Vulnerable Children and Youth Studies
An International Interdisciplinary Journal for Research, Policy and Care
Volume 9, Issue 4, 2014
http://www.tandfonline.com/toc/rvch20/current#.Uzg2bFcWNdc

No place is safe: violence against and among children and youth in street situations in Uganda
DOI:10.1080/17450128.2014.934750
Eddy J. Walakiraa*, Ismael Ddumba-Nyanzia, Saba Lishanb & Michael Baizermanc
pages 332-340
Abstract
This article explores street children’s exposure to and responses to violence based on data collected in 21 major towns in Uganda. Findings show that violence among Ugandan street children is endemic, perpetuated by both street children against each other and adults. Both male and female children suffer outright abuse from police, occasional strangers, and from each other. Boys were more frequently physically abused while girls were more frequently abused emotionally and sexually. The study recommends policy-oriented actions linked to addressing the variations in the vulnerability to violence among children on the basis of gender, age and other risk factors and targeting the change of attitudes and behavior among duty bearers in various settings, which result in violence against children on the street.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 13 September 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

pdf verion: The Sentinel_ week ending 13 September 2014

blog edition: comprised of the 35+ entries below posted on 14 September 2014

Editorial
WHO for the 21st Century
Margaret Chan
Margaret Chan is Director General of the World Health Organization, CH1211 Geneva 27, Switzerland.
Science Translational Medicine; 10 September 2014 vol 6, issue 253
http://stm.sciencemag.org/content/current

Next year, 2015, will be pivotal for global health. The deadline for reaching the United Nations Millennium Development Goals (MDGs) expires, and the MDGs will be succeeded by a new framework that focuses on poverty reduction and sustainable development (1). In the lead-up to 2015, the spotlight is already on the achievements and disappointments of the MDG era. Among the successes, 2 billion people have gained access to improved sanitation since 1990. Yet, there are still 2.5 billion people worldwide who do not have day-to-day use of functioning toilets. The death rate of children under 5 years has been cut by about one-half, and the rates of decline in child mortality in some African countries, notably Senegal and Rwanda, are among the fastest ever recorded. Nevertheless, between 6 million and 7 million children died in 2012, nearly half of whom died in the first month of life (2). The great majority of these deaths could have been prevented. During this period of reflection on the MDGs, we are also looking to the future. Our attention at the World Health Organization (WHO) is focused on ways to build on the global health successes of the past 25 years, on how to fill in the gaps, and on how we can continue to improve health in the post-2015 era.

Any allusion to our current place in the 21st century brings to mind events that take place over decades. Such events include the long-running epidemiological transition from communicable to noncommunicable diseases in our aging populations, now mostly located in cities, and the long-term health impacts of climate change and environmental degradation. But we must also contend with major events that take place on shorter time scales. The MDG era has coincided with, and is partly a product of, the huge increase in development (financial) assistance for health. This is reflected in the proliferation of health donors, global funds and partnerships, nongovernmental and civil society organizations, philanthropists, and commercial investors. The MDG era has also coincided with the growing wealth and more assertive voices of formerly low-income countries,

Symbolized by the BRIC nations (Brazil, Russia, India, China), and other countries such as Indonesia, Nigeria, and Thailand that have moved from low to middle income. As these events have unfolded, the reach of health has extended far beyond clinical practice and epidemiology. In the midst of debates about the changing role of international aid—and with the emergence of SARS, pandemic influenza, and most recently the Ebola virus—global health has become central to foreign policy and international relations.

In this time of transition, I will highlight some of the challenges we face in putting health at the heart of sustainable development. In confronting these challenges, we can draw on 66 years of WHO experience, but we are also prepared to work in new ways (3). As the post-2015 agenda is being crafted through international debate, our most important message is that good health is a valuable goal in its own right, and indispensable to poverty reduction and sustainable development. This is a global message with a human face: People want assurance that they have access to the health services they need and at a price they can afford. This is the essence and the promise of universal health coverage (4).

WHO is often referred to as a technical agency. We are certainly that—in our use of science and technology to underpin health policy. But WHO has a bigger role, in showing how technical approaches to health promotion and disease control are part of a larger vision for health and well-being, one in which good health for everyone is integral to social cohesion and stability.

The first of our challenges is to help reach, and surpass, the health targets set in the MDG era. One urgent task is to tackle the persistent causes of maternal and neonatal mortality. From a technical standpoint, we know how to do this, but we must find the right approach in each and every setting. Most maternal and child deaths can be prevented with high-quality care during pregnancy, delivery of babies by skilled birth attendants, breastfeeding, and through guaranteed access to appropriate antibiotics and immunization. Another well-defined task is to expand the coverage of antiretroviral therapy for HIV-positive people and to ensure prompt diagnosis and treatment for people with malaria, tuberculosis, and hepatitis. During the MDG era, disease control programs rightly emphasized the provision of good health services. But there are some extra steps to be taken—for example, to ensure that people who live under the threat of communicable diseases are adequately protected from financial risk, a vital ingredient of universal health coverage. Furthermore, our commitments to communicable disease control include elimination and eradication of, for example, malaria from selected countries, including Mexico, Malaysia, and South Africa, and polio and guinea worm disease from all countries.

The growing importance of noncommunicable diseases such as heart disease, diabetes, and cancer is, in part, the inevitable consequence of successfully controlling infections. In 2012, the average life expectancy at birth worldwide had increased to 70 years. This astonishing fact means that a large number of people now live long enough to suffer and eventually die from chronic illnesses—mainly cardiovascular disease and cancer. Clearly, we must all die of something, but many deaths from noncommunicable diseases are premature and preventable. Having examined the underlying causes and possible remedies, WHO’s World Health Assembly set a target of reducing premature mortality due to cardiovascular disease, cancer, diabetes, or chronic respiratory disease by 25% between 2010 and 2025.

To achieve this goal, WHO, as an intergovernmental organization, is using all available instruments at its disposal. The 2005 Framework Convention on Tobacco Control was the first global health treaty negotiated under the auspices of WHO. In 2013, with 178 signatories, an estimated 2.3 billion people were protected by at least one measure reducing tobacco demand that had been fully implemented by governments worldwide. The entire campaign against noncommunicable diseases was given a huge boost by the 2011 United Nations General Assembly, which recognized chronic diseases to be a major challenge, not merely for health but also for development in the 21st century.

The task of controlling communicable and noncommunicable diseases inevitably focuses on specific causes or risk factors. These are aided and abetted by insidious, systemic causes of ill health in populations, among which social inequality is a prime example. Despite some arguments to the contrary, we still inhabit a very unequal world. The richest 1% of people own ~40% of the world’s assets, and less than 1% of all assets are owned by the poorest 50% of people. The result is that 1.2 billion people still live in extreme poverty. And there are some disturbing trends. Over the past two decades, income inequality has been growing on average within and among countries—a trend that drives health inequalities, too. Social inequality is a structural problem that requires many kinds of remedy, but universal health coverage can make a powerful contribution. The first point about universal health coverage is that it must be precisely that: universal. However, universal health coverage is not merely the quest to reach an arithmetic target, but also has the goal of demanding equal rights to health and social protection for all, even those in the smallest minority.

The 1978 Alma Ata Declaration was one of the 20th century’s landmarks in public health. It emphasized the role of the state in providing adequate health and social measures. In the 21st century, states still have this responsibility of course, but now, health depends on many more actors. Recognizing that no intergovernmental organization can achieve its goals by operating from within the public sector alone, WHO now works with a multiplicity of nonstate actors—including nongovernmental organizations, philanthropic organizations, and academic institutions—to create and protect global public goods, such as standards of medical practice and the quality control of health products. WHO also works with nonstate actors to draw on private expertise, knowledge, commodities, personnel, and finances for the benefit of health and to encourage nonstate actors to improve their own activities to protect and promote health.

Last, nearly 30 years after the publication of a seminal report from the Rockefeller Foundation, we do still place a high premium on Good Health at Low Cost (5). Besides supporting research into better ways of sharing financial risks, and in addition to providing technical guidance for major funding initiatives (the Global Fund, the GAVI Alliance, and others), WHO is also promoting market mechanisms to lower the prices of high-quality commodities, including vaccines and essential medicines. Among the most successful efforts so far is “prequalification,” a mechanism that guarantees the quality of vaccines, drugs, and diagnostics for purchasing agencies, including the GAVI Alliance, and opens up the market to new manufacturers. In 2013, for example, prequalification of a Japanese encephalitis vaccine made in China cut the cost of each dose to US$0.30, well below the price of other Japanese encephalitis vaccines then on the market. This decision followed WHO approval, in 2011, of the China Food and Drug Administration as a functional regulatory authority for vaccines, a milestone on China’s road to becoming a global vaccine supplier.

In ventures of this kind, United Nations agencies often work best together, rather than alone. The 2013 report on Promoting Access to Medical Technologies and Innovation, prepared jointly by WHO, the World Intellectual Property Organization (WIPO), and the World Trade Organization (WTO), is a comprehensive guide to the interface between health, trade, and intellectual property. Likewise, the Pharmaceutical Manufacturing Plan for Africa, a proposal of the African Union Commission, is jointly supported by WHO, the Joint United Nations Programme on HIV and AIDS (UNAIDS), and the United Nations Industrial Development Organization (UNIDO).

As WHO moves into the post-2015 era of development, we shall remain true to our roots. We shall covetously guard our reputation for impartiality and sound science. We shall continue to serve as an honest broker, acting in the best interests of our Member States. We shall monitor health trends and track progress toward universal health coverage. We shall draw on our global perspective to help shape the agenda for health research. From guidelines to treaties, we shall use all of the instruments available to us in the cause of better health.

But, we are also open to new ways of doing business, by putting disease control programs in the context of universal health coverage, by actively seeking alliances beyond the public sector, and by promoting health, not only through health institutions, but also through agriculture, the economy, education, and the environment.

Everyone has a stake in health, and WHO has always worked to guard the health of everyone. But the professional business of health has changed profoundly since the turn of the millennium. WHO’s role, more than ever, is to provide leadership by building consensus around a shared responsibility for health, and by responding with agility to the unexpected challenges and new opportunities of the 21st century.

References
United Nations, Sustainable Development Knowledge Platform (United Nations, New York, 2014).
United Nations, The Millennium Development Goals Report 2013 (United Nations, New York, 2013).
World Health Organization, WHO Reforms for a Healthy Future. Report by the Director-General (World Health Organization, Geneva, 2012).
World Health Organization, The World Health Report 2013: Research for Universal Health Coverage (World Health Organization, Geneva, 2013).
S. Halstead, J. Walsh, K. Warren, Eds., Good Health at Low Cost (Rockefeller Foundation, Bellagio, Italy, 1985).

As Sixty-eighth Session Nears Conclusion, General Assembly Adopts Resolution Incorporating Sustainable Development Goals into Post-2015 Agenda
Delegates Also Pass Measures Addressing Malaria, Revitalizing Work of Assembly
United Nations
Sixty-eighth General Assembly GA/11544
Plenary
108th Meeting (PM)
10 September 2014

The General Assembly adopted three resolutions today, including one that would pave the way for the incorporation of sustainable development goals into the post-2015 development agenda.
In adopting the “Report of the Open Working Group on Sustainable Development Goals established pursuant to General Assembly resolution 66/288” (document A/68/L.61), as orally amended, the Assembly decided that the outcome document from the Open Working Group on Sustainable Development Goals would be the main basis for integrating the sustainable development goals into the future development agenda. The resolution went on to state that other inputs would also be considered during the intergovernmental negotiation process at the upcoming General Assembly session…

…In a final act, the Assembly adopted ”Consolidating gains and accelerating efforts to control and eliminate malaria in developing countries, particularly in Africa, by 2015” (document A/68/L.60), thereby calling for increased support for the implementation of international commitments and goals pertaining to the fight to eliminate malaria.

The resolution urged malaria-endemic countries to work towards financial sustainability to increase national resources allocated to controlling that disease, while also working with the private sector to improve access to quality medical services. Further, the resolution called upon Member States to establish or strengthen national policies, operational plans and research, with a view to achieving internationally agreed malaria targets for 2015…

…The General Assembly will reconvene on Thursday, 11 September, for a high-level stock-taking event on the Post-2015 Development Agenda.

International Development Committee – Fifth Report
Strengthening Health Systems in Developing Countries
U.K. Parliament
12 September 2014
Summary
Better health is a basic human right and an end in itself. A healthy population is also essential to development. Recent years have seen some rapid improvements in health partly driven by the Millennium Development Goals and the large international funds set up to accelerate progress towards them. However, these improvements have at times been achieved despite the poor state of health systems in many developing countries. Stronger health systems will be required to ensure efficiency, tackle growing challenges such as non-communicable diseases and progress towards self-sufficiency.

DFID has long had a good reputation for health system strengthening and this is reflected in its own work. But DFID now relies on international partners, which do not all share this reputation, in an increasing number of countries and to manage an ever-greater proportion of its expenditure. We recommend that DFID reviews in each country whether its funding arrangements enable its health systems strengthening objectives to be met.

Assessing the effectiveness and value for money of health system strengthening work by DFID and its international partners is more difficult than it ought to be. Expenditure and performance figures are not published and the research base is inadequate. This must change. We also recommend DFID takes the lead in system governance and finance, and publishes a new strategy on health workforces.

The UK has one of the best health systems in the world, but DFID makes only limited use of it. We call on DFID to work with the NHS in expanding volunteering schemes for doctors and nurses and making more use of NHS finance and management skills.

Finally, we urge DFID to demonstrate global leadership worthy of its health systems expertise. It should be a vocal champion of system strengthening and seek to influence its international partners to prioritise it in their work. It looks likely that universal health coverage will be a target in the global post-2015 development goals, providing a chance to increase international focus on system strengthening. DFID must grasp this opportunity.

The Trade and Development Report 2014: Global Governance and Policy Space for Development
UNCTAD – Report by the secretariat of the United Nations Conference on Trade and Development
September 2014 :: 242 pages
UN Symbol: UNCTAD/TDR/2014
http://unctad.org/en/PublicationsLibrary/tdr2014_en.pdf

This report examines recent trends in the global economy, with a focus on growth, trade and commodity prices. The Report highlights that, six years after the onset of the global economic and financial crisis, the world economy has not yet established a new sustainable growth regime. With an expected growth between 2.5 and 3 per cent in 2014, the recovery of global output remains weak. Furthermore, the policies supporting the recovery are frequently inadequate, as they do not address the rise of income inequality, the steady erosion of policy space along with the diminishing economic role of governments and the primacy of the financial sector of the economy, which are the root causes of the crisis of 2008. Putting the world economy on the path of sustainable growth requires strengthening domestic and regional demand, with a reliance on better income distribution rather than new financial bubbles.

Media Release
Developing countries need sufficient policy space to advance post-2015 development agenda, UNCTAD report says
10 September 2014
With a new set of wide-ranging sustainable development goals already tabled in New York, a post-2015 development agenda will not be feasible without the availability of more instruments and greater flexibilities in policymaking, say UNCTAD in its Trade and Development Report 2014, launched today.
Key conclusions of this years’ report:
:: The ‘new normal’ in advanced countries is neither new nor normal and risks repeating past policy mistakes.
:: Developing countries need sufficient space to make macro and industrial policies work effectively to support structural transformation.
:: International and national action needed to combat tax evasion and avoidance.
:: Multilateral institutions need to focus on promoting the public interest as much as boosting market confidence and reducing financial risks.

Education at a Glance 2014 –OECD Indicators
September 2014 : 570 pages
pdf: http://www.oecd.org/edu/Education-at-a-Glance-2014.pdf

This annual publication is the authoritative source for accurate and relevant information on the state of education around the world.
Featuring more than 150 charts, 300 tables, and over 100,000 figures, it provides data on the structure, finances, and performance of education systems in the OECD’s 34 member countries, as well as a number of partner countries

Access to education continues to expand worldwide but the socio-economic divisions between tertiary-educated adults and the rest of society are growing. Governments must do more to ensure that everyone has the same opportunity to a good education early in life, according to a new OECD report.

At the same time, among the younger age group of 25-34 year-olds, where the tertiary attainment rate had risen to 43%, the impact of parents’ educational background was just as strong: of adults with at least one tertiary-educated parent, 65% attained a tertiary qualification, while of the adults with low-educated parents only 23% did. These data suggest that the expansion in education has not translated into a more inclusive society.

Education can lift people out of poverty and social exclusion, but to do so we need to break the link between social background and educational opportunity,” said OECD Secretary-General Angel Gurría. “The biggest threat to inclusive growth is the risk that social mobility could grind to a halt. Increasing access to education for everyone and continuing to improve people’s skills will be essential to long-term prosperity and a more cohesive society.”

IRCT [to 13 September 2014]

News
IRCT distributes 350,000 Euros from OAK Foundation for the rehabilitation of torture victims
12-09-2014
After an application process featuring almost 70 organisations, the IRCT is pleased to announce the distribution of 350,000 Euros in Centre Support Grants to 43 centres across the globe who deliver rehabilitation services in their region.
The grants, funded by philanthropic group the Oak Foundation, ensure that torture victims have access to professional and effective treatment in a range of centres from low-and-middle income countries.
Grants were awarded to more than half the applicants and each individual grant ranges from 5,000 to 15,000 Euros.
Fourteen centres in Sub-Saharan Africa received the largest portion of the grants, totalling 117,500 Euros (34 per-cent of the overall fund allocated by the Oak Foundation). Ten centres out of 17 applicants in Asia benefit from grants totalling 81,000 Euro, eight centres in Latin and Central America share 72,500 Euro, seven centres in Europe split 50,000, and four IRCT members in the Middle East and North Africa share 27,500 Euro.
Of all the recipients, 36 are IRCT members and seven are other organisations working in the torture rehabilitation and human rights fields. Each year the IRCT encourages applications for the funds, giving priority to centres providing effective rehabilitation on a small budget who operate in low to middle-income countries.
The grants, which cover a yearly period from April to March the following year, are directed to the provision of medical and psychological rehabilitation services, activities to document torture, and internal capacity development to ensure care for caregivers and effective centre management….

BMC Public Health
(Accessed 13 September 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Factors influencing adolescent girls’ decision in initiation for human papillomavirus vaccination: a cross-sectional study in Hong Kong
Albert Lee, Mandy Ho, Calvin Ka Cheung, Vera Mei Keung BMC Public Health 2014, 14:925 (8 September 2014)
Abstract (provisional)
Background
Cervical cancer is one of the common cancers among women worldwide. Despite HPV vaccination being one of the effective preventive measures, it is not included in government vaccination programme in Hong Kong. This study aimed to assess the knowledge of and attitude towards cervical cancer prevention among Chinese adolescent girls in Hong Kong, and to identify factors influencing the initiation of HPV vaccination.
Methods
This was a cross-sectional study conducted in Hong Kong during the period of October 2010 to November 2010. A self-administered questionnaire was used, with 1,416 girls from 8 secondary schools completing the questionnaire. Knowledge scores were composited and initiation of HPV vaccination was staged based on stage of change. Analyses were conducted to identify the association of initiation of HPV vaccination with participant’s personal and family factors as well as their knowledge and attitude towards cervical cancer prevention.
Results
The uptake rate of HPV vaccination was low (7%) with 58% respondents in pre-contemplation and contemplation stage. The survey identified a significant gap in knowledge on cervical cancer prevention. The main channels of information were from media and very few from schools or parents. However, 70% expressed their wishes to have more information on cancer prevention, and 78% stated that they were willing to change their lifestyles if they knew the ways of prevention. Multivariate analysis identified three independent significant factors for initiation of vaccination (action and intention): perceived cancer as terrifying disease, school should provide more information on cancer prevention, and comments from relatives and friends having received the vaccine. The cost of vaccination and socio-economic background were not found to be significant.
Conclusions
Public education on cervical cancer needs to be well penetrated into the community for more sharing among friends and relatives. School as setting to provide source of information would facilitate uptake rate of HPV vaccine as students have expressed their wishes that school should provide more information on prevention of cancer. School and community education on cancer prevention would help adolescents to have better understanding of the seriousness of cancer.

British Medical Journal
13 September 2014(vol 349, issue 7974)
http://www.bmj.com/content/349/7974

Research
Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes
Neeraj Sood, associate professor123, Eran Bendavid, assistant professor45, Arnab Mukherji, associate professor6, Zachary Wagner, PhD student7, Somil Nagpal, senior health specialist8,
Patrick Mullen, senior health specialist8
Author affiliations
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5114 (Published 11 September 2014) Cite this as: BMJ 2014;349:g5114
Abstract
Objectives To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality.
Design Geographic regression discontinuity study.
Setting 572 villages in Karnataka, India.
Participants 31 476 households (22 796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28 633 households (21 767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme.
Intervention A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012.
Main outcome measure Out-of-pocket expenditures, hospital use, and mortality.
Results Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; P<0.001). We found no difference in mortality rates for households above the poverty line (households above the poverty line were not eligible for the scheme), with a mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared with 0.55% in ineligible villages (difference of 0.01 percentage points, −0.03 to 0.03; P=0.95). Eligible households had significantly reduced out-of-pocket health expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; P<0.001). There was no significant increase in use of covered services, although the point estimate of a 44.2% increase approached significance (−5.1% to 90.5%; P=0.059). Both reductions in out-of-pocket expenditures and potential increases in use might have contributed to the observed reductions in mortality.
Conclusions Insuring poor households for efficacious but costly and underused health services significantly improves population health in India.

Conflict and Health
[Accessed 13 September 2014]
http://www.conflictandhealth.com/

Meeting report
Fragile and conflict affected states: report from the consultation on Collaboration for Applied Health Research and Delivery
Joanna Raven, Tim Martineau, Eleanor MacPherson, Amuda Baba Dieu-Merci, Sarah Ssali, Steve Torr and Sally Theobald
Author Affiliations
Conflict and Health 2014, 8:15 doi:10.1186/1752-1505-8-15
Published: 8 September 2014
Abstract (provisional)
Fragile and Conflict Affected States present difficult contexts to achieve health system outcomes and are neglected in health systems research. This report presents key debates from the Consultation of the Collaboration for Applied Health Research and Delivery, Liverpool, June, 2014

Globalization and Health
[Accessed 13 September 2014]
http://www.globalizationandhealth.com/

Research
Trade and investment liberalization and Asia’s noncommunicable disease epidemic – A synthesis of data and existing literature
Phillip I Baker, Adrian Kay and Helen L Walls
Author Affiliations
Globalization and Health 2014, 10:66 doi:10.1186/s12992-014-0066-8
Published: 12 September 2014
Abstract (provisional)
Background
Trade and investment liberalization (trade liberalization) can promote or harm health. Undoubtedly it has contributed, although unevenly, to Asia’s social and economic development over recent decades with resultant gains in life expectancy and living standards. In the absence of public health protections, however, it is also a significant upstream driver of non-communicable diseases (NCDs) including cardiovascular disease, cancer and diabetes through facilitating increased consumption of the `risk commodities” tobacco, alcohol and ultra-processed foods, and by constraining access to NCD medicines. In this paper we describe the NCD burden in Asian countries, trends in risk commodity consumption and the processes by which trade liberalization has occurred in the region and contributed to these trends. We further establish pressing questions for future research on strengthening regulatory capacity to address trade liberalization impacts on risk commodity consumption and health.
Methods
A semi-structured search of scholarly databases, institutional websites and internet sources for academic and grey literature. Data for descriptive statistics were sourced from Euromonitor International, the World Bank, the World Health Organization, and the World Trade Organization.
Results
Consumption of tobacco, alcohol and ultra-processed foods was prevalent in the region and increasing in many countries. We find that trade liberalization can facilitate increased trade in goods, services and investments in ways that can promote risk commodity consumption, as well as constrain the available resources and capacities of governments to enact policies and programmes to mitigate such consumption. Intellectual property provisions of trade agreements may also constrain access to NCD medicines. Successive layers of the evolving global and regional trade regimes including structural adjustment, multilateral trade agreements, and preferential trade agreements have enabled transnational corporations that manufacture, market and distribute risk commodities to increasingly penetrate and promote consumption in Asian markets.
Conclusions
Trade liberalization is a significant driver of the NCD epidemic in Asia. Increased participation in trade agreements requires countries to strengthen regulatory capacity to ensure adequate protections for public health. How best to achieve this through multilateral, regional and unilateral actions is a pressing question for ongoing research.

Health Affairs
September 2014; Volume 33, Issue 9
http://content.healthaffairs.org/content/current

Theme: Advancing Global Health Policy
Global Health Leaders Recommit To Reducing Child Deaths
Jessica Bylander
Health Aff September 2014 33:1503-1506; doi:10.1377/hlthaff.2014.0848

Innovation & Implementation
Accountable Care Around The World: A Framework To Guide Reform Strategies
Mark McClellan, James Kent, Stephen J. Beales, Samuel I.A. Cohen, Michael Macdonnell, Andrea Thoumi, Mariam Abdulmalik, and Ara Darzi
Health Aff September 2014 33:1507-1515; doi:10.1377/hlthaff.2014.0373

ANALYSIS & COMMENTARY:
Lessons From Eight Countries On Diffusing Innovation In Health Care
Oliver P. Keown, Greg Parston, Hannah Patel, Fiona Rennie, Fathy Saoud, Hanan Al Kuwari, and Ara Darzi
Health Aff September 2014 33:1516-1522; doi:10.1377/hlthaff.2014.0382

ANALYSIS & COMMENTARY:
Developing Public Policy To Advance The Use Of Big Data In Health Care
Axel Heitmueller, Sarah Henderson, Will Warburton, Ahmed Elmagarmid, Alex “Sandy” Pentland, and Ara Darzi
Health Aff September 2014 33:1523-1530; doi:10.1377/hlthaff.2014.0771

The Hidden Cost Of Low Prices: Limited Access To New Drugs In India
Ernst R. Berndt and Iain M. Cockburn
Health Aff September 2014 33:1567-1575; doi:10.1377/hlthaff.2013.1307

Improving Access To Malaria Medicine Through Private-Sector Subsidies In Seven African Countries
Sarah Tougher, Andrea G. Mann, ACTwatch Group, Yazoume Ye, Idrissa A. Kourgueni, Rebecca Thomson, John H. Amuasi, Ruilin Ren, Barbara A. Willey, Daniel Ansong, Katia Bruxvoort, Graciela Diap, Charles Festo, Boniface Johanes, Admirabilis Kalolella, Oumarou Mallam, Blessing Mberu, Salif Ndiaye, Samual Blay Nguah, Moctar Seydou, Mark Taylor, Marilyn Wamukoya, Fred Arnold, Kara Hanson, and Catherine Goodman
Health Aff September 2014 33:1576-1585; doi:10.1377/hlthaff.2014.0104

JAMA
September 10, 2014, Vol 312, No. 10
http://jama.jamanetwork.com/issue.aspx

Editorial | September 10, 2014
Open Access to Clinical Trials Data
Harlan M. Krumholz, MD, SM1; Eric D. Peterson, MD, MPH2,3
[+] Author Affiliations
JAMA. 2014;312(10):1002-1003. doi:10.1001/jama.2014.9647.
Excerpt
Well-conducted randomized clinical trials (RCTs) are the gold standard for evaluating the safety and efficacy of medical therapeutics. Yet most often, a single group of individuals who conducted the trial are the only ones who have access to the raw data, conduct the analysis, and publish the study results. This limited access does not typically allow others to replicate the trial findings. Given the time and expense required to conduct an RCT, it is often unlikely that others will independently repeat a similar experiment. Thus, the scientific community and the public often accept the results produced and published by the original research team without an opportunity for reanalysis. Increasingly, however, opinions and empirical data are challenging the assumption that the analysis of a clinical trial is straightforward and that analysis by any other group would obtain the same results.1- 3…

Medical News & Perspectives | September 10, 2014
Largest-Ever Outbreak of Ebola Virus Disease Thrusts Experimental Therapies, Vaccines Into Spotlight
Tracy Hampton, PhD
JAMA. 2014;312(10):987-989. doi:10.1001/jama.2014.11170.
As efforts to successfully contain the largest outbreak of Ebola virus disease in history prove elusive, the mounting number of cases and deaths has brought research to develop much-needed treatments and protective vaccines into the spotlight. Although the approval process for drugs and vaccines is typically slow and deliberate, the latest outbreak, declared by the World Health Organization (WHO) on August 8 as an international health emergency, has galvanized regulatory officials to consider proposals for providing as-yet unproven treatments under special emergency New Drug Applications.

Journal of Infectious Diseases
Volume 210 Issue 13 September 15, 2014
http://jid.oxfordjournals.org/content/current

Emergency Settings: Be Prepared to Vaccinate Persons Aged 15 and Over Against Measles
Reinhard Kaiser
Advance Access 10.1093/infdis/jiu463
[Initial text]
In their landmark article on measles prevention in emergency settings, Toole and colleagues recommended in 1989 that all children aged 6 months to 5 years should be immunized with measles vaccine at the time they enter an organized camp or settlement [1]. In 2000, Salama and colleagues documented substantial mortality during a famine emergency in Ethiopia, with measles and malnutrition as major contributing factors. In a retrospective study of mortality, measles alone, or in combination with wasting, accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5–14 years. The setting was a rural population without routine childhood immunization and exposure to natural measles virus infection [2]. The authors concluded that measles vaccination, in combination with vitamin A distribution, should be implemented in all types of complex emergencies. Vaccination coverage should be 90% and extended to children up to age 12–15 years [2]. A vaccination age range up to 14 years was included in the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) statement to reduce measles mortality in emergencies [3], and the revised SPHERE project guidelines [4]. However, since then, the discussion about target age groups has increasingly included the potential need to vaccinate adults. As early as 2000–2001, Kamugisha and colleagues documented 21% of measles cases that were 16 years and older in a major outbreak in Tanzanian camps with refugees from Burundi [5]. The authors concluded that in some emergency settings, achieving population immunity adequate to prevent virus transmission may require vaccinating persons older than 15 years, and the selection of target age groups for vaccination should consider measles epidemiology in source and refugee populations [5]. A recent review documented additional measles outbreaks in emergencies that included adult cases [6], and the recommendation to review the measles epidemiology to inform decisions about vaccination target age groups has increasingly become standard in emergency [7, 8] and nonemergency settings [9]. This shift in recommendations has been a result of the changing epidemiology of measles in Africa [10].

The Lancet
Sep 13, 2014 Volume 384 Number 9947 p929 – 1070 e38
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The silver bullet of resilience
The Lancet
The irony of September being US National Preparedness month was not lost as Médecins sans Frontières (MSF) made an uncharacteristic global call for rapid deployment of civil and military medical assets with expertise in biohazard containment to west Africa. With 42% of all reported Ebola infections occurring in the past month, and more than 2000 reported deaths, local health systems and international organisations were not prepared for the scale and speed of the current outbreak. MSF called for countries such as the UK and USA to deploy disaster response teams with medical and logistical experts for water and sanitation, building of mobile laboratories, isolation centres, hospitals, crematoriums, and the establishment of dedicated air bridges to move personnel and equipment between countries. On Sept 7, the US government announced that their military would be mobilised to set up isolation units and equipment, and provide security for public health workers.

Delayed international action has been largely blamed on the chronic underfunding and inability of WHO to mount an adequate initial response to manage the outbreak. This institutional failure begs first and foremost an urgent rethink of how the world responds to outbreaks, and with whom. The second equally important task is building resilience into health systems.

The notion of resilience is defined as the capacity to adapt and thrive in the face of challenge. For health organisations, this could mean creating more redundancy and organisational slack to respond efficiently to crises

For companies, it might mean rethinking the development pipeline of their products, delinked from profit, to contribute to a better prepared world. For countries and their partners, it means investing in weak health systems, building back the trust of communities, and examining the complex interactions between people and the environment. However, to earn the luxury of a much needed resilience debate for west Africa, countries and international organisations must heed the call to immediately deploy medical assets to contain the Ebola outbreak and offset further deaths.

The Lancet
Sep 13, 2014 Volume 384 Number 9947 p929 – 1070 e38
http://www.thelancet.com/journals/lancet/issue/current

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Haidong Wang, et al.
Summary
Background
Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.
Methods
We generated updated estimates of child mortality in early neonatal (age 0—6 days), late neonatal (7—28 days), postneonatal (29—364 days), childhood (1—4 years), and under-5 (0—4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.
Findings
We estimated that 6•3 million (95% UI 6•0—6•6) children under-5 died in 2013, a 64% reduction from 17•6 million (17•1—18•1) in 1970. In 2013, child mortality rates ranged from 152•5 per 1000 livebirths (130•6—177•4) in Guinea-Bissau to 2•3 (1•8—2•9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from −6•8% to 0•1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000—13 than during 1990—2000. In 2013, neonatal deaths accounted for 41•6% of under-5 deaths compared with 37•4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1•4 million more child deaths, and rising income per person and maternal education led to 0•9 million and 2•2 million fewer deaths, respectively. Changes in secular trends led to 4•2 million fewer deaths. Unexplained factors accounted for only −1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.
Interpretation
Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.
Funding
Bill & Melinda Gates Foundation, US Agency for International Development.

Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Nicholas J Kassebaum, et al
Summary
Background
The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.
Methods
We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990—2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.
Findings
292 982 (95% UI 261 017—327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483—407 574) in 1990. The global annual rate of change in the MMR was −0•3% (—1•1 to 0•6) from 1990 to 2003, and −2•7% (—3•9 to −1•5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290—2866) maternal deaths were related to HIV in 2013, 0•4% (0•2—0•6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956•8 (685•1—1262•8) in South Sudan to 2•4 (1•6—3•6) in Iceland.
Interpretation
Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.
Funding
Bill & Melinda Gates Foundation.

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Christopher J L Murray, et al
Summary
Background
The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.
Methods
To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010—13) of incidence, drug resistance, and coverage of insecticide-treated bednets.
Findings
Globally in 2013, there were 1•8 million new HIV infections (95% uncertainty interval 1•7 million to 2•1 million), 29•2 million prevalent HIV cases (28•1 to 31•7), and 1•3 million HIV deaths (1•3 to 1•5). At the peak of the epidemic in 2005, HIV caused 1•7 million deaths (1•6 million to 1•9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19•1 million life-years (16•6 million to 21•5 million) have been saved, 70•3% (65•4 to 76•1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7•5 million (7•4 million to 7•7 million), prevalence was 11•9 million (11•6 million to 12•2 million), and number of deaths was 1•4 million (1•3 million to 1•5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7•1 million (6•9 million to 7•3 million), prevalence was 11•2 million (10•8 million to 11•6 million), and number of deaths was 1•3 million (1•2 million to 1•4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64•0% of cases (63•6 to 64•3) and 64•7% of deaths (60•8 to 70•3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1•2 million deaths (1•1 million to 1•4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31•5% (15•7 to 44•1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.
Interpretation
Our estimates of the number of people living with HIV are 18•7% smaller than UNAIDS’s estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.
Funding
Bill & Melinda Gates Foundation.

Maternal and Child Health Journal
Volume 18, Issue 7, September 2014
http://link.springer.com/journal/10995/18/7/page/1

Using the Principles of Complex Systems Thinking and Implementation Science to Enhance Maternal and Child Health Program Planning and Delivery
Charlan D. Kroelinger, Kristin M. Rankin…
Abstract
Traditionally, epidemiologic methodologies have focused on measurement of exposures, outcomes, and program impact through reductionistic, yet complex statistical modeling. Although not new to the field of epidemiology, two frameworks that provide epidemiologists with a foundation for understanding the complex contexts in which programs and policies are implemented were presented to maternal and child health (MCH) professionals at the 2012 co-hosted 18th Annual MCH Epidemiology Conference and 22nd CityMatCH Urban Leadership Conference. The complex systems approach offers researchers in MCH the opportunity to understand the functioning of social, medical, environmental, and behavioral factors within the context of implemented public health programs. Implementation science provides researchers with a framework to translate the evidence-based program interventions into practices and policies that impact health outcomes. Both approaches offer MCH epidemiologists conceptual frameworks with which to re-envision how programs are implemented, monitored, evaluated, and reported to the larger public health audience. By using these approaches, researchers can begin to understand and measure the broader public health context, account for the dynamic interplay of the social environment, and ultimately, develop more effective MCH programs and policies.

Commentary
Bringing Sexual and Reproductive Health in the Urban Contexts to the Forefront of the Development Agenda: The Case for Prioritizing the Urban Poor
Blessing Mberu1 , Joyce Mumah1, Caroline Kabiru1 and Jessica Brinton1
African Population and Health Research Centre, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya
Published online: 19 December 2013
Abstract
Estimates suggest that over 90 % of population increase in the least developed countries over the next four decades will occur in urban areas. These increases will be driven both by natural population growth and rural–urban migration. Moreover, despite its status as the world’s least urbanized region, the urban population in the sub-Saharan Africa region is projected to increase from under 40 % currently to over 60 % by 2050. Currently, approximately 70 % of all urban residents in the region live in slums or slum-like conditions. Sexual and reproductive health (SRH) risks for the urban poor are severe and include high rates of unwanted pregnancies, sexually transmitted infections, and poor maternal and child health outcomes. However, the links between poverty, urbanization, and reproductive health priorities are still not a major focus in the broader development agenda. Building on theoretical and empirical data, we show that SRH in urban contexts is critical to the development of healthy productive urban populations and, ultimately, the improvement of quality of life. We posit that a strategic focus on the sexual and reproductive health of urban residents will enable developing country governments achieve international goals and national targets by reducing health risks among a large and rapidly growing segment of the population. To that end, we identify key research, policy and program recommendations and strategies required for bringing sexual and reproductive health in urban contexts to the forefront of the development agenda.

Efficacy and Effectiveness of Maternal Influenza Vaccination During Pregnancy: A Review of the Evidence
Jill M. Manske
Abstract
Influenza vaccine is universally recommended for pregnant women during any trimester of pregnancy. In light of this recommendation, a comprehensive literature review was conducted to examine the available evidence regarding influenza vaccine efficacy and effectiveness during pregnancy. A comprehensive Medline search identified potentially relevant articles published between January 1, 1964 and February 1, 2013. Articles were selected that specifically evaluated the efficacy and effectiveness of maternal influenza vaccine in protecting women and infants from influenza infection. These were reviewed with a particular focus on the methods used to confirm influenza infection. Ten of 476 articles met the inclusion criteria. None of the six studies evaluating maternal outcomes were randomized controlled studies using a laboratory-confirmed influenza diagnosis to measure vaccine efficacy. Two studies included reverse-transcriptase polymerase chain reaction confirmation; four relied solely on clinical outcomes. The reported vaccine effectiveness (VE) ranged from −15 to 70 %. Seven studies examined the potential for maternal vaccination to protect infants. Four of these applied some form of laboratory confirmation, with VE ranging from 41 to 91 %. Vaccination against infectious disease is an unparalleled public health success. However, studies to date demonstrate that influenza vaccine provides only moderate protection from influenza infection in pregnant women. This review found broad heterogeneity among studies, with no uniform outcome measured and little data based on laboratory-confirmed influenza, leading to wide-ranging estimates of effectiveness. Rigorously designed studies assessing clearly defined outcomes are needed to support the development of reasoned public health policy about influenza prevention in this population.

Nature
Volume 513 Number 7517 pp143-272 11 September 2014
http://www.nature.com/nature/current_issue.html

Sustainable development: The promise and perils of roads
Stephen G. Perz
A global map of the potential economic benefits of roads together with the environmental damage they can inflict provides a planning tool for sustainable development

A global strategy for road building
William F. Laurance, Gopalasamy Reuben Clements, Sean Sloan, Christine S. O’Connell, Nathan D. Mueller+ et al.
The number and extent of roads will expand dramatically this century1. Globally, at least 25 million kilometres of new roads are anticipated by 2050; a 60% increase in the total length of roads over that in 2010. Nine-tenths of all road construction is expected to occur in developing nations1, including many regions that sustain exceptional biodiversity and vital ecosystem services. Roads penetrating into wilderness or frontier areas are a major proximate driver of habitat loss and fragmentation, wildfires, overhunting and other environmental degradation, often with irreversible impacts on ecosystems2, 3, 4, 5. Unfortunately, much road proliferation is chaotic or poorly planned3, 4, 6, and the rate of expansion is so great that it often overwhelms the capacity of environmental planners and managers2, 3, 4, 5, 6, 7. Here we present a global scheme for prioritizing road building. This large-scale zoning plan seeks to limit the environmental costs of road expansion while maximizing its benefits for human development, by helping to increase agricultural production, which is an urgent priority given that global food demand could double by mid-century8, 9. Our analysis identifies areas with high environmental values where future road building should be avoided if possible, areas where strategic road improvements could promote agricultural development with relatively modest environmental costs, and ‘conflict areas’ where road building could have sizeable benefits for agriculture but with serious environmental damage. Our plan provides a template for proactively zoning and prioritizing roads during the most explosive era of road expansion in human history.

Nature
Volume 513 Number 7517 pp143-272 11 September 2014
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Ebola: time to act
Governments and research organizations must mobilize to end the West African outbreak.
09 September 2014
After disproportionate media attention on Ebola’s negligible risk to people in Western and Asian countries, the focus seems at last to be shifting towards how to stop the outbreak in West Africa. The grim reality is that medical organizations are struggling: the flood of new cases far outpaces available beds and treatment centres. Many of those who are ill are not receiving the basic health care that could keep them alive.
The tragedy is that we know how to stop Ebola. Well-informed communities can reduce the main routes of spread by avoiding unprotected home-based care of infected people and by modifying traditional burial practices. Infection-control measures protect health-care workers. Together with rapid identification and isolation of ill people, and tracing and monitoring of their contacts for 21 days (the maximum incubation period of the disease), such measures have stopped Ebola outbreaks in the past.
But the dysfunctional health-care infrastructure of the three countries at the centre of the outbreak — Guinea, Sierra Leone and Liberia, which are poor and struggling to emerge from years of war — is simply not up to the task. The nations need help, and urgently…

Make diagnostic centres a priority for Ebola crisis
Bottlenecks in testing samples for Ebola leave patients stranded for days in isolation wards and raise fears of seeking treatment, says J. Daniel Kelly.