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).

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 30 April 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 30 April 2016

blog edition: comprised of the 35+ entries  posted belo

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 23 April 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 23 April 2016

blog edition: comprised of the 35+ entries  posted belo

:: Week in Review [posts below]

A highly selective capture of strategic developments, research, commentary, analysis and announcements spanning Human Rights Action, Humanitarian Response, Health, Education, Holistic Development, Heritage Stewardship, Sustainable Resilience. Achieving a balance across these broad themes is a challenge and we appreciate your observations and ideas in this regard. This is not intended to be a “news and events” digest.

Syria; EU Turkey Agreement; Refugees

Editor’s Note:
We aggregate below a number of announcements, analyses, and calls-to-action addressing the continuing refugee-migrant crisis.
Please see additional European Commission and agency/NGO announcements around the EU-Turkey Agreement and migration-refugee issues overall below.

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Mediterranean Migrant Arrivals in 2016: 180,245; Deaths: 1,232
04/22/16
IOM reports that an estimated 180,245 migrants and refugees have entered Europe by sea in 2016, arriving in Italy, Greece, Cyprus and Spain, through 20 April.

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Survivors report massive loss of life in latest Mediterranean Sea tragedy
18 April 2016
On Tuesday, a UNHCR team interviewed survivors of what could be one of the worst tragedies involving refugees and migrants in the last 12 months. If confirmed, as many as 500 people may have lost their lives when a large ship went down in the Mediterranean Sea at an unknown location between Libya and Italy. The 41 survivors (37 men, three women and a three-year-old child) were rescued by a merchant ship and taken to Kalamata, in the Peloponnese peninsula of Greece on 16 April. Those rescued include 23 Somalis, 11 Ethiopians, 6 Egyptians and a Sudanese…

…UNHCR continues to call for increased regular pathways for the admission of refugees and asylum-seekers to Europe, including resettlement and humanitarian admission programmes, family reunification, private sponsorship and student and work visas for refugees. These will all serve to reduce the demand for people smuggling and dangerous irregular sea journeys.

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Managing the Refugee Crisis: Commission reports on implementation of EU-Turkey Statement
European Commission – Press release Brussels, 20 April 2016
The Commission has today reported on the implementation of the EU-Turkey Agreement and finds that good progress has been made to operationalise the Statement. Continued efforts and commitments are needed to consolidate this position and carry out sustained return and resettlement operations, given that this aspect of implementation still largely lies ahead. On 18 March 2016, EU Heads of State or Government and Turkey agreed to end the irregular migration from Turkey to the EU and replace it instead with legal channels of resettlement of refugees to the European Union. This new approach has started to deliver results, with a sharp decrease seen in the number of people irregularly crossing the Aegean from Turkey into Greece. Today’s report also constitutes the fourth report on the implementation of the EU-Turkey Joint Action Plan of 29 November 2015.

European Commission First Vice-President Frans Timmermans said: “The first result of our cooperation with Turkey is that the message is starting to get through that turning to smugglers is the wrong choice to make. In the past three weeks we have seen a sharp decrease in irregular arrivals, which now needs to go hand-in-hand with opening up the legal channel of resettlement to those in need of protection. Although we have seen good progress in the initial stages of implementation, the Commission will remain engaged to ensure full and timely delivery of all elements of the EU-Turkey Statement, including projects for refugees from Syria in Turkey, the visa liberalisation process and compliance with EU and international laws.”

Today’s Report concludes that there has been good progress since 18 March, with joint efforts by the Greek and Turkish authorities, the Commission, Member States and EU agencies making headway in operationalising the Statement:

:: The return of irregular migrants to Turkey started on 4 April. So far, 325 irregular migrants arriving to Greece via Turkey after 20 March have been returned to Turkey under the Statement. We welcome that a number of legal changes have been undertaken by both Greece and Turkey to ensure full respect of EU and international law. Frontex has deployed 318 escort officers and 21 readmission experts to the Greek islands to support the return operations. In addition, a total of 25 Turkish liaison officers have been deployed in the Greek hotspots and 5 Greek liaison officers to arrival points in Turkey.

:: The first resettlements from Turkey following the Statement took place on 4-5 April. So far, 103 Syrian refugees have been resettled to the EU under the 1:1 scheme. Standard Operating Procedures for resettlement have been developed in close cooperation between the Commission, Member States, EASO, UNHCR and Turkey, and now need to be finalised.

:: Greece has set up accelerated procedures for the processing of all stages of asylum applications on the islands, from the initial interviews to the appeals. Greece has already deployed case officers and police officers to the islands, in line with the requirements of the Asylum Procedures Directive. EASO has deployed 60 asylum officers and 67 interpreters to the Greek islands to support the processing of asylum applications.

:: The Commission will present its third visa liberalisation progress report for Turkey on 4 May and, if Turkey takes the necessary measures to fulfil the remaining benchmarks, the report will be accompanied by a legislative proposal for transferring Turkey to the visa-free list.

:: Programming and project preparation under the Facility for Refugees in Turkey have been accelerated. In addition to €1 billion from the EU budget, 16 EU Member States have now sent in their contribution certificates, covering €1.61 billion out of the €2 billion pledged for 2016-2017. The first contracts under the Facility, worth €77 million, were signed on 4 March and the first payments were made on 18 March.

The good progress in the initial phase of implementation now needs to be stepped up in the next phases. The Commission will remain fully engaged in implementing all elements of the Statement. Member States need to step up their efforts in supporting Greece, particularly given the need to pay particular attention to children and vulnerable groups; more pledges and acceptances are needed in terms of resettlement, relocation and support to the EU agencies. Those Member States that have not sent in their contribution certificates under the Facility for Refugees in Turkey should quickly do so.

Equally, further efforts are required by Turkey to make sure that those who need international protection receive the kind of support they most require including through the Facility. Turkey also needs to take the necessary measures to fulfil the remaining benchmarks of the visa liberalisation roadmap by the end of April, with a view to lifting the visa requirements for Turkish citizens at the latest by the end of June 2016.

The Commission will present its second report on the implementation of the EU-Turkey Statement in early June 2016…

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New measures approved to improve stability and tackle the root causes of irregular migration
European Commission – Press release Brussels, 18 April 2016
The European Commission today announced the introduction of 20 new measures in the Sahel region and Lake Chad Basin, worth over EUR 280 million in total.

The European Commission today announced the adoption of 20 new measures to assist the Sahel region and the Lake Chad Basin under the ‘Emergency Trust Fund for stability and addressing root causes of irregular migration and displaced persons in Africa’.

These measures, with a budget of over EUR 280 million, correspond directly to the commitments made under the Action Plan adopted at the Valletta Summit (11 12 November 2015). The aim of the measures is to improve the management of migration flows, create sustainable economic opportunities for young people and address the factors of instability and vulnerability. Under these measures, EUR 100 million are earmarked for the Lake Chad region, in particular to support those affected by the Boko Haram terrorist group.

EU Commissioner for International Cooperation and Development, Neven Mimica, added: ‘With these twenty new measures worth almost EUR 300 million, the Trust Fund is demonstrating once again its added value in swiftly launching projects to tackle the root causes of instability and irregular migration in the Sahel and Lake Chad Basin regions. We are focusing in particular on job creation, especially for young people, and the socio economic reintegration of vulnerable groups. These sections of the population are the main victims of instability and they should be the main beneficiaries of our projects.’

The measures are targeted specifically at the areas of origin and transit of migrants and the main areas of instability. They are part of a comprehensive response by the European Union and are the result of an enhanced political dialogue with its partners on the question of migration.

Eight countries in the region will benefit from this assistance through an integrated approach which reflects the complexity of migration and the diversity of the challenges in the region:
:: Three measures (EUR 63 million) will be geared to the regions of origin of migrants in Senegal and Mauritania in order to create economic opportunities for young people, prevent irregular migration and promote voluntary returns.
:: Two measures (EUR 37 million) will target the areas of transit in Niger in order to increase employment opportunities and income-generating activities for migrants and local populations.
:: One measure (EUR 6 million) will be aimed at setting up a joint investigation team in Niger to combat networks engaged in smuggling migrants and human trafficking.
:: A regional measure (EUR 5 million) will build on the capacities of the countries of the Economic Community of West African States (ECOWAS) in the fight against organised crime, trafficking and terrorism by creating or strengthening capacity to collect, pool, manage and share police data.
:: One measure (EUR 3 million) will help to protect migrant children from exploitation and human trafficking in Mauritania.
:: One measure (EUR 6 million) will be aimed at strengthening the commitment of the Malian diaspora in Europe to developing Mali’s economy and in particular the areas of origin of migrants.
:: One measure (EUR 10 million) will underpin the implementation of the Northern Mali Peace Agreement.
:: Eight measures (EUR 118 million) will target the Lake Chad region and the areas affected by the crisis linked to Boko Haram in order to boost the resilience of vulnerable groups, in particular women and the displaced, and strengthen conflict prevention and management.
:: Two measures (EUR 30 million) will be aimed at supporting the most vulnerable groups and contributing to the socio-economic integration of women in northern Burkina Faso.

Other measures more specifically aimed at combating migrant smuggling and human trafficking, supporting internal security forces, border management and governance of migration flows are currently being formulated and will be presented in the coming weeks.

Following the adoption of 10 measures in January 2016 worth EUR 100 million in addition to today’s EUR 280 million, the Fund thus confirms its ability to respond swiftly and in a targeted manner to the specific challenges of the region, complementing other EU action.

:::::::

IOM Releases Global Migration Trends 2015 Factsheet
Posted: 04/19/16
IOM’s Global Migration Trends Factsheet 2015 presents a snapshot of the migration trends worldwide for the year 2015, based on migration statistics from a variety of sources.

In 2015, the number of international migrants worldwide – people residing in a country other than their country of birth – was the highest ever recorded, at 244 million (up from 232 million in 2013).

As a share of the world population, however, international migration has remained fairly constant over the past decades, at around 3 percent.

While female migrants constitute only 48 percent of the international migrant stock worldwide, and 42 percent in Asia, women make up the majority of international migrants in Europe (52.4 percent) and North America (51.2 percent).

South-South migration flows (across developing countries) continued to grow compared to South-North movements (from developing to developed countries.) In 2015, 90.2 million international migrants born in developing countries were living in other countries in the Global South, while 85.3 million born in the South lived in countries in the Global North.

Germany became the second most popular destination for international migrants globally (in absolute numbers), following the United States and ahead of the Russian Federation, with an estimated 12 million foreign-born people living in the country in 2015 (compared to 46.6 million in the US and 11.9 million in the Russian Federation).

As a proportion of the host country’s population, however, numbers of international migrants continue to be highest in the Gulf Cooperation Council countries. The foreign-born population makes up 88.4 percent of the total population in the United Arab Emirates, 75.7 percent in Qatar and 73.6 percent in Kuwait.

Close to 1 in 5 migrants in the world live in the top 20 largest cities, according to IOM’s World Migration Report 2015. International migrants make up over a third of the total population in cities like Sydney, Auckland, Singapore and London. At least one in four residents in Amsterdam, Frankfurt and Paris is foreign-born.

The year 2015 saw the highest levels of forced displacement globally recorded since World War II, with a dramatic increase in the number of refugees, asylum-seekers and internally displaced people across various regions of the world – from Africa to the Middle East and South Asia.

The world hosted 15.1 million refugees by mid-2015. This is a 45 percent increase compared to three and a half years ago, largely due to continued conflict in the Syria, now well into its fifth year. Some five million people were newly displaced in the first half of 2015…

For more information and figures, see the Global Migration Trends Factsheet 2015
http://iomgmdac.org/global-trends-2015-factsheet/

The Social Monitor: Social Protection for Child Rights and Wellbeing in Central and Eastern Europe, the Caucasus and Central Asia
UNICEF Regional Report
December 2015 :: 188 pages
Pdf: http://www.unicef.org/ceecis/Social_Monitor_Regional_Report.pdf

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Press Release
Invest in better social protection for the most disadvantaged children: UNICEF
Low public spending, ineffective social protection policies and programmes are hampering progress for children in Central and Eastern Europe, the Caucasus and Central Asia

GENEVA, 20 April 2016 – Children who are falling furthest behind in society benefit the most when countries invest in more effective social protection, according to a new UNICEF Report launched today.

The Social Monitor: Social Protection for Child Rights and Wellbeing in Central and Eastern Europe, the Caucasus and Central Asia report consolidates recent evidence on trends and patterns of change in child poverty and the impact of social protection on children in 30 countries and territories in the region.

It highlights key challenges that the region faces in meeting the social protection needs of children and shares UNICEF recommendations on how to tackle them. Social protection for children includes cash assistance, subsidies for health or education services, counselling and social work, and parental leave.

The report found children are doing better in the region than 20 years ago but too many children are still living in poor households, deprived of basic necessities, excluded from services, communities and societies.

Key findings include:
:: Cash benefits in the region are increasingly reaching children and families who need them. However, too many children in need are still not covered, especially if they come from disadvantaged groups. Among the most vulnerable and discriminated are children with disabilities, children from ethnic and linguistic minorities, and children affected by migration.
:: What children and families receive, in most countries and territories of the region, is not making a difference in their lives.
:: Parents with low incomes or without a job do not get quality social support to help them deal with family conflicts or connect with available benefits and services, including training and employment opportunities…

MILLIONS LEARNING – SCALING UP QUALITY EDUCATION IN DEVELOPING COUNTRIES
Brookings – Center for Universal Education
Jenny Perlman Robinson and Rebecca Winthrop with Eileen McGivney
April 2016 :: 83 pages
Pdf: http://www.brookings.edu/~/media/Research/Files/Reports/2016/04/millions-learning/FINAL-Millions-Learning-Report.pdf?la=en

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Executive summary
Around the world, countries are grappling with how to scale quality education for their children and youth. Quality education is at the center of a nation’s progress, and it is also enshrined in the United Nations Sustainable Development Goals, which 193 countries have recently committed to support. While the spread of schooling over the past 150 years is one of the most widely successful “going to scale” stories, this expansion too often has been met with little mastery of core academic content and higher-order thinking skills.

An estimated “100-year gap” persists between education levels in developed and developing countries, and if business proceeds as usual in the education sector, this gap is not projected to close. Today, 250 million children around the globe—many of them having spent at least four years of school in a developing country—lack the most basic literacy and numeracy skills. Additionally, countries around the world are struggling to help young people develop 21st-century skills, such as critical thinking and collaborative problem solving, which are increasingly demanded by the labor market.

Millions Learning tells the story of where and how quality education has scaled in the developing world. The story emerges from wide-ranging research on scaling and learning, including 14 in-depth case studies, from Brazil and Honduras, to Uganda and Zambia, to Jordan and India.

What we found is that from the slums of New Delhi to the rainforest in Brazil, transformational change in children’s learning is happening at large scale in many places around the world. We found that successful scaling of quality learning often occurs when new approaches and ideas are allowed to develop and grow on the margins and then spread to reach many more children and youth. What constitutes the margins varies on a case-by-case basis. For some, it means a flexible central government giving freedom to its officials within a district to try a new approach. For others, it involves a community movement that develops new ways of reaching marginalized children whose educational options are limited.

Scaling from the margins occurs in two main ways: idea adoption, namely the spread of new approaches across an education ecosystem, and delivery innovation, the development of new ways to deliver education to marginalized children and youth. With the former, effective new approaches to improving components of the teaching and learning process—from curriculum, to materials, to teacher development—have spread across education ecosystems and been adopted by different actors. With the latter, new education delivery approaches for the most marginalized communities— such as distance learning models or alternative education programs—have developed and grown within and across countries.

We identified 14 core ingredients, in different combinations depending on the context, contribute to scaling quality learning. Each of these ingredients is central for scaling effective approaches that improve learning. Their importance is frequently reinforced from evidence in the broader scaling literature. They include essential elements for designing, delivering, financing, and enabling scaling of quality education.