BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 9 January 2016)

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Commentary
Infection prevention and control of the Ebola outbreak in Liberia, 2014–2015: key challenges and successes
Catherine Cooper, Dale Fisher, Neil Gupta, Rose MaCauley and Carmem L. Pessoa-Silva
Published on: 5 January 2016
Abstract
Prior to the 2014–2015 Ebola outbreak, infection prevention and control (IPC) activities in Liberian healthcare facilities were basic. There was no national IPC guidance, nor dedicated staff at any level of government or healthcare facility (HCF) to ensure the implementation of best practices. Efforts to improve IPC early in the outbreak were ad hoc and messaging was inconsistent. In September 2014, at the height of the outbreak, the national IPC Task Force was established with a Ministry of Health (MoH) mandate to coordinate IPC response activities. A steering group of the Task Force, including representatives of the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), supported MoH leadership in implementing standardized messaging and IPC training for the health workforce. This structure, and the activities implemented under this structure, played a crucial role in the implementation of IPC practices and successful containment of the outbreak. Moving forward, a nationwide culture of IPC needs to be maintained through this governance structure in Liberia’s health system to prevent and respond to future outbreaks.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 9 January 2016)

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Research article
Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study
Laura B. Drew, Jeffrey P. Wilkinson, William Nundwe, Margaret Moyo, Ronald Mataya, Mwawi Mwale and Jennifer H. Tang
Published on: 5 January 2016
Abstract
Background
Obstetric fistula affects a woman’s life physically, psychosocially, and economically. Although surgery can repair the physical damage of fistula, the devastating consequences that affect a woman’s quality of life may persist when she reintegrates into her community. This qualitative study assessed long-term outcomes among women who underwent obstetric fistula repair in Malawi. We explored three domains: overall quality of life before and after repair, fertility and pregnancy outcomes after repair, and understanding of fistula.
Methods
In-depth interviews were conducted in Chichewa with 20 women from seven districts across Central Malawi. All women were interviewed 1 to 2 years after surgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. Interviews were independently coded and analyzed using content analysis.
Results
About half of women were married and nine of 20 women reported some degree of urinary incontinence. With the exception of relationship challenges, women’s concerns before and after repair were different. Additionally, repair had resolved many of the concerns women had before repair. However, challenges, both directly and indirectly related to fistula, persisted. Improvements in quality of life at the individual level included feelings of freedom, confidence and personal growth, and improved income-earning ability. Interpersonal quality of life improvements included improved relationships with family and friends, reduced stigma, and increased participation with their communities. Nearly half of women desired future pregnancies, but many were uncertain about their ability to bear children and feared additional pregnancies could cause fistula recurrence. Most women were well informed about fistula development but myths about witchcraft and fear of delivery were present. Nearly all women would recommend fistula repair to other women, and many were advocates in their communities.
Conclusions
Nearly all women believed their quality of life had improved at the individual and interpersonal levels since fistula repair, even among women who continued to have urinary incontinence. Contrary to other studies, women reported they were welcomed back by their communities and had limited challenges when reintegrating. Despite the overall improvements in quality of life, many continued to have relationship problems and were concerned about future fertility. These issues need to be further explored in other studies.

BMJ Open
2016, Volume 6, Issue 1
http://bmjopen.bmj.com/content/current

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Global health
Systematic review of the literature on viral persistence and sexual transmission from recovered Ebola survivors: evidence and recommendations
Anna Thorson1,2, Pierre Formenty1, Clare Lofthouse1, Nathalie Broutet1
Author Affiliations
1World Health Organization (WHO), Geneva, Switzerland
2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Published 7 January 2016
Abstract
Objective The main aim of this article is to present a comprehensive, systematic review on evidence of sexual transmission from Ebola survivors and persistence of Ebola virus in body fluids of relevance to sexual transmission, and additionally to review condom effectiveness against sexual transmission of Ebola.
Design We performed a systematic review of viral persistence in body fluids of relevance to sexual transmission of Ebola survivors and evidence of sexual transmission of Ebola, and carried out a targeted review of condom effectiveness.
Results We identified nine published original articles presenting results on persistence of Ebola virus in relevant body fluids, or reporting suspect sexual transmission from Ebola survivors. We also included unpublished reports from the current 2014/2015 Ebola epidemic in West Africa. We found no articles reporting on condom effectiveness, but have included a targeted review on general condom efficacy and effectiveness.
Conclusions We conclude that the risk of sexual transmission from people who have recovered from Ebola cannot be ruled out. We found the longest duration of persistent Ebola RNA in a relevant body fluid from a survivor, to be reported from a man in Sierra Leone who had reverse transcriptase PCR (RT-PCR) positive semen 284 days after symptom onset. In line with current WHO recommendations. We recommend that men are offered the possibility to test their semen regularly for presence of Ebola RNA from3 months post-symptom onset. Safe sex practices including sexual abstinence, or else condom use, are recommended by WHO until semen has tested negative twice, or in absence of testing for at least 6 months post-symptom onset. Based on evidence reviewed, we conclude that male and female latex condoms offer some protection against EBOV compared to no condom use. Survivors should be offered access to care and prevention, in order to provide them with possibilities to mitigate any risks that may occur, and efforts should be linked to destigmatising activities.

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Global health
Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries
Aaron M Kipp1,2, Meridith Blevins1,3, Connie A Haley1,2, Kasonde Mwinga4, Phanuel Habimana4, Bryan E Shepherd1,3, Muktar H Aliyu1,5, Tigest Ketsela4, Sten H Vermund1,6
Author Affiliations
1Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
2Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
4World Health Organization/Regional Office for Africa, Brazzaville, Congo
5Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
6Pediatrics Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Published 8 January 2016
Abstract
Objective Inadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013.
Setting Ecological analysis using publicly available data from the 46 nations within the WHO African Region.
Outcome measures We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models.
Results Most factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=−0.47; 95% CI −0.69 to −0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries.
Conclusions Improvements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M.

Bulletin of the World Health Organization
Volume 94, Number 1, January 2016, 1-76
http://www.who.int/bulletin/volumes/94/1/en/

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Editorials
Health systems strengthening, universal health coverage, health security and resilience
Joseph Kutzin a & Susan P Sparkes a
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2016;94:2. doi: http://dx.doi.org/10.2471/BLT.15.165050
Initial text
Global and national initiatives focused on health systems strengthening, universal health coverage, health security, and resilience suffer when these terms are not well understood or believed to be different ways of saying the same thing. Here we aim to facilitate understanding and highlight key policy considerations by identifying critical attributes of each concept and emphasizing the distinction between ends and means in health policy…

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Research
Estimating mortality using data from civil registration: a cross-sectional study in India
Mamta Gupta, Chalapati Rao, PVM Lakshmi, Shankar Prinja & Rajesh Kumar
Abstract
Objective
To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data.
Methods
We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice.
Findings
Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered.
Conclusion
The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state.

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Policy & Practice
An integrated national mortality surveillance system for death registration and mortality surveillance, China
Shiwei Liu, Xiaoling Wu, Alan D Lopez, Lijun Wang, Yue Cai, Andrew Page, Peng Yin, Yunning Liu, Yichong Li, Jiangmei Liu, Jinling You & Maigeng Zhou
Abstract
In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention’s disease surveillance points system and the Ministry of Health’s vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China’s 31 provinces using an iterative method involving multistage stratification that took into account the sociodemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time.

Development in Practice
Volume 26, Issue 1, 2016
http://www.tandfonline.com/toc/cdip20/current

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Articles
Right to information (RTI) legislation: the role of infomediaries in enhancing citizens’ access to information
DOI:10.1080/09614524.2016.1119248
Kazi Nazrul Fattah
ABSTRACT
Merely creating a legal space by enacting right to information (RTI) legislation is often not enough to ensure citizens’, especially women’s, access to information. Based on a pilot intervention on RTI implementation in Bangladesh, this article explores whether the introduction of information intermediaries, or “infomediaries”, enhances rural citizens’ access to information through using the RTI Act. It was found that due to the assisted access provided by infomediaries, the number of RTI Act users increased significantly in the intervention areas compared to the national average, with five times more women than men being able to use the Act.

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Articles
Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda
DOI:10.1080/09614524.2016.1112769
Purity Mwendwa
ABSTRACT
This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.

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Articles
The learning organisation: conditions of possibility in a feminist NGO
DOI:10.1080/09614524.2016.1118017
Jacques P. de Wet* & Jonathan Schoots
ABSTRACT
Amidst criticism of the concept of “the learning organisation” there is a perspective which is both critical of, and open to, innovative ways of developing the notion of a learning organisation. This article contributes to this perspective by examining the learning practices of a feminist NGO which operates across Southern Africa. The ways in which this NGO has interpreted the idea of a learning organisation and put it into practice are an example of a bottom-up approach which is informed by humanism. The findings of this qualitative study demonstrate both innovative possibilities for organisational learning and potential pitfalls.

Development Policy Review
January 2016 Volume 34, Issue 1 Pages i–ii, 5–174
http://onlinelibrary.wiley.com/doi/10.1111/dpr.2016.34.issue-1/issuetoc

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Original Articles
Probing for Proof, Plausibility, Principle and Possibility: A New Approach to Assessing Evidence in a Systematic Evidence Review (pages 5–27)
Anouk S. Rigterink and Mareike Schomerus
Article first published online: 13 DEC 2015 | DOI: 10.1111/dpr.12145
Abstract
This article proposes a new approach to assessing evidence during a systematic evidence review aiming to inform international development policy. Drawing lessons from a number of social science systematic evidence reviews, the article identifies how the method’s limiting perspective on evidence (including the exclusive focus on ‘gold standard’ empirical information) has serious disadvantages for the usability of evidence reviews for policy. This article aims to provide an alternative framework that allows for a less exclusionary, yet policy-practical, way of assessing evidence. We propose four perspectives on evidence, appropriate for different stages in the policy process: principle when setting or prioritising broad policy goals, plausibility when assessing specific future policies, proof when evaluating past policies and possibility when striving for innovation and allowing exchange of ideas.

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100 key research questions for the post-2015 development agenda (pages 55–82)
Johan A. Oldekop, Lorenza B. Fontana, Jean Grugel, Nicole Roughton, Emmanuel A. Adu-Ampong, Gemma K. Bird, Alex Dorgan, Marcia A. Vera Espinoza, Sara Wallin, Daniel Hammett, Esther Agbarakwe, Arun Agrawal, Nurgul Asylbekova, Clarissa Azkoul, Craig Bardsley, Anthony J. Bebbington, Savio Carvalho, Deepta Chopra, Stamatios Christopoulos, Emma Crewe, Marie-Claude Dop, Joern Fischer, Daan Gerretsen, Jonathan Glennie, William Gois, Mtinkheni Gondwe, Lizz A. Harrison, Katja Hujo, Mark Keen, Roberto Laserna, Luca Miggiano, Sarah Mistry, Rosemary J. Morgan, Linda L. Raftree, Duncan Rhind, Thiago Rodrigues, Sonia Roschnik, Flavia Senkubuge, Ian Thornton, Simon Trace, Teresa Ore, René Mauricio Valdés, Bhaskar Vira, Nicola Yeates and William J. Sutherland
Article first published online: 13 DEC 2015 | DOI: 10.1111/dpr.12147
Abstract
The Sustainable Development Goals (SDGs) herald a new phase for international development. This article presents the results of a consultative exercise to collaboratively identify 100 research questions of critical importance for the post-2015 international development agenda. The final shortlist is grouped into nine thematic areas and was selected by 21 representatives of international and non-governmental organisations and consultancies, and 14 academics with diverse disciplinary expertise from an initial pool of 704 questions submitted by 110 organisations based in 34 countries. The shortlist includes questions addressing long-standing problems, new challenges and broader issues related to development policies, practices and institutions. Collectively, these questions are relevant for future development-related research priorities of governmental and non-governmental organisations worldwide and could act as focal points for transdisciplinary research collaborations.

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Big Data for Development: A Review of Promises and Challenges (pages 135–174)
Martin Hilbert
Article first published online: 13 DEC 2015 | DOI: 10.1111/dpr.12142
Abstract
The article uses a conceptual framework to review empirical evidence and some 180 articles related to the opportunities and threats of Big Data Analytics for international development. The advent of Big Data delivers a cost-effective prospect for improved decision-making in critical development areas such as healthcare, economic productivity and security. At the same time, the well-known caveats of the Big Data debate, such as privacy concerns and human resource scarcity, are aggravated in developing countries by long-standing structural shortages in the areas of infrastructure, economic resources and institutions. The result is a new kind of digital divide: a divide in the use of data-based knowledge to inform intelligent decision-making. The article systematically reviews several available policy options in terms of fostering opportunities and minimising risks

The European Journal of Public Health
Volume 25, Issue 6, 1 December 2015
http://eurpub.oxfordjournals.org/content/25/6

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Editorials
Categorizations of migrants and ethnic minorities—are they useful for decisions on public health interventions?
Allan Krasnik
DOI: http://dx.doi.org/10.1093/eurpub/ckv177 907
Extract
Decisions regarding population-based preventive interventions require convincing measures of health and risks. Is it justified to initiate special community programs on diabetes prevention among migrants on the basis of a higher prevalence of diabetes than in the non-migrant population? Even as we know that diabetes is not a problem for the majority of the migrants? And that diabetes is also a problem for many non-migrants—however less prevalent? Relative risks and differences in prevalence of risks and diseases between groups are often used to justify such new programs for selected groups and communities based on certain characteristics such as ethnicity, migrant status, family situation or socio-economic position.
Mulinari et al.1 question the use of broad categorizations as instruments for predicting individual health problems using the area of ethnicity, migration and health as an example, and warn against the practice of only including measures of association in the consideration of public health interventions. Instead, these kinds of measures should always be reported together with measures of discriminatory accuracy…

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Editor’s Choice
Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden
Shai Mulinari, Anna Bredström, Juan Merlo
DOI: http://dx.doi.org/10.1093/eurpub/ckv099 911-917
Abstract
Background: Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
Design, setting and participants: We analyzed 27 723 individuals aged 18–80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
Results: Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
Conclusions: Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.

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How do economic crises affect migrants’ risk of infectious disease? A systematic-narrative review
Alexander Kentikelenis, Marina Karanikolos, Gemma Williams, Philipa Mladovsky, Lawrence King, Anastasia Pharris, Jonathan E. Suk, Angelos Hatzakis, Martin McKee, Teymur Noori, David Stuckler
DOI: http://dx.doi.org/10.1093/eurpub/ckv151 937-944 First published online: 28 August 2015
Abstract
Background: It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs.
Methods: We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research.
Results: The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases, and that economic crises and subsequent responses have tended to exacerbate such risks. Recessions lead to unemployment, impoverishment and other risk factors that can be linked to the transmissibility of disease among migrants. Austerity measures that lead to cuts in prevention and treatment programmes further exacerbate infectious disease risks among migrants. Non-governmental health service providers occasionally stepped in to cater to specific populations that include migrants.
Conclusions: There is evidence that migrants are especially vulnerable to infectious disease during economic crises. Ring-fenced funding of prevention programs, including screening and treatment, is important for addressing this vulnerability.

Food Security
Volume 7, Issue 6, December 2015
http://link.springer.com/journal/12571/7/6/page/1

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Editorial
Introduction to the special section “Food Trade Relations of the Middle East and North Africa with Countries of the Tropics: Opportunities and Risks of South-South Cooperation”
Jordi Bacaria, Karim El Aynaoui, Eckart Woertz
Initial text
We are very pleased to present this special section in Food Security. Its papers were first presented at the conference “Tropical Agriculture as “Last Frontier’? Food Import Needs
of the Middle East and North Africa, Ecological Risks and New Dimensions of South-South Cooperation with Africa, Latin America and South-East Asia.” The conference was jointly held in Barcelona on 29–30 January 2015 together with our co-organizers, King’s College, London (KCL), the Getulyo Vargas Foundation in Sao Paolo and Wageningen University.

The special section is one of the latest products of the strategic partnership between CIDOB, the Barcelona Center for International Relations, and the OCP Policy Center in Rabat, a partnership that has been effective since 2010. Both institutions have embarked on a joint project on food security and agriculture, covering key areas such as food politics, tropical “agriculturalization”, climate change mitigation, development cooperation, as well as socio-cultural, institutional and gender aspects of water and food security. The choice of these topics is testimony to the importance our partners attribute to agriculture and food security as strategic fields as well as game changers in development discourse and practice…

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 9 January 2016]

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Editorial
Envisioning a Global Health Partnership Movement
Andrew Jones
Globalization and Health201612:1
DOI: 10.1186/s12992-015-0138-4
Published: 6 January 2016
Initial text
“A universal truth: No health without a workforce” was the rallying cry of the flagship report commissioned by the Global Health Workforce Alliance Secretariat and the World Health Organization [1] and one which must be embraced if the aspiration for universal health coverage is ever to be realised [2]. One in seven people will never see a qualified health worker in their lives. The world will be short of 12.9 million health-care workers by 2035. The figures speak for themselves. It has never been clearer that there has to be a major global effort to recruit, educate and train health workers.
As the international development community prepare for the delivery of the next set of development goals, focus must include a meaningful revitalisation of the concept of partnership and a shift from short-term global interests to strengthening systems in low and middle-income countries. The Sustainable Development Goals call on new forms of partnership that speak to co-development rather than traditional models of international development – mutuality, co-learning and a recognition that we gain as much as we give by working through partnerships. It is time for donors and governments to look beyond monetary contributions to also consider what resources, expertise and technology that, if shared, could result in mutual benefit. In this sense, health partnerships offer a vision of the way in which learning and knowledge-exchange will take place in the future…

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 9 January 2016]

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Research
Mapping the use of research to support strategies tackling maternal and child health inequities: evidence from six countries in Africa and Latin America
Emily Vargas, Victor Becerril-Montekio, Miguel Gonzalez-Block, Patricia Akweongo, Cynthia Hazel, Maria Cuembelo, Felix Limbani, Wanderley Bernardo, Fernando Muñoz
Published: 7 January 2016
Abstract
Background
Striving to foster collaboration among countries suffering from maternal and child health (MCH) inequities, the MASCOT project mapped and analyzed the use of research in strategies tackling them in 11 low- and middle-income countries. This article aims to present the way in which research influenced MCH policies and programs in six of these countries – three in Africa and three in Latin America.
Methods
Qualitative research using a thematic synthesis narrative process was used to identify and describe who is producing what kind of research, how research is funded, how inequities are approached by research and policies, the countries’ research capacities, and the type of evidence base that MCH policies and programs use. Four tools were designed for these purposes: an online survey for researchers, a semi-structured interview with decision makers, and two content analysis guides: one for policy and programs documents and one for scientific articles.
Results
Three modalities of research utilization were observed in the strategies tackling MCH inequities in the six included countries – instrumental, conceptual and symbolic. Instrumental utilization directly relates the formulation and contents of the strategies with research results, and is the least used within the analyzed policies and programs. Even though research is considered as an important input to support decision making and most of the analyzed countries count five or six relevant MCH research initiatives, in most cases, the actual impact of research is not clearly identifiable.
Conclusions
While MCH research is increasing in low- and middle-income countries, the impact of its outcomes on policy formulation is low. We did not identify a direct relationship between the nature of the financial support organizations and the kind of evidence utilization within the policy process. There is still a visible gap between researchers and policymakers regarding their different intentions to link evidence and decision making processes.

IDRiM Journal
Vol 5, No 2 (2015)
http://idrimjournal.com/index.php/idrim/issue/view/14

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Systems Approach to Management of Disasters – A Missed Opportunity?
Slobodan P Simonovic
Abstract
Everyday life is overwhelmed by critical phenomena that occur on specific spatial and temporal scales. Typical examples are floods, landslides, storm surges, and similar. All these phenomena might have, whenever they occur, significant negative consequences for human lives. They often result from complex dynamics involving interaction of innumerable system parts within three major systems: (i) the physical environment; (ii) the social and demographic characteristics of the communities that experience them; and (iii) the buildings, roads, bridges, and other components of the constructed environment. In nonscientific terms, such events are commonly referred to as disasters. Proper management in the face of a natural disaster necessitates a transformation of attitude towards integration of economic, social and environmental concerns related to disasters, and of the actions necessary to deal with them.
Recent trends in confronting disasters include consideration of the entire region under threat, explicit consideration of all costs and benefits, elaboration of a large number of alternatives to reduce the damages, and the greater participation of all stakeholders in decision-making. Systems approaches based on simulation, optimization, and multi-objective analyses have great potential for providing appropriate support for effective disaster management in this emerging context.
The systems approach to managing disasters outlines proven strategies for pooling interdisciplinary resources more efficiently to boost emergency responses. Looking at the disaster management practice, with primary focus on Canada, this paper explores the question of why advances in systems theory have failed on a broader scale to majorly transform management of disasters. The paper identifies whether and how that knowledge and systems science can be deployed to improve disaster management in the face of rapid climate destabilization so that sustainability becomes the norm, not the occasional success story.

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Estimation of Alternative Ports for Container Transport after Large-scale Disasters – Estimation Method and Application to Port-BCPs –
Yasuhiro Akakura, Kenji Ono, Tomihiro Watanabe, Hiroshi Kawamura

International Journal of Sustainable Development & World Ecology
Volume 23, Issue 2, 2016
http://www.tandfonline.com/toc/tsdw20/current

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Original Articles
The victims of unsustainability: a challenge to sustainable development goals
DOI:10.1080/13504509.2015.1111269
Helen Kopnina*ab
pages 113-121
Abstract
Environmental unsustainability is due to both structural features and historically specific characteristics of industrial capitalism resulting in specific patterns of production and consumption, as well as population growth. Sustainability literature criticises the established corporate and political power hegemonies, interested in maintaining economic growth, as well as inability or unwillingness of citizen-consumers to counteract these hegemonic tendencies. Yet, official policies are still targeted at social and economic ‘development’ as a panacea for unsustainability challenges. Instead, renewed accent on social and economic objectives are outlined by a set of sustainable development goals (SDG) that include objectives of fighting poverty, promoting better health, reducing mortality, and stimulating equitable economic growth. What is less commonly critiqued is the underlying morality of unsustainability and ethical questions concerned with the ‘victims of unsustainability’ outside of socioeconomic discourse. The achievement of SDG goals, as will be further elaborated on in this article, is unlikely to lead to greater social equality and economic prosperity, but to a greater spread of unsustainable production and consumption, continuous economic as well as population growth that has caused environmental problems in the first place and further objectification of environment and its elements. This article argues that an invocation of ethical duty toward environment and its elements is required in order to move beyond the current status quo. Such ethical approach to unsustainability can effectively address the shortcomings of the mainstream sustainability discourse that is mainly anthropocentric and therefore fails to identify the correct locus of unsustainability.

JAMA
January 5, 2016, Vol 315, No. 1
http://jama.jamanetwork.com/issue.aspx

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Research Letter | January 5, 2016
Subsequent Maltreatment in Children With Disabilities After an Unsubstantiated Report for Neglect
Caroline J. Kistin, MD, MSc1; Martha C. Tompson, PhD2; Howard J. Cabral, PhD3; Robert D. Sege, MD, PhD4; Michael R. Winter, MPH5; Michael Silverstein, MD, MPH1
Author Affiliations
JAMA. 2016;315(1):85-87. doi:10.1001/jama.2015.12912.
Extract
This cohort study uses data from the US National Child Abuse and Neglect Data System to examine the incidence and timing of re-referral of children with disabilities to child protective services after an initial referral for neglect in fiscal years 2008 through 2012.
Children with disabilities are at increased risk for maltreatment,1,2 and neglect accounts for the majority of such cases.3 Although most cases of suspected neglect are unsubstantiated at the time of the initial report to child protective services (CPS),4 meaning there is insufficient legal evidence of maltreatment, these children are at risk for subsequent maltreatment.5

JAMA Pediatrics
January 2016, Vol 170, No. 1
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint | January 2016
Harnessing Social Media for Child Health Research – Pediatric Research 2.0
Kurt R. Schumacher, MD, MS1; Joyce M. Lee, MD, MPH2,3
Author Affiliations
JAMA Pediatr. 2016;170(1):5-6. doi:10.1001/jamapediatrics.2015.2696.

Extract
This Viewpoint reviews both the opportunities and the challenges of using social media to obtain condition-specific, patient-reported data.
The term social media refers to the forms of electronic communication that enable users to create or share content with others, and these forms of electronic communication are nearly universal in the adolescent pediatric population, with more than 90% of teens 12 to 17 years of age reporting use of some form of social media.1 Facebook is still the dominant social network, but adolescents are using other channels, including Twitter, Instagram, and private messaging applications.1 With the widespread adoption of any new technology, including social media, there will likely be consequences for child health outcomes. The majority of pediatric research has focused on the potential harms (ie, a proliferation of research studies that have evaluated the adverse effects of social media on outcomes including sexting, cyberbullying, depression, and substance abuse).2,3 These represent important contributions to the literature but neglect the possible opportunities that social media bring to the research enterprise, including disease-specific investigations relevant to both pediatric generalists and subspecialists, because only a handful of pediatric studies have focused on specific medical conditions.2 The use of social media in child health research is in its infancy; we believe that social media hold great promise as a research tool to be leveraged across the entire child health research continuum, especially given that electronic resources are by far the most common media used by teens seeking health information.4 We review both the opportunities and the challenges of using social media to obtain condition-specific, patient-reported data…

 Journal of Human Trafficking
Volume 1, Issue 4, 2015
http://www.tandfonline.com/toc/uhmt20/current

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Articles
Project Backpage: Using Text Messaging to Initiate Outreach Support for Victims of Human Trafficking and Sexual Exploitation
pages 259-274
Gordon A. Gow, Timothy Barlott, Kathleen Quinn, Jacqui Linder, Andrea Soler, Gillian Edwards & Samina Hossain
Abstract
The sex industry occurs in many venues, ranging from the highly visible survival sex trade on the street to venues such as regulated massage parlors and strip clubs, to less visible escort agencies making use of hotel venues, and the highly invisible exploitation that occurs through trick pads and microbrothels operating out of homes, apartments, or condos. In many communities, outreach efforts have focused primarily on direct face-to-face contact with individuals in the survival sex trade. However, in recent years, there has been a marked decrease in the street survival sex trade as the use of the Internet to buy and sell sites has become widespread. In this article, we describe the design and outcome of a multiphase community-university collaboration in Edmonton, Canada, to explore the use of Short Message Service (SMS) text messaging to initiate outreach with individuals advertising on the adult services section of the Web site Backpage.com. The article describes the impetus behind the project, the project goals and design, as well as results thus far. We also reflect on the results and present a set of emerging best practices, including the contribution of two-way text-based interaction for establishing trust between outreach organizations and the individuals seeking support. Overall, results from the project provide evidence to show that SMS is a cost-effective and important complementary communication strategy for outreach organizations seeking to initiate outreach to victims of human trafficking and sexual exploitation.

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Fighting Human Trafficking Through Transit Monitoring: A Data-Driven Model Developed in Nepal
Jonathan Hudlow a*
DOI:10.1080/23322705.2015.1098521 pages 275-295
Published online: 08 Dec 2015
Abstract
Transit monitoring is an innovative approach to fighting human trafficking that involves identifying and intercepting potential victims of human trafficking before they are exploited. In doing so, it relies upon established indicators of trafficking, local staff with special training, and data from a customized human-trafficking fusion center. As an anti-trafficking strategy, it provides tangible impact on the dollar, and, by focusing on trafficking as it is occurring, it creates otherwise rare opportunities for engagement. Among these is the opportunity for gathering actionable intelligence on traffickers, which can then be used in proactive investigations. Intervening prior to the exploitation phase of trafficking also presents a number of exceptional challenges from navigating situations with inconclusive evidence to ensuring that interceptions do not infringe upon the human rights of migrants. Transit monitoring has developed as an anti-trafficking strategy through the work of nongovernmental organizations in Nepal, where a unique combination of factors created an urgent need for such an approach. Initial efforts have been made to replicate the model in India and Bangladesh, and there is reason to believe that transit monitoring could be an effective strategy for fighting human trafficking in many other countries as well.

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Understanding the Support Needs of Human-Trafficking Victims: A Review of Three Human-Trafficking Program Evaluations
pages 318-337
Deanna Davy
DOI:10.1080/23322705.2015.1090865
Abstract
Human trafficking is a global crime and human rights violation that affects nearly every country of the world. Victims of human trafficking may suffer severe physical, psychological, and emotional health consequences as they are often subjected to a range of abuses such as physical violence, sexual assault, emotional abuse, mind-control, and torture. A variety of human-trafficking victim support programs exist in the United States and other countries that receive human-trafficking victims to support their immediate and longer-term needs. There is a dearth of contemporary literature on the subject of the support needs of human-trafficking victims. Further, due to a lack of publicly available program evaluations, little is also known about whether victim support programs are able to meet the needs of human-trafficking victims. This article aims to bridge a gap in knowledge and understanding of human-trafficking victims’ support needs and whether they are being met by support programs by reviewing three recent U.S.-based human-trafficking victim support program evaluations.

The Lancet
Jan 09, 2016 Volume 387 Number 10014 p95-198 e1-e8
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Zika virus: a new global threat for 2016
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00014-3
Summary
Concerns about the threat posed to global health security by Zika virus are escalating, with new outbreaks reported in Central and South America. Locally transmitted (autochthonous) cases of Zika have now been detected in Colombia, El Salvador, Guatemala, Mexico, Paraguay, Puerto Rico, and Venezuela. The first five autochthonous cases detected in Suriname are reported in Correspondence online, with complete coding of the Zika virus sequence for one patient, and envelope protein coding sequences for three others.

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Comment
Civil–military cooperation in Ebola and beyond
Adam Kamradt-Scott, Sophie Harman, Clare Wenham, Frank Smith III
DOI: http://dx.doi.org/10.1016/S0140-6736(15)01128-9
Summary
The 2014 Ebola outbreak in west Africa blurred the lines between a public health emergency and humanitarian crisis. In so doing, it highlighted serious problems with coordinating disaster responses. Civilian agencies were overwhelmed; several non-government organisations closed down their operations and exited the affected countries; and, although the health sector in Liberia stepped up, Sierra Leone and Guinea remained in disarray. Since then WHO declared Sierra Leone to be Ebola free on Nov 7, 2015,1 and declared the end of human-to-human transmission of Ebola virus in Guinea on Dec 29, 2015.

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Series
Antimicrobials: access and sustainable effectiveness
Access to effective antimicrobials: a worldwide challenge
Ramanan Laxminarayan, Precious Matsoso, Suraj Pant, Charles Brower, John-Arne Røttingen, Keith Klugman, Sally Davies

Antimicrobials: access and sustainable effectiveness
Understanding the mechanisms and drivers of antimicrobial resistance
Alison H Holmes, Luke S P Moore, Arnfinn Sundsfjord, Martin Steinbakk, Sadie Regmi, Abhilasha Karkey, Philippe J Guerin, Laura J V Piddock

Antimicrobials: access and sustainable effectiveness
Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries
Marc Mendelson, John-Arne Røttingen, Unni Gopinathan, Davidson H Hamer, Heiman Wertheim, Buddha Basnyat, Christopher Butler, Göran Tomson, Manica Balasegaram
Summary
Access to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. The key global enablers of sustainable financing, governance, and leadership will be necessary to achieve access while preventing excess antimicrobial use.

The Lancet Infectious Diseases
Jan 2016 Volume 16 Number 1 p1-130 e1-e9
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Measles immunisation: time to close the gap
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00504-6
Summary
Since the beginning of the century, the number of measles-related deaths has fallen substantially; between 2000 and 2014 mass immunisation efforts prevented an estimated 17·1 million deaths worldwide, and the number of cases decreased from 146 to 40 per million. Unfortunately, after this decrease the situation has stagnated and many countries are falling far behind the 2015 elimination targets according to a report by WHO and the US Centers for Disease Control and Prevention (CDC) released in November, 2015.

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Comment
Duration of immune responses after Ebola virus vaccination
Open Access
Steven B Bradfute
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00408-9
Summary
In The Lancet Infectious Diseases, Milagritos Tapia and colleagues1 address two important facets of Ebola virus immunity: longevity of vaccine-induced immune responses and correlates of immunity. Early attempts at Ebola virus vaccines on the basis of traditional methods, such as inactivated preparations and subunit vaccines, were not effective in animal studies2 (although later publications on these platforms are more promising3). Subsequent studies used a wide diversity of vaccine platforms that had not been used in approved human vaccines, such as non-pathogenic viral vectors engineered to express Ebola virus surface glycoprotein.

Articles
Use of ChAd3-EBO-Z Ebola virus vaccine in Malian and US adults, and boosting of Malian adults with MVA-BN-Filo: a phase 1, single-blind, randomised trial, a phase 1b, open-label and double-blind, dose-escalation trial, and a nested, randomised, double-blind, placebo-controlled trial
Milagritos D Tapia, Samba O Sow, Kirsten E Lyke, Fadima Cheick Haidara, Fatoumata Diallo, Moussa Doumbia, Awa Traore, Flanon Coulibaly, Mamoudou Kodio, Uma Onwuchekwa, Marcelo B Sztein, Rezwanul Wahid, James D Campbell, Marie-Paule Kieny, Vasee Moorthy, Egeruan B Imoukhuede, Tommy Rampling, Francois Roman, Iris De Ryck, Abbie R Bellamy, Len Dally, Olivier Tshiani Mbaya, Aurélie Ploquin, Yan Zhou, Daphne A Stanley, Robert Bailer, Richard A Koup, Mario Roederer, Julie Ledgerwood, Adrian V S Hill, W Ripley Ballou, Nancy Sullivan, Barney Graham, Myron M Levine
Open Access
Summary
Background
The 2014 west African Zaire Ebola virus epidemic prompted worldwide partners to accelerate clinical development of replication-defective chimpanzee adenovirus 3 vector vaccine expressing Zaire Ebola virus glycoprotein (ChAd3-EBO-Z). We aimed to investigate the safety, tolerability, and immunogenicity of ChAd3-EBO-Z in Malian and US adults, and assess the effect of boosting of Malians with modified vaccinia Ankara expressing Zaire Ebola virus glycoprotein and other filovirus antigens (MVA-BN-Filo).
Methods
In the phase 1, single-blind, randomised trial of ChAd3-EBO-Z in the USA, we recruited adults aged 18–65 years from the University of Maryland medical community and the Baltimore community. In the phase 1b, open-label and double-blind, dose-escalation trial of ChAd3-EBO-Z in Mali, we recruited adults 18–50 years of age from six hospitals and health centres in Bamako (Mali), some of whom were also eligible for a nested, randomised, double-blind, placebo-controlled trial of MVA-BN-Filo. For randomised segments of the Malian trial and for the US trial, we randomly allocated participants (1:1; block size of six [Malian] or four [US]; ARB produced computer-generated randomisation lists; clinical staff did randomisation) to different single doses of intramuscular immunisation with ChAd3-EBO-Z: Malians received 1 × 1010 viral particle units (pu), 2·5 × 1010 pu, 5 × 1010 pu, or 1 × 1011 pu; US participants received 1 × 1010 pu or 1 × 1011 pu. We randomly allocated Malians in the nested trial (1:1) to receive a single dose of 2 × 108 plaque-forming units of MVA-BN-Filo or saline placebo. In the double-blind segments of the Malian trial, investigators, clinical staff, participants, and immunology laboratory staff were masked, but the study pharmacist (MK), vaccine administrator, and study statistician (ARB) were unmasked. In the US trial, investigators were not masked, but participants were. Analyses were per protocol. The primary outcome was safety, measured with occurrence of adverse events for 7 days after vaccination. Both trials are registered with ClinicalTrials.gov, numbers NCT02231866 (US) and NCT02267109 (Malian).
Findings
Between Oct 8, 2014, and Feb 16, 2015, we randomly allocated 91 participants in Mali (ten [11%] to 1 × 1010 pu, 35 [38%] to 2·5 × 1010 pu, 35 [38%] to 5 × 1010 pu, and 11 [12%] to 1 × 1011 pu) and 20 in the USA (ten [50%] to 1 × 1010 pu and ten [50%] to 1 × 1011 pu), and boosted 52 Malians with MVA-BN-Filo (27 [52%]) or saline (25 [48%]). We identified no safety concerns with either vaccine: seven (8%) of 91 participants in Mali (five [5%] received 5 × 1010 and two [2%] received 1 × 1011 pu) and four (20%) of 20 in the USA (all received 1 × 1011 pu) given ChAd3-EBO-Z had fever lasting for less than 24 h, and 15 (56%) of 27 Malians boosted with MVA-BN-Filo had injection-site pain or tenderness.
Interpretation
1  × 1011 pu single-dose ChAd3-EBO-Z could suffice for phase 3 efficacy trials of ring-vaccination containment needing short-term, high-level protection to interrupt transmission. MVA-BN-Filo boosting, although a complex regimen, could confer long-lived protection if needed (eg, for health-care workers).
Funding
Wellcome Trust, Medical Research Council UK, Department for International Development UK, National Cancer Institute, Frederick National Laboratory for Cancer Research, Federal Funds from National Institute of Allergy and Infectious Diseases.

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Personal View
The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans
Jacqueline Deen, Lorenz von Seidlein, Francisco J Luquero, Christopher Troeger, Rita Reyburn, Anna Lena Lopez, Amanda Debes, David A Sack
Summary
Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists. The supply of licensed, WHO-prequalified cholera vaccines is not sufficient to meet endemic and epidemic needs worldwide and so prioritisation is needed. We have developed a scenario approach to systematically classify situations in which oral cholera vaccination might be useful. Our scenario approach distinguishes between five types of cholera epidemiology based on experiences from around the world and provides evidence that we hope will spur the development of detailed guidelines on how and where oral cholera vaccines could, and should, be most rationally deployed.

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The Ebola Vaccine Team B: a model for promoting the rapid development of medical countermeasures for emerging infectious disease threats
Michael Osterholm, Kristine Moore, Julie Ostrowsky, Kathleen Kimball-Baker, Jeremy Farrar, Wellcome Trust-CIDRAP Ebola Vaccine Team B
Summary
In support of accelerated development of Ebola vaccines from preclinical research to clinical trials, in November, 2014, the Wellcome Trust and the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota established the Wellcome Trust-CIDRAP Ebola Vaccine Team B initiative. This ongoing initiative includes experts with global experience in various phases of bringing new vaccines to market, such as funding, research and development, manufacturing, determination of safety and efficacy, regulatory approval, and vaccination delivery. It also includes experts in community engagement strategies and ethical issues germane to vaccination policies, including eight African scientists with direct experience in developing and implementing vaccination policies in Africa. Ebola Vaccine Team B members have worked on a range of vaccination programmes, such as polio eradication (Africa and globally), development of meningococcal A disease vaccination campaigns in Africa, and malaria and HIV/AIDS vaccine research. We also provide perspective on how this experience can inform future situations where urgent development of vaccines is needed, and we comment on the role that an independent, expert group such as Team B can have in support of national and international public health authorities toward addressing a public health crisis.

Nature
Volume 529 Number 7584 pp6-122 7 January 2016
http://www.nature.com/nature/current_issue.html

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Letter
Influence of extreme weather disasters on global crop production
Corey Lesk, Pedram Rowhani & Navin Ramankutty
Abstract
In recent years, several extreme weather disasters have partially or completely damaged regional crop production1, 2, 3, 4, 5. While detailed regional accounts of the effects of extreme weather disasters exist, the global scale effects of droughts, floods and extreme temperature on crop production are yet to be quantified. Here we estimate for the first time, to our knowledge, national cereal production losses across the globe resulting from reported extreme weather disasters during 1964–2007. We show that droughts and extreme heat significantly reduced national cereal production by 9–10%, whereas our analysis could not identify an effect from floods and extreme cold in the national data. Analysing the underlying processes, we find that production losses due to droughts were associated with a reduction in both harvested area and yields, whereas extreme heat mainly decreased cereal yields. Furthermore, the results highlight ~7% greater production damage from more recent droughts and 8–11% more damage in developed countries than in developing ones. Our findings may help to guide agricultural priorities in international disaster risk reduction and adaptation efforts.

New England Journal of Medicine
January 7, 2016 Vol. 374 No. 1
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Effect of Artesunate–Amodiaquine on Mortality Related to Ebola Virus Disease
Etienne Gignoux, M.P.H., Andrew S. Azman, Ph.D., Martin de Smet, M.D., Philippe Azuma, M.D., Moses Massaquoi, M.D., Dorian Job, M.D., Amanda Tiffany, M.P.H., Roberta Petrucci, M.D., Esther Sterk, M.D., M.I.H., Julien Potet, M.D., Motoi Suzuki, M.D., Andreas Kurth, Ph.D., Angela Cannas, Ph.D., Anne Bocquin, M.Sc., Thomas Strecker, Ph.D., Christopher Logue, Ph.D., Thomas Pottage, B.Sc., Constanze Yue, Ph.D., Jean-Clement Cabrol, M.D., Micaela Serafini, M.D., M.P.H., and Iza Ciglenecki, M.D.
N Engl J Med 2016; 374:23-32 January 7, 2016 DOI: 10.1056/NEJMoa1504605
Abstract
Background
Malaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systeomatically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether–lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate–amodiaquine; amodiaquine is a compound with anti–Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.
Full Text of Background…
Methods
We fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate–amodiaquine (artesunate–amodiaquine group), as compared with those who were prescribed artemether–lumefantrine (artemether–lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).
Full Text of Methods…
Results
Between June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether–lumefantrine and 71 were prescribed artesunate–amodiaquine. The characteristics of the patients in the artesunate–amodiaquine group were similar to those in the artemether–lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether–lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate–amodiaquine group (50.7%). In adjusted analyses, the artesunate–amodiaquine group had a 31% lower risk of death than the artemether–lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.
Full Text of Results…
Conclusions
Patients who were prescribed artesunate–amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether–lumefantrine. However, our analyses cannot exclude the possibility that artemether–lumefantrine is associated with an increased risk of death or that the use of artesunate–amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.

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Original Article
Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea
Johan van Griensven, M.D., Ph.D., Tansy Edwards, M.Sc., Xavier de Lamballerie, M.D., Ph.D., Malcolm G. Semple, M.D., Ph.D., Pierre Gallian, Ph.D., Sylvain Baize, Ph.D., Peter W. Horby, M.D., Ph.D., Hervé Raoul, Ph.D., N’Faly Magassouba, Ph.D., Annick Antierens, M.D., Carolyn Lomas, M.D., Ousmane Faye, Ph.D., Amadou A. Sall, Ph.D., Katrien Fransen, M.Sc., Jozefien Buyze, Ph.D., Raffaella Ravinetto, Pharm.D., Pierre Tiberghien, M.D., Ph.D., Yves Claeys, M.Sc., Maaike De Crop, M.Sc., Lutgarde Lynen, M.D., Ph.D., Elhadj Ibrahima Bah, M.D., Peter G. Smith, D.Sc., Alexandre Delamou, M.D., Anja De Weggheleire, M.D., and Nyankoye Haba, M.Sc. for the Ebola-Tx Consortium
N Engl J Med 2016; 374:33-42 January 7, 2016 DOI: 10.1056/NEJMoa1511812
Abstract
Background
In the wake of the recent outbreak of Ebola virus disease (EVD) in several African countries, the World Health Organization prioritized the evaluation of treatment with convalescent plasma derived from patients who have recovered from the disease. We evaluated the safety and efficacy of convalescent plasma for the treatment of EVD in Guinea.
Full Text of Background…
Methods
In this nonrandomized, comparative study, 99 patients of various ages (including pregnant women) with confirmed EVD received two consecutive transfusions of 200 to 250 ml of ABO-compatible convalescent plasma, with each unit of plasma obtained from a separate convalescent donor. The transfusions were initiated on the day of diagnosis or up to 2 days later. The level of neutralizing antibodies against Ebola virus in the plasma was unknown at the time of administration. The control group was 418 patients who had been treated at the same center during the previous 5 months. The primary outcome was the risk of death during the period from 3 to 16 days after diagnosis with adjustments for age and the baseline cycle-threshold value on polymerase-chain-reaction assay; patients who had died before day 3 were excluded. The clinically important difference was defined as an absolute reduction in mortality of 20 percentage points in the convalescent-plasma group as compared with the control group.
Full Text of Methods…
Results
A total of 84 patients who were treated with plasma were included in the primary analysis. At baseline, the convalescent-plasma group had slightly higher cycle-threshold values and a shorter duration of symptoms than did the control group, along with a higher frequency of eye redness and difficulty in swallowing. From day 3 to day 16 after diagnosis, the risk of death was 31% in the convalescent-plasma group and 38% in the control group (risk difference, −7 percentage points; 95% confidence interval [CI], −18 to 4). The difference was reduced after adjustment for age and cycle-threshold value (adjusted risk difference, −3 percentage points; 95% CI, −13 to 8). No serious adverse reactions associated with the use of convalescent plasma were observed.
Full Text of Results…
Conclusions
The transfusion of up to 500 ml of convalescent plasma with unknown levels of neutralizing antibodies in 84 patients with confirmed EVD was not associated with a significant improvement in survival. (Funded by the European Union’s Horizon 2020 Research and Innovation Program and others; ClinicalTrials.gov number, NCT02342171.)

Oxford Monitor of Forced Migration
OxMo – Vol. 5, No. 2
http://oxmofm.com/current-issue/

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Academic Article
State responsibility for international cooperation on migration control: the case of Australia
Nikolas Feith Tan
This article examines international cooperation on migration control with particular reference to the case of Australia, a state that has entered into a range of migration control and asylum processing arrangements with neighbouring developing countries. The article defines such arrangements, designed to prevent access to asylum, as cooperative non-entrée. In the past 15 years, Australia has developed a far-reaching cooperative nonentrée regime with countries of origin and transit. These extraterritorial cooperation arrangements challenge the reach of human rights and refugee law. The article considers two avenues to hold Australia internationally responsible for human rights and refugee law violations in the course of cooperative non-entrée practices, namely extraterritorial human rights jurisdiction and complicity under the law of State Responsibility. The article concludes that despite the extraterritorial and international character of cooperative nonentrée, Australia is not beyond the reach of international law.

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Policy Monitor
On encampment and gendered vulnerabilities: a critical analysis of the UK’s vulnerable persons relocation scheme for Syrian refugees
Lewis Turner
This paper offers a critical analysis of the UK’s Vulnerable Persons Relocation scheme for Syrian refugees, arguing that its focus on  refugee camps is neither reflective of the realities of refugeehood for Syrians in the Middle East, nor in line with developments in UNHCR
policy. In its substance and presentation, the scheme exploits gendered notions of vulnerability, allowing the UK to position itself as a defender of the helpless in camps, while simultaneously reinforcing its attempts to depict refugees and migrants in Europe as
‘threatening’, and to resist their resettlement in the UK.

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Syrian informal tented settlements in Jordan: humanitarian gaps and challenges
Alex Odlum
Syrian refugees in Jordan have predominantly rented accommodation in urban and periurban areas or relied on humanitarian assistance channelled through formal camps. Yet, faced with unaffordable rents and living costs in Jordanian towns, the unsuitability of remote refugee camps, and the prospect of etching out a living through informal agricultural labour, over 16,000 Syrians have resorted to living in informal tented settlements (ITS) across rural Jordan. This article draws attention to the neglected plight of Syrian ITS in Jordan, analyses the Jordanian Government’s policy response to the expansion of ITS, and calls for stronger humanitarian as well as legal support to vulnerable ITS dwellers.

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Law Monitor
Forced displacement as a war crime in non-international armed conflicts under the ICC Statute: exploring the horizons of a wider interpretation complimenting international humanitarian law
Anubhav Dutt Tiwara
Forced displacement has become a regular feature of non-international armed conflicts pointing towards the fragrant violation of international humanitarian law (IHL) by parties to the conflicts. The paper addresses the war crime of forced displacement in internal armed conflicts under the Statute of the International Criminal Court and advances the argument that the provision must be interpreted against the background of IHL principles. Such wider interpretation not only fulfills the legal obligation to interpret the treaty in good faith, but may act as a deterrent to armed actors in such conflict, and thus prove beneficial for the effective protection of civilians during internal armed conflicts.