BMC Public Health
(Accessed 7 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Using a community-based definition of poverty for targeting poor households for premium subsidies in the context of a community health insurance in Burkina Faso
Germain Savadogo, Aurelia Souarès, Ali Sié, Divya Parmar, Gilles Bibeau, Rainer Sauerborn BMC Public Health 2015, 15:84 (6 February 2015)
Abstract (provisional) Provisional PDF
Background
One of the biggest challenges in subsidizing premiums of poor households for community health insurance is the identification and selection of these households. Generally, poverty assessments in developing countries are based on monetary terms. The household is regarded as poor if its income or consumption is lower than a predefined poverty cut-off. These measures fail to recognize the multi-dimensional character of poverty, ignoring community members? perception and understanding of poverty, leaving them voiceless and powerless in the identification process. Realizing this, the steering committee of Nouna’s health insurance devised a method to involve community members to better define `perceived? poverty, using this as a key element for the poor selection. The community-identified poor were then used to effectively target premium subsidies for the insurance scheme.
Methods
The study was conducted in the Nouna’s Health District located in northwest Burkina Faso. Participants in each village were selected to take part in focus-group discussions (FGD) organized in 41 villages and 7 sectors of Nouna’s town to discuss criteria and perceptions of poverty. The discussions were audio recorded, transcribed and analyzed in French using the software NVivo 9.
Results
From the FGD on poverty and the subjective definitions and perceptions of the community members, we found that poverty was mainly seen as scarcity of basic needs, vulnerability, deprivation of capacities, powerlessness, voicelessness, indecent living conditions, and absence of social capital and community networks for support in times of need. Criteria and poverty groups as described by community members can be used to identify poor who can then be targeted for subsidies.
Conclusion
Policies targeting the poorest require the establishment of effective selection strategies. These policies are well-conditioned by proper identification of the poor people. Community perceptions and criteria of poverty are grounded in reality, to better appreciate the issue. It is crucial to take these perceptions into account in undertaking community development actions which target the poor. For most community-based health insurance schemes with limited financial resources, using a community-based definition of poverty in the targeting of the poorest might be a less costly alternative.

British Medical Journal
07 February 2015(vol 350, issue 7994)
http://www.bmj.com/content/350/7994

Analysis
International donations to the Ebola virus outbreak: too little, too late?
BMJ 2015;350:h376 (Published 03 February 2015)
Karen Grépin examines the pledges made to the Ebola crisis, how much has actually reached affected countries, and the lessons to be learnt
…In this article, I examine the level and speed of the international donations to tackle the Ebola epidemic and how they aligned with evolving estimates of funds required to bring the epidemic under control. Understanding what has and has not worked well in the early phases of this crisis can help us learn from it and prepare for future humanitarian and public health emergencies. My analysis considers only international donations captured in the UN Office for the Coordination of Humanitarian Affairs’ (OCHA) financial tracking system (http://fts.unocha.org, box), which does not capture all resources that have been pledged to the outbreak…
Key messages
:: Pledges to the Ebola outbreak have reached at least $2.89bn
:: However, only about one third of these resources have been be disbursed to countries
:: Delays have occurred in requests for funding and translating pledges into paid contributions
:: New mechanisms to speed up disbursements could help in future crises

Cost Effectiveness and Resource Allocation
(Accessed 7 February 2015)
http://www.resource-allocation.com/

Research
Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar
Bishai D, Sachathep K, LeFevre A, Thant HNN, Zaw M, Aung T, McFarland W, Montagu D et al. Cost Effectiveness and Resource Allocation 2015, 13:3 (5 February 2015)
Abstract (provisional)
Introduction
This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL.
Background
The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices.
Methods
Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods.
Findings
Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted.
Interpretation
Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.

Globalization and Health
[Accessed 7 February 2015]
http://www.globalizationandhealth.com/

Research
Reverse innovation: an opportunity for strengthening health systems
Anne W Snowdon12*, Harpreet Bassi12, Andrew D Scarffe12 and Alexander D Smith12
Author Affiliations
Globalization and Health 2015, $article.volume.volumeNumber:2 doi:10.1186/s12992-015-0088-x
Published: 7 February 2015
Abstract (provisional)
Background
Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada.
Methods
An open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a $50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team.
Results
The competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women?s health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize.
Conclusions
The results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the Canadian health system.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 7 February 2015]

Commentary
Informing the establishment of the WHO global observatory on health research and development: a call for papers
Taghreed Adam, John-Arne Røttingen, Marie-Paule Kieny Health Research Policy and Systems 2015

Infectious Diseases of Poverty
[Accessed 7 February 2015]
http://www.idpjournal.com/content

Research Article
Incidence of human rabies exposure and associated factors at the Gondar Health Center, Ethiopia: a three-year retrospective study
Meseret Yibrah, Debasu Damtie Infectious Diseases of Poverty 2015, 4:3 (2 February 2015)
Abstract | Provisional PDF | Editor’s summary
A three year retrospective study revealed a significant incidence of human rabies exposure in Ethiopia. This study also depicted being male and living in urban areas as a potential risk factor for human rabies exposure. Image: Canine rabies is a significant problem in Ethiopia.

Research Article
Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database
Waleed M Sweileh, Samah W Al-Jabi, Alaeddin Abuzanat, Ansam F Sawalha, Adham S AbuTaha, Mustafa A Ghanim, Sa¿ed H Zyoud Infectious Diseases of Poverty 2015, 4:2 (2 February 2015)
Abstract | Provisional PDF | Editor’s summary
Arab countries, like other developing poor countries, suffer from various types of infectious diseases. Some of these diseases might be endemic or unique to the Arab countries. However, Arab countries are still lagging behind in research in the field of infectious diseases. More efforts and further financial support are needed to encourage research and publications in this field. Image: Dr. Adham Abu Taha doing microbiological testing for specimens at An-Najah National University.

JAMA
February 3, 2015, Vol 313, No. 5
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 3, 2015
Digital Multimedia: A New Approach for Informed Consent?
Alan R. Tait, PhD1,2; Terri Voepel-Lewis, PhD, RN1
1Department of Anesthesiology, University of Michigan Health System, Ann Arbor
2Center for Bioethics and Social Sciences in Medicine, University of Michigan Health System, Ann Arbor
JAMA. 2015;313(5):463-464. doi:10.1001/jama.2014.17122.
This Viewpoint discusses use of digital multimedia as a strategy to enhance study participants’ understanding of research information.
The bioethical principle of respect for persons requires that individuals participating in research studies are provided with sufficient information to allow them to make autonomous and informed decisions. In general, the process of informed consent requires that investigators disclose pertinent information regarding procedures to be performed, risks, and benefits, etc, in a manner that participants can understand. In most cases, this information is reinforced by having the study participant or parent/guardian read a consent document, which is then signed to authorize participation…

Journal of Global Infectious Diseases (JGID)
January-March 2015 Volume 7 | Issue 1 Page Nos. 1-50
http://www.jgid.org/currentissue.asp?sabs=n

Editorial
State of Globe: Rabies: The lethality since antiquity!
Inder Maurya, Ketan Vagholkar, Bhavesh Patel, Mohsin Siddiqui, Shreshtha Tiwari, Premkumar Maurya
DOI:10.4103/0974-777X.150880

The Lancet
Feb 07, 2015 Volume 385 Number 9967 p481-576 e5-e6
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Don’t forget health when you talk about human rights
The Lancet
Last week, Human Rights Watch (HRW) released World Report 2015, their 25th annual global review documenting human rights practices in more than 90 countries and territories in 2014. The content is based on a comprehensive investigation by HRW staff, together with in-country human rights activists. In his opening essay, HRW’s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence.

Comment
FGM: the mutilation of girls and young women must stop
Audrey Ceschia
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60176-3
Summary
Feb 6, 2015, marks International Day of Zero Tolerance for Female Genital Mutilation/Cutting, a day to reflect on one of the most cruel of human practices—an ancestral tradition that became a social norm—which has been tolerated for far too long. “Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”, according to WHO’s definition. More than 125 million women have undergone FGM in 29 countries across Africa and the Middle East where FGM is concentrated.

Comment
Health in an ageing world—what do we know?
Richard Suzman, John R Beard, Ties Boerma, Somnath Chatterji
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61597-X
Summary
The ageing of populations is poised to become the next global public health challenge. During the next 5 years, for the first time in history, people aged 65 years and older in the world will outnumber children aged younger than 5 years.1 Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanisation, modernisation, globalisation, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic conditions.

Series
Ageing
Causes of international increases in older age life expectancy
Colin D Mathers, Gretchen A Stevens, Ties Boerma, Richard A White, Martin I Tobias

Ageing
The burden of disease in older people and implications for health policy and practice
Martin J Prince, Fan Wu, Yanfei Guo, Luis M Gutierrez Robledo, Martin O’Donnell, Richard Sullivan, Salim Yusuf

Ageing
Health, functioning, and disability in older adults—present status and future implications
Somnath Chatterji, Julie Byles, David Cutler, Teresa Seeman, Emese Verdes

The Lancet Global Health
Feb 2015 Volume 3 Number 2 e62-e112
http://www.thelancet.com/journals/langlo/issue/current

Editorial
All about the money
Zoë Mullan
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70003-3
Summary
It’s finally 2015: a year by the end of which extreme poverty and hunger are to be eradicated, maternal and child mortality are to be drastically reduced, and the trajectory of the global incidence of HIV, tuberculosis, and malaria are to be reversed. Much has been written about where the Millennium Development Goals succeeded and failed as global targets, and what has changed in the world since 2000. Much work has also been done to establish what happens next. In his synthesis report on the post-2015 agenda released last month, UN Secretary-General Ban Ki-Moon summarised and annotated this work, ultimately backing the 17 goals proposed by the Open Working Group on Sustainable Development Goals as the basis for a truly transformative agenda.

Articles
Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial
Dr Silvina Arrossi, PhD, Laura Thouyaret, BSc, Rolando Herrero, PhD, Alicia Campanera, MD, Adriana Magdaleno, BSc, Milca Cuberli, MSc, Paula Barletta, BSc, Rosa Laudi, MD, Liliana Orellana, PhD, the EMA Study team
EMA Study team members listed at end of reportOpen Access
DOI: http://dx.doi.org/10.1016/S2214-109X(14)70354-7
Open access funded by the Author(s)
Summary
Background
Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV DNA self-collection could increase screening coverage, but implementation of this technology is difficult in countries of middle and low income. We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening.
Methods
We did a population-based cluster-randomised trial in the province of Jujuy, Argentina, between July 1, 2012, and Dec 31, 2012. Community health workers were eligible for the study if they scored highly on a performance score, and women aged 30 years or older were eligible for enrolment by the community health worker. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). The primary outcome was screening uptake, measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02095561.
Findings
100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group; nine did not take part. 191 participating community health workers (94 in the intervention group and 97 in the control group) initially contacted 7650 women; of 3632 women contacted by community health workers in the intervention group, 3049 agreed to participate; of 4018 women contacted by community health workers in the control group, 2964 agreed to participate. 2618 (86%) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit, compared with 599 (20%) of 2964 in the control group (risk ratio 4•02, 95% CI 3•44–4•71).
Interpretation
Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake, showing that this strategy is effective to improve cervical screening coverage. This intervention reduces women’s barriers to screening and results in a substantial and rapid increase in coverage. Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage.
Funding
Instituto Nacional del Cáncer (Argentina).

New England Journal of Medicine
February 5, 2015 Vol. 372 No. 6
http://www.nejm.org/toc/nejm/medical-journal

Editorial
Ebola in West Africa at One Year — From Ignorance to Fear to Roadblocks
Jeffrey M. Drazen, M.D., Edward W. Campion, M.D., Eric J. Rubin, M.D., Ph.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden, M.D.
N Engl J Med 2015; 372:563-564 February 5, 2015 DOI: 10.1056/NEJMe1415398

It has been a year since the first case associated with the current Ebola virus outbreak in West Africa was identified and just over 8 months since we first started reporting on the outbreaks that stemmed from that patient in Guinea.1 Today’s posts at NEJM.org include an anniversary update on the fight against Ebola virus disease (EVD).2 It is painfully clear that the world’s initial handling of this dangerous outbreak was far from optimal, but we now appear to be making progress in the battle. This headway is evidenced by the observations that the rate of appearance of new cases is not as high as had been predicted by the World Health Organization or the U.S. Centers for Disease Control and Prevention in September 2014 and that outcomes may be improving at some Ebola treatment units.2,3

Patients in the hardest-hit areas are able to receive care at one of many Ebola treatment units that have been set up in West Africa. These units now offer hope for patients with EVD in places where 6 months ago there was little care available and little hope. The ongoing case finding and contact tracing are essential to preventing new outbreak clusters. Staffing the treatment units, tracing contacts, and providing basic health care services for the populations in the most severely affected areas, where the health care infrastructure has been devastated, are just a few of the tasks that must be performed if the battle against Ebola is to be won. If we don’t bring this outbreak to a halt now, it may again expand throughout the region and spread to other parts of the world. To deliver a victory, we need more volunteers who are willing to serve, to live in austere conditions, and to put themselves in harm’s way. All estimates indicate that the number of personnel needed far exceeds the current supply. We need to make it easier for those who want to help in the fight against Ebola to do so.

That brings us to academic medical centers in the United States. As the Ebola outbreak has burned its way deep into Guinea, Liberia, and Sierra Leone, in one of the worst acute public health crises in 50 years, our academic medical centers have sat largely on the sidelines. They have spent a fortune preparing their facilities and staff for the much-feared scenario of a local patient with possible Ebola virus infection. What has been lacking is leadership to help quell the crisis where it is actually happening. The problem is more than a lack of effective, positive leadership, as Rosenbaum reports4: the difficulties created by many academic medical centers for trainees and staff who want to go to West Africa to help control this outbreak are more akin to roadblocks. This response stands in contrast to that in the United Kingdom, where the Wellcome Trust has encouraged academic institutions to join the fight and has provided emergency funding for their research initiatives, and to that of the U.S. National Institute of Allergy and Infectious Diseases, which is offering extensions for grant renewals to people who have taken time to participate in Ebola mitigation efforts.

The medical centers that have helped pave the way for their personnel to fight Ebola deserve praise. The leaders of academic medical centers that have put roadblocks in the path of those wishing to serve need to rethink their priorities. They should be making it easier, not harder, for altruistic physicians, nurses, and other health care providers to help care for the sick and control the Ebola epidemic in West Africa. Our medical centers have immense resources and expertise; the countries wracked by Ebola have almost none. Something is wrong when some of the greatest health care centers in the world are not helping in the fight against this disastrously dangerous threat to human health. We ask the leaders of every medical center in the country to figure out how to make it possible for their staff, and even qualified trainees, to help on the ground in West Africa. And once the leaders have decided what to do, they need to tell their risk managers and their lawyers to make it work, rather than make decisions based on the worst-case scenarios and risks to their reputation, image, and market share painted by corporate advisors and legal staff. If in a year’s time this epidemic has not been controlled, we will have only ourselves to blame.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 7 February 2015)

Measles Vaccination Coverage Survey in Moba, Katanga, Democratic Republic of Congo, 2013: Need to Adapt Routine and Mass Vaccination Campaigns to Reach the Unreached
February 2, 2015 • Research
Julita Gil Cuesta, Narcisse Mukembe, Palle Valentiner-Branth, Pawel Stefanoff, Annick Lenglet
The Democratic Republic of Congo (DRC) has committed to eliminate measles by 2020. In 2013, in response to a large outbreak, Médecins Sans Frontières conducted a mass vaccination campaign (MVC) in Moba, Katanga, DRC. We estimated the measles vaccination coverage for the MVC, the Expanded Programme on Immunization routine measles vaccination (EPI) and assessed reasons for non-vaccination.
We conducted a household-based survey among caretakers of children aged 6 months-15 years in Moba from November to December 2013. We used a two-stage-cluster-sampling, where clusters were allocated proportionally to village size and households were randomly selected from each cluster. The questionnaire included demographic variables, vaccination status (card or oral history) during MVC and EPI and reasons for non-vaccination. We estimated the coverage by gender, age and the reasons for non-vaccination and calculated 95% confidence intervals (95% CI).
We recruited 4,768 children living in 1,684 households. The MVC coverage by vaccination card and oral history was 87% (95% CI 84-90) and 66% (95% CI 61-70) if documented by card. The EPI coverage was 76% (95% CI 72-81) and 3% (95% CI 1-4) respectively. The MVC coverage was significantly higher among children previously vaccinated during EPI 91% (95% CI 88-93), compared to 74% (95% CI 66-80) among those not previously vaccinated. Six percent (n=317) of children were never vaccinated. The main reason for non-vaccination was family absence 68% (95% CI 58-78).
The MVC and EPI measles coverage was insufficient to prevent the recurrence of outbreaks in Moba. Lack of EPI vaccination and lack of accessibility by road were associated with lower MVC coverage. We recommend intensified social mobilization and extended EPI and MVCs to increase the coverage of absent residents and unreached children. Routine and MVCs need to be adapted accordingly to improve coverage in hard-to-reach populations in DRC.
Conclusions
We estimated 87% coverage of the MVC in response to the measles outbreak in Moba territory. This coverage may be insufficient to prevent future outbreaks. Lack of a EPI vaccination and lack of accessibility by road were associated with lower MVC campaign coverage. Absence during the MVC and EPI vaccination were the main reasons for non-vaccination. On the basis of these conclusions, we recommend more accessible vaccination sites for each village in order to improve vaccination coverage during EPI and MVCs. We recommend improved social mobilization of the population through extended vaccination time in less accessible villages and to give notice well ahead of vaccination days. Campaign staff must emphasise children and their parents the importance of keeping the vaccination cards. EPI and MVCs need to be adapted accordingly to face these logistical and communication barriers. Hence, the vaccination of hard-to-reach children can contribute to meet the goal of measles elimination in DRC and similar settings.

PLoS Medicine
(Accessed 7 February 2015)
http://www.plosmedicine.org/

Enabling Dynamic Partnerships through Joint Degrees between Low- and High-Income Countries for Capacity Development in Global Health Research: Experience from the Karolinska Institutet/Makerere University Partnership
Nelson Sewankambo, James K. Tumwine, Göran Tomson, Celestino Obua, Freddie Bwanga, Peter Waiswa, Elly Katabira, Hannah Akuffo, Kristina Persson, Stefan Peterson
Health in Action | published 03 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001784
Summary Points
:: Partnerships between universities in high- and low-income countries have the potential to increase research capacity in both settings.
:: We describe a partnership between the Karolinska Institutet in Sweden and Makerere University in Uganda that includes a joint PhD degree program and sharing of scientific ideas and resources.
:: Ten years of financial support from the Swedish International Development Cooperation Agency has enabled 44 graduated PhD students and more than 500 peer-reviewed articles, the majority with a Ugandan as first author.
:: The collaborative research environment is addressing Ugandan health and health system priorities, in several cases resulting in policy and practice reforms.
:: Even though all Ugandan PhD graduates have remained in the country and 13 have embarked on postdoc training, remaining institutional challenges include developing functioning research groups, grant writing, network building at Makerere, and continued funding on both sides of the partnership.

Prehospital & Disaster Medicine
Volume 30 – Issue 01 – February 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Professionalization of Anesthesiologists and Critical Care Specialists in Humanitarian Action: A Nationwide Poll Among Italian Residents
Alba Ripoll Gallardo, Pier Luigi Ingrassia, Luca Ragazzoni, Ahmadreza Djalali, Luca Carenzo, Frederick M. Burkle, Jr. and Francesco Della Corte
Prehospital and Disaster Medicine / Volume 30 / Issue 01 / February 2015, pp 16 – 21
DOI: http://dx.doi.org/10.1017/S1049023X14001320 (About DOI), Published online: 15 December 2014

Comprehensive Review
Multi-disciplinary Care for the Elderly in Disasters: An Integrative Review
Heather L. Johnsona1 c1, Catherine G. Linga1 and Elexis C. McBeea2
a1 The Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland USA
a2 The Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine and Biometrics, Bethesda, Maryland USA
Abstract
Introduction
Older adults are disproportionately affected by disaster. Frail elders, individuals with chronic diseases, conditions, or disabilities, and those who live in long-term care facilities are especially vulnerable.
Purpose
The purpose of this integrative review of the literature was to describe the system-wide knowledge and skills that multi-disciplinary health care providers need to provide appropriate care for the elderly during domestic-humanitarian and disaster-relief efforts.
Data sources
A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed, CINAHL, and PsycINFO were conducted using terms such as Disaster, Geological Processes, Aged, Disaster Planning, and Vulnerable Populations. Forty-six articles met criteria for inclusion in the review.
Conclusions
Policies and guidance regarding evacuating versus sheltering in place are lacking. Tenets of elderly-focused disaster planning/preparation and clarification of legal and ethical standards of care and liability issues are needed. Functional capacity, capabilities, or impairments, rather than age, should be considered in disaster preparation. Older adults should be included in disaster planning as population-specific experts.
Implications for Practice
A multifaceted approach to population-specific disaster planning and curriculum development should include consideration of the biophysical and psychosocial aspects of care, ethical and legal issues, logistics, and resources.

Special Report
Cardiopulmonary Resuscitation in Resource-limited Health Systems–Considerations for Training and Delivery
Jason Friesen, Dean Patterson and Kevin Munjal
Prehospital and Disaster Medicine / Volume 30 / Issue 01 / February 2015, pp 97 – 101
Copyright © World Association for Disaster and Emergency Medicine 2014
DOI: http://dx.doi.org/10.1017/S1049023X14001265 (About DOI), Published online: 19 November 2014

World Heritage Review
n°74 – January 2015
http://whc.unesco.org/en/review/74/

World Heritage: Fostering resilience
In focus
:: Fostering resilience: Towards reducing disaster risks to World Heritage, p. 4
World Heritage sites are exposed to a wide variety of natural and human-induced hazards, such as earthquakes, cyclones or fires, which can have devastating effects on their value as well as on the lives and assets of the communities concerned.

:: Post-disaster reconstruction: Xijie historic quarter in Dujiangyan, Sichuan province, p. 16
The reconstruction project combined the objectives of heritage conservation, post-disaster reconstruction and social equity through broad community participation and close cooperation among concerned government agencies, stateowned enterprises, local residents and universities.

:: Building resilience at iSimangaliso Wetland Park, p. 22
iSimangaliso has built ecological and social resilience, dealing with risks to the site, and is implementing a broad-based strategy that will mitigate the social and ecological stressors associated with predicted environmental change.

:: Post-disaster heritage initiative in Pakistan, p. 28
The post-disaster development programmes undertaken by the Heritage Foundation of Pakistan are designed to nurture traditional and creative skills, particularly of women in marginalized sections of society.

:: The 3rd World Conference on Disaster Risk Reduction, p. 38
The 3rd UN World Conference on Disaster Risk Reduction, which will take place in Sendai (Japan) from 14 to 18 March 2015, is the most important intergovernmental gathering on disaster risks in ten years. The conference is expected to adopt the post-2015 international policy on Disaster Risk Reduction…

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 31 January 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 31 January 2015

blog edition: comprised of the 35+ entries to be posted below on 1 February 2015

Editor’s Note:
The WHO’s Executive Board – which continues its meetings in Geneva through mid-week –met last Sunday in a special session on ebola. The resolution adopted at that meeting – EBSS3.R1 – has been posted and is excerpted below.

This resolution represents, to our understanding , a milestone in affirming WHO’s special and specific charter and role in preparing for and responding to disease outbreaks and “humanitarian emergencies with health consequences.” This role has been a focus of debate and concern as the ebola/EVD crisis has unfolded.

Given the implications of this resolution, we recommend that readers engage the full special session documentation at http://apps.who.int/gb/e/e_ebss3.html and the full resolution at http://apps.who.int/gb/ebwha/pdf_files/EBSS3/EBSS3_R1-en.pdf.
.
WHO: EXECUTIVE BOARD: Special session on the Ebola emergency

EBSS3.R1 [Resolution adopted Sunday, 25 January 2015 at Special Session]
Agenda item 3 :: 25 January 2015
Ebola: ending the current outbreak, strengthening global preparedness and ensuring WHO’s capacity to prepare for and respond to future large-scale outbreaks and emergencies with health consequences
[Editor’s excerpts]
… Recalling resolution WHA64.10 on strengthening national health emergency and disaster management capacities and the resilience of health systems, which reaffirms, inter alia, that countries should ensure the protection of health, safety and welfare of their people and should ensure the resilience and self-reliance of the health system, which is critical for minimizing health hazards and vulnerabilities;

…Committed to an effective and coordinated response both for the current Ebola crisis and to make the corrective changes needed to prevent, detect and contain future outbreaks, and reaffirming the central and specialized role played by WHO in emergency preparedness and response, including in health emergency situations as described in Health Assembly resolutions WHA54.14, WHA58.1, WHA59.22, WHA64.10, WHA65.20 and WHA65.23;

Recalling resolution WHA65.20, which affirms WHO’s role as the health cluster lead in responding to the growing demands of health in humanitarian emergencies, and recognizes the specific requirements for effective health-related emergency operations;..

…Emphasizing also the fundamentally civilian character of humanitarian assistance, and reaffirming, in situations in which military capacity and assets are used as a last resort to support the implementation of humanitarian assistance, the need for the use to be undertaken with the consent of affected States and in conformity with relevant provisions of international law, [See United Nations General Assembly resolutions 60/124 and 69/135.]…

Current context and challenges; stopping the epidemic; and global preparedness
1. EXPRESSES its unwavering commitment to contain the Ebola outbreak and to remain engaged in promoting urgent actions to accelerate prevention, detection, control and treatment until we reach zero cases of Ebola virus disease; to contribute to building resilient health systems in the affected countries and other highly at-risk countries; and to provide support for people who have survived Ebola, and their families, and for children orphaned by the disease, including psychosocial support;

Leadership and coordination
2. RECALLS and REAFFIRMS the constitutional mandate given to WHO to act, inter alia, as the directing and coordinating authority on international health work, and to furnish, in emergencies,2 necessary aid upon the request or acceptance of governments, and recognizes the need to accelerate ongoing reform of the Organization;

3. FURTHER REAFFIRMS WHO’s role as the lead agency of the global health cluster, including its role to ensure the timely declaration of appropriate response levels to humanitarian emergencies with health consequences, and calls on Member States3 and relevant actors in humanitarian situations with health consequences to support WHO in fulfilling its role as lead agency of the Global Health Cluster within its mandate;

4. FURTHER REAFFIRMS that, in connection with the declaration on 8 August 2014, by the WHO Director-General that the 2014 outbreak of Ebola virus disease in some West African countries is a public health emergency of international concern, all WHO authorities with respect to the administration, deployment and other human resource matters concerning preparedness, surveillance and response rest with the Director-General, and shall be exercised in a manner consistent with the principles and objectives of WHO’s Emergency Response Framework, while minimizing the negative impact on regular and routine work of WHO…

UNICEF launches US$3.1 billion appeal to reach more children in emergencies
GENEVA, 29 January 2015 – UNICEF is launching a US$3.1 billion appeal – its largest ever – to reach 62 million children at risk in humanitarian crises worldwide – a US$1 billion jump in funding needs since last year’s appeal.

“From deadly natural disasters to brutal conflicts and fast-spreading epidemics, children across the world are facing a new generation of humanitarian crises,” said Afshan Khan, UNICEF’s Director of Emergency Programmes. “Whether in the headlines or hidden from view, emergencies sparked by social fracture, climate change and disease are stalking children in ways we have never seen before.”…

UNICEF’s Humanitarian Action for Children 2015 appeal targets a total of 98 million people, around two thirds of whom are children, in 71 countries:
:: The biggest portion of the appeal is for Syria and the sub-region. UNICEF is calling for US$903 million for the regional response to protect children at risk and deliver life-saving assistance like immunisations, safe water and sanitation, and education.
:: UNICEF is also appealing for US$500 million to accelerate its work in the heart of Ebola-affected communities. The money will be used to scale up efforts to rapidly isolate and treat every case, prevent further outbreaks, and continue to promote healthy behaviours to prevent the spread of the disease. The goal for 2015 is to get to zero cases and support the revitalisation of basic social services.
:: In Nigeria, where attacks by armed groups have escalated in the past year causing more than 1 million people in the northeast to flee their homes, UNICEF is asking for $US26.5 million.
:: A year into the conflict in Ukraine, UNICEF is appealing for US$32.45 million as the country faces a humanitarian crisis with 5.2 million people living in conflict zones, over 600,000 people internally displaced and some 1.7 million children affected.

The appeal also includes hugely under-funded and forgotten crises where children are in desperate need – including Afghanistan (35 per cent funded in 2014), the State of Palestine (23 per cent funded in 2014) and Niger (35 per cent funded in 2014)…
– The full Humanitarian Action for Children 2015 appeal and related country information can be found here: http://www.unicef.org/appeals
– Video and photos are available here: http://uni.cf/1zwEJ4M

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UNICEF: Thousands of children to be gradually released from armed group in South Sudan
Some 280 children handed over to UNICEF today
[Press release excerpt]

JUBA/NAIROBI/GENEVA/NEW YORK, 27 January, 2015 – UNICEF and partners have secured the release of approximately 3,000 children from an armed group in South Sudan – one of the largest ever demobilizations of children. The first group of 280 children were released today, at the village of Gumuruk in Jonglei State, eastern South Sudan. Further phased releases of the other children will occur over the coming month.

Recruited by the South Sudan Democratic Army (SSDA) Cobra Faction led by David Yau Yau, the children range in age from eleven to 17 years old. Some have been fighting for up to four years and many have never attended school. In the last year, 12,000 children, mostly boys, have been recruited and used as soldiers by armed forces and groups in South Sudan as a whole.

The children surrendered their weapons and uniforms in a ceremony overseen by the South Sudan National Disarmament, Demobilization and Reintegration Commission, and the Cobra Faction and supported by UNICEF.

“These children have been forced to do and see things no child should ever experience,” said UNICEF South Sudan Representative Jonathan Veitch. “The release of thousands of children requires a massive response to provide the support and protection these children need to begin rebuilding their lives.”

The children released from the Cobra Faction are being supported with basic health care and protection services and necessities such as food, water and clothing to help them get ready to return to their families. Counselling and other psychological support programmes are urgently being established. The children will soon have access to education and skills training programmes.

UNICEF is working to trace and reunify the children with their families, a daunting task in a country where more than 1 million children have either been displaced internally or have fled to neighbouring countries since fighting broke out in December 2013.

Support will extend to local communities to prevent and reduce discrimination against the returning children and also to prevent possible recruitment.

“The successful reintegration of these children back into their communities depends on a timely, coordinated response to meet their immediate and long-term needs. These programmes require significant resources,” said Veitch.

UNICEF estimates the costs for the release and reintegration of each child is approximately $2,330 for 24 months. So far UNICEF has received EUR 1.6 million from the IKEA Foundation – a first and critical contribution to funding for the release and reintegration programme – and is appealing for an additional $10 million in support. Other donors include the EU and the German and United Kingdom National Committees for UNICEF.