BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 30 April 2016)

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Research article
Stigma, explanatory models and unmet needs of caregivers of children with developmental disorders in a low-income African country: a cross-sectional facility-based survey
Understanding the perspectives of caregivers of children with developmental disorders living in low-income countries is important to inform intervention programmes.
Dejene Tilahun, Charlotte Hanlon, Abebaw Fekadu, Bethlehem Tekola, Yonas Baheretibeb and Rosa A. Hoekstra
BMC Health Services Research 2016 16:152
Published on: 27 April 2016

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Research article
Assessment of medicines use pattern using World Health Organization’s Prescribing, Patient Care and Health facility indicators in selected health facilities in eastern Ethiopia
About one-third of the world’s population lack access to essential medicines and this is further compounded by inappropriate prescription, dispensing, sale and use of the available medicines.
Arebu I. Bilal, Ebrahim D. Osman and Anwar Mulugeta
BMC Health Services Research 2016 16:144
Published on: 23 April 2016

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 30 April 2016)

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Research article
The ethics of community-based research with people who use drugs: results of a scoping review
Rusty Souleymanov, Dario Kuzmanović, Zack Marshall, Ayden I. Scheim, Mikiki Mikiki, Catherine Worthington and Margaret (Peggy) Millson
Published on: 29 April 2016
Abstract
Background
Drug user networks and community-based organizations advocate for greater, meaningful involvement of people with lived experience of drug use in research, programs and services, and policy initiatives. Community-based approaches to research provide an opportunity to engage people who use drugs in all stages of the research process. Conducting community-based participatory research (CBPR) with people who use drugs has its own ethical challenges that are not necessarily acknowledged or supported by institutional ethics review boards. We conducted a scoping review to identify ethical issues in CBPR with people who use drugs that were documented in peer-reviewed and grey literature.
Methods
The search strategy focused on three areas; community-based research, ethical issues, and drug use. Searches of five academic databases were conducted in addition to a grey literature search, hand-searching, and consultation with organizational partners and key stakeholders. Peer reviewed literature and community reports published in English between 1985 and 2013 were included, with initial screening conducted by two reviewers.
Results
The search strategy produced a total of 874 references. Twenty-five references met the inclusion criteria and were included in our thematic analysis. Five areas were identified as important to the ethics of CBPR with people who use drugs: 1) participant compensation, 2) drug user perspectives on CBPR, 3) peer recruitment and representation in CBPR, 4) capacity building, and 5) participation and inclusion in CBPR.
Conclusions
We critically discuss implications of the emerging research in this field and provide suggestions for future research and practice.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 30 April 2016)

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Research article
The influence of grandmothers on breastfeeding rates: a systematic review
Exclusive breastfeeding for the first six months of an infant’s life has enormous potential to reduce mortality and morbidity. The older generation, particularly the infant’s grandmothers, play a central role …
Joel Negin, Jenna Coffman, Pavle Vizintin and Camille Raynes-Greenow
BMC Pregnancy and Childbirth 2016 16:91
Published on: 27 April 2016

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Research article
Stressful events, social health issues and psychological distress in Aboriginal women having a baby in South Australia: implications for antenatal care
Around 6 % of births in Australia are to Aboriginal and Torres Strait Islander families. Aboriginal and Torres Strait Islander women are 2–3 times more likely to experience adverse maternal and perinatal outcomes…
Donna Weetra, Karen Glover, Mary Buckskin, Jackie Ah Kit, Cathy Leane, Amanda Mitchell, Deanna Stuart-Butler, May Turner, Jane Yelland, Deirdre Gartland and Stephanie J Brown
BMC Pregnancy and Childbirth 2016 16:88
Published on: 26 April 2016

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Research article
Perinatal health outcomes of East African immigrant populations in Victoria, Australia: a population based study
Sub-Saharan African women are often treated as a single group in epidemiological studies of immigrant birth outcomes, potentially masking variations across countries.
Fetene B. Belihu, Mary-Ann Davey and Rhonda Small
BMC Pregnancy and Childbirth 2016 16:86
Published on: 26 April 2016

Child Care, Health and Development
May 2016 Volume 42, Issue 3 Pages 297–454
http://onlinelibrary.wiley.com/doi/10.1111/cch.v42.3/issuetoc

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Reviews
Long-term cognitive and school outcomes of late-preterm and early-term births: a systematic review (pages 297–312)
E. Chan, P. Leong, R. Malouf and M. A. Quigley
Article first published online: 10 FEB 2016 | DOI: 10.1111/cch.12320

Reviews
The role of collaboration in the cognitive development of young children: a systematic review (pages 313–324)
J. Sills, G. Rowse and L.-M. Emerson
Article first published online: 16 MAR 2016 | DOI: 10.1111/cch.12330

Reviews
Interagency collaboration in children and young people’s mental health: a systematic review of outcomes, facilitating factors and inhibiting factors (pages 325–342)
M. Cooper, Y. Evans and J. Pybis
Article first published online: 10 FEB 2016 | DOI: 10.1111/cch.12322

Eurosurveillance
Volume 21, Issue 17, 28 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Review articles
Best practices in ranking communicable disease threats: a literature review, 2015
by EC O’Brien, R Taft, K Geary, M Ciotti, JE Suk
The threat of serious, cross-border communicable disease outbreaks in Europe poses a significant challenge to public health and emergency preparedness because the relative likelihood of these threats and the pathogens involved are constantly shifting in response to a range of changing disease drivers. To inform strategic planning by enabling effective resource allocation to manage the consequences of communicable disease outbreaks, it is useful to be able to rank and prioritise pathogens. This paper reports on a literature review which identifies and evaluates the range of methods used for risk ranking. Searches were performed across biomedical and grey literature databases, supplemented by reference harvesting and citation tracking. Studies were selected using transparent inclusion criteria and underwent quality appraisal using a bespoke checklist based on the AGREE II criteria. Seventeen studies were included in the review, covering five methodologies. A narrative analysis of the selected studies suggests that no single methodology was superior. However, many of the methods shared common components, around which a ‘best-practice’ framework was formulated. This approach is intended to help inform decision makers’ choice of an appropriate risk-ranking study design.

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News
World Health Organization announces European Region malaria free
On 20 April 2016, the World Health Organization (WHO) announced that the WHO European Region, which comprises 53 countries, is the first of the WHO regions to have interrupted the indigenous transmission of malaria [1].

In 2005, the WHO European Regional Office for Europe adopted the Tashkent Declaration, ‘The Move from Malaria Control to Elimination’ [2] which paved the way for a new malaria elimination strategy, the ‘Regional Strategy: From Malaria Control to Elimination in the WHO European Region 2006-2015’ [3]. The Regional Strategy set out milestones for the countries of the WHO European Region to eliminate malaria. Between 1995 and 2015, the number of indigenous malaria cases went from around 90,000 to zero in the European Region.

In July 2016, the WHO will hold its first meeting on the prevention of the re-introduction of malaria into the WHO European Region. According to the WHO, the meeting will focus on prevention through (i) sustained political commitment, (ii) strong vigilance to test and treat all malaria cases promptly, (iii) understanding how malaria transmission could be reintroduced and the risk it poses; and (iv) immediate action if local malaria transmission resumes.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 30 April 2016]

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Research
Partnerships in global health and collaborative governance: lessons learnt from the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals
David Beran, Sigiriya Aebischer Perone, Gabriel Alcoba, Alexandre Bischoff, Claire-Lise Bussien, Gilles Eperon, Olivier Hagon, Olivia Heller, Frédérique Jacquerioz Bausch, Nicolas Perone, Thomas Vogel and François Chappuis
Published on: 29 April 2016
Abstract
Background
In 2007 the “Crisp Report” on international partnerships increased interest in Northern countries on the way their links with Southern partners operated. Since its establishment in 2007 the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals has developed a variety of partnerships. Frameworks to assess these partnerships are needed and recent attention in the field of public management on collaborative governance may provide a useful approach for analyzing international collaborations.
Methods
Projects of the Division of Tropical and Humanitarian Medicine were analyzed by collaborators within the Division using the model proposed by Emerson and colleagues for collaborative governance, which comprises different components that assess the collaborative process.
Results
International projects within the Division of Tropical and Humanitarian Medicine can be divided into four categories: Human resource development; Humanitarian response; Neglected Tropical Diseases and Noncommunicable diseases. For each of these projects there was a clear leader from the Division of Tropical and Humanitarian Medicine as well as a local counterpart. These individuals were seen as leaders both due to their role in establishing the collaboration as well as their technical expertise. Across these projects the actual partners vary greatly. This diversity means a wide range of contributions to the collaboration, but also complexity in managing different interests. A common definition of the collaborative aims in each of the projects is both a formal and informal process. Legal, financial and administrative aspects of the collaboration are the formal elements. These can be a challenge based on different administrative requirements. Friendship is part of the informal aspects and helps contribute to a relationship that is not exclusively professional.
Conclusion
Using collaborative governance allows the complexity of managing partnerships to be presented. The framework used highlights the process of establishing collaborations, which is an element often negated by other more traditional models used in international partnerships. Applying the framework to the projects of the Division of Tropical and Humanitarian Medicine highlights the importance of shared values and interests, credibility of partners, formal and informal methods of management as well as friendship.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 30 April 2016]

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Commentary
The Life Science Exchange: a case study of a sectoral and sub-sectoral knowledge exchange programme
Brian Lee Perkins, Rob Garlick, Jodie Wren, Jon Smart, Julie Kennedy, Phil Stephens, Gwyn Tudor, Jonathan Bisson and David V. Ford
Published on: 27 April 2016
Abstract
Background
Local and national governments have implemented sector-specific policies to support economic development through innovation, entrepreneurship and knowledge exchange. Supported by the Welsh Government through the European Regional Development Fund, The Life Science Exchange® project was created with the aim to increase interaction between stakeholders, to develop more effective knowledge exchange mechanisms, and to stimulate the formation and maintenance of long-term collaborative relationships within the Welsh life sciences ecosystem. The Life Science Exchange allowed participants to interact with other stakeholder communities (clinical, academic, business, governmental), exchange perspectives and discover new opportunities.
Methods
Six sub-sector focus groups comprising over 200 senior stakeholders from academia, industry, the Welsh Government and National Health Service were established. Over 18 months, each focus group provided input to inform healthcare innovation policy and knowledge mapping exercises of their respective sub-sectors. Collaborative projects identified during the focus groups and stakeholder engagement were further developed through sandpit events and bespoke support.
Results
Each sub-sector focus group produced a report outlining the significant strengths and opportunities in their respective areas of focus, made recommendations to overcome any ‘system failures’, and identified the stakeholder groups which needed to take action. A second outcome was a stakeholder-driven knowledge mapping exercise for each area of focus. Finally, the sandpit events and bespoke support resulted in participants generating more than £1.66 million in grant funding and inward investment. This article outlines four separate outcomes from the Life Science Exchange programme.
Conclusions
The Life Science Exchange process has resulted in a multitude of collaborations, projects, inward investment opportunities and special interest group formations, in addition to securing over ten times its own costs in funding for Wales. The Life Science Exchange model is a simple and straightforward mechanism for a regional or national government to adapt and implement in order to improve innovation, skills, networks and knowledge exchange.

JAMA
April 26, 2016, Vol 315, No. 16
http://jama.jamanetwork.com/issue.aspx

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Special Communication | April 26, 2016
The Association Between Income and Life Expectancy in the United States, 2001-2014
Raj Chetty, PhD1; Michael Stepner, BA2; Sarah Abraham, BA2; Shelby Lin, MPhil3; Benjamin Scuderi, BA4; Nicholas Turner, PhD5; Augustin Bergeron, MA4; David Cutler, PhD4
Author Affiliations
JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226.
Abstract
Importance
The relationship between income and life expectancy is well established but remains poorly understood.
Objectives
To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.
Design and Setting
Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.
Exposure
Pretax household earnings as a measure of income.
Main Outcomes and Measures
Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.
Results
The sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61 175 per year). There were 4 114 380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r=-0.69, P  < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r= 0.42, P < .001), and government expenditures (r=0.57, P < .001).
Conclusions and Relevance
In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics

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Editorials:
Associations Between Money and Death; Angus Deaton, PhD
Improving Opportunity, Population Health, and Well-being Collectively; Steven H. Woolf, MD, MPH; Jason Q. Purnell, PhD, MPH
Income, Longevity, and Community Health; J. Michael McGinnis, MD, MPP

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 27, Number 2, May 2016 Supplement
https://muse.jhu.edu/issue/33442

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Introduction to Public Health and Incarceration: Social Justice Matters
Overview Providing health care in jails, prisons, half-way houses, and community-supervised correctional programs, correctional facilities, and community systems has a direct effect on health outcomes of incarcerated populations. Moreover, effective linkages to a myriad of services upon release and assistance with community reintegration are key components for reducing recidivism. In an effort to highlight some of the disparity issues and challenges in corrections, we offer this issue, titled, Public Health and Incarceration: Social Justice Matters. In 2012, U.S. state prison systems, comprising 50 independent entities, incarcerated over 1.3 million people, of whom a disproportionate share were minorities, primarily African Americans and Hispanics. Despite recent reports that 2012 marked a decrease in the number of imprisonments of males and females, the U.S. continues to lead the world in incarceration of its residents. The reported decrease in incarceration may be attributed to alternative sentences, such as probation, which maintains individuals under correctional supervision.

Mass incarceration disrupts families and affects health status and the quality of life within families. Prisoners are more likely than the general population to have chronic health conditions and infectious diseases. In 2012, 43.9% of offenders reported a chronic condition, relative to 31.0% of the general population; 21.0% of offenders had had an infectious disease, relative to 4.8% of the general population. The disparities in mental health and substance abuse are equally troubling. These health risks are not proportionately distributed across populations. African American males have an imprisonment rate of 2,841 per 100,000; Hispanic males have a rate of 1,158 per 100,000; and White males have a rate of 463 per 100,000. There are similar disparities for African American and Hispanic females relative to Whites.

Although some of the health problems experienced by offenders are addressed during their incarceration, many are not addressed upon their release, which poses serious health risks for the former offenders and for the local communities to which they return. Health problems of former offenders become those of the local community, where there may be little knowledge and discussion related to the intersections of corrections, public health, and reentry for this subset of a vulnerable population.

This special issue of the JHCPU-with a focus on disparities related to racial and ethnic minorities, reentry, and public health-explores innovative research, services, and programs that deal with the health of the offender population. The social justice system is burdened with imperfections deleterious to health equity. The system disproportionately lessens the life opportunities of African Americans, Latinos, and other disadvantaged ethnic minority groups. Eliminating such imperfections is a formidable task, but nevertheless one that must be accomplished if the nation is to achieve true health equity.

The articles in this issue of the JHCPU report on strategies for change. In the commentary by Ferguson, et al., a strong case is made that systems change is the “order of the day”; this case is eloquently presented as a “Call for Action.” While there have been many other such appeals, this call offers recommendations for clinical practice, criminal justice studies, health science institutions, and communities. Much like the compelling call for action in Michelle Alexander’s book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, a stage is set for sector stakeholders to move in a new direction, one involving sector accountability without compromise. We must change the mass incarceration practices and eliminate their catastrophic effects on racial and ethnic minorities, in the U.S. In the manuscript by Coughlin, Lewis, and Smith, developments in ethics in the context of the racial/ethnic disparities that exist in corrections, are discussed. Ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Factors in mental health research are summarized, along with issues pertaining to research involving female inmates. The ethics of research involving incarcerated people extends beyond traditional ethical concerns related to human subjects to include issues in the domains of bioethics and public health ethics. Tamburello and Ferguson present a commentary on marginalized individuals diagnosed with mental health conditions and the medication-prescribing practices in correctional facilities. Several articles in this issue concern incarcerated women specifically…

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Commentaries
Ethical and Social Issues in Health Research Involving Incarcerated People
pp. 18-28
Steven S. Coughlin, Sharon R. Lewis, Selina A. Smith
Abstract:
The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.

Journal of International Development
May 2016 Volume 28, Issue 4 Pages 445–646
http://onlinelibrary.wiley.com/doi/10.1002/jid.v28.4/issuetoc

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Research Articles
In Harm’s Way: Children’s Work in Risky Occupations in Brazil (pages 447–472)
Deborah S. DeGraff, Andrea R. Ferro and Deborah Levison
Article first published online: 30 JUN 2015 | DOI: 10.1002/jid.3111
Abstract
There were large numbers of child workers in domestic services, street work, construction and selected areas of agricultural production in Brazil at the turn of the century. These kinds of occupations are often problematic for youth. We show that children engaged in these risky categories of work are more disadvantaged than other employed children and non-employed children. Results from a large representative survey show that children in ‘risky’ work are more likely to have parents also engaged in hazardous activities or be living without both parents, characteristics that may be useful for targeting policy.

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Evidences on Donors Competition in Africa: Traditional Donors versus China (pages 528–551)
Eric Gabin Kilama
Article first published online: 28 DEC 2015 | DOI: 10.1002/jid.3198
Abstract
This paper describes the aid allocation behaviours of the Development Assistance Committee (DAC) donors and their response to the emergence of China in the aid landscape. Our analysis presents evidences of donors’ competition in Africa.
We investigate whether African countries with the Chinese influence expanding receive favourable aid modalities from G7 donors over the period 2000–2011. We find a robust positive relationship between the level of aid and the number of China projects a country receives and the level of bilateral aid from G7 donors, even after accounting for standard economic and political factors. Results indicate that DAC donors use bilateral aid to tackle the increasing influence of China in Africa, by delivering more aid to countries with natural resources or strategic political interest. The paper also assesses empirically whether strategic interests and economic competition between DAC donors and China have influenced the composition of aid flows received by African countries.
Our empirical strategy is sharpened by the use of a spatial-X model and a difference-in-difference estimation that leverages a ‘natural’ experiment in DAC aid flows in the aftermath of the financial crisis, with China increasing his sphere of influence in Africa.

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Field Report
How a Strong Sense of Community Led to Improvements in Rural Health Care: The Case of Patanatic, Guatemala (pages 631–639)
Jeffrey S. Smith, Rachel J. Loder, Sonia Xiquin and Ana Adela Garcia
Article first published online: 26 JUN 2015 | DOI: 10.1002/jid.3122
Abstract
Improving rural health in the Global South has been approached from different perspectives. Since World War II, most aid has been funded through top-down approaches seeking to eliminate specific problems. There is a growing push, however, to involve local residents in the process, and the literature asserts that programs meshing with local cultural traditions and drawing upon resident knowledge are more successful. Here is a case study of how Patanatic, Guatemala developed its own rural health program. The lessons learned are worth considering and show promise of being applicable to other rural Global South locations.

Journal of Public Health Policy
Volume 37, Issue 2 (May 2016)
http://www.palgrave-journals.com/jphp/journal/v37/n2/index.html

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Editorial
How to understand the results of the climate change summit: Conference of Parties21 (COP21) Paris 2015 FREE
Our Co-Editor reports on developments from Paris, where he joined 40,000 people in November at the Summit at Le Bourget
Anthony Robbins
J Public Health Pol 37: 129-132; advance online publication, January 7, 2016; doi:10.1057/jphp.2015.47

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Viewpoints
Zika virus: An international emergency? FREE
A distinguished Mexican researcher anguishes about next steps to control this epidemic and its frightening consequences
Adolfo Martinez Palomo
J Public Health Pol 37: 133-135; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.11
Abstract
This Viewpoint discusses the World Health Organization’s Declaration on 1 February 2016 that the epidemic infection caused by the Zika virus is a public health emergency of international concern – the basis of the decision and controversy surrounding it.

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Viewpoints
Unhealthy marketing of pharmaceutical products: An international public health concern
Shai Mulinari
J Public Health Pol 37: 149-159; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.6
Abstract
I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care

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Original Articles
Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education
Lonzozou Kpanake, Komlantsè Gossou, Paul Clay Sorum, and Etienne Mullet
J Public Health Pol 37: 160-172; advance online publication, February 11, 2016; doi:10.1057/jphp.2016.1
Abstract
To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea.

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Social world of organ transplantation, trafficking, and policies
Farhan Navid Yousaf and Bandana Purkayastha
J Public Health Pol 37: 190-199; advance online publication, February 4, 2016; doi:10.1057/jphp.2016.2
Abstract
Although success of organ transplants reflects advances in medical procedures, the success has generated debates about the ethical standards and policies that govern transplants, especially the acquisition of organs for transplants. We focus on laws, policies, and organ trafficking to highlight the interdisciplinary perspectives that can shape our understanding of transplantation as a social phenomenon. We discuss international policies and country-specific legislation from Pakistan to point to gaps and their implications for protecting vulnerable people who are exploited for organ removal. International collaboration and the legal framework need to be strengthened to fight the menace globally and to deal with the cases of organ trafficking within the legal ambit of human trafficking so that the rights of victims are upheld by states, justice systems, and ultimately medical establishments and practitioners.

Journal of the Royal Society – Interface
01 April 2016; volume 13, issue 117
http://rsif.royalsocietypublishing.org/content/current

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Life Sciences–Mathematics interface
Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
Amy Wesolowski, Keitly Mensah, Cara E. Brook, Miora Andrianjafimasy, Amy Winter, Caroline O. Buckee, Richter Razafindratsimandresy, Andrew J. Tatem, Jean-Michel Heraud, C. Jessica E. Metcalf
J. R. Soc. Interface 2016 13 20151101; DOI: 10.1098/rsif.2015.1101. Published 27 April 2016
Abstract
Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

The Lancet
Apr 30, 2016 Volume 387 Number 10030 p1789-1878 e25
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
The next Director-General of WHO
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30358-0
Summary
WHO last week fired a starting pistol to launch the election for its next Director-General. The final vote does not take place until May, 2017. Procedures have been substantially revised since 2012, when Margaret Chan was elected to serve a second term. It is likely that this lengthy process will therefore be more transparent, accountable, and disputatious (and considerably less corrupt) than past elections.

[Excerpt]
…The deadline for member states to nominate candidates is Sept 22. Several prominent individuals have already disclosed their intentions to stand. Philippe Douste-Blazy served two terms as France’s Minister of Health and subsequently became Foreign Minister. He has been a leader on innovative financing for health and has chaired UNITAID since 2006. Tedros Adhanom Ghebreyesus is currently Ethiopia’s Minister of Foreign Affairs. He was Minister of Health from 2005–12. The African Union has endorsed him as the sole African candidate for Director-General. Sania Nishtar, Pakistan’s former Minister of Health (among several other government portfolios), has had a distinguished career as a civil society leader. She founded the influential non-governmental organisation Heartfile in 1999. All three candidates are highly accomplished global health leaders, which bodes well for the future of WHO…

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe
Selidji T. Agnandji, M.D., Angela Huttner, M.D., Madeleine E. Zinser, M.D., Patricia Njuguna, M.Med., Christine Dahlke, Ph.D., José F. Fernandes, M.D., Sabine Yerly, M.Sc., Julie-Anne Dayer, M.D., Verena Kraehling, Ph.D., Rahel Kasonta, Ph.D., Akim A. Adegnika, M.D., Ph.D., Marcus Altfeld, M.D., Ph.D., Floriane Auderset, Ph.D., Emmanuel B. Bache, M.Sc., Nadine Biedenkopf, Ph.D., Saskia Borregaard, Ph.D., Jessica S. Brosnahan, M.H.Sc., Rebekah Burrow, B.Sc., Christophe Combescure, Ph.D., Jules Desmeules, M.D., Markus Eickmann, Ph.D., Sarah K. Fehling, Ph.D., Axel Finckh, M.D., Ana Rita Goncalves, Ph.D., Martin P. Grobusch, M.D., Ph.D., Jay Hooper, Ph.D., Alen Jambrecina, M.D., Anita L. Kabwende, M.D., Gürkan Kaya, M.D., Ph.D., Domtila Kimani, B.Sc., Bertrand Lell, M.D., Barbara Lemaître, M.Sc., Ansgar W. Lohse, M.D., Marguerite Massinga-Loembe, Ph.D., Alain Matthey, M.D., Benjamin Mordmüller, M.D., Anne Nolting, M.D., Caroline Ogwang, M.B., Ch.B., Michael Ramharter, M.D., Jonas Schmidt-Chanasit, M.D., Stefan Schmiedel, M.D., Peter Silvera, Ph.D., Felix R. Stahl, M.D., Ph.D., Henry M. Staines, D.Phil., Thomas Strecker, Ph.D., Hans C. Stubbe, M.D., Benjamin Tsofa, Ph.D., Sherif Zaki, M.D., Ph.D., Patricia Fast, M.D., Ph.D., Vasee Moorthy, Ph.D., Laurent Kaiser, M.D., Sanjeev Krishna, Sc.D., Stephan Becker, Ph.D., Marie-Paule Kieny, Ph.D., Philip Bejon, Ph.D., Peter G. Kremsner, M.D., Marylyn M. Addo, M.D., Ph.D., and Claire-Anne Siegrist, M.D.*
N Engl J Med 2016; 374:1647-1660 April 28, 2016 DOI: 10.1056/NEJMoa1502924

Abstract
Background
The replication-competent recombinant vesicular stomatitis virus (rVSV)–based vaccine expressing a Zaire ebolavirus (ZEBOV) glycoprotein was selected for rapid safety and immunogenicity testing before its use in West Africa.
Methods
We performed three open-label, dose-escalation phase 1 trials and one randomized, double-blind, controlled phase 1 trial to assess the safety, side-effect profile, and immunogenicity of rVSV-ZEBOV at various doses in 158 healthy adults in Europe and Africa. All participants were injected with doses of vaccine ranging from 300,000 to 50 million plaque-forming units (PFU) or placebo.
Results
No serious vaccine-related adverse events were reported. Mild-to-moderate early-onset reactogenicity was frequent but transient (median, 1 day). Fever was observed in up to 30% of vaccinees. Vaccine viremia was detected within 3 days in 123 of the 130 participants (95%) receiving 3 million PFU or more; rVSV was not detected in saliva or urine. In the second week after injection, arthritis affecting one to four joints developed in 11 of 51 participants (22%) in Geneva, with pain lasting a median of 8 days (interquartile range, 4 to 87); 2 self-limited cases occurred in 60 participants (3%) in Hamburg, Germany, and Kilifi, Kenya. The virus was identified in one synovial-fluid aspirate and in skin vesicles of 2 other vaccinees, showing peripheral viral replication in the second week after immunization. ZEBOV-glycoprotein–specific antibody responses were detected in all the participants, with similar glycoprotein-binding antibody titers but significantly higher neutralizing antibody titers at higher doses. Glycoprotein-binding antibody titers were sustained through 180 days in all participants.
Conclusions
In these studies, rVSV-ZEBOV was reactogenic but immunogenic after a single dose and warrants further evaluation for safety and efficacy. (Funded by the Wellcome Trust and others; ClinicalTrials.gov numbers, NCT02283099, NCT02287480, and NCT02296983; Pan African Clinical Trials Registry number, PACTR201411000919191.)

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal
Original Article
A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA
Katie Ewer, Ph.D., Tommy Rampling, M.R.C.P., Navin Venkatraman, M.R.C.P., Georgina Bowyer, B.A., Danny Wright, M.Sc., Teresa Lambe, Ph.D., Egeruan B. Imoukhuede, M.D., Ruth Payne, M.R.C.P., Sarah Katharina Fehling, Ph.D., Thomas Strecker, Ph.D., Nadine Biedenkopf, Ph.D., Verena Krähling, Ph.D., Claire M. Tully, B.A., Nick J. Edwards, B.Sc., Emma M. Bentley, B.Sc., Dhanraj Samuel, Ph.D., Geneviève Labbé, Ph.D., Jing Jin, Ph.D., Malick Gibani, M.R.C.P., Alice Minhinnick, M.B., Ch.B., Morven Wilkie, M.R.C.P., Ian Poulton, Dip.H.E., Natalie Lella, B.A., Rachel Roberts, M.Sc., Felicity Hartnell, M.B., B.S., Carly Bliss, B.A., Kailan Sierra-Davidson, B.A., Jonathan Powlson, B.Sc., Eleanor Berrie, Ph.D., Richard Tedder, M.B., B.Chir., Francois Roman, M.D., Iris De Ryck, Ph.D., Alfredo Nicosia, Ph.D., Nancy J. Sullivan, Ph.D., Daphne A. Stanley, M.S., Olivier T. Mbaya, M.D., Julie E. Ledgerwood, D.O., Richard M. Schwartz, Ph.D., Loredana Siani, Ph.D., Stefano Colloca, Ph.D., Antonella Folgori, Ph.D., Stefania Di Marco, Ph.D., Riccardo Cortese, M.D., Edward Wright, Ph.D., Stephan Becker, Ph.D., Barney S. Graham, M.D., Richard A. Koup, M.D., Myron M. Levine, M.D., Ariane Volkmann, Ph.D., Paul Chaplin, Ph.D., Andrew J. Pollard, Ph.D., Simon J. Draper, D.Phil., W. Ripley Ballou, M.D., Alison Lawrie, Ph.D., Sarah C. Gilbert, Ph.D., and Adrian V.S. Hill, D.M.
N Engl J Med 2016; 374:1635-1646 April 28, 2016 DOI: 10.1056/NEJMoa1411627

Abstract
Background
The West African outbreak of Ebola virus disease that peaked in 2014 has caused more than 11,000 deaths. The development of an effective Ebola vaccine is a priority for control of a future outbreak.
Methods
In this phase 1 study, we administered a single dose of the chimpanzee adenovirus 3 (ChAd3) vaccine encoding the surface glycoprotein of Zaire ebolavirus (ZEBOV) to 60 healthy adult volunteers in Oxford, United Kingdom. The vaccine was administered in three dose levels — 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles — with 20 participants in each group. We then assessed the effect of adding a booster dose of a modified vaccinia Ankara (MVA) strain, encoding the same Ebola virus glycoprotein, in 30 of the 60 participants and evaluated a reduced prime–boost interval in another 16 participants. We also compared antibody responses to inactivated whole Ebola virus virions and neutralizing antibody activity with those observed in phase 1 studies of a recombinant vesicular stomatitis virus–based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) to determine relative potency and assess durability.
Results
No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the ChAd3 vaccine, ZEBOV-specific antibody responses were similar to those induced by rVSV-ZEBOV vaccination, with a geometric mean titer of 752 and 921, respectively. ZEBOV neutralization activity was also similar with the two vaccines (geometric mean titer, 14.9 and 22.2, respectively). Boosting with the MVA vector increased virus-specific antibodies by a factor of 12 (geometric mean titer, 9007) and increased glycoprotein-specific CD8+ T cells by a factor of 5. Significant increases in neutralizing antibodies were seen after boosting in all 30 participants (geometric mean titer, 139; P<0.001). Virus-specific antibody responses in participants primed with ChAd3 remained positive 6 months after vaccination (geometric mean titer, 758) but were significantly higher in those who had received the MVA booster (geometric mean titer, 1750; P<0.001).
Conclusions
The ChAd3 vaccine boosted with MVA elicited B-cell and T-cell immune responses to ZEBOV that were superior to those induced by the ChAd3 vaccine alone. (Funded by the Wellcome Trust and others; ClinicalTrials.gov number, NCT02240875.)

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 April 2016)

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Perspective
Child Homicide: A Global Public Health Concern
Delan Devakumar, David Osrin
| published 26 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002004

Despite recent increases in child survival, some 5.9 million children still die each year, and reducing global childhood mortality remains a public health priority [1]. The greatest numbers of deaths are due to infections, intrapartum events, and preterm births, but reductions in all causes of mortality are needed to reach the Sustainable Development Goal target of 25 deaths for every 1,000 live-born infants. In a research article in PLOS Medicine, Naeemah Abrahams and colleagues shed some light on the occurrence of child homicide [2]. Tragedy radiates from such events, backward in time to the pressure and emotional burden that might lead people, willfully or not, to end the life of a child, and forward to the effects on parents and families. Children who survive attempted homicide may go on to suffer long-term traumatic consequences [3].

Abrahams and colleagues examined data on homicides of children aged under five years in South Africa. They began by assessing records of unnatural deaths over a single year, 2009, in postmortem reports from a sample of medico-legal laboratories of different sizes and in urban and rural settings. They contacted investigating police officers and interviewed them to gather more information. Most of the deaths (74.4%) were of infants less than one year old (of whom 53.2% were neonates in their first 28 days of life). Mortality rates among neonates, infants, and children aged 1–4 years were 19.6, 28.4, and 1.0 per 100,000 live births, respectively. These figures are substantial: assuming an overall neonatal mortality rate of 12–14 per 1,000, the neonatal mortality estimate from homicide in the present study corresponds to ~1.5% of all neonatal deaths in South Africa in 2009.

Were the high rates of child homicide found in the study a product of South Africa’s high aggregate homicide rate (31 per 100,000), or were they unexpected [4]? Global homicide rates average 6.2 per 100,000, but there is large variation. Young people under the age of 20 years make up around a quarter of homicide victims [4]: 95,000 children were killed in 2012, a rate of eight per 100,000. Rates are particularly high in Latin America (12 per 100,000) and east and central Africa (10 per 100,000). The highest estimate is for El Salvador, at 27 per 100,000 [3]. In some countries, such as Venezuela, improvements in child health have been vitiated by child homicides [3].

We should view global estimates with caution as data are often incomplete, analysis requires assumptions, and misclassification is particularly likely with regard to homicide of young infants [3]. In general, homicides are likely to be underreported, particularly for neonates in countries that do not have complete coverage of birth registration and where deliveries take place outside institutions. Categorisation is always going to be elusive, but Abrahams and colleagues used the best methods they could, with an emphasis on conservative estimates. The researchers excluded cases for which no information was available and deaths ascribed to sudden infant death syndrome (of which up to 10% might represent homicide) [5], which could have produced an underestimate of the burden of child homicide. Conversely, they classified all cases of abandonment and subsequent death as homicide, which might have produced an overestimate.

The most common antecedent to death was abandonment of young infants, but there was little information on cause of death beyond this. Concealment of pregnancy is relatively common worldwide [6], and other studies have shown that suffocation and drowning are frequent methods of infanticide [7]. Causal inference is difficult if the child’s body is found in a partially decomposed state, and misclassification of stillbirths is possible. An assessment of abandoned fetuses and newborn infants in South Africa, by du Toit-Prinsloo and co-workers, found that 35% were decomposed. Amongst infants of greater than 26 weeks gestation, 28% (n = 31) were thought to have been born alive, but differentiation was not possible in 31% [8].

Abrahams and colleagues found no difference in child homicide rates by sex, although there was a decreased likelihood of male deaths in rural settings compared to urban settings. They rightly draw comparisons with south Asia and China, where both feticide and infanticide of girls have been a serious concern [9,10], but we should be cautious, given the modest size of Abrahams and colleagues’ study. In a related paper, Mathews and co-workers describe the epidemiology of child homicide in South Africa [11]. The pattern of homicide is similar for boys and girls, but changes with age. The homicide rate amongst males aged 15–17 years was five times that for females of the same age.

Abrahams and colleagues found—as have others—that mothers were the perpetrators in two-thirds of cases (maternal filicide). Studies from high-income countries suggest that the characteristics of mothers implicated in infanticide at birth and homicides of older infants are different. Women who commit neonaticide—the bulk of deaths—are more often young, unemployed or in school, and unmarried. Women implicated in the homicide of older infants tend to be older, and the homicide often occurs within a cycle of abuse [7]. The association of infanticide with maternal mental health is complex, and some studies support a link, while others do not [6]. Some women who commit infanticide are living with mental illness, including frank psychosis, but most infanticide does not seem to be associated with overt maternal mental illness [7].

What can the health community do? There are two general approaches: child protection and law enforcement, and primary prevention. Protecting vulnerable children is a priority, with an emphasis on supporting under-resourced and sometimes nonexistent child protection services, as is convicting perpetrators. In many cases, primary prevention of homicide through work with parents and families may be the best approach. Referring to deaths caused by parents, Resnick suggested a classification that included altruistic motives (to relieve suffering), acute psychosis, unwanted pregnancy, fatal consequences of child maltreatment, and revenge against another person, often a spouse [12]. Each of these categories has implications for the way we think about potential public health approaches. Some countries allow women to leave their infants anonymously in a safe place. The USA, for example, has introduced “safe havens” where infants can be abandoned legally. The effectiveness of such initiatives has yet to be determined, and it is not known whether mothers who might commit infanticide would call on them [13].

We agree with Abrahams and colleagues that more funds should go into maternity services, and also suggest that interventions need to be instigated before conception. As many births are unwanted, accessible and contextually appropriate family planning interventions are needed. Much work needs to be done with adolescent women to provide advice and support on sexual health, contraception, and childbirth. For women who present antenatally, a mental health assessment should be part of routine practice, with extra support for those in whom conditions are diagnosed or predicted [14]. Mortality data should be disaggregated and include homicide statistics, even if the numbers are small, so that we can move forward with a clearer picture of where interventions would yield the greatest benefit. We know a little, but not enough.

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Research Article
Gender Differences in Homicide of Neonates, Infants, and Children under 5 y in South Africa: Results from the Cross-Sectional 2009 National Child Homicide Study
Naeemah Abrahams, Shanaaz Mathews, Lorna J. Martin, Carl Lombard, Nadine Nannan, Rachel Jewkes
| published 26 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002003

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 30 April 2016)

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Editorial
Nutritional Enteric Failure: Neglected Tropical Diseases and Childhood Stunting
Kirkby D. Tickell, Judd L. Walson
| published 28 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004523
[Initial text]
Chronic malnutrition, defined by linear growth failure, or stunting, affects over 165 million children globally [1]. In many areas of the world with a high prevalence of stunting, children experience frequent and recurrent exposure to pathogens, including neglected tropical diseases (NTDs). These infections appear to have detrimental effects on linear growth [2–6], but interventions to promote linear growth have demonstrated limited benefit. Difficulty in establishing effective growth-promoting interventions is not unique to NTDs; even the optimal delivery of all interventions known to improve nutritional status is estimated to be able to reverse less than a quarter of all stunting [7]. The failure to identify effective interventions to reverse stunting offers the opportunity to develop a new conceptual model of chronic malnutrition that furthers our understanding of the mechanism linking pathogen and environmental exposures to linear growth failure. Such a conceptual model may guide the identification of new targets for intervention to reduce the substantial morbidity and mortality associated with chronic malnutrition [1]…

PLoS One
http://www.plosone.org/
[Accessed 30 April 2016]

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Research Article
Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama
Danny V. Colombara, Bernardo Hernández, Alexandra Schaefer, Nicholas Zyznieuski, Miranda F. Bryant, Sima S. Desai, Marielle C. Gagnier, Casey K. Johanns, Claire R. McNellan, Erin B. Palmisano, Diego Ríos-Zertuche, Paola Zúñiga-Brenes, Emma Iriarte, Ali H. Mokdad
Research Article | published 27 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0154388

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 30 April 2016)

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Commentary:
Anthropogenic disturbances infiltrate forest fragments
Exequiel Ezcurraa,1
Extract
In the years after Edward O. Wilson and Robert MacArthur’s seminal book, The Theory of Island Biogeography (1), which laid the foundations for understanding species diversity and extinction rates in isolated habitats, was published in 1967, a flurry of papers erupted on the effect of fragmentation in tropical rainforests. The big question at that time was whether it would be more advisable to protect massive tracts of continuous rainforest or smaller patches forming an archipelago of forest fragments within an anthropogenic matrix of pasturelands and tropical farms. Tom Lovejoy, who, like MacArthur, had earned his doctoral degree at Yale University under the mentorship of G. Evelyn Hutchinson, decided to put the question to a test by taking advantage of the ongoing land clearings around Manaus, Brazil, to create a large-scale experiment. In collaboration with Amazonian ranchers, the team cleared the trees around a series of fragments of rainforest of varying sizes to create islands of intact forest, and have been monitoring the plots since 1978, carefully documenting how deforestation harms neighboring pristine fragments as plants and animals of the mature forest give way to more opportunistic species that thrive in disturbed habitats (2⇓–4). The Manaus experiment has been replicated in many different tropical regions with similar results, showing the vulnerability of small reserves to large-scale human disturbance. The detailed underlying mechanisms of biodiversity loss, however, remained to be unraveled. In PNAS, a group of Mexican ecologists tackle the problem of ecosystem fragmentation from a different perspective, the demography of understory plants, adding important information to our knowledge on the dynamics of forest fragments (5).

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial
Original Research Article
Pages 2437-2443
Gretchen J. Domek, Ingrid L. Contreras-Roldan, Sean T. O’Leary, Sheana Bull, Anna Furniss, Allison Kempe, Edwin J. Asturias
Abstract
Background
Patient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous.
Objective
To determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala.
Methods
A pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8–14 weeks presenting for the first dose of the primary immunization series were enrolled in March–April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups.
Results
The participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p = .12) and visit 3 (84.4% vs. 80.7%, p = .69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p < .0001), agreed to being interested in receiving future SMS reminders (p < .0001), and said that they would be willing to pay for future SMS reminders (p = .01).
Conclusion
This proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).