ICRC – International Committee of the Red Cross [to 28 February 2015]
http://www.icrc.org/eng/resources/index.jsp

Philippines: Supporting displaced families in central Mindanao
News release
27 February 2015
Manila (ICRC) – Around 4,000 families displaced by the recent fighting between armed groups in central Mindanao are being assisted by the International Committee of the Red Cross (ICRC) and the Philippine Red Cross (PRC)…

Ukraine / Russia: Leaders agree that aid must reach eastern Ukraine
News release
27 February 2015
Geneva / Kiev / Moscow (ICRC) – ICRC President Peter Maurer today completed high-level talks in Moscow and Kiev, in which he focused on the severe humanitarian crisis in eastern Ukraine and urged the governments of both countries to ensure that vital aid reaches people in need. During a four-day visit to the region, he met with President Vladimir Putin and President Petro Poroshenko, and senior officials of both countries…

Niger: Displaced persons in Diffa region utterly destitute
News release
25 February 2015
Niamey (ICRC) – The conflict which broke out several months ago in north-eastern Nigeria has spilled over the border into neighbouring Niger. Since 6 February several areas in the Diffa region in the south-eastern corner of Niger have been the scene of fighting and violence which has caused many deaths and injuries and displaced thousands of people.
“The humanitarian situation is extremely worrying,” says Loukas Petridis, head of the ICRC delegation in Niger. “People have been killed and wounded in what are sometimes indiscriminate attacks and we are very anxious about the plight of thousands of displaced persons.”…

MSF/Médecins Sans Frontières [to 28 February 2015]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Selected Press Releases/Field News

Press release
MSF Survey Shows High Viral Load in Men and People with CD4 500-75
February 25, 2015
SEATTLE/NEW YORK—Among individuals not receiving antiretroviral treatment, men had twice the level of HIV virus in their blood as women at the same stage in the disease, according to one of the major findings of a three-country Doctors Without Borders/Médecins Sans Frontières (MSF) population survey presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle Wednesday.

Press release
Preliminary Results of the JIKI Clinical Trial to test the Efficacy of Favipiravir in Reducing Mortality in Individuals Infected by Ebola Virus in Guinea
February 24, 2015
Initial results of a clinical trial of the experimental drug favipiravir suggest that it can reduce mortality among patients with low levels of the Ebola virus in their blood, but is ineffective for patients with high viral loads who are very sick with the disease.

Field news
CAR: Ongoing Violence Means Ongoing Health Needs in Bambari Area
February 25, 2015
The volatile security situation in Bambari, in the Ouaka province of Central African Republic (CAR), is disrupting life for the town’s residents and impeding aid agencies’ efforts to respond to urgent health needs. While the barricades set up in recent days have been dismantled, the atmosphere in the area remains tense, and residents of Bambari live in fear. Violence and the armed robbery of civilians by undisciplined groups are still a daily occurrence.

Field news
CAR: MSF Begins Vaccination Campaign for 18,000 Displaced by Violence
February 25, 2015
This week, Doctors Without Borders/Médecins Sans Frontières (MSF) began a campaign to vaccinate at least 18,000 children under 15 years old against measles and polio in and around the internally displaced persons (IDP) camp near Batangafo in northern CAR.

ODI [to 28 February 2015]
http://www.odi.org/media

Delivering humanitarian aid in Somalia: Islamic identity doesn’t automatically unlock access to areas controlled by Al-Shabaab – new report
News – 26 February 2015
Being a Muslim humanitarian organisation doesn’t instantly open doors when trying to provide aid in conflict zones controlled by Islamic extremist groups such as Al-Shabaab in Somalia, finds leading UK think tank the Overseas Development Institute (ODI) in a report launched today.

The report debunks the commonly-held belief that Islamic extremist groups automatically grant access to Muslim humanitarian organisations, and reveals how Islamic and Somali NGOs coordinated by the Organisation of Islamic Cooperation (OIC) gained access into Al-Shabaab held territory during the 2011 famine because they had the necessary existing local networks, rather than due to their Islamic identity or the links with the OIC…

The Sphere Project [to 28 February 2015]
http://www.sphereproject.org/news/

Comparing the Core Humanitarian Standard and Sphere Core Standards
24 February 2015 | Sphere Project
The Sphere Project office has published a short comparative analysis of the Sphere Handbook’s Core Standards and the recently released Core Humanitarian Standard on Quality and Accountability.
On November 2014, the Sphere Project Board endorsed the Core Humanitarian Standard (CHS). The intention of the Board is to fully integrate the CHS into the Sphere Handbook, substituting it for the Handbook’s Core Standards once the CHS key indicators and guidance notes are developed and tested.

In the interim period, The Core Humanitarian Standard and the Sphere Core Standards: Analysis and Comparison aims to help Sphere practitioners understand how the CHS will fit within the structure of the Sphere Handbook. It also aims to help Sphere trainers begin to integrate the CHS into their presentations….

Start Network [Consortium of British Humanitarian Agencies] [to 28 February 2015]
http://www.start-network.org/news-blog/#.U9U_O7FR98E

Spotlight on the Start Fund: Malawi Flood Response – Uniting to Secure People’s Rights
February 26, 2015
Posted by Tegan Rogers in Blog.
…Using 88,129GBP secured from the Start Fund, ActionAid Malawi and local partners launched a 45 day humanitarian response in January 2015. The response has supported approximately 45,000 people living in 15 camps to date, including approximately 1,000 lactating mothers, 300 pregnant women, and 5,000 children under five with food items (maize flour, beans, oil, salt, corn soya), and household and sanitary items (mosquito nets, bedding mats, blankets, water guard, soap, kitchen utensils and washing basins). Twelve camp monitors were also recruited and deployed to camps to work with committees to regulate the camps, monitor the distribution of supplies and raise any protection issues. ActionAid Malawi was assigned nine camps to manage….

Vacancy: Start Network urgently seeks new Transitional Chair
February 22, 2015
Posted by Tegan Rogers in News.
The Start Network is undergoing a transitional phase of rapid change and development. This is part of our strategy to move from our launch in 2014 toward becoming a global network that connects people in crisis to the best possible response. We anticipate the next phase of our development taking approximately 18 months and are looking for a visionary independent person who can work with us to make our ambition a reality.

We are urgently looking for a Transitional Chair to steer this process, lead our Board of Trustees and provide support to the Start Network Director.

The Transitional Chair will be one of a number of independent representatives who will sit on the Board of Trustees alongside member agency representatives, to ensure governance excellence while maintaining the Network’s humanitarian vision….

BMC Medical Ethics
(Accessed 28 February 2015)
http://www.biomedcentral.com/bmcmedethics/content

Debate
Innovations in research ethics governance in humanitarian settings
Doris Schopper12*, Angus Dawson3, Ross Upshur4, Aasim Ahmad56, Amar Jesani7, Raffaella Ravinetto89, Michael J Segelid10, Sunita Sheel11 and Jerome Singh12
Author Affiliations
BMC Medical Ethics 2015, 16:10 doi:10.1186/s12910-015-0002-3
Published: 26 February 2015
Abstract (provisional)
Background
Médecins Sans Frontières (MSF) is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board (ERB) in 2001. The ERB has encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
Findings
We first update our previous work from 2009 describing ERB performance and then highlight five innovative practices:
• A new framework to guide ethics review
• The introduction of a policy exempting a posteriori analysis of routinely collected data
• The preapproval of “emergency” protocols • General ethical approval of “routine surveys”
• Evaluating the impact of approved studies
The new framework encourages a conversation about ethical issues, rather than imposing quasi-legalistic rules, is more engaged with the specific MSF research context and gives greater prominence to certain values and principles. Some of the innovations implemented by the ERB, such as review exemption or approval of generic protocols, may run counter to many standard operating procedures. We argue that much standard practice in research ethics review ought to be open to challenge and revision. Continued interaction between MSF researchers and independent ERB members has allowed for progressive innovations based on a trustful and respectful partnership between the ERB and the researchers. In the future, three areas merit particular attention.
First, the impact of the new framework should be assessed. Second, the impact of research needs to be defined more precisely as a first step towards being meaningfully assessed, including changes of impact over time. Finally, the dialogue between the MSF ERB and the ethics committees in the study countries should be enhanced.
Conclusions
We hope that the innovations in research ethics governance described may be relevant for other organisations carrying out research in fragile contexts and for ethics committees reviewing such research.

BMC Public Health
(Accessed 28 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Diarrhea and health inequity among Indigenous children in Brazil: results from the First National Survey of Indigenous People’s Health and Nutrition
Ana Lúcia Escobar1, Carlos EA Coimbra2*, James R Welch2, Bernardo L Horta3, Ricardo Ventura Santos24 and Andrey M Cardoso2
Author Affiliations
BMC Public Health 2015, 15:191 doi:10.1186/s12889-015-1534-7
Published: 27 February 2015
Abstract (provisional)
Background
Globally, diarrhea is the second leading cause of death among children under five. In Brazil, mortality due to diarrhea underwent a significant reduction in recent decades principally due to expansion of the primary healthcare network, use of oral rehydration therapy, reduced child undernutrition, and improved access to safe drinking water. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first survey based on a nationwide representative sample to study the prevalence of diarrhea and associated factors among Indigenous children in the country.
Methods
The survey assessed the health and nutritional status of Indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for Indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Interviews were based on a seven day recall period. Prevalence rates of acute diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess associations.
Results
Information on diarrhea was obtained for 5,828 children (95.1% of the total sample). The overall prevalence of diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher risk of diarrhea was observed among younger children and those who had less maternal schooling, lower household socioeconomic status, undernutrition (weight-for-age deficit), presence of another child with diarrhea in the household, and occurrence of upper respiratory infection.
Conclusions
According to results of the First National Survey of Indigenous People’s Health and Nutrition, almost a quarter of Indigenous children throughout the country had diarrhea during the previous week. This prevalence is substantially higher than that documented in 2006 for Brazilian children < 5 years generally (9.4%). Due to its exceedingly multicausal nature, the set of associated variables that remained associated with child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and health inequities faced by Indigenous peoples in contemporary Brazil.

Research article
Child survival and BCG vaccination: a community based prospective cohort study in Uganda
Victoria Nankabirwa12*, James K Tumwine3, Proscovia M Mugaba3, Thorkild Tylleskär4, Halvor Sommerfelt25 and for the PROMISE- EBF Study Group
Author Affiliations
BMC Public Health 2015, 15:175 doi:10.1186/s12889-015-1497-8
Published: 22 February 2015
Abstract
Background
Data on non-specific effects of BCG vaccination in well described, general population African cohorts is scanty. We report the effects of BCG vaccination on post-neonatal infant and post-infancy mortality in a cohort of children in Mbale, Eastern Uganda.
Methods
A community-based prospective cohort study was conducted between January 2006 and February 2014. A total of 819 eligible pregnant women were followed up for pregnancy outcomes and survival of their children up to 5 years of age. Data on the children’s BCG vaccination status was collected from child health cards at multiple visits between 3 weeks and 7 years of age. Data was also collected on mothers’ residence, age, parity, household income, self-reported HIV status as well as place of birth. Multivariable Cox proportional hazards regression models taking into account potential confounders were used to estimate the association between BCG vaccination and child survival.
Results
The neonatal mortality risk was 22 (95% CI: 13, 35), post-neonatal infant mortality 21 (12, 34) per 1,000 live births and the mortality risk among children between 1 and 5 years of age (post-infancy) was 63 (47, 82) per 1,000 live births. The median age at BCG vaccination was 4 days. Out of 819 children, 647 (79%) had received the BCG vaccine by 24 weeks of age. In the adjusted analysis, the rate of post-neonatal death among infants vaccinated with BCG tended to be nearly half of that among those who had not received the vaccine (adjusted HR: 0.47; 95% CI: 0.14, 1.53). BCG vaccination was associated with a lower rate of death among children between 1 and 5 years of age (adjusted HR: 0.26; 95% CI: 0.14, 0.48).
Conclusion
The risk of early childhood death in Mbale, Uganda is unacceptably high. BCG vaccination was associated with an increased likelihood of child survival.

British Medical Journal
28 February 2015(vol 350, issue 7997)
http://www.bmj.com/content/350/7997

Clinical Review
Multidrug resistant tuberculosis
James Millard, clinical lecturer in global health1,
Cesar Ugarte-Gil, epidemiologist2,
David A J Moore, professor of infectious diseases & tropical medicine3
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h882 (Published 26 February 2015) Cite this as: BMJ 2015;350:h882

The bottom line
– Multidrug resistant tuberculosis refers to tuberculosis with resistance to at least rifampicin and isoniazid
– Multidrug resistant tuberculosis is increasingly common; however, there is a large shortfall between the estimated total number of cases and the numbers diagnosed and treated
– Diagnosis is hampered by lack of access to quality assured diagnostics, although newer, rapid molecular and phenotypic methods may go some way to improving this situation
– Compared with drug susceptible tuberculosis, treatment for multidrug resistant tuberculosis requires the use of drug regimens that are prolonged (18-24 months), less efficacious, and noticeably more toxic; new drugs and regimens are becoming available for the first time in decades and ongoing trials should define how best they should be used
– Worldwide, treatment success is only around 50%; however, several settings, including some low income countries, have proved that higher success rates are achievable

Bulletin of the World Health Organization
Volume 93, Number 3, March 2015, 133-208
http://www.who.int/bulletin/volumes/93/3/en/

Research
Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey
Willemijn LA Schäfer, Wienke GW Boerma, Anna M Murante, Herman JM Sixma, François G Schellevis & Peter P Groenewegen
Abstract
Objective
To investigate patients’ perceptions of improvement potential in primary care in 34 countries.
Methods
We did a cross-sectional survey of 69 201 patients who had just visited general practitioners at primary-care facilities. Patients rated five features of person-focused primary care – accessibility/availability, continuity, comprehensiveness, patient involvement and doctor–patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. We calculated the potential for improvement by multiplying the proportion of negative patient experiences with the mean importance score in each country. Scores were divided into low, medium and high improvement potential. Pair-wise correlations were made between improvement scores and three dimensions of the structure of primary care – governance, economic conditions and workforce development.
Findings
In 26 countries, one or more features of primary care had medium or high improvement potentials. Comprehensiveness of care had medium to high improvement potential in 23 of 34 countries. In all countries, doctor–patient communication had low improvement potential. An overall stronger structure of primary care was correlated with a lower potential for improvement of continuity and comprehensiveness of care. In countries with stronger primary care governance patients perceived less potential to improve the continuity of care. Countries with better economic conditions for primary care had less potential for improvement of all features of person-focused care.
Conclusion
In countries with a stronger primary care structure, patients perceived that primary care had less potential for improvement.

Systematic Review
The burden of child maltreatment in China: a systematic review
Xiangming Fang, Deborah A Fry, Kai Ji, David Finkelhor, Jingqi Chen, Patricia Lannen & Michael P Dunne
Abstract
Objective
To estimate the health and economic burdens of child maltreatment in China.
Methods
We did a systematic review for studies on child maltreatment in China using PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure databases. We did meta-analyses of studies that met inclusion criteria to estimate the prevalence of child neglect and child physical, emotional and sexual abuse. We used data from the 2010 global burden of disease estimates to calculate disability-adjusted life-years (DALYs) lost as a result of child maltreatment.
Findings
From 68 studies we estimated that 26.6% of children under 18 years of age have suffered physical abuse, 19.6% emotional abuse, 8.7% sexual abuse and 26.0% neglect. We estimate that emotional abuse in childhood accounts for 26.3% of the DALYs lost because of mental disorders and 18.0% of those lost because of self-harm. Physical abuse in childhood accounts for 12.2% of DALYs lost because of depression, 17.0% of those lost to anxiety, 20.7% of those lost to problem drinking, 18.8% of those lost to illicit drug use and 18.3% of those lost to self-harm. The consequences of physical abuse of children costs China an estimated 0.84% of its gross domestic product – i.e. 50 billion United States dollars – in 2010. The corresponding losses attributable to emotional and sexual abuse in childhood were 0.47% and 0.39% of the gross domestic product, respectively.
Conclusion
In China, child maltreatment is common and associated with large economic losses because many maltreated children suffer substantial psychological distress and might adopt behaviours that increase their risk of chronic disease.

Systematic Review
Participants’ understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis
Nguyen Thanh Tam, Nguyen Tien Huy, Le Thi Bich Thoa, Nguyen Phuoc Long, Nguyen Thi Huyen Trang, Kenji Hirayama & Juntra Karbwang
Abstract
Objective
To estimate the proportion of participants in clinical trials who understand different components of informed consent.
Methods
Relevant studies were identified by a systematic review of PubMed, Scopus and Google Scholar and by manually reviewing reference lists for publications up to October 2013. A meta-analysis of study results was performed using a random-effects model to take account of heterogeneity.
Findings
The analysis included 103 studies evaluating 135 cohorts of participants. The pooled proportion of participants who understood components of informed consent was 75.8% for freedom to withdraw at any time, 74.7% for the nature of study, 74.7% for the voluntary nature of participation, 74.0% for potential benefits, 69.6% for the study’s purpose, 67.0% for potential risks and side-effects, 66.2% for confidentiality, 64.1% for the availability of alternative treatment if withdrawn, 62.9% for knowing that treatments were being compared, 53.3% for placebo and 52.1% for randomization. Most participants, 62.4%, had no therapeutic misconceptions and 54.9% could name at least one risk. Subgroup and meta-regression analyses identified covariates, such as age, educational level, critical illness, the study phase and location, that significantly affected understanding and indicated that the proportion of participants who understood informed consent had not increased over 30 years.
Conclusion
The proportion of participants in clinical trials who understood different components of informed consent varied from 52.1% to 75.8%. Investigators could do more to help participants achieve a complete understanding.

Policy & Practice
Big data in global health: improving health in low- and middle-income countries
Rosemary Wyber, Samuel Vaillancourt, William Perry, Priya Mannava, Temitope Folaranmi & Leo Anthony Celi
Abstract
Over the last decade, a massive increase in data collection and analysis has occurred in many fields. In the health sector, however, there has been relatively little progress in data analysis and application despite a rapid rise in data production. Given adequate governance, improvements in the quality, quantity, storage and analysis of health data could lead to substantial improvements in many health outcomes. In low- and middle-income countries in particular, the creation of an information feedback mechanism can move health-care delivery towards results-based practice and improve the effective use of scarce resources. We review the evolving definition of big data and the possible advantages of – and problems in – using such data to improve health-care delivery in low- and middle-income countries. The collection of big data as mobile-phone based services improve may mean that development phases required elsewhere can be skipped. However, poor infrastructure may prevent interoperability and the safe use of patient data. An appropriate governance framework must be developed and enforced to protect individuals and ensure that health-care delivery is tailored to the characteristics and values of the target communities.

Epidemics
Volume 11, In Progress (June 2015)
http://www.sciencedirect.com/science/journal/17554365

Optimal prophylactic vaccination in segregated populations: When can we improve on the equalising strategy?
Original Research Article
Pages 7-13
Matt J. Keeling, J.V. Ross
Abstract
Highlights
– Allocating prophylactic vaccination in a segregated population is a key issue.
– The equalising strategy (ES) has been proposed as an optimal means of vaccination.
– However, the ES only holds for density-dependent transmission,
– We consider more realistic types of transmission and show the ES can be improved.
– This highlights the possibility of more targeted vaccination strategies

Pneumococcal vaccination in older adults in the era of childhood vaccination: Public health insights from a Norwegian statistical prediction study
Original Research Article
Pages 24-31
Anneke Steens, Didrik F. Vestrheim, Birgitte Freiesleben de Blasio
Abstract
Highlights
– Prediction analysis estimates a nearly elimination of PCV13-IPD among the 65+.
– Combining PCV13 and PPV23 likely has highest impact on IPD prevention in the 65+.
– Increasing PPV23 uptake will prevent more IPD cases than adding PCV13 to PPV23.
– The preventive potential of pneumococcal vaccines may decrease among the 65+.

Globalization and Health
[Accessed 28 February 2015]
http://www.globalizationandhealth.com/

Debate
Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program
Spiegel JM, Breilh J and Yassi A Globalization and Health 2015, 11:9 (27 February 2015)

Debate
Preparing for Ebola Virus Disease in West African countries not yet affected: perspectives from Ghanaian health professionals
Nyarko Y, Goldfrank L, Ogedegbe G, Soghoian S, de-Graft Aikins A and NYU-UG-KBTH Ghana Ebola Working Group Globalization and Health 2015, 11:7 (26 February 2015)

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 28 February 2015]

Research
Developing and refining the methods for a ‘one-stop shop’ for research evidence about health systems
John N Lavis, Michael G Wilson, Kaelan A Moat, Amanda C Hammill, Jennifer A Boyko, Jeremy M Grimshaw and Signe Flottorp
Health Research Policy and Systems 2015, 13:10 doi:10.1186/1478-4505-13-10
Published: 25 February 2015
Abstract (provisional)
Background
Policymakers, stakeholders and researchers have not been able to find research evidence about health systems using an easily understood taxonomy of topics, know when they have conducted a comprehensive search of the many types of research evidence relevant to them, or rapidly identify decision-relevant information in their search results.
Methods
To address these gaps, we developed an approach to building a ‘one-stop shop’ for research evidence about health systems. We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of research evidence. We identified systematic reviews, systematic review protocols, and review-derived products through searches of Medline, hand searches of several databases indexing systematic reviews, hand searches of journals, and continuous scanning of LISTSERVS and websites. We developed an approach to providing ‘added value’ to existing content (e.g., coding systematic reviews according to the countries in which included studies were conducted) and to expanding the types of evidence eligible for inclusion (e.g., economic evaluations and health system descriptions). Lastly, we developed an approach to continuously updating the online one-stop shop in seven supported languages.
Results
The taxonomy is organized by governance, financial, and delivery arrangements and by implementation strategies. The ‘one-stop shop’, called Health Systems Evidence, contains a comprehensive inventory of evidence briefs, overviews of systematic reviews, systematic reviews, systematic review protocols, registered systematic review titles, economic evaluations and costing studies, health reform descriptions and health system descriptions, and many types of added-value coding. It is continuously updated and new content is regularly translated into Arabic, Chinese, English, French, Portuguese, Russian, and Spanish.
Conclusions
Policymakers and stakeholders can now easily access and use a wide variety of types of research evidence about health systems to inform decision-making and advocacy. Researchers and research funding agencies can use Health Systems Evidence to identify gaps in the current stock of research evidence and domains that could benefit from primary research, systematic reviews, and review overviews.

International Journal of Epidemiology
Volume 44 Issue 1 February 2015
http://ije.oxfordjournals.org/content/current

Data Resource Profile: The sentinel panel of districts: Tanzania’s national platform for health impact evaluation
Gregory S Kabadi1,3,*, Eveline Geubbels1, Isaac Lyatuu1, Paul Smithson1, Richard Amaro1,
Sylvia Meku2, Joanna A Schellenberg3 and Honorati Masanja1
Abstract
The Sentinel Panel of Districts (SPD) consists of 23 districts selected to provide nationally representative data on demographic and health indicators in Tanzania. The SPD has two arms: SAVVY and FBIS. SAVVY (SAmple Vital registration with Verbal autopsY) is a demographic surveillance system that provides nationally representative estimates of mortalities based on age, sex, residence and zone. SAVVY covers over 805 000 persons, or about 2% of the Tanzania mainland population, and uses repeat household census every 4–5 years, with ongoing reporting of births, deaths and causes of deaths. The FBIS (Facility-Based Information System) collects routine national health management information system data. These health service use data are collected monthly at all public and private health facilities in SPD districts, i.e. about 35% of all facilities in Mainland Tanzania. Both SAVVY and FBIS systems are capable of generating supplementary information from nested periodic surveys. Additional information about the design of the SPD is available online: access to some of SPD’s aggregate data can be requested by sending an e-mail to [hmasanja@ihi.or.tz].

.
Infant birthweight and risk of childhood cancer: international population-based case control studies of 40 000 cases
Kate A O’Neill1,4,*, Michael FG Murphy2,4, Kathryn J Bunch3,4, Susan E Puumala5, Susan E Carozza6, Eric J Chow7, Beth A Mueller7, Colleen C McLaughlin8, Peggy Reynolds9, Tim J Vincent4, Julie Von Behren9 and Logan G Spector10
Author Affiliations
1Department of Paediatrics, 2Nuffield Department of Obstetrics and Gynaecology, 3National Perinatal Epidemiology Unit, 4Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, 5Sanford Research Center, Sioux Falls, SD, USA, 6College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, 7Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 8New York State Department of Health, Albany, NY, USA, 9Cancer Prevention Institute of California, Berkeley, CA, USA and 10Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
Accepted December 15, 2014.
Abstract
Background: High birthweight is an established risk factor for childhood leukaemia. Its association with other childhood cancers is less clear, with studies hampered by low case numbers.
Methods: We used two large independent datasets to explore risk associations between birthweight and all subtypes of childhood cancer. Data for 16 554 cases and 53 716 controls were obtained by linkage of birth to cancer registration records across five US states, and 23 772 cases and 33 206 controls were obtained from the UK National Registry of Childhood Tumours. US, but not UK, data were adjusted for gestational age, birth order, plurality, and maternal age and race/ethnicity.
Results: Risk associations were found between birthweight and several childhood cancers, with strikingly similar results between datasets. Total cancer risk increased linearly with each 0.5 kg increase in birthweight in both the US [odds ratio 1.06 (95% confidence interval 1.04, 1.08)] and UK [1.06 (1.05, 1.08)] datasets. Risk was strongest for leukaemia [USA: 1.10 (1.06, 1.13), UK: 1.07 (1.04, 1.10)], tumours of the central nervous system [USA: 1.05 (1.01, 1.08), UK: 1.07 (1.04, 1.10)], renal tumours [USA: 1.17 (1.10, 1.24), UK: 1.12 (1.06, 1.19)] and soft tissue sarcomas [USA: 1.12 (1.05, 1.20), UK: 1.07 (1.00, 1.13)]. In contrast, increasing birthweight decreased the risk of hepatic tumours [USA: 0.77 (0.69, 0.85), UK: 0.79 (0.71, 0.89) per 0.5 kg increase]. Associations were also observed between high birthweight and risk of neuroblastoma, lymphomas, germ cell tumours and malignant melanomas. For some cancer subtypes, risk associations with birthweight were non-linear. We observed no association between birthweight and risk of retinoblastoma or bone tumours.
Conclusions: Approximately half of all childhood cancers exhibit associations with birthweight. The apparent independence from other factors indicates the importance of intrauterine growth regulation in the aetiology of these diseases.

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 26, Number 1, February 2015
http://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.26.1.html

Building Surgical Capacity in Developing Countries: Lessons from Haiti and Honduras
Daniel G. Hottinger, Bhavesh M. Patel, Richard L. Frechette, Wynn Walent, Marc E. Augustin, Peter J. Daly
pp. 278-286 | 10.1353/hpu.2015.0011
Abstract
Summary:
The unmet burden of surgical disease in developing countries is large and growing. We successfully initiated two surgical field hospitals in austere environments. Similar problems were encountered in the areas of facility development, operations, and social considerations. A literature review was performed to contextualize our experience and compare it with that of others.

Conclusion
The unmet burden of surgical disease in the developing world is increasingly recognized as an important and justifiable public health priority, but there is a great deal of work to be done. We still do not know the precise burden of surgical disease in low and middle- income countries around the world. Countries must collect better data quantifying not only the current amount of surgical care being performed, but that details the numbers and types of surgical problems that go untreated. Only then can the global humanitarian community fully understand the problem and be engaged to bring the necessary resources to bear in a coordinated fashion. In addition to understanding local facility infrastructure and operational needs, building sustainable surgical capacity requires an understanding and engagement of the community being served.

Nature
Volume 518 Number 7540 pp456-568 26 February 2015
http://www.nature.com/nature/current_issue.html

Nature | Comment
Data sharing: Make outbreak research open access
Nathan L. Yozwiak, Stephen F. Schaffner& Pardis C. Sabeti
25 February 2015
Establish principles for rapid and responsible data sharing in epidemics
Last April, five months into the largest Ebola outbreak in history, an international group of researchers sequenced three viral genomes, sampled from patients in Guinea1. The data were made public that same month. Two months later, our group at the Broad Institute in Cambridge, Massachusetts, sequenced 99 more Ebola genomes, from patients at the Kenema Government Hospital in Sierra Leone.

We immediately uploaded the data to the public database GenBank (see go.nature.com/aotpbk). Our priority was to help curb the outbreak. Colleagues who had worked with us for a decade were at the front lines and in immediate danger; some later died. We were amazed by the surge of collaboration that followed. Numerous experts from diverse disciplines, including drug and vaccine developers, contacted us. We also formed unexpected alliances — for instance, with a leading evolutionary virologist, who helped us to investigate when the strain of virus causing the current outbreak arose….

…In an increasingly connected world, rapid sequencing, combined with new ways to collect clinical and epidemiological data, could transform our response to outbreaks. But the power of these potentially massive data sets to combat epidemics will be realized only if the data are shared as widely and as quickly as possible. Currently, no good guidelines exist to ensure that this happens….

…The Kenema way
As a first step, we call on health agencies such as the World Health Organization, the US Centers for Disease Control and Prevention and Médecins Sans Frontières, as well as genome-sequencing centres and other research institutions, to convene a meeting this year — similar to that held in Bermuda in 1996. Attendees must include scientists, funders, ethicists, biosecurity experts, social scientists and journal editors.

We urge researchers working on outbreaks to embrace a culture of openness. For our part, we have released all our sequence data as soon as it has been generated, including that from several hundred more Ebola samples we recently received from Kenema. We have listed the research questions that we are pursuing at virological.org and through GenBank, and we plan to present our results at virological.org as we generate them, for others to weigh in on. We invite people either to join our publication, or to prepare their own while openly laying out their intentions online. We have also made clinical data for 100 patients publicly available and have incorporated these into a user-friendly data-visualization tool, Mirador, to allow others to explore the data and uncover new insights.

Kenema means ‘translucent, clear like a river stream’ or ‘open to the public gaze’9. To honour the memory of our colleagues who died at the forefront of the Ebola outbreak, and to ensure that no future epidemic is as devastating, let’s work openly in outbreaks.

New England Journal of Medicine
February 26, 2015 Vol. 372 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Enduring and Emerging Challenges of Informed Consent
Christine Grady, Ph.D.
N Engl J Med 2015; 372:855-862 February 26, 2015 DOI: 10.1056/NEJMra1411250
The author summarizes emerging standards for informed consent as the underpinning of ethical research in humans.

PLOS Currents: Disasters
[Accessed 28 February 2015]
http://currents.plos.org/disasters/

Performance Assessment of Communicable Disease Surveillance in Disasters: A Systematic Review
February 24, 2015 • Research article
Background: This study aimed to identify the indices and frameworks that have been used to assess the performance of communicable disease surveillance (CDS) in response to disasters and other emergencies, including infectious disease outbreaks.

Method: In this systematic review, PubMed, Google Scholar, Scopus, ScienceDirect, ProQuest databases and grey literature were searched until the end of 2013. All retrieved titles were examined in accordance with inclusion criteria. Abstracts of the relevant titles were reviewed and eligible abstracts were included in a list for data abstraction. Finally, the study variables were extracted.

Results: Sixteen articles and one book were found relevant to our study objectives. In these articles, 31 criteria and 35 indicators were used or suggested for the assessment/evaluation of the performance of surveillance systems in disasters. The Centers for Disease Control (CDC) updated guidelines for the evaluation of public health surveillance systems were the most widely used.

Conclusion: Despite the importance of performance assessment in improving CDS in response to disasters, there is a lack of clear and accepted frameworks. There is also no agreement on the use of existing criteria and indices. The only relevant framework is the CDC guideline, which is a common framework for assessing public health surveillance systems as a whole. There is an urgent need to develop appropriate frameworks, criteria, and indices for specifically assessing the performance of CDS in response to disasters and other emergencies, including infectious diseases outbreaks.

PLoS Medicine
(Accessed 28 February 2015)
http://www.plosmedicine.org/

Humanitarian Access to Unapproved Interventions in Public Health Emergencies of International Concern
Jerome Amir Singh
Essay | published 24 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001793
Summary Points
– Time-sensitive access to unapproved experimental interventions should be permitted on humanitarian grounds when patients or communities are facing death or irreversible disease progression and no other efficacious diagnostic, preventive, or therapeutic alternative exists.
– Regulatory deficits could stymie time-sensitive efforts to contain public health threats when no efficacious curative, therapeutic, or preventive interventions exist to counter the threat in question.
– United States regulatory mechanisms may provide useful guidance from a regulatory perspective to policy makers grappling with how to adequately prepare for, or respond to, potential or emerging public health emergencies.
– Access to unapproved experimental interventions should be underpinned by a robust monitoring and evaluation component that will inform product development and licensure.
– A global-level rapid-response governance framework for the employment of unapproved interventions in humanitarian contexts should be established as a matter of urgency.

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The Movement of Multidrug-Resistant Tuberculosis across Borders in East Africa Needs a Regional and Global Solution
Kevin P. Cain, Nina Marano, Maureen Kamene, Joseph Sitienei, Subroto Mukherjee, Aleksandar Galev, John Burton, Orkhan Nasibov, Jackson Kioko, Kevin M. De Cock
Policy Forum | published 24 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001791
Summary Points
– Multidrug-resistant tuberculosis (MDR TB) and other deadly infectious diseases commonly occur in states suffering from political turmoil and armed conflict.
– The same conditions that promote MDR TB and other diseases often diminish the capacity of the public health system to address these needs, leading patients to seek care in other countries.
– In East Africa, a large number of patients from Somalia with MDR TB crossed the border to Kenya seeking treatment. While diagnostic capacity for MDR TB exists in Somalia, treatment capacity does not.
– Identification and management of such diseases need to be a priority for countries in the region both for humanitarian purposes and for the protection of their own residents. Often diseases will need to be diagnosed and treated outside of the country in which they are occurring.
– The solutions must be regional and global. Control of an infectious disease, such as MDR TB, must be focused at its source to be successful. Its control cannot depend on the existing capacity of the country in which it happens to occur.

PLoS One
[Accessed 28 February 2015]
http://www.plosone.org/

Care Seeking Behaviour for Children with Suspected Pneumonia in Countries in Sub-Saharan Africa with High Pneumonia Mortality
Aaltje Camielle Noordam, Liliana Carvajal-Velez, Alyssa B. Sharkey, Mark Young, Jochen W. L. Cals
Research Article | published 23 Feb 2015 | PLOS ONE 10.1371/journal.pone.0117919
Abstract
Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as ‘appropriate’ providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16–18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3–39.3) more likely to be brought for care than children from the poorest households, after controlling for the child’s age, sex, caregiver’s education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic

Refugee Survey Quarterly
Volume 34 Issue 1 March 2015
http://rsq.oxfordjournals.org/content/current

Special Issue: The Role of International Organizations and Human Rights Monitoring Bodies in Refugee Protection

Introduction: The Role of International Organizations and Human Rights Monitoring Bodies in Refugee Protection
María-Teresa Gil-Bazo*
PhD in International Law; Senior Lecturer in Law (Newcastle Law School, Newcastle University); Research Associate (Refugee Studies Centre, University of Oxford).
Abstract
Developments in international law in the field of asylum, including the development of regional legal and institutional frameworks, have resulted in an increasing complexity and fragmentation that deserves revisiting. In this view, this Special Issue of the Refugee Survey Quarterly enquires into the role of international organizations and international human rights monitoring bodies in the protection of refugees. Despite the lack of an explicit mandate to receive communications from individuals regarding their immigration status, these monitoring bodies have developed a sound body of case-law on the rights of non-nationals in relation to the entry and stay, as well as non-removal from their countries of asylum. Their work in fact suggests that we may be witnessing a change in paradigm as international human rights law evolves beyond the prohibition of refoulement into the positive obligations of States. This has the potential for opening new ways for studying refugee protection under international law in a holistic manner.
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Refugee Protection under International Human Rights Law: From Non-Refoulement to Residence and Citizenship
María-Teresa Gil-Bazo Refugee Survey Quarterly (2015) 34 (1): 11-42 doi:10.1093/rsq/hdu021

Time for Reform? Refugees, Asylum-seekers, and Protection Under International Human Rights Law
Colin Harvey
Refugee Survey Quarterly (2015) 34 (1): 43-60 doi:10.1093/rsq/hdu018

Recent Jurisprudence of the United Nations Committee against Torture and the International Protection of Refugees
Fernando M. Mariño Menéndez
Refugee Survey Quarterly (2015) 34 (1): 61-78 doi:10.1093/rsq/hdu019

Reframing Relationships: Revisiting the Procedural Standards for Refugee Status Determination in Light of Recent Human Rights Treaty Body Jurisprudence
David James Cantor
Refugee Survey Quarterly (2015) 34 (1): 79-106 doi:10.1093/rsq/hdu017

International Protection in Court: The Asylum Jurisprudence of the Court of Justice of the EU and UNHCR
Madeline Garlick
Refugee Survey Quarterly (2015) 34 (1): 107-130 doi:10.1093/rsq/hdu020