Africa, southern Asia, or Latin America and the Caribbean. They found that overall, the odds (chance) of contamination within a given study were considerably lower for “improved” sources than “unimproved” sources (odds ratio = 0.15). However, in 38% of 191 studies, over a quarter of samples from improved sources contained fecal contamination. In particular, protected dug wells were rarely free of fecal contamination. The researchers also found that water sources in low-income countries, and rural areas were more likely to be contaminated (both had odds ratios of 2.37).
What Do These Findings Mean?
These findings show that while water from improved sources is less likely to contain fecal contamination than unimproved sources, they are not consistently safe. This study also provides evidence that by equating “improved” with “safe,” the number of people with access to a safe water source has been greatly overstated, and suggests that a large number and proportion of the world’s population use unsafe water. As studies rarely reported stored water quality or sanitary risks, the accuracy of these findings may be limited. Nevertheless, the findings from this study suggest that the Global Burden of Disease 2010 may greatly underestimate diarrheal disease burden by assuming zero risk from improved water sources and that new indicators are needed to assess access to safe drinking water. Therefore, greater use should be made of other measures, such as sanitary inspections, to provide a complementary means of assessing safety and to help identify corrective actions to prevent water contamination.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 10 May 2014)

Governance, agricultural intensification, and land sparing in tropical South America
Michele Graziano Ceddiaa,1, Nicholas Oliver Bardsleyb, Sergio Gomez-y-Palomac, and Sabine Sedlaceka
Author Affiliations
Edited by B. L. Turner, Arizona State University, Tempe, AZ, and approved April 11, 2014 (received for review September 23, 2013)
Abstract
Significance
Tropical South America has forest resources of global significance but exhibits a relatively high rate of deforestation. As agricultural expansion remains the most important cause of forest loss and degradation there, it is important to understand its main drivers. In this paper we address two important questions: How do the quality of governance and agricultural intensification combine to impact the spatial expansion of agriculture? Which aspects of governance are more likely to ensure that agricultural intensification allows sparing land for nature? By distinguishing between conventional and environmental dimensions of governance (which includes also the establishment of protected areas), we investigate which of these two aspects, by interacting with the process of agricultural intensification, is likely to promote land sparing.
Abstract
In this paper we address two topical questions: How do the quality of governance and agricultural intensification impact on spatial expansion of agriculture? Which aspects of governance are more likely to ensure that agricultural intensification allows sparing land for nature? Using data from the Food and Agriculture Organization, the World Bank, the World Database on Protected Areas, and the Yale Center for Environmental Law and Policy, we estimate a panel data model for six South American countries and quantify the effects of major determinants of agricultural land expansion, including various dimensions of governance, over the period 1970–2006. The results indicate that the effect of agricultural intensification on agricultural expansion is conditional on the quality and type of governance. When considering conventional aspects of governance, agricultural intensification leads to an expansion of agricultural area when governance scores are high. When looking specifically at environmental aspects of governance, intensification leads to a spatial contraction of agriculture when governance scores are high, signaling a sustainable intensification process.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH
March 2014 Vol. 35, No. 3
http://www.paho.org/journal/index.php?option=com_content&view=article&id=141&Itemid=235&lang=en

Child malnutrition and prenatal care: evidence from three Latin American countries [Desnutrición infantil y atención prenatal: datos probatorios de tres países latinoamericanos]
Nohora Forero-Ramirez, Luis F. Gamboa, Arjun Bedi, and Robert Sparrow

“Peri-border” health care programs: the Ecuador—Peru experience [Programas de atención de salud en zonas fronterizas: la experiencia de Ecuador y Perú]
Gianluca Cafagna, Eduardo Missoni, and Rosa Luz Benites de Beingolea