Journal of Epidemiology & Community Health
January 2016, Volume 70, Issue 1
http://jech.bmj.com/content/current

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Editorial
The 2014–2015 Ebola saga: lessons for the future
James A Ayukekbong
Author Affiliations
Section of Clinical Virology, Redeem Biomedical System, Buea, Cameroon
Extract
The duration and characteristics of the current devastating and unprecedented Ebola epidemic highlight the need for global public health surveillance to establish preparedness mechanisms for future outbreaks. Since the discovery of the virus in 1976, at least 25 Ebola outbreaks have been recorded, on average occurring every 1.5 years with case fatality rate (CFR) between 30% and 90%.1 ,2 The largest interval between two outbreaks is 15 years, that is, from the 1979 outbreak in Sudan due to the Sudan Ebola virus and the subsequent 1994 outbreak in Gabon caused by the Zaire Ebola virus.
Remarkably, only six previous outbreaks generated >100 deaths but the approximately 11 222 deaths (as of 30 June 2015) in the ongoing epidemic is already more than seven times the number of deaths reported for all previous outbreaks combined, which is estimated to be about 1580 deaths.3 ,4 Obviously, the present epidemic is the longest, largest and most complex Ebola outbreak since the virus was first discovered about 40 years ago. The outbreak started in December 2013 in Guinea,2 spread across land borders to Sierra Leone and Liberia, and then subsequently, by some infected persons, to seven other countries (Mali, Nigeria, Senegal, Spain, the UK, Germany and the USA). In some of these countries, individuals were only diagnosed as Ebola virus disease (EVD) cases after their arrival (eg, the USA), while other countries received known patients for treatment (eg, Spain). However, in these countries, the disease was rapidly contained, thanks to improved healthcare facilities, timely patient isolation and treatment. Meanwhile, the outbreak in Guinea, Liberia and Sierra Leone continued on …

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Ebola, viewed through a lens of African epidemiology
Musa Abubakar Kana, Olufunmilayo Y Elegba, Jackie Obey, Faina Linkov, Eugene Shubnikov
J Epidemiol Community Health 2016;70:6-8 Published Online First: 5 August 2015 doi:10.1136/jech-2015-205874

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Commentary
The impact of pornography on gender-based violence, sexual health and well-being: what do we know?
Megan S C Lim1,2, Elise R Carrotte1, Margaret E Hellard1,2
Author Affiliations
1Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
2School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Introduction
As Internet access and literacy increases, pornography has become highly accessible, cheap and diverse. Online pornography use is common in the USA, with nearly 9 out of 10 men and 1 out of 3 women aged 18–26 reporting accessing pornography online.1 In June 2013, legal pornographic websites received more UK-based traffic than social networks, shopping, news and media, email, finance, gaming and travel websites.2 For example, popular pornography website ‘pornhub’ received 79 billion video views in 2014.3

Increased access to pornography online has been accompanied by rising concerns that it negatively impacts health and well-being, particularly with regard to young people. These concerns include that viewing any sexually explicit material erodes morals and that specific types of pornography, such as that depicting violence against women, leads to increased violence against women in real life. Even in the case of non-violent pornography, there is anxiety that people view pornography as ‘real’ rather than fantasy and that this negatively influences attitudes and real-life sexual behaviour, particularly when people’s sexual experience is limited such as in adolescence.4 Other concerns include the scarcity of condom use in pornography (both for diminishing condom use as a social norm and for the risks to the health of performers), impacts on body image (including trends in pubic hair removal and labiaplasty), and the harms of pornography addiction.

Despite the myriad of fears about online pornography, questions remain over its actual harm. Do viewers really imitate pornography in their own lives and does this negatively influence their health and well-being? Does watching violence in pornography lead to misogyny and gender-based violence? Are young people at greater risk of the negative effects of viewing pornography (if they exist) than older adults? In this paper, we explore the most commonly cited concerns over online pornography by …

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Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women’s groups to reduce newborn mortality in Asia and Africa
Tanja A J Houweling, Joanna Morrison, Glyn Alcock, Kishwar Azad, Sushmita Das, Munir Hossen, Abdul Kuddus, Sonia Lewycka, Caspar W Looman, Bharat Budhathoki Magar, Dharma S Manandhar, Mahfuza Akter, Albert Lazarous Nkhata Dube, Shibanand Rath, Naomi Saville, Aman Sen, Prasanta Tripathy, Anthony Costello, for the EquiNaM group
J Epidemiol Community Health 2016;70:31-41 Published Online First: 5 August 2015 doi:10.1136/jech-2014-204685
Abstract
Background
Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa.
Methods
We conducted a secondary analysis of seven randomised trials of participatory women’s groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70 574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results.
Results
Socioeconomic differences in women’s group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them.
Conclusions
Community-based women’s groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants’ convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos.