The Lancet Infectious Diseases
May 2016 Volume 16 Number 5 p507-618 e64-e81
http://www.thelancet.com/journals/laninf/issue/current
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Editorial
Ebola PHEIC is over but emergency continues
The Lancet Infectious Diseases
Summary
On March 29, WHO Director-General Margaret Chan announced that the outbreak of Ebola virus disease in countries of west Africa was no longer a Public Health Emergency of International Concern (PHEIC). This decision was taken because, in the opinion of the International Health Regulations Emergency Committee on Ebola, the outbreak is no longer an extraordinary event, there is little risk of international spread, and affected countries have the capacity to rapidly respond to new cases. The Emergency Committee acknowledged that new clusters will continue to occur, but that they are happening at a decreasing frequency.
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Articles
Group B streptococcus vaccination in pregnant women with or without HIV in Africa: a non-randomised phase 2, open-label, multicentre trial
Robert S Heyderman, Shabir A Madhi, Neil French, Clare Cutland, Bagrey Ngwira, Doris Kayambo, Robert Mboizi, Anthonet Koen, Lisa Jose, Morounfolu Olugbosi, Frederik Wittke, Karen Slobod, Peter M Dull
Open Access
Summary
Background
Neonates born to women infected with HIV are at increased risk for invasive group B streptococcus (GBS) disease. We aimed to compare safety and immunogenicity of trivalent glycoconjugate GBS vaccine in pregnant women with and without HIV in Malawi and South Africa.
Methods
In our non-randomised phase 2, open-label, multicentre study, we recruited pregnant women attending two antenatal clinics, one in Blantyre, Malawi, and one in Soweto, Johannesburg, South Africa. Participants were divided into three groups on the basis of their HIV infection status (no infection, infection and high CD4 cell count [>350 cells per μL], and infection and low CD4 cell count [>50 to ≤350 cells per μL]) and received a 5 μg dose of glycoconjugate GBS vaccine (serotypes Ia, Ib, and III, with CRM197 [Novartis Vaccines, Siena, Italy]) intramuscularly at 24–35 weeks’ gestation. GBS serotype-specific antibody concentrations were measured before vaccination (day 1), day 15, day 31, and at delivery, and in infants at birth and day 42 of life. The primary outcomes were safety in mothers and infants and the amount of placental transfer of GBS serotype-specific antibodies from mothers to their infants. All immunogenicity and safety analyses were done on the full analysis set, including participants who, or whose mother, correctly received the vaccine and who provided at least one valid assessable serum sample. This study is registered with ClinicalTrials.gov, number NCT01412801.
Findings
270 women and 266 infants were enrolled between Sept 26, 2011, and Dec 4, 2012 (90 women and 87 infants without HIV, 89 and 88 with HIV and high CD4 cell counts, and 91 and 91 with HIV and low CD4 cell counts, respectively). Seven women were lost to follow-up, six withdrew consent, one died, and two relocated. Eight infants died or were stillborn and two were lost to follow-up. Across serotypes, fold change in antibody concentrations were higher for the HIV-uninfected group than the HIV-infected groups. Transfer ratios were similar across all three groups (0·49–0·72; transfer ratio is infant geometric mean antibody concentration in blood collected within 72 h of birth divided by maternal geometric mean antibody concentration in blood collected at delivery); however, at birth, maternally derived serotype-specific antibody concentrations were lower for infants born to women infected with HIV (0·52–1·62 μg/mL) than for those born to women not infected with HIV (2·67–3·91 μg/mL). 151 (57%) of 265 women reported at least one solicited adverse reaction: 39 (45%) of 87 women with HIV and low CD4 cell counts, 52 (59%) of 88 women with HIV and high CD4 cell counts, and 60 (67%) of 90 women in the HIV-uninfected group. 49 (18%) of 269 women had at least one adverse event deemed possibly related to the vaccine (six [7%] in the HIV and low CD4 cell count group, 12 [13%] in the HIV and high CD4 cell count group, and 21 [23%] in the HIV-uninfected group), as did three (1%) of 266 neonates (zero, two [1%], and one [1%]); none of these events was regarded as serious.
Interpretation
The vaccine was less immunogenic in women infected with HIV than it was in those not infected, irrespective of CD4 cell count, resulting in lower levels of serotype-specific maternal antibody transferred to infants, which could reduce vaccine protection against invasive GBS disease. A validated assay and correlate of protection is needed to understand the potential protective value of this vaccine.
Funding
Novartis Vaccines and Diagnostics division (now part of the GlaxoSmithKline group of companies), Wellcome Trust UK, Medical Research Council: Respiratory and Meningeal Pathogens Research U

Lancet Global Health
May 2016 Volume 4 Number 5 e287-e343
http://www.thelancet.com/journals/langlo/issue/current

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Editorial
Research capacity in Africa—will the sun rise again?
Justine Davies, Zoë Mullan
Published Online: 31 March 2016
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(16)30046-8
Summary
Africa has a problem. It has the greatest burden of disease and lowest density of health-care professionals in the world. This we know. We also know that although infectious diseases and maternal, child, and neonatal health are improving, the burden of non-communicable diseases (NCDs) has been steadily increasing in the past few decades. We know that the health-care successes in Africa have largely been driven by donor aid, providing vertical solutions to specific problems; however, NCDs require complex care and strong health systems.

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Comment
How the MDGs gave up on measuring access to medicines
Dzintars Gotham, Kristine H Onarheim, Melissa J Barber
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(16)00066-8
Summary
In March, 2016, the United Nations Statistics Commission agreed upon the metrics used to measure progress towards, or away from, the new Sustainable Development Goals (SDGs).1 These so-called indicators define the real-world, measurable counterparts to the targets within the visionary goals of the sustainable development agenda. In the context of health in the SDGs, we wish to highlight the little-known story of the Millennium Development Goals’ (MDG) target on access to medicines. Of the 21 targets in the eight MDGs that permeated the development debate over the past 15 years, it was the only target that was dropped from the MDG report.

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Comment
Consigned to the margins: a call for global action to challenge intellectual disability stigma
Katrina Scior, Aseel Hamid, Richard Hastings, Shirli Werner, Catherine Belton, Adebisi Laniyan, Maya Patel, Nora Groce, Maria Kett
Summary
Stigma as an important public health concern has been recognised in relation to conditions as diverse as HIV, leprosy, and mental illness. Little attention has been paid to date, however, to the pernicious effects of stigma on the wellbeing and life chances of one heavily stigmatised population: people with intellectual disabilities. Of the 15 billion people globally affected by disability,1 an estimated 2%, or 300 million, have an intellectual disability. They experience the same disadvantages and inequities as do people with other types of disabilities, but often face the additional disadvantage of having their needs inadequately understood and met, having limited recourse to assert their rights, and being poorly represented, including within the Disability Rights movement.

New England Journal of Medicine
May 12, 2016 Vol. 374 No. 19
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
The Zika Challenge
C.J. Haug, M.P. Kieny, and B. Murgue
[Concluding text]
…Many lessons learned from the response to the recent Ebola outbreak have helped in the response to the ZIKV outbreak. Most important, there is general agreement on the need for international collaboration on regulatory issues, research, and data sharing. For example, major regulatory agencies (such as Brazil’s Agência Nacional de Vigilância Sanitária, the U.S. Food and Drug Administration, and the European Medicines Agency) have committed to prioritizing the expedited evaluation of Zika products and will proactively reach out to product developers to provide advice on regulatory issues. Regulators have also initiated collaborations and are sharing their experiences with each other.

Another major advance over the Ebola response has been the speed with which data are being shared — for example, through the real-time posting of data from pathogenesis experiments in nonhuman primates. The December 2015 statement from the International Committee of Medical Journal Editors clarifying that prepublication dissemination of critical information will not prejudice later journal publication related to ZIKV or future public health emergencies has been helpful. Similarly, a February 2016 statement on open data sharing in ZIKV has been transformative in signaling that funders expect proactive data sharing. ZIKV provides a case study of the need for expedited research to answer basic questions, which will allow for development of control measures.

We are working in a new area with many unknowns. But as the WHO meeting showed, there is ample experience and expertise from work with other viruses and vectors — ranging from basic science to field work and surveillance — to guide clinical practice, research, and product development. It is critical that we collaborate rather than compete to find answers to the questions that worry millions of women of child-bearing age in areas where ZIKV is spreading rapidly and may become endemic.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 14 May 2016)

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Review
Socioeconomic Inequalities in Neglected Tropical Diseases: A Systematic Review
Tanja A. J. Houweling, Henrike E. Karim-Kos, Margarete C. Kulik, Wilma A. Stolk, Juanita A. Haagsma, Edeltraud J. Lenk, Jan Hendrik Richardus, Sake J. de Vlas
| published 12 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004546
Abstract
Background
Neglected tropical diseases (NTDs) are generally assumed to be concentrated in poor populations, but evidence on this remains scattered. We describe within-country socioeconomic inequalities in nine NTDs listed in the London Declaration for intensified control and/or elimination: lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminthiasis (STH), trachoma, Chagas’ disease, human African trypanosomiasis (HAT), leprosy, and visceral leishmaniasis (VL).
Methodology
We conducted a systematic literature review, including publications between 2004–2013 found in Embase, Medline (OvidSP), Cochrane Central, Web of Science, Popline, Lilacs, and Scielo. We included publications in international peer-reviewed journals on studies concerning the top 20 countries in terms of the burden of the NTD under study.
Principal findings
We identified 5,516 publications, of which 93 met the inclusion criteria. Of these, 59 papers reported substantial and statistically significant socioeconomic inequalities in NTD distribution, with higher odds of infection or disease among poor and less-educated people compared with better-off groups. The findings were mixed in 23 studies, and 11 studies showed no substantial or statistically significant inequality. Most information was available for STH, VL, schistosomiasis, and, to a lesser extent, for trachoma. For the other NTDs, evidence on their socioeconomic distribution was scarce.
The magnitude of inequality varied, but often, the odds of infection or disease were twice as high among socioeconomically disadvantaged groups compared with better-off strata. Inequalities often took the form of a gradient, with higher odds of infection or disease each step down the socioeconomic hierarchy. Notwithstanding these inequalities, the prevalence of some NTDs was sometimes also high among better-off groups in some highly endemic areas.
Conclusions
While recent evidence on socioeconomic inequalities is scarce for most individual NTDs, for some, there is considerable evidence of substantially higher odds of infection or disease among socioeconomically disadvantaged groups. NTD control activities as proposed in the London Declaration, when set up in a way that they reach the most in need, will benefit the poorest populations in poor countries.

PLoS One
http://www.plosone.org/
[Accessed 14 May 2016]

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Research Article
Population-Level Impact of Ontario’s Infant Rotavirus Immunization Program: Evidence of Direct and Indirect Effects
Sarah E. Wilson, Laura C. Rosella, Jun Wang, Nicole Le Saux, Natasha S. Crowcroft, Tara Harris, Shelly Bolotin, Shelley L. Deeks
| published 11 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0154340
Abstract
Objective
To evaluate the direct and indirect population impact of rotavirus (RV) immunization on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) in Ontario before and after the publicly-funded RV immunization program.
Methods
Administrative data was used to identify ED visits and hospitalizations for all Ontarians using ICD-10 codes. We used two outcome definitions: RV-specific AGE (RV-AGE) and codes representing RV-, other viral and cause unspecified AGE (“overall AGE”). The pre-program and public program periods were August 1, 2005 to July 31, 2011; and August 1, 2011 to March 31, 2013, respectively. A negative binominal regression model that included the effect of time was used to calculate rates and rate ratios (RRs) and 95% confidence intervals (CIs) for RV-AGE and overall AGE between periods, after adjusting for age, seasonality and secular trends. Analyses were conducted for all ages combined and age stratified.
Results
Relative to the pre-program period, the adjusted RRs for RV-AGE and overall AGE hospitalizations in the public program period were 0.29 (95%CI: 0.22–0.39) and 0.68 (95%CI: 0.62–0.75), respectively. Significant reductions in RV-AGE hospitalizations were noted overall and for the following age bands: < 12 months, 12–23 months, 24–35 months, 3–4 years, and 5–19 years. Significant declines in overall AGE hospitalizations were observed across all age bands, including older adults > = 65 years (RR 0.80, 95%CI: 0.72–0.90). The program was associated with adjusted RRs of 0.32 (95% CI: 0.20–0.52) for RV-AGE ED visits and 0.90 (95% CI: 0.85–0.96) for overall AGE ED visits.
Conclusions
This large, population-based study provides evidence of the impact of RV vaccine in preventing hospitalizations and ED visits for RV-AGE and overall AGE, including herd effects.

Science
13 May 2016 Vol 352, Issue 6287
http://www.sciencemag.org/current.dtl

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Editorial
Pursuit of integral ecology
Marcelo Sánchez Sorondo1,*, Veerabhadran Ramanathan2,†
Summary
Later this month (23 and 24 May), the United Nations will convene the first World Humanitarian Summit in Istanbul, where global and local leaders will commit to putting each and every person’s safety, dignity, freedom, and right to thrive at the heart of decision-making. More than 125 million people are in need of humanitarian assistance, a level of suffering not seen since World War II. The social problems are wide and deep, from war and human trafficking to the gross inequality between the wealthy 1% and the poorest 3 billion of the population. Included in the summit’s Agenda for Humanity are climate and natural disasters. Indeed, 1 year ago, Pope Francis emphasized, in the encyclical Laudato Si, that complex crises have both social and environmental dimensions. The bond between humans and the natural world means that we live in an “integral ecology,” and as such, an integrated approach to environmental and social justice is required.

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Perspectives
Reconciliation in Sierra Leone
By Katherine Casey, Rachel Glennerster
Science13 May 2016 : 766-767
Short, low-cost interventions can help communities to recover from civil war
Summary
Since the end of World War II, there have been 259 armed conflicts in 159 locations (1). Sierra Leone’s civil war began 25 years ago, at a time when roughly 25% of all countries worldwide were experiencing civil war (2). How can individuals and groups recover from such violent conflicts? On page 787 of this issue, Cilliers et al. (3) provide rigorous evidence on the efficacy of one postwar reconciliation strategy that was implemented in 100 communities in Sierra Leone (4).

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Refugee protection and resettlement problems
By Elizabeth Cullen Dunn
Science13 May 2016 : 772-773
Refugees face painful uncertainties that could be ameliorated by aid agency coordination
Summary
In 2015, more than a million refugees and other migrants entered the European Union. They are just a small part of the world’s rapidly burgeoning population of displaced people, which climbed by more than 37% between 2009 and 2015 to reach 59.5 million people. Humanitarian aid to these people has been dramatically insufficient, and many displaced people now lack adequate food, medical care, housing, or transportation. As a geographer, I spent 16 months between 2009 and 2013 conducting participant observation research in camps for displaced people in Georgia (see the photo), where I discovered serious shortfalls in the humanitarian aid system. Increasingly, humanitarian aid is a temporary solution to a permanent problem, a stopgap that not only does not help displaced people resettle but, instead, makes it more difficult for them to move on with their lives.

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Reconciling after civil conflict increases social capital but decreases individual well-being
By Jacobus Cilliers, Oeindrila Dube, Bilal Siddiqi
Science13 May 2016 : 787-794
Exposure to the truth promotes social reconciliation, but at the cost of mental health.
Editor’s Summary
The psychological cost of reconciliation
During civil wars, individuals and communities who were previously good neighbors can end up fighting each other. One approach to reknit these sundered social ties is to bring perpetrators and victims together in truth and reconciliation forums. Cilliers et al. found that these forums have helped to reestablish social bonds in Sierra Leone, but that they have also imposed a cost on the victims’ mental health (see the Perspective by Casey and Glennerster).
Abstract
Civil wars divide nations along social, economic, and political cleavages, often pitting one neighbor against another. To restore social cohesion, many countries undertake truth and reconciliation efforts. We examined the consequences of one such effort in Sierra Leone, designed and implemented by a Sierra Leonean nongovernmental organization called Fambul Tok. As a part of this effort, community-level forums are set up in which victims detail war atrocities, and perpetrators confess to war crimes. We used random assignment to study its impact across 200 villages, drawing on data from 2383 individuals. We found that reconciliation had both positive and negative consequences. It led to greater forgiveness of perpetrators and strengthened social capital: Social networks were larger, and people contributed more to public goods in treated villages. However, these benefits came at a substantial cost: The reconciliation treatment also worsened psychological health, increasing depression, anxiety, and posttraumatic stress disorder in these same villages. For a subset of villages, we measured outcomes both 9 months and 31 months after the intervention. These results show that the effects, both positive and negative, persisted into the longer time horizon. Our findings suggest that policy-makers need to restructure reconciliation processes in ways that reduce their negative psychological costs while retaining their positive societal benefits.

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Zika virus impairs growth in human neurospheres and brain organoids
By Patricia P. Garcez, Erick Correia Loiola, Rodrigo Madeiro da Costa, Luiza M. Higa, Pablo Trindade, Rodrigo Delvecchio, Juliana Minardi Nascimento, Rodrigo Brindeiro, Amilcar Tanuri, Stevens K. Rehen
Science13 May 2016 : 816-818
Zika virus infection in cell culture models damages human neural stem cells to limit growth and cause cell death.

Social Science & Medicine
Volume 155, Pages 1-102 (April 2016)
http://www.sciencedirect.com/science/journal/02779536/155

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Review article
Global health diplomacy: A critical review of the literature
Review Article
Pages 61-72
Arne Ruckert, Ronald Labonté, Raphael Lencucha, Vivien Runnels, Michelle Gagnon
Abstract
Global health diplomacy (GHD) describes the practices by which governments and non-state actors attempt to coordinate and orchestrate global policy solutions to improve global health. As an emerging field of practice, there is little academic work that has comprehensively examined and synthesized the theorization of Global Health Diplomacy (GHD), nor looked at why specific health concerns enter into foreign policy discussion and agendas. With the objective of uncovering the driving forces behind and theoretical explanations of GHD, we conducted a critical literature review. We searched three English-language scholarly databases using standardized search terms which yielded 606 articles. After screening of abstracts based on our inclusion/exclusion criteria, we retained 135 articles for importing into NVivo10 and coding. We found a lack of rigorous theorizing about GHD and fragmentation of the GHD literature which is not clearly structured around key issues and their theoretical explanations. To address this lack of theoretical grounding, we link the findings from the GHD literature to how theoretical concepts used in International Relations (IR) have been, and could be invoked in explaining GHD more effectively. To do this, we develop a theoretical taxonomy to explain GHD outcomes based on a popular categorization in IR, identifying three levels of analysis (individual, domestic/national, and global/international) and the driving forces for the integration of health into foreign policy at each level.

Stability: International Journal of Security & Development
http://www.stabilityjournal.org/articles
[accessed 14 May 2016]

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Commentary
Migratory Crisis in the Mediterranean: Managing Irregular Flows
Susana Ferreira
12 May 2016
Abstract
The current migratory crisis in the Mediterranean questions the European Union’s (EU) capacity to manage migratory flows. So far, the EU has placed a particular emphasis on border management, given a lack of political will that continues to prevent more in depth institutional responses. The current situation in the Mediterranean, and the EU’s response is a cause of concern due to the risk it represents to the human security of migrants, and the questions it raises regarding the management of migratory flows within the EU. The major question to emerge during this crisis is: How does the EU manage irregular migration flows while safeguarding migrants’ human rights?

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 7 May 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 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: The Sentinel_ week ending 7 May 2016

:: 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.

American Journal of Tropical Medicine and Hygiene
May 2016; 94 (5)
http://www.ajtmh.org/content/current

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Perspective Piece
Modeling Key Malaria Drugs’ Impact on Global Health: A Reason to Invest in the Global Health Impact Index
Nicole Hassoun
Am J Trop Med Hyg 2016 94:942-946; Published online February 8, 2016, doi:10.4269/ajtmh.15-0409
Abstract
Millions of people cannot access good quality essential medicines they need for some of the world’s worst diseases like malaria. The World Health Organization estimates that, in 2013, 198 million people became sick with malaria and 584,000 people died of the disease, while the Institute for Health Metrics Evaluation estimates that there were 164,929,872 cases of malaria in 2013 and 854,568 deaths in 2013. There are many attempts to model different aspects of the global burden of tropical diseases like malaria, but it is also important to measure success in averting malaria-related death and disability. This perspective proposes investing in a systematic effort to measure the benefits of health interventions for malaria along the lines of a model embodied in the Global Health Impact Index (global-health-impact.org).

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Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis
Steven J. Hoffman, G. Emmanuel Guindon, John N. Lavis, Harkanwal Randhawa, Francisco Becerra-Posada, Masoumeh Dejman, Katayoun Falahat, Hossein Malek-Afzali, Parasurama Ramachandran, Guang Shi, and C. A. K. Yesudian
Abstract
Research evidence continues to reveal findings important for health professionals’ clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals’ knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals’ knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices “often or very often” (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals’ knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.

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Effectiveness of Oral Cholera Vaccine in Haiti: 37-Month Follow-Up
Karine Sévère, Vanessa Rouzier, Stravinsky Benedict Anglade, Claudin Bertil, Patrice Joseph,
Alexandra Deroncelay, Marie Marcelle Mabou, Peter F. Wright, Florence Duperval Guillaume,
and Jean William Pape
Am J Trop Med Hyg 2016 94:1136-1142; Published online February 29, 2016, doi:10.4269/ajtmh.15-0700
Abstract
The first oral cholera vaccine (OCV) campaign, since its prequalification by the World Health Organization, in response to an ongoing cholera epidemic (reactive vaccination) was successfully conducted in a poor urban slum of approximately 70,000 inhabitants in Port-au-Prince, Haiti, in 2012. Vaccine coverage was 75% of the target population. This report documents the impact of OCV in reducing the number of culture-confirmed cases of cholera admitted to the Groupe Haïtien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) cholera treatment center from that community in the 37 months postvaccination (April 2012–April 30, 2015). Of 1,788 patients with culture-confirmed cholera, 1,770 (99%) were either from outside the vaccine area (1,400 cases) or from the vaccinated community who had not received OCV (370 cases). Of the 388 people from the catchment area who developed culture-confirmed cholera, 370 occurred among the 17,643 people who had not been vaccinated (2.1%) and the remaining 18 occurred among the 52,357 people (0.034%) who had been vaccinated (P < 0.001), for an efficacy that approximates 97.5%. Despite not being designed as a randomized control trial, the very high efficacy is a strong evidence for the effectiveness of OCV as part of an integrated package for the control of cholera in outbreak settings.

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Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia
Hailay D. Teklehaimanot, Awash Teklehaimanot, Aregawi A. Tedella, and Mustofa Abdella
Am J Trop Med Hyg 2016 94:1157-1169; Published online February 29, 2016, doi:10.4269/ajtmh.15-0192
Abstract
In 2004, Ethiopia introduced a community-based Health Extension Program to deliver basic and essential health services. We developed a comprehensive performance scoring methodology to assess the performance of the program. A balanced scorecard with six domains and 32 indicators was developed. Data collected from 1,014 service providers, 433 health facilities, and 10,068 community members sampled from 298 villages were used to generate weighted national, regional, and agroecological zone scores for each indicator. The national median indicator scores ranged from 37% to 98% with poor performance in commodity availability, workforce motivation, referral linkage, infection prevention, and quality of care. Indicator scores showed significant difference by region (P < 0.001). Regional performance varied across indicators suggesting that each region had specific areas of strength and deficiency, with Tigray and the Southern Nations, Nationalities and Peoples Region being the best performers while the mainly pastoral regions of Gambela, Afar, and Benishangul-Gumuz were the worst. The findings of this study suggest the need for strategies aimed at improving specific elements of the program and its performance in specific regions to achieve quality and equitable health services.

Annals of Internal Medicine
3 May 2016, Vol. 164. No. 9
http://annals.org/issue.aspx

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Ideas and Opinions
Zika Virus: Rapid Spread in the Western Hemisphere FREE
Lin H. Chen, MD; and Davidson H. Hamer, MD

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 7 May 2016)

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Research article
The effect of early versus late treatment initiation after diagnosis on the outcomes of patients treated for multidrug-resistant tuberculosis: a systematic review
Globally it is estimated that 480 000 people developed multidrug-resistant tuberculosis (MDR-TB) in 2014 and 190 000 people died from the disease. Successful treatment outcomes are achieved in only 50 % of patients…
Rebecca C. Harris, Louis Grandjean, Laura J. Martin, Alexander J. P. Miller, Joseph-Egre N. Nkang, Victoria Allen, Mishal S. Khan, Katherine Fielding and David A. J. Moore
BMC Infectious Diseases 2016 16:193
Published on: 4 May 2016

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 7 May 2016)

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Study protocol
Study protocol: Mother and Infant Nutritional Assessment (MINA) cohort study in Qatar and Lebanon
The Middle East and North Africa region harbors significant proportions of stunting and wasting coupled with surging rates of non-communicable diseases (NCDs).
Farah Naja, Lara Nasreddine, Al Anoud Al Thani, Khaled Yunis, Michael Clinton, Anwar Nassar, Sara Farhat Jarrar, Patricia Moghames, Ghina Ghazeeri, Sajjad Rahman, Walaa Al-Chetachi, Eman Sadoun, Nibal Lubbad, Zelaikha Bashwar, Hiba Bawadi and Nahla Hwalla
BMC Pregnancy and Childbirth 2016 16:98
Published on: 4 May 2016

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 7 May 2016)

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Research article
Determinants of domestic violence against women in Ghana
The prevalence of domestic violence remains unacceptably high with numerous consequences ranging from psychological to maternal and neonatal mortality and morbidity outcomes in pregnant women.
Ebenezer S. Owusu Adjah and Isaac Agbemafle
BMC Public Health 2016 16:368
Published on: 2 May 2016

BMJ Open
2016, Volume 6, Issue 5
http://bmjopen.bmj.com/content/current

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Evidence based practice
Research
Examining the quality of evidence to support the effectiveness of interventions: an analysis of systematic reviews
Professor Robert L Kane; kanex001@umn.edu, Mary Butler, Weiwen Ng
BMJ Open 2016;6:e011051 doi:10.1136/bmjopen-2016-011051
Abstract
Objective This analysis examines the quality of evidence (QOE) for 1472 outcomes linked to interventions where the QOE was rated in 42 systematic reviews of randomised clinical trials and/or observational studies across different topics.
Setting Not applicable.
Participants 76 systematic reviews.
Primary and secondary outcome measures Strength of evidence ratings by initial reviewers.
Results Among 76 systematic reviews, QOE ratings were available for only 42, netting 1472 comparisons. Of these, 57% included observational studies; 4% were rated as high and 12% as moderate; the rest were low or insufficient. The ratings varied by topic: 74% of the surgical study pairs were rated as low or insufficient, compared with 82% of pharmaceuticals and 86% of device studies, 88% of organisational, 91% of lifestyle studies, and 94% of psychosocial interventions.
Conclusions We are some distance from being able to claim evidence-based practice. The press for individual-level data will make this challenge even harder.

Bulletin of the World Health Organization
Volume 94, Number 5, May 2016, 309-404
http://www.who.int/bulletin/volumes/94/5/en/

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Special theme: the Global strategy for women’s, children’s and adolescents’ health (2016-2030)
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EDITORIALS
Knowledge for effective action to improve the health of women, children and adolescents in the sustainable development era
Flavia Bustreo, Robin Gorna & David Nabarro
http://dx.doi.org/10.2471/BLT.16.174243
…Achieving the global strategy and the SDGs will require the use of the best available knowledge for action, as well as investment in new research and innovation. This month’s Bulletin theme issue seeks to broaden the evidence on effective country implementation and lessons learnt from the MDGs. Kuruvilla et al.3 summarize the current global strategy, show how the objectives of the strategy are aligned with the SDGs and how selected countries are already making progress.

Several papers in this issue deal with progress on the survival objective of the global strategy; Negandhi et al.4 present a surveillance-based maternal and infant death review system in India; Murguía-Peniche et al.5 and McKinnon et al.6 address under-researched topics, such as the factors associated with stillbirths in Mexico and the high prevalence of suicidal behaviours among adolescents in low- and middle-income countries, respectively.

The strategy’s thrive objective addresses the overall health and well-being of mothers, children and adolescents. Chai et al.7 determine how exposure to violence hinders child development and can affect health across the life-course and subsequent generations. Askew et al.8 describe the importance of ensuring sexual and reproductive health and rights in humanitarian settings.

The transform objective of the strategy focuses on expanding enabling environments and aims to transform societies so that women, children and adolescents everywhere can realize their rights to the highest attainable standards of health and well-being. Several papers address the global strategy’s transform objective. Newberry et al.9 present a formal emergency response infrastructure developed in India for gender-based violence.

This special issue also includes papers on approaches that have helped countries achieve improved health outcomes for women, children and adolescents. Marston et al.10 discuss the importance of community engagement in achieving results. Ahmed et al.11 describe policies and programmes that contributed to reductions in child and maternal mortality. Frost et al.12 explain how multistakeholder dialogues are used to clarify what works and does not work in policy-making and implementation…

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EDITORIALS
Sexual and reproductive health and rights in emergencies
Ian Askew, Rajat Khosla, Ugochi Daniels, Sandra Krause, Clare Lofthouse, Lale Say, Kate Gilmore & Sarah Zeid
http://dx.doi.org/10.2471/BLT.16.173567

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Research
Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys
Jeanne Chai, Günther Fink, Sylvia Kaaya, Goodarz Danaei, Wafaie Fawzi, Majid Ezzati, Jeffrey Lienert & Mary C Smith Fawzi
http://dx.doi.org/10.2471/BLT.15.152462
Abstract
Objective
To determine the impact of intimate partner violence against women on children’s growth and nutritional status in low- and middle-income countries.
Methods
We pooled records from 42 demographic and health surveys in 29 countries. Data on maternal lifetime exposure to physical or sexual violence by an intimate partner, socioeconomic and demographic characteristics were collected. We used logistic regression models to determine the association between intimate partner violence and child stunting and wasting.
Findings
Prior exposure to intimate partner violence was reported by 69 652 (34.1%) of the 204 159 ever-married women included in our analysis. After adjusting for a range of characteristics, stunting in children was found to be positively associated with maternal lifetime exposure to only physical (adjusted odds ratio, aOR: 1.11; 95% confidence interval, CI: 1.09–1.14) or sexual intimate partner violence (aOR: 1.09; 95% CI: 1.05–1.13) and to both forms of such violence (aOR: 1.10; 95% CI: 1.05–1.14). The associations between stunting and intimate partner violence were stronger in urban areas than in rural ones, for mothers who had low levels of education than for women with higher levels of education, and in middle-income countries than in low-income countries. We also found a small negative association between wasting and intimate partner violence (aOR: 0.94; 95%CI: 0.90–0.98).
Conclusion
Intimate partner violence against women remains common in low- and middle-income countries and is highly detrimental to women and to the growth of the affected women’s children. Policy and programme efforts are needed to reduce the prevalence and impact of such violence.

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Perspectives
The sustainable development goals, violence and women’s and children’s health
Claudia García-Moreno & Avni Amin
http://dx.doi.org/10.2471/BLT.16.172205

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The Global strategy for women’s, children’s and adolescents’ health (2016–2030): a roadmap based on evidence and country experience
Shyama Kuruvilla, Flavia Bustreo, Taona Kuo, CK Mishra, Katie Taylor, Helga Fogstad, Geeta Rao Gupta, Kate Gilmore, Marleen Temmerman, Joe Thomas, Kumanan Rasanathan, Ted Chaiban, Anshu Mohan, Anna Gruending, Julian Schweitzer, Hannah Sarah Dini, John Borrazzo, Hareya Fassil, Lars Gronseth, Rajat Khosla, Richard Cheeseman, Robin Gorna, Lori McDougall, Kadidiatou Toure, Kate Rogers, Kate Dodson, Anita Sharma, Marta Seoane & Anthony Costello
http://dx.doi.org/10.2471/BLT.16.170431

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Country perspectives on integrated approaches to maternal and child health: the need for alignment and coordination
Pascal Bijleveld, Blerta Maliqi, Paul Pronyk, Jennifer Franz-Vasdeki, Bennett Nemser, Diana Sera, Renee van de Weerdt & Benedicte Walter
http://dx.doi.org/10.2471/BLT.15.168823

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 7 May 2016]

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Research
Developing a framework for successful research partnerships in global health
Fiona Larkan, Ogenna Uduma, Saheed Akinmayọwa Lawal and Bianca van Bavel
Published on: 6 May 2016
Abstract
Background
The Centre for Global Health, Trinity College Dublin has as one of its goals, strengthening health systems in developing countries. In realising this goal we work across more than 40 countries with third-level, civil society, government, private sector and UN partners. Each of these requires that different relationships be established. Good principles must guide all global health research partnerships.
An exploratory research project was undertaken with research partners of, and staff within, the Centre for Global Health. The aim was to build an evidence-based framework.
Methods
An inductive exploratory research process was undertaken using a grounded theory approach in three consecutive phases: Phase I: An open-ended questionnaire was sent via email to all identified partners. Phase II: A series of consultative meetings were held with the staff of the Centre for Global Health. Phase III: Data sets from Phases I and II were applied to the development of a unifying framework. Data was analysed using grounded theory three stage thematic analysis – open, axial and selective coding.
Results
Relational and operational aspects of partnership were highlighted as being relevant across every partnership. Seven equally important core concepts emerged (focus, values, equity, benefit, leadership, communication and resolution), and are described and discussed here. Of these, two (leadership and resolution) are less often considered in existing literature on partnerships.
Conclusions
Large complex partnerships can work well if all parties are agreed in advance to a common minimum programme, have been involved from the design stage, and have adequate resources specifically allocated. Based on this research, a framework for partnerships has been developed and is shared.
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Debate
The Capabilities Approach: Fostering contexts for enhancing mental health and wellbeing across the globe
Ross G. White, Maria Grazia Imperiale and Em Perera
Published on: 5 May 2016
Abstract
Concerted efforts have been made in recent years to achieve equity and equality in mental health for all people across the globe. This has led to the emergence of Global Mental Health as an area of study and practice. The momentum that this has created has contributed to the development, implementation and evaluation of services for priority mental disorders in many low- and middle-income countries.
This paper discusses two related issues that may be serving to limit the success of mental health initiatives across the globe, and proposes potential solutions to these issues. First, there has been a lack of sophistication in determining what constitutes a ‘good outcome’ for people experiencing mental health difficulties. Even though health is defined and understood as a state of ‘wellbeing’ and not merely an absence of illness, mental health interventions tend to narrowly focus on reducing symptoms of mental illness. The need to also focus more broadly on enhancing subjective wellbeing is highlighted. The second limitation relates to the lack of an overarching theoretical framework guiding efforts to reduce inequalities and inequities in mental health across the globe. This paper discusses the potential impact that the Capabilities Approach (CA) could have for addressing both of these issues. As a framework for human development, the CA places emphasis on promoting wellbeing through enabling people to realise their capabilities and engage in behaviours that they subjectively value.
The utilization of the CA to guide the development and implementation of mental health interventions can help Global Mental Health initiatives to identify sources of social inequality and structural violence that may impede freedom and individuals’ opportunities to realise their capabilities.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 7 May 2016]

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Research
Applying a system dynamics modelling approach to explore policy options for improving neonatal health in Uganda
Agnes Rwashana Semwanga, Sarah Nakubulwa and Taghreed Adam
Published on: 4 May 2016

The Lancet
May 07, 2016 Volume 387 Number 10031 p1879-1968
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Australia’s offshore refugee policy in disarray
The Lancet
Summary
Australia’s contentious way of dealing with refugees and asylum seekers arriving by boat, long condemned by human rights organisations, has come under renewed attack and public scrutiny. On April 26, the Supreme Court of Papua New Guinea (PNG) ruled that the offshore detention centre on Manus Island, PNG, which had been used by Australia under the so-called Pacific Solution, was unconstitutional and ordered its closure. In its ruling, the court said that the centre violated the detainees’ rights to personal liberty under the PNG constitution.

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Comment
Mind the gap: jumping from vaccine licensure to routine use
Katherine L O’Brien, Fred Binka, Kevin Marsh, Jon S Abramson
Summary
The contribution of immunisation to improving childhood survival is one of the great achievements of global health. Driving down further infectious disease burden will require new vaccines, many of which have taken decades to develop. We are entering an era where the path from licensure to widespread routine vaccine implementation requires more than efficacy and safety data; policy recommendations for new vaccines may only be realised through implementation research to determine how to most effectively ensure widespread use.

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Articles
Global and regional health effects of future food production under climate change: a modelling study
Marco Springmann, Daniel Mason-D’Croz, Sherman Robinson, Tara Garnett, H Charles J Godfray, Douglas Gollin, Mike Rayner, Paola Ballon, Peter Scarborough
Summary
Background
One of the most important consequences of climate change could be its effects on agriculture. Although much research has focused on questions of food security, less has been devoted to assessing the wider health impacts of future changes in agricultural production. In this modelling study, we estimate excess mortality attributable to agriculturally mediated changes in dietary and weight-related risk factors by cause of death for 155 world regions in the year 2050.
Methods
For this modelling study, we linked a detailed agricultural modelling framework, the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT), to a comparative risk assessment of changes in fruit and vegetable consumption, red meat consumption, and bodyweight for deaths from coronary heart disease, stroke, cancer, and an aggregate of other causes. We calculated the change in the number of deaths attributable to climate-related changes in weight and diets for the combination of four emissions pathways (a high emissions pathway, two medium emissions pathways, and a low emissions pathway) and three socioeconomic pathways (sustainable development, middle of the road, and more fragmented development), which each included six scenarios with variable climatic inputs.
Findings
The model projects that by 2050, climate change will lead to per-person reductions of 3·2% (SD 0·4%) in global food availability, 4·0% (0·7%) in fruit and vegetable consumption, and 0·7% (0·1%) in red meat consumption. These changes will be associated with 529,000 climate-related deaths worldwide (95% CI 314,000–736,000), representing a 28% (95% CI 26–33) reduction in the number of deaths that would be avoided because of changes in dietary and weight-related risk factors between 2010 and 2050. Twice as many climate-related deaths were associated with reductions in fruit and vegetable consumption than with climate-related increases in the prevalence of underweight, and most climate-related deaths were projected to occur in south and east Asia. Adoption of climate-stabilisation pathways would reduce the number of climate-related deaths by 29–71%, depending on their stringency.
Interpretation
The health effects of climate change from changes in dietary and weight-related risk factors could be substantial, and exceed other climate-related health impacts that have been estimated. Climate change mitigation could prevent many climate-related deaths. Strengthening of public health programmes aimed at preventing and treating diet and weight-related risk factors could be a suitable climate change adaptation strategy.