Center for Global Development [to 20 February 2016]
http://www.cgdev.org/page/press-center
Selected Press Releases, Blog Posts, Publications

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Middle-Class Heroes: The Best Guarantee of Good Governance
2/16/16
Nancy Birdsall
The two economic developments that have garnered the most attention in recent years are the concentration of massive wealth in the richest one percent of the world’s population and the tremendous, growth-driven decline in extreme poverty in the developing world, especially in China. But just as important has been the emergence of large middle classes in developing countries around the planet. This phenomenon—the result of more than two decades of nearly continuous fast-paced global economic growth—has been good not only for economies but also for governance. After all, history suggests that a large and secure middle class is a solid foundation on which to build and sustain an effective, democratic state. Middle classes not only have the wherewithal to finance vital services such as roads and public education through taxes; they also demand regulations, the fair enforcement of contracts, and the rule of law more generally—public goods that create a level social and economic playing field on which all can prosper.

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Next Generation Financing for Global Health: What, Why, When, How?
2/16/16
Amanda Glassman and Rachel Silverman
Many researchers and policymakers have hypothesized that funding models tying grant payments to achieved and verified results — next generation financing models — offer an opportunity for global health funders to push forward their strategic interests and accelerate the impact of their investments. This brief, summarizing the conclusions of a CGD working group on the topic, outlines concrete steps global health funders can take to change the basis of payment of their grants from expenses (inputs) to outputs, outcomes, or impact.

ODI [to 20 February 2016]
http://www.odi.org/media

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News | 17 February 2016
Anti-migration policies do not stop people making the decision to migrate to Europe – new report
New research from the Overseas Development Institute suggests European anti-migration policies have limited impact on a migrant’s decision to embark on dangerous, lengthy and expensive journeys in search of a better life

Budget support to Uganda 1998-2012: a review
Briefing papers | February 2016 | Tim Williamson, Fiona Davies, Imran Aziz, Edward Hedger
This paper provides a critical appraisal of the suspended budget support programme in Uganda, highlighting important lessons for the donor community.

Climate resilience and financial services
Working and discussion papers | February 2016 | Anna Haworth, Camille Frandon-Martinez, Virginie Fayolle and Catherine Simonet
This BRACED working paper provides a high-level overview of the context and structure of the financial services sector in three BRACED countries; Ethiopia, Mali and Myanmar.

The political economy of voter engagement in Niger
Research reports and studies | February 2016 | Aoife McCullough, Abdoutan Harouna and Hamani Oumarou with Yaye Djingarey Zaratou Idi Mamadou, Maman Noura, Sadjo Aissa and Abdouramane Magagi Kabo
Based on research carried out in three regions of Niger, this briefing explores how political parties and candidates engage with Nigerien voters.

Collective action and the deployment of teachers in Niger: a political economy analysis
Research reports and studies | February 2016 | Clare Cummings and Ali Bako M. Tahirou with Hamissou Rhissa, Falmata Hamed, Hamadou Goumey, and Idi Mahamadou Mamane Noura
This briefing paper explores causes of inequitable teacher deployment in Niger and asks whether collective action might be the solution.

What is impact?
Working and discussion papers | February 2016 | Simon Hearn and Anne Buffardi
How ‘impact’ is defined and used has a significant effect on the design, management and evaluation of development programmes.

Aga Khan Foundation [to 20 February 2016]
http://www.akdn.org/pr.asp

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12 February 2016
Reducing Risk and Preparing Communities for Disasters in Tajikistan and Kyrgyzstan Republics of Central Asia
– Hazard Vulnerability and Risk Assessments (HVRAs) have been completed in 339 villages in GBAO and Naryn town, reaching approximately 400,000 individuals and 139 organizations, through the DIPECHO project “Fostering Disaster Resilient Communities in Isolated Mountain Environments”…

…The eighth phase of the project has been successfully completed, which stems from an agreement between the European Commission’s Humanitarian Aid Department (ECHO) under the auspices of its Disaster Preparedness Program (DIPECHO) and Aga Khan Foundation (AKF) United Kingdom. The ninth phase of the project is due to commence in February 2016.

FOCUS, MSDSP and AKF through the DIPECHO project reduces risk, develops sustainable solutions and promotes widespread systemic changes in risk reduction policy making at the local and national levels in Tajikistan and Kyrgyzstan. Strengthening the capacity of Disaster Risk Management (DRM) and educational institutions increases the ability to assess and prepare for natural hazards and to respond more effectively to emergencies.

Conrad N. Hilton Foundation [to 20 February 2016]
http://www.hiltonfoundation.org/news

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New Release
Continuing our Commitment to Ending Homelessness: Board Approves Phase II of Strategic Initiative
By Andrea Iloulian, February 17, 2016

Over the past 25 years, the Conrad N. Hilton Foundation has supported efforts to end long-term homelessness across the nation. We have sought to advance compassionate and cost-effective solutions to homelessness, awarding more than $90 million in grants—primarily by advancing the permanent supportive housing model since 1990.

At the close of 2015, our board approved the second phase of our strategy—an additional five-year commitment to begin in January 2016…

MacArthur Foundation [to 20 February 2016]
http://www.macfound.org/

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Publication
Fewer Women Ages 65 and Over Living Alone
Published February 18, 2016
A report by the Pew Research Center, conducted in partnership with the MacArthur Foundation Research Network on an Aging Society, finds the share of older Americans who live alone has fallen 3% since 1990, largely because women ages 65 to 84 are increasingly likely to live with their spouse or their children. The report attributes this trend to an increase in life expectancy, especially among men, which has made it more likely that older women would be living with their spouses rather than as widows.

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Publication
$18M in Grants to Advance Public Interest Technology
Published February 16, 2016
In a joint commitment to uncover new ways the Internet can be used to foster learning and promote justice, MacArthur and the Ford, Knight, Open Society, and Mozilla foundations have committed a combined $18M in grants to strengthen the emerging field of public interest technology. The grants will support a range of initiatives from fellowships that bring technology into journalism, science, and public policy, to a program that partners with civil society and government organizations to explore how technologies impact civil liberties, civil rights, and consumer protection matters. The NetGain partners also released their first report detailing opportunities and best practices for others to join the movement to build and expand public interest technology.

Pew Charitable Trusts [to 20 February 2016]
http://www.pewtrusts.org/en/about/news-room/press-releases

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Statement
Pew Applauds Designation of National Monuments in California Desert
‘Momentous action’ protects the Mojave Trails, Sand to Snow, and Castle Mountains regions
February 12, 2016
Note: On Feb. 12, 2016, President Barack Obama designated three new national monuments in the California desert, encompassing nearly 1.8 million acres.
WASHINGTON—The Pew Charitable Trusts today praised the Obama administration’s designation of three new national monuments in the California desert: Mojave Trails, along historic Route 66 between Needles and Barstow; Sand to Snow, northwest of Palm Springs; and Castle Mountains, on the Nevada border south of Las Vegas. Mojave Trails is the largest land monument designated by President Barack Obama.

Mike Matz, director of Pew’s U.S. public lands program, released the following statement:
“President Obama’s designation of the most expansive national monuments of his administration is a momentous action with positive implications for local economies, threatened historic and cultural areas, and migrating wildlife. We applaud the president’s thoughtful use of authority granted to him by Congress under the Antiquities Act to safeguard Mojave Trails, Sand to Snow, and Castle Mountains…

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Opinion
The Transparency That Public Pensions Need
Pension investments are increasingly complex, but disclosure standards have not kept pace
February 16, 2016

American Journal of Public Health
Volume 106, Issue 3 (March 2016)
http://ajph.aphapublications.org/toc/ajph/current

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AJPH LAW & ETHICS
EBOLA VACCINE
Ethical Rationale for the Ebola “Ring Vaccination” Trial Design
Annette Rid, Franklin G. Miller
American Journal of Public Health: March 2016, Vol. 106, No. 3: 432–435.
Abstract |
The 2014 Ebola virus epidemic is the largest and most severe ever recorded. With no approved vaccines or specific treatments for Ebola, clinical trials were launched within months of the epidemic in an unprecedented show of global partnership. One of these trials used a highly innovative “ring vaccination” design. The design was chosen for operational, scientific, and ethical reasons—in particular, it was regarded as ethically superior to individually randomized placebo-controlled trials.

We scrutinize the ethical rationale for the ring vaccination design. We argue that the ring vaccination design is ethical but fundamentally equivalent to placebo-controlled designs with respect to withholding a potentially effective intervention from the control group.
We discuss the implications for the ongoing ring vaccination trial and future research.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 20 February 2016)

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Research article
Evaluating a complex model designed to increase access to high quality primary mental health care for under-served groups: a multi-method study
Christopher Dowrick, Peter Bower, Carolyn Chew-Graham, Karina Lovell, Suzanne Edwards, Jonathan Lamb, Katie Bristow, Mark Gabbay, Heather Burroughs, Susan Beatty, Waquas Waheed, Mark Hann and Linda Gask
BMC Health Services Research 2016 16:58
Published on: 17 February 2016
Abstract
Background
Many people with mental distress are disadvantaged because care is not available or does not address their needs. In order to increase access to high quality primary mental health care for under-served groups, we created a model of care with three discrete elements: community engagement, primary care training and tailored wellbeing interventions. We have previously demonstrated the individual impact of each element of the model. Here we assess the effectiveness of the combined model in increasing access to and improving the quality of primary mental health care. We test the assumptions that access to the wellbeing interventions is increased by the presence of community engagement and primary care training; and that quality of primary mental health care is increased by the presence of community engagement and the wellbeing interventions.
Methods
We implemented the model in four under-served localities in North-West England, focusing on older people and minority ethnic populations. Using a quasi-experimental design with no-intervention comparators, we gathered a combination of quantitative and qualitative information. Quantitative information, including referral and recruitment rates for the wellbeing interventions, and practice referrals to mental health services, was analysed descriptively. Qualitative information derived from interview and focus group responses to topic guides from more than 110 participants. Framework analysis was used to generate findings from the qualitative data.
Results
Access to the wellbeing interventions was associated with the presence of the community engagement and the primary care training elements. Referrals to the wellbeing interventions were associated with community engagement, while recruitment was associated with primary care training. Qualitative data suggested that the mechanisms underlying these associations were increased awareness and sense of agency. The quality of primary mental health care was enhanced by information gained from our community mapping activities, and by the offer of access to the wellbeing interventions. There were variable benefits from health practitioner participation in community consultative groups. We also found that participation in the wellbeing interventions led to increased community engagement.
Conclusions
We explored the interactions between elements of a multilevel intervention and identified important associations and underlying mechanisms. Further research is needed to test the generalisability of the model.
Trial registration
Current Controlled Trials, reference ISRCTN68572159. Registered 25 February 2013.

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Research article
Maternal mental health in primary care in five low- and middle-income countries: a situational analysis
Emily C. Baron, Charlotte Hanlon, Sumaya Mall, Simone Honikman, Erica Breuer, Tasneem Kathree, Nagendra P. Luitel, Juliet Nakku, Crick Lund, Girmay Medhin, Vikram Patel, Inge Petersen, Sanjay Shrivastava and Mark Tomlinson
BMC Health Services Research 2016 16:53
Published on: 16 February 2016
Abstract
Background
The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care.
Methods
The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness.
Results
Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3–50 %) and alcohol consumption during pregnancy (5–51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community.
Conclusions
It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 20 February 2016)

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Research article
Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review
K. E. Gallagher, E. Kadokura, L. O. Eckert, S. Miyake, S. Mounier-Jack, M. Aldea, D. A. Ross and D. Watson-Jones
BMC Public Health 2016 16:172
Published on: 19 February 2016
Abstract
Background
Completion of multiple dose vaccine schedules is crucial to ensure a protective immune response, and maximise vaccine cost-effectiveness. While barriers and facilitators to vaccine uptake have recently been reviewed, there is no comprehensive review of factors influencing subsequent adherence or completion, which is key to achieving vaccine effectiveness. This study identifies and summarises the literature on factors affecting completion of multi-dose vaccine schedules by adolescents.
Methods
Ten online databases and four websites were searched (February 2014). Studies with analysis of factors predicting completion of multi-dose vaccines were included. Study participants within 9–19 years of age were included in the review. The defined outcome was completion of the vaccine series within 1 year among those who received the first dose.
Results
Overall, 6159 abstracts were screened, and 502 full texts were reviewed. Sixty one studies were eligible for this review. All except two were set in high-income countries. Included studies evaluated human papillomavirus vaccine, hepatitis A, hepatitis B, and varicella vaccines. Reported vaccine completion rates, among those who initiated vaccination, ranged from 27 % to over 90 %. Minority racial or ethnic groups and inadequate health insurance coverage were risk factors for low completion, irrespective of initiation rates. Parental healthcare seeking behaviour was positively associated with completion. Vaccine delivery in schools was associated with higher completion than delivery in the community or health facilities. Gender, prior healthcare use and socio-economic status rarely remained significant risks or protective factors in multivariate analysis.
Conclusions
Almost all studies investigating factors affecting completion have been carried out in developed countries and investigate a limited range of variables. Increased understanding of barriers to completion in adolescents will be invaluable to future new vaccine introductions and the further development of an adolescent health platform.
PROSPERO reg# CRD42014006765.

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Research article
Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014
Adam Haji, S. Lowther, Z. Ngan’ga, Z. Gura, C. Tabu, H. Sandhu and Wences Arvelo
BMC Public Health 2016 16:152
Published on: 16 February 2016
Abstract
Background
Globally, vaccine preventable diseases are responsible for nearly 20 % of deaths annually among children <5 years old. Worldwide, many children dropout from the vaccination program, are vaccinated late, or incompletely vaccinated. We evaluated the impact of text messaging and sticker reminders to reduce dropouts from the vaccination program.
Methods
The evaluation was conducted in three selected districts in Kenya: Machakos, Langata and Njoro. Three health facilities were selected in each district, and randomly allocated to send text messages or provide stickers reminding parents to bring their children for second and third dose of pentavalent vaccine, or to the control group (routine reminder) with next appointment date indicated on the well-child booklet. Children aged <12 months presenting for their first dose of pentavalent vaccine were enrolled. A dropout was defined as not returning for vaccination ≥2 weeks after scheduled date for third dose of pentavalent vaccine. We calculated dropout rate as a percentage of the difference between first and third pentavalent dose.
Results
We enrolled 1,116 children; 372 in each intervention and 372 controls between February and October 2014. Median age was 45 days old (range: 31–99 days), and 574 (51 %) were male. There were 136 (12 %) dropouts. Thirteen (4 %) children dropped out among those who received text messages, 60 (16 %) among who received sticker reminders, and 63 (17 %) among the controls. Having a caregiver with below secondary education [Odds Ratio (OR) 1.8, 95 % Confidence Interval (CI) 1.1–3.2], and residing >5 km from health facility (OR 1.6, CI 1.0–2.7) were associated with higher odds of dropping out. Those who received text messages were less likely to drop out compared to controls (OR 0.2, CI 0.04–0.8). There was no statistical difference between those who received stickers and controls (OR 0.9, CI 0.5–1.6).
Conclusion
Text message reminders can reduce vaccination dropout rates in Kenya. We recommend the extended implementation of text message reminders in routine vaccination services.

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Research article
The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest…
Daniel H. de Vries, Jude T. Rwemisisi, Laban K. Musinguzi, Turinawe E. Benoni, Denis Muhangi, Marije de Groot, David Kaawa-Mafigiri and Robert Pool
BMC Public Health 2016 16:161
Published on: 16 February 2016

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 20 February 2016)

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Research
The economic burden of childhood pneumococcal diseases in The Gambia
Effua Usuf, Grant Mackenzie, Sana Sambou, Deborah Atherly and Chutima Suraratdecha
Published on: 17 February 2016
Abstract
Background
Streptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases.
Methods
We recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit.
Results
A total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members’ time loss from work was taken into account.
Conclusion
The economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society.

British Medical Journal
20 February 2016 (vol 352, issue 8045)
http://www.bmj.com/content/352/8045

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Research Update
Publication and reporting of clinical trial results: cross sectional analysis across academic medical centers
BMJ 2016; 352 :i637 (Published 17 February 2016)
Abstract
Objective
To determine rates of publication and reporting of results within two years for all completed clinical trials registered in ClinicalTrials.gov across leading academic medical centers in the United States.
Design
Cross sectional analysis.
Setting
Academic medical centers in the United States.
Participants
Academic medical centers with 40 or more completed interventional trials registered on ClinicalTrials.gov.
Methods
Using the Aggregate Analysis of ClinicalTrials.gov database and manual review, we identified all interventional clinical trials registered on ClinicalTrials.gov with a primary completion date between October 2007 and September 2010 and with a lead investigator affiliated with an academic medical center.
Main outcome measures
The proportion of trials that disseminated results, defined as publication or reporting of results on ClinicalTrials.gov, overall and within 24 months of study completion.
Results
We identified 4347 interventional clinical trials across 51 academic medical centers. Among the trials, 1005 (23%) enrolled more than 100 patients, 1216 (28%) were double blind, and 2169 (50%) were phase II through IV. Overall, academic medical centers disseminated results for 2892 (66%) trials, with 1560 (35.9%) achieving this within 24 months of study completion. The proportion of clinical trials with results disseminated within 24 months of study completion ranged from 16.2% (6/37) to 55.3% (57/103) across academic medical centers. The proportion of clinical trials published within 24 months of study completion ranged from 10.8% (4/37) to 40.3% (31/77) across academic medical centers, whereas results reporting on ClinicalTrials.gov ranged from 1.6% (2/122) to 40.7% (72/177).
Conclusions
Despite the ethical mandate and expressed values and mission of academic institutions, there is poor performance and noticeable variation in the dissemination of clinical trial results across leading academic medical centers.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 20 February 2016]

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Research
The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds
Roderik F. Viergever and Thom C. C. Hendriks
Published on: 18 February 2016
Abstract
Background
Little is known about who the main public and philanthropic funders of health research are globally, what they fund and how they decide what gets funded. This study aims to identify the 10 largest public and philanthropic health research funding organizations in the world, to report on what they fund, and on how they distribute their funds.
Methods
The world’s key health research funding organizations were identified through a search strategy aimed at identifying different types of funding organizations. Organizations were ranked by their reported total annual health research expenditures. For the 10 largest funding organizations, data were collected on (1) funding amounts allocated towards 20 health areas, and (2) schemes employed for distributing funding (intramural/extramural, project/‘people’/organizational and targeted/untargeted funding). Data collection consisted of a review of reports and websites and interviews with representatives of funding organizations. Data collection was challenging; data were often not reported or reported using different classification systems.
Results
Overall, 55 key health research funding organizations were identified. The 10 largest funding organizations together funded research for $37.1 billion, constituting 40% of all public and philanthropic health research spending globally. The largest funder was the United States National Institutes of Health ($26.1 billion), followed by the European Commission ($3.7 billion), and the United Kingdom Medical Research Council ($1.3 billion). The largest philanthropic funder was the Wellcome Trust ($909.1 million), the largest funder of health research through official development assistance was USAID ($186.4 million), and the largest multilateral funder was the World Health Organization ($135.0 million). Funding distribution mechanisms and funding patterns varied substantially between the 10 largest funders.
Conclusions
There is a need for increased transparency about who the main funders of health research are globally, what they fund and how they decide on what gets funded, and for improving the evidence base for various funding models. Data on organizations’ funding patterns and funding distribution mechanisms are often not available, and when they are, they are reported using different classification systems. To start increasing transparency in health research funding, we have established http://www.healthresearchfunders.org that lists health research funding organizations worldwide and their health research expenditures.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

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Editorial
Methods to estimate maternal mortality: a global perspective
Serena Donati, Alice Maraschini, Marta Buoncristiano, the Regional Maternal Mortality Working Group
Author Affiliations
National Centre for Epidemiology, Surveillance, and Health Promotion—Istituto Superiore di Sanità, Italian National Institute of Health, Rome Italy
Extract
The maternal mortality ratio (MMR) is globally a reproductive health core indicator, and the death of a woman, while pregnant or within 42 days of termination of pregnancy, is always, anywhere and anyway, a tragedy for the entire community. Reducing the MMR is one of the Millennium Development Goals and the UN Global strategy for women’s and children’s health mobilised multiple resources and commitments to accelerate this objective.1 However MMR estimates and accurate identification of the causes of maternal death are still a complex and difficult challenge. In most developing country settings, owing to the lack of complete and accurate civil registration systems, MMR estimates are based on data from a variety of alternative sources including censuses, household surveys, reproductive age mortality studies and verbal autopsies.2 The WHO classified 183 countries/territories according to the availability and quality of maternal mortality data: 67 countries (covering 17% of births) having complete civil registration data with good attribution of causes of death, 96 countries (covering 81% of births) having incomplete civil registration and/or other types of maternal mortality data and 20 countries (covering 2% of births) lacking national data on maternal mortality. For the last two categories, a regression model has been developed to estimate maternal mortality figures.3 The Demographic and Health Surveys Program4 uses the sisterhood method for Maternal Mortality estimations. This method remains the major source of empirical data on maternal mortality in developing countries, although it presents notable limitations.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

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Ebola, jobs and economic activity in Liberia
Jeremy Bowles, Jonas Hjort, Timothy Melvin, Eric Werker
J Epidemiol Community Health 2016;70:271-277 Published Online First: 5 October 2015 doi:10.1136/jech-2015-205959
Abstract
Background
The 2014 Ebola virus disease (EVD) outbreak in the neighbouring West African countries of Guinea, Liberia and Sierra Leone represents the most significant setback to the region’s development in over a decade. This study provides evidence on the extent to which economic activity declined and jobs disappeared in Liberia during the outbreak.
Methods
To estimate how the level of activity and number of jobs in a given set of firms changed during the outbreak, we use a unique panel data set of registered firms surveyed by the business-development non-profit organisation, Building Markets. We also compare the change in economic activity during the outbreak, across regions of the country that had more versus fewer Ebola cases in a difference-in-differences approach.
Findings
We find a large decrease in economic activity and jobs in all of Liberia during the Ebola outbreak, and an especially large decline in Monrovia. Outside of Monrovia, the restaurants, and food and beverages sectors have suffered the most among the surveyed sectors, and in Monrovia, the construction and restaurant sectors have shed the most employees, while the food and beverages sectors experienced the largest drop in new contracts. We find little association between the incidence of Ebola cases and declines in economic activity outside of Monrovia.
Conclusions
If the large decline in economic activity that occurred during the Ebola outbreak persists, a focus on economic recovery may need to be added to the efforts to rebuild and support the healthcare system in order for Liberia to regain its footing.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

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Immunisation coverage in rural–urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis
Abiyemi Benita Awoh, Emma Plugge
J Epidemiol Community Health 2016;70:305-311 Published Online First: 7 September 2015 doi:10.1136/jech-2015-205652
Abstract
Background
The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural–urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural–urban migrant (RUM) children being less likely to be immunised.
Objectives
To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children.
Methods A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis.
Results
Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates.
Conclusions
This review indicates that there is an association between rural–urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.

The Lancet
Feb 20, 2016 Volume 387 Number 10020 p717-816
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
An ambitious agenda for humanity
The Lancet
As highlighted in today’s Lancet, protracted conflicts continue to harm human health and wellbeing. In Yemen, 21 million of 24 million people are now in need of humanitarian assistance and 15 million lack access to health care (see World Report). In Syria, despite a recent ceasefire agreement, fighting looks set to continue into its sixth year. A letter in this issue draws attention to the plight of the 1 million Syrian children who have been orphaned by the war.

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Comment
Zika virus and microcephaly: why is this situation a PHEIC?
David L Heymann, Abraham Hodgson, Amadou Alpha Sall, David O Freedman, J Erin Staples, Fernando Althabe, Kalpana Baruah, Ghazala Mahmud, Nyoman Kandun, Pedro F C Vasconcelos, Silvia Bino, K U MenonPublished Online: 10 February 2016
Summary
When the Director-General of WHO declared, on Feb 1, 2016, that recently reported clusters of microcephaly and other neurological disorders are a Public Health Emergency of International Concern (PHEIC),1 it was on the advice of an Emergency Committee of the International Health Regulations and of other experts whom she had previously consulted. We are the members of the Emergency Committee, and we were identified by the Director-General from rosters of experts that had been submitted by WHO Member States.

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Health Policy
Moving towards universal health coverage: lessons from 11 country studies
Michael R Reich, Joseph Harris, Naoki Ikegami, Akiko Maeda, Cheryl Cashin, Edson C Araujo, Keizo Takemi, Timothy G Evans
Summary
In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls—but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

New England Journal of Medicine
February 18, 2016 Vol. 374 No. 7
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Zika Virus in the Americas — Yet Another Arbovirus Threat
A.S. Fauci and D.M. Morens
[Extract; Free full text]
The explosive pandemic of Zika virus infection occurring throughout South America, Central America, and the Caribbean and potentially threatening the United States is the most recent of four unexpected arrivals of important arthropod-borne viral diseases in the Western Hemisphere over the past 20 years. It follows dengue, which entered this hemisphere stealthily over decades and then more aggressively in the 1990s; West Nile virus, which emerged in 1999; and chikungunya, which emerged in 2013. Are the successive migrations of these viruses unrelated, or do they reflect important new patterns of disease emergence? Furthermore, are there secondary health consequences of this arbovirus pandemic that set it apart from others?..

Original Articles
Clinical Management of Ebola Virus Disease in the United States and Europe
T.M. Uyeki and Others

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 20 February 2016)

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Essay
The Health Care Consequences Of Australian Immigration Policies
John-Paul Sanggaran, Bridget Haire, Deborah Zion
Essay | published 16 Feb 2016 | PLOS Medicine
10.1371/journal.pmed.1001960
Summary Points
:: In Australia, immigration policy is to incarcerate those seeking asylum in order to deter others from coming.
:: Within this environment, health care providers frequently experience “dual loyalty” conflict, whereby they cannot serve the interests of both their patients and their employers.
:: The ratification of the Optional Protocol to the Convention Against Torture (OPCAT) would allow for domestic and international monitoring of places of detention, which would serve to ameliorate some of the most problematic aspects of the detention system, including the undemocratic lack of transparency.
:: This would assist in resolving the “dual loyalty” conflict that health care workers must contend with in the current situation.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 20 February 2016)

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Research Article
Concerted Efforts to Control or Eliminate Neglected Tropical Diseases: How Much Health Will Be Gained?
Sake J. de Vlas, Wilma A. Stolk, Epke A. le Rutte, Jan A. C. Hontelez, Roel Bakker, David J. Blok, Rui Cai, Tanja A. J. Houweling, Margarete C. Kulik, Edeltraud J. Lenk, Marianne Luyendijk, Suzette M. Matthijsse, William K. Redekop, Inge Wagenaar, Julie Jacobson, Nico J. D. Nagelkerke, Jan H. Richardus
Research Article | published 18 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004386
Abstract
Background
The London Declaration (2012) was formulated to support and focus the control and elimination of ten neglected tropical diseases (NTDs), with targets for 2020 as formulated by the WHO Roadmap. Five NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma) are to be controlled by preventive chemotherapy (PCT), and four (Chagas’ disease, human African trypanosomiasis, leprosy and visceral leishmaniasis) by innovative and intensified disease management (IDM). Guinea worm, virtually eradicated, is not considered here. We aim to estimate the global health impact of meeting these targets in terms of averted morbidity, mortality, and disability adjusted life years (DALYs).
Methods
The Global Burden of Disease (GBD) 2010 study provides prevalence and burden estimates for all nine NTDs in 1990 and 2010, by country, age and sex, which were taken as the basis for our calculations. Estimates for other years were obtained by interpolating between 1990 (or the start-year of large-scale control efforts) and 2010, and further extrapolating until 2030, such that the 2020 targets were met. The NTD disease manifestations considered in the GBD study were analyzed as either reversible or irreversible. Health impacts were assessed by comparing the results of achieving the targets with the counterfactual, construed as the health burden had the 1990 (or 2010 if higher) situation continued unabated.
Principle Findings/Conclusions
Our calculations show that meeting the targets will lead to about 600 million averted DALYs in the period 2011–2030, nearly equally distributed between PCT and IDM-NTDs, with the health gain amongst PCT-NTDs mostly (96%) due to averted disability and amongst IDM-NTDs largely (95%) from averted mortality. These health gains include about 150 million averted irreversible disease manifestations (e.g. blindness) and 5 million averted deaths. Control of soil-transmitted helminths accounts for one third of all averted DALYs. We conclude that the projected health impact of the London Declaration justifies the required efforts.
Author Summary
Neglected tropical diseases (NTDs) are a group of infectious diseases that occur mostly in poor, warm countries. NTDs are caused by various bacteria and parasites, such as worms. They can either be cured or prevented through drugs and other interventions, such as control of insects that spread the infection. The London Declaration is a statement by various organizations, including the World Health Organization (WHO) and pharmaceutical companies that donate the necessary drugs. The declaration endorses targets for disease reductions by 2020, as recently formulated in the WHO Roadmap, to be achieved by rigorous application of available interventions. We explore how much health can be gained if these targets are indeed achieved. We estimate that in such case 5 million deaths can be averted before 2030 and also that huge reductions in ill-health and disability can be realized. Over the period 2011–2030, a total health gain would be accomplished of about 600 million disability adjusted life years (DALYs) averted. DALYs are a measure of disease burden, consisting of life years lost and years lived with disability. This enormous health gain seems to justify similar investments as for e.g. HIV or malaria control.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 20 February 2016)

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Social Sciences – Economic Sciences – Social Sciences – Sustainability Science:
The effect of rights-based fisheries management on risk taking and fishing safety
Lisa Pfeiffer and Trevor Gratz
PNAS 2016 ; published ahead of print February 16, 2016, doi:10.1073/pnas.1509456113
Significance
Commercial fishing is a dangerous occupation despite decades of regulatory initiatives aimed at making it safer. We posit that the individual allocation of fishing quota can improve safety by solving many of the problems associated with the competitive race to fish, which manifest themselves in risky behavior such as fishing in poor weather. We present a previously unidentified approach to evaluation: estimating the change in the propensity to start a fishing trip in poor weather conditions as a result of the management change. We chronicle a revolution in risk-taking behavior by fishermen (a 79% decrease in the annual average rate of fishing on high wind days) that is due to the change in economic incentives provided by rights-based management.
Abstract
Commercial fishing is a dangerous occupation despite decades of regulatory initiatives aimed at making it safer. We posit that rights-based fisheries management (the individual allocation of fishing quota to vessels or fishing entities, also called catch shares) can improve safety by solving many of the problems associated with the competitive race to fish experienced in fisheries around the world. The competitive nature of such fisheries results in risky behavior such as fishing in poor weather, overloading vessels with fishing gear, and neglecting maintenance. Although not necessarily intended to address safety issues, catch shares eliminate many of the economic incentives to fish as rapidly as possible. We develop a dataset and methods to empirically evaluate the effects of the adoption of catch shares management on a particularly risky type of behavior: the propensity to fish in stormy weather. After catch shares was implemented in an economically important US West Coast fishery, a fisherman’s probability of taking a fishing trip in high wind conditions decreased by 82% compared with only 31% in the former race to fish fishery. Overall, catch shares caused the average annual rate of fishing on high wind days to decrease by 79%. These results are evidence that institutional changes can significantly reduce individual, voluntary risk exposure and result in safer fisheries.