BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 12 March 2016)

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Research article
A survey of the governance capacity of national public health associations to enhance population health
James Chauvin, Mahesh Shukla, James Rice and Laetitia Rispel
BMC Public Health 2016 16:251
Published on: 11 March 2016
Abstract
Background
National public health associations (PHAs) are key partners with governments and communities to improve, protect and promote the public’s health. Governance and organizational capacity are among the key determinants of a PHA’s effectiveness as an advocate for appropriate public health policies and practice.
Methods
During 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysis
Results
Responses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA’s leaders (77 %) and the competence of people serving on the PHA’s governing body (76 %). The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %). The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders.
Conclusion
National PHA have a responsibility to put into place the practices and infrastructure that enhance organizational governance. This will enhance their ability to be effective advocates for policies and practices that enhance, protect and promote the public’s health. The WFPHA has an important role to play in providing the technical assistance and financial resources to assist PHAs in attaining and sustaining a higher level of governance capacity.

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Research article
Integrating acute malnutrition interventions into national health systems: lessons from Niger
Since 2007, integrated care of acute malnutrition has been promoted in Niger, a country affected by high burden of disease. This policy change aimed at strengthening capacity and ownership to manage the condition…
Hedwig Deconinck, Mahaman Hallarou, Bart Criel, Philippe Donnen and Jean Macq
BMC Public Health 2016 16:249
Published on: 10 March 2016

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Research article
Influence of internal migration on reproductive health in Myanmar: results from a recent cross-sectional survey
Maternal and reproductive health remains a significant public health issue in Myanmar. Little data exists on women’s health issues, including social and demographic influences.
May Sudhinaraset, Nadia Diamond-Smith, May Me Thet and Tin Aung
BMC Public Health 2016 16:246
Published on: 9 March 2016

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Research article
Maternal knowledge, outcome expectancies and normative beliefs as determinants of cessation of exclusive breastfeeding: a cross-sectional study in rural Kenya
Despite the importance of multiple psychosocial factors on nutrition-related behavior, very few studies have explored beyond the role of mothers’ knowledge and perception of child-focused outcomes on the duration…
Constance A. Gewa and Joan Chepkemboi
BMC Public Health 2016 16:243
Published on: 9 March 2016

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 12 March 2016]

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Research
Retrospective analysis of reproductive health indicators in the United Nations High Commissioner for Refugees post-emergency camps 2007–2013
Jennifer Whitmill, Curtis Blanton, Sathyanarayanan Doraiswamy, Nadine Cornier, Marian Schilperood, Paul Spiegel and Barbara Tomczyk
Published on: 9 March 2016
Abstract
Background
The United Nations Refugee Agency’s Health Information System issues analytical reports on the current camp conditions and trends for priority reproductive health issues. The goal was to assess the status of reproductive health by analyzing seven indicators and comparing them to standards and host country estimates.
Methods
Data on seven indicators were extracted from the database during a seven-year period (2007 through 2013). A standardized country inclusion criterion was created based on the year of country implementation and the percentage of missing reports per camp and year. The unit of analysis was monthly camp reports by year within a country. To account for the lack of independence of monthly camp reports, the variance was computed using Taylor Series Linearization methods in SAS.
Results
Ten of the 23 eligible countries met the inclusion criterion. The mean camp maternal and neonatal mortality rates, except for two country years, were lower than the host country estimates for all countries and years. There was a significant increase in the percent of births attended by a skilled birth attendant (p <0.0001), and 8 of 10 countries did not meet the standard of 100 % for all reporting years. The percent of births performed by Caesarian section (p<0.001), were below the recommended minimum standard for nearly half of the countries every year. There was a significant increase in the percent of women screened for syphilis across years (p<0.0001) and the percent of women who received post HIV exposure prophylaxis (p<0.0001) and 10 % reached the standard for all reporting years, respectively.
Conclusion
Comprehensive, consistent and comparable statistics on reproductive health provides an opportunity to assess progress towards indicator standards. Despite some improvements over time, this analysis confirms that most countries did not meet standards and that there were differences in reproductive health indicators between countries and across years. Consequently, the HIS periodic monitoring of key reproductive health indicators at the camp level should continue. Data should be used to improve intervention strategies.

Disasters
April 2016 Volume 40, Issue 2 Pages 183–383
http://onlinelibrary.wiley.com/doi/10.1111/disa.2016.40.issue-2/issuetoc

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Papers
The professional humanitarian and the downsides of professionalisation
Eric James*
Article first published online: 17 AUG 2015
DOI: 10.1111/disa.12140
Abstract
Criticisms lodged at humanitarian relief often include the belief that professionalisation is needed. The problems associated with humanitarianism would end, it is assumed, if the delivery of aid, and relief workers themselves, were more professional and ‘business like’. To explore this further, the paper asks what comprises a profession, and offers four criteria: 1) specialisation of knowledge; 2) establishment of the profession as a livelihood; 3) organisation and institutionalisation; and 4) legitimacy and authority. A model for understanding professionalisation, as developed by the author, is then presented. The analysis compares six other professions against the same criteria to argue that the humanitarian community already constitutes a profession. Finally, three potential downsides of professionalisation are offered: the distance of the relief worker from the beneficiary, barriers to entry into the humanitarian sector, and adding to risk aversion and a decline in innovation. Based on these findings, professionalisation should be approached with some caution.

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Papers
Livelihoods, conflict and aid programming: is the evidence base good enough? (pages 226–245)
Richard Mallett and Rachel Slater
Article first published online: 17 AUG 2015 | DOI: 10.1111/disa.12142
Abstract
In conflict-affected situations, aid-funded livelihood interventions are often tasked with a dual imperative: to generate material welfare benefits and to contribute to peacebuilding outcomes. There may be some logic to such a transformative agenda, but does the reality square with the rhetoric? Through a review of the effectiveness of a range of livelihood promotion interventions—from job creation to microfinance—this paper finds that high quality empirical evidence is hard to come by in conflict-affected situations. Many evaluations appear to conflate outputs with impacts and numerous studies fail to include adequate information on their methodologies and datasets, making it difficult to appraise the reliability of their conclusions. Given the primary purpose of this literature—to provide policy guidance on effective ways to promote livelihoods—this silence is particularly concerning. As such, there is a strong case to be made for a restrained and nuanced handling of such interventions in conflict-affected settings

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Papers
Country logistics performance and disaster impact (pages 262–283)
Alain Vaillancourt and Ira Haavisto
Article first published online: 17 AUG 2015 | DOI: 10.1111/disa.12146
Abstract
The aim of this paper is to deepen the understanding of the relationship between country logistics performance and disaster impact. The relationship is analysed through correlation analysis and regression models for 117 countries for the years 2007 to 2012 with disaster impact variables from the International Disaster Database (EM-DAT) and logistics performance indicators from the World Bank. The results show a significant relationship between country logistics performance and disaster impact overall and for five out of six specific logistic performance indicators. These specific indicators were further used to explore the relationship between country logistic performance and disaster impact for three specific disaster types (epidemic, flood and storm). The findings enhance the understanding of the role of logistics in a humanitarian context with empirical evidence of the importance of country logistics performance in disaster response operations.

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Papers
Arts as a vehicle for community building and post-disaster development (pages 284–303)
Ephrat Huss, Roni Kaufman, Amos Avgar and Eitan Shuker
Article first published online: 17 AUG 2015 | DOI: 10.1111/disa.12143
Abstract
Use of the arts in international aid is common in an ad hoc form, but it has not been systematically theorised or evaluated. The arts have the potential to be a culturally contextualised and sustainable intervention for adults and children in the aftermath of war or disaster. On the micro level, the arts are a method to enable the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words. On a macro level, they can help to reconstruct a group narrative of a disaster as well as mobilise people back into control of their lives. This paper researches a long-term project using arts in Sri Lanka following the civil war and tsunami. A central finding is the need to understand arts within their cultural context, and their usefulness in strengthening the voices and problem-solving capacities of the victims of the disaster.

Eurosurveillance
Volume 21, Issue 10, 10 March 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid communications
Profile of illness in Syrian refugees: A GeoSentinel analysis, 2013 to 2015
by F Mockenhaupt, K Barbre, M Jensenius, C Larsen, E Barnett, W Stauffer, C Rothe, H Asgeirsson, D Hamer, D Esposito, P Gautret, P Schlagenhauf
Abstract
Screening of 488 Syrian unaccompanied minor refugees (< 18 years-old) in Berlin showed low prevalence of intestinal parasites (Giardia, 7%), positive schistosomiasis serology (1.4%) and absence of hepatitis B. Among 44 ill adult Syrian refugees examined at GeoSentinel clinics worldwide, cutaneous leishmaniasis affected one in three patients; other noteworthy infections were active tuberculosis (11%) and chronic hepatitis B or C (9%). These data can contribute to evidence-based guidelines for infectious disease screening of Syrian refugees.

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Research Articles
Children and young people with perinatal HIV in Europe: epidemiological situation in 2014 and implications for the future
by Writing group for the Kids to Adults Working Group and Data Management and Harmonisation Group in EuroCoord

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 12 March 2016]

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Scoping Review
Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective
Om Prakash Singh, Bhawana Singh, Jaya Chakravarty and Shyam Sundar
Published on: 8 March 2016
Abstract
Visceral leishmaniasis (VL) is a serious parasitic disease causing considerable mortality and major disability in the Indian subcontinent. It is most neglected tropical disease, particularly in terms of new drug development for the lack of financial returns. An elimination campaign has been running in India since 2005 that aim to reduce the incidence of VL to below 1 per 10,000 people at sub-district level. One of the major components in this endeavor is reducing transmission through early case detection followed by complete treatment. Substantial progress has been made during the recent years in the area of VL treatment, and the VL elimination initiatives have already saved many lives by deploying them effectively in the endemic areas. However, many challenges remain to be overcome including availability of drugs, cost of treatment (drugs and hospitalization), efficacy, adverse effects, and growing parasite resistance. Therefore, better emphasis on implementation research is urgently needed to determine how best to deliver existing interventions with available anti-leishmanial drugs. It is essential that the new treatment options become truly accessible, not simply available in endemic areas so that they may promote healing and save lives. In this review, we highlight the recent advancement and challenges in current treatment options for VL in disease endemic area, and discuss the possible strategies to improve the therapeutic outcome.

International Journal of Infectious Diseases
March 2016 Volume 44, p1-74
http://www.ijidonline.com/current

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Editorial
HIV in the MENA Region: Cultural and Political Challenges
Seif Al-Abri, Jacques E. Mokhbat
p64–65
Published online: February 9 2016
Preview
Over the last few years, our knowledge of the HIV epidemic and its drivers in the Middle East and North Africa (MENA) region have improved markedly, thanks to many recently conducted studies.1 While the annual number of new HIV infections in sub-Saharan Africa has declined by 33% since 2005, new HIV infections in the MENA region have increased by 31% since 2001, the greatest increase in all regions in the world. There are growing HIV epidemics in key populations (KPs) including people who inject drugs, men who have sex with men, and to a lesser extent, female sex workers.

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Reviews
Rapid Spread of Zika Virus in The Americas – Implications for Public Health Preparedness for Mass Gatherings at the 2016 Brazil Olympic Games
Eskild Petersen, Mary E. Wilson, Sok Touch, Brian McCloskey, Peter Mwaba, Matthew Bates, Osman Dar, Frank Mattes, Mike Kidd, Giuseppe Ippolito, Esam I. Azhar, Alimuddin Zumla
p11–15
Published online: February 4 2016
Highlights
:: We discuss the global spread of the Zika virus (ZIKV) since its first discovery in 1947 in Uganda to the current outbreak in the Americas which has been declared a ‘Global emergency’ by the World Health Organization.
:: We highlight that ZIKV and other arboviruses may pose a threat to the attendees of the 2016 Rio De Janeiro Olympic and Paralympic games and to residents of Brazil.
:: We review clinical features and highlight the need for more accurate and rapid screening tests for ZIKV
:: We discuss the recent possible linkage of microcephaly in babies exposed to ZIKV in utero, and highlight knowledge gaps in the epidemiology and pathogenesis of ZIKV.
:: We review the public health implications of the current ZIKV outbreak and highlight the need for enhanced preparedness and proactive surveillance for all infectious diseases before, during and after the 2016 Olympic games.
:: We stress that there is no specific treatment available or preventive vaccines and that that the emergence of ZIKV soon after the Ebola outbreak, is yet another wake up call for the urgent need for a coordinated global response for prevention and spread of infectious diseases with epidemic potential at mass gatherings events
Summary
Mass gatherings at major international sporting events put millions of international travelers and local host-country residents at risk of acquiring infectious diseases, including locally endemic infectious diseases. The mosquito-borne Zika virus (ZIKV) has recently aroused global attention due to its rapid spread since its first detection in May 2015 in Brazil to 22 other countries and other territories in the Americas. The ZIKV outbreak in Brazil, has also been associated with a significant rise in the number of babies born with microcephaly and neurological disorders, and has been declared a ‘Global Emergency by the World Health Organization. This explosive spread of ZIKV in Brazil poses challenges for public health preparedness and surveillance for the Olympics and Paralympics which are due to be held in Rio De Janeiro in August, 2016. We review the epidemiology and clinical features of the current ZIKV outbreak in Brazil, highlight knowledge gaps, and review the public health implications of the current ZIKV outbreak in the Americas. We highlight the urgent need for a coordinated collaborative response for prevention and spread of infectious diseases with epidemic potential at mass gatherings events.

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Reviews
HIV/AIDS: trends in the Middle East and North Africa region
Deniz Gökengin, Fardad Doroudi, Johnny Tohme, Ben Collins, Navid Madani
p66–73
Published in issue: March 2016
Highlights
:: New HIV infections have been on the rise in the Middle East and North Africa (MENA) region in recent years.
:: There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region.
:: Overall, the major route of infection in the MENA region seems to be sexual transmission, but a range of challenges limit interventions to determine the actual sexual trends.
:: Despite unfavorable conditions, many countries in the region have put significant efforts into scaling up their response to this growing epidemic.
Summary
Objectives
To give an overview of the HIV epidemic in the Middle East and North Africa (MENA) region.
Methods
Articles on the MENA region were reviewed.
Results
The MENA region comprises a geographically defined group of countries including both high-income, well-developed nations and low- and middle-income countries. While the annual number of new HIV infections in Sub-Saharan Africa has declined by 33% since 2005, new HIV infections in the MENA region have increased by 31% since 2001, which is the highest increase among all regions in the world. Moreover, the number of AIDS-related deaths in 2013 was estimated to be 15 000, representing a 66% increase since 2005. However, the current prevalence of 0.1% is still among the lowest rates globally. There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region. Despite unfavorable conditions, many countries in the region have put significant effort into scaling up their response to this growing epidemic, while in others the response to HIV is proving slower due to denial, stigma, and reluctance to address sensitive issues.
Conclusions
The HIV epidemic in the MENA region is still at a controllable level, and this opportunity should not be missed.

JAMA
March 8, 2016, Vol 315, No. 10
http://jama.jamanetwork.com/issue.aspx

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Viewpoint | March 8, 2016
The Ethical Challenges of Compassionate Use
FREE
Arthur L. Caplan, PhD; Amrit Ray, MD, MBA

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Viewpoint | March 8, 2016
Immunization Policy and the Importance of Sustainable Vaccine Pricing
H. Cody Meissner, MD1
[Initial text]
This Viewpoint discusses vaccine costs and policy and explains the importance of balancing these factors to provide optimal care while restricting spending on costly interventions with limited benefit.

The individual, societal, and economic benefits of disease prevention resulting from childhood and adult immunization programs in the United States are without question. A report from the Centers for Disease Control and Prevention (CDC) describing the benefits of vaccination of the 2009 birth cohort through 18 years of age estimated that 20 million cases of vaccine-preventable disease will not occur, 42 000 early deaths related to these diseases will be avoided, and $76 billion in direct and indirect costs will be averted.1 This economic benefit stands in stark contrast to the comparatively small cost for vaccine purchases. The estimated vaccine purchasing cost for a similar birth cohort based on 2015 pricing is $7.8 billion, based on CDC costs, and $11.6 billion at private sector pricing (eTable in the Supplement).2…

JAMA Pediatrics
March 2016, Vol 170, No. 3
http://archpedi.jamanetwork.com/issue.aspx

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Editorial | March 2016
The Grand Divergence in Global Child Health Confronting Data Requirements in Areas of Conflict and Chronic Political Instability
FREE
Paul H. Wise, MD, MPH1,2; Gary L. Darmstadt, MD, MS1,2
Author Affiliations
1Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
2Freeman Spogli Institute for International Studies, Stanford University, Stanford, California
[Initial text]
There is something deeply troubling about a death that goes unnoticed. Beyond the humane impulse to provide solace through collective acknowledgment and community support lies the recognition that an unnoticed death implies an unnoticed life. There can be no doubt that the accurate counting and causal attribution of morbidity and mortality provide technical information that is essential for public health planning, evaluation, and improvement in program performance. However, there is also a justice imperative inherent in counting and attribution—an imperative that transcends the practical and touches on the moral basis of global health and its commitment to the rights and societal claims of those whose health and well-being have for too long gone unnoticed.

At a global level, available data demonstrate that dramatic reductions in child mortality have occurred in many low- and middle-income countries. Moreover, long-standing disparities in survival between materially wealthy and poorer regions of the world are dissipating. If sustained, this historic record of reduced mortality inequality could drive a “grand convergence” in life expectancy during the next 2 decades.1 This prospect has been used constructively to advocate for a continued global commitment to economic development and the provision of effective health interventions.

On closer examination, however, it is apparent that the trends toward convergence have not been universal. Some countries are being left behind. These countries have experienced stagnant or, in some arenas, worsening child health outcomes. Indeed, these countries could be described as contributing to a “grand divergence” in life expectancies, in which their health indicators fall increasingly behind those of other low- and middle-income countries.2

The article by the Global Burden of Disease (GBD) Pediatrics Collaboration in this issue of JAMA Pediatrics represents an important contribution to the field of global health and provides troubling evidence of the diverging trends in child health and well-being.3 What is now evident from even a cursory examination of presented child mortality trends is that the countries making the least progress in child survival and well-being, particularly since 2000, are those most likely to be plagued by chronic civil conflict, political instability, and weak governance. Nigeria and the Democratic Republic of the Congo, which together account for more than a third of all child deaths in sub-Saharan Africa, experienced annual child mortality declines of 2.2% and 1.8%, respectively (eTable 9 in their Supplement). It is useful to note that during this same period among the most rapid annual declines were those recorded in China (6.01%), Iran (5.97%), and Bangladesh (5.24%).

Using data from the GBD 2013 study, the article presents detailed child mortality and morbidity trends for the 50 countries with the largest child and adolescent populations in the world, information that will prove essential for programmatic evaluation and planning…

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Special Communication
Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study
FREE
Global Burden of Disease Pediatrics Collaboration
Includes: Supplemental Content
Abstract
Importance
The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.
Objective
To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged Evidence Review
Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates.
Findings
Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905,059 deaths; 95% UI, 810 304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115186 deaths; 95% UI, 105 185-124870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world’s deaths from neonatal encephalopathy. Half of the world’s diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia.
Conclusions and Relevance
Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

The Lancet
Mar 12, 2016 Volume 387 Number 10023 p1027-1132
http://www.thelancet.com/journals/lancet/issue/current
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Editorial
The health crisis of mental health stigma
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00687-5
Many people with mental illness experience shame, ostracism, and marginalisation due to their diagnosis, and often describe the consequences of mental health stigma as worse than those of the condition itself. Interventions to address stigma educate about mental illness and overcome the stereotypes that underlie prejudicial reactions. Along with pharmacological and psychological therapies, stigma interventions have emerged as potentially valuable and complementary tools.
In today’s Lancet, Graham Thornicroft and colleagues review the evidence for effectiveness of interventions to reduce mental health stigma and discrimination, and conclude that they can work at an individual and population level. The evidence of benefit was strongest for interventions involving an individual with lived experience of mental illness, with sustained commitment to delivery over a long period…

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Review
Evidence for effective interventions to reduce mental-health-related stigma and discrimination
Graham Thornicroft, Nisha Mehta, Sarah Clement, Sara Evans-Lacko, Mary Doherty, Diana Rose, Mirja Koschorke, Rahul Shidhaye, Claire O’Reilly, Claire Henderson
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00298-6
Summary
Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user’s perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.

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Comment
NextGen HIV prevention: new possibilities and questions
Kenneth H Mayer
Published Online: 04 March 2016
Summary
In less than a decade, HIV prevention has evolved from a reliance on education, behavioural interventions, and use of condoms to focusing on the optimum use of antiretrovirals to suppress infectiousness and for primary prophylaxis. Landmark studies have shown the efficacy of the early initiation of treatment for people infected with HIV,1 and the use of oral pre-exposure prophylaxis (PrEP) for those at highest risk to decrease HIV transmission.2 Despite PrEP being shown to be efficacious in most trials in which it was assessed, the paramount importance of consistent use of preventive medication was shown when oral and topical tenofovir-based regimens did not show efficacy in three studies involving young African women, primarily because of suboptimum adherence.

New England Journal of Medicine
March 10, 2016 Vol. 374 No. 10
http://www.nejm.org/toc/nejm/medical-journal

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Brief Report
Zika Virus Associated with Microcephaly
Jernej Mlakar, M.D., Misa Korva, Ph.D., Nataša Tul, M.D., Ph.D., Mara Popović, M.D., Ph.D., Mateja Poljšak-Prijatelj, Ph.D., Jerica Mraz, M.Sc., Marko Kolenc, M.Sc., Katarina Resman Rus, M.Sc., Tina Vesnaver Vipotnik, M.D., Vesna Fabjan Vodušek, M.D., Alenka Vizjak, Ph.D., Joze Pizem, M.D., Ph.D., Miroslav Petrovec, M.D., Ph.D., and Tatjana Avsic Zupanc, Ph.D.
Abstract
A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 in South and Central America and the Caribbean. A major concern associated with this infection is the apparent increased incidence of microcephaly in fetuses born to mothers infected with ZIKV. In this report, we describe the case of an expectant mother who had a febrile illness with rash at the end of the first trimester of pregnancy while she was living in Brazil. Ultrasonography performed at 29 weeks of gestation revealed microcephaly with calcifications in the fetal brain and placenta. After the mother requested termination of the pregnancy, a fetal autopsy was performed. Micrencephaly (an abnormally small brain) was observed, with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement and mild focal inflammation. ZIKV was found in the fetal brain tissue on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay, with consistent findings on electron microscopy. The complete genome of ZIKV was recovered from the fetal brain.

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Editorial
Zika Virus and Microcephaly
Eric J. Rubin, M.D., Ph.D., Michael F. Greene, M.D., and Lindsey R. Baden, M.D.
DOI: 10.1056/NEJMe1601862
[Extract]
…Zika virus has spread explosively since its introduction into South America and has now been found throughout Central America and the Caribbean. The full extent of disease is not clear — most infections are asymptomatic and many are associated with only mild disease.6 But the apparent risk of microcephaly was enough for the World Health Organization to declare a public health emergency of international concern on February 1.

What more do we need to know to help us manage and control this outbreak? Certainly, understanding the disease better could have long-term benefits, including the development of protective vaccines. However, it is the information that we do not yet have that has potential immediate applications.

Although many authorities are counseling women who are pregnant or could become pregnant to avoid travel to affected areas, the millions of women who live in these places are faced with enormous uncertainty, and as the virus spreads, many more will be affected. For example, assuming the association between Zika virus and microcephaly exists, we do not know whether the timing of the infection during pregnancy has an effect on the risk of fetal abnormalities, nor do we have any idea of the magnitude of that risk. The development of rapid, scalable diagnostic tests is needed, since the current polymerase-chain-reaction assay detects viral RNA and thus should be positive only during the period of viremia, which may be relatively short.

Current serologic assays have considerable cross-reactivity with other flaviviruses, including those that are endemic in the same areas (as in the case now being reported), and serologic assays specific for Zika virus are not easily available. Thus, it may be difficult to determine retrospectively whether a woman has been infected. This will be particularly difficult in areas where dengue virus and other pathogens can cause symptoms similar to those of the Zika virus.
In addition, it is unclear whether asymptomatic or minimally symptomatic disease poses a risk to the fetus. It is possible that as is the case with mumps, early infection could result in fetal loss rather than malformations. And, as in this case report, ultrasonography may detect severe fetal abnormalities only very late in gestation — in many cases, too late to terminate the pregnancy. Is there a sensitive test that can be applied earlier? And is previous infection protective?

Although we need a good deal of research to define critical aspects of infection, there is much to do immediately. A vulnerable point for Zika virus transmission is the mosquito vector. Unfortunately, mosquito-control efforts have failed to curtail the spread of many similar pathogens, including dengue and chikungunya viruses, which are carried by the same aedes species and are spreading in the same communities currently affected by the Zika virus. Perhaps this new threat will help boost such control efforts with the use of both old and new approaches. Women need to have access to relevant health care services, including contraception, diagnostics, and pregnancy-termination services. And the many affected children need to have care. Coming shortly after the global response to the Ebola virus, the rapid spread of the Zika virus reminds us how connected we all are.7 Once again, an outbreak is going to challenge our public health infrastructure and require a substantial response.

Nonprofit and Voluntary Sector Quarterly
April 2016; 45 (2)
http://nvs.sagepub.com/content/current

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Articles
Tip of the Iceberg: The Nonprofit Underpinnings of For-Profit Social Enterprise
Curtis Child
Nonprofit and Voluntary Sector Quarterly April 2016 45: 217-237, first published on March 8, 2015 doi:10.1177/0899764015572901
Abstract
Market-based solutions to social and environmental problems in the form of for-profit social enterprise ventures have attracted considerable attention in recent years. According to popular discourse, the reason for their appeal is that they are not dependent on government grants or charitable support and are therefore more efficient and sustainable than existing alternatives. Using data collected from two social enterprise industries, this article challenges that discourse. It concludes that even though the recent focus on market-based ventures crowds out the importance of philanthropic ones, social enterprises rely substantially on civil society to accomplish their prosocial missions. By shifting attention away from the nonprofit–government relationship and toward the nonprofit–business one, these findings have implications for theorizing in nonprofit studies.

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High-Stakes Volunteer Commitment – A Qualitative Analysis
Lacy G. McNamee1, Brittany L. Peterson2
1Baylor University, Waco, TX, USA
2Ohio University, Athens, OH, USA
Abstract
This study examines the social network ties, motivations, and experiences of high-stakes volunteers (HSVs): individuals who fulfill long-term, consistent, and intense time commitments providing medical, social, and/or psychological assistance. Interview, focus group, and observational data from three settings (volunteer firefighting, victims’ services/advocacy, outreach for at-risk youth) were analyzed using qualitative methods. Accordingly, five types of HSVs (stable lifer, imbalanced lifer, conventionalist, professional, crusader) are presented and discussed. These findings advance theoretical insight into the variety of individuals who take on HSV roles and contribute to growing scholarship on diversified approaches to volunteer management.

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Managed Morality – The Rise of Professional Codes of Conduct in the U.S. Nonprofit Sector
Patricia Bromley1, Charlene D. Orchard1
1University of Utah, Salt Lake City, USA
Abstract
Calls for accountability in the nonprofit sector have never been stronger, and the rise of various forms of self-regulation represents a profound shift for nonprofits. Existing studies tend to focus on effective design and implementation of accountability policies, with an eye toward improving nonprofit efficiency and reducing instances of misconduct. Against this backdrop, we draw on sociological institutionalism to theorize an alternative view of one form of self-regulation, formal codes of conduct or ethical codes. In this view, formal policies, such as codes, are assumed to be adopted as a response to pressures in an organization’s institutional environment, beyond their purported instrumental value. Using a quantitative analysis of code adoption by 24 of 45 state nonprofit associations over the period 1994 to 2011, we provide evidence that codes arise due to general environmental conditions, particularly related to the influences of neoliberalism and professionalization, net of the functional demands of any particular context.

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A Cross-Cultural Study of Explicit and Implicit Motivation for Long-Term Volunteering
Arzu Aydinli1,2 Michael Bender1, Athanasios Chasiotis1, Fons J. R. van de Vijver1,3,4, Zeynep Cemalcilar2, Alice Chong5, Xiaodong Yue5
1Tilburg University, The Netherlands
2Koç University, İstanbul, Turkey
3North-West University, Potchefstroom, South Africa
4University of Queensland, Brisbane, Australia
5City University of Hong Kong, People’s Republic of China
Abstract
We propose a model of volunteering and test its validity across four cultural groups. We hypothesize that individuals’ explicit prosocial motivation relates positively to sustained volunteering, which is conceptualized as a latent factor comprising activity as a volunteer, service length, service frequency, and hours of volunteering. Moreover, we introduced implicit prosocial motivation and hypothesized that the relationship between explicit prosocial motivation and sustained volunteering would be amplified by implicit prosocial motivation. Data were collected from samples in China, Germany, Turkey, and the United States. Results confirmed our expectation that, across cultures, sustained volunteering was associated with explicit prosocial motivation and that the relationship between explicit prosocial motivation and sustained volunteering was strongest when implicit prosocial motivation was also high. By including implicit prosocial motivation, our study offers a novel approach to identifying sustained volunteer involvement, which can be of particular relevance for recruitment activities of voluntary organizations across various cultural contexts.

Pediatrics
March 2016, VOLUME 137 / ISSUE
http://pediatrics.aappublications.org/content/137/3?current-issue=y

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Articles
Mental Health of Transgender Children Who Are Supported in Their Identities
Kristina R. Olson, Lily Durwood, Madeleine DeMeules, Katie A. McLaughlin
Pediatrics Mar 2016, 137 (3) 1-8; DOI: 10.1542/peds.2015-3223

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 12 March 2016)

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Parental Vaccine Hesitancy in Quebec (Canada)
March 7, 2016 · Research Article
Abstract
Introduction: “Vaccine hesitancy” is a concept frequently used in the discourse around vaccine acceptance. This study aims to contribute to the ongoing reflections on tools and indicators of vaccine hesitancy by providing results of a knowledge, attitudes and beliefs (KAB) survey conducted among parents.
Methods: Data were collected in 2014 through a computer-assisted telephone interview survey administered to a sample of parents of children aged between 2 months and 17 years of age.
Results: The majority of the 589 parents included in the analyses agreed on the importance of vaccination to protect their children’s health and to prevent the spread of diseases in the community. The majority of the parents (81%) reported that their child had received all doses of recommended vaccines and 40% of parents indicated having hesitated to have their child vaccinated. Fear of adverse events and low perceived vulnerability of the child or severity of the disease were the most frequent reasons mentioned by these vaccine-hesitant parents. In multivariate analyses, KAB items remaining significantly associated both with an incomplete vaccination status of the child and parents’ vaccine hesitancy were: not thinking that it is important to have the child vaccinated to prevent the spreading of diseases in the community; not trusting the received vaccination information and having felt pressure to have the child vaccinated.
Discussion: Further researches will be needed to better understand when, how and why these beliefs are formed in order to prevent the onset of vaccine hesitancy.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 12 March 2016)

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Trans-Pacific Partnership Provisions in Intellectual Property, Transparency, and Investment Chapters Threaten Access to Medicines in the US and Elsewhere
Brook K. Baker
Essay | published 08 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001970
Summary Points
:: The recently negotiated Trans Pacific Partnership Agreement (TPP) contains provisions that would dramatically and negatively impact access to affordable medicines in the United States and elsewhere if it is ratified.
:: Provisions in the Intellectual Property (IP) Chapter of TPP lengthen, broaden, and strengthen patent-related monopolies on medicine and erect new monopoly protections on regulatory data as well. IP Chapter enforcement provisions also mandate injunctions preventing medicines sales, increase damage awards, and expand confiscation of medicines at the border.
:: IP rightholders gain new powers in the Investment Chapter to bring private, IP-related investor-state-dispute-settlement (ISDS) damage claims directly against foreign governments before unreviewable, three-person arbitration panels. Unrestricted IP-investor damage claims deter countries’ willingness to render adverse IP decisions and to adopt IP policy flexibilities designed to increase access to affordable medicines.
:: The Transparency Chapter contains provisions that allow pharmaceutical companies more access to government decisions listing medicines and medical devices for reimbursement.
At the very least, these multiple TPP provisions that extend pharmaceutical powers should be scaled back to the minimum consensus standards reached in the 1994 World Trade Organization (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Health advocates should convince the US Congress and opponents in other countries to reject an agreement that could so adversely impact access to medicines.

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Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys
Oona M. R. Campbell, Luca Cegolon, David Macleod, Lenka Benova
Research Article | published 08 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001972
Abstract
Background
Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants.
Methods and Findings
We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” ( Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries.
Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation.
Conclusions
Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care.

Editors’ Summary
Background
The general recommendation to women, especially to women in resource-poor settings (where more than 95% of all maternal and newborn deaths occur), is to give birth in a health facility. How long women and infants should stay after birth, i.e., the appropriate time to discharge, depends on many factors, but it is known that during the first 24 hours after birth mothers and children are at the highest risk of complications and death. During the postpartum stay, the objectives are to monitor maternal and newborn health, and to provide education on breastfeeding and signs for health problems in mothers and infants. WHO recommends that, in resource-poor settings, mothers and newborns stay for a minimum of 24 hours after vaginal birth.
Why Was This Study Done?
Considerable effort has gone into getting women to give birth in health facilities, and some countries have even made it illegal to give birth at home. However, some reports have suggested that women and infants often spend less than the recommended minimum time after birth in the facility. Actual data on duration of postpartum stays are limited, especially for low- and middle-income countries. This study was done to provide an overview of the reality in all countries for which current data exist, and to explore factors that influence the postpartum length of stay…
What Do these Findings Mean?
For many countries, the researchers were unable to find information on postpartum length of stay, and additional research seems warranted. Moreover, in the 30 DHS countries included in the analysis here, the percentage of births in health facilities ranged from 25.1% to 99.2%, suggesting that many countries still need to increase facility births. The postpartum lengths of stay reported vary widely between countries and are likely influenced by national norms and health system features in addition to specific needs of mothers and newborns. The reasons why women leave or are discharged early appear complex and are not well understood. Nonetheless, it seems that many women stay too short to receive adequate postnatal care. This is alarming, especially in low-income settings, where access to care after discharge is often limited. Countries in which staying too short is common should examine the reasons, clearly define appropriate care in health facilities during and after birth, and ensure both that such care is offered and that mothers and newborns stay long enough to receive it.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 12 March 2016)

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Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone
Kamalini Lokuge, Grazia Caleo, Jane Greig, Jennifer Duncombe, Nicholas McWilliam, James Squire, Manjo Lamin, Emily Veltus, Anja Wolz, Gary Kobinger, Marc-Antoine de la Vega, Osman Gbabai, Sao Nabieu, Mohammed Lamin, Ronald Kremer, Kostas Danis, Emily Banks, Kathryn Glass
Research Article | published 09 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004498
Abstract
Introduction
The scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas.
Methods
Internal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected.
Results
There were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ2 p-value<0·001), the proportion of confirmed patients admitted to the EMC
Discussion
Our findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks.

Author Summary
Ebola Virus Disease (EVD) is a severe illness that is usually spread from person to person through caring for someone who is sick, or if they die, contact with their body during their funeral. The recent EVD outbreak in West Africa caused illness and death in many thousands in Guinea, Sierra Leone and Liberia. It has been the largest and most difficult to control of any EVD outbreak in history, and this led to doubts as to the effectiveness of established control measures. Our study describes the successful control of EVD in a rural district of Sierra Leone. As in previous outbreaks, we found that control was achieved by working with communities to identify people who may have been exposed to EVD; if they then became sick, their early admission for testing and care to specialised centres that have equipment and procedures to prevent EVD passing on to staff or other patients, and safe burial of those who die of EVD by trained workers with appropriate protective equipment. We describe the resources and response structure needed to implement such measures effectively, information that will assist in controlling future outbreaks.

PLoS One
http://www.plosone.org/
[Accessed 12 March 2016]

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Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review
Emilia Vynnycky, Elisabeth J. Adams, Felicity T. Cutts, Susan E. Reef, Ann Marie Navar, Emily Simons, Lay-Myint Yoshida, David W. J. Brown, Charlotte Jackson, Peter M. Strebel, Alya J. Dabbagh
Research Article | published 10 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149160

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Factors Associated with Nursing Activities in Humanitarian Aid and Disaster Relief
Norihito Noguchi, Satoshi Inoue, Chisato Shimanoe, Kaoru Shibayama, Koichi Shinchi
Research Article | published 09 Mar 2016 | PLOS ONE
10.1371/journal.pone.0151170
Abstract
Background
Although nurses play an important role in humanitarian aid and disaster relief (HA/DR), little is known about the nursing activities that are performed in HA/DR. We aimed to clarify the nursing activities performed by Japanese nurses in HA/DR and to examine the factors associated with the frequency of nursing activities.
Methods
A self-administered questionnaire survey was completed by 147 nurses with HA/DR experience. The survey extracted information on demographic characteristics, past experience (e.g., disaster medical training experience, HA/DR experience), circumstances surrounding their dispatched to HA/DR (e.g., team size, disaster type, post-disaster phase, mission term), and the frequency of nursing activities performed under HA/DR. The frequency of nursing activities was rated on a 5-point Likert scale. Evaluation of nursing activities was conducted based on the “nursing activity score”, which represents the frequency of each nursing activity. Factors related to the nursing activity score were evaluated by multiple logistic regression analysis.
Results
Nurses were involved in 27 nursing activities in HA/DR, 10 of which were performed frequently. On analysis, factors significantly associated with nursing activity score were nursing license as a registered nurse (OR 7.79, 95% CI 2.95–20.57), two or more experiences with disaster medical training (OR 2.90 95%, CI 1.12–7.49) and a post-disaster phase of three weeks or longer (OR 8.77, 95% CI 2.59–29.67).
Conclusions
These results will contribute to the design of evidence-based disaster medical training that improves the quality of nursing activities.

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Crippling Violence: Conflict and Incident Polio in Afghanistan
Alison Norris, Kevin Hachey, Andrew Curtis, Margaret Bourdeaux
Research Article | published 09 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149074
Abstract
Background
Designing effective public health campaigns in areas of armed conflict requires a nuanced understanding of how violence impacts the epidemiology of the disease in question.
Methods
We examine the geographical relationship between violence (represented by the location of detonated Improvised Explosive Devices) and polio incidence by generating maps of IEDs and polio incidence during 2010, and by comparing the mean number of IED detonations in polio high-risk districts with non polio high-risk districts during 2004–2009.
Results
We demonstrate a geographic relationship between IED violence and incident polio. Districts that have high-risk for polio have highly statistically significantly greater mean numbers of IEDs than non polio high-risk districts (p-values 0.0010–0.0404).
Conclusions
The geographic relationship between armed conflict and polio incidence provides valuable insights as to how to plan a vaccination campaign in violent contexts, and allows us to anticipate incident polio in the regions of armed conflict. Such information permits vaccination planners to engage interested armed combatants to co-develop strategies to mitigate the effects of violence on polio.

Refugee Survey Quarterly
Volume 35 Issue 1 March 2016
http://rsq.oxfordjournals.org/content/current

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Special Issue: The Challenge of Asylum Detention to Refugee Protection
Guest Editors: Philippe De Bruycker and Evangelia (Lilian) Tsourdi

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The Challenge of Asylum Detention to Refugee Protection
Philippe De Bruycker* and Evangelia (Lilian) Tsourdi**
Abstract
Detention poses a specific challenge to refugee protection; detained asylum-seekers risk not being able to file and meaningfully pursue their claim and benefit only from restrained social and economic rights. They pay a steep human cost. Courts, the legislature, and the United Nations High Commissioner for Refugees have made efforts to rationalise its use, with the aim to render it a truly exceptional measure of last resort. However, challenges remain and there are pitfalls in asylum detention regulation. One major challenge is non-implementation of legal guarantees in practice and insufficient control by the judge. This can nullify legal guarantees, especially in a highly sophisticated framework like European Union law, where individualisation and the necessity and proportionality requirements, are the elements that rationalise otherwise broadly phrased detention grounds. The misuse of alternatives to detention that have been established to rationalise the use of asylum detention is another, as they may paradoxically be used to enhance control over asylum-seekers instead. Finally, migration management imperatives pose distinct challenges to refugee protection, where asylum detention is used arbitrarily as a means to their end.
[Six articles in this Special Issue]

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 12 March 2016]

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Research
Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda
Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, h…
Emmanueil Benon Turinawe, Jude T. Rwemisisi, Laban K. Musinguzi, Marije de Groot, Denis Muhangi, Daniel H. de Vries, David K. Mafigiri, Achilles Katamba, Nadine Parker and Robert Pool
Reproductive Health 2016 13:24
Published on: 12 March 2016

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Study protocol
PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana
The Preventing Maternal And Neonatal Deaths (PREMAND) project works to understand the social and cultural factors that may contribute to the deaths and near-misses (people who almost die but end up surviving) …
Cheryl A. Moyer, Raymond A. Aborigo, Elizabeth B. Kaselitz, Mira L. Gupta, Abraham Oduro and John Williams
Reproductive Health 2016 13:20
Published on: 9 March 2016

Tropical Medicine & International Health
March 2016 Volume 21, Issue 3 Pages 293–453
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-3/issuetoc

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Reviews
The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature (pages 294–311)
Dawn M. Becker, Chelsea A. Tafoya, Sören L. Becker, Grant H. Kruger, Matthew J. Tafoya and Torben K. Becker
Article first published online: 10 JAN 2016 | DOI: 10.1111/tmi.12657
Abstract
Objectives
To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.
Methods
The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.
Results
A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).
Conclusions
Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

Nepal Digest – Evidence for Action

__________________________________________________
February 2016

In support of building evidence-based practice, this digest aggregates selected research, analysis and insight about Nepal from UN agencies, INGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. A key resource for this digest is the peer-reviewed journal literature, attempting to better connect academic and other primary and secondary researchers to field practice leaders and practitioners.

pdf version and earlier editions available here: https://ge2p2-center.net/country-digests/

Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
– email: david.r.curry@ge2p2center.net
– twitter: @ge2p2
– skype: davidrcurry1