New England Journal of Medicine
November 19, 2015 Vol. 373 No. 21
http://www.nejm.org/toc/nejm/medical-journal

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Editorials
Vaccine-Resistant Malaria
C.V. Plowe
[Free Full Text]
To ensure efficacy against wild poliovirus, Jonas Salk methodically classified circulating polio strains before choosing three to use in his inactivated vaccine.1 Several other successful vaccines against viruses and bacteria have likewise included immunogen variants that were selected through careful assessments of pathogen genetic diversity and strain-specific protective immunity.

In contrast, virtually all vaccines against the malaria parasite Plasmodium falciparum, including RTS,S/AS01, have been designed with the use of genetic sequences that are derived from a single, well-characterized reference strain thought to be of West African origin — 3D7. In light of the extreme diversity of malaria parasites, could this “freezer epidemiology” approach to vaccine development be one reason it has been so hard to make an effective malaria vaccine?

Phase 2 field trials of two malaria vaccines targeting highly polymorphic blood-stage antigens have shown strain-specific efficacy — that is, parasites that are genetically divergent from the strain used in the vaccine escaped its effect.2,3 However, field trials of RTS,S, which is based on the pre-erythrocytic P. falciparum circumsporozoite protein, showed no clear evidence of strain-specific efficacy.4,5 Circumsporozoite protein has polymorphism within two major T-cell epitopes, and although there is some variation in the immunodominant central repeat region, for decades it has been hoped that antibodies targeting a single dominant epitope based on the tetrapeptide repeat NANP would provide strain-transcending immunity. A molecular epidemiologic study showed no evidence of naturally acquired strain-specific immunity to different variants of circumsporozoite protein in African children,6 which added to the hope that RTS,S might not be threatened by “vaccine-resistant malaria.”7

These previous studies each examined malaria parasites in a few hundred children at a single African site and were constrained by the challenges of sequencing the long central repeat region of the circumsporozoite protein. Neafsey et al.8 now describe in the Journal how they used next-generation sequencing to measure strain-specific efficacy in a phase 3 trial of RTS,S/AS01 involving 15,000 children at 11 study sites across Africa. Parasite DNA was extracted from several thousand dried blood spots collected from children who were randomly assigned to receive the malaria vaccine or a control vaccine, and the efficacy of the vaccine against infection and clinical malaria with circumsporozoite protein identical to, or different from, the vaccine strain 3D7 was measured by means of a sieve analysis.9

The approach is straightforward: if vaccine-induced immunity is acting like a sieve that filters out parasites that are identical to the vaccine strain at immunologically important polymorphic amino acid positions, then less vaccine-type malaria should occur among vaccinated children, as compared with the control group. The large sample size was needed — vaccine-type parasites were in the minority at all study sites. Several predetermined analyses examining different variant components of circumsporozoite protein showed that, at least in older children, RTS,S/AS01 was indeed better at protecting against malaria caused by vaccine-type parasites. There was no such allele-specific efficacy in young infants, a group in which RTS,S efficacy was lower and in which there may have been different immune responses to both vaccination and malaria infection.

The effect of parasite genetic diversity on efficacy in older children was modest. Various measures of efficacy were approximately 10 to 15 percentage points lower when they were evaluated against non–vaccine-type parasites. This is a much smaller blow to efficacy than the more than 40-point deficit seen with a blood-stage vaccine.3

If we had a vaccine with 80% or 90% efficacy, we might be willing to accept a loss of this magnitude. But RTS,S/AS01 starts off with about 50 to 60% efficacy at best; the efficacy is lower in younger children, and it wanes over time. As this first malaria vaccine moves toward licensure, the results of this study should give pause to those considering whether, where, and when to deploy it. If RTS,S/AS01 is introduced into wide use, over time the loss of efficacy could be more profound than that seen during just a year of follow-up among children who are exposed to a large surrounding population of malaria parasites that are not under selection pressure from vaccine-induced immunity. The most prudent course may be to use RTS,S/AS01 in the specific populations that will benefit most, while redoubling efforts to improve this pioneering vaccine on the basis of new understanding provided by this study of the strain-specific basis of its partial efficacy.

The news is not all bad. The modest loss of efficacy against divergent parasites implies that RTS,S/AS01 offers some degree of cross-protection — vaccine escape is not complete. A multivalent version of RTS,S with carefully chosen circumsporozoite protein variants, possibly combined with additional antigens, might offer broader protection.10 The large set of molecular epidemiologic data on the prevalence of circumsporozoite protein variants across Africa that was generated for this study should provide the evidence needed to select a combination of strains for a more broadly efficacious, next-generation malaria vaccine.

Nonprofit and Voluntary Sector Quarterly
December 2015; 44 (6)
http://nvs.sagepub.com/content/current

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To Volunteer or Not: The Influence of Individual Characteristics, Resources, and Social Factors on the Likelihood of Volunteering by Older Adults
Sarah Dury, Liesbeth De Donder, Nico De Witte, Tine Buffel, Wolfgang Jacquet, and Dominique Verté
Nonprofit and Voluntary Sector Quarterly December 2015 44: 1107-1128, first published on November 13, 2014 doi:10.1177/0899764014556773
Abstract
The study examines a hybrid theory containing individual characteristics, resources, and social factors and volunteering of older adults living in Belgium. As scholars have pointed out the under-researched importance of taking the recruitment potential of older adults into account, this study investigates whether potential volunteers, actual volunteers, and non-volunteers in later life are different from each other in terms of individual characteristics (e.g., religiosity), resources (e.g., socioeconomic status), and social factors (e.g., social networks and social roles). Data for the present research were derived from the Belgian Aging Studies, a sample of 31,581 individuals aged 65 to 80 years. Logistic regression analyses indicate that altruistic and religious values, physical health, frequent contact with friends, and providing help to others are important predictors for potential volunteers as well as actual volunteers. Overall, the results indicate important insights for recruitment and retention of older volunteers.

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The Effect of an Online Self-Assessment Tool on Nonprofit Board Performance
Yvonne D. Harrison1, Vic Murray2
1University at Albany, State University of New York, USA
2University of Victoria, British Columbia, Canada
Abstract
This article reports on perceptions of the effectiveness of nonprofit organization boards of directors and changes in governance behavior obtained from the first 1,446 users of a free online board performance self-assessment tool known as the Board Check-Up (www.boardcheckup.com), Board Effectiveness Survey Application (BESA). Respondents came from 122 organizations in Canada, the United States, Australia, and other countries. The article describes the conceptual framework for the study and the underlying theory of change on which it is based. It presents findings on the types of governance issues respondents perceived as most problematic in their boards. It also describes changes in governance behavior and practices reported by respondents, who completed an impact assessment some time after the use of the online self-assessment tool. The results provide empirical support for the value of utilizing the online board performance self-assessment application and insights into its impact as a means of making changes in the governance process. Next steps in this international longitudinal research study are discussed.

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Fraud and Corruption in U.S. Nonprofit Entities
A Summary of Press Reports 2008-2011
Deborah S. Archambeault1, Sarah Webber1, Janet Greenlee1
1University of Dayton, OH, USA
Abstract
The charitable sector is vulnerable to fraud losses, with these losses negatively impacting the organization’s reputation, future funding, and ability to advance its mission. Research on nonprofit fraud is relatively scarce, due mainly to limited availability of data. We create a database that summarizes and describes basic facts (nature and timing of fraud, description of organization, magnitude of loss, and perpetrators) for 115 incidents of detected fraud occurring in U.S. nonprofit organizations. We find a disproportionately high incidence of nonprofit fraud in the Health and Human Services National Taxonomy of Exempt Entities Groups, a high percentage of females committing misappropriation frauds, and that the organizational role of the perpetrator is related to the size of the fraud loss. We also investigate whether organizations detecting a nonprofit fraud report this information, as required, on Internal Revenue Service Form 990, and find that many organizations do not comply.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 21 November 2015)

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The First Use of the Global Oral Cholera Vaccine Emergency Stockpile: Lessons from South Sudan
Abdinasir Abubakar, Andrew S. Azman, John Rumunu, Iza Ciglenecki, Trina Helderman, Haley West, Justin Lessler, David A. Sack, Stephen Martin, William Perea, Dominique Legros, Francisco J. Luquero
Health in Action | published 17 Nov 2015 | PLOS Medicine
10.1371/journal.pmed.1001901
Summary Points
:: A global oral cholera vaccine (OCV) stockpile was established in 2013 to improve rapid access to the vaccine in outbreaks and emergencies in which cholera risk is high. The first deployment from the global OCV stockpile was to South Sudan in 2014 because of high cholera risk from massive population displacements within the civil war.
:: 256,700 doses of OCV were delivered, with high coverage, throughout the country as part of a comprehensive cholera prevention strategy by multiple agencies, some of which had little to no previous experience with this vaccine.
:: A cholera epidemic began during vaccination, and a basic comparison of epidemic curves in vaccinated and unvaccinated areas suggests little to no transmission occurred in vaccinated areas, though more in depth analysis is needed.
:: This deployment highlights the feasibility of effective deployments from the OCV stockpile and the importance of strong coordination between governmental and nongovernmental agencies in cholera prevention and control planning from the assessment of cholera risk to the deployment of the vaccines.
:: A larger global supply of OCV is urgently needed to cover those most in need. With limited vaccine availability now and likely in the upcoming years, more work is needed on deciding how to most efficiently use the vaccine, which may include alternative dosing regimens and targeting specific subpopulations.

PLoS One
http://www.plosone.org/
[Accessed 21 November 2015]

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Developing and Optimising the Use of Logic Models in Systematic Reviews: Exploring Practice and Good Practice in the Use of Programme Theory in Reviews
Dylan Kneale, James Thomas, Katherine Harris
Research Article | published 17 Nov 2015 | PLOS ONE
10.1371/journal.pone.0142187
Abstract
Background
Logic models are becoming an increasingly common feature of systematic reviews, as is the use of programme theory more generally in systematic reviewing. Logic models offer a framework to help reviewers to ‘think’ conceptually at various points during the review, and can be a useful tool in defining study inclusion and exclusion criteria, guiding the search strategy, identifying relevant outcomes, identifying mediating and moderating factors, and communicating review findings.
Methods and Findings
In this paper we critique the use of logic models in systematic reviews and protocols drawn from two databases representing reviews of health interventions and international development interventions. Programme theory featured only in a minority of the reviews and protocols included. Despite drawing from different disciplinary traditions, reviews and protocols from both sources shared several limitations in their use of logic models and theories of change, and these were used almost unanimously to solely depict pictorially the way in which the intervention worked. Logic models and theories of change were consequently rarely used to communicate the findings of the review.
Conclusions
Logic models have the potential to be an aid integral throughout the systematic reviewing process. The absence of good practice around their use and development may be one reason for the apparent limited utility of logic models in many existing systematic reviews. These concerns are addressed in the second half of this paper, where we offer a set of principles in the use of logic models and an example of how we constructed a logic model for a review of school-based asthma interventions.

PLoS One
http://www.plosone.org/
[Accessed 21 November 2015]

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Food Security Monitoring via Mobile Data Collection and Remote Sensing: Results from the Central African Republic
Markus Enenkel, Linda See, Mathias Karner, Mònica Álvarez, Edith Rogenhofer, Carme Baraldès-Vallverdú, Candela Lanusse, Núria Salse
Research Article | published 18 Nov 2015 | PLOS ONE
10.1371/journal.pone.0142030
Abstract
The Central African Republic is one of the world’s most vulnerable countries, suffering from chronic poverty, violent conflicts and weak disaster resilience. In collaboration with Doctors without Borders/Médecins Sans Frontières (MSF), this study presents a novel approach to collect information about socio-economic vulnerabilities related to malnutrition, access to resources and coping capacities. The first technical test was carried out in the North of the country (sub-prefecture Kabo) in May 2015. All activities were aimed at the investigation of technical feasibility, not at operational data collection, which requires a random sampling strategy. At the core of the study is an open-source Android application named SATIDA COLLECT that facilitates rapid and simple data collection. All assessments were carried out by local MSF staff after they had been trained for one day. Once a mobile network is available, all assessments can easily be uploaded to a database for further processing and trend analysis via MSF in-house software. On one hand, regularly updated food security assessments can complement traditional large-scale surveys, whose completion can take up to eight months. Ideally, this leads to a gain in time for disaster logistics. On the other hand, recording the location of every assessment via the smart phones’ GPS receiver helps to analyze and display the coupling between drought risk and impacts over many years. Although the current situation in the Central African Republic is mostly related to violent conflict it is necessary to consider information about drought risk, because climatic shocks can further disrupt the already vulnerable system. SATIDA COLLECT can easily be adapted to local conditions or other applications, such as the evaluation of vaccination campaigns. Most importantly, it facilitates the standardized collection of information without pen and paper, as well as straightforward sharing of collected data with the MSF headquarters or other aid organizations.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 21 November 2015)

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Biological Sciences – Sustainability Science:
Global impacts of energy demand on the freshwater resources of nations
Robert Alan Holland, Kate A. Scott, Martina Flörke, Gareth Brown, Robert M. Ewers, Elizabeth Farmer, Valerie Kapos, Ann Muggeridge, Jörn P. W. Scharlemann, Gail Taylor, John Barrett, and Felix Eigenbrod
PNAS 2015 ; published ahead of print November 16, 2015, doi:10.1073/pnas.1507701112
Significance
Understanding the role of international trade in driving pressures on freshwater resources is key to meeting challenges at the water–energy nexus. A coupled trade and hydrological model is used to examine pressures on freshwater resources associated with energy production across the global economy. While the electric and gas sectors induce freshwater consumption predominantly within countries where demand originates (91% and 81%, respectively), the petroleum sector exhibits a high international footprint (56%). Critical geographic areas and economic sectors are identified, providing focus for resource-management actions to ensure energy and freshwater security. Our analysis demonstrates the importance of broadening the discourse on energy policy to address issues including freshwater scarcity, the role of international trade, and wider environmental and societal considerations.
Abstract
The growing geographic disconnect between consumption of goods, the extraction and processing of resources, and the environmental impacts associated with production activities makes it crucial to factor global trade into sustainability assessments. Using an empirically validated environmentally extended global trade model, we examine the relationship between two key resources underpinning economies and human well-being—energy and freshwater. A comparison of three energy sectors (petroleum, gas, and electricity) reveals that freshwater consumption associated with gas and electricity production is largely confined within the territorial boundaries where demand originates. This finding contrasts with petroleum, which exhibits a varying ratio of territorial to international freshwater consumption, depending on the origin of demand. For example, although the United States and China have similar demand associated with the petroleum sector, international freshwater consumption is three times higher for the former than the latter. Based on mapping patterns of freshwater consumption associated with energy sectors at subnational scales, our analysis also reveals concordance between pressure on freshwater resources associated with energy production and freshwater scarcity in a number of river basins globally. These energy-driven pressures on freshwater resources in areas distant from the origin of energy demand complicate the design of policy to ensure security of fresh water and energy supply. Although much of the debate around energy is focused on greenhouse gas emissions, our findings highlight the need to consider the full range of consequences of energy production when designing policy.

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 21 November 2015]

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Research
Factors associated with early resumption of sexual intercourse among postnatal women in Uganda
Alice Alum, Irene Kizza, Charles Osingada, Godfrey Katende, Dan Kaye Reproductive Health 2015, 12:107 (19 November 2015)

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Research
“Once you join the streets you will have to do it”: sexual practices of street children and youth in Uasin Gishu County, Kenya
Lonnie Embleton, Juddy Wachira, Allan Kamanda, Violet Naanyu, Susanna Winston, David Ayuku, Paula Braitstein Reproductive Health 2015, 12:106 (1)

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
September 2015 Vol. 38, No. 3
http://www.paho.org/journal/

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SERIES ON EQUITY IN HEALTH AND SUSTAINABLE DEVELOPMENT
Social determinants and inequalities in tuberculosis incidence in Latin America and the Caribbean [Determinantes sociales y desigualdades en la incidencia de tuberculosis en América Latina y el Caribe]
César V. Munayco, Oscar J. Mújica, Francisco X. León, Mirtha del Granado, and Marcos A. Espinal

La ventaja epidemiológica de la orientación preferencial del control de la tuberculosis hacia los pobres [The epidemiological advantage of preferential targeting of tuberculosis control at the poor]
J. R. Andrews, S. Basu, D. W. Dowdy, and M. B. Murray

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SPECIAL REPORTS
Technology transfer for the implementation of a clinical trials network on drug abuse and mental health treatment in Mexico [Transferencia de tecnología para la implantación de una red de investigaciones clínicas sobre el tratamiento de la drogadicción y los problemas de salud mental en México]
Viviana E. Horigian, Rodrigo A. Marín-Navarrete, Rosa E. Verdeja, Elizabeth Alonso, María A. Perez, José Fernández-Mondragón, Carlos Berlanga, María Elena Medina-Mora, and José Szapocznik
Abstract
Low- and middle-income countries (LMIC) lack the research infrastructure and capacity to conduct rigorous substance abuse and mental health effectiveness clinical trials to guide clinical practice. A partnership between the Florida Node Alliance of the United States National Drug Abuse Treatment Clinical Trials Network and the National Institute of Psychiatry in Mexico was established in 2011 to improve substance abuse practice in Mexico. The purpose of this partnership was to develop a Mexican national clinical trials network of substance abuse researchers and providers capable of implementing effectiveness randomized clinical trials in community-based settings. A technology transfer model was implemented and ran from 2011–2013. The Florida Node Alliance shared the “know how” for the development of the research infrastructure to implement randomized clinical trials in community programs through core and specific training modules, role-specific coaching, pairings, modeling, monitoring, and feedback. The technology transfer process was bi-directional in nature in that it was informed by feedback on feasibility and cultural appropriateness for the context in which practices were implemented. The Institute, in turn, led the effort to create the national network of researchers and practitioners in Mexico and the implementation of the first trial. A collaborative model of technology transfer was useful in creating a Mexican researcher-provider network that is capable of changing national practice in substance abuse research and treatment. Key considerations for transnational technology transfer are presented.

Science
20 November 2015 vol 350, issue 6263, pages 885-1000
http://www.sciencemag.org/current.dtl

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Feature
What does a disease deserve?
Jocelyn Kaiser
Since the early 1990s, Congress and the National Institutes of Health (NIH) have agreed to dedicate roughly 10% of the NIH budget to fighting HIV/AIDS. Now, however, that special arrangement is under fire. Health policy experts, lawmakers, and even NIH officials have wondered why, 2 decades after AIDS death rates began dropping dramatically in the United States, the disease still gets a lion’s share of NIH resources, or $3 billion this year. As questions have arisen about how HIV/AIDS research funds are spent, NIH has also resolved to refocus AIDS money on ending the epidemic. Some voice a broader critique: that NIH’s spending on a disease often doesn’t align with how much suffering it causes. They note that diseases imposing a relatively small burden on U.S. society, such as AIDS, can get a larger share of NIH funding than those that cause greater harm, such as heart disease. Recently, while responding to pointed questions from a member of Congress about the issue, NIH Director Francis Collins said the agency is ready to abandon the 10% set-aside. And next month officials are expected to release an agency-wide strategic plan that they say will address how disease burden should influence the allocation of research dollars.

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Policy Forum
Energy and Environment
Transport: A roadblock to climate change mitigation?
Felix Creutzig1,2,*, Patrick Jochem3, Oreane Y. Edelenbosch4, Linus Mattauch1,2, Detlef P. van Vuuren4,5, David McCollum6, Jan Minx1,7
Author Affiliations
1Mercator Research Institute on Global Commons and Climate Change (MCC), 10829 Berlin, Germany.
2Technical University Berlin, 10623 Berlin, Germany.
3Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.
4PBL Netherlands Environmental Assessment Agency, 3720AH Bilthoven, Netherlands.
5Copernicus Institute of Sustainable Development of Geosciences, Utrecht University, 3584CS Utrecht, Netherlands.
6International Institute for Applied Systems Analysis (IIASA), 2361 Laxenburg, Austria.
7Hertie School of Governance, 10117 Berlin, Germany.
Summary
Global emissions scenarios studies, such as those informing the Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (AR5), highlight the importance of the transport sector for climate change mitigation—along with the difficulties of achieving deep reductions therein (1) [supplementary materials (SM)]. Transport is responsible for about 23% of total energy-related CO2 emissions worldwide (2). The sector is growing more rapidly than most others, with emissions projected to double by 2050. Global scenario studies, specifically those produced by integrated assessment models (IAMs), communicate aggregate mitigation potentials by sectors in IPCC reports. Yet recent evidence indicates that emissions may be reduced further than these global scenario studies suggest—if policy-makers use the full suite of policies at their disposal.

ocial Science & Medicine
Volume 144, Pages 1-148 (November 2015)
http://www.sciencedirect.com/science/journal/02779536/144

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Toward a multidimensional understanding of culture for health interventions
Original Research Article
Pages 79-87
Asad L. Asad, Tamara Kay
Abstract
Although a substantial literature examines the relationship between culture and health in myriad individual contexts, a lack of comparative data across settings has resulted in disparate and imprecise conceptualizations of the concept for scholars and practitioners alike. This article examines scholars and practitioners’ understandings of culture in relation to health interventions. Drawing on 169 interviews with officials from three different nongovernmental organizations working on health issues in multiple countries—Partners in Health, Oxfam America, and Sesame Workshop—we examine how these respondents’ interpretations of culture converge or diverge with recent developments in the study of the concept, as well as how these understandings influence health interventions at three different stages—design, implementation, and evaluation—of a project. Based on these analyses, a tripartite definition of culture is built—as knowledge, practice, and change—and these distinct conceptualizations are linked to the success or failure of a project at each stage of an intervention. In so doing, the study provides a descriptive and analytical starting point for scholars interested in understanding the theoretical and empirical relevance of culture for health interventions, and sets forth concrete recommendations for practitioners working to achieve robust improvements in health outcomes.

Social Science & Medicine
Volume 144, Pages 1-148 (November 2015)
http://www.sciencedirect.com/science/journal/02779536/144

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Toward a multidimensional understanding of culture for health interventions
Original Research Article
Pages 79-87
Asad L. Asad, Tamara Kay
Abstract
Although a substantial literature examines the relationship between culture and health in myriad individual contexts, a lack of comparative data across settings has resulted in disparate and imprecise conceptualizations of the concept for scholars and practitioners alike. This article examines scholars and practitioners’ understandings of culture in relation to health interventions. Drawing on 169 interviews with officials from three different nongovernmental organizations working on health issues in multiple countries—Partners in Health, Oxfam America, and Sesame Workshop—we examine how these respondents’ interpretations of culture converge or diverge with recent developments in the study of the concept, as well as how these understandings influence health interventions at three different stages—design, implementation, and evaluation—of a project. Based on these analyses, a tripartite definition of culture is built—as knowledge, practice, and change—and these distinct conceptualizations are linked to the success or failure of a project at each stage of an intervention. In so doing, the study provides a descriptive and analytical starting point for scholars interested in understanding the theoretical and empirical relevance of culture for health interventions, and sets forth concrete recommendations for practitioners working to achieve robust improvements in health outcomes.

Stability: International Journal of Security & Development
http://www.stabilityjournal.org/articles
[accessed 21 November 2015]

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Research Article
Preparing Stabilisation for 21st Century Security Challenges
Steven A. Zyck, Robert Muggah
Abstract
Stabilisation, as a concept and set of practices, has proliferated over the past two decades and is now implicitly integrated into a range of global frameworks. However, this enthusiasm has at times risked turning this increasingly common, albeit contested, idea into a piece of jargon that discounts its unique facets: a focus on all sorts of violence, not just conflict, that create political instability and human harm and a problem-solving approach that draws selectively on various forms of intervention (e.g., statebuilding, counterinsurgency, peacekeeping, etc.) without being beholden to any one toolkit. The pragmatism inherent within the concept of stabilisation will grow increasingly important as new security challenges emerge or proliferate. These include the fragmentation and regionalisation of conflict systems, transnational organised crime, large-scale migration and new, disruptive technologies. Novel approaches rooted in big data and technology will increasingly need to be applied. Most importantly, in foreign policy, military and development communities often driven by perceptions about what causes, ends or prevents violence, stabilisation must maintain its agnostic, problem-solving roots and allegiance to evidence over ideology.
DOI: http://doi.org/10.5334/sta.gs

Tropical Medicine & International Health
November 2015 Volume 20, Issue 11 Pages 1405–1589
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2015.20.issue-11/issuetoc

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Improving survey data on pregnancy-related deaths in low-and middle-income countries: a validation study in Senegal (pages 1415–1423)
Stéphane Helleringer, Gilles Pison, Bruno Masquelier, Almamy Malick Kanté, Laetitia Douillot, Cheikh Tidiane Ndiaye, Géraldine Duthé, Cheikh Sokhna and Valérie Delaunay
Article first published online: 28 AUG 2015 | DOI: 10.1111/tmi.12583

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Reduction in symptomatic malaria prevalence through proactive community treatment in rural Senegal (pages 1438–1446)
Annē M. Linn, Youssoupha Ndiaye, Ian Hennessee, Seynabou Gaye, Patrick Linn, Karin Nordstrom and Matt McLaughlin
Article first published online: 7 AUG 2015 | DOI: 10.1111/tmi.12564

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Use of a bibliometric literature review to assess medical research capacity in post-conflict and developing countries: Somaliland 1991–2013 (pages 1507–1515)
Ross Boyce, Richard Rosch, Alexander Finlayson, Djibril Handuleh, Said Ahmed Walhad, Susannah Whitwell and Andy Leather
Article first published online: 14 SEP 2015 | DOI: 10.1111/tmi.12590

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Disease mapping for informing targeted health interventions: childhood pneumonia in Bohol, Philippines (pages 1525–1533)
Deborah S. K. Thomas, Peter Anthamatten, Elisabeth Dowling Root, Marilla Lucero, Hanna Nohynek, Veronica Tallo, Gail M. Williams, Eric A. F. Simões and the ARIVAC Consortium
Article first published online: 21 JUL 2015 | DOI: 10.1111/tmi.12561

World Heritage Review
n°77 – October 2015
http://whc.unesco.org/en/review/77

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Climate Change
The network of World Heritage properties was inter alia intended to ensure the proper preservation of the natural and cultural values of sites inscribed on the World Heritage List. Today, as the planet finds itself confronted with the impact of climate change, the existence of this network is proving to be of the highest importance in monitoring changing conditions and advancing solutions on the ground….

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 14 November 2015

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

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: The Sentinel_ week ending 14 November 2015

blog edition: comprised of the 35+ entries  posted below on 19 November 2015

Secretary-General Nominates Filippo Grandi of Italy United Nations High Commissioner for Refugees
11 November 2015
SG/A/1605-REF/1217
Press Release
United Nations Secretary-General Ban Ki-moon, following consultations with the Chairs of the regional groups of Member States, today informed the General Assembly of his intention to appoint Filippo Grandi of Italy as the new United Nations High Commissioner for Refugees, Office of the United Nations High Commissioner for Refugees (UNHCR).
Mr. Grandi was Commissioner-General of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) from 2010 to 2014 and it’s Deputy Commissioner-General from 2005 until 2010. He served as the Secretary-General’s Deputy Special Representative with the United Nations Assistance Mission in Afghanistan (UNAMA) and has a long-standing career with UNHCR, notably as Chief of Mission in Afghanistan and Chief of Staff in the High Commissioner’s Executive Office. His vast UNHCR field experience includes various positions in Sudan, Syria, Turkey and Iraq, having also led emergency operations in Kenya, Benin, Ghana, Liberia, the Great Lakes region of Central Africa, Democratic Republic of Congo and Yemen.

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High Commissioner welcomes nomination of successor
Press Releases, 12 November 2015
U.N. High Commissioner for Refugees António Guterres on Thursday welcomed the announcement in New York of the nomination of Italian diplomat Filippo Grandi as his successor.

Mr. Grandi’s nomination was announced yesterday at United Nations headquarters by Secretary-General Ban Ki-Moon. The General Assembly is expected to elect the new High Commissioner in the coming days.

“Mr. Grandi is a highly respected leader with a wealth of international and refugee experience,” Mr. Guterres said. “Given the scale and urgency of today’s refugee crisis, with 60 million people worldwide uprooted by conflict and persecution, someone of his abilities and profound knowledge of forced displacement will be of great benefit to UNHCR and the people we are mandated to protect and assist.”

Mr. Guterres ends over 10 years as High Commissioner on 31 December 2015. His term, which began in June 2005, spanned one of the most tumultuous decades in UNHCR’s history. The agency, which has more than 9,300 staff in some 123 countries, marks the 65th anniversary of its founding next month.

Valletta Summit: Launch of the EU Trust Fund for Africa
President Juncker launches the EU Emergency Trust Fund (€1.8 billion) to tackle the root causes of irregular migration in Africa. Yesterday, a Common Agenda for Mobility and Migration (CAMM) with Ethiopia was signed
News 12/11/2015
European Commission President Jean-Claude Juncker, together with a number of European Heads of State or Government, launched today in Valletta (Malta) the EU’s Emergency Trust Fund for stability and addressing root causes of irregular migration and displaced persons in Africa.

The Emergency Trust Fund is made up of €1.8 billion from the European Union financing instruments as well as contributions from EU Member States and other donors. So far, 25 EU Member States and 2 non-EU donors (Norway and Switzerland) have announced a total contribution of around €78.2 million.

The Emergency Trust Fund is an innovative way how the EU is stepping up its collective response to current challenges on the ground and is a complementary tool to the EU’s already existing development cooperation in the region to assist the most fragile and vulnerable countries across Africa. It will benefit the Sahel region and Lake Chad area; the Horn of Africa and the North of Africa. Together, these encompass the major African migration routes to Europe. Neighbouring countries in these regions may also benefit from the Trust Fund’s projects to address regional migration flows and related cross-border challenges.

The first meeting of the Strategic Board of the EU’s Emergency Trust Fund will take place already today in Valletta to ensure the swift launch of activities.

Yesterday, in the margins of the Valletta Summit, President Juncker and High Representative / Vice-President Mogherini also signed the Common Agenda for Mobility and Migration (CAMM) with Ethiopia.

The Agenda reflects the importance of Ethiopia as a key country of origin, transit and destination of irregular migrants and refugees from the Horn of Africa on the route to Europe.

The two parties will cooperate on issues of international protection and refugees’ needs, legal migration and mobility, irregular migration, smuggling and trafficking in human beings and development policy. Funding will be made available for implementation of concrete activities, notably through the EU Emergency Trust Fund for Africa.

The Valletta Summit also adopts a political declaration and a joint action plan. The aim of the Action Plan is to step up cooperation on migration, including concrete actions in order to:
:: maximise the development benefits of migration and address root causes;
:: better organise legal channels for migration and mobility;
:: ensure international protection for migrants and asylum seekers;
:: intensify the fight against criminal networks engaged in migrant smuggling and human trafficking,
:: step up the cooperation on return and readmission.

RIGHT TO A FUTURE – Empowering refugees from Syria and host governments to face a long-term crisis
JOINT AGENCY BRIEFING PAPER 9 NOVEMBER 2015 :: 20 pages
Download full report
Signatories: Care, Danish Refugee Council, International Rescue Committee, Norwegian Refugee Council, Oxfam, Save the Children and World Vision International

Overview
With no end to the conflict in Syria in sight, the four million people forced to flee the country have no foreseeable prospect of safe return. And as the impact of the crisis on neighbouring countries grows and aid dries up, the situation for these refugees is becoming increasingly dire.
This briefing calls for a new approach by the international community, including Syria’s neighbours; one which offers hope, safety and dignity to the millions of refugees, and gives them a chance to contribute to the societies and economies of their hosts.

Excerpt
…To address the challenges facing refugees and the countries that received them, seven organizations call on international donors and refugee-hosting governments to work together on five different areas:
:: Ensuring the ‘resilience agenda’ benefits the most vulnerable. The resilience agenda should include and benefit all those affected by displacement – including refugees and vulnerable members of host communities.
:: Enabling refugees from Syria to reside in neighbouring countries legally without discrimination. Procedures to maintain valid documentation and registration must be clear, accessible, and affordable.
:: Allowing refugees from Syria to access basic services, including adequate and affordable education, medical care and housing, without compromising the quality of public services for host communities. This means significant new investment in national institutions and infrastructure to boost service delivery.
:: Supporting refugees to be more self-reliant through greater livelihoods opportunities, without negatively affecting the economies of host communities. Donors and host governments should work together to unlock the potential economic contribution that refugees can make to meet their basic needs, while also benefiting the countries where they temporarily reside.
:: Ensuring countries neighbouring Syria receive adequate support to change policies and practices to allow refugees and the communities hosting them to cope better; pending a political solution to the conflict in Syria and options for the safe return of refugees or resettlement or other forms of admission to third countries…

G20 Antalya Summit: The Elders’ letter to leaders on climate change
12 November 2015
The Elders have written to world leaders attending the G20 Summit in Antalya, Turkey. They call for strong leadership to ensure an equitable and ambitious international agreement on climate change in Paris in December.

Your excellency,
We are writing to you ahead of your meeting in Antalya with fellow G20 Heads of State on 15 and 16 November, to urge strong G20 leadership for an equitable and ambitious international agreement on climate change in Paris in December.

In September in New York, all governments agreed the Sustainable Development Goals (SDGs). We applaud your vision and leadership in concluding these Goals. Yet without a strong agreement in Paris, the SDGs will not be deliverable. Instead development gains achieved to date will be wiped out by the impacts of climate change.

This is a human rights and justice issue, not just an economic one. As we rapidly approach the tipping point beyond which climate change may become irreversible, we risk denying future generations their right to a liveable, sustainable planet.

Time and leadership are of the essence. The draft text for Paris still contains too many complex options and competing views. Your engagement as a G20 leader is thus crucial in reaching a strong, inclusive and equitable agreement at Paris.

When you meet in Turkey, we urge you to resolve with your fellow G20 heads to include these crucial elements in the Paris agreement:
:: an overarching goal for all nations to reach a state of carbon neutrality by 2050. The world’s governments agreed in 2010 to limit the increase in average global temperature rise to less than 2 degrees Celsius. But to shift investments in the real economy away from fossil fuels and into clean energy, it will be necessary to fix a precise goal and timeline in the Paris agreement;

:: a clear and strong commitment on climate finance. Public climate finance is crucial to enable developing countries to shift to clean energy production and to adapt to the impacts of climate change. Developed countries cannot simply insist that poorer countries refrain from using fossil fuels on account of climate change, but should provide feasible alternatives to enable a transition to a carbon-neutral future. Public climate finance should be new money and not a redistribution of other pledged funds. Crucially the Least Developed Countries Fund must be replenished to allow the most vulnerable countries to continue to implement urgent adaptation actions. Small Island Developing States face an existential threat from climate change and require urgent financial support to allow them to adapt and shift to renewable energy sources;

:: a mechanism that will assess collective progress and ratchet up the commitments of all countries on mitigation and adaptation every five years. The Intended Nationally Determined Contributions are an important beginning, but they will not limit global temperature rise to below 2 degrees Celsius. So the Paris agreement must be designed to increase ambition progressively over time;

:: enabling conditions for the introduction of a global carbon price. Accurately pricing carbon is crucial to accelerate development of alternative sources of energy. No clauses or protocols should be included in the Paris agreement that could negate any future decisions on carbon pricing.

Without these crucial elements in the Paris agreement, we will be unable to address climate change, and will thus fail the ultimate challenge of our globalised age. For the sake of our children and grandchildren, this cannot be allowed to happen. We urge you to rise to this challenge and to seize the opportunity to achieve sustainable growth and development, harnessing technological advances in renewable energy to create jobs, increase prosperity and end poverty.

As an African proverb says: the Earth is not ours; it is a treasure we hold in trust for our children and grand-children. We are confident you agree with us.

Trends in Maternal Mortality: 1990 to 2015
Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population
Publication date: November 2015 :: 12 pages
WHO reference number: WHO /RHR/15.23
Full report pdf, 5 MB :: Executive summary pdf, 1 MB
Millennium Development Goal (MDG) 5 Target 5A called for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. It has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data – particularly in developing-country settings where maternal mortality is high. As part of ongoing efforts, the WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division updated estimates of maternal mortality for the years 1990, 1995, 2000, 2005 and 2015.

Joint news release
Maternal deaths fell 44% since 1990 – UN
Report from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division highlights progress

12 NOVEMBER 2015 ¦ GENEVA ¦ NEW YORK – Maternal mortality has fallen by 44% since 1990, United Nations agencies and the World Bank Group reported today.
Maternal deaths around the world dropped from about 532 000 in 1990 to an estimated 303 000 this year, according to the report, the last in a series that has looked at progress under the Millennium Development Goals (MDGs). This equates to an estimated global maternal mortality ratio (MMR) of 216 maternal deaths per 100 000 live births, down from 385 in 1990.

Maternal mortality is defined as the death of a woman during pregnancy, childbirth or within 6 weeks after birth.

“The MDGs triggered unprecedented efforts to reduce maternal mortality,” said Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women’s and Children’s Health. “Over the past 25 years, a woman’s risk of dying from pregnancy-related causes has nearly halved. That’s real progress, although it is not enough. We know that we can virtually end these deaths by 2030 and this is what we are committing to work towards.”

Achieving that goal will require much more effort, according to Dr. Babatunde Osotimehin, the Executive Director of UNFPA, the United Nations Population Fund. “Many countries with high maternal death rates will make little progress, or will even fall behind, over the next 15 years if we don’t improve the current number of available midwives and other health workers with midwifery skills,” he said. “If we don’t make a big push now, in 2030 we’ll be faced, once again, with a missed target for reducing maternal deaths.”

The analyses contained in Trends in Maternal Mortality: 1990 to 2015 – Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division are being published simultaneously in the medical journal The Lancet.

Ensuring access to high-quality health services during pregnancy and child birth is helping to save lives. Essential health interventions include: practising good hygiene to reduce the risk of infection; injecting oxytocin immediately after childbirth to reduce the risk of severe bleeding; identifying and addressing potentially fatal conditions like pregnancy-induced hypertension; and ensuring access to sexual and reproductive health services and family planning for women.

Uneven gains
Despite global improvements, only 9 countries achieved the MDG 5 target of reducing the maternal mortality ratio by at least 75% between 1990 and 2015. Those countries are Bhutan, Cabo Verde, Cambodia, Iran, Lao People’s Democratic Republic, Maldives, Mongolia, Rwanda and Timor-Leste. Despite this important progress, the MMR in some of these countries remains higher than the global average.

“As we have seen with all of the health-related MDGs, health system strengthening needs to be supplemented with attention to other issues to reduce maternal deaths,” said UNICEF Deputy Executive Director, Geeta Rao Gupta. “The education of women and girls, in particular the most marginalized, is key to their survival and that of their children. Education provides them with the knowledge to challenge traditional practices that endanger them and their children.”

By the end of this year, about 99% of the world’s maternal deaths will have occurred in developing regions, with Sub-Saharan Africa alone accounting for 2 in 3 (66%) deaths. But that represents a major improvement: Sub-Saharan Africa saw nearly 45% decrease in MMR, from 987 to 546 per 100 000 live births between 1990 and 2015.
The greatest improvement of any region was recorded in Eastern Asia, where the maternal mortality ratio fell from approximately 95 to 27 per 100 000 live births (a reduction of 72%). In developed regions, maternal mortality fell 48% between 1990 and 2015, from 23 to 12 per 100 000 live births.

Working towards ending preventable maternal deaths
A new Global Strategy for Women’s, Children’s and Adolescents’ Health, launched by the UN Secretary General in September 2015, aims to help achieve the ambitious target of reducing maternal deaths to fewer than 70 per 100,000 live births globally, as included in the Sustainable Development Goals (SDGs). Reaching that goal will require more than tripling the pace of progress – from the 2.3% annual improvement in MMR that was recorded between 1990 and 2015 to 7.5% per year beginning next year.

The Global Strategy highlights the need to reinforce country leadership by mobilizing domestic and international resources for women’s, children’s and adolescents’ health. It will be important to strengthen health systems so they can provide good quality care in all settings, promote collaboration across sectors, and support individuals and communities to make informed decisions about their health and demand the quality care they need. The strategy emphasizes that special attention is imperative during humanitarian crises and in fragile settings, since maternal deaths tend to rise in these contexts.

“The SDG goal of ending maternal deaths by 2030 is ambitious and achievable provided we redouble our efforts,” said Dr Tim Evans, Senior Director of Health, Nutrition and Population at the World Bank Group. “The recently launched Global Financing Facility in Support of Every Woman Every Child, which focuses on smarter, scaled and sustainable financing, will help countries deliver essential health services to women and children.”

Need for better data
The 2015 maternal mortality estimates present the tremendous progress achieved towards the Millennium Development Goal 5 on maternal mortality reduction. They show a strong trend of reduction over the years. At the same time, we have seen more and better data coming from various countries, enhancing the accuracy of the absolute numbers reported.

Efforts to strengthen data and accountability especially over the past years have helped fuel this improvement. However, much more needs to be done to develop complete and accurate civil and vital registration systems that include births, deaths and causes of death.

Maternal death audits and reviews also need to be implemented to understand why, where and when women die and what can be done to prevent similar deaths. Since 2012, WHO, UNFPA and partners have developed Maternal Death Surveillance and Response for identification and timely notification of all maternal deaths, followed by review of their causes and the best methods of prevention. An increasing number of low- and middle-income countries are now implementing this approach.