Emergency Medicine Journal
November 2014, Volume 31, Issue 11
http://emj.bmj.com/content/current

Review
Development of hospital disaster resilience: conceptual framework and potential measurement
Shuang Zhong1, Michele Clark1, Xiang-Yu Hou1, Yu-Li Zang2, Gerard Fitzgerald1
Author Affiliations
1Centre for Emergency and Disaster Management, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
2School of Nursing, Shandong University, Jinan, Shandong Province, P. R. China
Published Online First 12 September 2013
Abstract
Objective
Despite ‘hospital resilience’ gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement.
Methods
Searches were conducted of the commonly used health databases to identify relevant literature and reports. Search terms included ‘resilience and framework or model’ or ‘evaluation or assess or measure and hospital and disaster or emergency or mass casualty and resilience or capacity or preparedness or response or safety’. Articles were retrieved that focussed on disaster resilience frameworks and the evaluation of various hospital capacities.
Result
A total of 1480 potentially eligible publications were retrieved initially but the final analysis was conducted on 47 articles, which appeared to contribute to the study objectives. Four disaster resilience frameworks and 11 evaluation instruments of hospital disaster capacity were included.
Discussion and conclusion
Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.

Forum for Development Studies
Volume 41, Issue 3, 2014
http://www.tandfonline.com/toc/sfds20/current

Special Issue: Nordic Conference for Development Research, 2013

Iatrogenic Violence? Lived Experiences of Recipients of Aid that Targets Vulnerable Children in Makete, Tanzania
Marguerite Daniela*
Open access
DOI:10.1080/08039410.2014.962601
pages 415-431
Published online: 28 Oct 2014
Abstract
Humanitarian aid does not always achieve its intended outcomes but may have unintended side-effects which harm rather than help recipient communities in the long run. In the context of aid, iatrogenic violence refers to circumstances where aid intended to benefit recipients instead causes social disruption. The relations between donor and recipient contribute significantly to the outcomes of aid. This article aims to explore the recipient side of donor–recipient relationships in humanitarian aid targeting children affected by HIV/AIDS in Makete, Tanzania. Specific objectives include exploring (i) the lived experiences of the children who are targeted by the aid, (ii) the lived experiences of related caregivers and community members and (iii) the responses of local leaders, both non-governmental organisation (NGO) officers and local government leaders. Forty-one orphaned children aged 9–18 were involved in 3 one-hour-long participatory activities. From these, 12 were selected for in-depth interviews. Four caregivers of orphaned children and 15 key informants (community leaders and NGO officers) were interviewed. Findings show that the type of aid and method of distribution are determined by the donors and do not fit well with local conditions. Examples of iatrogenic violence include conflict and division between those in the community who receive aid and those who do not, increasing dependency with a corresponding reduction in self-reliance, criteria that exclude the most vulnerable children from aid and passivity and non-participation. Donor-controlled humanitarian aid is causing unintended harm in the recipient communities.

Communicating What Works Bringing Knowledge into Development Policy
Carl-Gustav Lindéna*
DOI:10.1080/08039410.2014.962602
pages 477-500
Abstract
This article explores attitudes of social scientists engaged in international development research, mainly development economists, towards the role of communication in influencing development policy. It is based on an international survey of researchers (N = 79) as well as in-depth interviews (N  = 6) with representatives of the same group. Results confirm the two-communities’ thesis that researchers and policy-makers are situated in different institutional settings. The article also provides a more nuanced view, how this divide differs across topics or contexts. A common judgement was that research should strive to influence policy and the respondents stressed that they were actively working to make this come true. Still, they also found that the academic reward structure have a negative impact on a more sustained engagement with policy-makers. Researchers will rise in academic rankings based on what they publish in peer-reviewed journals, not because of efforts to improve development policy. Researchers tended to believe that engaging with policy-makers in face-to-face settings would give them the best opportunity to achieve impact, a finding which echoes previous studies. There was broad support for the idea that researchers and policy-makers should get involved in constructive engagement based on mutual respect. Somewhat surprisingly, using specialists such as communications experts for getting the message through was not regarded highly despite all the promotion going on for development research communication.

Globalization and Health
[Accessed 1 November 2014]
http://www.globalizationandhealth.com/

Debate
Towards a comprehensive global approach to prevention and control of NCDs
Martin McKee1*, Andy Haines2, Shah Ebrahim3, Peter Lamptey3, Mauricio L Barreto4, Don Matheson5, Helen L Walls367, Sunia Foliaki5, J Jaime Miranda8, Oyun Chimeddamba9, Luis Garcia-Marcos10, Paolo Vineis11 and Neil Pearce36
Abstract
Background
The “25×25” strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors.
Discussion
We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal “one-size fits all” approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors.
Summary
The 25×25 is approach is absolutely necessary but insufficient to tackle the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.

Health Policy and Planning
Volume 29 Issue 7 October 2014
http://heapol.oxfordjournals.org/content/current

Acceptability of conditions in a community-led cash transfer programme for orphaned and vulnerable children in Zimbabwe
Morten Skovdal1,2, Laura Robertson3, Phyllis Mushati4, Lovemore Dumba5, Lorraine Sherr6,
Constance Nyamukapa3,4 and Simon Gregson3,4
Author Affiliations
1Institute of Social Psychology, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK, 2Save the Children, 1 St John’s Lane, EC1M 4AR, London, UK, 3Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Praed Street, W2 1NY, London, UK, 4Biomedical Research and Training Institute, No. 10 Seagrave Road, Avondale, Harare, Zimbabwe, 5Catholic Relief Services, 95 Park Lane, Harare, Zimbabwe and 6Department of Infection and Population Health, Royal Free Hospital, Rowland Hill Street, NW3 2PF, University College London, London, UK
Accepted July 8, 2013.
Abstract
Evidence suggests that a regular and reliable transfer of cash to households with orphaned and vulnerable children has a strong and positive effect on child outcomes. However, conditional cash transfers are considered by some as particularly intrusive and the question on whether or not to apply conditions to cash transfers is an issue of controversy. Contributing to policy debates on the appropriateness of conditions, this article sets out to investigate the overall buy-in of conditions by different stakeholders and to identify pathways that contribute to an acceptability of conditions.
The article draws on data from a cluster-randomized trial of a community-led cash transfer programme in Manicaland, eastern Zimbabwe. An endpoint survey distributed to 5167 households assessed community members’ acceptance of conditions and 35 in-depth interviews and 3 focus groups with a total of 58 adults and 4 youth examined local perceptions of conditions. The study found a significant and widespread acceptance of conditions primarily because they were seen as fair and a proxy for good parenting or guardianship. In a socio-economic context where child grants are not considered a citizen entitlement, community members and cash transfer recipients valued the conditions associated with these grants. The community members interpreted the fulfilment of the conditions as a proxy for achievement and merit, enabling them to participate rather than sit back as passive recipients of aid.
Although conditions have a paternalistic undertone and engender the sceptics’ view of conditions being pernicious and even abominable, it is important to recognize that community members, when given the opportunity to participate in programme design and implementation, can take advantage of conditions and appropriate them in a way that helps them manage change and overcome the social divisiveness or conflict that otherwise may arise when some people are identified to benefit and others not.

Health and access to care for undocumented migrants living in the European Union: a scoping review
Aniek Woodward1,2,*, Natasha Howard1 and Ivan Wolffers3
Author Affiliations
1Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, 2King’s International Development Institute and King’s Centre for Global Health, King’s College London, London, WC2R 2LS, UK and 3Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
Accepted July 11, 2013.
Abstract
Background
Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990–2012), thus clarifying what is known, key gaps, and potential next steps.
Methods
Authors used Arksey and O’Malley’s six-stage scoping framework, with Levac, Colquhoun and O’Brien’s revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights.
Results
Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005–2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels.
Conclusions
This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.

Does the distribution of healthcare utilization match needs in Africa?
Igna Bonfrer1,*, Ellen van de Poel1, Michael Grimm2,3 and Eddy Van Doorslaer1,4
Author Affiliations
1Institute of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands, 2Department of Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany, 3International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, 2518 AX, The Hague, The Netherlands and 4Erasmus School of Economics, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
Accepted September 9, 2013.
Abstract
An equitable distribution of healthcare use, distributed according to people’s needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). We examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities we find that wealth is the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that our findings are likely to even underestimate actual inequities in health care. At a macro level, we find that a better match of needs and use is realized in those countries with better governance and more physicians. Given the absence of social health insurance in most of these countries, policies that aim to reduce inequities in access to and use of health care must include an enhanced capacity of the poor to generate income.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 1 November 2014]

Research
How can we establish more successful knowledge networks in developing countries? Lessons learnt from knowledge networks in Iran
Bahareh Yazdizadeh, Reza Majdzadeh, Ali Alemi and Sima Amrolalaei
Author Affiliations
Health Research Policy and Systems 2014, 12:63 doi:10.1186/1478-4505-12-63
Published: 29 October 2014
Abstract (provisional)
Background
Formal knowledge networks are considered among the solutions for strengthening knowledge translation and one of the elements of innovative systems in developing and developed countries. In the year 2000, knowledge networks were established in Iran’s health system to organize, lead, empower, and coordinate efforts made by health-related research centers in the country. Since the assessment of a knowledge network is one of the main requirements for its success, the current study was designed in two qualitative and quantitative sections to identify the strengths and weaknesses of the established knowledge networks and to assess their efficiency.
Methods
In the qualitative section, semi-structured, in-depth interviews were held with network directors and secretaries. The interviews were analyzed through the framework approach. To analyze effectiveness, social network analysis approach was used. That is, by considering the networks’ research council members as ‘nodes’, and the numbers of their joint articles – before and after the network establishments – as ‘relations or ties’, indices of density, clique, and centrality were calculated for each network. In the qualitative section, non-transparency of management, lack of goals, administrative problems were among the most prevalent issues observed.
Results
Currently, the most important challenges are the policies related to them and their management. In the quantitative section, we observed that density and clique indices had risen for some networks; however, the centrality index for the same networks was not as high. Consequently the attribution of density and clique indices to these networks was not possible.
Conclusion
Therefore, consolidating and revising policies relevant to the networks and preparing a guide for establishing managing networks could prove helpful. To develop knowledge and technology in a country, networks need to solve the problems they face in management and governance. That is, the first step towards the realization of true knowledge networks in health system.

Human Rights Quarterly
Volume 36, Number 4, November 2014
http://muse.jhu.edu/journals/human_rights_quarterly/toc/hrq.36.4.html

Cultural Diversity, Legal Pluralism, and Human Rights from an Indigenous Perspective: The Approach by the Colombian Constitutional Court and the Inter-American Court of Human Rights
Felipe Gómez Isa
I. INTRODUCTION
The main objective of this article is to analyze the evolution of human rights from when they first appeared during the Enlightenment in eighteenth century Europe, and to explore how the exclusion and invisibility of indigenous peoples has been a constant throughout. In recent decades, however, the so-called indigenous emergence has radically transformed this landscape. In this new and evolving context, a number of legal instruments have been adopted, both nationally and internationally, which have transformed indigenous peoples into true subjects of both individual and collective rights. The indigenous presence has spurred the quest for a more open, dynamic and inclusive conception of universal human rights. This process culminated in the adoption of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) in September 2007.
Second, the way in which the indigenous plurality of many Latin American countries is influencing the increasingly multicultural understanding of human rights will be highlighted; one example is the progressive case law being handed down by the Colombian Constitutional Court (Constitutional Court), which has played a pioneering role in the application of principles deriving from multiculturalism, and another is the Inter-American Court of Human Rights (Inter-American Court). There is no doubt that the interpretation of human rights principles as expounded by these institutions provides us with an interesting road map when it comes to applying these principles to specific contexts, and also when initiating an intercultural dialogue that takes into account indigenous diversity…

Toward Effective Intervention for Haiti’s Former Child Slaves
Cara L. Kennedy
pp. 756-778 | 10.1353/hrq.2014.0059
I. INTRODUCTION
One of the most widespread forms of child slavery worldwide is domestic slavery. Child domestic slavery exists in various forms depending on the cultural context in which it arises, and is driven by common “push” and “pull” factors. “Push” factors include social and economic disparities, social exclusion, lack of educational access and the illusion of opportunity for education and social mobility, loss of parents to illness or conflict, and the perception that the “employer” is extended family and a protected environment. “Pull” factors include low-resource environments where daily demands for household work exceed household members’ capacity and cultural norms allow that a child is an appropriate choice to carry this labor. In all of its forms, child domestic slavery poses serious risks to children. Beyond the denial of children’s fundamental rights to education, health care, play, and rest, child domestic slavery involves humiliating and degrading treatment; sexual, physical, and verbal abuse; work that exceeds the capacity of children; and insufficient food and accommodation…

Putting the Puzzle Pieces Together: Human Rights Advocacy and the History of International Human Rights Standards Website
Carrie Booth Walling, Susan Waltz
pp. 905-914 | 10.1353/hrq.2014.0049
I. INTRODUCTION
As human rights professionals with more than thirty years of teaching experience between us, we have often been challenged by our students—and by the activists we encounter—to explain changes we have witnessed in the human rights domain. Questions arise about emerging human rights concerns, about the piecemeal nature of the UN monitoring system, about human rights research methodologies, and about changing views of accountability for human rights standards. Our students have asked us, for example, why it took so long for the domestic abuse of women to be recognized as a human rights concern. And community groups and activists have on occasion pressed us to explain the evolving relationship between human rights and humanitarian law. This short resource note introduces the website Human Rights Advocacy and the History of International Human Rights Standards, hosted by the University of Michigan at http://humanrightshistory.umich.edu The open-access website is intended to help human rights learners—of all types and at all stages—to better understand the explosive growth of international human rights standards over the past five decades. It opens up the history of international human rights policy and highlights the role that human rights organizations have played in advocating new treaties and structures for implementation. While international human rights organizations (IHROs) are widely recognized for their advocacy work, the contributions they have made to the development of international human rights norms and standards are not equally appreciated or understood. This website seeks to fill that void. The website serves as a portal for instructors, students, advocates, and researchers interested in the standard-setting advocacy work of the international human rights movement and the intellectual history of contemporary international human rights policy. We hope it will inform current human rights actors about the lesser known history of the emergence and growth of international human rights standards, inspire a new generation of advocates to consider past lessons as they consider new human rights problems, and become a useful resource for instructors and practitioners as a ready link to human rights policy materials…

Infectious Diseases of Poverty
[Accessed 1 November 2014]
http://www.idpjournal.com/content

Editorial
Acquired immunity and asymptomatic reservoir impact on frontline and airport ebola outbreak syndromic surveillance and response
Ernest Tambo and Zhou Xiao-Nong
Author Affiliations
Infectious Diseases of Poverty 2014, 3:41 doi:10.1186/2049-9957-3-41
Published: 29 October 2014
Abstract (provisional)
The number of surveillance networks for infectious disease diagnosis and response has been growing. In 2000, the World Health Organization (WHO) established the Global Outbreak Alert and Response Network, which has been endorsed by each of the 46 WHO African members since then. Yet, taming the dynamics and plague of the vicious Ebola virus disease (EVD) in African countries has been patchy and erratic due to inadequate surveillance and contact tracing, community defiance and resistance, a lack of detection and response systems, meager/weak knowledge and information on the disease, inadequacies in protective materials protocols, contact tracing nightmare and differing priorities at various levels of the public health system. Despite the widespread acceptance of syndromic surveillance (SS) systems, their ability to provide early warning alerts and notifications of outbreaks is still unverified. Information is often too limited for any outbreak, or emerging or otherwise unexpected disease, to be recognized at either the community or the national level. Indeed, little is known about the role and the interactions between the Ebola infection and exposure to other syndemics and the development of acquired immunity, asymptomatic reservoir, and Ebola seroconversion. Can lessons be learnt from smallpox, polio, and influenza immunity, and can immunization against these serve as a guide? In most endemic countries, community health centers and disease control and prevention at airports solely relies on passive routine immunization control and reactive syndromic response. The frontline and airport Ebola SS systems in West Africa have shown deficiencies in terms of responding with an alarming number of case fatalities, and suggest that more detailed insights into Ebola, and proactive actions, are needed. The quest for effective early indicators (EEE) in shifting the public and global health paradigm requires the development and implementation of a comprehensive and effective community or regional integrated pandemic preparedness and surveillance response systems tailored to local contexts. These systems must have mechanisms for early identification, rapid contact tracing and tracking, confirmation, and communication with the local population and the global community, and must endeavor to respond in a timely manner.

International Journal of Disaster Resilience in the Built Environment
Volume 5 Issue 3
http://www.emeraldinsight.com/toc/ijdrbe/5/3

The role of NGOs in building sustainable community resilience
Tal Fitzpatrick (Education Policy and Research, Volunteering Queensland, Brisbane, Australia)
Julie Molloy (Social Engagement Initiatives, Volunteering Queensland, Brisbane, Australia)
DOI: http://dx.doi.org/10.1108/IJDRBE-01-2014-0008
Abstract:
Purpose
– This case study aims to explore the findings and documented impacts of Volunteering Qld’s “Step Up” programme which is the largest community resilience building programme led by a non-government organisation (NGO) in Australia.
Design/methodology/approach
– It will describe the programme design and systems that support this type of qualitative work using evidence-based data collected by the project coordinators over the duration of the programme and contextualising these within a broader resilience framework.
Findings
– This case study will demonstrate and advocate for the need to create stronger partnerships and more significant opportunities for the sector to engage in resilience-building activities.
Research limitations/implications
– The scope of this project was limited by organisational capacity to conduct research into its own programme, as it was being delivered and with limited resourcing. There is a significant need for further research into the work of NGOs in the emergency management and disaster resilience and the impacts of these programmes on communities.
Practical implications
– The practical implications of this case study is a recognition that there are inherent challenges for disaster management agencies trying to engage communities in dialogue around planning risk-informed response and recovery plans for disasters.
Social implications
– However, NGOs are ideally placed to work in and with the communities which they service, to educate and support them at all stages of disaster management.
Originality/value
– This is a unique first-hand account of the experience of a NGO delivering community resilience programme in Australia and provides an important insight for practitioners and researchers alike.

Journal of Epidemiology & Community Health
December 2014, Volume 68, Issue 12
http://jech.bmj.com/content/current

Microcredit participation and child health: results from a cross-sectional study in Peru
H Moseson1, R Hamad2, L Fernald3
Author Affiliations
1Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
2Division of General Medical Disciplines, Stanford University, Stanford, California, USA
3Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, California, USA
Received 24 February 2014
Revised 11 July 2014
Accepted 6 August 2014
Published Online First 1 September 2014
Abstract
Background
Childhood malnutrition is a major consequence of poverty worldwide. Microcredit programmes—which offer small loans, financial literacy and social support to low-income individuals—are increasingly promoted as a way to improve the health of clients and their families. This study evaluates the hypothesis that longer participation in a microcredit programme is associated with improvements in the health of children of microcredit clients.
Methods
Cross-sectional data were collected in February 2007 from 511 clients of a microcredit organisation in Peru and 596 of their children under 5 years of age. The primary predictor variable was length of participation in the microcredit programme. Outcome variables included height, weight, anaemia, household food security and parent-reported indicators of child health. Multivariate linear and logistic regressions assessed the association between the number of loan cycles and child health outcomes. Pathways through which microcredit may have influenced health outcomes were also explored via mediation analyses.
Results
Longer participation in microcredit was associated with greater household food security and reduced likelihood of childhood anaemia. No significant associations were observed between microcredit participation and incidence of childhood illnesses or anthropometric indicators. Increased consumption of red meat may mediate the association between the number of loan cycles and food security, but not the association with anaemia.
Conclusions
The effects of microcredit on the health of clients’ children are understudied. Exploratory findings from this analysis suggest that microcredit may positively influence child health, and that diet may play a causal role.

The Lancet
Nov 01, 2014 Volume 384 Number 9954 p1549 – 1640
http://www.thelancet.com/journals/lancet/issue/current

Editorial
WHO AFRO: in need of new leadership
The Lancet
Preview |
The past 6 months have shone an unprecedented spotlight on health in Africa. Although now is not the time for a detailed review of the failures that led to the current Ebola outbreak in west Africa, enough is known to say that WHO’s Regional Office for Africa (WHO AFRO) failed catastrophically in its mandate to monitor emerging health threats on the continent and to signal those threats to the wider international community. It is already known that some WHO country offices in west Africa simply did not recognise the importance of Ebola or act quickly enough to scale up the agency’s global response.

Violence against children in Cambodia: breaking the silence
The Lancet
Preview |
“When we arrive at school and it is early and we are alone, it is quiet and we are afraid…”, admits a 13-year-old Cambodian girl. School should be a familiar and welcoming place; however, findings from the first-of-its-kind Cambodia’s Violence Against Children Survey, coordinated by UNICEF Cambodia, reveal that many children are subjected to violence at the hands of people they know and should trust in places that should feel safe.

The Lancet Commissions
Culture and health
A David Napier, Clyde Ancarno, Beverley Butler, Joseph Calabrese, Angel Chater, Helen Chatterjee, François Guesnet, Robert Horne, Stephen Jacyna, Sushrut Jadhav, Alison Macdonald, Ulrike Neuendorf, Aaron Parkhurst, Rodney Reynolds, Graham Scambler, Sonu Shamdasani, Sonia Zafer Smith, Jakob Stougaard-Nielsen, Linda Thomson, Nick Tyler, Anna-Maria Volkmann, Trinley Walker, Jessica Watson, Amanda C de C Williams, Chris Willott, James Wilson, Katherine Woolf
Preview |
Planned and unplanned migrations, diverse social practices, and emerging disease vectors transform how health and wellbeing are understood and negotiated. Simultaneously, familiar illnesses—both communicable and non-communicable—continue to affect individual health and household, community, and state economies. Together, these forces shape medical knowledge and how it is understood, how it comes to be valued, and when and how it is adopted and applied.

Maternal and Child Health Journal
Volume 18, Issue 9, November 2014
http://link.springer.com/journal/10995/18/9/page/1

Household Food Insecurity, Maternal Nutritional Status, and Infant Feeding Practices Among HIV-infected Ugandan Women Receiving Combination Antiretroviral Therapy
Sera L. Young, Albert H. J. Plenty, Flavia A. Luwedde, Barnabas K. Natamba, Paul Natureeba,
Jane Achan, Julia Mwesigwa, Theodore D. Ruel, Veronica Ades, Beth Osterbauer,
Abstract
Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) −0.79 (−1.56, −0.02), p = 0.04; −2.06 (−4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7–73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3–85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02–5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored.

Nature
Volume 514 Number 7524 pp535-658 30 October 2014
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Call to action – Time to ramp up science’s contribution to controlling the Ebola outbreak.
29 October 2014
Science has so far taken a back seat as the Ebola outbreak has continued to spread. Research has deferred to the need to gear up the public-health response. But there is a growing sense that, unless science can somehow now change the game, the outbreak will be difficult to bring under control.
The Ebola virus has killed more than 4,800 people in six countries, and has affected people in another two, the latest being Mali. There are still not enough medical staff and treatment beds to handle the current caseload. The World Health Organization (WHO) projects that as many as 10,000 new cases could be arising per week by December if the outbreak is not turned around.
Enter science. Speeding the development of treatments and vaccines is one area in which the international community is trying to move forward. On 22 October, the US Biomedical Advanced Research and Development Authority and the US Army awarded US$17.1 million to Profectus BioSciences, a company based in Baltimore, Maryland, that is developing vaccines against Ebola based on vesicular stomatitis virus. It is the third candidate Ebola vaccine to have moved towards or into clinical trials this year. On 24 October, the WHO outlined plans to test the first two — one licensed to NewLink Genetics of Ames, Iowa, the other being developed by GlaxoSmithKline, headquartered in London. These two vaccines have already entered human safety trials and the WHO says that they could be tested in health-care workers and others in West Africa as early as December.
In the meantime, aid agencies such as Médecins Sans Frontières (also known as Doctors Without Borders) and researchers funded by the European Union will test candidate Ebola treatments, including experimental drugs, medicines already approved for other uses that could be made available ‘off label’, and purified plasma or blood from Ebola survivors.
Beyond treatments and vaccines, scientists have more fundamental questions, about both the Ebola virus behind the current outbreak and other viruses in the family to which it belongs, the filoviruses. This group includes Marburg virus, also capable of causing a lethal haemorrhagic fever, which killed a Ugandan health-care worker on 28 September. A third filovirus outbreak occurred this year in the Democratic Republic of the Congo, where an Ebola outbreak unrelated to that in West Africa has killed 49 people.
The emergence of three filovirus outbreaks this year and the increasing frequency and reach of such outbreaks — which have occurred every year except 2 in the past 21 years — should serve as the clearest warning possible: we urgently need to understand more about the pathology, distribution, epidemiology and clinical aspects of these viruses. A World View on page 537 argues that such science should help to steer the response; a News Feature on page 554 lays out the five most pressing questions about the filo¬viruses, and says why answering them might help to prevent a future outbreak or even help to bring this one under control.
For instance, new filoviruses have been discovered within the past five years, such as the Lloviu virus discovered in 2011 in bats in Spain. And scientists have learnt that these viruses have a much more widespread distribution than was suspected. The Reston virus, for example, an ebolavirus that does not seem to harm humans, has turned up in recent years in pigs in both the Philippines and China. Scientists suspect that there are more of these viruses to be found, in more places, and urgently want to understand why some are lethal to humans and others are not — and whether that could change.
It is also not known which animals harbour Ebola virus in the wild, or how the first person infected in the West African outbreak last December contracted the disease. Understanding this is crucial if people are to avoid a possible reservoir in the future.
It has been difficult to answer these questions for many reasons, such as the (fortunate) relative rarity and un¬predictability of human filovirus outbreaks. And laboratory studies require highly contained, specialized biosafety-level-4 (BSL-4) labs — of which there are too few around the world.
Thanks to a biodefence building boom over the past decade, there are now 13 such labs planned or operating in the United States. Canada, France, Australia, Germany, the United Kingdom, South Africa, Gabon and Russia are among the select nations that also have such facilities. But there are major research-funding nations, such as Japan, that do not have BSL-4 labs, or do not allow them to perform the highest-containment research because of worries that pathogens could escape and spark lethal local epidemics.
The current Ebola outbreak proves the fallacy of that decision. The world would not be in the position it is today, with the possibility of deploying an Ebola vaccine during the current outbreak, without the existence of both high-containment facilities and money for research on diseases that are, thankfully, rare in developing countries. More of both, in more places, can only hasten our understanding of Ebola and other diseases. Because one thing is clear: whether it is Ebola virus, another filovirus or something completely different, there will be a next time.

Nature | Column: World View
Developed nations must not fear sending Ebola help
The anxiety and stigma associated with Ebola are hampering Australia’s willingness and ability to help with the control efforts in Africa, argues Tim Inglis.

New England Journal of Medicine
October 30, 2014 Vol. 371 No. 18
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Ebola Then and Now
Joel G. Breman, M.D., D.T.P.H., and Karl M. Johnson, M.D.
N Engl J Med 2014; 371:1663-1666October 30, 2014DOI: 10.1056/NEJMp1410540
[Excerpt]
In October 1976, the government of Zaire (now the Democratic Republic of Congo [DRC]) asked what was then the U.S. Center for Disease Control, where we worked, to join an international group of scientists in elucidating and controlling an outbreak of an unusually lethal hemorrhagic fever. Just before we arrived in Zaire, our laboratory had used virologic and immunologic tests to identify the cause as a new filovirus, and we brought electron micrographs of the agent.1 In Zaire, we became, respectively, the chief of surveillance, epidemiology, and control and the scientific director of the International Commission for the Investigation and Control of Ebola Hemorrhagic Fever in Zaire.
The 2013–2014 outbreak of Ebola virus disease (EVD) has much in common with the 1976 outbreak. Both were caused by Zaire ebolavirus 2 and began in rural forest communities, where wild game is hunted for food (though no animal has been implicated as the trigger of these outbreaks). Severely ill patients came to provincial hospitals with systemic illness resembling malaria, typhoid, Lassa fever, yellow fever, or influenza. Unsuspecting hospital staff had contact with patients’ blood and body fluids, which amplified the outbreaks. Cases were exported to cities, and chains of transmission were established…

New England Journal of Medicine
October 30, 2014 Vol. 371 No. 18
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Mounting a Good Offense against Measles
Walter Orenstein, M.D., and Katherine Seib, M.S.P.H.
N Engl J Med 2014; 371:1661-1663October 30, 2014DOI: 10.1056/NEJMp1408696
[Excerpt]
…Measles meets the biologic criteria for eradication. Humans are necessary to maintain the virus in nature, since there is no nonhuman reservoir. There is an effective intervention measure — measles vaccines. Diagnostic tests can confirm whether someone has measles. And proof of principle has been demonstrated by prolonged elimination of indigenous circulation of the virus in the Western Hemisphere.
It may be premature to embark on another global eradication effort until polio eradication is achieved; however, much more can be done to reduce measles transmission in its current reservoirs. We can increase support for improving global routine-immunization programs so that they include two doses of measles vaccine in their schedules and for ensuring that there is adequate vaccine and infrastructure to conduct special mass-vaccination campaigns against measles. Support is also needed for strengthening the global laboratory network to permit detection and analysis of which measles strains are persisting and which have been eliminated.5
We must also overcome vaccine hesitancy. Despite the overwhelming evidence that vaccines — including the measles, mumps, and rubella vaccine — are safe, too many people still believe that greater risk is posed by vaccinating than by not vaccinating. Research is needed on how best to address public concerns about vaccine safety. The lack of apparent measles disease in the United States — which is attributable to the enormous success of the U.S. immunization program — gives a false sense that there is little or no threat. Efforts are also needed to educate the public that measles is a serious disease, which no one need suffer from, and that vaccines are highly effective in preventing it.
In the end, we can best protect our population against measles by ensuring that people eligible for vaccination are vaccinated and by supporting global efforts to go on the offensive against this major cause of the global disease burden.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
(Accessed 1 November 2014)
http://www.pnas.org/content/early/

Human population reduction is not a quick fix for environmental problems
Corey J. A. Bradshaw1 and Barry W. Brook
Author Affiliations
Edited by Paul R. Ehrlich, Stanford University, Stanford, CA, and approved September 15, 2014 (received for review June 5, 2014)
Significance
The planet’s large, growing, and over-consuming human population, especially the increasing affluent component, is rapidly eroding many of the Earth’s natural ecosystems. However, society’s only real policy lever to reduce the human population humanely is to encourage lower per capita fertility. How long might fertility reduction take to make a meaningful impact? We examined various scenarios for global human population change to the year 2100 by adjusting fertility and mortality rates (both chronic and short-term interventions) to determine the plausible range of outcomes. Even one-child policies imposed worldwide and catastrophic mortality events would still likely result in 5–10 billion people by 2100. Because of this demographic momentum, there are no easy ways to change the broad trends of human population size this century.
Abstract
The inexorable demographic momentum of the global human population is rapidly eroding Earth’s life-support system. There are consequently more frequent calls to address environmental problems by advocating further reductions in human fertility. To examine how quickly this could lead to a smaller human population, we used scenario-based matrix modeling to project the global population to the year 2100. Assuming a continuation of current trends in mortality reduction, even a rapid transition to a worldwide one-child policy leads to a population similar to today’s by 2100. Even a catastrophic mass mortality event of 2 billion deaths over a hypothetical 5-y window in the mid-21st century would still yield around 8.5 billion people by 2100. In the absence of catastrophe or large fertility reductions (to fewer than two children per female worldwide), the greatest threats to ecosystems—as measured by regional projections within the 35 global Biodiversity Hotspots—indicate that Africa and South Asia will experience the greatest human pressures on future ecosystems. Humanity’s large demographic momentum means that there are no easy policy levers to change the size of the human population substantially over coming decades, short of extreme and rapid reductions in female fertility; it will take centuries, and the long-term target remains unclear. However, some reduction could be achieved by midcentury and lead to hundreds of millions fewer people to feed. More immediate results for sustainability would emerge from policies and technologies that reverse rising consumption of natural resources.

Science
31 October 2014 vol 346, issue 6209, pages 513-668
http://www.sciencemag.org/current.dtl

In Depth
Infectious Diseases
The Ebola vaccine underdog
Jon Cohen
In the race to develop an Ebola vaccine, a small cancer therapy company, NewLink Genetics, has been in the shadows of GlaxoSmithKline (GSK), a big pharma company with lots of experience and far deeper resources. But at a high-level meeting held by the World Health Organization on 23 October, it became clear that NewLink, which is based in Ames, Iowa, by next spring may have more vaccine on hand than GSK, which is based in the United Kingdom. NewLink’s projections come with a major caveat: It all depends on dose. Specifically, the NewLink vaccine is made from an Ebola gene stitched into a livestock pathogen, vesicular stomatitis virus (VSV). It’s currently unknown whether the vaccine needs 1 million VSV particles per dose or 100 million. Early human studies now under way should answer this question. Charles Link Jr., the CEO of NewLink, has avoided media attention until now, but he spoke with Science at length about the prospects and the caveats.

Stability: International Journal of Security & Development
[accessed 1 November 2014]
http://www.stabilityjournal.org/articles

Decentralizing the State in Liberia: The Issues, Progress and Challenges
Ibrahim Al-bakri Nyei
Abstract
Decentralization reforms have become a major part of governance reform in postwar countries. After emerging from fourteen years of civil conflict, Liberia has begun implementing a wide range of governance reform programs, among which decentralization has become a key issue. Although there is consensus among actors – politicians, government officials and civil society activists – on the need to decentralize governance and service delivery there remain disagreement on the scope, nature and timing of decentralization reforms. Overtime, several steps have been taken towards devolution of power, including the promulgation of relevant policies and the deconcentration of services to the counties. There remain, however, a myriad of issues ranging from structural to legal and procedural issues – constitutional reform, revenue collection and expenditure – actors in Liberia need to better consider while rolling out a decentralization program. This includes taking into account the existing capacity and resources constraints. This article discusses issues and progress towards decentralization in Liberia’s governance reform efforts, and sheds light on the challenges in implementing decentralization

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Open Forum Infectious Diseases
Volume 1 Issue 3 Fall 2014
http://ofid.oxfordjournals.org/content/current

Hepatitis E Vaccine to Prevent Morbidity and Mortality During Epidemics
Kenrad E. Nelson1, James W.K. Shih2, Jun Zhang2, QingJian Zhao2, Ningshao Xia2,
John Ticehurst1 and Alain Labrique1
Author Affiliations
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
2National Institute of Diagnostics and Vaccine Development, School of Public Health, Xiamen University, Xiamen, Fujian 361005, PR China
Abstract
Recurrent large water-borne epidemics of Hepatitis E occur regularly after monsoon rains contaminate water supplies in Asia or during humanitarian crises in Africa. These epidemics commonly affect thousands of persons with high mortality in pregnant women who become infected. Although a subunit HEV vaccine has been developed by Chinese investigators and found to be highly effective and safe in a large clinical trial, this vaccine is only available in China. Until it is pre-qualified by WHO, the vaccine may not be available for use outside China in low income countries who lack national vaccine regulatory agencies. In this manuscript we explore possible strategies for providing access to this potentially important vaccine for international use in responding to epidemics of HEV in low resource countries.
Tropical Medicine & International Health
November 2014 Volume 19, Issue 11 Pages 1293–1390
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2014.19.issue-11/issuetoc

Systematic review
Non-clinical interventions for acute respiratory infections and diarrheal diseases among young children in developing countries
Miguel Niño Zarazúa1,* and Maureen Seguin2
DOI: 10.1111/tmi.12423
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)
Abstract
Objective
To assess the effectiveness of non-clinical interventions against acute respiratory infections and diarrheal diseases among young children in developing countries.
Methods
Experimental and observational impact studies of non-clinical interventions aimed at reducing the incidence of mortality and/or morbidity among children due to acute respiratory infections and/or diarrhoeal diseases were reviewed, following the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines.
Results
Enhancing resources and/or infrastructure, and promoting behavioural changes, are effective policy strategies to reduce child morbidity and mortality due to diarrhoeal disease and acute respiratory infections in developing countries. Interventions targeting diarrhoeal incidence generally demonstrated a reduction, ranging from 18.3% to 61%. The wide range of impact size reflects the diverse design features of policies and the heterogeneity of socio-economic environments in which these policies were implemented. Sanitation promotion at household level seems to have a greater protective effect for small children.
Conclusion
Public investment in sanitation and hygiene, water supply and quality, and the provision of medical equipment that detect symptoms of childhood diseases, in combination of training and education for medical workers, are effective policy strategies to reduce diarrhoeal diseases and acute respiratory infections. More research is needed in the countries that are most affected by childhood diseases. There is a need for disaggregation of analysis by age-cohorts, as impact effectiveness of policies depends on children’s age.
Special Focus Newsletters
RotaFlash [PATH] October 29, 2014
Global total of national rotavirus vaccine introductions reaches 70 with Norway
New rotavirus vaccines advance in their development as rollouts continue to rise

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 25 October 2014

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, consortiums 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 verion: The Sentinel_ week ending 25 October 2014

blog edition: comprised of the 35+ entries posted below on 26 October 2014

Opinion: The long-term cure for Ebola – An investment in health systems
by Ellen Johnson-Sirleaf, President of Liberia
Washington Post, 19 October 2014

As the Ebola nightmare continues in Liberia and as we battle to contain the epidemic, it is important to look beyond the immediate crisis. Many more lives will be lost before this dreadful outbreak is beaten, but to properly honor the memory of the victims we need to ask how it happened in the first place and, more pressingly, how we can prevent it from happening again.

After 30 years of brutal civil and political unrest, Liberia was a nation reborn. We transformed our country from a failed state into a stable democracy, rebuilding its infrastructure and its education and health systems, and enjoying one of the most promising growth records in Africa. Then Ebola swept in, threatening to tear apart that progress. It is a terrifying reminder of the destructive power of infectious disease, one all the more devastating given how far Liberia has come.

Without a doubt, part of the reason for this situation is that, with the exception of Doctors Without Borders, the initial international response to this emergency was markedly slow. This gave Ebola the time it needed to overwhelm our already-fragile health infrastructure.

President Obama has since committed to sending up to 4,000 military personnel to West Africa to set up much-needed health-care facilities and to train health-care workers, and last week he authorized the use of additional reserves, if needed. This will help our efforts to contain the outbreak, and we are truly thankful.

Similarly, a suitable vaccine and treatment for Ebola could have helped prevent this outbreak from getting out of control. And, indeed, efforts to fast-track the development of a promising candidate vaccine could potentially help to bring this all to a swifter end, even if initially there were only enough doses to vaccinate health workers on the front line.

But while these are very much welcome developments, they are nevertheless responses to an outbreak already out of control. After all, military field hospitals would not be needed if adequate health-care services were in place. And, as Uganda has demonstrated after several terrible outbreaks, the key to preventing a major outbreak is a health infrastructure robust enough to be able to respond quickly and effectively when cases first appear.

Medical staff in Uganda now have the training and means to recognize symptoms and isolate patients immediately, and they have access to appropriate equipment and protective clothing. Similarly, social mobilization networks are in place to get information out to the people to reduce the risk of spread, while laboratory facilities can confirm cases swiftly. It is a highly effective setup that was created with considerable help from the U.S. Centers for Disease Control and Prevention, but it relies wholly upon having strong health infrastructure.

In Liberia, a country that never before had an incidence of Ebola, we were utterly ill-equipped and unprepared. What is so tragic is that, until this outbreak, Liberia had made significant progress in building up its public health systems. With help from organizations such as Gavi, the Vaccine Alliance, we have reduced childhood mortality by two-thirds since 1990, thanks largely to expansive immunization programs.

Much of that good work has now been undermined. Having worked its way through the cracks in our fragile health infrastructure, Ebola has effectively brought health care to a halt in Liberia, as people avoid seeking medical attention. There is nowhere to go. So, with the malaria season setting in and routine immunization programs stopped, even when this outbreak is over we must prepare for other diseases to take hold.

Yet, with Ebola having claimed the lives of 96 of our health workers and infected more than 209 others, recovering is going to be hard. This is a huge hit for a country that had barely 50 doctors to care for a population of 4.4 million at the start of this outbreak.

More than ever, we will be reliant upon assistance from partners such as the United States and Britain, and global health organizations such as the World Health Organization, UNICEF and Gavi, to help rebuild our health systems, invest in health facilities, staff and equipment and restore immunization levels. And it’s not just Liberia — any African nation with a fragile health system is potentially vulnerable to this terrible disease. After all, infectious disease knows no borders.

The United Nations has said it is going to take $1 billion to stop this outbreak. Of course, that’s our immediate priority. But at the same time, countries like Liberia need long-term investment to build up our health systems to prevent outbreaks of this scale from ever happening again. We owe it to the thousands of citizens and health workers who have so far lost their lives to be prepared.