“Outbreaks” Report Finds Gaps in Nation’s Ability to Respond to Ebola and Other Infectious Diseases; 25 States Reach Half or Fewer of Key Indicators

Robert Wood Johnson Foundation

“Outbreaks” Report Finds Gaps in Nation’s Ability to Respond to Ebola and Other Infectious Diseases; 25 States Reach Half or Fewer of Key Indicators
December 18, 2014 | News Release
The Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats. Understand how states perform against key indicators.

American Journal of Public Health – January 2015

American Journal of Public Health
Volume 105, Issue 1 (January 2015)

Coupled Ethical–Epistemic Analysis of Public Health Research and Practice: Categorizing Variables to Improve Population Health and Equity
S. Vittal Katikireddi, MRCP, MFPH, PhD, and Sean A Valles, PhD
S. Vittal Katikireddi is with the Medical Research Council and the Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Sean A. Valles is with Lyman Briggs College and the Department of Philosophy, Michigan State University, East Lansing.
The categorization of variables can stigmatize populations, which is ethically problematic and threatens the central purpose of public health: to improve population health and reduce health inequities. How social variables (e.g., behavioral risks for HIV) are categorized can reinforce stigma and cause unintended harms to the populations practitioners and researchers strive to serve.
Although debates about the validity or ethical consequences of epidemiological variables are familiar for specific variables (e.g., ethnicity), these issues apply more widely.
We argue that these tensions and debates regarding epidemiological variables should be analyzed simultaneously as ethical and epistemic challenges. We describe a framework derived from the philosophy of science that may be usefully applied to public health, and we illustrate its application.

EDITORIAL The Moral Challenge of Ebola
Mark A. Rothstein
American Journal of Public Health: January 2015, Vol. 105, No. 1: 6–8.
Citation | Full Text | PDF (651 KB) | PDF Plus (653 KB)

Assessing the Expected Impact of Global Health Treaties: Evidence From 90 Quantitative Evaluations
Steven J. Hoffman, BHSc, MA, JD, and John-Arne Røttingen, MD, PhD, MSc, MPA
Steven J. Hoffman is with the Faculty of Law, University of Ottawa, Canada, and the Department of Global Health and Population, Harvard School of Public Health, Boston, MA. John-Arne Røttingen is with the Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway, and the Institute of Health and Society, University of Oslo, Norway.
We assessed what impact can be expected from global health treaties on the basis of 90 quantitative evaluations of existing treaties on trade, finance, human rights, conflict, and the environment.
It appears treaties consistently succeed in shaping economic matters and consistently fail in achieving social progress. There are at least 3 differences between these domains that point to design characteristics that new global health treaties can incorporate to achieve positive impact: (1) incentives for those with power to act on them; (2) institutions designed to bring edicts into effect; and (3) interests advocating their negotiation, adoption, ratification, and domestic implementation.
Experimental and quasiexperimental evaluations of treaties would provide more information about what can be expected from this type of global intervention.

Cognitive Dissonance in the Early Thirties: The League of Nations Health Organization Confronts the Worldwide Economic Depression
Theodore M. Brown, Elizabeth Fee
American Journal of Public Health: January 2015, Vol. 105, No. 1: 65–65.
Citation | Full Text | PDF (163 KB) | PDF Plus (165 KB)

Human Papillomavirus Vaccination Among Young Adult Gay and Bisexual Men in the United States
Paul L. Reiter, PhD, Annie-Laurie McRee, DrPH, Mira L. Katz, PhD, and Electra D. Paskett, PhD
Paul L. Reiter and Electra D. Paskett are with the Division of Cancer Prevention and Control, College of Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus. Annie-Laurie McRee and Mira L. Katz are with the Division of Health Behavior and Health Promotion, College of Public Health and the Comprehensive Cancer Center, Ohio State University.
Objectives. We examined human papillomavirus (HPV) vaccination among gay and bisexual men, a population with high rates of HPV infection and HPV-related disease.
Methods. A national sample of gay and bisexual men aged 18 to 26 years (n = 428) completed online surveys in fall 2013. We identified correlates of HPV vaccination using multivariate logistic regression.
Results. Overall, 13% of participants had received any doses of the HPV vaccine. About 83% who had received a health care provider recommendation for vaccination were vaccinated, compared with only 5% without a recommendation (P < .001). Vaccination was lower among participants who perceived greater barriers to getting vaccinated (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.27, 0.78). Vaccination was higher among participants with higher levels of worry about getting HPV-related disease (OR = 1.54; 95% CI =  1.05, 2.27) or perceived positive social norms of HPV vaccination (OR = 1.57; 95% CI =  1.02, 2.43).
Conclusions. HPV vaccine coverage is low among gay and bisexual men in the United States. Future efforts should focus on increasing provider recommendation for vaccination and should target other modifiable factors.

Knowledge and attitude of healthcare workers about middle east respiratory syndrome in multispecialty hospitals of qassim, Saudi Arabia

BMC Public Health
(Accessed 20 December 2014)

Research article
Knowledge and attitude of healthcare workers about middle east respiratory syndrome in multispecialty hospitals of qassim, Saudi Arabia
Muhammad Umair Khan, Shahjahan Shah, Akram Ahmad and Omotayo Fatokun
BMC Public Health 2014, 14:1281 doi:10.1186/1471-2458-14-1281
Published: 16 December 2014
Abstract (provisional)
With the increase in prevalence of Middle East Respiratory Syndrome (MERS), healthcare workers (HCWs) are at risk of acquiring and subsequently transmitting this lethal virus. In view of this, HCWs were evaluated for their knowledge of and attitude towards MERS in Saudi Arabia.
A cross sectional study was performed in two hospitals of Qassim region in Saudi Arabia. A total of 280 healthcare workers were selected to participate in this study. Knowledge and attitude were assessed by using self-administered and pretested questionnaire. Descriptive statistics were carried out to express participants’ demographic information, mean knowledge score and mean attitude score of HCWs. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests, p < 0.05) were used to examine differences between study variables. Chi squares tests were used to assess the association between study variables and attitude questions. Spearman’s rho correlation was used to identify the association between the knowledge, attitude scores. Result: Participants demonstrated good knowledge and positive attitude towards MERS. The mean scores of knowledge and attitude were 9.45 +/- 1.69 (based on 13 knowledge questions) and 1.82 +/- 0.72 (based on 7 attitude questions). The correlation between knowledge and attitude was significant (correlation coefficient: 0.12; P <0.001). HCWs were less educated about the management (42.4%), source (66%) and consequences of MERS (67.3%), while a majority of them were well aware of the hallmark symptoms (96%), precautionary measures (96%) and hygiene issues (94%). Although the majority of respondents showed positive attitude towards the use of protective measures (1.52 +/- 0.84), their attitude was negative towards their active participation in infection control program (2.03 +/- 0.97). Gender and experience were significantly associated with knowledge and attitude (P < 0.05).
The findings of this study showed that healthcare workers in Qassim region of Saudi Arabia have good knowledge and positive attitude towards MERS. Yet there are areas where low knowledge and negative attitude of HCWs was observed. However, studies are required to assess the knowledge and attitude of HCWs at national level so that effective interventions could be designed as surveillance and infection control measures are critical to global public health.

Development in Practice – Volume 25, Issue 1, 2015

Development in Practice
Volume 25, Issue 1, 2015

Community rehabilitation workers as catalysts for disability: inclusive youth development through service learning
Theresa Lorenzo*, Jane Motau, Tania van der Merwe, Elize Janse van Rensburg & Jane Murray Cramm
pages 19-28
This paper explores access to health and education for disabled youth in sites with and without community rehabilitation workers (CRWs). A cross-sectional survey using a structured questionnaire was undertaken in nine sites in South Africa, and a snowball sample of 523 disabled youths of both sexes, aged between 18 and 35 years, was selected. The survey found that a significantly larger proportion of disabled youth living in sites with CRWs were seen by health care workers at home, and that there was a large difference in educational access between sites with and without CRWs. CRWs are well positioned to promote equal citizenship for disabled youth through service learning with occupational therapy final year students to improve access to health and education, so that barriers to their participation in economic development are removed.

Challenges and dilemmas of international development volunteering: a case study from Vanuatu
Adam M. Trau*
pages 29-41
This article looks at the key challenges and dilemmas of international development volunteering (IDV) as experienced within a community project in Vanuatu. By focusing on the nature and significance of IDV engagements at the local community level, it offers critical insights into roles and relationships among international development volunteers and local host communities, together with the complex global–local interface in which projects are negotiated and constructed. The article concludes by offering some ways in which IDV can be more effective in assisting community projects address the needs of contemporary village life.

Needs assessment to strengthen capacity in water and sanitation research in Africa: experiences of the African SNOWS consortium

Health Research Policy and Systems
[Accessed 20 December 2014]

Needs assessment to strengthen capacity in water and sanitation research in Africa: experiences of the African SNOWS consortium
Paul R Hunter12*, Samira H Abdelrahman3, Prince Antwi-Agyei4, Esi Awuah4, Sandy Cairncross5, Eileen Chappell5, Anders Dalsgaard6, Jeroen HJ Ensink5, Natasha Potgieter7, Ingrid Mokgobu2, Edward W Muchiri8, Edgar Mulogo9, Mike van der Es1 and Samuel N Odai4
Author Affiliations
Health Research Policy and Systems 2014, 12:68 doi:10.1186/1478-4505-12-68
Published: 15 December 2014
Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in Africa. This paper focuses on the research training needs of the consortium as identified during the first three years of the project.
We reviewed the reports of two needs assessments. The first was a detailed needs assessment led by one northern partner, with follow-up visits which included reciprocal representation from the African universities. The second assessment, led by another northern partner, focused primarily on training needs. The reports from both needs assessments were read and stated needs were extracted and summarised.
Key common issues identified in both assessments were supervisory skills, applications for external research funding, research management, and writing for publication in the peer-reviewed scientific literature. The bureaucratisation of university processes and inconsistencies through administration processes also caused problems. The lack of specialist laboratory equipment presented difficulties, particularly of inaccessibility through a lack of skilled staff for operation and maintenance, and of a budget provision for repairs and running costs. The lack of taught PhD modules and of research training methods also caused problems. Institutionally, there were often no mechanisms for identifying funding opportunities. On the other hand, grantees were often unable to understand or comply with the funders’ financial and reporting requirements and were not supported by their institution. Skills in staff recruitment, retention, and performance were poor, as were performance in proposal and paper writing. The requirements for ethical clearance were often not known and governance issues not understood, particularly those required by funders.
SNOWS believes that working with African universities to develop networks that support African-led research driven by the local context is an effective approach to develop and retain research skills needed to change policy and practice in water, sanitation, and hygiene in Africa.

Corrupt governments do not receive more state-to-state aid: Governance and the delivery of foreign aid through non-state actors

Journal of Development Economics
Volume 114, In Progress (May 2015)

Corrupt governments do not receive more state-to-state aid: Governance and the delivery of foreign aid through non-state actors
Original Research Article
Pages 20-33
Martin Acht, Toman Omar Mahmoud, Rainer Thiele
A core result of the aid allocation literature is that the quality of governance in recipient countries does not affect the amounts of foreign aid received. Donor countries may still give aid to poorly-governed countries because of a dilemma they face: those countries most in need typically also lack proper institutions. This paper argues that donors try to resolve this dilemma by delivering aid through non-state actors. Using aid shares as well as absolute amounts of aid allocated through state and non-state channels and considering different dimensions of governance, we provide evidence that bypassing governments via NGOs and multilateral organizations is indeed a response to weak recipient state institutions. The effect is stronger in aid sectors where donors can more easily switch between channels, and weaker for higher levels of economic self-interest among donors.

The Lancet – Dec 27, 2014

The Lancet
Dec 27, 2014 Volume 384 Number 9961 p2173-2266 e67-e69

Ebola: protection of health-care workers
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62413-2
The Ebola outbreak in west Africa has taken a substantial toll on health-care workers in Guinea, Liberia, and Sierra Leone—not only doctors and nurses, but also other cadres including ambulance drivers, hospital cleaners, and burial team members. More than 600 of the nearly 17 000 cases of Ebola virus disease have been in health-care workers, more than half of them fatal. In today’s issue of The Lancet we pay tribute to several of the health workers who have lost their lives to the disease since the outbreak began a year ago.

Remembering health workers who died from Ebola in 2014
Andrew Green
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62417-X

HPV vaccination: for women of all ages?
Philip E Castle, Kathleen M Schmeler
Published Online: 01 September 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61230-7
The discovery of human papillomavirus (HPV) DNA in cervical cancer by Harald zur Hausen sparked 30 years of research that established that persistent cervical infection by certain HPV genotypes causes cervical cancer. This research has led to revolutionary technical advances for the prevention of cervical cancer: prophylactic HPV vaccination and sensitive molecular HPV testing for screening. These promising technologies can be used to complement or enhance established cervical cancer prevention programmes, and to provide robust solutions in low-resource settings without screening programmes.

Offline: Can Ebola be a route to nation-building?
Richard Horton
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62387-4
At one of the first meetings of the UN Mission for Ebola Emergency Response, someone is reported to have said that if anyone present wanted to use Ebola as a reason to strengthen health systems they should leave the room. The Ebola response was about one goal and one goal only—getting to zero cases. How times have changed. Last week, WHO convened a High-Level Meeting on Building Resilient Systems for Health in Ebola-Affected Countries. What seems clear now is that Ebola in west Africa is not (only) about Ebola.

Global surgery: defining an emerging global health field
Dr Anna J Dare, MBChB, Caris E Grimes, MBBS, Rowan Gillies, FRACS, Sarah L M Greenberg, Lars Hagander, MD, John G Meara, MD, Andrew J M Leather, FRCS
Published Online: 19 May 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60237-3
Global health is one of the defining issues of the 21st century, attracting unprecedented levels of interest and propelling health and disease from a biomedical process to a social, economic, political, and environmental concern. Surgery, however, has not been considered an integral component of global health and has remained largely absent from the discipline’s discourse.1 After much inattention, surgery is now gaining recognition as a legitimate component of global health. In January, 2014, Jim Kim, President of the World Bank, urged the global health community to challenge the injustice of global inequity in surgical care, stating that “surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage”.

Improving the assessment and attribution of effects of development assistance for health
Nour Ataya, MPH, Christoph Aluttis, MSc, Prof Antoine Flahault, PhD, Prof Rifat Atun, FRCP, Prof Andy Haines, FMedSci
Published Online: 25 June 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60791-1
Overseas development assistance for health (DAH) increased substantially from 2000, but has plateaued since 2010 because of the global economic crisis,1 with growing public demands for funders and beneficiary countries to show the effect of investments.2–5 When showing effect, donor agencies and countries need to address two challenges: first, accurate estimation of the effects of investments in different areas (eg, vaccines or health systems) on health outcomes; and second, attribution of the effects to specific investments.

The Milbank Quarterly A Multidisciplinary Journal of Population Health and Health Policy – December 2014

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
December 2014 Volume 92, Issue 4 Pages 633–840

Ebola Fever and Global Health Responsibilities (pages 633–639)
Article first published online: 10 DEC 2014 | DOI: 10.1111/1468-0009.12084
Abstract Full Article (HTML)

The Strange Journey of Population Health (pages 640–643)
Article first published online: 10 DEC 2014 | DOI: 10.1111/1468-0009.12082
Abstract Full Article (HTML)

Ethical Allocation of Drugs and Vaccines in the West African Ebola Epidemic (pages 662–666)
Article first published online: 10 DEC 2014 | DOI: 10.1111/1468-0009.12089
Abstract Full Article (HTML)

Infectious disease: Mobilizing Ebola survivors to curb the epidemic

Volume 516 Number 7531 pp287-444 18 December 2014

Infectious disease: Mobilizing Ebola survivors to curb the epidemic
Joshua M. Epstein, Lauren M. Sauer, Julia Chelen, Erez Hatna, Jon Parker, Richard E. Rothman & Lewis Rubinson
17 December 2014
Scaling up the recruitment of individuals who have recovered from infection deserves urgent consideration, argue Joshua M. Epstein, Lauren M. Sauer and colleagues.
Multiple governments and non-governmental organizations have called on health-care personnel the world over to help control West Africa’s Ebola outbreak; these include Médecins Sans Frontières (MSF), the World Health Organization (WHO) and United Nations children’s charity UNICEF. But the demand for labour far exceeds the supply1. UN estimates, which may be low, suggest that approximately 5,000 international medical, training and support personnel are needed in the coming months.
While foreign assistance must continue, a nascent local strategy is a candidate for broad adoption. We call it MORE, for MObilization of REcovered individuals. The idea is simple: those who have recovered from Ebola could be engaged to reduce transmission, helping to bring the epidemic under control.
Examples of the approach can be seen in Sierra Leone, Guinea and Liberia. For instance, the UN is training survivors to support children who have had contact with infected individuals and are within Ebola’s 21-day incubation window (the time it takes to develop symptoms after being infected with the virus). MSF is similarly employing survivors to work in their Ebola treatment units in Guinea and Liberia.
There are uncertainties about the ultimate size of this cadre and, crucially, about the immunity of recovered responders to reinfection, both immediately and in the longer term (because immunity may wane). Nonetheless, the potential of MORE to shift the epidemic’s dynamics makes its consideration imperative…

New England Journal of Medicine – December 18, 2014

New England Journal of Medicine
December 18, 2014 Vol. 371 No. 25

Panic, Paranoia, and Public Health — The AIDS Epidemic’s Lessons for Ebola
Gregg Gonsalves, B.S., and Peter Staley
N Engl J Med 2014; 371:2348-2349 December 18, 2014
DOI: 10.1056/NEJMp1413425
For those of us who lived through the early days of the U.S. AIDS epidemic, the current national panic over Ebola brings back some very bad memories. The toxic mix of scientific ignorance and paranoia on display in the reaction to the return of health care workers from the front lines of the fight against Ebola in West Africa, the amplification of these reactions by politicians and the media, and the fear-driven suspicion and shunning of whole classes of people are all reminiscent of the response to the emergence of AIDS in the 1980s…

Evaluating Ebola Therapies — The Case for RCTs
Edward Cox, M.D., M.P.H., Luciana Borio, M.D., and Robert Temple, M.D.
N Engl J Med 2014; 371:2350-2351 December 18, 2014
DOI: 10.1056/NEJMp1414145

Brief Report
Clinical Care of Two Patients with Ebola Virus Disease in the United States
G. Marshall Lyon, M.D., M.M.Sc., Aneesh K. Mehta, M.D., Jay B. Varkey, M.D., Kent Brantly, M.D., Lance Plyler, M.D., Anita K. McElroy, M.D., Ph.D., Colleen S. Kraft, M.D., Jonathan S. Towner, Ph.D., Christina Spiropoulou, Ph.D., Ute Ströher, Ph.D., Timothy M. Uyeki, M.D., M.P.H., M.P.P., and Bruce S. Ribner, M.D., M.P.H. for the Emory Serious Communicable Diseases Unit
N Engl J Med 2014; 371:2402-2409
December 18, 2014
DOI: 10.1056/NEJMoa1409838
West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients’ condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma.

Out of Africa — Caring for Patients with Ebola
Eric J. Rubin, M.D., Ph.D., and Lindsey R. Baden, M.D.
N Engl J Med 2014; 371:2430-2432 December 18, 2014
DOI: 10.1056/NEJMe1412744
[Final paragraph]
…The most important take-home message from these case reports is the importance of intensive fluid management and care. The case fatality rate in the current outbreak is approximately 70%.8 It is unlikely that the patient treated in Germany would have survived without modern, state-of-the-art care. But approximately 30% of patients are surviving with only the modest support that is available in treatment centers in West Africa. Another filovirus infection, Marburg hemorrhagic fever, was associated with a mortality rate of approximately 25% in Germany but approximately 80% in sub-Saharan Africa, further suggesting that optimal supportive care plays a crucial role in the overall outcome of these infections.9,10 Although this news is encouraging for patients with access to an intensive care unit, it is only more discouraging for those in areas where such infections are endemic and even basic care is often unavailable. It will be a tremendous challenge to bring to all patients the benefits of routine care, such as intravenous fluid and electrolyte support, as part of the response to this epidemic, but it must be done.

PLOS Currents: Disasters [Accessed 20 December 2014]

PLOS Currents: Disasters
[Accessed 20 December 2014]

Art of Disaster Preparedness in European Union: a Survey on the Health Systems
December 17, 2014 • Research article
Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries.
Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient.
Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%).
Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal.

Validating Indicators of Disaster Recovery with Qualitative Research
December 16, 2014 • Research article
Introduction: Recovery from disasters is a critical function of federal, state, and local governments, yet measurable, validated indicators of community recovery remain unidentified. A list of potential recovery indicators was developed by the authors through a literature review, recovery plan review, and case study of two disaster impacted communities.
Methods: To validate the indicators, qualitative data was collected from experts on disaster recovery. Twenty-one key informant interviews and two focus groups were conducted between January and April of 2014 to solicit feedback from disaster recovery practitioners and academics.
Results: Five major themes emerged from the qualitative data. These included: the flexibility of the indicators to serve multiple purposes for communities and individuals both pre- and post- disaster; the focus areas are comprehensive, but content and organization can be improved; the importance of seeing the indicators as a self-assessment, rather than a tool for comparing communities; the potential challenges of collecting data for some indicators; and the identification of potential measurement issues with the indicators.
Discussion: The proposed recovery indicators can be utilized by both practitioners and researchers to effectively track post-disaster recovery. They capture many of the complexities of community disaster recovery and provide potential opportunities for linkages to the development of disaster recovery plans and other activities that could increase community resilience in the future.

PLoS Currents: Outbreaks (Accessed 20 December 2014) [Ebola, MERS]

PLoS Currents: Outbreaks
(Accessed 20 December 2014)

Ebola and Indirect Effects on Health Service Function in Sierra Leone
December 19, 2014 • Research
Background: The indirect effects of the Ebola epidemic on health service function may be significant but is not known. The aim of this study was to quantify to what extent admission rates and surgery has changed at health facilities providing such care in Sierra Leone during the time of the Ebola epidemic.
Methods: Weekly data on facility inpatient admissions and surgery from admission and surgical theatre register books were retrospectively retrieved during September and October. 21 Community Health Officers enrolled in a surgical task-shifting program personally visited the facilities. The study period was January 6 (week 2) to October 12, (week 41) 2014.
Results: Data was retrieved from 40 out of 55 facilities. A total of 62,257 admissions and 12,124 major surgeries were registered for the study period.
Total admissions in the week of the first Ebola case were 2,006, median 40 (IQR 20-76) compared to 883, median 12 (IQR 4-30) on the last week of the study. This equals a 70% drop in median number of admissions (p=0.005) between May and October. Total number of major surgeries fell from 342, median 6 (IQR 2-14) to 231, median 3 (IQR 0-6) in the same period, equal 50% reduction in median number of major surgeries (p=0.014).
Conclusions: Inpatient health services have been severely affected by the Ebola outbreak. The dramatic documented decline in facility inpatient admissions and major surgery is likely to be an underestimation. Reestablishing such care is urgent and must be a priority.

Estimation of MERS-Coronavirus Reproductive Number and Case Fatality Rate for the Spring 2014 Saudi Arabia Outbreak: Insights from Publicly Available Data
December 18, 2014 • Research
Background: The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was initially recognized as a source of severe respiratory illness and renal failure in 2012. Prior to 2014, MERS-CoV was mostly associated with sporadic cases of human illness, of presumed zoonotic origin, though chains of person-to-person transmission in the healthcare setting were reported. In spring 2014, large healthcare-associated outbreaks of MERS-CoV infection occurred in Jeddah and Riyadh, Kingdom of Saudi Arabia. To date the epidemiological information published by public health investigators in affected jurisdictions has been relatively limited. However, it is important that the global public health community have access to information on the basic epidemiological features of the outbreak to date, including the basic reproduction number (R0) and best estimates of case-fatality rates (CFR). We sought to address these gaps using a publicly available line listing of MERS-CoV cases.
Methods: R0 was estimated using the incidence decay with exponential adjustment (“IDEA”) method, while period-specific case fatality rates that incorporated non-attributed death data were estimated using Monte Carlo simulation.
Results: 707 cases were available for evaluation. 52% of cases were identified as primary, with the rest being secondary. IDEA model fits suggested a higher R0 in Jeddah (3.5-6.7) than in Riyadh (2.0-2.8); control parameters suggested more rapid reduction in transmission in the former city than the latter. The model accurately projected final size and end date of the Riyadh outbreak based on information available prior to the outbreak peak; for Jeddah, these projections were possible once the outbreak peaked. Overall case-fatality was 40%; depending on the timing of 171 deaths unlinked to case data, outbreak CFR could be higher, lower, or equivalent to pre-outbreak CFR.
Conclusions: Notwithstanding imperfect data, inferences about MERS-CoV epidemiology important for public health preparedness are possible using publicly available data sources. The R0 estimated in Riyadh appears similar to that seen for SARS-CoV, but CFR appears higher, and indirect evidence suggests control activities ended these outbreaks. These data suggest this disease should be regarded with equal or greater concern than the related SARS-CoV.

World Health Organization Guidelines for Management of Acute Stress, PTSD, and Bereavement: Key Challenges on the Road Ahead

PLoS Medicine
(Accessed 20 December 2014)

Policy Forum
World Health Organization Guidelines for Management of Acute Stress, PTSD, and Bereavement: Key Challenges on the Road Ahead
Wietse A. Tol mail, Corrado Barbui, Jonathan Bisson, Judith Cohen, Zeinab Hijazi, Lynne Jones, Joop T. V. M. de Jong, Nicola Magrini, Olayinka Omigbodun, Soraya Seedat, Derrick Silove, Renato Souza, Athula Sumathipala, [ … ], Mark van Ommeren , [ view all ]
Published: December 16, 2014
DOI: 10.1371/journal.pmed.1001769
Summary Points
:: The implementation of new WHO mental health guidelines for conditions and disorders specifically related to stress is likely to face obstacles, particularly in low- and middle-income countries.
:: Formulation of evidence-based guidelines is complicated by limited knowledge regarding (a) the effectiveness of commonly implemented interventions, (b) the effectiveness of established evidence-based interventions when used in situations of ongoing adversity, and (c) the effectiveness of widely used cultural practices in LMICs. The application of the guidelines requires improved knowledge on how to reduce potentially harmful practices that are widely applied.
:: The implementation of recommendations regarding psychotherapeutic interventions will require an approach that balances (a) strengthening the availability and capacity of specialists to train and supervise and (b) shifting to the delivery of psychotherapy by non-specialists.
:: The strengthening of evidence for managing these conditions will require collaborative efforts by researchers and practitioners in a manner that is mindful of local sociocultural and health system realities.

Prehospital & Disaster Medicine – December 2014

Prehospital & Disaster Medicine
Volume 29 – Issue 06 – December 2014

Ebola: Who is Responsible for the Political Failures?
Prehospital and Disaster Medicine / Volume 29 / Issue 06 / December 2014, pp 553 – 554
DOI: http://dx.doi.org/10.1017/S1049023X14001307
Published online: 17 December 2014

Original Research
Factors Associated with the Intention of Health Care Personnel to Respond to a Disaster
Susan B. Connor
Introduction Over the past decade, numerous groups of researchers have studied the willingness of health care personnel (HCP) to respond when a disaster threatens the health of a community. Not one of those studies reported that 100% of HCP were willing to work during a public-health event (PHE).
Problem The objective of this study was to explore factors associated with the intent of HCP to respond to a future PHE.
Methods The theory of planned behavior (TPB) framed this cross-sectional study. Data were obtained via a web-based survey from 305 HCP. Linear associations between the TPB-based predictor and outcome variables were examined using Pearson’s correlations. Differences between two groups of HCP were calculated using independent t tests. A model-generating approach was used to develop and assess a series of TBP-based observed variable structural equation models for prediction of intent to respond to a future PHE and to explore moderating and mediating effects.
Results The beginning patterns of relationships identified by the correlation matrix and t tests were evident in the final structural equation model, even though the patterns of prediction differed from those posited by the theory. Outcome beliefs had both a significant, direct effect on intention and an indirect effect on intention that was mediated by perceived behavioral control. Control beliefs appeared to influence intention through perceived behavioral control, as posited by the TPB, and unexpectedly through subjective norm. Subjective norm not only mediated the relationship between control beliefs and intention, but also the relationship between referent beliefs and intention. Additionally, professional affiliation seemed to have a moderating effect on intention.
Conclusion The intention to respond was influenced primarily by normative and control factors. The intent of nurses to respond to a future PHE was influenced most by the control factors, whereas the intent of other HCP was shaped more by the normative factors. Health care educators can bolster the normative and control factors through education by focusing on team building and knowledge related to accessing supplies and support needed to respond when a disaster occurs.

Special Reports
Mass-gathering Health Research Foundational Theory: Part 1 – Population Models for Mass Gatherings
Adam Lunda1a2 c1, Sheila A. Turrisa2a3a4, Ron Bowlesa2, Malinda Steenkampa5, Alison Huttona5, Jamie Ransea6 and Paul Arbona5
a1 Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
a2 Justice Institute of British Columbia, New Westminster, British Columbia, Canada
a3 Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
a4 School of Nursing, University of Victoria, Victoria, British Columbia, Canada
a5 Flinders University, World Health Organization Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University of South Australia, Adelaide, South Australia, Australia
a6 University of Canberra, Faculty of Health, Bruce, Australian Capital Territory, Australia
The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events.
A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings.
Findings and Interpretation
Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event.
A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations.
Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.

Special Reports
Mass-gathering Health Research Foundational Theory: Part 2 – Event Modeling for Mass Gatherings
Sheila A. Turrisa1a2a3, Adam Lunda1a3 c1, Alison Huttona4, Ron Bowlesa3, Elizabeth Ellersona4, Malinda Steenkampa4, Jamie Ransea5 and Paul Arbona4
a1 Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
a2 School of Nursing, University of Victoria, Victoria, British Columbia, Canada
a3 Justice Institute of British Columbia, New Westminster, British Columbia, Canada
a4 Flinders University, World Health Organization Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University of South Australia, Adelaide, South Australia, Australia
a5 University of Canberra, Faculty of Health, Bruce, Australian Capital Territory, Australia
Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning “MG event model,” complimenting the “MG population model” reported elsewhere.
Existing descriptions of “MGs” were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion.
Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events.
The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.

Ebola/EVD: Additional Coverage [to 20 December 2014]

Ebola/EVD: Additional Coverage [to 20 December 2014]

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse
UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and what it titles “developments.” We present a composite below from the week ending 20 December 2014.

UNMEER confident that Conakry Warehouse fire will not hinder Ebola response (18 December 2014)

Ebola: UN Secretary-General will visit West Africa to ‘show solidarity with those affected’
17 December 2014 Secretary-General Ban Ki-moon announced he will leave today for the countries hardest hit by the Ebola outbreak “to show my solidarity with those affected and urge even greater global action” to fight the epidemic, which two United Nations food agencies said could push the number of people facing food insecurity to more than one million by next spring.

Ebola: UN says health workers in Sierra Leone to receive hazard pay using mobile money
16 December 2014 Response workers battling the Ebola outbreak in West Africa will receive “hazard pay” for the first time in Sierra Leone using mobile money because “unless there is a certain element of incentives, or danger pay, it’s very difficult to attract and retain people,” the United Nations Development Programme (UNDP) announced today.

Ebola: UN forum urges debt relief for hard-hit countries, as search for faster diagnostics gets underway
15 December 2014 The United Nations Economic Commission for Africa (ECA) today recommended that creditors should seriously consider debt cancellation for the countries worst-hit by the Ebola epidemic in West Africa, and also projected that even if those most affected were to register zero economic growth, the impact on Africa as a continent would be minimal.
UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Response Efforts and Health
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present highly-selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

19 December 2014 |
Key Political and Economic Developments
1. UN Secretary-General Ban Ki-moon arrived in Ghana yesterday, the first stop on his visit to West Africa. He met with Ghanaian president John Dramani Mahama to discuss the EVD response, which is being directed from the UNMEER headquarters in Accra. He was briefed on the response and UNMEER’s work by Tony Banbury, the head of UNMEER, and the UNMEER senior leadership. Today the Secretary-General will visit Liberia and Sierra Leone.
2. A warehouse with supplies for the EVD operation caught fire yesterday morning in Conakry, at the main humanitarian logistics base located at the city’s airport. No casualties were reported. The fire in the warehouse, mainly containing pharmaceutical supplies and laboratory materials, was discovered when the workers arrived in the morning. The warehouse is used by Médecins sans Frontières (MSF), the World Health Organization (WHO), UNICEF, the Red Cross, the World Food Programme (WFP) and the Pharmacie Centrale de Guinée to store supplies for the EVD emergency response under the umbrella of UNMEER. The exact amount of property and material damaged as a result of the fire is not yet known. Firefighters of the airport and of the city of Conakry, who immediately intervened, extinguished the fire. An investigation is ongoing. “This is a regrettable loss, but no one was hurt and we will move quickly together with our partners to replace the lost supplies”, SRSG Banbury said. “We certainly won’t be deterred in our fight against Ebola.”
Response Efforts and Health
4. According to WHO, a number of healthcare workers have tested EVD positive in the main health centre in Kérouané, Guinea. The affected personnel includes the centre’s director, a midwife, 2 nurses and an ambulance driver. The patients have been transferred to the Donka ETC in Conakry, and contacts are being identified and followed up. Following the spread of this news, a security incident occurred on 17 December when members of the local community including groups of youths threatened to ransack the EVD transit centre in Kérouané. The prefectural coordination appealed for calm and instructed responders from WHO, African Union and ECOWAS/ West African Health Organization to suspend their activities and remain in their hotel. The authorities also dispatched a police unit. As a result of these measures, the threats of violence were not carried out.
6. China has approved a domestically developed experimental EVD vaccine for clinical trials. The Chinese vaccine is being developed by the Academy of Military Medical Sciences, a military research unit which is also involved in developing a drug to treat the disease. It has been reported that the trials would start this month.
Resource Mobilisation
12. The OCHA Ebola Virus Outbreak Overview of Needs and Requirements, now totaling US$ 1.5 billion, has been funded for $ 1.04 billion, which is around 69 percent of the total ask.
13. The Ebola Response Multi-Partner Trust Fund currently has US$ 129.8 million in commitments. In total $ 140 million has been pledged.

18 December 2014 |
Key Political and Economic Developments
1. UN Secretary-General Ban Ki-moon today will start his visit to the African countries affected by the EVD outbreak, to express his support and advocate for continued international assistance until the epidemic ends. He will start his tour in Accra, Ghana, where UNMEER’s headquarters are located. He will be joined by Margaret Chan, Director-General of the World Health Organization, David Nabarro, his special envoy on Ebola, and Tony Banbury, head of UNMEER, on visits to Sierra Leone, Guinea, Liberia and Mali. “I want to see the response for myself, and show my solidarity with those affected and urge even greater global action,” Ban said before leaving New York. “The Ebola response strategy is working, and we are beginning to see improvements,” he added. “But now is not the time to ease up on our efforts. As long as there is one case of Ebola, the risk remains.”
Response Efforts and Health
3. EVD transmission remains intense in Sierra Leone, with 327 new confirmed cases reported in the week to 14 December. Transmission is most intense and persistent in the western and northern districts of the country. The capital, Freetown, accounted for 125 of all new confirmed cases. Response partners and the government of Sierra Leone have implemented the Western Area Surge, an operation to intensify efforts to curb the disease in the western parts of the country. The response targets Freetown and neighbouring areas to break chains of transmission, and increase the number of beds to ensure patients with clinical symptoms of EVD are isolated and receive appropriate treatment..
Outreach and Education
14. This week, 11,501 households across 15 counties in Liberia were reached through door-to-door visits with EVD prevention and home protection messages. 17,966 women, 13,660 men and 11,112 children were engaged through 221 meetings and group discussions. 410 people across the country participated in 13 training workshops on community engagement. Social mobilizers also interacted with 692 community leaders and elders through community dialogues.
Essential Services
15. The number of people facing food insecurity due to the EVD epidemic in Guinea, Liberia, and Sierra Leone could top 1 million by March 2015 unless access to food is drastically improved and measures are put in place to safeguard crop and livestock production, the UN Food and Agriculture Organization (FAO) and the World Food Programme (WFP) warned Wednesday. Already, the EVD epidemic has seriously affected food supply chains in West Africa, leaving 500,000 people without enough to eat. Food security has deteriorated due to crop losses and the disruption of production and supply chains. In addition, the outbreak has hurt the overall economies in the three countries, leaving them with less money to pay for necessary food imports. FAO and WFP urged donors to jump-start agriculture in the region by funding necessary products including seeds, fertilizers and farming technology. They also recommended that people should be given cash or vouchers to stimulate markets.
17. The first US$ 2 million tranche from the Ebola Multi Partner Trust Fund has been received by UNICEF for a project aimed at supporting the wellbeing and protection of EVD affected children in Liberia. The $ 4 million project, implemented in partnership with the Ministry of Health and Social Welfare, is meant to support appropriate alternative care, social protection, social mobilization and social safety nets for EVD-affected children in Liberia.

17 December 2014 |
Key Political and Economic Developments
1. President Ernest Bai Koroma of Sierra Leone announced that government officials will begin a house-to-house search on Wednesday for sick people in the Western Area, which includes Freetown. It was not clear, however, if people had to stay in their homes and, if so, for how long. The Sierra Leonean government has periodically restricted movements into and out of hot spots in order to slow the disease’s spread. Freetown and its surrounding areas currently account for more than half of the country’s new infections.
2. The director of the United States Centres for Disease Control and Prevention (CDC), Dr. Thomas Frieden, visited Guinea on 15 December. Dr. Frieden met, among others, with the coordinator of the National Ebola Response Cell, Dr. Sakoba Keita and participated in the national response coordination meeting. Dr. Frieden, Dr. Sakoba and a delegation including the United States Ambassador took part in a visit to the ETC in Macenta, where they attended a ceremony awarding a certificate to two survivors of EVD.
3. Britain said on Tuesday it would not be seeking US military assistance to fight EVD in Sierra Leone, where it expects to see “enormous change” by the end of January following a surge in response measures. The head of the British taskforce, Donal Brown, said he expected a breakthrough within four to six weeks. “The pieces are in place to fight the disease, which weren’t here a month ago. So I think you will see enormous change in the next few weeks,” Brown said Tuesday. While Britain is discussing how the US government might provide more foreign health workers and assist in the building of additional laboratories for EVD testing, Brown said there was no need for US military support in Sierra Leone. The UK is calling for additional resources from the World Health Organization to boost case surveillance for rural areas.
Outreach and Education
16. UNMEER’s FCM covering Nzérékoré, Guinea, was informed about instances of resistance in different parts of the prefecture where the local community has resorted to hiding persons suspected of having EVD or has outright refused to refer them to the nearest ETC in Nzérékoré. Villages such as Kaya and Tilepulo have refused any EVD response activity. In the district of Wessoah, youth groups have reportedly decided to prevent any EVD-related activities by community agents or the Guinean Red Cross. In response, UNMEER has proposed a meeting to be held this week with the prefectural coordination and UNICEF to plan a sensitization campaign to be funded by UNICEF, with highly regarded community members such as elders, teachers and other civil servants who will in turn disseminate EVD prevention and response messages at the local level. This campaign is to be followed by a sensitization mission led by the prefect in communities displaying resistance.

16 December 2014 |
Key Political and Economic Developments
1. Liberia will hold delayed senatorial elections on December 20, the National Election Commission said on Sunday, a day after the Supreme Court ruled the vote should go ahead despite the EVD outbreak. The court had suspended campaigning for the vote last month, while it considered a petition from a group that included some former government officials and political party representatives. The group had warned that electioneering risked spreading the virus.
2. WHO Assistant Director-General Bruce Aylward has stated that the failure of Sierra Leone’s strategy for fighting EVD may be down to a missing ingredient: a big shock that could change people’s behavior and prevent further infection, such as what happened in Monrovia in August when the disease had a big flare-up there. “Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die … before those behaviors start to change,” Aylward said. Sierra Leone’s Health Minister Abu Bakarr Fofanah said the government was considering banning some unsafe practices. He recognized however that it would be difficult to police such a law. Fofanah noted that some areas of eastern Sierra Leone that were hit hardest early in the epidemic — around the towns of Kenema and Kailahun — have seen a massive reduction in case numbers as people change behavior. “The areas that are now doing badly are the areas that were affected last. They are still on the learning curve.”
3. The UN Security Council on Monday extended the mandate of the UN Mission in Liberia (UNMIL) for another nine months until September 30, 2015. The mission will continue to provide, among other tasks, humanitarian assistance and electoral support, as well as human rights promotion and protection. The council recognized that the EVD outbreak in Liberia has slowed the efforts of the government to advance certain governance and national reform priorities, and emphasized the need for continued progress on constitutional and institutional reforms, especially of the rule of law and security sectors and the national reconciliation processes.
4. The UN Economic Commission for Africa has asked for more debt cancellations for the three countries hardest hit by EVD. The commission said Monday that it is crucial that the current health crisis not be a catalyst for financial distress in Sierra Leone, Guinea and Liberia. Carlos Lopez, the executive secretary of the commission, appealed on Monday for loan forgiveness.
Response Efforts and Health
7. Liberia has begun treating EVD patients with serum therapy – a treatment made from the blood of recovered survivors. If a person has successfully fought off EVD infection, they will have antibodies in their blood that can attack the virus. Doctors can then take a sample of their blood and turn it into a serum – by removing the red blood cells but keeping the antibodies – which can be used to treat other patients. Patients treated in the UK and the US have already received this type of treatment. The treatment is being given by doctors at the ELWA Hospital in Monrovia.
9. A pilot project in Guinea spearheaded by the NERC with support from experts from Columbia University, on collection and transmission of contact tracing information via mobile phones, is being conducted in Conakry, Dubreka and Coyah prefectures. To date, a training of trainers has been provided to 27 supervisors and 130 community agents working in these 3 prefectures. The pilot will test whether the data collected via mobile transmission corresponds to the data collected via the current paper-based system. If the pilot phase is successful, the NERC is to decide whether to roll out this solution in the country’s 33 prefectures.

15 December 2014 |
Response Efforts and Health
4. The Sierra Leonean National Ebola Response Centre (NERC), with UNMEER support, will for the first time pay hazard payments to Ebola Response Workers (ERWs) using mobile money. This marks an important shift from cash payments to an electronic solution that improves the overall efficiency, timeliness and security of payments for the ERWs. The transition to electronic payments will bolster the effectiveness of fiscal operations through efficient receipts and payments, as well as the security of transactions targeting the ERWs. It will help to eliminate wastes and leakages and ensure a strong transaction audit trail. This cycle of hazard payments will be made from December 15, 2014 to December 19, 2014 through a consortium of private sector partners, namely Airtel, Africell, and Splash Money.
5. UNICEF in Liberia, together with the NGO IntraHealth and the Liberian health ministry, are piloting mHERO – an SMS-based tool that can be used on basic mobile phones. mHERO stands for Mobile Health Worker Electronic Response and Outreach. It will allow the ministry to instantly send critical information to health workers’ mobile phones during the outbreak and in the future. The pilot will start with 430 health workers in Grand Gedeh, Grand Cape Mount and Margibi counties.
Outreach and Education
16. In Kindia prefecture, Guinea, the Minister of Youth and Youth Employment launched a training of trainers funded by UNICEF which is intended to reach 15,000 young people. They will then convey the key messages of prevention and the fight against EVD in all sub-prefectures, in order to promote behavior change and help lift community resistance.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
Week ending 13 December 2014

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortiums and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice

pdf verion: The Sentinel_ ge2p2_week ending 13 December 2014

blog edition: comprised of the 35+ entries to be posted below on 14-15 December 2014

UN members agree deal at Lima climate talks [14 December 2014]

UN members agree deal at Lima climate talks
BBC News 14 December 2014 Last updated at 10:02 ET
Delegates have approved a framework for setting national pledges to be submitted to a summit next year.

Differences over the draft text caused the talks in Lima, Peru, to overrun by two days.

Environmental groups have criticised the deal as a weak and ineffectual compromise, saying it weakens international climate rules.
The talks proved difficult because of divisions between rich and poor countries over how to spread the burden of pledges to cut carbon emissions.

‘Not perfect’
Peru’s environment minister, Manuel Pulgar-Vidal, who chaired the summit, told reporters: “As a text it’s not perfect, but it includes the positions of the parties.”
The agreement was adopted hours after a previous draft was rejected by developing countries, who accused rich nations of shirking their responsibilities to fight global warming and pay for its impacts.

The final draft is said to have alleviated those concerns with by saying countries have “common but differentiated responsibilities”.

Further advancing the Durban Platform
United Nations
Framework Convention in Climate Change
13 December 2014 :: 5 pages
Conference of the Parties – Twentieth session
Lima, 1–12 December 2014
Agenda item 4 Report of the Ad Hoc Working Group on the Durban Platform for Enhanced Action

With 15 million children caught up in major conflicts, UNICEF declares 2014 a devastating year for children

With 15 million children caught up in major conflicts, UNICEF declares 2014 a devastating year for children
UNICEF Press release
NEW YORK/GENEVA, 8 December 2014 – The year 2014 has been one of horror, fear and despair for millions of children, as worsening conflicts across the world saw them exposed to extreme violence and its consequences, forcibly recruited and deliberately targeted by warring groups, UNICEF said today. Yet many crises no longer capture the world’s attention, warned the children’s agency.

“This has been a devastating year for millions of children,” said Anthony Lake, UNICEF Executive Director. “Children have been killed while studying in the classroom and while sleeping in their beds; they have been orphaned, kidnapped, tortured, recruited, raped and even sold as slaves. Never in recent memory have so many children been subjected to such unspeakable brutality.”

As many as 15 million children are caught up in violent conflicts in the Central African Republic, Iraq, South Sudan, the State of Palestine, Syria and Ukraine – including those internally displaced or living as refugees. Globally, an estimated 230 million children currently live in countries and areas affected by armed conflicts.

In 2014, hundreds of children have been kidnapped from their schools or on their way to school. Tens of thousands have been recruited or used by armed forces and groups. Attacks on education and health facilities and use of schools for military purposes have increased in many places.

:: In the Central African Republic, 2.3 million children are affected by the conflict, up to 10,000 children are believed to have been recruited by armed groups over the last year, and more than 430 children have been killed and maimed – three times as many as in 2013
:: In Gaza, 54,000 children were left homeless as a result of the 50-day conflict during the summer that also saw 538 children killed, and more than 3,370 injured.
:: In Syria, with more than 7.3 million children affected by the conflict including 1.7 million child refugees, the United Nations verified at least 35 attacks on schools in the first nine months of the year, which killed 105 children and injured nearly 300 others. In Iraq, where an estimated 2.7 million children are affected by conflict, at least 700 children are believed to have been maimed, killed or even executed this year. In both countries, children have been victims of, witnesses to and even perpetrators of increasingly brutal and extreme violence.
:: In South Sudan, an estimated 235,000 children under five are suffering from severe acute malnutrition. Almost 750,000 children have been displaced and more than 320,000 are living as refugees. According to UN verified data, more than 600 children have been killed and over 200 maimed this year, and around 12,000 children are now being used by armed forces and groups.
The sheer number of crises in 2014 meant that many were quickly forgotten or captured little attention. Protracted crises in countries like Afghanistan, the Democratic Republic of the Congo, Nigeria, Pakistan, Somalia, Sudan and Yemen, continued to claim even more young lives and futures.

This year has also posed significant new threats to children’s health and well-being, most notably the Ebola outbreak in Guinea, Liberia, and Sierra Leone, which has left thousands of children orphaned and an estimated 5 million out of school.

Despite the tremendous challenges children have faced in 2014, there has been hope for millions of children affected by conflict and crisis. In the face of access restrictions, insecurity, and funding challenges, humanitarian organizations including UNICEF have worked together to provide life-saving assistance and other critical services like education and emotional support to help children growing up in some of the most dangerous places in the world.

:: In Central African Republic, a campaign is under way to get 662,000 children back to school as the security situation permits. Nearly 68 million doses of the oral polio vaccine were delivered to countries in the Middle East to stem a polio outbreak in Iraq and Syria.
:: In South Sudan, more than 70,000 children were treated for severe malnutrition.
:: In Ebola-hit countries, work continues to combat the virus in local communities through support for community care centres and Ebola treatment Units; through training of health workers and awareness-raising campaigns to reduce the risks of transmission; and through supporting children orphaned by Ebola.

“It is sadly ironic that in this, the 25th anniversary year of the Convention on the Rights of the Child when we have been able to celebrate so much progress for children globally, the rights of so many millions of other children have been so brutally violated,” said Lake. “Violence and trauma do more than harm individual children – they undermine the strength of societies. The world can and must do more to make 2015 a much better year for every child. For every child who grows up strong, safe, healthy and educated is a child who can go on to contribute to her own, her family’s, her community’s, her nation’s and, indeed, to our common future.”

UNHCR, IOM, IMO, UNODC and OHCHR Joint Statement on Protection at Sea in the Twenty-First Century

UNHCR, IOM, IMO, UNODC and OHCHR Joint Statement on Protection at Sea in the Twenty-First Century
8 December 2014
[Full text]
We are deeply concerned about the loss of life, injury, trauma and serious human rights violations affecting migrants, asylum-seekers and refugees traveling by sea. The situation is stretching rescue and reception infrastructure, as well as coast guard and navy resources, and affecting international shipping.

The high frequency of incidents involving death in the Mediterranean has captured international attention. However, these tragedies are not only occurring in the Mediterranean, but in many locations around the globe. Behind the statistics of those rescued or lost at sea are individual stories of human tragedy and human rights violations throughout the migration process.

The time-honored tradition of rescue at sea enshrined in international law is in jeopardy. Important conventions establish the obligation of a ship’s captain to render assistance to people in distress at sea and of States to coordinate and cooperate to deliver those rescued at sea to a place of safety within a reasonable time. These obligations apply regardless of the migration status of the persons in distress at sea.

Much media and public attention has focused on the irregular or criminal nature of this maritime migration. We wish to stress that the people undertaking these journeys are not criminals. Those who exploit their need for protection or hope for a better future, putting lives at risk and violating human rights for profit, are the criminals.

We are convinced that concerted action from the international community is needed to address all aspects of this issue. Closer cooperation between States of origin, transit and destination, and other relevant actors, is critical to reducing loss of life at sea, addressing the drivers of dangerous sea journeys, as well as ensuring that responses by States upon arrival and disembarkation uphold human rights and dignity, and address specific needs for protection of migrants, asylum-seekers and refugees. Such cooperation is also critical to identifying, prosecuting and punishing the criminal gangs who are responsible for human rights abuses and for arranging sea transportation in breach of all safety regulations.

Robust action to combat criminal networks is crucial, but tackling migrant smuggling and the associated corruption is only part of the equation. The real root causes of irregular maritime migration, which include lack of access to safe and regular migration channels, must also be rigorously tackled. Without credible alternative options to escape desperation, people will continue to place their lives and those of their families at risk by making unsafe boat journeys.

Focus on saving lives, says UNHCR, as numbers of people taking to the seas in search of asylum or migration passes 348,000 globally
Press Releases, 10 December 2014
UNHCR warned today that the international community was losing its focus on saving lives amid confusion among coastal nations and regional blocs over how to respond to the growing number of people making risky sea journeys in search of asylum or migration.

With preparations under way for the opening later today in Geneva of UNHCR’s 2014 High Commissioner’s Dialogue – an informal policy discussion forum whose focus this year is Protection at Sea – High Commissioner for Refugees António Guterres said some governments are increasingly seeing keeping foreigners out as being a higher priority than upholding asylum.

“This is a mistake, and precisely the wrong reaction for an era in which record numbers of people are fleeing wars,” Guterres said. “Security and immigration management are concerns for any country, but policies must be designed in a way that human lives do not end up becoming collateral damage.”…