IRCT [to 4 April 2015]
http://www.irct.org/

Statements & declarations
Fundamental rights in the EU: Where to next?
30 March 2015
(This opinion piece was originally published in the EUobserver and signed by: AGE Platform Europe; European Disability Forum; European Network Against Racism; European Youth Forum; European Women’s Lobby; ILGA-Europe – the European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association; International Rehabilitation Council for Torture Victims; Save the Children EU Office and Social Platform. To read the article in the EUobserver click here.)

The nomination – for the first time – of a Vice-President of the European Commission in charge of fundamental rights gave rise to high expectations among citizens and human rights organisations in the European Union. It triggered hopes that the European Union would finally make the respect of fundamental rights enshrined in the EU treaties a priority, not just outside the European Union but also within its borders. We hope the European Commission will live up to these expectations…

MSF/Médecins Sans Frontières [to 4 April 2015]
http://www.doctorswithoutborders.org/news-stories/press/press-releases

Selected Press Releases/Field News
Press release
MSF Medical Team Helps Treat More Than 70 Wounded in Kenya Garissa University Attack
April 03, 2015
In response to the April 2 attack on Garissa University a Doctors Without Borders/Médecins Sans Frontières (MSF) medical team is providing support to the Kenyan Ministry of Health at Garissa Hospital. Currently, MSF is treating survivors of the attack suffering from gunshot and blast wounds, as well as people who sustained cut injuries from shattered glass during their escape.

Field News
Restoring Public Health Services in Liberia
April 02, 2015
While the number of Ebola-infected patients in Liberia has steadily declined, MSF is assisting the local health system to safely restore medical services.

Press release
Yemen: Medical Supplies and Personnel Unable to Reach Conflict Areas
March 31, 2015
SANA’A/PARIS—More medical supplies and trained health personnel are urgently needed in Yemen as the violence there escalates, but with air and sea transport obstructed, it is currently impossible to bring in this essential support, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Press release
Yemen: MSF Treats 34 Wounded After Airstrike on Camp for Displaced People
March 30, 2015
More than two dozen people injured in an airstrike today at a displaced persons camp in northern Yemen have been treated by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), the organization announced.

Mercy Corps [to 4 April 2015]
http://www.mercycorps.org/press-room/releases

Press Releases
Colombia: Mercy Corps Receives $750,000 Grant from Starbucks Foundation to Support Coffee Farmers in Rural Colombia
April 2, 2015
Washington, DC — Global humanitarian organization Mercy Corps has received a $750,000 grant from the Starbucks Foundation to boost food security, formalize property rights and improve sustainable water and land management for more than 1,000 coffee growing families in Southern Tolima, Colombia. Working with coffee farmers in Colombia since 2013, Mercy Corps will expand its reach and impact to an additional 5,000 people by 2016 thanks to support from Starbucks Foundation.

OXFAM [to 4 April 2015]
http://www.oxfam.org/en/pressroom/pressreleases
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Billions in “out of control” IFC investments into third-parties causing human rights abuses around the world
2 April 2015
IFC investment portfolio in financial intermediaries grows to $36 billion in four years – three times as much as World Bank global education lending – needs urgent reform
The International Finance Corporation has little accountability for billions of dollars’ worth of investments into banks, hedge funds and other financial intermediaries, resulting in projects that are causing human rights abuses around the world.
The claim is part of a new report by Oxfam International and other NGOs, released a week before the World Bank Spring meetings. “The Suffering of Others” says that the IFC (the World Bank’s private sector lending arm) is failing to perform due diligence and to identify or effectively manage risk in many of its investments in third-party lenders…

Partners In Health [to 4 April 2015]
http://www.pih.org/blog

Apr 01, 2015
PIH Mexico Expands to Two New Sites in Chiapas
CES (Compaňeros En Salud, PIH’s sister organization in Mexico) partners with Mexico’s Ministry of Health to recruit and train young doctors, who manage public clinics throughout Chiapas during their social service year. The first-year doctors, or pasantes, have conducted more than 45,000 patient visits in eight communities throughout the southeastern state since CES began providing services there in 2012. CES expanded to Letrero and Monterrey in February, pushing its reach farther into the surrounding Sierra Madre mountains.

PATH [to 4 April 2015]
http://www.path.org/news/index.php

Announcement | April 01, 2015
Laos launches national Japanese encephalitis vaccination campaign
National launch signifies PATH’s decade-long work to bring a lifesaving vaccine to at-risk countries

SOS-Kinderdorf International [to 4 April 2015]
http://www.sos-childrensvillages.org/about-sos/press/press-releases

Advocacy success: Child protection and care system reforms passed in Lithuania
03.04.2015 – Through the Care for ME! campaign, SOS Children’s Villages Lithuania has successfully advocated for child protection and care system reforms to better protect and promote the rights of Lithuanian children who have lost, or risk losing, parental care…

EHLRA/R2HC [to 4 April 2015]
http://www.elrha.org/news/elrha

FUNDING ALERT! Call for Large Grant applications is open.
The Humanitarian Innovation Fund supports organisations and individuals to identify, nurture and share innovative and scalable solutions to the challenges facing effective humanitarian assistance.

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UKCDS Ebola Research Database
31.03.2015
The UKCDS Ebola Research Database contains information on all current academic research relevant to Ebola that we have been informed about.

Global Fund [to 4 April 2015]
http://www.theglobalfund.org/en/mediacenter/newsreleases/

01 April 2015
Global Fund Affirms Commitment to Resilient Health Systems
GENEVA – Members of the Board of the Global Fund called for accelerated efforts to build resilient health systems that can contribute to ending AIDS, tuberculosis and malaria as epidemics.
At a Board meeting, several members stressed the need to support countries in strengthening health systems, at a national level and also at a community level, with the entire Global Fund partnership working together to achieve resilience and sustainability in health systems…
There is broad recognition that the Ebola crisis in West Africa drew increased attention to the importance of health systems.
Prof. Onyebuchi Chukwu, former Minister of Health of Nigeria, spoke about how his country relied with great success on health systems that were built to respond to polio in combating Ebola. He also stressed the importance of community involvement and participation.
The Global Fund has been investing in health systems since its beginning, both in investments that are channelled through disease-specific grants as well as through grants that are solely on strengthening health systems.
Mark Dybul, Executive Director of the Global Fund, said more than a third of the Global Fund’s investments go to strengthening health systems in the countries and communities where programs treat, prevent and care for those affected by HIV, TB and malaria. Dr. Dybul said that health systems will be best sustained and strengthened where investments are firmly anchored within communities.
At its two-day meeting which closed today, the Board also approved a framework for financing co-infections and co-morbidities of HIV/AIDS, TB and malaria…

Global Fund Board Selects New Chair and Vice-Chair
01 April 2015
GENEVA – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria selected Norbert Hauser, a former Member of Parliament and international auditor from Germany, as its new Chair and also named Aida Kurtovic of Bosnia and Herzegovina as Vice-Chair. Both began serving a two-year term today…

ODI [to 4 April 2015]
http://www.odi.org/media
Press Releases
International aid earmarked for saving forests in Brazil and Indonesia dwarfed by billions spent on subsidies for palm oil, soy and beef industries that cause deforestation – new report
News – 30 March 2015

Research Reports and Studies
Establishing a workable follow-up and review process for the Sustainable Development Goals
Research reports and studies, April 2015
Shannon Kindornay and Sarah Twigg
This paper rounds up the current content and politics of the debate on accountability in the post-2015 agenda. http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/9588.pdf

Securing communities: redefining community policing to achieve results
Research reports and studies, April 2015
Lisa Denney
This synthesis paper draws together findings from ODI’s ‘Securing communities’ project, which attempted to map the diversity of practices that fall under the remit of community policing, examine how community policing is shaped in different contexts and probe the plausibility of many of the objectives ascribed to the approach.

Doing legal empowerment differently: learning from pro-poor litigation in Bangladesh
Research reports and studies, March 2015
Tam O’Neil, Craig Valters and Cynthia Farid
This study documents two cases of successful public interest litigation in Bangladesh in order to explore the conditions that favour, and constrain, pro-poor mobilisation. It forms part of ODI’s ongoing efforts to document approaches and ways of working that make a difference in terms of achieving development results.

The rising cost of a healthy diet: Changing relative prices of foods in high-income and emerging economies
Research reports and studies, March 2015
Steve Wiggins and Sharada Keats with Euan Han, Satoru Shimokawa, Joel Alberto Vargas Hernández and Rafael Moreira Claro
This report investigates the prices of different foods in some of the rapidly-growing emerging economies, where incomes have risen notably in the last 20 years. We ask what effect this has had on growing rates of overweight and obesity and if policy changes, taxes and subsidies could reverse this trend.

Jobs for the future
Research reports and studies, March 2015
Claudia Pompa
This report deals with perhaps one of the most pressing issues facing employers and employees, students and teachers, politicians and experts today: what and where are tomorrow’s jobs and what skills will they require?

Start Network [to 4 April 2015]
http://www.start-network.org/news-blog/#.U9U_O7FR98E
[Consortium of British Humanitarian Agencies]

Start Fund provides £100,000 for Tanzania flood response
March 30, 2015
Posted by Tegan Rogers in News.

Last week the Start Fund disbursed £100,000 for response to the recent flooding in Tanzania. A local project selection committee composed of Start Network member agency staff met in Dar es Salaam on Saturday 21 March and agreed to award the funds to Oxfam and World Vision, who will work together to help 3,573 crisis affected people.
The Start Fund was alerted on March 18 by World Vision, following heavy rain and storms in Tanzania earlier in the month which have severely affected the Northwest of the country. The ACAPS briefing note produced following the alert described how the floods have affected up to 5000 people in three villages in Kahama district, Shinyanga region…

Open Society Foundation [to 4 April 2015]
http://www.opensocietyfoundations.org/termsearch/8175/listing?f[0]=type%3Anews

An Action Plan to Strengthen the Execution of European Human Rights Rulings
March 27, 2015 News
NEW YORK—Six civil society groups, including the Open Society Justice Initiative, have set out an action plan for member states of the Council of Europe (CoE), aimed at improving how they carry out the judgments of the European Court of Human Rights (ECHR).

The action plan, with ten specific proposals, was issued after a high-level meeting of CoE member states in Brussels which set a deadline of June 2016 to improve the execution of ECHR judgments….

American Journal of Infection Control
April 2015 Volume 43, Issue 4, p313-422
http://www.ajicjournal.org/current

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APIC 2015 opening plenary to feature thought-provoking panel discussion on Ebola: Music City Center in Nashville, TN, June 27-29, 2015
p313
The APIC 2015 Annual Conference, June 27-29 in Nashville, represents the most comprehensive infection prevention meeting in the world, complete with infection prevention experts, cutting-edge education, an exhibit hall showcasing the latest innovations, and vibrant networking events.

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Handling Europe’s first Ebola case: Internal hospital communication experience
Margarita Mosquera, MD, PhD, MPH, Victoria Melendez, PhD, Pello Latasa, MD, MPH
Published Online: February 24, 2015
Highlights
– Media communication plays an important role in a public health crisis to alarm or reassure the population.
– Internal hospital communication needs to be clear, science-based, and understandable.
– Health care workers are benchmarks for the rest of the population as a trusted source.
– Institutional communication preparedness reducing crisis response time will help social media and networks to convey reassuring coverage.
Abstract
Europe’s first Ebola virus disease (EVD) case was diagnosed in our hospital. There was an unjustified panic in the population because of an imbalance of credibility assigned to the media as opposed to scientific information. A reinforcement of hospital internal communication was needed to keep health care workers informed with up-to-date scientific EVD information. The proactive management of information flow to both internal and external actors is required to reduce unjustified fear within the public.

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Disinfecting personal protective equipment with pulsed xenon ultraviolet as a risk mitigation strategy for health care workers
Chetan Jinadatha, MD, MPH, Sarah Simmons, BS, MPH, Charles Dale, BA, Nagaraja Ganachari-Mallappa, PhD, Frank Charles Villamaria, MPH, Nicole Goulding, BS, Benjamin Tanner, PhD, Julie Stachowiak, PhD, Mark Stibich, MHS, PhD
Open Access
DOI: http://dx.doi.org/10.1016/j.ajic.2015.01.013
Highlights
– We determined the effectiveness of pulsed xenon ultraviolet against an Ebola surrogate virus on a dry inanimate surface.
– We determined the effectiveness of pulsed xenon ultraviolet against personal protective equipment material inoculated with an Ebola surrogate virus.
– We determined the level of ultraviolet exposure for a person wearing personal protective equipment.
– We described the distribution of germicidal light coverage on personal protective equipment.
Abstract
The doffing of personal protective equipment (PPE) after contamination with pathogens such as Ebola poses a risk to health care workers. Pulsed xenon ultraviolet (PX-UV) disinfection has been used to disinfect surfaces in hospital settings. This study examined the impact of PX-UV disinfection on an Ebola surrogate virus on glass carriers and PPE material to examine the potential benefits of using PX-UV to decontaminate PPE while worn, thereby reducing the pathogen load prior to doffing. Ultraviolet (UV) safety and coverage tests were also conducted. PX-UV exposure resulted in a significant reduction in viral load on glass carriers and PPE materials. Occupational Safety and Health Administration–defined UV exposure limits were not exceeded during PPE disinfection. Predoffing disinfection with PX-UV has potential as an additive measure to the doffing practice guidelines. The PX-UV disinfection should not be considered sterilization; all PPE should still be considered contaminated and doffed and disposed of according to established protocols.

American Journal of Tropical Medicine and Hygiene
April 2015; 92 (4)
http://www.ajtmh.org/content/current

Direct Killing of Patients in Humanitarian Situations and Armed Conflicts: The Profession of Medicine is Losing Its Meaning
Ramin Asgary*
Author Affiliations
Departments of Population Health and Medicine, New York University School of Medicine, New York, New York
Author Notes
Address correspondence to Ramin Asgary, New York University School of Medicine, 227 E 30th St., New York, NY 10016. E-mail: ramin.asgary@caa.columbia.edu
Abstract
During armed conflicts over the past several years, attacks on humanitarian workers and patients have increased, including the most recent overt killing of patients in their hospital beds in South Sudan and Central African Republic, and bombardments of hospitals in Iraq, Syria, and other countries. Direct attacks on patients inside hospitals, as well as social structural dynamics that undermine patient safety and security, are met with apparent indifference by international and medical communities. How can the medical profession remain silent and stand by while these factors render its core mission futile? In this article, I aim to shed light on this issue, and its implications for the future of the neutral and impartial provision of medical care; provide an analysis of underlying and contributing factors; discuss current international strategies; reflect on the responsibility of health providers; explore ways to strengthen our roles as physician advocates; and call for the medical profession to do more to protect medicine’s core values.

American Journal of Tropical Medicine and Hygiene
April 2015; 92 (4)
http://www.ajtmh.org/content/current

Costs of Dengue to the Health System and Individuals in Colombia from 2010 to 2012
Raul Castro Rodriguez*, Katia Galera-Gelvez, Juan Guillermo López Yescas and Jorge A. Rueda-Gallardo
Author Affiliations
Department of Economics, Universidad de los Andes, Bogotá, Colombia; Sanofi Pasteur Latin America, Mexico DF, Mexico
Abstract.
Dengue fever (DF) is an important health issue in Colombia, but detailed information on economic costs to the healthcare system is lacking. Using information from official databases (2010–2012) and a face-to-face survey of 1,483 households with DF and dengue hemorrhagic fever (DHF) patients, we estimated the average cost per case. In 2010, the mean direct medical costs to the healthcare system per case of ambulatory DF, hospitalized DF, and DHF (in Colombian pesos converted to US dollars using the average exchange rate for 2012) were $52.8, $235.8, and $1,512.2, respectively. The mean direct non-medical costs to patients were greater ($29.7, $46.7, and $62.6, respectively) than the mean household direct medical costs ($13.3, $34.8, and $57.3, respectively). The average direct medical cost to the healthcare system of a case of ambulatory DF in 2010 was 57% of that in 2011. Our results highlight the high economic burden of the disease and could be useful for assigning limited health resources.

American Journal of Tropical Medicine and Hygiene
April 2015; 92 (4)
http://www.ajtmh.org/content/current

Geographic Variation of Female Genital Mutilation and Legal Enforcement in Sub-Saharan Africa: A Case Study of Senegal
Ngianga-Bakwin Kandala* and Paul N. Komba
Author Affiliations
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Populations, Evidence and Technologies Group, Warwick Evidence, Coventry, United Kingdom; Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Wolfson College, Centre of African Studies, University of Cambridge, Cambridge, United Kingdom
Author Notes
Authors’ addresses: Ngianga-Bakwin Kandala, Division of Health Sciences, University of Warwick Medical School, Coventry, UK, and Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, E-mail: N-B.Kandala@warwick.ac.uk. Paul N. Komba, Wolfson College, Centre of African Studies, University of Cambridge, Cambridge, UK, E-mail: pk261@cam.ac.uk.
Address correspondence to Ngianga-Bakwin Kandala, Division of Health Sciences, University of Warwick Medical School, Medical School Building, Gibbet Hill Campus, Coventry CV4 7AL, United Kingdom. E-mail: N-B.Kandala@warwick.ac.uk
Abstract.
This paper draws on household data to examine the prevalence of female genital mutilation (FGM) in Senegal and the effectiveness of the country’s anti-FGM law in dealing with actual breaches and providing protection to the victims. The 2010–2011 Senegal Demographic Health Survey and Multiple Indicators Cluster Survey (SDHS-MICS) covers 14,228 women and their daughters. Logistic regression was used to investigate the geographic distribution of FGM across regions. For the enforceability of anti-FGM, desk research was used. Overall prevalence among women and daughters was 28.1% and 6.2%, respectively. Significant factors were sociodemographics, ethnicity, and region. This analysis shows both advantages and vulnerabilities of the anti-FGM law in relation to the issue of enforcement. It indicates that the law falls short of offering adequate protection to potential victims. FGM is a cultural and social norm imbedded predominantly in rural settings and as such, drives resistance to jettisoning FGM. Legislation has been one of the driving forces behind the eradication of the practice.

American Journal of Tropical Medicine and Hygiene
April 2015; 92 (4)
http://www.ajtmh.org/content/current
The “Performance of Rotavirus and Oral Polio Vaccines in Developing Countries” (PROVIDE) Study: Description of Methods of an Interventional Study Designed to Explore Complex Biologic Problems
Beth D. Kirkpatrick*, E. Ross Colgate, Josyf C. Mychaleckyj, Rashidul Haque, Dorothy M. Dickson, Marya P. Carmolli, Uma Nayak, Mami Taniuchi, Caitlin Naylor, Firdausi Qadri, Jennie Z. Ma, Masud Alam, Mary Claire Walsh, Sean A. Diehl, the PROVIDE Study Teams and William A. Petri Jr.
Author Affiliations
Department of Medicine and Vaccine Testing Center, The University of Vermont College of Medicine, Burlington, Vermont; Departments of Medicine, The University of Virginia, Charlottesville, Virginia; The icddr,b, Dhaka, Bangladesh
Abstract.
Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 4 April 2015)

Research article
Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker’s perspective
Amani Flexson Shao123*, Clotilde Rambaud-Althaus12, Ndeniria Swai4, Judith Kahama-Maro4, Blaise Genton125, Valerie D’Acremont125 and Constanze Pfeiffer12
* Corresponding author: Amani F Shao shaotz@gmail.com
Author Affiliations
BMC Health Services Research 2015, 15:135 doi:10.1186/s12913-015-0805-4
Published: 2 April 2015
Abstract (provisional)
Background
The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. Methods
A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker’s perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified.
Results
In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient’s trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices.
Conclusions
The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 4 April 2015)

Research article
Cost of installing and operating an electronic clinical decision support system for maternal health care: case of Tanzania rural primary health centres
Happiness Pius Saronga14*, Maxwell Ayindenaba Dalaba24, Hengjin Dong3, Melkizedeck Leshabari1, Rainer Sauerborn4, Felix Sukums14, Antje Blank4, Jens Kaltschmidt4 and Svetla Loukanova4
Author Affiliations
BMC Health Services Research 2015, 15:132 doi:10.1186/s12913-015-0780-9
Published: 2 April 2015
Abstract (provisional)
Background
Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a “know-do gap” where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. Methods
This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations.
Results
Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations.
Conclusions
Our study presents financial and economic cost estimates of installing and operating an electronic CDSS for maternal health care in six rural health centres. From these findings one can understand exactly what goes into a similar investment and thus determine sorts of input modification needed to fit their context.

British Medical Journal
04 April 2015(vol 350, issue 8002)
http://www.bmj.com/content/350/8002

Research
Avoidable waste of research related to inadequate methods in clinical trials
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h809 (Published 24 March 2015) Cite this as: BMJ 2015;350:h809
Youri Yordanov, physician and PhD student12, Agnes Dechartres, researcher134, Raphaël Porcher, associate professor134, Isabelle Boutron, professor1345, Douglas G Altman, professor and director6, Philippe Ravaud, professor and director13457
Author affiliations
Abstract
Objective
To assess the waste of research related to inadequate methods in trials included in Cochrane reviews and to examine to what extent this waste could be avoided. A secondary objective was to perform a simulation study to re-estimate this avoidable waste if all trials were adequately reported.
Design
Methodological review and simulation study.
Data sources
Trials included in the meta-analysis of the primary outcome of Cochrane reviews published between April 2012 and March 2013.
Data extraction and synthesis
We collected the risk of bias assessment made by the review authors for each trial. For a random sample of 200 trials with at least one domain at high risk of bias, we re-assessed risk of bias and identified all related methodological problems. For each problem, possible adjustments were proposed that were then validated by an expert panel also evaluating their feasibility (easy or not) and cost. Avoidable waste was defined as trials with at least one domain at high risk of bias for which easy adjustments with no or minor cost could change all domains to low risk. In the simulation study, after extrapolating our re-assessment of risk of bias to all trials, we considered each domain rated as unclear risk of bias as missing data and used multiple imputations to determine whether they were at high or low risk.
Results
Of 1286 trials from 205 meta-analyses, 556 (43%) had at least one domain at high risk of bias. Among the sample of 200 of these trials, 142 were confirmed as high risk; in these, we identified 25 types of methodological problem. Adjustments were possible in 136 trials (96%). Easy adjustments with no or minor cost could be applied in 71 trials (50%), resulting in 17 trials (12%) changing to low risk for all domains. So the avoidable waste represented 12% (95% CI 7% to 18%) of trials with at least one domain at high risk. After correcting for incomplete reporting, avoidable waste due to inadequate methods was estimated at 42% (95% CI 36% to 49%).
Conclusions
An important burden of wasted research is related to inadequate methods. This waste could be partly avoided by simple and inexpensive adjustments.