The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
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Week ending 26 November 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-26-november-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

:: Journal Watch
The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 26 November 2106)

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Research article
It’s complicated: why do tuberculosis patients not initiate or stay adherent to treatment? A qualitative study from South Africa
Individuals who test positive for active tuberculosis (TB) but do not initiate treatment present a challenge to TB programmes because they contribute to ongoing transmission within communities. To better under...
Donald Skinner and Mareli Claassens
BMC Infectious Diseases 2016 16:712
Published on: 25 November 2016

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Research article
Community-based interventions to enhance knowledge, protective attitudes and behaviors towards canine rabies: results from a health communication intervention study in Guangxi, China
In China canine rabies poses a serious public health problem in that human mortality ranks the second highest globally. While rabies health education interventions are advocated by WHO to be critical component…
Hairong Wu, Jiao Chen, Lianbin Zou, Liefeng Zheng, Weichao Zhang, Zhenmu Meng, Ricardo J. Soares Magalhaes, Youming Wang, Jingli Kang and Xiangdong Sun
BMC Infectious Diseases 2016 16:701
Published on: 24 November 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 26 November 2106)

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Commentary
A framework: make it useful to guide and improve practice of clinical trial design in smaller populations
The increased attention to design and analysis of randomised clinical trials in small populations has triggered thinking regarding the most appropriate design methods for a particular clinical research question…
Kit C. B. Roes
BMC Medicine 2016 14:195
Published on: 25 November 2016

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CORRESPONDENCE
How do you design randomised trials for smaller populations? A framework
How should we approach trial design when we can get some, but not all, of the way to the numbers required for a randomised phase III trial?
Mahesh K. B. Parmar, Matthew R. Sydes and Tim P. Morris
BMC Medicine 2016 14:183
Published on: 25 November 2016

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 26 November 2106)

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Research article
Domestic violence among antenatal attendees in a Kathmandu hospital and its associated factors: a cross-sectional study
Domestic violence during pregnancy is a public health problem which violates human rights and causes an adverse effect on both maternal and fetal health. The objectives of the study were to assess the prevalen…
Monika Shrestha, Sumina Shrestha and Binjwala Shrestha
BMC Pregnancy and Childbirth 2016 16:360
Published on: 21 November 2016

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 26 November 2106)
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Research article
Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana
In tuberculosis (TB) control, early disclosure is recommended for the purposes of treatment as well as a means of reducing or preventing person-to-person transmission of the bacteria. However, disclosure maybe…
Joshua Amo-Adjei
BMC Public Health 2016 16:1196
Published on: 25 November 2016
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Research article
Social norms and family planning decisions in South Sudan
Sumit Kane, Maryse Kok, Matilda Rial, Anthony Matere, Marjolein Dieleman and Jacqueline EW Broerse
BMC Public Health 2016 16:1183
Published on: 22 November 2016
Abstract
Background
With a maternal mortality ratio of 789 per 100,000 live births, and a contraceptive prevalence rate of 4.7%, South Sudan has one of the worst reproductive health situations in the world. Understanding the social norms around sexuality and reproduction, across different ethnic groups, is key to developing and implementing locally appropriate public health responses.
Methods
A qualitative study was conducted in the state of Western Bahr el Ghazal (WBeG) in South Sudan to explore the social norms shaping decisions about family planning among the Fertit community. Data were collected through five focus group discussions and 44 semi-structured interviews conducted with purposefully selected community members and health personnel.
Results
Among the Fertit community, the social norm which expects people to have as many children as possible remains well established. It is, however, under competitive pressure from the existing norm which makes spacing of pregnancies socially desirable. Young Fertit women are increasingly, either covertly or overtly, making family planning decisions themselves; with resistance from some menfolk, but also support from others. The social norm of having as many children as possible is also under competitive pressure from the emerging norm that equates taking good care of one’s children with providing them with a good education. The return of peace and stability in South Sudan, and people’s aspirations for freedom and a better life, is creating opportunities for men and women to challenge and subvert existing social norms, including but not limited to those affecting reproductive health, for the better.
Conclusions
The sexual and reproductive health programmes in WBeG should work with and leverage existing and emerging social norms on spacing in their health promotion activities. Campaigns should focus on promoting a family ideal in which children become the object of parental investment, rather than labour to till the land — instead of focusing directly or solely on reducing family size. The conditions are right in WBeG and in South Sudan for public health programmes to intervene to trigger social change on matters related to sexual and reproductive health; this window of opportunity should be leveraged to achieve sustainable change.
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Research article
Causes of maternal and child mortality among Cambodian sex workers and their children: a cross sectional study
To reach global and national goals for maternal and child mortality, countries must identify vulnerable populations, which includes sex workers and their children. The objective of this study was to identify a…
Brian Willis, Saki Onda and Hanni Marie Stoklosa
BMC Public Health 2016 16:1176
Published on: 21 November 2016

Food Policy
Volume 65, Pages 1-90 (December 2016)
http://www.sciencedirect.com/science/journal/03069192/65

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Original Research Article
Returns to food and agricultural R&D investments in Sub-Saharan Africa, 1975–2014
Pages 1-8
Philip G. Pardey, Robert S. Andrade, Terrance M. Hurley, Xudong Rao, Frikkie G. Liebenberg
Abstract
Research-enabled growth in agricultural productivity is pivotal to sub-Saharan Africa’s overall economic growth prospects. Yet, investments in research and development (R&D) targeted to many national food and agricultural economies throughout Africa are fragile and faltering. To gain insight into what could be driving this trend, this article updates, summarizes and reassesses the published evidence on the returns to African agricultural R&D. Based on a compilation of 113 studies published between 1975 and 2014 spanning 25 countries, the reported internal rates of return (IRRs) to food and agricultural research conducted in or of direct consequence for sub-Saharan Africa averaged 42.3%py. In addition to the 376 IRR estimates, the corresponding 129 benefit-cost ratios (BCRs) averaged 30.1. Most (96.5%) of the returns-to-research evaluations are of publicly performed R&D, and the majority (87.6%) of the studies were published in the period 1990–2009. The large dispersion in the reported IRRs and BCRs makes it difficult to discern meaningful patterns in the evidence. Moreover, the distribution of IRRs is heavily (positively) skewed, such that the median value (35.0%py) is well below the mean, like it is for research done elsewhere in the world (mean 62.4%py; median 38.0%py). Around 78.5% of the evaluations relate to the commodity-specific consequences of agricultural research, while 5.5% report on the returns to an “all agriculture” aggregate. The weight of commodity-specific evaluation evidence is not especially congruent with the composition of agricultural production throughout Africa, nor, to the best that can be determined, the commodity orientation of public African agricultural R&D.

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Original Research Article
Facing famine: Somali experiences in the famine of 2011
Pages 63-73
Daniel Maxwell, Nisar Majid, Guhad Adan, Khalif Abdirahman, Jeeyon Janet Kim
Abstract
In 2011–12, Somalia experienced the worst famine of the twenty- first century. Since then, research on the famine has focused almost exclusively on the external response, the reasons for the delay in the international response, and the implications for international humanitarian action in the context of the “global war on terror.” This paper focuses on the internal, Somali response to the famine. Themes of diversification, mobility and flexibility are all important to understanding how people coped with the famine, but this paper focuses on the factor that seemed to determine whether and how well people survived the famine: social connectedness, the extent of the social networks of affected populations, and the ability of these networks to mobilize resources. These factors ultimately determined how well people coped with the famine. The nature of reciprocity, the resources available within people’s networks, and the collective risks and hazards faced within networks, all determined people’s individual and household outcomes in the famine and are related to the social structures and social hierarchies within Somali society. But these networks had a distinctly negative side as well—social identity and social networks were also exploited to trap humanitarian assistance, turn displaced people into “aid bait,” and to a large degree, determined who benefited from aid once it started to flow. This paper addresses several questions: How did Somali communities and households cope with the famine of 2011 in the absence of any state-led response—and a significant delay in a major international response? What can be learned from these practices to improve our understanding of famine, and of mitigation, response and building resilience to future crises?

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 26 November 2106]

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Research
‘The stars seem aligned’: a qualitative study to understand the effects of context on scale-up of maternal and newborn health innovations in Ethiopia, India and Nigeria
Donors commonly fund innovative interventions to improve health in the hope that governments of low and middle-income countries will scale-up those that are shown to be effective. Yet innovations can be slow t…
Neil Spicer, Della Berhanu, Dipankar Bhattacharya, Ritgak Dimka Tilley-Gyado, Meenakshi Gautham, Joanna Schellenberg, Addis Tamire-Woldemariam, Nasir Umar and Deepthi Wickremasinghe
Globalization and Health 2016 12:75
Published on: 25 November 2016

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 26 November 2106]

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Review
What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review
Michelle M. Haby, Evelina Chapman, Rachel Clark, Jorge Barreto, Ludovic Reveiz and John N. Lavis
Published on: 25 November 2016
Abstract
Background
Rapid reviews have the potential to overcome a key barrier to the use of research evidence in decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice?
Methods
This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42015015998). A comprehensive search strategy was used, including published and grey literature, written in English, French, Portuguese or Spanish, from 2004 onwards. Eleven databases and two websites were searched. Two review authors independently applied the eligibility criteria. Data extraction was done by one reviewer and checked by a second. The methodological quality of included studies was assessed independently by two reviewers. A narrative summary of the results is presented.
Results
Five systematic reviews and one randomised controlled trial (RCT) that investigated methodologies for rapid reviews met the inclusion criteria. None of the systematic reviews were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews. While a wide range of ‘shortcuts’ are used to make rapid reviews faster than a full systematic review, the included studies found little empirical evidence of their impact on the conclusions of either rapid or systematic reviews. There is some evidence from the included RCT (that had a low risk of bias) that rapid reviews may improve clarity and accessibility of research evidence for decision makers.
Conclusions
Greater care needs to be taken in improving the transparency of the methods used in rapid review products. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way. We offer an improved definition of rapid reviews to guide future research as well as clearer guidance for policy and practice.

International Journal of Community Medicine and Public Health
2016, Volume: 3, Issue: 12
http://www.scopemed.org/?iid=2016-3-12.000&&jid=109&lng=

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Review Articles
Factors influencing knowledge and practice of birth preparedness and complication readiness in sub-saharan Africa: a narrative review of cross-sectional studies
Joshua Sumankuuro, Judith Crockett, Shaoyu Wang
Int J Community Med Public Health. 2016; 3(12): 3297-3307

JAMA
November 22, 2016, Vol 316, No. 20, Pages 2059-2162
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Pharmaceuticals and Public Health
Rena M. Conti, PhD; Rebekah E. Gee, MD; Joshua M. Sharfstein, MD
JAMA. 2016;316(20):2083-2084. doi:10.1001/jama.2016.15397
This Viewpoint argues for a shift in pharmaceutical pricing from an individual- to a population-based perspective and proposes policy options to incentivize pricing that would make treating populations with disease sustainable.
Abstract
The national debate over increasing costs and spending for pharmaceuticals has reached a fever pitch. Special concern has focused on new “specialty” drugs, for which per-patient treatment costs often exceed $1000 per month or more than $10 000 for a course of a therapy. The most commonly discussed solutions include approaches to pricing these drugs based on their value to individual patients.1 However, for pharmaceuticals vital to public health, such as immunizations and drugs to treat communicable diseases, policy makers should broaden their perspective to consider the population as a whole.

JBI Database of Systematic Review and Implementation Reports
October 2016 – Volume 14 – Issue 10 pp: 1-275
http://journals.lww.com/jbisrir/Pages/currenttoc.aspx

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Editorial
Software to support the systematic review process: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI)
Munn, Zachary

Journal of Immigrant & Refugee Studies
Volume 14, Issue 4, 2016
http://www.tandfonline.com/toc/wimm20/current

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Articles
Visibilities and the Politics of Space: Refugee Activism in Berlin
Fazila Bhimji
Pages 432-450 | Published online: 19 Apr 2016
Abstract
This article examines the ways in which refugee activists attained visibility within the public sphere while they contested, resisted, and helped transform multiple spaitials as part of their movement in Berlin, Germany. Scholarship on refugee and immigrant protests has focused on demonstrations and every day acts of resistance in refugee camps or accommodation. However, there has been less focus on the ways in which refugees engage in spatial politics. This article focuses on urban resistance in Berlin where refugee activists in alliance with supporters occupied several spaces and transformed them to political sites.

Journal of Medical Ethics
December 2016, Volume 42, Issue 12
http://jme.bmj.com/content/current

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Extended essay
Victims, vectors and villains: are those who opt out of vaccination morally responsible for the deaths of others?
Euzebiusz Jamrozik, Toby Handfield, Michael J Selgelid
J Med Ethics 2016;42:762-768 Published Online First: 3 October 2016 doi:10.1136/medethics-2015-103327
Abstract
Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others’ freedom to opt out of vaccination. It is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate.

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Research ethics
Paper: Deciphering assumptions about stepped wedge designs: the case of Ebola vaccine research
Adélaïde Doussau, Christine Grady
J Med Ethics 2016;42:797-804 Published Online First: 17 October 2016 doi:10.1136/medethics-2015-103292
Abstract
Ethical concerns about randomising persons to a no-treatment arm in the context of Ebola epidemic led to consideration of alternative designs. The stepped wedge (SW) design, in which participants or clusters are randomised to receive an intervention at different time points, gained popularity. Common arguments in favour of using this design are (1) when an intervention is likely to do more good than harm, (2) all participants should receive the experimental intervention at some time point during the study and (3) the design might be preferable for practical reasons. We examine these assumptions when considering Ebola vaccine research. First, based on the claim that a stepped wedge design is indicated when it is likely that the intervention will do more good than harm, we reviewed published and ongoing SW trials to explore previous use of this design to test experimental drugs or vaccines, and found that SW design has never been used for trials of experimental drugs or vaccines. Given that Ebola vaccines were all experimental with no prior efficacy data, the use of a stepped wedge design would have been unprecedented. Second, we show that it is rarely true that all participants receive the intervention in SW studies, but rather, depending on certain design features, all clusters receive the intervention. Third, we explore whether the SW design is appealing for feasibility reasons and point out that there is significant complexity. In the setting of the Ebola epidemic, spatiotemporal variation may have posed problematic challenge

The Lancet
Nov 26, 2016 Volume 388 Number 10060 p2565-2712 e15
http://www.thelancet.com/journals/lancet/issue/current

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Articles
Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people
Enrique Regidor, Fernando Vallejo, José A Tapia Granados, Francisco J Viciana-Fernández, Luis de la Fuente, Gregorio Barrio
Summary
Background
Studies of the effect of macroeconomic fluctuations on mortality in different socioeconomic groups are scarce and have yielded mixed findings. We analyse mortality trends in Spain before and during the Great Recession in different socioeconomic groups, quantifying the change within each group.
Methods
We did a nationwide prospective study, in which we took data from the 2001 Census. All people living in Spain on Nov 1, 2001, were followed up until Dec 31, 2011. We included 35 951 354 people alive in 2001 who were aged between 10 and 74 years in each one of the four calendar years before the economic crisis (from 2004 to 2007) and in each one of the first four calendar years of the crisis (from 2008 to 2011), and analysed all-cause and cause-specific mortality in those people. We classified individuals by socioeconomic status (low, medium, or high) using two indicators of household wealth: household floor space (104 m2) and number of cars owned by the residents of the household (none, one, and two or more). We used Poisson regression to calculate the annual percentage reduction (APR) in mortality rates during 2004–07 (pre-crisis) and 2008–11 (crisis) in each socioeconomic group, as well as the effect size, measured by the APR difference between the pre-crisis and crisis period.
Findings
The annual decline in all-cause mortality in the three socioeconomic groups was 1·7% (95% CI 1·2 to 2·1) for the low group, 1·7% (1·3 to 2·1) for the medium group, and 2·0% (1·4 to 2·5) for the high group in 2004–07, and 3·0% (2·5 to 3·5) for the low group, 2·8% (2·5 to 3·2) for the medium group, and 2·1% (1·6 to 2·7) for the high group in 2008–11 when individuals were classified by household floor space. The annual decline in all-cause mortality when people were classified by number of cars owned by the household was 0·3% (–0·1 to 0·8) for the low group, 1·6% (1·2 to 2·0) for the medium group, and 2·2% (1·6 to 2·8) for the high group in 2004–07, and 2·3% (1·8 to 2·8) for the low group, 2·4% (2·0 to 2·7) for the medium group and 2·5% (1·9 to 3·0) for the high group in 2008–11. The low socioeconomic group showed the largest effect size for both wealth indicators.
Interpretation
In Spain, probably due to the decrease in exposure to risk factors, all-cause mortality decreased more during the economic crisis than before the economic crisis, especially in low socioeconomic groups.
Funding
None.

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The Lancet Commissions
A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension
Michael H Olsen, Sonia Y Angell, Samira Asma, Pierre Boutouyrie, Dylan Burger, Julio A Chirinos, Albertino Damasceno, Christian Delles, Anne-Paule Gimenez-Roqueplo, Dagmara Hering, Patricio López-Jaramillo, Fernando Martinez, Vlado Perkovic, Ernst R Rietzschel, Giuseppe Schillaci, Aletta E Schutte, Angelo Scuteri, James E Sharman, Kristian Wachtell, Ji Guang Wang

Nature
Volume 539 Number 7630 pp467-602 24 November 2016
http://www.nature.com/nature/current_issue.html

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Editorials
The power of big data must be harnessed for medical progress
But grave challenges remain before the promise of individually tailored medicine becomes reality.
There is art in ‘big data’ — in the poetic claims that it competes in volume with all the stars in the firmament. And in the seductive potential of its exponential, uncontrolled, ungraspable growth to improve our lives: by allowing medical treatments to be developed and approved more quickly — and, ultimately, truly personal medicine.
But at a workshop held in London by the European Medicines Agency earlier this month, just how much science has to happen to make this beautiful future a reality was apparent to all. Patient groups and research scientists attended, alongside computational heavyweights from IBM Watson Health and Google Cloud Platform. Together, they tackled chewy questions to which there are few answers.
How many data are ‘enough’ to reliably predict clinical effect? Which data sets can be useful? How can they be managed? What’s the best way to win the confidence of public and regulators? And, crucially, is academia training enough mathematicians and medical-data scientists, who will have to develop and harness all this new potential? The last of these questions at least has a clear answer: no…

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 26 November 2106)

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Research Article
Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial
Badara Cissé, El Hadj Ba, Cheikh Sokhna, Jean Louis NDiaye, Jules F. Gomis, Yankhoba Dial, Catherine Pitt, Mouhamed NDiaye, Matthew Cairns, Ernest Faye, Magatte NDiaye, Aminata Lo, Roger Tine, Sylvain Faye, Babacar Faye, Ousmane Sy, Lansana Konate, Ekoue Kouevijdin, Clare Flach, Ousmane Faye, Jean-Francois Trape, Colin Sutherland, Fatou Ba Fall, Pape M. Thior, Oumar K. Faye, Brian Greenwood, Oumar Gaye, Paul Milligan
Research Article | published 22 Nov 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002175

PLoS One
http://www.plosone.org/
[Accessed 26 November 2106]

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Research Article
National Survey Indicates that Individual Vaccination Decisions Respond Positively to Community Vaccination Rates
John Romley, Prodyumna Goutam, Neeraj Sood
Research Article | published 21 Nov 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0166858
Abstract
Some models of vaccination behavior imply that an individual’s willingness to vaccinate could be negatively correlated with the vaccination rate in her community. The rationale is that a higher community vaccination rate reduces the risk of contracting the vaccine-preventable disease and thus reduces the individual’s incentive to vaccinate. At the same time, as for many health-related behaviors, individuals may want to conform to the vaccination behavior of peers, counteracting a reduced incentive to vaccinate due to herd immunity. Currently there is limited empirical evidence on how individual vaccination decisions respond to the vaccination decisions of peers. In the fall of 2014, we used a rapid survey technology to ask a large sample of U.S. adults about their willingness to use a vaccine for Ebola. Respondents expressed a greater inclination to use the vaccine in a hypothetical scenario with a high community vaccination rate. In particular, an increase in the community vaccination rate from 10% to 90% had the same impact on reported utilization as a nearly 50% reduction in out-of-pocket cost. These findings are consistent with a tendency to conform with vaccination among peers, and suggest that policies promoting vaccination could be more effective than has been recognized.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/

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Biological Sciences – Microbiology:
Armed conflict and population displacement as drivers of the evolution and dispersal of Mycobacterium tuberculosis
Vegard Eldholm, John H.-O. Pettersson, Ola B. Brynildsrud, Andrew Kitchen, Erik Michael Rasmussen, Troels Lillebaek, Janne O. Rønning, Valeriu Crudu, Anne Torunn Mengshoel, Nadia Debech, Kristian Alfsnes, Jon Bohlin, Caitlin S. Pepperell, and Francois Balloux
PNAS 2016 ; published ahead of print November 21, 2016, doi:10.1073/pnas.1611283113
Significance
We used population genomic analyses to reconstruct the recent history and dispersal of a major clade of Mycobacterium tuberculosis in central Asia and beyond. Our results indicate that the fall of the Soviet Union and the ensuing collapse of public health systems led to a rise in M. tuberculosis drug resistance. We also show that armed conflict and population displacement is likely to have aided the export of this clade from central Asia to war-torn Afghanistan and beyond.
Abstract
The “Beijing” Mycobacterium tuberculosis (Mtb) lineage 2 (L2) is spreading globally and has been associated with accelerated disease progression and increased antibiotic resistance. Here we performed a phylodynamic reconstruction of one of the L2 sublineages, the central Asian clade (CAC), which has recently spread to western Europe. We find that recent historical events have contributed to the evolution and dispersal of the CAC. Our timing estimates indicate that the clade was likely introduced to Afghanistan during the 1979–1989 Soviet–Afghan war and spread further after population displacement in the wake of the American invasion in 2001. We also find that drug resistance mutations accumulated on a massive scale in Mtb isolates from former Soviet republics after the fall of the Soviet Union, a pattern that was not observed in CAC isolates from Afghanistan. Our results underscore the detrimental effects of political instability and population displacement on tuberculosis control and demonstrate the power of phylodynamic methods in exploring bacterial evolution in space and time.

Prehospital & Disaster Medicine
Volume 31 – Issue 6 – December 2016
https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/latest-issue

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Editorial
Access to Essential Medications During Disaster Events
Samuel J. Stratton
DOI: https://doi.org/10.1017/S1049023X16001035
Published online: 26 September 2016, pp. 579-580
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A Systematic Review of Health Outcomes Among Disaster and Humanitarian Responders
Published online: 19 September 2016, pp. 635-642
Stephanie C. Garbern, Laura G. Ebbeling, Susan A. Bartels
DOI: https://doi.org/10.1017/S1049023X16000832
Abstract
Disaster and humanitarian responders are at-risk of experiencing a wide range of physical and psychological health conditions, from minor injuries to chronic mental health problems and fatalities. This article reviews the current literature on the major health outcomes of responders to various disasters and conflicts in order to better inform individuals of the risks and to inform deploying agencies of the health care needs of responders.

In March 2014, an EMBASE search was conducted using pre-defined search criteria. Two reviewers screened the resultant 2,849 abstracts and the 66 full-length manuscripts which are included in the review.

The majority of research on health outcomes of responders focused on mental health (57 of 66 articles). Posttraumatic stress disorder (PTSD) and depression were the most studied diagnoses with prevalence of PTSD ranging from 0%-34% and depression from 21%-53%. Physical health outcomes were much less well-studied and included a wide range of environmental, infectious, and traumatic conditions such as heat stroke, insect bites, dermatologic, gastrointestinal, and respiratory diseases, as well as burns, fractures, falls, and other traumatic injuries.

The prevalence of mental health disorders in responders may vary more and be higher than previously suggested. Overall health outcomes of responders are likely poorly monitored and under-reported. Improved surveillance systems and risk mitigation strategies should be employed in all disaster and conflict responses to better protect individual responders.

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Comprehensive Reviews
Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US
Published online: 19 September 2016, pp. 643-647
Bhakti Hansoti, Dylan S. Kellogg, Sara J. Aberle, Morgan C. Broccoli, Jeffrey Feden, Arthur French, Charles M. Little, Brooks Moore, Joseph Sabato, Tara Sheets, R. Weinberg, Pat Elmes, Christopher Kang
DOI: https://doi.org/10.1017/S1049023X16000820

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Article
Women’s Mental Health and Intimate Partner Violence Following Natural Disaster: A Scoping Review
Published online: 19 September 2016, pp. 648-657
Sue Anne Bell, Lisa A. Folkerth
DOI: https://doi.org/10.1017/S1049023X16000911