Women for Women International [to 7 March 2015]
http://www.womenforwomen.org/press-releases

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Women for Women International Elects New Board Leadership and Members
Tuesday, March 3, 2015 (Washington, D.C.) – The Board of Directors of Women for Women International (WfWI) today announced the appointment of philanthropist and business entrepreneur Jan Rock Zubrow as Board chair in addition to the election of new members. Prior to her appointment, Rock Zubrow served as Vice Chair of the Board and co-Chair of the Revenue and Advancement Committee…

ODI [to 7 March 2015]
http://www.odi.org/media

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Banks’ fear of breaching counter-terrorism laws hinders the work of UK charities in Syria – new report
Press release
5 March 2015
Banks’ fear of breaching counter-terrorism laws hinders the work of UK charities in Syria – new report
A lack of guidance from the UK Government, specifically the Treasury, on how banks should respond to counter-terrorism legislation has resulted in overly risk averse actions being taken towards UK charities working in conflict zones says new report launched today.

Driven by a fear of financing terrorism which is a breach of this legislation, international banks including HSBC, UBS and NatWest are effectively “de-risking” by closing and freezing bank accounts held by these charities and delaying, blocking or returning millions of pounds of donations with “no detailed explanation” says the report by UK think tank the Overseas Development Institute (ODI)…

Download: UK humanitarian aid in the age of counterterrorism: perceptions and reality –
Victoria Metcalfe-Hough, Tom Keatinge and Sara Pantuliano
ODI – March 2015 :: 36 pages
http://www.odi.org/sites/odi.org.uk/files/styles/history_202_wide/public/odi-assets/publications-opinion-file-covers/9479.png?itok=1-J4cpRt

Start Network [to 7 March 2015]
http://www.start-network.org/news-blog/#.U9U_O7FR98E
[Consortium of British Humanitarian Agencies]

Start Network response in Cameroon & West Africa thanks to long term DFID funding
March 3, 2015
Posted by Tegan Rogers
Start Network member agencies will be implementing long term responses to the ongoing refugee crisis in Cameroon and the Ebola crisis in West Africa. This is thanks to two grants from the UK Department for International Development which have been earmarked specifically for these two crises.

DFID have allocated £3 million for the refugee crisis in Cameroon. More than two years of violence in the Central African Republic has driven thousands of refugees into neighbouring Cameroon, which has resulted in its own humanitarian crisis as the camps struggle to meet their needs. This crisis is low profile, meaning it has attracted little funding for humanitarian agencies to respond to the increasing needs.

The West Africa Ebola response is to ensure preparedness and prevention in four specified West African countries to start with. The funding totalling £7m will cover projects up to twelve months in duration…

BMGF (Gates Foundation)
http://www.gatesfoundation.org/Media-Center/Press-Releases

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MARCH 05, 2015
The Bill & Melinda Gates Foundation and CureVac Collaborate to Accelerate the Development of Transformative Vaccine Technology
SEATTLE, WA, USA and TÜBINGEN, GERMANY (March 5, 2015) – The Bill & Melinda Gates Foundation and CureVac today announced that the foundation has made a commitment to invest $52 million (€46 million) in CureVac, a leading clinical-stage biopharmaceutical company specializing in mRNA-based vaccine technologies. As part of the agreement, the foundation will also provide separate funding for several projects to develop prophylactic vaccines based on CureVac’s proprietary messenger RNA (mRNA) platform. In addition, CureVac’s longstanding investor dievini Hopp BioTech announced a commitment of $24 million (€21 million) of additional equity.

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

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Research article
The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers
Diane Cooper, Joanne E Mantell, Jennifer Moodley, Sumaya Mall BMC Public Health 2015, 15:217 (4 March 2015)
Abstract (provisional)
Background
Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa’s prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH’s SRH and combatting the global HIV epidemic. This paper explores South African policymakers’ perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation.
Methods
It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008–2009 and 2011–2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH’s childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes.
Results
Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier.
Conclusion
The past decade’s HIV policy changes have increased opportunities for SRH –HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.

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Debate
A critical review of population health literacy assessment
Diana Guzys1*, Amanda Kenny1, Virginia Dickson-Swift1 and Guinever Threlkeld2
Abstract
Background
Defining health literacy from a public health perspective places greater emphasis on the knowledge and skills required to prevent disease and for promoting health in everyday life. Addressing health literacy at the community level provides great potential for improving health knowledge, skills and behaviours resulting in better health outcomes. Yet there is a notable absence of discussion in the literature of what a health literate population looks like, or how this is best assessed.
Discussion
The emphasis in assessing health literacy has predominantly focused on the functional health literacy of individuals in clinical settings. This review examines currently available health literacy assessment tools to identify how well suited they are in addressing health literacy beyond clinical care settings and beyond the individual. Although public health literature appears to place greater emphasis on conceptualizing critical health literacy, the focus continues to remain on assessing individuals, rather than on health literacy within the context of families, communities and population groups. When a population approach is adopted, an aggregate of individual health literacy assessment is generally used. Aggregation of individual health literacy fails to capture the dynamic and often synergistic relationships within communities, and fails to reflect societal influences on health knowledge, beliefs and behaviours.
We hypothesise that a different assessment framework is required to adequately address the complexities of community health literacy. We assert that a public health approach, founded on health promotion theories provides a useful scaffold to assess the critical health literacy of population groups. It is proposed that inclusion of community members in the research process is a necessary requirement to coproduce such an appropriate assessment framework.
Summary
We contend that health literacy assessment and potential interventions need to shift to promoting the knowledge and skills essential for critical health literacy at a societal level. The challenge for researchers is to negotiate the myriad of complexities associated with each concept and component required for this task.

British Medical Journal
07 March 2015 (vol 350, issue 7998)
http://www.bmj.com/content/350/7998

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Editorials
The evidence base for new drugs
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h952 (Published 02 March 2015) Cite this as: BMJ 2015;350:h952
Peter Doshi, associate editor1,
Tom Jefferson, reviewer2
Author affiliations

New legislation in Germany provides another piece of a complex puzzle
Marketing campaigns cast new drugs as “must haves.” In reality, the public evidence base for new drugs often leaves more questions than answers.1 2 While marketing authorization indicates that regulators judged the risk-benefit profile to be favorable, product labels rarely list and quantify these benefits and harms. Publications of premarketing trials might fill in some gaps, but readers beware: not all trials are published and those that are may be inaccurately or incompletely reported.3 4

Data transparency in clinical trials has emerged as a way to tackle the reporting biases that affect literature, enabling independent scrutiny of trials.5 But it is not enough. Even with open data we rarely know how new drugs compare with existing options or whether they improve patient centered outcomes. An analysis published in this issue (doi:10.1136/bmj.h796) suggests that new legislation in Germany may provide another piece of the puzzle.6

The German act on the reform of the market for medicinal products (AMNOG) was introduced in 2011 to inform drug pricing for all new drugs. To control costs, sponsors must submit a standardized dossier including evidence of the drug’s added benefit over already available drugs. This dossier is then reviewed by scientists, usually at the Institute for Quality and Efficiency in Health Care (IQWiG), who produce an assessment report.

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Editorials
Health literacy: towards system level solutions
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1026 (Published 24 February 2015) Cite this as: BMJ 2015;350:h1026
Trisha Greenhalgh, professor of primary care health sciences
Author affiliations

A new World Health Organization toolkit aimed at low and middle income countries could help reduce health inequalities in the rest of the world too
A new resource aimed at low and middle income countries, the World Health Organization has redefined health literacy as “the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health.”1

Low health literacy is associated with poor engagement with health services, health knowledge, concordance with prescribed medication, self management of illness, markers of disease progression, overall health status, and survival. It is also associated with high rates of hospital admission and use of emergency care.2 3 4 5 6 7

Low health literacy is more common in low income and minority ethnic groups, immigrants, people without full citizenship, those with fewer years of education, and older people; it is especially common in people who fall into several of these risk groups.8 9 10 11 People with low health literacy may feel ashamed and try to conceal it from professional carers and family members.12 Differences in health literacy explain a substantial proportion of inequity in the uptake and use …

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Research
The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial
BMJ 2015; 350 :h1019 (Published 04 March 2015)
Open Access
Abstract
Objective
To examine the impact of providing rapid diagnostic tests for malaria on fever management in private drug retail shops where most poor rural people with fever present, with the aim of reducing current massive overdiagnosis and overtreatment of malaria.
Design
Cluster randomized trial of 24 clusters of shops.
Setting
Dangme West, a poor rural district of Ghana.
Participants
Shops and their clients, both adults and children.
Interventions
Providing rapid diagnostic tests with realistic training.
Main outcome measures
The primary outcome was the proportion of clients testing negative for malaria by a double-read research blood slide who received an artemisinin combination therapy or other antimalarial. Secondary outcomes were use of antibiotics and antipyretics, and safety.
Results Of 4603 clients, 3424 (74.4%) tested negative by double-read research slides. The proportion of slide-negative clients who received any antimalarial was 590/1854 (32%) in the intervention arm and 1378/1570 (88%) in the control arm (adjusted risk ratio 0.41 (95% CI 0.29 to 0.58), P<0.0001). Treatment was in high agreement with rapid diagnostic test result. Of those who were slide-positive, 690/787 (87.8%) in the intervention arm and 347/392 (88.5%) in the control arm received an artemisinin combination therapy (adjusted risk ratio 0.96 (0.84 to 1.09)). There was no evidence of antibiotics being substituted for antimalarials. Overall, 1954/2641 (74%) clients in the intervention arm and 539/1962 (27%) in the control arm received appropriate treatment (adjusted risk ratio 2.39 (1.69 to 3.39), P<0.0001). No safety concerns were identified.
Conclusions
Most patients with fever in Africa present to the private sector. In this trial, providing rapid diagnostic tests for malaria in the private drug retail sector significantly reduced dispensing of antimalarials to patients without malaria, did not reduce prescribing of antimalarials to true malaria cases, and appeared safe. Rapid diagnostic tests should be considered for the informal private drug retail sector.
Registration Clinicaltrials.gov NCT01907672

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Information on new drugs at market entry: retrospective analysis of health technology assessment reports versus regulatory reports, journal publications, and registry reports
BMJ 2015; 350 :h796 (Published 26 February 2015)
Open Access
Abstract
Background
When a new drug becomes available, patients and doctors require information on its benefits and harms. In 2011, Germany introduced the early benefit assessment of new drugs through the act on the reform of the market for medicinal products (AMNOG). At market entry, the pharmaceutical company responsible must submit a standardised dossier containing all available evidence of the drug’s added benefit over an appropriate comparator treatment. The added benefit is mainly determined using patient relevant outcomes. The “dossier assessment” is generally performed by the Institute for Quality and Efficiency in Health Care (IQWiG) and then published online. It contains all relevant study information, including data from unpublished clinical study reports contained in the dossiers. The dossier assessment refers to the patient population for which the new drug is approved according to the summary of product characteristics. This patient population may comprise either the total populations investigated in the studies submitted to regulatory authorities in the drug approval process, or the specific subpopulations defined in the summary of product characteristics (“approved subpopulations”).
Objective
To determine the information gain from AMNOG documents compared with non-AMNOG documents for methods and results of studies available at market entry of new drugs. AMNOG documents comprise dossier assessments done by IQWiG and publicly available modules of company dossiers; non-AMNOG documents comprise conventional, publicly available sources—that is, European public assessment reports, journal publications, and registry reports. The analysis focused on the approved patient populations.
Design
Retrospective analysis.
Data sources
All dossier assessments conducted by IQWiG between 1 January 2011 and 28 February 2013 in which the dossiers contained suitable studies allowing for a full early benefit assessment. We also considered all European public assessment reports, journal publications, and registry reports referring to these studies and included in the dossiers.
Data analysis
We assessed reporting quality for each study and each available document for eight methods and 11 results items (three baseline characteristics and eight patient relevant outcomes), and dichotomised them as “completely reported” or “incompletely reported (including items not reported at all).” For each document type we calculated the proportion of items with complete reporting for methods and results, for each item and overall, and compared the findings.
Results
15 out of 27 dossiers were eligible for inclusion and contained 22 studies. The 15 dossier assessments contained 28 individual assessments of 15 total study populations and 13 approved subpopulations. European public assessment reports were available for all drugs. Journal publications were available for 14 out of 15 drugs and 21 out of 22 studies. A registry report in ClinicalTrials.gov was available for all drugs and studies; however, only 11 contained results. In the analysis of total study populations, the AMNOG documents reached the highest grade of completeness, with about 90% of methods and results items completely reported. In non-AMNOG documents, the rate was 75% for methods and 52% for results items; journal publications achieved the best rates, followed by European public assessment reports and registry reports. The analysis of approved subpopulations showed poorer complete reporting of results items, particularly in non-AMNOG documents (non-AMNOG versus AMNOG: 11% v 71% for overall results items and 5% v 70% for patient relevant outcomes). The main limitation of our analysis is the small sample size.
Conclusion
Conventional, publicly available sources provide insufficient information on new drugs, especially on patient relevant outcomes in approved subpopulations. This type of information is largely available in AMNOG documents, albeit only partly in English. The AMNOG approach could be used internationally to develop a comprehensive publication model for clinical studies and thus represents a key open access measure.

Developing World Bioethics
April 2015 Volume 15, Issue 1 Pages ii–iii, 1–57
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2015.15.issue-1/issuetoc

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EDITORIAL
Empirical Research and Bioethics
Debora Diniz
Article first published online: 3 MAR 2015
DOI: 10.1111/dewb.12078
Extract
What counts as empirical evidence in bioethics? Differently from epidemiology or social sciences, bioethics is more argumentative than demonstrative, more normative than explanatory. Saying that, I am suggesting some parameters for the field: we need strong concepts, yet pieces of data. My provocative argument is that we should not import the epistemic criteria of what counts as data from epidemiology or social sciences to evaluate a contribution as relevant to bioethics. An ethical argument is more important than a long deep description of data…

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ARTICLE
Cultural Conundrums: The Ethics of Epidemiology and the Problems of Population in Implementing Pre-Exposure Prophylaxis
Kirk Fiereck*
Article first published online: 23 DEC 2013
DOI: 10.1111/dewb.12034
Abstract
The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of ‘who’ are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiologic category in the specific national context of South Africa.

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ARTICLE
Not Fit for Purpose: The Ethical Guidelines of the Indian Council of Medical Research
Priya Satalkar* and David Shaw
Article first published online: 8 NOV 2013
DOI: 10.1111/dewb.12036
Abstract
In 2006, the Indian Council of Medical Research (ICMR) published its ‘Ethical guidelines for Biomedical Research on human participants’. The intention was to translate international ethical standards into locally and culturally appropriate norms and values to help biomedical researchers in India to conduct ethical research and thereby safeguard the interest of human subjects. Unfortunately, it is apparent that the guideline is not fit for purpose. In addition to problems with the structure and clarity of the guidelines, there are several serious omissions and contradictions in the recommendations. In this paper, we take a close look at the two key chapters and highlight some of the striking flaws in this important document. We conclude that ethics committees and national authorities should not lose sight of international ethical standards while incorporating local reality and cultural and social values, as focusing too much on the local context could compromise the safety of human subjects in biomedical research, particularly in India.

Disaster Medicine and Public Health Preparedness
Volume 9 – Issue 01 – February 2015
http://journals.cambridge.org/action/displayIssue?jid=DMP&tab=currentissue

Ebola Special Section
Ebola Virus and Public Health (Part 1)
pp 29 – 29
DOI: http://dx.doi.org/10.1017/dmp.2015.18 (About DOI), Published online: 04 March 2015

Introduction
Ebola Virus and Public Health
Charles W. Beadling, Frederick M. Burkle, Jr, Kristi L. Koenig and Trueman W. Sharp
pp 31 – 31
DOI: http://dx.doi.org/10.1017/dmp.2015.16 (About DOI), Published online: 04 March 2015

Editorial
The Ebola Epidemic and Translational Public Health
James J. James
pp 32 – 32
DOI: http://dx.doi.org/10.1017/dmp.2014.106 (About DOI), Published online: 07 October 2014

Special Reports
A Primer on Ebola for Clinicians
Eric Toner, Amesh Adalja and Thomas Inglesby
pp 33 – 37
DOI: http://dx.doi.org/10.1017/dmp.2014.115 (About DOI), Published online: 17 October 2014

Triage Management, Survival, and the Law in the Age of Ebola
Frederick M Burkle, Jr and Christopher M Burkle
pp 38 – 43
DOI: http://dx.doi.org/10.1017/dmp.2014.117 (About DOI), Published online: 24 October 2014

Commentaries
Operationalizing Public Health Skills to Resource Poor Settings: Is This the Achilles Heel in the Ebola Epidemic Campaign?
Frederick M. Burkle, Jr
pp 44 – 46
DOI: http://dx.doi.org/10.1017/dmp.2014.95 (About DOI), Published online: 07 October 2014

Global and Domestic Legal Preparedness and Response: 2014 Ebola Outbreak
James G. Hodge, Jr
pp 47 – 50
DOI: http://dx.doi.org/10.1017/dmp.2014.96 (About DOI), Published online: 10 October 2014

Hubris: The Recurring Pandemic
Tom Koch
pp 51 – 56
DOI: http://dx.doi.org/10.1017/dmp.2014.107 (About DOI), Published online: 22 October 2014

Ebola Triage Screening and Public Health: The New “Vital Sign Zero”
Kristi L. Koenig
pp 57 – 58
DOI: http://dx.doi.org/10.1017/dmp.2014.120 (About DOI), Published online: 29 October 2014

Journalists and Public Health Professionals: Challenges of a Symbiotic Relationship
Pauline Lubens
pp 59 – 63
DOI: http://dx.doi.org/10.1017/dmp.2014.127 (About DOI), Published online: 10 November 2014

The Ebola Threat: China’s Response to the West African Epidemic and National Development of Prevention and Control Policies and Infrastructure
Hao-Jun Fan, Hong-Wei Gao, Hui Ding, Bi-Ke Zhang and Shi-Ke Hou
pp 64 – 65
DOI: http://dx.doi.org/10.1017/dmp.2014.152 (About DOI), Published online: 07 January 2015

Mapping Medical Disasters: Ebola Makes Old Lessons, New
Tom Koch
pp 66 – 73
DOI: http://dx.doi.org/10.1017/dmp.2015.14 (About DOI), Published online: 09 February 2015

Brief Reports
Ebola Virus Disease: Preparedness in Japan
Yugo Ashino, Haorile Chagan-Yasutan, Shinichi Egawa and Toshio Hattori
pp 74 – 78
DOI: http://dx.doi.org/10.1017/dmp.2014.130 (About DOI), Published online: 17 November 2014

Favipiravir: A New Medication for the Ebola Virus Disease Pandemic
Takashi Nagata, Alan K. Lefor, Manabu Hasegawa and Masami Ishii
pp 79 – 81
DOI: http://dx.doi.org/10.1017/dmp.2014.151 (About DOI), Published online: 29 December 2014

Concepts in Disaster Medicine
Ebola Outbreak Response: The Role of Information Resources and the National Library of Medicine
Cynthia B. Love, Stacey J. Arnesen and Steven J. Phillips
pp 82 – 85
DOI: http://dx.doi.org/10.1017/dmp.2014.108 (About DOI), Published online: 17 October 2014

Sign Me Up: Rules of the Road for Humanitarian Volunteers During the Ebola Outbreak
preview
Ryan Wildes, Stephanie Kayden, Eric Goralnick, Michelle Niescierenko, Miriam Aschkenasy, Katherine M. Kemen, Michael Vanrooyen, Paul Biddinger and Hilarie Cranmer

Disasters
April 2015 Volume 39, Issue 2 Pages 185–405
http://onlinelibrary.wiley.com/doi/10.1111/disa.2015.39.issue-2/issuetoc

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Papers
Reason, emotion, compassion: can altruism survive professionalisation in the humanitarian sector?
Gilles Carbonnier
Article first published online: 28 NOV 2014
DOI: 10.1111/disa.12096
Abstract
The humanitarian sector has grown enormously over the past two decades. Some fear that professionalisation comes at the expense of altruistic volunteering. This may be a valid concern if altruism is the product of organisational culture and individual experiences rather than an innate trait. This paper examines advances in evolutionary biology and neurology that provide evidence in support of both the nature and nurture arguments, echoing earlier insights from social sciences. It then questions to what extent humanitarian principles build on altruistic impulses or instead seek to constrain them, and reviews recruitment profiles of selected humanitarian organisations and applicants’ letters accordingly. This initial investigation warrants further research to identify how altruism as a personal trait and an organisational principle has influenced diverse humanitarian actors and traditions. This paper outlines how training curricula and organisational reward systems can build on—rather than stifle—natural altruism to nurture critical, reflexive practitioners.

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Papers
The promise of acceptance as an NGO security management approach
Larissa Fast1, Faith Freeman2, Michael O’Neill3 and Elizabeth Rowley4
Article first published online: 28 NOV 2014
DOI: 10.1111/disa.12097
Abstract
This paper explores three questions related to acceptance as a security management approach. Acceptance draws upon relationships with community members, authorities, belligerents and other stakeholders to provide consent for the presence and activities of a non-governmental organisation (NGO), thereby reducing threats from these actors. Little is documented about how NGOs gain and maintain acceptance, how they assess and monitor the presence and degree of acceptance, or how they determine whether acceptance is effective in a particular context. Based on field research conducted in April 2011 in Kenya, South Sudan and Uganda, we address each of these three issues and argue that acceptance must be actively sought as both a programme and a security management strategy. In the paper we delineate elements common to all three contexts as well as missed opportunities, which identify areas that NGOs can and should address as part of an acceptance approach.

Global Health: Science and Practice (GHSP)
March 2015 | Volume 3 | Issue 1
http://www.ghspjournal.org/content/current

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EDITORIALS
ARVs: The Next Generation. Going Boldly Together to New Frontiers of HIV Treatment
New antiretrovirals (ARVs), particularly the potentially “game-changing” ARV dolutegravir, offer major potential to meet the compelling need for simpler and better HIV treatment for tens of millions of people in the coming decade. Advantages include substantially lower manufacturing cost, fewer side effects, and less risk of resistance. But key obstacles must be addressed in order to develop and introduce new ARVs in specific combinations optimized for the needs of low- and middle-income countries. Strong leadership will be essential from the global health community to nurture more focused collaboration between the private and public sectors.
Matthew Barnhart, James D Shelton
Glob Health Sci Pract 2015;3(1):1-11. First published online January 27, 2015. http://dx.doi.org/10.9745/GHSP-D-14-00243

Stunning Popularity of LARCs With Good Access and Quality: A Major Opportunity to Meet Family Planning Needs
Given true choice, a very high proportion of women, perhaps most, would select one of the long-acting reversible contraceptives (LARCs)—implants or IUDs—for contraception. If implemented on a wide scale, it would not only drastically alter the current method mix but also serve client needs much better and prevent unintended pregnancy more successfully.
Glob Health Sci Pract 2015;3(1):12-13. First published online February 25, 2015. http://dx.doi.org/10.9745/GHSP-D-15-00044

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ORIGINAL ARTICLES
Delivering High-Quality Family Planning Services in Crisis-Affected Settings I: Program Implementation
Dora Ward Curry, Jesse Rattan, Jean Jose Nzau, Kamlesh Giri
Glob Health Sci Pract 2015;3(1):14-24. First published online February 4, 2015. http://dx.doi.org/10.9745/GHSP-D-14-00164
ABSTRACT
In 2012, about 43 million women of reproductive age experienced the effects of conflict. Provision of basic sexual and reproductive health services, including family planning, is a recognized right and need of refugees and internally displaced people, but funding and services for family planning have been inadequate. This article describes lessons learned during the first 2.5 years of implementing the ongoing Supporting Access to Family Planning and Post-Abortion Care in Emergencies (SAFPAC) initiative, led by CARE, which supports government health systems to deliver family planning services in 5 crisis-affected settings (Chad, Democratic Republic of the Congo, Djibouti, Mali, and Pakistan). SAFPAC’s strategy focuses on 4 broad interventions drawn from public health best practices in more stable settings: competency-based training for providers, improved supply chain management, regular supervision, and community mobilization to influence attitudes and norms related to family planning. Between July 2011 and December 2013, the initiative reached 52,616 new users of modern contraceptive methods across the 5 countries (catchment population of 698,053 women of reproductive age), 61% of whom chose long-acting methods of implants or intrauterine devices. Prudent use of data to inform decision making has been an underpinning to the project’s approach. A key approach to ensuring sustained ability to train and supervise new providers has been to build capacity in clinical skills training and supervision by establishing in-country training centers. In addition, monthly supervision using simple checklists has improved program and service quality, particularly with infection prevention procedures and stock management. We have generally instituted a “pull” system to manage commodities and other supplies, whereby health facilities place resupply orders as needed based on actual consumption patterns and stock-alert thresholds. Finally, reaching the community with mobilization efforts appropriate to the cultural context has been integral to meeting unmet family planning needs rapidly in these crisis-affected settings. Despite the constraints in crisis-affected countries, such as travel difficulties due to security issues, in our experience, we have been able to extend access to a range of contraceptive methods, including long-acting reversible contraceptives, in such settings using best practice approaches established in more stable environments.

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Delivering High-Quality Family Planning Services in Crisis-Affected Settings II: Results
Dora Ward Curry, Jesse Rattan, Shuyuan Huang,
Elizabeth Noznesky
Glob Health Sci Pract 2015;3(1):25-33. First published online February 4, 2015. http://dx.doi.org/10.9745/GHSP-D-14-00112
ABSTRACT
An estimated 43 million women of reproductive age experienced the effects of conflict in 2012. Already vulnerable from the insecurity of the emergency, women must also face the continuing risk of unwanted pregnancy but often are unable to obtain family planning services. The ongoing Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) initiative, led by CARE, has provided contraceptives, including long-acting reversible contraceptives (LARCs), to refugees, internally displaced persons, and conflict-affected resident populations in Chad, the Democratic Republic of the Congo (DRC), Djibouti, Mali, and Pakistan. The project works through the Ministry of Health in 4 key areas: (1) competency-based training, (2) supply chain management, (3) systematic supervision, and (4) community mobilization to raise awareness and shift norms related to family planning. This article presents data on program results from July 2011 to December 2013 from the 5 countries. Project staff summarized monthly data from client registers using hard-copy forms and recorded the data electronically in Microsoft Excel for compilation and analysis. The initiative reached 52,616 new users of modern contraceptive methods across the 5 countries, ranging from 575 in Djibouti to 21,191 in Chad. LARCs have predominated overall, representing 61% of new modern method users. The percentage of new users choosing LARCs varied by country: 78% in the DRC, 72% in Chad, and 51% in Mali, but only 29% in Pakistan. In Djibouti, those methods were not offered in the country through SAFPAC during the period discussed here. In Chad, the DRC, and Mali, implants have been the most popular LARC method, while in Pakistan the IUD has been more popular. Use of IUDs, however, has comprised a larger share of the method mix over time in all 4 of these countries. These results to date suggest that it is feasible to work with the public sector in fragile, crisis-affected states to deliver a wide range of quality family planning services, to do so rapidly, and to see a dramatic increase in the percentage of users choosing long-acting reversible methods.

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Successful Proof of Concept of Family Planning and Immunization Integration in Liberia
Chelsea M Coopera⇑, Rebecca Fieldsb, Corinne I Mazzeoc, Nyapu Taylord, Anne Pfitzera, Mary Momolue, Cuallau Jabbeh-Howee
ABSTRACT
Globally, unmet need for postpartum family planning remains high, while immunization services are among the most wide-reaching and equitable interventions. Given overlapping time frames, integrating these services provides an opportunity to leverage existing health visits to offer women more comprehensive services. From March through November 2012, Liberia’s government, with support from the Maternal and Child Health Integrated Program (MCHIP), piloted an integrated family planning and immunization model at 10 health facilities in Bong and Lofa counties. Vaccinators provided mothers bringing infants for routine immunization with targeted family planning and immunization messages and same-day referrals to co-located family planning services. In February 2013, we compared service statistics for family planning and immunization during the pilot against the previous year’s statistics. We also conducted in-depth interviews with service providers and other personnel and focus group discussions with clients. Results showed that referral acceptance across the facilities varied from 10% to 45% per month, on average. Over 80% of referral acceptors completed the family planning visit that day, of whom over 90% accepted a contraceptive method that day. The total number of new contraceptive users at participating facilities increased by 73% in Bong and by 90% in Lofa. Women referred from immunization who accepted family planning that day accounted for 44% and 34% of total new contraceptive users in Bong and Lofa, respectively. In Lofa, pilot sites administered 35% more Penta 1 and 21% more Penta 3 doses during the pilot period compared with the same period of the previous year, while Penta 1 and Penta 3 administration decreased in non-pilot facilities. In Bong, there was little difference in the number of Penta 1 and Penta 3 doses administered between pilot and non-pilot facilities. In both counties, Penta 1 to Penta 3 dropout rates increased at pilot sites but not in non-pilot facilities, possibly due to higher than average background dropout rates at pilot sites prior to the intervention in Lofa and the disproportionate effect of data from 1 large facility in Bong. The project provided considerable basic support to assess this proof of concept. However, results suggest that introducing a simple model that is minimally disruptive to existing immunization service delivery can facilitate integration. The model is currently being scaled-up to other counties in Liberia, which could potentially contribute to increased postpartum contraceptive uptake, leading to longer birth intervals and improved health outcomes for children and mothers

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Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria
Charles A Uzondua, Henry V Doctora,b, Sally E Findleyb, Godwin Y Afenyadua, Alastair Agerb
Author Affiliations
aPartnership for Reviving Routine Immunization in Northern Nigeria–Maternal Newborn and Child Health Initiative, Kano, Nigeria
bColumbia University, Mailman School of Public Health, New York, NY, USA

Deployment of resident female Community Health Extension Workers (CHEWs) to a remote rural community led to major and sustained increases in service utilization, including antenatal care and facility-based deliveries. Key components to success: (1) providing an additional rural residence allowance to help recruit and retain CHEWs; (2) posting the female CHEWs in pairs to avoid isolation and provide mutual support; (3) ensuring supplies and transportation means for home visits; and (4) allowing CHEWs to perform deliveries.

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Engaging Communities With a Simple Tool to Help Increase Immunization Coverage
Use of a simple, publicly placed tool that monitors vaccination coverage in a community has potential to broaden program coverage by keeping both the community and the health system informed about every infant’s vaccination status.
Manish Jain, Gunjan Taneja, Ruhul Amin, Robert Steinglass, Michael Favin
Glob Health Sci Pract 2015;3(1):117-125. http://dx.doi.org/10.9745/GHSP-D-14-00180

Global Public Health
Volume 10, Issue 4, 2015
http://www.tandfonline.com/toc/rgph20/current#.VPudJy5nBhU

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Endgame for polio eradication? Options for overcoming social and political factors in the progress to eradicating polio
Pavan V. Ganapathirajuab*, Christiaan B. Morssinkc & James Plumbd
pages 463-473
DOI:10.1080/17441692.2014.994655
Abstract
In 1988, the Global Polio Eradication Initiative (GPEI) was launched with the goal of eradicating polio by the year 2000. After 25 years, several dynamics still challenge this large public health campaign with new cases of polio being reported annually. We examine the roots of this initiative to eradicate polio, its scope, the successes and setbacks during the last 25 years and reflect on the current state of affairs. We examine the social and political factors that are barriers to polio eradication. Options are discussed for solving the current impasse of polio eradication: using force, respecting individual freedoms and gaining support from those vulnerable to fundamentalist ‘propaganda’. The travails of the GPEI indicate the need for expanding the Convention on the Rights of the Child to address situations of war and civic strife. Such a cultural and structural reference will provide the basis for global stakeholders to engage belligerent local actors whose local political conflicts are barriers to the eradication of polio. Disregard for these actors will result in stagnation of polio eradication policy, delaying eradication beyond 2018.

Health Affairs
March 2015; Volume 34, Issue 3
http://content.healthaffairs.org/content/current

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People In Sub-Saharan Africa Rate Their Health And Health Care Among The Lowest In The World
Angus S. Deaton1,* and Robert Tortora2
Author Affiliations
1Angus S. Deaton (deaton@princeton.edu) is the Dwight D. Eisenhower Professor of International Affairs and a professor of economics and international affairs at the Woodrow Wilson School, Princeton University, in New Jersey.
2Robert Tortora was principal scientist and chief methodologist at the Gallup Organization, in Washington, D.C., when this article was written. He is now a senior fellow of survey methodology at ICF International, in Rockville, Maryland.
Abstract
The health of people in sub-Saharan Africa is a major global concern. However, data are weak, and little is known about how people in the region perceive their health or their health care. We used data from the Gallup World Poll in 2012 to document sub-Saharan Africans’ perceived health status, their satisfaction with health care, their contact with medical professionals, and the priority they attach to health care. In comparison to other regions of the world, sub-Saharan Africa has the lowest ratings for well-being and the lowest satisfaction with health care. It also has the second-lowest perception of personal health, after only the former Soviet Union and its Eastern European satellites. HIV prevalence is positively correlated with perceived improvements in health care in countries with high prevalence. This is consistent with an improvement in at least some health care services as a result of the largely aid-funded rollout of antiretroviral treatment. Even so, sub-Saharan Africans do not prioritize health care as a matter of policy, although donors are increasingly shifting their aid efforts in the region toward health.

Health Policy and Planning
Volume 30 Issue 2 March 2015
http://heapol.oxfordjournals.org/content/current

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Integrating mental health and social development in theory and practice
Sophie Plagerson*
Author Affiliations
Centre for Social Development in Africa, University of Johannesburg, Auckland Park, Johannesburg 2006, South Africa
Accepted December 17, 2013.
Abstract
In many low and middle income countries, attention to mental illness remains compartmentalized and consigned as a matter for specialist policy. Despite great advances in global mental health, mental health policy and practice dovetail only to a limited degree with social development efforts. They often lag behind broader approaches to health and development. This gap ignores the small but growing evidence that social development unavoidably impacts the mental health of those affected, and that this influence can be both positive and negative. This article examines the theoretical and practical challenges that need to be overcome for a more effective integration of social development and mental health policy. From a theoretical perspective, this article demonstrates compatibility between social development and mental health paradigms. In particular, the capability approach is shown to provide a strong framework for integrating mental health and development. Yet, capability-oriented critiques on ‘happiness’ have recently been applied to mental health with potentially detrimental outcomes. With regard to policy and practice, horizontal and vertical integration strategies are suggested. Horizontal strategies require stronger devolution of mental health care to the primary care level, more unified messages regarding mental health care provision and the gradual expansion of mental health packages of care. Vertical integration refers to the alignment of mental health with related policy domains (particularly the social, economic and political domains). Evidence from mental health research reinforces aspects of social development theory in a way that can have tangible implications on practice. First, it encourages a focus on avoiding exclusion of those affected by or at risk of mental illness. Secondly, it underscores the importance of the process of implementation as an integral component of successful policies. Finally, by retaining a focus on the individual, it seeks to avoid uneven approaches to development.

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Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries
Helen Saxenian1, Robert Hecht2,*, Miloud Kaddar3, Sarah Schmitt4, Theresa Ryckman2 and Santiago Cornejo5
Author Affiliations
1Consultant to Results for Development Institute, Washington, DC 20005, USA, 2Results for Development Institute, Washington, DC 20005, USA, 3World Health Organization, 1211 Geneva, Switzerland, 4Consultant to World Health Organization, 1211 Geneva, Switzerland, 5GAVI Alliance, 1202 Geneva, Switzerland
Accepted January 6, 2014.
Abstract
Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency.

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Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi
Qun Wang, Stephan Brenner, Gerald Leppert, Thomas Hastings Banda, Olivier Kalmus, and Manuela De Allegri
Health Policy Plan. (2015) 30 (2): 242-252 doi:10.1093/heapol/czu004

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Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries
Tuan Anh Nguyen1,2,*, Rosemary Knight3, Elizabeth Ellen Roughead1, Geoffrey Brooks4 and
Andrea Mant3
Author Affiliations
1Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia 2Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam 3School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and 4Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
Accepted November 27, 2013.
Abstract
Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries (LMICs), however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-of-pocket which creates a different dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively preferred; rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems.

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

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Research
How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature
Maryse C Kok12*, Sumit S Kane1, Olivia Tulloch3, Hermen Ormel1, Sally Theobald3, Marjolein Dieleman1, Miriam Taegtmeyer3, Jacqueline EW Broerse2 and Korrie AM de Koning1
Author Affiliations
Health Research Policy and Systems 2015, 13:13 doi:10.1186/s12961-015-0001-3
Published: 7 March 2015
Abstract (provisional)
Background
Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.
Methods
We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized.
Results
Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes.
Conclusions
Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance

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Editorial
Health research improves healthcare: now we have the evidence and the chance to help the WHO spread such benefits globally
Stephen R Hanney1* and Miguel A González-Block2
Author Affiliations
Health Research Policy and Systems 2015, 13:12 doi:10.1186/s12961-015-0006-y
Published: 3 March 2015
Abstract
There has been a dramatic increase in the body of evidence demonstrating the benefits that come from health research. In 2014, the funding bodies for higher education in the UK conducted an assessment of research using an approach termed the Research Excellence Framework (REF). As one element of the REF, universities and medical schools in the UK submitted 1,621 case studies claiming to show the impact of their health and other life sciences research conducted over the last 20 years. The recently published results show many case studies were judged positively as providing examples of the wide range and extensive nature of the benefits from such research, including the development of new treatments and screening programmes that resulted in considerable reductions in mortality and morbidity.

Analysis of specific case studies yet again illustrates the international dimension of progress in health research; however, as has also long been argued, not all populations fully share the benefits. In recognition of this, in May 2013 the World Health Assembly requested the World Health Organization (WHO) to establish a Global Observatory on Health Research and Development (R&D) as part of a strategic work-plan to promote innovation, build capacity, improve access, and mobilise resources to address diseases that disproportionately affect the world’s poorest countries.

As editors of Health Research Policy and Systems (HARPS), we are delighted that our journal has been invited to help inform the establishment of the WHO Global Observatory through a Call for Papers covering a range of topics relevant to the Observatory, including topics on which HARPS has published articles over the last few months, such as approaches to assessing research results, measuring expenditure data with a focus on R&D, and landscape analyses of platforms for implementing R&D. Topics related to research capacity building may also be considered. The task of establishing a Global Observatory on Health R&D to achieve the specified objectives will not be easy; nevertheless, this Call for Papers is well timed – it comes just at the point where the evidence of the benefits from health research has been considerably strengthened.

International Health
Volume 7 Issue 2 March 2015
http://inthealth.oxfordjournals.org/content/current

Special issue: Digital methods in epidemiology
Digital methods in epidemiology can transform disease control
Extract
Modern society has been transformed by the digital revolution through cellular phones for communication, remote sensing of weather and other terrestrial data, cheap and plentiful digital computation and data storage, genomic sequencing and analysis, GPS for geolocation and navigation, and many other marvels. These advances have been concurrent with major changes in the burden, dynamics and distributions of diseases. The burden of disease remains intolerably high in much of the world,1 and current challenges facing epidemiology include reducing the prevalence of both communicable and non-communicable diseases,1 completing the Global Polio Eradication Initiative,2 developing strategies to control and eliminate malaria,2,3 and responding to outbreaks of emerging infectious diseases such as the recent Ebola epidemic.4 In this special issue of International Health, the authors illustrate both the ways in which modern digital methods are already being applied to these current challenges in epidemiology and also the opportunities for even greater impact.

Advancing digital methods in the fight against communicable diseases
Guillaume Chabot-Couturea,*, Vincent Y. Seamanb, Jay Wengerb, Bruno Moonenb and Alan Magillb
Author Affiliations
aInstitute for Disease Modeling, Intellectual Ventures, Bellevue, 98005, USA
bBill & Melinda Gates Foundation, Seattle, 98109, USA
Received December 23, 2014.
Revision received January 23, 2015.
Accepted January 26, 2015.
Abstract
Important advances are being made in the fight against communicable diseases by using new digital tools. While they can be a challenge to deploy at-scale, GPS-enabled smartphones, electronic dashboards and computer models have multiple benefits. They can facilitate program operations, lead to new insights about the disease transmission and support strategic planning. Today, tools such as these are used to vaccinate more children against polio in Nigeria, reduce the malaria burden in Zambia and help predict the spread of the Ebola epidemic in West Africa.

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The promise of reverse vaccinology
Ashley I. Heinson, Christopher H. Woelk* and Marie-Louise Newell
Author Affiliations
Faculty of Medicine, University of Southampton, Southampton, UK
Received October 22, 2014.
Revision received January 6, 2015.
Accepted January 7, 2015.
Abstract
Reverse vaccinology (RV) is a computational approach that aims to identify putative vaccine candidates in the protein coding genome (proteome) of pathogens. RV has primarily been applied to bacterial pathogens to identify proteins that can be formulated into subunit vaccines, which consist of one or more protein antigens. An RV approach based on a filtering method has already been used to construct a subunit vaccine against Neisseria meningitidis serogroup B that is now registered in several countries (Bexsero). Recently, machine learning methods have been used to improve the ability of RV approaches to identify vaccine candidates. Further improvements related to the incorporation of epitope-binding annotation and gene expression data are discussed. In the future, it is envisaged that RV approaches will facilitate rapid vaccine design with less reliance on conventional animal testing and clinical trials in order to curb the threat of antibiotic resistance or newly emerged outbreaks of bacterial origin.

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Poverty, health and satellite-derived vegetation indices: their inter-spatial relationship in West Africa
Luigi Sedda, Andrew J. Tatem, David W. Morley, Peter M. Atkinson, Nicola A. Wardrop, Carla Pezzulo, Alessandro Sorichetta, Joanna Kuleszo, and David J. Rogers
Int. Health (2015) 7 (2): 99-106 doi:10.1093/inthealth/ihv005
Abstract
Background
Previous analyses have shown the individual correlations between poverty, health and satellite-derived vegetation indices such as the normalized difference vegetation index (NDVI). However, generally these analyses did not explore the statistical interconnections between poverty, health outcomes and NDVI.
Methods
In this research aspatial methods (principal component analysis) and spatial models (variography, factorial kriging and cokriging) were applied to investigate the correlations and spatial relationships between intensity of poverty, health (expressed as child mortality and undernutrition), and NDVI for a large area of West Africa.
Results
This research showed that the intensity of poverty (and hence child mortality and nutrition) varies inversely with NDVI. From the spatial point-of-view, similarities in the spatial variation of intensity of poverty and NDVI were found.
Conclusions
These results highlight the utility of satellite-based metrics for poverty models including health and ecological components and, in general for large scale analysis, estimation and optimisation of multidimensional poverty metrics. However, it also stresses the need for further studies on the causes of the association between NDVI, health and poverty. Once these relationships are confirmed and better understood, the presence of this ecological component in poverty metrics has the potential to facilitate the analysis of the impacts of climate change on the rural populations afflicted by poverty and child mortality.

Intervention – Journal of Mental Health and Psychological Support in Conflict Affected Areas
March 2015 – Volume 13 – Issue 1 pp: 1-102
http://journals.lww.com/interventionjnl/pages/currenttoc.aspx

New Frontiers issue of Intervention
Articles
Surviving juntas (together): lessons of resilience of indigenous Quechua women in the aftermath of conflict in Peru
Suarez, Eliana Barrios

Measuring suffering: assessing chronic stress through hair cortisol measurement in humanitarian settings
Cunningham, Tim

Special Section
Ebola: reflections from the field
Introduction to the Special Section on Ebola: reflections from the field
Tankink, Marian

Personal reflections
Mental health and psychosocial support in the face of Ebola in Liberia: the personal and professional intersect. A personal account
Cooper, Janice L.

The travellers dance: how Ebola prevention measures affect day to day life
Gonzalez, Teresa

Field reports
Mental illness and health in Sierra Leone affected by Ebola: lessons for health workers
Hughes, Peter

An outbreak of fear, rumours and stigma: psychosocial support for the Ebola Virus Disease outbreak in West Africa
Cheung, Eliza Y.L.

Psychosocial support during the Ebola outbreak in Kailahun, Sierra Leone
Garoff, Ferdinand

How to eat an elephant: psychosocial support during an Ebola outbreak in Sierra Leone
Jónasdóttir, Elín

Announcement
Reaching out a helping hand during Ebola: adaptation of the Psychological First Aid guide

JAMA
http://jama.jamanetwork.com/issue.aspx

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Online First
March 05, 2015
Editorial
Emergency Treatment for Exposure to Ebola Virus: The Need to Fast-Track Promising Vaccines
Thomas W. Geisbert, PhD.
JAMA. Published online March 05, 2015. doi:10.1001/jama.2015.2057

Ebola virus is among the most deadly pathogens, with case fatality rates of up to 90%.1 Ebola virus is categorized as a tier 1 pathogen by the US government because of its potential for deliberate misuse with significant potential for mass casualties. The current outbreak of Ebola virus in West Africa with more than 23 000 cases and 9000 deaths2 also demonstrates the long-underestimated public health threat that Ebola virus poses as a natural human pathogen. There are no licensed vaccines or postexposure treatments for combating Ebola virus. However, substantial progress has been made in developing vaccines and antivirals that can protect laboratory animals against lethal disease.1,3 Advancing these interventions for human use is a matter of utmost urgency.

In this issue of JAMA, Lai et al4 report the use of a first-generation recombinant vesicular stomatitis virus–based Ebola vaccine (VSVΔG-ZEBOV)5 to treat a physician who experienced a needlestick in an Ebola treatment unit in Sierra Leone during the current Ebola virus outbreak. A single dose of the VSVΔG-ZEBOV vaccine was administered approximately 43 hours after the potential exposure. The patient experienced a transient febrile syndrome after vaccination. Importantly, no evidence of Ebola virus infection was detected, and the vaccine elicited strong innate and Ebola virus–specific adaptive immune responses. Most significantly, the vaccine, which expresses the surface glycoprotein of Ebola virus, was able to induce an IgG antibody response against the Ebola virus glycoprotein at a level that has been associated with protection of nonhuman primates.5
It is difficult to draw any definitive conclusions from a single case report. The inability to detect evidence of Ebola virus infection most likely is because there was not an actual exposure; however, it cannot be completely ruled out that the intervention was effective in controlling Ebola virus replication. Even though this patient experienced some adverse events after vaccination, the patient reported having traveler’s diarrhea prior to receiving the VSVΔG-ZEBOV vaccine; therefore, it is also not possible to draw any strong conclusions regarding any adverse events from this case in regard to the safety of the vaccine. This is the second time that the VSVΔG-ZEBOV vaccine has been used to treat a potential exposure to Ebola virus. The initial use occurred in 2009 for a laboratory worker in Germany6 and also involved a needlestick injury. The results of that incident were nearly identical; however, the severity of adverse events following vaccination was less notable in the German case compared with the patient in the case report by Lai et al…4

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Preliminary Communication
Emergency Postexposure Vaccination With Vesicular Stomatitis Virus–Vectored Ebola Vaccine After Needlestick
Lilin Lai, MD, Richard Davey, MD, Allison Beck, MPAS, et al.
JAMA. Published online March 05, 2015. doi:10.1001/jama.2015.1995
Abstract
Importance
Safe and effective vaccines and drugs are needed for the prevention and treatment of Ebola virus disease, including following a potentially high-risk exposure such as a needlestick.
Objective
To assess response to postexposure vaccination in a health care worker who was exposed to the Ebola virus.
Design and Setting
Case report of a physician who experienced a needlestick while working in an Ebola treatment unit in Sierra Leone on September 26, 2014. Medical evacuation to the United States was rapidly initiated. Given the concern about potentially lethal Ebola virus disease, the patient was offered, and provided his consent for, postexposure vaccination with an experimental vaccine available through an emergency Investigational New Drug application. He was vaccinated on September 28, 2014.
Interventions
The vaccine used was VSVΔG-ZEBOV, a replicating, attenuated, recombinant vesicular stomatitis virus (serotype Indiana) whose surface glycoprotein gene was replaced by the Zaire Ebola virus glycoprotein gene. This vaccine has entered a clinical trial for the prevention of Ebola in West Africa.
Results
The vaccine was administered 43 hours after the needlestick occurred. Fever and moderate to severe symptoms developed 12 hours after vaccination and diminished over 3 to 4 days. The real-time reverse transcription polymerase chain reaction results were transiently positive for vesicular stomatitis virus nucleoprotein gene and Ebola virus glycoprotein gene (both included in the vaccine) but consistently negative for Ebola virus nucleoprotein gene (not in the vaccine). Early postvaccination cytokine secretion and T lymphocyte and plasmablast activation were detected. Subsequently, Ebola virus glycoprotein-specific antibodies and T cells became detectable, but antibodies against Ebola viral matrix protein 40 (not in the vaccine) were not detected.
Conclusions and Relevance
It is unknown if VSVΔG-ZEBOV is safe or effective for postexposure vaccination in humans who have experienced a high-risk occupational exposure to the Ebola virus, such as a needlestick. In this patient, postexposure vaccination with VSVΔG-ZEBOV induced a self-limited febrile syndrome that was associated with transient detection of the recombinant vesicular stomatitis vaccine virus in blood. Strong innate and Ebola-specific adaptive immune responses were detected after vaccination. The clinical syndrome and laboratory evidence were consistent with vaccination response, and no evidence of Ebola virus infection was detected.

JAMA Pediatrics
March 2015, Vol 169, No. 3
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint | March 2015
A Landmark Report on Improving Medicines for Children
Geert W. ‘t Jong, MD, PhD1,2; Terry P. Klassen, MD, MSc, FRCPC1,2; Stuart M. MacLeod, BSc(Med), MD, PhD, FRCPC3
[+] Author Affiliations
Extract
This Viewpoint discusses the publication of the Council of Canadian Academies report “Improving Medicines for Children in Canada.”
Children have been classified as “therapeutic orphans” for more than 50 years, but the pediatric community has made important strides toward evidence-based safe and effective drug therapy for children through improved legislation, increased quantity and quality of research, and better stakeholder community involvement. In September 2014, another major step forward was taken with publication of the Council of Canadian Academies report “Improving Medicines for Children in Canada.”1 An international Expert Panel drafted the report, and many North American and European authorities participated in the final review. The Council of Canadian Academies was asked by Canada’s federal government to review the status of pediatric therapeutics in Canada, based on the following question: “What is the state of clinical pharmacology, in Canada and abroad, that can be applied to the ethical development of safe and effective pharmaceuticals and biologics labeled as therapies for infants, children and youth?”1

Journal of Community Health
Volume 40, Issue 2, April 2015
http://link.springer.com/journal/10900/40/2/page/1

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Commentary
Ebola Therapy and Health Equity
Neil J. Nusbaum
Abstract
Current care for Ebola patients in resource poor countries is hampered by a lack of resources to isolate patients and their close contacts. The current Ebola epidemic offers the opportunity to harvest convalescent serum to help contain this and future outbreaks. A systemic and just process to accomplish this goal can incorporate procedures to improve care for current Ebola patients and their close contacts.

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Factors Impacting Influenza Vaccination of Urban Low-Income Latino Children Under Nine Years Requiring Two Doses in the 2010–2011 Season
Annika M. Hofstetter, Angela Barrett, Melissa S. Stockwell
Abstract
The Advisory Committee on Immunization Practices (ACIP) recommends that certain children under 9 years of age receive two influenza vaccine doses in a season for optimal protection. Recent data indicate that many of these children fail to receive one or both of these needed doses. Contributing factors to under-vaccination of this population remain unclear. Caregivers of children aged 6 months–8 years requiring two influenza vaccine doses in the 2010–2011 season were identified from households enrolled in four urban Head Start programs. Recruitment and survey administration were conducted between March and June 2011. The impact of caregiver, provider, and practice-based factors on influenza vaccine receipt was assessed using bivariate and multivariable logistic regression analyses. Caregivers (n = 128) were predominantly mothers, Latina, Spanish-speaking, and non-U.S. born. Few children received one (31 %) or both (7 %) influenza vaccine doses. Caregivers who discussed influenza vaccination with providers were more likely to know their child needed two doses (55 vs. 35 %, p < 0.05) and have a fully vaccinated child (11 vs. 0 %, p < 0.05). Among caregivers whose child received the first dose, those who reported being told when to return for the second dose were also more likely to have a fully vaccinated child (35 vs. 0 %, p = 0.05). Belief in influenza vaccine effectiveness was positively associated with vaccination (p < 0.001), while safety concerns were negatively associated (p < 0.05). This study highlights the importance of provider-family communication about the two-dose regimen as well as influenza vaccine effectiveness and safety.

Journal of Epidemiology & Community Health
March 2015, Volume 69, Issue 3
http://jech.bmj.com/content/current

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Child health
The impact of the Iraq War on neonatal polio immunisation coverage: a quasi-experimental study
Valeria Cetorelli
Correspondence to Valeria Cetorelli, Department of Social Policy, London School of Economics
Abstract
Background The public health consequences of the Iraq War (2003–2011) have remained difficult to quantify, mainly due to a scarcity of adequate data. This paper is the first to assess whether and to what extent the war affected neonatal polio immunisation coverage.
Method The study relies on retrospective neonatal polio vaccination histories from the 2000, 2006 and 2011 Iraq Multiple Indicator Cluster Surveys (N=64 141). Pooling these surveys makes it possible to reconstruct yearly trends in immunisation coverage from 1996 to 2010. The impact of the war is identified with a difference-in-difference approach contrasting immunisation trends in the autonomous Kurdish provinces, which remained relatively safe during the war, with trends in the central and southern provinces, where violence and disruption were pervasive.
Results After controlling for individual and household characteristics, year of birth and province of residence, children exposed to the war were found to be 21.5 percentage points (95% CI −0.341 to −0.089) less likely to have received neonatal polio immunisation compared with non-exposed children.
Conclusions The decline in neonatal polio immunisation coverage is part of a broader war-induced deterioration of routine maternal and newborn health services. Postwar strategies to promote institutional deliveries and ensure adequate vaccine availability in primary health facilities could increase dramatically the percentage of newborns immunised.