The Lancet
Feb 14, 2015 Volume 385 Number 9968 p577-662 e7-e11
http://www.thelancet.com/journals/lancet/issue/current

Articles
A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial
Dr Fernando Althabe, MD, José M Belizán, MD, Elizabeth M McClure, PhD, Jennifer Hemingway-Foday, MPH, Mabel Berrueta, MD, Agustina Mazzoni, MD, Alvaro Ciganda, BIT, Prof Shivaprasad S Goudar, MD, Prof Bhalachandra S Kodkany, MD, Prof Niranjana S Mahantshetti, MD, Prof Sangappa M Dhaded, DM, Geetanjali M Katageri, MD, Prof Mrityunjay C Metgud, MD, Anjali M Joshi, BAMS, Prof Mrutyunjaya B Bellad, MD, Narayan V Honnungar, MBBS, Prof Richard J Derman, MD, Sarah Saleem, MBBS, Omrana Pasha, MD, Sumera Ali, MD, Farid Hasnain, PhD,
Prof Robert L Goldenberg, MD, Fabian Esamai, MBChB, Paul Nyongesa, MD, Silas Ayunga, MD, Edward A Liechty, MD, Ana L Garces, MD, Lester Figueroa, MD, Prof K Michael Hambidge, MD, Nancy F Krebs, MD, Prof Archana Patel, MD, Anjali Bhandarkar, MD, Manjushri Waikar, MD, Prof Patricia L Hibberd, MD, Prof Elwyn Chomba, MD, Prof Waldemar A Carlo, MD, Angel Mwiche, MD, Melody Chiwila, RN, Albert Manasyan, MD, Sayury Pineda, MD, Sreelatha Meleth, PhD, Vanessa Thorsten, MPH, Kristen Stolka, MPH, Dennis D Wallace, PhD, Marion Koso-Thomas, MD, Prof Alan H Jobe, MD, Prof Pierre M Buekens, MD
Published Online: 15 October 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61651-2
Summary
Background
Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries.
Methods
In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096.
Findings
The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47 394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50 743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p<0•0001). Among the less-than-5th-percentile infants, 28-day neonatal mortality was 225 per 1000 livebirths for the intervention group and 232 per 1000 livebirths for the control group (relative risk [RR] 0•96, 95% CI 0•87–1•06, p=0•65) and suspected maternal infection was reported in 236 (10%) of 2361 women in the intervention group and 133 (6%) of 2094 in the control group (odds ratio [OR] 1•67, 1•33–2•09, p<0•0001). Among the whole population, 28-day neonatal mortality was 27•4 per 1000 livebirths for the intervention group and 23•9 per 1000 livebirths for the control group (RR 1•12, 1•02–1•22, p=0•0127) and suspected maternal infection was reported in 1207 (3%) of 48 219 women in the intervention group and 867 (2%) of 51 523 in the control group (OR 1•45, 1•33–1•58, p<0•0001).
Interpretation
Despite increased use of antenatal corticosteroids in low-birthweight infants in the intervention groups, neonatal mortality did not decrease in this group, and increased in the population overall. For every 1000 women exposed to this strategy, an excess of 3•5 neonatal deaths occurred, and the risk of maternal infection seems to have been increased.
Funding
Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The Lancet
Feb 14, 2015 Volume 385 Number 9968 p577-662 e7-e11
http://www.thelancet.com/journals/lancet/issue/current

Series
Subjective wellbeing, health, and ageing
Prof Andrew Steptoe, DPhil, Prof Angus Deaton, PhD, Prof Arthur A Stone, PhD
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(13)61489-0
Summary
Subjective wellbeing and health are closely linked to age. Three aspects of subjective wellbeing can be distinguished—evaluative wellbeing (or life satisfaction), hedonic wellbeing (feelings of happiness, sadness, anger, stress, and pain), and eudemonic wellbeing (sense of purpose and meaning in life). We review recent advances in the specialty of psychological wellbeing, and present new analyses about the pattern of wellbeing across ages and the association between wellbeing and survival at older ages. The Gallup World Poll, a continuing survey in more than 160 countries, shows a U-shaped relation between evaluative wellbeing and age in high-income, English speaking countries, with the lowest levels of wellbeing in ages 45–54 years. But this pattern is not universal. For example, respondents from the former Soviet Union and eastern Europe show a large progressive reduction in wellbeing with age, respondents from Latin America also shows decreased wellbeing with age, whereas wellbeing in sub-Saharan Africa shows little change with age. The relation between physical health and subjective wellbeing is bidirectional. Older people with illnesses such as coronary heart disease, arthritis, and chronic lung disease show both increased levels of depressed mood and impaired hedonic and eudemonic wellbeing. Wellbeing might also have a protective role in health maintenance. In an analysis of the English Longitudinal Study of Ageing, we identify that eudemonic wellbeing is associated with increased survival; 29•3% of people in the lowest wellbeing quartile died during the average follow-up period of 8•5 years compared with 9•3% of those in the highest quartile. Associations were independent of age, sex, demographic factors, and baseline mental and physical health. We conclude that the wellbeing of elderly people is an important objective for both economic and health policy. Present psychological and economic theories do not adequately account for the variations in patterns of wellbeing with age across different parts of the world. The apparent association between wellbeing and survival is consistent with a protective role of high wellbeing, but alternative explanations cannot be ruled out at this stage.

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Series
Macroeconomic implications of population ageing and selected policy responses
Prof David E Bloom, PhD, Somnath Chatterji, MD, Paul Kowal, PharmD, Peter Lloyd-Sherlock, PhD, Prof Martin McKee, DSc, Bernd Rechel, PhD, Larry Rosenberg, MPA, James P Smith, PhD
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61464-1
Summary
Between now and 2030, every country will experience population ageing—a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population—a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries’ economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.

Nature
Volume 518 Number 7538 pp137-268 12 February 2015
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Spot the difference
The US measles outbreak highlights why most states should reconsider their vaccination rules.
11 February 2015
Over the past decade, increasing numbers of US parents have chosen not to vaccinate their children against diseases such as whooping cough, mumps and measles. The consequence has been a periodic return of these historical scourges, in localized outbreaks of a few dozen to a few hundred people. These episodes often appear in local news reports, some of which warn that lower vaccination rates could result in a nationwide outbreak.

Reading the US news media over the past two weeks, you might conclude that that day has come. The current US measles outbreak, which began in December and was first reported in late January, has blown up into a national debate over the rights of parents to decide whether their children should be vaccinated. But by global standards, it is a tempest in a teapot: as of 6 February, measles had struck 121 people in 17 states and the District of Columbia.

Those numbers are unremarkable. Since October, a measles outbreak has affected more than 370 people in Germany; it saw almost 1,800 cases in 2013 and more than 1,600 in 2011. The Philippines had more than 50,000 cases in 2014. The United Kingdom had only 137 cases last year, but in both 2012 and 2013 it had close to 2,000 (see page 148).
In fact, even by US standards, the current outbreak is not unprecedented. Last year, a much larger outbreak was sparked by Amish missionaries returning from the Philippines to Ohio, where low vaccination rates among the community caused 383 cases.

Perhaps that incident stayed out of the national spotlight because it was an unusual set of circumstances that occurred in an isolated rural community. But the current outbreak centres on ‘the happiest place on Earth’ — Disneyland in southern California. At least 42 people seem to have been exposed to measles at the theme park, which receives an estimated 16 million visits a year.
Fortunately for the public’s health, attention around the outbreak has come down in favour of vaccination and against the myths about its dangers. Public opinion has turned against parents and physicians who are suspicious of vaccines. Two potential Republican presidential candidates, Governor Chris Christie of New Jersey and Senator Rand Paul of Kentucky, at first declared that parents should have the right to decide whether their children are vaccinated, and then had to clarify their positions in the face of harsh criticism.

Whether or not the theme park’s involvement in the episode contributed to the media coverage, Disneyland’s cherished place in US culture makes it ideal for an infectious-disease outbreak. It is popular with international tourists eager for a quintessential American experience, who as a group are less likely than US residents to be vaccinated. The park also hosts large numbers of infants less than one year old — younger than the age at which the first measles shot is generally given in the United States.

And Disneyland is at the epicentre of the US anti-vaccine movement. Although 94.7% of US children entering school at around age 5 are vaccinated against measles, in hundreds of California schools the percentage of vaccinated children falls well short of the 92% considered necessary to produce the ‘herd immunity’ that prevents transmission of the disease. The state’s public-health department reports that 2.54% of children entered school in 2014 with an exemption from vaccination based on personal belief.

The federal government has little say in who gets a measles shot — those rules are written by individual states. Most, like California, allow parents to send their children to school unvaccinated by claiming a religious or philosophical objection to the practice. But two — Mississippi and West Virginia — allow only medical exceptions. And that, many observers have argued, is why Mississippi, one of the poorest states in the union, has the highest percentage of 5-year-old children who have received vaccination for measles, mumps and rubella.

Last month, the Mississippi state legislature was considering a bill to allow the same types of personal-belief exemption that most other states allow. But on 3 February, a committee in the state’s House of Representatives killed the proposal. On 4 February, legislators in California said that they would introduce a bill to adopt the same strict rules as Mississippi. And several other states, including Maine, Minnesota and Oregon, are considering measures that would require parents to consult with a physician about vaccines before being granted an exemption.

That is a step in the right direction. Parents, of course, have the right to decide what is best for their children. But when it comes to vaccination, those decisions should be based on complete and accurate information about the risks and benefits.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 14 February 2015)

Temporal Changes in Ebola Transmission in Sierra Leone and Implications for Control Requirements: a Real-time Modelling Study
February 10, 2015 • Research
Abstract
Background: Between August and November 2014, the incidence of Ebola virus disease (EVD) rose dramatically in several districts of Sierra Leone. As a result, the number of cases exceeded the capacity of Ebola holding and treatment centres. During December, additional beds were introduced, and incidence declined in many areas. We aimed to measure patterns of transmission in different regions, and evaluate whether bed capacity is now sufficient to meet future demand.

Methods: We used a mathematical model of EVD infection to estimate how the extent of transmission in the nine worst affected districts of Sierra Leone changed between 10th August 2014 and 18th January 2015. Using the model, we forecast the number of cases that could occur until the end of March 2015, and compared bed requirements with expected future capacity.

Results: We found that the reproduction number, R, defined as the average number of secondary cases generated by a typical infectious individual, declined between August and December in all districts. We estimated that R was near the crucial control threshold value of 1 in December. We further estimated that bed capacity has lagged behind demand between August and December for most districts, but as a consequence of the decline in transmission, control measures caught up with the epidemic in early 2015.

Conclusions: EVD incidence has exhibited substantial temporal and geographical variation in Sierra Leone, but our results suggest that the epidemic may have now peaked in Sierra Leone, and that current bed capacity appears to be sufficient to keep the epidemic under-control in most districts.

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Estimating Drivers of Autochthonous Transmission of Chikungunya Virus in its Invasion of the Americas
February 10, 2015 • Research
Abstract
Background
Chikungunya is an emerging arbovirus that has caused explosive outbreaks in Africa and Asia for decades and invaded the Americas just over a year ago. During this ongoing invasion, it has spread to 45 countries where it has been transmitted autochthonously, infecting nearly 1.3 million people in total.
Methods
Here, we made use of weekly, country-level case reports to infer relationships between transmission and two putative climatic drivers: temperature and precipitation averaged across each country on a monthly basis. To do so, we used a TSIR model that enabled us to infer a parametric relationship between climatic drivers and transmission potential, and we applied a new method for incorporating a probabilistic description of the serial interval distribution into the TSIR framework.
Results
We found significant relationships between transmission and linear and quadratic terms for temperature and precipitation and a linear term for log incidence during the previous pathogen generation. The lattermost suggests that case numbers three to four weeks ago are largely predictive of current case numbers. This effect is quite nonlinear at the country level, however, due to an estimated mixing parameter of 0.74. Relationships between transmission and the climatic variables that we estimated were biologically plausible and in line with expectations.
Conclusions
Our analysis suggests that autochthonous transmission of Chikungunya in the Americas can be correlated successfully with putative climatic drivers, even at the coarse scale of countries and using long-term average climate data. Overall, this provides a preliminary suggestion that successfully forecasting the future trajectory of a Chikungunya outbreak and the receptivity of virgin areas may be possible. Our results also provide tentative estimates of timeframes and areas of greatest risk, and our extension of the TSIR model provides a novel tool for modeling vector-borne disease transmission.

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High-resolution Genomic Surveillance of 2014 Ebolavirus Using Shared Subclonal Variants
February 9, 2015 • Research
Abstract
Background: Viral outbreaks, such as the 2014 ebolavirus, can spread rapidly and have complex evolutionary dynamics, including coinfection and bulk transmission of multiple viral populations. Genomic surveillance can be hindered when the spread of the outbreak exceeds the evolutionary rate, in which case consensus approaches will have limited resolution. Deep sequencing of infected patients can identify genomic variants present in intrahost populations at subclonal frequencies (i.e. <50%). Shared subclonal variants (SSVs) can provide additional phylogenetic resolution and inform about disease transmission patterns.

Methods: We use metrics from population genetics to analyze data from the 2014 ebolavirus outbreak in Sierra Leone and identify phylogenetic signal arising from SSVs. We use methods derived from information theory to measure a lower bound on transmission bottleneck size.

Results and Conclusions: We identify several SSV that shed light on phylogenetic relationships not captured by consensus-based analyses. We find that transmission bottleneck size is larger than one founder population, yet significantly smaller than the intrahost effective population. Our results demonstrate the important role of shared subclonal variants in genomic surveillance.

Science
13 February 2015 vol 347, issue 6223, pages 689-800
http://www.sciencemag.org/current.dtl

In Depth
Infectious Diseases
Ebola drug trials lurch ahead
Kai Kupferschmidt, Jon Cohen
News leaked last week that the drug favipiravir worked in some Ebola patients, but even researchers running the study in Guinea said questions remain about its efficacy. Interpreting the data is difficult because there is no control arm that treated patients can be compared with. This is just one of several confusing twists in the search for a treatment that can stave off death and disease from Ebola virus. Chimerix, the maker of an antiviral called brincidofovir, surprised investigators in Liberia when it suddenly ended a study of its drug after discussions with the U.S. Food and Drug Administration. Chimerix noted that the study was having trouble enrolling patients because Liberia has seen a steep drop in cases, but the researchers running it said they had hoped to expand the trial to Sierra Leone, where most new infections are happening. Liberia is also beginning another trial with ZMapp, a cocktail of Ebola antibodies, and study leaders are having difficulty convincing Sierra Leone and Guinea to join because the study uses a placebo control. Finally, a trial of convalescent serum taken from recovered patients is getting under way in Guinea, but there are now questions about whether it should be compared with favipiravir as a control.

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Policy Forum
Health Care Policy
Randomize evaluations to improve health care delivery
Amy Finkelstein1,2,3,*, Sarah Taubman2
Author Affiliations
1Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
2J-PAL North America, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
3National Bureau of Economic Research, Cambridge, MA 02138, USA.
The medical profession has long recognized the importance of randomized evaluations; such designs are commonly used to evaluate the safety and efficacy of medical innovations such as drugs and devices. Unfortunately, innovations in how health care is delivered (e.g., health insurance structures, interventions to encourage the use of appropriate care, and care coordination approaches) are rarely evaluated using randomization. We consider barriers to conducting randomized trials in this setting and suggest ways for overcoming them. Randomized evaluations of fundamental issues in health care policy and delivery should be—and can be—closer to the norm than the exception.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 7 February 2015

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
david.r.curry@ge2p2center.net

pdf verion: The Sentinel_ week ending 7 February 2015

blog edition: comprised of the 35+ entries to be posted below on 8 February 2015

Women and Girls at Risk of Female Genital Mutilation/Cutting in the United States
The Population Reference Bureau (PRB): Data Brief
Mark Mather and Charlotte Feldman-Jacobs
6 February 2015

Summary of Methods: http://www.prb.org/pdf15/prb-unitedstates-fgmc-methodology.pdf

The Population Reference Bureau (PRB) data included in this data brief are preliminary. A new Centers for Disease Control and Prevention (CDC) report on female genital mutilation/cutting in the United States also will be released soon, providing additional information on women and girls at risk.
[Excerpt]
…The Risk of FGM/C in the United States
In 2013, there were up to 507,000 U.S. women and girls who had undergone FGM/C or were at risk of the procedure, according to PRB’s preliminary data analysis. This figure is more than twice the number of women and girls estimated to be at risk in 2000 (228,000).4 The rapid increase in women and girls at risk reflects an increase in immigration to the United States, rather than an increase in the share of women and girls at risk of being cut. The estimated U.S. population at risk of FGM/C is calculated by applying country- and age-specific FGM/C prevalence rates to the number of U.S. women and girls with ties to those countries…

…Just three sending countries—Egypt, Ethiopia, and Somalia—accounted for 55 percent of all U.S. women and girls at risk in 2013 (see Table 1). These three countries stand out because they have a combination of high FGM/C prevalence rates and a relatively large number of immigrants to the United States. The FGM/C prevalence rate for women and girls ages 15 to 49 is 91 percent in Egypt, 74 percent in Ethiopia, and 98 percent in Somalia. About 97 percent of U.S. women and girls at risk were from African countries, while just 3 percent were from Asia (Iraq and Yemen)…

Joint statement on Humanitarian principles
Danish Refugee Council Press release
04.02.15
During the World Humanitarian Summit Budapest consultations, the Danish Refugee Council along with 34 other concerned humanitarian organizations presented a joint statement on the universality of humanitarian principles. Check out our four recommendations.

Today, the humanitarian sector faces an unprecedented number of protracted and acute humanitarian crises, such as the crisis in Syria, in Central African Republic, in South Sudan or the regional Ebola crisis, compelling humanitarian actors to stretch existing structures and practices to breaking point. Considering the role the World Humanitarian Summit may play in the future of humanitarian action, it is of utmost importance that the international community uses this opportunity to reaffirm the shared value of humanitarian principles of humanity, neutrality, impartiality and independence.

The humanitarian principles emerged from International Humanitarian Law and are based on a common understanding that humanitarian action is driven by a sense of humanity, a willingness to relieve human suffering, regardless of culture, origins or religion. They are encompassed within the core of key humanitarian references, such as the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief or the European Consensus on Humanitarian Aid.

NGOs are operating in exceptionally volatile and insecure environments where political agendas are interfering with the delivery of humanitarian aid, causing increased threats to the safety and security of humanitarian aid workers and assets, and in some situations hamper impartial access of affected population to relief operations. For example, the growing numbers of counter-terrorism laws and measures adopted by States and inter-governmental organizations are restricting humanitarian actor’s ability to develop partnerships, run projects in complex environments, and are delaying programs implementation. The involvement of some donor states in stabilization operations in many contexts where humanitarian aid is needed, are increasingly blurring lines between political, military and humanitarian objectives, thus reducing humanitarian NGOS abilities to deliver aid. Therefore, due respect of the principles implies that governmental and institutional funding must remain detached from political or other agendas.

While affected states keep the primary responsibility to organize and deliver humanitarian support, they also have the fundamental duty to facilitate the work of other actors in situations when international solidarity is requested to answer the needs. Relief operations should not be considered as a challenge to State sovereignty nor the humanitarian imperative be undermined by making national sovereignty an excuse.

We concur that re-shaping aid is urgent with new actors and new donors playing bigger roles. Humanitarian aid must remain based on the needs as assessed by humanitarian actors and donors should abstain from using aid as a crisis management tool.

Consequently humanitarian NGOs, concerned about the threats posed on these principles, take the opportunity of the World Humanitarian Summit to strongly reassert their commitment to the humanitarian principles, as being critical in guaranteeing people in need will have safe access to humanitarian aid. The humanitarian principles must be fully supported and adequately implemented by states and all organizations, and systematically feed all policies and practices on humanitarian aid.

As humanitarian NGOs involved in crises around the world today, we strongly call upon Humanitarian actors, Donors, States and all parties involved in conflicts, to:

:: Re-affirm their commitment to respect and to promote the humanitarian principles of humanity, neutrality, impartiality and independence, towards any stakeholders involved in humanitarian crises, and re-affirm the value of the humanitarian imperative;

:: Review and design all humanitarian policies in compliance with the humanitarian principles and enhance existing commitments for good donor practices such as the GHD principles;

:: Reaffirm and protect the fundamental right for affected populations to access humanitarian aid;

:: Allow and support full unimpeded access to all people in need of assistance and promote the safety, protection and freedom of movement of humanitarian personnel.

We request that these recommendations be fully part of the outcomes of the World Humanitarian Summit.

The statement was signed by the following organisations:
Danish Refugee Council
ACF International
ACT Alliance
ACTED
CAFOD
CARE International
Caritas Internationalis Luxemburg
CBM International
ChildFund International
Christian Aid
Concern Worldwide US
DanChurchAid
Diakonie Katastrophenhilfe
Finnish Church Aid
Handicap International
HelpAge International
International Rescue Committee
International Medical Corps
Johanniter International Assistance
Life for Relief and Development
Malteser International
MEDAIR
Médecins du Monde
Mercy Corps
Norwegian Refugee Council
Première Urgence – Aide Médicale Internationale
Relief International
Secours Islamique France
Solidarités International
Terre des homes
The Lutheran World Federation
Welthungerhilfe
World Vision

Facing the Facts: the truth about ageing and development
Age International – UK member of the global HelpAge network.
February 2015 :: 88 pages
Report available: https://drive.google.com/folderview?id=0B-8FwpWcVk4NdEdlZXM5dS1VdXc&usp=sharing

Foreword
We all know that we are living through a time of global population growth unprecedented in human history. The number of people in the world has doubled since 1970, and will grow further, from 7 to 10 billion, by 2050.

But less well-known is the fact that the world is ageing as well as growing. There are currently 868 million older people in the world, and by 2050 this number will have reached more than 2 billion – 21 per cent of the world’s population. And most will live in developing countries.

Yet, to listen to most discussions about international development, you could be forgiven for thinking that it was only younger people who mattered.

We have produced this publication because, while the number and proportion of older people in the world grows so dramatically, discussions about international development do not give sufficient consideration to its implications – to the challenges and opportunities this remarkable reality present.

The articles within this report represent a range of views from high profile thought leaders, development experts and academics, about how population ageing should be taken into account in development thinking. The message that resonates throughout the report is that older people have a right to be valued for who they are, have needs that must be taken into account and are a global asset, making contributions to their families and communities that need to be recognised and supported.

It is worth noting that there have been attempts in recent years to raise the profile of older people: in a global context. The Madrid International Plan of Action on Ageing (MIPAA), agreed by 159 states in 2002, recognises older people as contributors to the development of their societies. However, this agreement is not legally binding and is relatively unknown in policy-making circles.

The fact that it has only been mentioned twice in this report implies that MIPAA has had limited impact. As our authors suggest, far more needs to be done to ensure people of all ages are respected, protected, and enabled to continue contributing and participating throughout their lives.

We all experience different challenges and have different needs at different stages of life. Each one of us should be supported to fulfil our potential at every age: in childhood, youth, middle-age and later life.

We hope this publication will help us to face the facts of global population ageing in international development; and in turn, to explore what must be done to respond to the benefits and challenges this worldwide phenomenon brings.

Selected Quotes from Press Release Launching Report
Chris Roles, Director of Age International, said: “Our analysis highlights how population ageing affects every aspect of development, but simply isn’t being given the attention it deserves. We need policies that are fit for the world around us and the future ahead, not ones based on out of date views of who lives in developing countries.
“For example, our experience tells us that older people are far too often invisible in emergency humanitarian situations as well as longer term development programmes. Ignoring the ageing population is no longer an option.”

Mary Robinson said: “The world has more older people today than ever before, yet too many older people still face prejudice and discrimination. ‘Facing the Facts’ is a welcome and much-needed step towards greater recognition of the rights, dignity and value of older people around the world.”

Margaret Chan said: “The health needs of the world’s population are being transformed by global ageing yet governments, development and health practitioners have been slow to react. The increase in the number of older people is one of the success stories of international development and how we respond to this reality will be one of the keys to prosperity in the future.”

World Report 2015 – Events of 2014
Human Rights Watch
February 2015 :: 660 pages
pdf: http://www.hrw.org/sites/default/files/wr2015_web.pdf
World Report 2015 is Human Rights Watch’s 25th annual review of human rights practices around the globe. It summarizes key human rights issues in more than 90 countries and territories worldwide.

In his keynote in the report, Human Rights Watch Executive Director Kenneth Roth reflects on a year so tumultuous, “it can seem as if the world is unraveling.” Surveying several of the year’s most daunting security challenges—including the rise of the extremist group Islamic State (also known as ISIS), China’s crackdown on Uighurs in Xinjiang, and Mexico’s abuse-riddled war on drugs—Roth stresses the important role that human rights violations played in fomenting and aggravating those crises.

The report “reflects extensive investigative work that Human Rights Watch staff undertook in 2014, usually in close partnership with human rights activists in the country in question. It also reflects the work of our advocacy team, which monitors policy developments and strives to persuade governments and international institutions to curb abuses and promote human rights.”

The book is divided into two main parts: an essay section, and country-specific chapters.

Editor’s Note:
We bring forward from our Foundation Watch section below two Ford Foundation announcement’s which we considered to warrant fuller treatment here.

New $25 million fund for South African civil society groups working to advance constitutionalism
Ford Foundation
5 February 2015
Joint statement from the Open Society Foundations, Ford Foundation and Atlantic Philanthropies
Today the Open Society Foundations, Ford Foundation and Atlantic Philanthropies announced the launch of a joint fund to support local organizations promoting and advancing constitutionalism in South Africa, to mark the first 20 years of South African democracy.

The three contributing foundations, each of which has decades of experience working in South Africa, and which ordinarily support civil society organizations, the local philanthropic community and also government, will provide a collective $25 million to South African organizations whose purpose is to advance a democratic and open society.

Twenty years after the adoption of the South African Constitution, described as the world’s most progressive, South Africa still has many challenges. Delivering on the civil, political and socioeconomic aspirations embedded in that Constitution requires a society that is transparent, open, non-discriminatory and operates according to the highest standards of Constitutional accountability.

Responding to these challenges, and recognizing the significant innovative and leadership role that South African civil society organizations play in both articulating these challenges and providing appropriate responses rooted in the rule of law, the three foundations will in implementing the fund rely extensively on an independent local Selection Panel, chaired by former Constitutional Court Justice Yvonne Mokgoro, to advise the foundations on allocating resources from the fund to South African organizations that meet the criteria of the fund…

Ford Foundation Expands Creative Commons Licensing for All Grant-Funded Projects
A change consistent with organization’s longtime commitment to transparency, knowledge-sharing
3 February 2015:
(New York) – The Ford Foundation announced today that it is adopting an open licensing policy for all grant-funded projects and research to promote greater transparency and accessibility of materials. Effective February 1, grantees and consultants will be required to make foundation-funded materials subject to a Creative Commons license allowing others, free of charge and without requesting permission, the ability to copy, redistribute, and adapt existing materials, provided they give appropriate credit to the original author.

The Ford Foundation has long supported transparency—including open licensing, which is an alternative to the traditional “all rights reserved” copyright and encourages sharing intellectual property in a digital global commons. By moving to broadly disseminate a large amount of educational and research materials resulting from its funding, the foundation hopes to make its work and the work of its grantees more accessible and ultimately, increase its impact.

“Our organization is committed to being as transparent and open as possible, and this philosophy extends to the work we fund and the valuable materials we and our grantees produce,” said Darren Walker, president of the Ford Foundation. “This policy change will help grantees and the public more easily connect with us and build upon our work, ensure our grant dollars go further and are more impactful, and—most importantly—increase our ability to advance social justice worldwide.”

The Ford Foundation plans to use the most recent Creative Commons Attribution License (CC BY 4.0), the most open license offered by Creative Commons, a nonprofit organization and Ford Foundation grantee dedicated to facilitating the sharing and use of materials through simple, standardized open licenses…

IMF [to 7 February 2015]
http://www.imf.org/external/news/default.aspx

IMF Establishes a Catastrophe Containment and Relief Trust to Enhance Support for Eligible Low Income Countries Hit by Public Health Disasters
Press Release No. 15/34
February 5, 2015
The Ebola epidemic in parts of West Africa is a humanitarian disaster that has drawn the attention of the international community to the threat posed by the rapid spread of life-threatening infectious diseases, both within and across international boundaries.

On February 4, 2015, the Executive Board of the International Monetary Fund (IMF) met to consider how the Fund could better support low-income countries hit by such public health disasters. This would take into account both the humanitarian case for providing such support and the wider international interest in supporting vigorous action to contain and halt a potential regional or global pandemic at the earliest possible stage.

To help meet these objectives, the Board approved the establishment of a new Catastrophe Containment and Relief (CCR) Trust, as a vehicle to provide exceptional support to countries confronting major natural disasters, including life-threatening, fast-spreading epidemics but also other types of catastrophic disasters, such as massive earthquakes. For eligible countries confronting epidemics that meet specified criteria, the IMF would use CCR trust fund resources to provide grants as a supplement to its conventional loan support. The grants would be used to pay off future debt service payments, thus reducing the country’s debt burden and freeing up resources to tackle relief and recovery challenges.

Subject to Board approval of requests from the individual countries, it is expected that the CCR trust would provide grants-for-debt relief of close to $100 million for the three countries affected by Ebola in West Africa –Liberia, Sierra Leone, and Guinea. These funds would come in addition to the $130 million of assistance provided in September 2014 and to a second round of new concessional loans amounting to about $160 million to be considered soon by the Executive Board.

At the conclusion of the Executive Board meeting on the CCR, IMF Managing Director Christine Lagarde stated: “I welcome the establishment of the Catastrophe Containment Relief Trust. It aims at enhancing our support to the countries in Africa hit by Ebola, as well as other low income countries that may be affected by public health disasters in the future. This is a strong example of the IMF demonstrating flexibility and innovation in responding to the needs of our global membership.”

Background
The primary tool through which the Fund supports low income countries confronting natural disasters is through the speedy provision of its interest-free loans to the affected countries, whether by expanding the amounts being provided under a pre-existing Fund financial program with the member or by disbursing funds under the Rapid Credit Facility (RCF).

In their November 2014 meeting in Brisbane, the G-20 called on the Bretton Woods Institutions to continue their strong support to countries severely affected by the Ebola outbreak through a combination of concessional loans, debt relief and grants, and asked the institutions to explore new, flexible mechanisms to address the economic effects of future comparable crises. The CCR Trust is the Fund’s response to that call. It replaces the Post-Catastrophe Debt Relief (PCDR) Trust established on June 25, 2010 in the wake of a massive earthquake in Haiti, and expands the circumstances under which the Fund can provide exceptional assistance to its low income members to include public health disasters.

Through the new instrument, the Fund is able to quickly and flexibly adjust its policies in the face of unexpected international developments, including pandemics, to serve the needs of its membership, especially the most vulnerable.

EBOLA/EVD [to 7 February 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Please see end of this edition for additional UNMEER daily reporting content.

WHO: Ebola Situation Report – 4 February 2015
[Excerpt; Editor’s text bolding]
SUMMARY
:: Weekly case incidence increased in all three countries for the first time this year. There were 124 new confirmed cases reported in the week to 1 February: 39 in Guinea, 5 in Liberia, and 80 in Sierra Leone.
:: Continued community resistance, increasing geographical spread in Guinea and widespread transmission in Sierra Leone, and a rise in incidence show that the EVD response still faces significant challenges.
:: As the wet season approaches, there is an urgent need to end the outbreak in as wide an area as possible, especially in remote areas that will become more difficult to access.
:: Guinea reported 39 new confirmed cases, compared with 30 the previous week. An unsafe burial that took place in early January in the eastern prefecture of Lola, on the border with Côte d’Ivoire, has so far resulted in an outbreak of 11 confirmed cases. A further confirmed case in the northern prefecture of Siguiri, on the border with Mali, also originated in Lola.
:: The north Guinean prefecture of Tougué, which also borders Mali, has reported its first 2 confirmed cases. Both cases originated in the western prefecture of Dubreka.
::: In light of the recent increase in cases in northern Guinea, cross-border meetings between Guinea, Mali, and Senegal are planned to strengthen coordination of surveillance. A rapid-response team has also arrived in the border area between Lola, Guinea, and Côte d’Ivoire to assess risk and strengthen surveillance.
:: A total of 80 new cases were reported in Sierra Leone in the week to 1 February, compared with 65 the previous week. The western districts of Port Loko and the capital Freetown are the worst-affected areas. Nine of 14 districts in the country reported at least 1 confirmed case, up from 7 districts in the previous week.
:: The target is for 100% of new cases to arise among registered contacts, so that each and every chain of transmission can be tracked and terminated. In Guinea in the week to 25 January, 14 of 26 (54%) new confirmed and probable cases in arose among registered contacts; in Liberia in the 9 days to 31 January, 7 of 7 (100%) new confirmed cases arose among registered contacts; and in Sierra Leone in the week to 18 January 26 of 121 (21%) confirmed cases arose among registered contacts.
:: The case fatality rate among hospitalized cases (calculated from all confirmed and probable hospitalized cases with a reported definitive outcome) is between 50% and 61% in the 3 intense-transmission countries.
:: A total of 822 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths.
:: A total of 10 of 34 prefectures in Guinea reported at least one security incident or other form of refusal to cooperate in the week to 1 February. No counties in Liberia and 3 districts in Sierra Leone reported at least one similar incident during the week to 27 January.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been almost 22 500 reported confirmed, probable, and suspected cases (Annex 1) of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 9000 reported deaths (outcomes for many cases are unknown). A total of 39 new confirmed cases were reported in Guinea, 5 in Liberia, and 80 in Sierra Leone in the 7 days to 1 February.
:: A stratified analysis of cumulative confirmed and probable cases indicates that the number of cases in males and females is similar (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are almost four times more likely to be affected than are children.
:: A total of 822 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths (table 3)….

United Nations – Secretary General, Security Council, General Assembly
Selected Press Releases [to 7 February 2015]
http://www.un.org/en/unpress/

3 February 2015
SG/SM/16512-OBV/1425-WOM/2013
Breaking Silence, ‘Disproving Myths’ around Female Genital Mutilation First Steps to Eliminating It, Says Secretary-General in Message for International Day
UN Secretary-General Ban Ki-moon’s message for the International Day of Zero Tolerance for Female Genital Mutilation, observed on 6 February.

2 February 2015
SG/SM/16509-ECOSOC/6665
Despite Global Unemployment, Crises, Young People Have Resolve to Fight for Peace, Progress, Secretary-General Tells Youth Forum, Urging Them to ‘Be Bold’
UN Secretary-General Ban Ki-moon’s remarks, as prepared for delivery, to the Economic and Social Council Youth Forum, in New York today.

UNICEF [to 7 February 2015]
http://www.unicef.org/media/media_71508.html

First regular session of the UNICEF Executive Board
3-5 February 2015, Conference Room 3, General Assembly (GA), UNHQ
Session documents/PaperSmart portal

Joint meeting of the Executive Boards of UNDP/UNFPA/UNOPS, UNICEF, UN-Women and WFP
2 February 2015, Conference Room 3, General Assembly (GA), UNHQ
Meeting documents/PaperSmart portal

.

Media Releases [selected]
More than 16,000 children lost parents or caregivers to Ebola – many are taken in by the communities: UNICEF
DAKAR, Senegal/GENEVA/NEW YORK, 6 February 2015 – Some 16,600 children are registered as having lost one or both parents, or their primary caregivers to Ebola in Guinea, Liberia and Sierra Leone, but less than 3 per cent have had to be placed outside family or community care, UNICEF said today.

A call to action for health workers around the world to mobilize against Female Genital Mutilation
NEW YORK, 6 February 2015 – A call to action for health workers around the world to mobilize against Female Genital Mutilation

UNICEF: South Sudan on the edge of nutrition catastrophe if hostilities don’t end now
JUBA, South Sudan, 4 February 2015 – UNICEF urged warring groups in South Sudan to follow up fast on the ceasefire deal reached Monday or face potentially catastrophic food shortages in the conflict areas of the country.

WHO & Regionals [to 7 February 2015]

:: 136th WHO Executive Board session
26 January–3 February 2015
Geneva, Switzerland
Documentation

:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 3 February 2015
– Human infection with avian influenza A(H7N9) virus – Canada 1 February 2015

:: The Weekly Epidemiological Record (WER) 6 February 2015, vol. 90, 6 (pp. 33–40)
Contents
33 Chagas disease in Latin America: an epidemiological update based on 2010 estimates
43 Monthly report on dracunculiasis cases, January– November 2014

:: GIN January 2015 pdf, 1.82Mb
30 January 2015

:: Cholera prevention measures reduce transmission in South Sudan
6 February 2015 — When violence erupted in South Sudan, tens of thousands of people fled the conflict and sought refuge in United Nations bases in the hopes of protection. As the rainy season approached it increased the risk of water-borne diseases, like cholera, and the potential for explosive outbreaks in congested camps. A timely decision to start cholera prevention and control measures, averted illness and death among the vulnerable camp inhabitants who had been at high-risk of the disease.

:: Preventing premature cancer deaths
4 February 2015 — Annually there are 14 million new cases of cancer and over 8 million people die from cancer, with 60% of deaths in Africa, Asia and Central and South America. WHO is working with countries to build solutions to reduce premature deaths from cancers through its global drive to prevent premature deaths from NCDs by 25% by 2025.
Read the commentary on cancer and tobacco
WHO Regional Offices

WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: PAHO/WHO says accessible, cost-effective measures can prevent premature cancer deaths (02/02/2015)

WHO South-East Asia Region SEARO
:: Beat cancer: Prevent, detect early 04 February 2015

WHO European Region EURO
:: WHO strengthens health operations in eastern Ukraine 06-02-2015
:: Influenza season underway in WHO European Region 04-02-2015

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

UNFPA United Nations Population Fund [to 7 February 2015]
http://www.unfpa.org/public/

6 February 2015
News
The start of a movement: Girls rising up against FGM
TARIME, Tanzania – Female genital mutilation (FGM) is a human rights violation – one that can lead to haemorrhage, infection, complications during childbirth, infertility, and, in some cases, even death. Yet it remains…

5 February 2015
News
Empowering women to lead the change: One woman’s fight against FGM
DOKA, Sudan – Like the vast majority of women in Sudan, Haja Aicha underwent female genital mutilation (FGM) as a child. And like many women, she says the procedure was agonizing. But unlike most people, Haja Aicha has…

3 February 2015
News
Ebola survivors facing stigma, unemployment, exclusion
MONROVIA, Liberia – After recovering from the near-death experience of an Ebola infection, survivors in Liberia are reporting that their ordeal is not yet over. Many say they are encountering hostility, exclusion and…

UNDP United Nations Development Programme [to 7 February 2015]
http://www.undp.org/content/undp/en/home/presscenter.html

03 Feb 2015
Helen Clark: Special Address at the Closing Session of the ECOSOC Youth Forum, “A Year of Opportunity for Youth”
New York, New York

02 Feb 2015
Helen Clark: Statement on “Innovative Approaches to Programme Design and Implementation to Support the Operationalisation of the post-2015 Development Agenda” at the Joint Meeting of the Executive Boards of UNDP/UNFPA/UNOPS, UNICEF, UN Women, and WFP
New York, New York

ILO International Labour Organization [to 7 February 2015]
http://www.ilo.org/global/lang–en/index.htm

ILO-UNCTAD book
Transforming economies
The ILO-UNCTAD book Transforming Economies: Making industrial policies work for growth, jobs and development , provides a deeper understanding of the process of structural and technological change, and distills lessons and principles for the design of policies that effectively create sustained and inclusive growth and quality jobs. The book is based on eight case studies (Costa Rica, Republic of Korea, Brazil, China, South Africa, Sub-Saharan Africa, the United States and the software industry in India), as well as cross-country and regional studies.