Tostan [to 8 November 2014]
November 7, 2014

Sewing and cloth dyeing skills training for detainees in Diourbel Prison
From the 20th to the 29th of October 2014, under the umbrella of the Community Empowerment Program(CEP), the Tostan Prison Project team delivered a training workshop in cloth dyeing.
This was the inaugural training workshop following the launch of the Prison Project in Diourbel in September 2014. 15 detainees took part in the workshop, which was overseen by Madame Awa Fall, an expert in the art of dyeing, who had herself taken part in the CEP whilst in prison. She had received a presidential pardon, and now provides training in dyeing in the five prisons where Tostan offers the CEP…

Disasters Emergency Committee  [to 8 November 2014]
http://www.dec.org.uk/
[Action Aid, Age International, British Red Cross, CAFOD, Care International, Christian Aid, Concern Worldwide, Islamic Relief, Oxfam, Plan UK, Save the Children, Tearfund and World Vision]

8m people reached
6/11/2014
Member agencies of the Disasters Emergency Committee have reached over 8 million people in the fight to tackle the devastating Ebola crisis in west Africa.

Over half a million people have received practical support and 7.5 million people have received vital public health information to keep themselves safe and stop the spread of the disease.

DEC member agencies and their partners have supported over 415,000 people in their homes or health clinics with water, sanitation and hygiene services or supplies. Partners of the British Red Cross have provided treatment for 143 people infected with Ebola, safely buried over 3,800 bodies of people infected or potentially infected with Ebola and have traced almost 50,000 people who have had contact with Ebola carriers so they could be quarantined, tested or treated. Members have also provided food to over 80,000 people, many of whom are living under quarantine.

Over 35,000 volunteers are getting life safe-messages across through street theatre, house to house information sessions and religious services, and members have also used radio broadcast to share life-saving information about how to avoid catching the disease, how to identify if a loved one might be infected and encouraging those infected to seek early treatment…

ODI [to 8 November 2014]
http://www.odi.org/media

The future framework for disaster risk reduction: A guide for decision makers – second edition
Research reports and studies, November 2014
Jan Kellett, Tom Mitchell, Emma Lovell, Virginie le Masson, Katie Peters, Emily Wilkinson, Amy Kirbyshire, Aditya Bahadur, Elizabeth Carabine and Virginia Murray (Public Health England)
This guide to the future framework for disaster risk reduction (DRR) is intended for decision-makers, particularly those in government responsible for contributing to the new agreement.

Counter-terrorism laws: what aid agencies need to know
HPN Network Papers, November 2014
Jessica Burniske, Naz Modirzadeh and Dustin Lewis
Do aid workers risk violating counter-terrorism laws to reach people who need humanitarian support? This Network Paper gives an overview on the challenges and possible consequences of counter-terrorism legislation for humanitarian action, the questions that humanitarian actors face in planning principled operations in high-risk environments and what approaches might enable them to tackle these challenges.
External Link: http://www.odihpn.org/hpn-resources/network-papers/counter-terrorism-laws-what-a…

Kellogg Foundation
http://www.wkkf.org/news-and-media#pp=10&p=1&f1=news

Statement on Detroit’s bankruptcy ruling – From the foundation working group engaged in the “Grand Bargain”
Nov. 7, 2014 Detroit, Mich. – The following is a statement to the people of Detroit and Michigan from a foundation working group, which includes the Community Foundation for Southeast Michigan, William Davidson Foundation, Fred A. and Barbara M. Erb Family Foundation, the Max M. & Marjorie S. Fisher Foundation, Ford Foundation, Hudson-Webber Foundation, W.K. Kellogg Foundation, John S. and James L. Knight Foundation, Kresge Foundation, McGregor Fund, Charles Stewart Mott Foundation and the A. Paul and Carol C. Schaap Foundation:
We are pleased with Judge Rhodes’ ruling that the plan of adjustment is fair and feasible, and glad that the City of Detroit has moved swiftly to resolve the bankruptcy and hasten the start of a new era. As foundations with deep ties to the region and a shared commitment to its future, we are proud to have contributed to a plan that helps put Detroit back in the starting blocks.
The DIA Settlement, commonly referred to as the “Grand Bargain,” is a balanced, forward-looking and thoughtful plan that helps the City honor its commitment to hardworking retirees and preserves a key civic asset that contributes to the City’s vibrancy and supports the local economy. It would not have been possible without the leadership and sacrifice shown by Detroit’s hardworking retirees and public sector unions, whose continued commitment to a better Detroit should be honored and acknowledged today.
We also applaud the diverse group of individuals and organizations that came together behind a common goal to forge a workable agreement, including residents of the region who have been steadfast in their commitment to a more sustainable Detroit; Judge Gerald Rosen, Eugene Driker and the entire mediation team; the governor, state legislators and city and county elected officials on both sides of the aisle; the DIA; and Detroit’s business community.
Today is a day of determination for Detroit. With Judge Rhodes’ confirmation, the City and its residents can focus on the important tasks of rebuilding institutions, repairing communities, reinvigorating the economy and restoring the trust of its citizens. We are confident in Detroit’s future – an optimism that stems from the spirit of positive engagement that exists in the City as it does from today’s ruling. As foundations, we will continue our investment in the City, and we pledge to work with all those in Detroit who are leading efforts to advance a better future for an essential American city – a future that is worthy of all those who call Detroit home.

American Journal of Preventive Medicine
Volume 47, Issue 5, p531-688 November 2014
http://www.ajpmonline.org/current

Assessing Immunization Interventions in the Women, Infants, and Children (WIC) Program
Tracy N. Thomas, MPH, MSc, Maureen S. Kolasa, MPH, Fan Zhang, PhD, Abigail M. Shefer, MD
National Center for Immunization and Respiratory Disease, CDC, Atlanta, Georgia
Published Online: September 13, 2014
DOI: http://dx.doi.org/10.1016/j.amepre.2014.06.017
Abstract
Background
Vaccination promotion strategies are recommended in Women, Infants, and Children (WIC) settings for eligible children at risk for under-immunization due to their low-income status.
Purpose
To determine coverage levels of WIC and non-WIC participants and assess effectiveness of immunization intervention strategies.
Methods
The 2007–2011 National Immunization Surveys were used to analyze vaccination histories and WIC participation among children aged 24–35 months. Grantee data on immunization activities in WIC settings were collected from the 2010 WIC Linkage Annual Report Survey. Coverage by WIC eligibility and participation status and grantee-specific coverage by intervention strategy were determined at 24 months for select antigens. Data were collected 2007–2011 and analyzed in 2013.
Results
Of 13,183 age-eligible children, 5,699 (61%, weighted) had participated in WIC, of which 3,404 (62%, weighted) were current participants. In 2011, differences in four or more doses of the diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine by WIC participation status were observed: 86% (ineligible); 84% (current); 77% (previous); and 69% (never-eligible). Children in WIC exposed to an immunization intervention strategy had higher coverage levels than WIC-eligible children who never participated, with differences as great as 15% (DTaP).
Conclusions
Children who never participated in WIC, but were eligible, had the lowest vaccination coverage. Current WIC participants had vaccination coverage comparable to more affluent children, and higher coverage than previous WIC participants.

American Journal of Tropical Medicine and Hygiene
November 2014; 91 (5)
http://www.ajtmh.org/content/current

Global Health Research in Narrative: A Qualitative Look at the FICRS-F Experience
Benjamin Bearnot, Alexandra Coria, Brian Scott Barnett, Eva H. Clark, Matthew G. Gartland, Devan Jaganath, Emily Mendenhall, Lillian Seu, Ayaba G. Worjoloh, Catherine Lem Carothers, Sten H. Vermund and Douglas C. Heimburger*
Author Affiliations
New York University School of Medicine, New York, New York; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Institute for Global Health, Nashville, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; University of California at Los Angeles, Los Angeles, California; Georgetown University, Washington, District of Columbia; Duke University Medical Center, Durham, North Carolina
Abstract.
For American professional and graduate health sciences trainees, a mentored fellowship in a low- or middle-income country (LMIC) can be a transformative experience of personal growth and scientific discovery. We invited 86 American trainees in the Fogarty International Clinical Research Scholars and Fellows Program and Fulbright–Fogarty Fellowship 2011–2012 cohorts to contribute personal essays about formative experiences from their fellowships. Nine trainees contributed essays that were analyzed using an inductive approach. The most frequently addressed themes were the strong continuity of research and infrastructure at Fogarty fellowship sites, the time-limited nature of this international fellowship experience, and the ways in which this fellowship period was important for shaping future career planning. Trainees also addressed interaction with host communities vis-à-vis engagement in project implementation. These qualitative essays have contributed insights on how a 1-year mentored LMIC-based research training experience can influence professional development, complementing conventional evaluations. Full text of the essays is available at http://fogartyscholars.org/.

Short-Term Global Health Education Programs Abroad: Disease Patterns Observed in Haitian Migrant Worker Communities Around La Romana, Dominican Republic
Brian J. Ferrara, Elizabeth Townsley, Christopher R. MacKay, Henry C. Lin and Lawrence C. Loh*
Author Affiliations
Departments of Internal Medicine and Pediatrics, Baystate Medical Center, Springfield, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; Department of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; The 53rd Week, Brooklyn, New York; Divisions of Global Health and Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Abstract.
The possibility of encountering rare tropical disease presentations is commonly described as a benefit derived by developed world medical trainees participating in clinical service-oriented short-term global health experiences in the developing world. This study describes the health status of a population served by a short-term experience conducted by a North American institute, and the results of a retrospective review are used to identify commonly encountered diseases and discuss their potential educational value. Descriptive analysis was conducted on 1,024 encounter records collected over four unique 1-week-long trips by a North American institution serving Haitian migrant workers in La Romana, Dominican Republic. The top five diagnoses seen in the clinic were gastroesophageal reflux disease (GERD), hypertension (HTN), upper respiratory infections, otitis media, and fungal skin infection. On occasion, diagnoses unique to an indigent tropical population were encountered (e.g., dehydration, malnutrition, parasites, and infections.). These findings suggest a similarity between frequently encountered diagnoses on a short-term clinical service trip in Dominican Republic and primary care presentations in developed world settings, which challenges the assumption that short-term service experiences provide exposure to rare tropical disease presentations. These findings also represent additional data that can be used to better understand the health and healthcare planning among this vulnerable population of Haitian migrant workers

Epidemiology of Sexually Transmitted Infections in Rural Southwestern Haiti: The Grand’Anse Women’s Health Study
Kathleen A. Jobe, Robert F. Downey*, Donna Hammar, Lori Van Slyke and Terri A. Schmidt
Author Affiliations
University of Washington, Division of Emergency Medicine, Seattle, Washington; Seattle–King County Disaster Team, Seattle, Washington; Sysmex America, Inc., Laboratory Application Services, San Diego, California; Providence Health and Services, North Coast Urgent Care Clinics, Seaside, Oregon; MultiCare Health System, Department of Social Work, Tacoma, Washington; Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon
Abstract.
The study attempts to define socioeconomic, clinical, and laboratory correlates in vaginitis and other sexually transmitted infections in rural southwestern Haiti. A convenience sample of subjects recruited from a rural women’s health clinic and attending an established clinic at the Haitian Health Foundation (HHF) clinic was studied. A standardized history and physical examination, including speculum examination, and collection of blood, urine, and vaginal swabs were obtained from the women at the rural clinic. Additional vaginal swab samples only for Nucleic Acid Amplification Test (NAAT) testing were obtained from women at the HHF clinic in Jérémie. Laboratory results from Leon subjects were positive for Gardnerella vaginalis in 41% (41 of 100), Trichomonas vaginalis in 13.5% (14 of 104), Candida sp. in 9% (9 of 100), Mycoplasma genitalium in 6.7% (7 of 104), Chlamydia trachomatis in 1.9% (2 of 104), and Neisseria gonorrhea in 1% (1 of 104) of patients. Human immunodeficiency virus (HIV) antibody tests were negative in 100% (103 of 103) of patients, and syphilis antibody testing was positive for treponemal antibodies in 7.7% (8 of 104) patients. For subjects from the HHF, 19.9% were positive for T. vaginalis, 11.9% were positive for C. trachomatis, 10.1% were positive for M. genitalium, and 4.1% were positive for N. gonorrhea. Infections with G. vaginalis, T. vaginalis, and Candida were the most common. N. gonorrhea, C. trachomatis, Candida sp., T. vaginalis, and M. genitalium infections were associated with younger age (less than 31 years old).

Cholera at the Crossroads: The Association Between Endemic Cholera and National Access to Improved Water Sources and Sanitation
Benjamin L. Nygren*, Anna J. Blackstock and Eric D. Mintz
Author Affiliations
Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Abstract.
We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation.

BMC Health Services Research
(Accessed 8 November 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Frontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa
Bvudzai Priscilla Magadzire1*, Ashwin Budden2, Kim Ward13, Roger Jeffery4 and David Sanders1
Author Affiliations
BMC Health Services Research 2014, 14:520 doi:10.1186/s12913-014-0520-6
Published: 5 November 2014
Abstract (provisional)
Background
Front-line health providers have a unique role as brokers (patient advocates) between the health system and patients in ensuring access to medicines (ATM). ATM is a fundamental component of health systems. This paper examines in a South African context supply- and demand- ATM barriers from the provider perspective using a five dimensional framework: availability (fit between existing resources and clients? needs); accessibility (fit between physical location of healthcare and location of clients); accommodation (fit between the organisation of services and clients? practical circumstances); acceptability (fit between clients? and providers? mutual expectations and appropriateness of care) and affordability (fit between cost of care and ability to pay).
Methods
This cross-sectional, qualitative study uses semi-structured interviews with nurses, pharmacy personnel and doctors. Thirty-six providers were purposively recruited from six public sector Community Health Centres in two districts in the Eastern Cape Province representing both rural and urban settings. Content analysis combined structured coding and grounded theory approaches. Finally, the five dimensional framework was applied to illustrate the interconnected facets of the issue.
Results
Factors perceived to affect ATM were identified. Availability of medicines was hampered by logistical bottlenecks in the medicines supply chain; poor public transport networks affected accessibility. Organization of disease programmes meshed poorly with the needs of patients with comorbidities and circular migrants who move between provinces searching for economic opportunities, proximity to services such as social grants and shopping centres influenced where patients obtain medicines. Acceptability was affected by, for example, HIV related stigma leading patients to seek distant services. Travel costs exacerbated by the interplay of several ATM barriers influenced affordability. Providers play a brokerage role by adopting flexible prescribing and dispensing for `stable? patients and aligning clinic and social grant appointments to minimise clients? routine costs. Occasionally they reported assisting patients with transport money.
Conclusion
All five ATM barriers are important and they interact in complex ways. Context-sensitive responses which minimise treatment interruption are needed. While broad-based changes encompassing all disease programmes to improve ATM are needed, a beginning could be to assess the appropriateness, feasibility and sustainability of existing brokerage mechanisms.

Research article
Cost-effectiveness analysis in Developing Nations: A cross sectional survey about Exposure, Interest and Barriers
Jackson Musuuza, Mendel E Singer, Anna Mandalakas and Achilles Katamba
Author Affiliations
BMC Health Services Research 2014, 14:539 doi:10.1186/s12913-014-0539-8
Published: 4 November 2014
Abstract (provisional)
Background
Cost effectiveness analysis (CEA) is a useful tool for allocation of constrained resources, yet CEA methodologies are rarely taught or implemented in developing nations. We aimed to assess exposure to, and interest in CEA, and identify barriers to implementation in Uganda.
Methods
A cross-sectional survey was carried out in Uganda using a newly developed self-administered questionnaire (via online and paper based approaches), targeting the main health care actors as identified by a previous study.
Results
Overall, there was a 68% response rate, with a 92% (69/75) response rate among the paper-based respondents compared to a 40% (26/65) rate with the online respondents. Seventy eight percent (74/95) of the respondents had no exposure to CEA. None of those with a master of medicine degree had any CEA exposure, and 80% of technical officers, who are directly involved in policy formulation, had no CEA exposure. Barriers to CEA identified by more than 50% of the participants were: lack of information technology (IT) infrastructure (hardware and software); lack of local experts in the field of CEA; lack of or limited local data; limited CEA training in schools; equity or ethical issues; and lack of training grants incorporating CEA. 93% reported a lot of interest in learning to conduct CEA, and over 95% felt CEA was important for clinical decision making and policy formulation.
Conclusions
Among health care actors in Uganda, there is very limited exposure to, but substantial interest in conducting CEA and including it in clinical decision making and health care policy formation. Capacity to undertake CEA needs to be built through incorporation into medical training and use of regional approaches.

BMC Public Health
(Accessed 8 November 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Knowledge and attitude towards child marriage practice among women married as children-a qualitative study in urban slums of Lahore, Pakistan
Muazzam Nasrullah, Rubeena Zakar, Muhammad Zakria Zakar, Safdar Abbas, Rabia Safdar, Mahwish Shaukat and Alexander Krämer
Author Affiliations
BMC Public Health 2014, 14:1148 doi:10.1186/1471-2458-14-1148
Published: 6 November 2014
Abstract (provisional)
Background
Child marriage (<18 years) is prevalent in Pakistan which is associated with negative health outcomes. Our aim is to describe women’s knowledge and attitude towards child marriage practice who themselves were married as children.
Methods
Women of reproductive age (15-49 years) who were married prior to 18 years, for at least 5 years and had at least one child birth were recruited from most populous slum areas of Lahore, Pakistan. Themes for the interview were developed using published literature and everyday observations of the researchers. Interviews were conducted by trained interviewers in Urdu language and were translated into English. The interviews were tape-recorded, transcribed, analyzed and categorized into themes.
Results
Nineteen of 20 participants who agreed to participate were married between 11-17 years. Most respondents were uneducated, poor and were working as housemaids. The majority participants were unaware of the negative health outcomes of child marriages. They appeared satisfied by the decision of their parents of marrying them before 18 years, and even condemned banning child marriages in Pakistan. Strong influence of culture and community perceptions, varying interpretation of religion, and protecting family honor are some of the reasons that were narrated by the participants, which seems playing a role in continuation of child marriage practice in Pakistan.
Conclusion
Raising awareness of the negative health outcomes of child marriage, implementing and enforcing strict laws against child marriage practice, promoting civil, sexual and reproductive health rights for women, can help eliminate child marriages in Pakistan.

Research article
Health effects of single motherhood on children in sub-Saharan Africa: a cross-sectional study
Lorretta FC Ntoimo and Clifford O Odimegwu
Author Affiliations
BMC Public Health 2014, 14:1145 doi:10.1186/1471-2458-14-1145
Published: 5 November 2014
Abstract (provisional)
Background
Although progress has been made toward reducing child morbidity and mortality globally, a large proportion of children in sub-Saharan Africa still die before age five and many suffer chronic malnutrition. This study investigated the influence of single motherhood on stunting and under-5 mortality in Cameroon, Nigeria and Democratic Republic of the Congo (DRC). Particular attention was paid to the influence of mother’s economic resources, parental care and health behaviour on the difference in children’s health in single and two-parent families.
Methods
Data were obtained from most recent Demographic and Health Surveys in Cameroon (2011), Nigeria (2008) and DRC (2007). The sample included women aged 15-49 years old and their under-5 children 11,748 in Cameroon, 28,100 in Nigeria, and 8,999 in DRC. Logistic regression and Cox proportional hazard analysis were used to estimate stunting and under-5 mortality, respectively.
Results
The result showed that compared with children whose mothers were in union, children of single mothers who were not widows were more likely to be stunted (OR 1.79 p < 0.01 in Cameroon and 1.69 p < .01 in DRC). Economic resources and parental care significantly influenced the higher odds of stunting in single mother households in Cameroon and DRC. Relative to children of mothers in union, the risk of under-5 mortality in single mother families was higher in the three countries (HR 1.40 p < .05 in Cameroon, 1.27 p < 0.10 in DRC, 1.55 p < .01 in Nigeria). Economic resources, parental care and health behaviour accounted for the difference in Nigeria and Cameroon; in DRC, only economic resources had marginal influence.
Conclusions
Single motherhood is a risk factor for children’s nutritional status and chances of survival before age 5 years in sub-Saharan Africa. To achieve improved reduction in children’s exposure to stunting and under-5 mortality, there is the need for public health interventions targeted at single mother households in sub-Saharan Africa.

Complexity
November/December 2014 Volume 20, Issue 2 Pages fmi–fmi, 1–81
http://onlinelibrary.wiley.com/doi/10.1002/cplx.v20.2/issuetoc

The Simply complex
Exponential growth in Ebola outbreak since May 14, 2014
Allen G. Hunt*
Article first published online: 18 OCT 2014
DOI: 10.1002/cplx.21615
Excerpt
Contrary to general opinion, the current Ebola outbreak in West Africa followed an exponential growth curve starting already in mid-May. The death toll followed an exponential growth curve with almost the same time constant, allowing direct calculation of the mortality of the outbreak. This value remained steady at about 72%, contrary to the estimate of the World Health Organization of slightly above 50%. Until the last 2 weeks, the projected date at which the number of infected individuals would reach 100,000 had remained steady at January 19. Updated statistics from September 6 advanced that date by at least a month. Estimates suggest that over 20,000 already have been infected, exceeding the number that the WHO has declared could be the eventual outcome…

Conflict and Health
[Accessed 8 November 2014]
http://www.conflictandhealth.com/

Research
Measurement of attacks and interferences with health care in conflict: validation of an incident reporting tool for attacks on and interferences with health care in eastern Burma
Rohini J Haar, Katherine H Footer, Sonal Singh, Susan G Sherman, Casey Branchini, Joshua Sclar, Emily Clouse and Leonard S Rubenstein
Author Affiliations
Conflict and Health 2014, 8:23 doi:10.1186/1752-1505-8-23
Published: 3 November 2014
Abstract (provisional)
Background
Attacks on health care in armed conflict and other civil disturbances, including those on health workers, health facilities, patients and health transports, represent a critical yet often overlooked violation of human rights and international humanitarian law. Reporting has been limited yet local health workers working on the frontline in conflict are often the victims of chronic abuse and interferences with their care-giving. This paper reports on the validation and revision of an instrument designed to capture incidents via a qualitative and quantitative evaluation method.
Methods
Based on previous research and interviews with experts, investigators developed a 33-question instrument to report on attacks on healthcare. These items would provide information about who, what, where, when, and the impact of each incident of attack on or interference with health. The questions are grouped into 4 domains: health facilities, health workers, patients, and health transports. 38 health workers who work in eastern Burma participated in detailed discussion groups in August 2013 to review the face and content validity of the instrument and then tested the instrument based on two simulated scenarios. Completed forms were graded to test the inter-rater reliability of the instrument.
Results
Face and content validity were confirmed with participants expressing that the instrument would assist in better reporting of attacks on health in the setting of eastern Burma where they work. Participants were able to give an accurate account of relevant incidents (86% and 82% on Scenarios 1 and 2 respectively). Item-by-item review of the instrument revealed that greater than 95% of participants completed the correct sections. Errors primarily occurred in quantifying the impact of the incident on patient care. Revisions to the translated instrument based on the results consisted primarily of design improvements and simplification of some numerical fields.
Conclusion
This instrument was validated for use in eastern Burma and could be used as a model for reporting violence towards health care in other conflict settings.

Review
Conflict, forced displacement and health in Sri Lanka: a review of the research landscape
Chesmal Siriwardhana and Kolitha Wickramage
Author Affiliations
Conflict and Health 2014, 8:22 doi:10.1186/1752-1505-8-22
Published: 3 November 2014
Abstract (provisional)
Sri Lanka has recently emerged from nearly three decades of protracted conflict, which came to an end five years ago in 2009. A number of researchers have explored the devastating effect the conflict has had on public health, and its impact on Sri Lanka’s health system – hailed as a success story in the South Asian region. Remarkably, no attempt has been made to synthesize the findings of such studies in order to build an evidence-informed research platform. This review aims to map the ‘research landscape’ on the impact of conflict on health in Sri Lanka. Findings highlight health status in select groups within affected communities and unmet needs of health systems in post-conflict regions. We contend that Sri Lanka’s post-conflict research landscape requires exploration of individual, community and health system resilience, to provide better evidence for health programs and interventions after 26 years of conflict.

Food Policy
Volume 49, Part 1, In Progress (December 2014)
http://www.sciencedirect.com/science/journal/03069192

Food as a human right during disasters in Uganda
Peter Milton Rukundoa, b, Per Ole Iversenb, Arne Oshaugc, Lovise Ribe Omuajuanfoc, Byaruhanga Rukookod, Joyce Kikafundae, Bård Anders Andreassenf
DOI: 10.1016/j.foodpol.2014.09.009
Open Access
Highlights
:: Implementation of relevant constitutional and policy provisions on the right to adequate food and disaster management in Uganda appeared slow.
:: There is a reality gap since supportive policies and plans are not financed by the national budget in anticipation of external assistance.
:: Specific legislation to fund and institutionalize disaster preparedness and management capabilities was lacking.
:: Due to capacity constraints, an approach of humanitarian relief was being entrenched in contradiction to State obligations on the right to adequate food.
:: Human rights capacity development is paramount.
Abstract
Natural and human induced disasters are a threat to food security, economic progress and livelihoods in Uganda. However, we have limited knowledge regarding the putative role of the human rights dimension to the impact and management of such tragedies. In this article we assessed the present policies, legislation and institutional capabilities to ascertain whether they could assure the right to adequate food during disaster situations in Uganda.
Using purposive sampling, 52 duty bearers working in institutions deemed relevant to food security, nutrition and disaster management were interviewed using a semi-structured guide. Relevant provisions from policy, legislation, institutional budgets and records of Parliament provided the context for analysis.
The most important concern coming from the analyses of the information retrieved were inadequate preparedness mechanisms and capabilities. Whereas Uganda’s Constitution proclaims the right to adequate food, and the need to establish a contingencies fund and commission responsible for disaster preparedness and management, they had not been instituted. Implementation of relevant policies appeared slow, especially with regard to assuring adequate relief food as a State obligation. Legislation to guarantee funding and institutionalisation of necessary disaster preparedness and management capabilities was not in place. An ambitious 5-year Uganda Nutrition Action Plan adopted in 2011 had not yet been funded by mid-2013, implying a reality gap in nutrition programming. Budget architecture and financing to disaster management have in effect fallen short of assuring adequate relief food as a human right.
Due to capacity constraints, an approach of humanitarian relief may be entrenched in contradiction of State obligations to respect, protect and fulfil human rights. To stay ahead of the potential threats, the Government with support of the Parliament and relevant partners need to enact legislation to appropriate budget resources needed to institute a mechanism of capabilities to implement the constitutional and policy provisions on the right to adequate food and disaster management.

Politics & technology: U.S. polices restricting unmanned aerial systems in agriculture
P.K. Freemana, R.S. Freelandb, ,
DOI: 10.1016/j.foodpol.2014.09.008
Highlights
:: UASs to enter US airspace by 2015.
:: Agriculture within the U.S. is posed to substantially benefit from UASs.
:: State “Ag-Gag” laws and privacy bills attempt to regulate UAS use.
:: The economic impact of ag drones is currently moderating legislation.
:: Local restrictions may cause short-term turmoil for UAS use.
Abstract
Many industry observers foresee that agriculture worldwide is posed to substantially benefit from the use of unmanned aircraft systems (UASs), commonly known as drones. Industry special interests predict that 80% of domestic sales of UASs in the U.S. will be for agriculture. However, some fear that the public anxiety of the UAS operating in U.S. airspace could stall their introduction, a move that would potentially place some of American farmers’ production practices at an economic disadvantage. Currently, this public policy controversy is influencing UAS integration into U.S. agriculture, with the potential of spilling over internationally.
This project examines the nature of the current debate surrounding the UAS within the U.S., analyzes the impact on agriculture from the legislation considered, discusses policy options to ameliorate the controversy, and describes the factors that will likely determine UAS operations within the U.S. The information was obtained from government documents, academic research, industry studies, nonprofit organizations, and media reports. An analysis was done using these data on how UAS legislation may affect agriculture.
Popularized images of the silent-kills overseas using militarized UASs, safety concerns, and a fear of privacy invasions were found to generate intense opposition to their domestic integration. Spurred by the FAA’s congressional mandate to fully integrate UASs into the nation’s airspace, a significant number of bills, particularly in state legislatures, have been introduced in an attempt to regulate UAS use. Although geared toward privacy protection and law enforcement, some laws may adversely affect agriculture because they create legal uncertainty and/or they sweepingly ban or highly curtail local UAS operations. Possible solutions have been proposed: (1) reducing the legal uncertainty regarding UASs, (2) adopting an industry Code of Conduct and Safe Practices, and (3) producing a consensus on UAS regulations among diverse groups through an open discussion of how to balance UAS operations with safeguards on privacy and property rights. The perceived economic potential of the UAS, particularly in agriculture, combined with the lobbying power of the UAS industry, strongly suggest that policy will eventually be developed that will allow the use of this technology for agriculture in U.S. airspace.

Health Affairs
November 2014; Volume 33, Issue 11
http://content.healthaffairs.org/content/current

Theme: Collaborating For Community Health
Integrating Public Health And Community Development To Tackle Neighborhood Distress And Promote Well-Being
Manuel Pastor1,* and Rachel Morello-Frosch2
Author Affiliations
1Manuel Pastor is a professor of sociology and of American studies and ethnicity and director of the Program for Environmental and Regional Equity, University of Southern California, in Los Angeles.
2Rachel Morello-Frosch is a professor in the School of Public Health and the Department of Environmental Science, Policy, and Management, both at the University of California, Berkeley.
Abstract
Recently there have been calls for public health to reconnect to urban planning in ways that emphasize the impact of place on health and that address fundamental causes of poor health, such as poverty, social inequality, and discrimination. Community developers have realized that poor health limits individuals’ and communities’ economic potential and have begun to integrate into their work such neighborhood health issues as access to fresh food and open space. In this article we review recent shifts in the community development field and give examples of programs that operate at the intersection of community development, public health, and civic engagement. For example, in Sacramento, California, the Building Healthy Communities program successfully promoted the creation of community gardens and bike paths and the redevelopment of brownfields. A major housing revitalization initiative in San Francisco, California, known as Sunnydale-Velasco, is transforming the city’s largest public housing site into a mixed-income community that provides existing residents with new housing, infrastructure, services, and amenities. These examples and others illustrate the need to identify and make use of interdisciplinary approaches to ensure that all places are strong platforms for economic mobility, full democratic participation, and community health.

Case Study: San Francisco’s Use Of Neighborhood Indicators To Encourage Healthy Urban Development
Rajiv Bhatia1
Author Affiliations
1Rajiv Bhatiais a visiting scholar at the University of California, Berkeley, and director of the Civic Engine, an organization that develops innovations for civic engagement and healthy public policy, in Oakland, California.
Abstract
Neighborhood indicators are quantitative measures of neighborhood quality, including measures of attributes such as crime, noise, proximity to parks, transit services, social capital, and student performance. In 2007 the San Francisco Department of Public Health, with broad public input, developed a comprehensive system of neighborhood indicators to inform, influence, and monitor decisions made by the Department of City Planning and other community development institutions. Local public agencies, businesses, and citizens’ groups used the indicators to identify disparities in environmental and social conditions, inform and shape neighborhood land use plans, select appropriate sites for development projects, craft new environmental regulations, and justify demands on developers to make financial contributions to community infrastructure. Among other things, the use of indicators contributed to policies to prevent residential displacement, a city ordinance requiring stricter building ventilation standards in areas with high air pollution, and the redeployment of traffic police to high-injury corridors. Data that can be used to create neighborhood indicators are increasingly available, and participation by public health and health care institutions in the indicators’ development, dissemination, and application could help improve several conditions that contribute to poor population health.

A Framework To Extend Community Development Measurement To Health And Well-Being
Joseph Schuchter1,* and Douglas P. Jutte2
Author Affiliations
1Joseph Schuchteris an independent consultant in Berkeley, California.
2Douglas P. Jutte is an associate professor at the University of California, Berkeley, and executive director of the Build Healthy Places Network, in San Francisco.
Abstract
Measurement can help community development and health practitioners align and optimize their investments and leverage additional resources to achieve shared goals. However, there is no clear guidance for reconciling the established systems for measuring community development activities and outputs—such as housing units built, jobs created, and people served—with the outcomes and impacts of health. We therefore reviewed community development measurement systems—encompassing assessment, monitoring, evaluation, and standards—and identified strategies for using those systems to support health in community development decision making. We highlight promising innovations by organizations such as the Reinvestment Fund and NeighborWorks America and place these in an ecosystem framework to illustrate opportunities for shared measurement. We then discuss policies and processes to build the ecosystem’s infrastructure, balance stakeholders’ priorities within the ecosystem, and use it to drive investments in health.

The Child Opportunity Index: Improving Collaboration Between Community Development And Public Health
Dolores Acevedo-Garcia1,*, Nancy McArdle2, Erin F. Hardy3, Unda Ioana Crisan4, Bethany Romano5, David Norris6, Mikyung Baek7 and Jason Reece8
Author Affiliations
1Dolores Acevedo-Garcia is the Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy and director of the Institute for Child, Youth, and Family Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts.
2Nancy McArdle is a senior research consultant at the Heller School for Social Policy and Management, Brandeis University.
3Erin F. Hardy is research director of diversitydatakids.org and a fellow at the Heller School for Social Policy and Management, Brandeis University.
4Unda Ioana Crisan is a research associate at the Heller School for Social Policy and Management, Brandeis University.
5Bethany Romano is senior department coordinator for the Institute for Child, Youth, and Family Policy at the Heller School for Social Policy and Management, Brandeis University.
6David Norris is a senior researcher at the Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, in Columbus.
7Mikyung Baek is a research and technical associate at the Kirwan Institute for the Study of Race and Ethnicity, Ohio State University.
8Jason Reece is director of research at the Kirwan Institute for the Study of Race and Ethnicity, Ohio State University.
Abstract
Improving neighborhood environments for children through community development and other interventions may help improve children’s health and reduce inequities in health. A first step is to develop a population-level surveillance system of children’s neighborhood environments. This article presents the newly developed Child Opportunity Index for the 100 largest US metropolitan areas. The index examines the extent of racial/ethnic inequity in the distribution of children across levels of neighborhood opportunity. We found that high concentrations of black and Hispanic children in the lowest-opportunity neighborhoods are pervasive across US metropolitan areas. We also found that 40 percent of black and 32 percent of Hispanic children live in very low-opportunity neighborhoods within their metropolitan area, compared to 9 percent of white children. This inequity is greater in some metropolitan areas, especially those with high levels of residential segregation. The Child Opportunity Index provides perspectives on child opportunity at the neighborhood and regional levels and can inform place-based community development interventions and non-place-based interventions that address inequities across a region. The index can also be used to meet new community data reporting requirements under the Affordable Care Act.

Infectious Diseases of Poverty
[Accessed 8 November 2014]
http://www.idpjournal.com/content

Research Article
Multinational corporations and infectious disease: Embracing human rights management techniques
Kendyl Salcito, Burton H Singer, Mitchell G Weiss, Mirko S Winkler, Gary R Krieger, Mark Wielga and Jürg Utzinger
Author Affiliations
Infectious Diseases of Poverty 2014, 3:39 doi:10.1186/2049-9957-3-39
Published: 3 November 2014
Abstract (provisional)
Background
Global health institutions have called for governments, international organisations and health practitioners to employ a human rights-based approach to infectious diseases. The motivation for a human rights approach is clear: poverty and inequality create conditions for infectious diseases to thrive, and the diseases, in turn, interact with social-ecological systems to promulgate poverty, inequity and indignity. Governments and intergovernmental organisations should be concerned with the control and elimination of these diseases, as widespread infections delay economic growth and contribute to higher healthcare costs and slower processes for realising universal human rights. These social determinants and economic outcomes associated with infectious diseases should interest multinational companies, partly because they have bearing on corporate productivity and, increasingly, because new global norms impose on companies a responsibility to respect human rights, including the right to health.
Methods
We reviewed historical and recent developments at the interface of infectious diseases, human rights and multinational corporations. Our investigation was supplemented with field-level insights at corporate capital projects that were developed in areas of high endemicity of infectious diseases, which embraced rights-based disease control strategies.
Results
Experience and literature provide a longstanding business case and an emerging social responsibility case for corporations to apply a human rights approach to health programmes at global operations. Indeed, in an increasingly globalised and interconnected world, multinational corporations have an interest, and an important role to play, in advancing rights-based control strategies for infectious diseases.
Conclusions
There are new opportunities for governments and international health agencies to enlist corporate business actors in disease control and elimination strategies. Guidance offered by the United Nations in 2011 that is widely embraced by companies, governments and civil society provides a roadmap for engaging business enterprises in rights-based disease management strategies to mitigate disease transmission rates and improve human welfare outcomes.

Intervention – Journal of Mental Health and Psychological Support in Conflict Affected Areas
November 2014 – Volume 12 – Issue 3 pp: 320-468
http://journals.lww.com/interventionjnl/pages/currenttoc.aspx

Special Section: Rehabilitation processes of former child soldiers
Introduction to the Special Section on former child soldiers’ rehabilitation: connecting individual and communal worlds
Derluyn, Ilse; De Haene, Lucia; Vandenhole, Wouter; Reiffers, Relinde; Tankink, Marian
[No abstract]

‘I Can’t Go Home’. Forced migration and displacement following demobilisation: the complexity of reintegrating former child soldiers in Colombia
Denov, Myriam; Marchand, Ines
Abstract
This paper examines the reintegration experiences of a group of demobilised youth who were associated with various armed groups during the course of ongoing armed conflict in Colombia. In particular, the paper traces how the realities of forced migration and displacement profoundly shape and inform their reintegration experiences. Drawing upon qualitative interviews with a sample of 22 former child soldiers, the authors highlight the key challenges and impacts participants faced as a result of forced migration and displacement, particularly in relation to family, place, and (in) security. Our study indicates that despite these ongoing challenges, and within a context of ongoing war and armed violence, these former child soldiers have been able to lead industrious and productive lives through their commitment to education, employment and peer support.

Protective and risk factors of psychosocial wellbeing related to the reintegration of former child soldiers in Nepal
Adhikari, Ramesh Prasad; Kohrt, Brandon A.; Luitel, Nagendra Prasad; Upadhaya, Nawaraj; Gurung, Dristy; Jordans, Mark J.D.
Abstract
This paper explores protective and risk factors for mental health and psychosocial wellbeing among 300 child solders (verified minors) through a longitudinal study. Both the Hopkins Symptoms Check list and the Posttraumatic Stress Disorder Checklist (civilian version) were used to measure mental health problems, while the Generalised Estimating Equation was used to identify both the protective and risk factors over time. Anxiety and posttraumatic stress disorder decreased over a nine month period, while depression prevalence did not change. Social support, inter-caste marriage, low caste and residence in far western geographic regions were all associated with greater mental health problems. Rehabilitation packages were not associated with improved mental health, and former child solders enrolled in vocational programmes had greater posttraumatic stress disorder symptom severity. The findings suggest that strong social support is needed, as rehabilitation packages alone may be insufficient to improve mental health.

Unfulfilled promises, unsettled youth: the aftermath of conflict for former child soldiers in Yumbe District, north western Uganda
Both, Jonna; Reis, Ria

Child soldiers or war affected children? Why the formerly abducted children of northern Uganda are not child soldiers
Angucia, Margaret

Harnessing traditional practices for use in the reintegration of child soldiers in Africa: examples from Liberia and Burundi
Babatunde, Abosede Omowumi

Rebuilding the social fabric: community counselling groups for Rwandan women with children born as a result of genocide rape
Hogwood, Jemma; Auerbach, Carl; Munderere, Sam; More

Emergency psychiatric care in North Kivu in the Democratic Republic of the Congo
Goodfriend, Marlene; ter Horst, Rachel; Pintaldi, Giovanni;

Key factors that facilitate intergroup dialogue and psychosocial healing in Rwanda: a qualitative study
King, Régine Uwibereyeho

Examining promising practice: an integrated review of services for young survivors of sexual violence in Liberia
Landis, Debbie; Stark, Lindsay

JAMA Pediatrics
November 2014, Vol 168, No. 11
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint | November 2014
Global Child Health: A Call to Collaborative Action for Academic Health Centers
Parminder S. Suchdev, MD, MPH1,2,3; Robert F. Breiman, MD3,4; Barbara J. Stoll, MD1,2
[+] Author Affiliations
JAMA Pediatr. 2014;168(11):983-984. doi:10.1001/jamapediatrics.2014.1566.
This Viewpoint calls for collaborative action in order for academic health centers to improve global child health.
Despite substantial progress toward achieving the Millennium Development Goals of maternal and child survival, challenges persist, including tackling factors beyond survival such as improving quality of life and long-term physical and cognitive development. The web of health determinants have evolved and include food security, climate change, urbanization, and noncommunicable diseases. These 21st century realities underscore an urgent need to engage a wide array of disciplines to catalyze new ways to implement sustainable solutions for the health of the planet.1

Viewpoint | November 2014
Social Impact Bonds – Behavioral Health Opportunities
Eric Trupin, PhD1; Nicholas Weiss, MD1; Suzanne E. U. Kerns, PhD1
[+] Author Affiliations
JAMA Pediatr. 2014;168(11):985-986. doi:10.1001/jamapediatrics.2014.1157.
The past 2 decades have seen remarkable growth in the development of cost-beneficial, evidence-based programs in pediatric health, behavioral health, youth juvenile justice, and child welfare. Despite the economic and system constraints that have slowed broad dissemination, research-proven approaches have exceptional potential to improve population-level well-being while simultaneously protecting society from the burdensome costs of failing to treat the problems they target.

Journal of Community Health
Volume 39, Issue 6, December 2014
http://link.springer.com/journal/10900/39/6/page/1

Comorbid Mental and Physical Health and Health Access in Cambodian Refugees in the US
S. Megan Berthold, Sengly Kong, Richard F. Mollica…
Pages 1045-105

Smallpox Inoculation (Variolation) in East Africa with Special Reference to the Practice Among the Boran and Gabra of Northern Kenya
Pascal James Imperato, Gavin H. Imperato
Pages 1053-106

Journal of Public Health Policy
Volume 35, Issue 4 (November 2014)
http://www.palgrave-journals.com/jphp/journal/v35/n4/index.html

Editorial
A proposal to rethink how we track tuberculosis spread around the world
Phyllis Freemana and Anthony Robbinsa
aCo-Editors
Journal of Public Health Policy (2014) 35, 423–424. doi:10.1057/jphp.2014.36; published online 11 September 2014

We are pleased to publish in this issue an article that lays out a novel and promising global strategy for tuberculosis (TB).1 Becerra and Swaminathan start with children, who within the global epidemic remain largely invisible. They explain why it is useful to think of children with TB as ‘sentinels’ – as well as a neglected population that urgently needs quality attention.

Every year about 1 million children get sick with TB. Children are exposed to TB, mostly in homes shared with others who cough the mycobacterium into the air. Each child is a sentinel, helping detect the infecting cases, and creating an opportunity for preventive treatment for some, treatment of active disease for many others. But it will not be easy.

Becerra and Swaminathan identify key difficulties:
– the very nature of pediatric TB;
– the inadequacy of diagnostic tools;
– lack of data for good disease burden estimates; and
– failure, in most of world, to field contact investigations.

The plight of children signals a continuing failure of two decades of global TB policy – focused on Directly Observed Therapy with a set regime of ‘first line drugs’ (effective in the absence of drug resistance) – for all but the most affluent countries. If the world were to adopt additional tools used commonly in wealthier nations, contact investigation followed by use of existing diagnostic tools, and drug sensitivity testing to learn about the infecting organisms, it should be possible to set quantitative treatment and prevention targets among children exposed at home to multidrug-resistant TB, country by country. The article describes the strategy in detail.
These authors are not satisfied with their ambitious proposal for case finding and preventive treatment. They have organized a science-advocacy network to take action – the Sentinel Project on Pediatric Drug-Resistant Tuberculosis. Their activities warrant following (sentinel-project.org).

Those in developing countries seem more aware of today’s dilemma for improving response to TB than those in more affluent settings. An Indian colleague writes: ‘It is disheartening to see that whenever the problem of TB is discussed among experts, it gets largely confined to multidrug resistant TB and HIV induced TB, as if the regular form is already under control’.2 His comment may reflect the difference between richer countries, where TB spread has nearly been halted compared with countries with fewer resources, where prevalence is high in the general population and epidemic spread persists. For richer countries two exceptions require special attention: continuing vulnerability for people infected with drug-resistant strains and for those with compromised immune systems.

To mount more urgent and informed global support, this article provides a crucial link between ‘business as usual’ in TB action, and a future where attention to children can protect many in danger and lead to a more comprehensive and effective set of programs worldwide.

.

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis
Open
Mercedes C Becerraa and Soumya Swaminathanb
aDepartment of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
bNational Institute for Research in Tuberculosis, Chennai, India
The online version of this article is available Open Access
Abstract
Tuberculosis (TB) is an airborne infectious disease that is both preventable and curable, yet it kills more than a million people every year. Children are highly vulnerable, but often invisible casualties. Drug-resistant forms of TB are on the rise globally, and children are as vulnerable as adults but less likely to be counted as cases of drug-resistant disease if they become sick. Four factors make children with drug-resistant TB ‘invisible’: first, the nature of the disease in children; second, deficiencies in existing diagnostic tools; third, overreliance on these tools; and fourth, our collective failure to deploy one effective tool for finding and treating children – contact investigation. We describe a nascent science-advocacy network – the Sentinel Project on Pediatric Drug-Resistant Tuberculosis – whose goal is to end child deaths from this disease. Provisional annual targets, focused on children exposed at home to multidrug-resistant TB, to be updated every year, constitute a framework to focus attention and collective actions at the community, national, and global levels. The targets in two age groups, under 5 and 5–14 years old, tell us the number of: (i) children who require complete evaluation for TB disease and infection; (ii) children who require treatment for TB disease; and (iii) children who would benefit from preventive therapy.

.

Building capacities of elected national representatives to interpret and to use evidence for health-related policy decisions: A case study from Botswana
Open
Anne Cockcrofta, Mokgweetsi Masisib, Lehana Thabanec, and Neil Anderssond,e
aCIET Trust Botswana, PO Box 1240, Gaborone, Botswana
bMinister for Presidential Affairs and Public Administration, Office of the President, Private Bag 001, Gaborone, Botswana
cDepartment of Epidemiology and Biostatistics, McMaster University, Canada
dCentro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
eCIET/PRAM, Department of Family Medicine, McGill University, Montreal, Canada
Correspondence: Anne Cockcroft, E-mail: acockcroft@ciet.org
The online version of this article is available Open Access
Abstract
Elected national representatives make decisions to fund health programmes, but may lack skills to interpret evidence on health-related topics. In 2011, we surveyed the 61 members of Botswana’s Parliament about their use of epidemiological evidence, then provided two half-days of training about using evidence. We included the importance of counter-factual evidence, the number needed to treat, and unit costs of interventions. A further session in 2012 covered evidence about the HIV epidemic in Botswana and planning the best mix of interventions to reduce new HIV infections. The 27 respondents reported they lacked good quality, timely evidence, and had difficulty interpreting and using evidence. Thirty-six, including seven ministers, attended one or both trainings. They participated actively and their evaluation was positive. Our experience in Botswana could potentially be extended to other countries in the region to support evidence-based efforts to tackle the HIV epidemic.

The Lancet
Nov 08, 2014 Volume 384 Number 9955 p1641 – 1720 e52 – 56
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The medium and the message of Ebola
The Lancet
…Social media during a health crisis has the potential to bring experts together in a transparent and democratic forum with global participation to generate a mass of new and potentially helpful ideas. Scaling up the positive and constructive discussion of an informed Twitter discussion could remove boundaries between scientists, health professionals, and policy makers, creating a new diverse community that gives everyone a voice and an opportunity to contribute. To create the conditions to defeat Ebola, we need more of that kind of global engagement, knowledge, and commitment.

A new Lancet Commission on Essential Medicines
The Lancet
Preview |
Access to essential medicines globally is a highly charged political issue that is often about trade, poliies, and protest. Essential medicines are crucial if countries are to achieve universal health coverage, and access will be a major goal for the post-2015 development era.

Special Report
The WHO AFRO Regional Director candidates
Udani Samarasekera
Preview |
The Lancet asked the candidates for one of the most important jobs in Africa five questions ahead of the meeting that will decide who will be nominated for the position. Udani Samarasekera reports.

PLoS One
[Accessed 8 November 2014]
http://www.plosone.org/

Research Article
Incidence of Rotavirus and Circulating Genotypes in Northeast Brazil during 7 Years of National Rotavirus Vaccination
Ricardo Q. Gurgel, Alberto De Juan Alvarez, Alda Rodrigues, Robergson R. Ribeiro, Sílvio S. Dolabella, Natanael L. Da Mota, Victor S. Santos, Miren Iturriza-Gomara, Nigel A. Cunliffe, Luis E. Cuevas mail
Published: October 31, 2014
DOI: 10.1371/journal.pone.0110217
Abstract
Background and Aims
Rotavirus causes severe diarrhoea and Brazil introduced the Rotarix G1P[8] vaccine in 2006. We aimed to describe changes in rotavirus incidence and diarrhoea epidemiology before and after vaccine introduction.
Methods
Design: (i) hospital-based survey of children with diarrhoea (2006–2012); (ii) diarrhea-mortality and hospitalization surveillance (1999–2012).
Setting
(i) Aracaju and (ii) state and national level.
Results
1841 children were enrolled and 231 (12.5%) had rotavirus. Rotavirus was less frequent from January-June than from July-December (9.4% versus 20.9%, p<0.01), but the seasonal variation was less defined after 2009. Very few rotavirus cases (8–3.9%) were detected in 2011, with an increase in 2012 (13–18.5%). In 2006, unvaccinated children were more likely to have rotavirus, but thereafter unvaccinated and vaccinated children had equally low incidence. Older children and those with rotavirus were more likely to have severe diarrhea episodes. The most frequent genotype from 2006 to 2010 was G2P[4]; except in 2009, when most cases were G1P[8]. Very few G2P[4] were detected from 2011 and 50% cases in 2012 were G8P[4]. Diarrhoea-hospitalizations decreased nationally from 89,934 (2003) to 53,705 (2012; 40.3% reduction) and in the state from 1729 to 748 (56.7% reduction). Diarrhoea-deaths decreased nationally from 4368 in 1999 to 697 in 2012 (84% reduction, p<0.001) and in the state from 132 to 18 (86% reduction). These changes were much larger after vaccine introduction.
Conclusions
The vaccine was associated with substantial reductions in rotavirus incidence and diarrhoea-hospitalizations and deaths. The G2P[4] genotype predominance disappeared over time and may be replaced by other heterotypic genotypes.

.
Research Article
Effect of Pneumococcal Conjugate Vaccination in Uruguay, a Middle-Income Country
Gabriela García Gabarrot, Mariana López Vega, Gabriel Pérez Giffoni, Silvia Hernández, Pablo Cardinal, Viviana Félix, Jean Marc Gabastou, Teresa Camou mail, the Uruguayan SIREVA II Group
Published: November 06, 2014
DOI: 10.1371/journal.pone.011233
Abstract
Background
In 2008, a 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine childhood immunization program in Uruguay, with a 2+1 schedule. In 2010, PCV13 replaced PCV7, and the same 2+1 schedule was used. The effect of these pneumococcal vaccines on the incidence of invasive pneumococcal infections (IPD) and on serotype distribution was analyzed retrospectively, based on passive national laboratory surveillance.
Methods
Data from 1,887 IPD isolates from 5 years before and 5 years after PCV7 introduction (7 before and 3 after PCV13 introduction) was examined to assess the incidence rate per 100,000 age-specific population of all IPD, PCV7-serotypes, and PCV13-serotypes associated IPD among children <2 years and 2 to 4 years old, and patients ≥5 years old. Trends of frequency for each serotype were also analyzed.
Results
Comparison of pre-vaccination (2003–2007) and post-vaccination (2008–2012) periods showed a significant decrease in IPD incidence among children <2 years old (IR 68.7 to IR 29.6, p<0.001) and children 2 to 4 years (p<0.04). IPD caused by serotypes in PCV7 was reduced by 95.6% and IPD caused by 6 serotypes added in PCV13 was reduced by 83.9% in children <5 years old. Indirect effects of both conjugate vaccines were observed among patients ≥5 years old one year after the introduction of each vaccine, in 2010 for PCV7 and in 2012 for PCV13. Nevertheless, for reasons that still need to be explained, perhaps due to ascertainment bias, total IPD in this group increased after 2007. In 2012, the relative frequency of vaccine serotypes among vaccinated and unvaccinated population declined, except for serotype 3. Non vaccine serotypes with increasing frequency were identified, in rank order: 12F, 8, 24F, 22F, 24A, 15C, 9N, 10A and 33.
Conclusion
Consecutive immunization with PCV7 and PCV13 has significantly reduced IPD in children <5 years of age in Uruguay.

.
Research Article
Global Systematic Review of the Cost-Effectiveness of Indigenous Health Interventions
Blake J. Angell mail, Janani Muhunthan, Michelle Irving, Sandra Eades, Stephen Jan Published: November 05, 2014
DOI: 10.1371/journal.pone.011124
Abstract
Background
Indigenous populations around the world have consistently been shown to bear a greater burden of disease, death and disability than their non-Indigenous counterparts. Despite this, little is known about what constitutes cost-effective interventions in these groups. The objective of this paper was to assess the global cost-effectiveness literature in Indigenous health to identify characteristics of successful and unsuccessful interventions and highlight areas for further research.
Methods and Findings
A systematic review of the published literature was carried out. MEDLINE, PSYCINFO, ECONLIT, EMBASE and CINAHL were searched with terms to identify cost-effectiveness evaluations of interventions in Indigenous populations around the world. The WHO definition was followed in identifying Indigenous populations. 19 studies reporting on 27 interventions were included in the review. The majority of studies came from high-income nations with only two studies of interventions in low and middle-income nations. 22 of the 27 interventions included in the analysis were found to be cost-effective or cost-saving by the respective studies. There were only two studies that focused on Indigenous communities in urban areas, neither of which was found to be cost-effective. There was little attention paid to Indigenous conceptions of health in included studies. Of the 27 included studies, 23 were interventions that specifically targeted Indigenous populations. Outreach programs were shown to be consistently cost-effective.
Conclusion
The comprehensive review found only a small number of studies examining the cost-effectiveness of interventions into Indigenous communities around the world. Given the persistent disparities in health outcomes faced by these populations and commitments from governments around the world to improving these outcomes, it is an area where the health economics and public health fields can play an important role in improving the health of millions of people.