British Medical Journal
13 December 2014 (vol 349, issue 7987)
http://www.bmj.com/content/349/7987

Research
Innovative research methods for studying treatments for rare diseases: methodological review
Joshua J Gagne, assistant professor, Lauren Thompson, research assistant, Kelly O’Keefe, research manager, Aaron S Kesselheim, assistant professor
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6802 (Published 24 November 2014) Cite this as: BMJ 2014;349:g6802
Abstract
Objective To examine methods for generating evidence on health outcomes in patients with rare diseases.
Design Methodological review of existing literature.
Setting PubMed, Embase, and Academic Search Premier searched for articles describing innovative approaches to randomized trial design and analysis methods and methods for conducting observational research in patients with rare diseases.
Main outcome measures We assessed information related to the proposed methods, the specific rare disease being studied, and outcomes from the application of the methods. We summarize methods with respect to their advantages in studying health outcomes in rare diseases and provide examples of their application.
Results We identified 46 articles that proposed or described methods for studying patient health outcomes in rare diseases. Articles covered a wide range of rare diseases and most (72%) were published in 2008 or later. We identified 16 research strategies for studying rare disease. Innovative clinical trial methods minimize sample size requirements (n=4) and maximize the proportion of patients who receive active treatment (n=2), strategies crucial to studying small populations of patients with limited treatment choices. No studies describing unique methods for conducting observational studies in patients with rare diseases were identified.
Conclusions Though numerous studies apply unique clinical trial designs and considerations to assess patient health outcomes in rare diseases, less attention has been paid to innovative methods for studying rare diseases using observational data.

Clinical Review
Ebola virus disease
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g7348 (Published 10 December 2014) Cite this as: BMJ 2014;349:g7348

Disasters
January 2015 Volume 39, Issue 1 Pages 1–184
http://onlinelibrary.wiley.com/doi/10.1111/disa.2015.39.issue-1/issuetoc

Social media and disasters: a functional framework for social media use in disaster planning, response, and research
J. Brian Houston1,*, Joshua Hawthorne2, Mildred F. Perreault3, Eun Hae Park4, Marlo Goldstein Hode5, Michael R. Halliwell6, Sarah E. Turner McGowen7, Rachel Davis8, Shivani Vaid9, Jonathan A. McElderry10 and Stanford A. Griffith11
Article first published online: 22 SEP 2014
DOI: 10.1111/disa.12092
Abstract
A comprehensive review of online, official, and scientific literature was carried out in 2012–13 to develop a framework of disaster social media. This framework can be used to facilitate the creation of disaster social media tools, the formulation of disaster social media implementation processes, and the scientific study of disaster social media effects. Disaster social media users in the framework include communities, government, individuals, organisations, and media outlets. Fifteen distinct disaster social media uses were identified, ranging from preparing and receiving disaster preparedness information and warnings and signalling and detecting disasters prior to an event to (re)connecting community members following a disaster. The framework illustrates that a variety of entities may utilise and produce disaster social media content. Consequently, disaster social media use can be conceptualised as occurring at a number of levels, even within the same disaster. Suggestions are provided on how the proposed framework can inform future disaster social media development and research.

Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis
Francesca Matthews Pillemer1,*, Robert J. Blendon2, Alan M. Zaslavsky3 andBruce Y. Lee4
Article first published online: 22 SEP 2014
DOI: 10.1111/disa.12089
Abstract
Non-pharmaceutical interventions (NPIs) are an important public health tool for responding to infectious disease outbreaks, including pandemics. However, little is known about the individual characteristics associated with support for NPIs, or whether they are consistent across regions. This study draws on survey data from four regions—Hong Kong, Singapore, Taiwan, and the United States—collected following the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002–03, and employs regression techniques to estimate predictors of NPI support. It finds that characteristics associated with NPI support vary widely by region, possibly because of cultural variation and prior experience, and that minority groups tend to be less supportive of NPIs when arrest is the consequence of noncompliance. Prior experience of face-mask usage also results in increased support for future usage, as well as other NPIs. Policymakers should be attentive to local preferences and to the application of compulsory interventions. It is speculated here that some public health interventions may serve as ‘gateway’ exposures to future public health interventions.

Global Health: Science and Practice (GHSP)
December 2014 | Volume 2 | Issue 4
http://www.ghspjournal.org/content/current

It’s not Ebola … it’s the systems
Victor K Barbiero
Glob Health Sci Pract 2014;2(4):374-375. First published online October 31, 2014. http://dx.doi.org/10.9745/GHSP-D-14-00186
The 2014 Ebola outbreak in West Africa demonstrates key deficiencies in investment in health systems. Despite some modest investment in health systems, our field has instead largely chosen to pursue shorter-term, vertical efforts to more rapidly address key global health issues such as smallpox, polio, malaria, and HIV/AIDS. While those efforts have yielded substantial benefits, we have paid a price for the lack of investments in general systems strengthening. The Ebola deaths we have seen represent a small portion of deaths from many other causes resulting from weak systems. Major systems strengthening including crucial nonclinical elements will not happen overnight but should proceed in a prioritized, systematic way.

COMMENTARIES
The future of routine immunization in the developing world: challenges and opportunities
Angela K Shen, Rebecca Fields, Mike McQuestion
Glob Health Sci Pract 2014;2(4):381-394. http://dx.doi.org/10.9745/GHSP-D-14-00137
Vaccine costs in the developing world have grown from < US$1/child in 2001 to about $21 for boys and $35 for girls in 2014, as more and costlier vaccines are being introduced into national immunization programs. To address these and other challenges, additional efforts are needed to strengthen 8 critical components of routine immunization: (1) policy, standards, and guidelines; (2) governance, organization, and management; (3) human resources; (4) vaccine, cold chain, and logistics management; (5) service delivery; (6) communication and community partnerships; (7) data generation and use; and (8) sustainable financing.

Strategies to reduce risks in ARV supply chains in the developing world
Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O’Keefe Douglas, Joel Kuritsky
Glob Health Sci Pract 2014;2(4):395-402. http://dx.doi.org/10.9745/GHSP-D-14-00105
Key strategies of the main ARV procurement program for PEPFAR to reduce supply chain risks include: (1) employing pooled procurement to reduce procurement and shipping costs and to accommodate changing country needs by making stock adjustments at the regional level, and (2) establishing regional distribution centers to facilitate faster turnaround of orders within defined catchment areas.

VIEWPOINTS
A stewardship approach to shaping the future of public health supply chain systems
Alan Bornbusch, Todd Dickens, Carolyn Hart, Chris Wright
Glob Health Sci Pract 2014;2(4):403-409. First published online October 29, 2014. http://dx.doi.org/10.9745/GHSP-D-14-00123
Guiding Principles: (1) Governments should see themselves as stewards of supply chains, providing vision, guidance, and oversight, not necessarily as operators of supply chains. (2) Governments should not be afraid to leverage the multiple supply chain actors and diverse options available; these can be woven into a coherent, integrated system, providing flexibility and reducing risk. (3) Governments will need new skills in leadership, regulation, market research, contract design, oversight of outsourced providers, financial analysis, and alliance-building.

Global Public Health
Volume 10, Issue 1, 2015
http://www.tandfonline.com/toc/rgph20/10/1#.VI0Y33tW_4U

The integration of water, sanitation and hygiene services into the US President’s Emergency Plan for AIDS Relief: A qualitative study
Lyana B. Mahmoudia, Jennifer L. Plattb & Jay P. Grahamac*
DOI:10.1080/17441692.2014.966736
pages 1-14
Abstract
Water, sanitation and hygiene (WASH) interventions have been associated with improving the health of people living with HIV/AIDS (PLHIV). WASH is increasingly integrated into the HIV sector and is now considered a key component of the transition from an emergency response to a better incorporated and coordinated AIDS response. However, limited research exists on integration efforts. This qualitative research study aims to address the limited body of research on WASH integration into HIV programmes through examining the US President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the US government’s initiative to combat AIDS in the most afflicted countries. This study analyses the perceptions of people who have worked or are working on WASH integration into PEPFAR, highlighting their views on accomplishments, challenges and areas for improvement. It concludes with recommendations for moving forward.

An economic framework for transitioning to capacity building
Eric Baranicka, Aaron Bairdb* & Ajay Vinzec
DOI:10.1080/17441692.2014.964745
pages 15-27
Abstract
Global Health Organizations (GHOs) often focus on resource provisioning strategies to assist communities in need, especially when disaster strikes. While such strategies are commendable, how should GHOs approach the challenge of developing sustainable strategic objectives after critical needs have been addressed? Leveraging the context of GHOs partnering with communities in need of support after disaster strikes, we propose an economic framework for use in strategic assessment and transition planning. We focus on a strategic process by which GHOs can systematically assess and manage the temporal shift from resource provisioning to capacity building strategies. The proposed framework is applied to pragmatic field experiences undertaken by the American Red Cross in the aftermath of the 2007 Peru earthquake. We specifically develop and propose: (1) An economic strategy assessment framework for GHOs seeking to provide support to communities characterised by high risk variances, incentive complexities and contingencies, and, (2) A practical strategic transition model for GHOs that emphasises proactively moving towards capacity building programme objectives through an emphasis on co-creation of value with community partners.

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

Research
Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment
Aantjes C, Quinlan T and Bunders J Globalization and Health 2014, 10:85 (11 December 2014)

Commentary
Non‐Communicable Diseases (NCDs) in developing countries: a symposium report
Islam SMS, Purnat TD, Phuong NTA, Mwingira U, Schacht K and Fröschl G Globalization and Health 2014, 10:81 (11 December 2014)

Health Affairs
December 2014; Volume 33, Issue 12
http://content.healthaffairs.org/content/current
Issue Theme: Children’s Health

How A New Funding Model Will Shift Allocations From The Global Fund To Fight AIDS, Tuberculosis, And Malaria
Victoria Y. Fan1,*, Amanda Glassman2 and Rachel L. Silverman3
Author Affiliations
1Victoria Y. Fan (vfan@post.harvard.edu) is an assistant professor in the Department of Public Health Sciences and Epidemiology at the University of Hawaii at Manoa, in Honolulu, and a research fellow at the Center for Global Development, in Washington, D.C.
2Amanda Glassman is director of global health policy and senior fellow at the Center for Global Development.
3Rachel L. Silverman is a policy analyst at the Center for Global Development.
Corresponding author
Abstract
Policy makers deciding how to fund global health programs in low- and middle-income countries face important but difficult questions about how to allocate resources across countries. In this article we present a typology of three allocation methodologies to align allocations with priorities. We then apply our typology to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. We examined the Global Fund’s historical HIV allocations and its predicted allocations under a new funding model that creates an explicit allocation methodology. We found that under the new funding model, substantial shifts in the Global Fund’s portfolio are likely to result from concentrating resources in countries with more HIV cases and lower per capita incomes. For example, South Africa, which had 15.8 percent of global HIV cases in 2009, could see its Global Fund HIV funding more than triple, from historic levels that averaged 3.0 percent to 9.7 percent of total Global Fund allocations. The new funding model methodology is expected, but not guaranteed, to improve the efficiency of Global Fund allocations in comparison to historical practice. We conclude with recommendations for the Global Fund and other global health donors to further develop their allocation methodologies and processes to improve efficiency and transparency.

International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care
Robin Osborn1,*, Donald Moulds2, David Squires3, Michelle M. Doty4 and Chloe Anderson5
Author Affiliations
1Robin Osborn (ro@cmwf.org) is vice president and director of the International Health Policy and Practice Innovations program at the Commonwealth Fund, in New York City.
2Donald Moulds is executive vice president for programs at the Commonwealth Fund.
3David Squires is senior researcher to the president at the Commonwealth Fund.
4Michelle M. Doty is vice president of survey research and evaluation at the Commonwealth Fund.
5Chloe Anderson is a research associate in the International Health Policy and Practice Innovations program at the Commonwealth Fund.
Corresponding author
Abstract
Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.

The Lancet
Dec 13, 2014 Volume 384 Number 9960 p2083-2172 e63-e66
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Universal health coverage post-2015: putting people first
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62355-2
Summary
Dec 12, 2014 marks the world’s first Universal Health Coverage (UHC) Day. Defined in the World Health Report 2010, UHC means that all people who need quality, essential health services (prevention, promotion, treatment, rehabilitation, and palliation) receive them without enduring financial hardship. UHC also means different things to different people. Vivian Lin, health systems director (WHO regional office for the Western Pacific), told The Lancet, “some define UHC as a journey or an aspiration but it is actually a strategy to get to equitable and sustainable outcomes”.

Comment
Meningococcal carriage: the dilemma of 4CMenB vaccine
Muhamed-Kheir Taha, Ala-Eddine Deghmane
Published Online: 18 August 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60935-1
Summary
The prevalence of acute bacterial meningitis and septicaemia due to Haemophilus influenzae b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis has greatly decreased in Europe and North America since the successful introduction of capsular polysaccharide conjugate vaccines targeting Hib, serogroup C (and ACWY in the USA) meningococci, and S pneumoniae. Incidence of meningitis due to N meningitidis serogroup A has also decreased in sub-Saharan Africa since the introduction of the meningococcal serogroup A conjugate vaccine (MenAfriVac).

Comment
Ebola and human rights in west Africa
Patrick M Eba
Published Online: 19 September 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61412-4
Summary
The fear caused by the Ebola outbreak in west Africa, which is projected to infect some 20 000 people, is understandable.1 However, the disproportionate measures recently adopted in some of the affected countries are a cause for concern. Some 25 years ago, Jonathan Mann, then Director of WHO’s Global Programme on AIDS, warned world leaders alarmed at the relentless spread of HIV.

Comment
Offline: Making it happen for women and girls
Richard Horton
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62046-8
Summary
It was not a matter of forgetting. “There were forces within the UN that didn’t want to include contraception.” Dr Babatunde Osotimehin is the Executive Director of the United Nations Population Fund (UNFPA) and doesn’t mince his words. He was speaking last week at the launch of the Guttmacher Institute’s signature report, Adding It Up. Sexual and reproductive health and rights were “deliberately” dropped by the UN back in 2000, he argued. Those forces are still active today. And they are “more nimble in pushing back”.

Articles
Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial
Prof Robert C Read, MD, David Baxter, PhD, David R Chadwick, PhD, Prof Saul N Faust, FRCPH, Prof Adam Finn, PhD, Prof Stephen B Gordon, MD, Prof Paul T Heath, FRCPCH, Prof David J M Lewis, MD, Prof Andrew J Pollard, PhD, David P J Turner, PhD, Rohit Bazaz, MD Amitava Ganguli, MRCP, Tom Havelock, MRCP, Prof Keith R Neal, MD, Ifeanyichukwu O Okike, MD, Begonia Morales-Aza, BSc, Kamlesh Patel, BSc, Matthew D Snape, MD, John Williams, MRCP, Stefanie Gilchrist, MSc, Steve J Gray, PhD, Prof Martin C J Maiden, PhD, Daniela Toneatto, MD, Huajun Wang, MSc, Maggie McCarthy, MPH, Peter M Dull, MD, Prof Ray Borrow, PhD
Published Online: 18 August 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60842-4
Summary
Background
Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18–24-year-olds.
Methods
In this phase 3, observer-blind, randomised controlled trial, university students aged 18–24 years from ten sites in England were randomly assigned (1:1:1, block size of three) to receive two doses 1 month apart of Japanese Encephalitis vaccine (controls), 4CMenB, or one dose of MenACWY-CRM then placebo. Participants were randomised with a validated computer-generated random allocation list. Participants and outcome-assessors were masked to the treatment group. Meningococci were isolated from oropharyngeal swabs collected before vaccination and at five scheduled intervals over 1 year. Primary outcomes were cross-sectional carriage 1 month after each vaccine course. Secondary outcomes included comparisons of carriage at any timepoint after primary analysis until study termination. Reactogenicity and adverse events were monitored throughout the study. Analysis was done on the modified intention-to-treat population, which included all enrolled participants who received a study vaccination and provided at least one assessable swab after baseline. This trial is registered with ClinicalTrials.gov, registration number NCT01214850.
Findings
Between Sept 21 and Dec 21, 2010, 2954 participants were randomly assigned (987 assigned to control [984 analysed], 979 assigned to 4CMenB [974 analysed], 988 assigned to MenACWY-CRM [983 analysed]); 33% of the 4CMenB group, 34% of the MenACWY-CRM group, and 31% of the control group were positive for meningococcal carriage at study entry. By 1 month, there was no significant difference in carriage between controls and 4CMenB (odds ratio 1•2, 95% CI 0•8–1•7) or MenACWY-CRM (0•9, [0•6–1•3]) groups. From 3 months after dose two, 4CMenB vaccination resulted in significantly lower carriage of any meningococcal strain (18•2% [95% CI 3•4–30•8] carriage reduction), capsular groups BCWY (26•6% [10•5–39•9] carriage reduction), capsular groups CWY (29•6% [8•1–46•0] carriage reduction), and serogroups CWY (28•5% [2•8–47•5] carriage reduction) compared with control vaccination. Significantly lower carriage rates were also noted in the MenACWY-CRM group compared with controls: 39•0% (95% CI 17•3–55•0) carriage reduction for serogroup Y and 36•2% (15•6–51•7) carriage reduction for serogroup CWY. Study vaccines were generally well tolerated, with increased rates of transient local injection pain and myalgia in the 4CMenB group. No safety concerns were identified.
Interpretation
Although we detected no significant difference between groups at 1 month after vaccine course, MenACWY-CRM and 4CMenB vaccines reduced meningococcal carriage rates during 12 months after vaccination and therefore might affect transmission when widely implemented.
Funding
Novartis Vaccines.

New England Journal of Medicine
December 11, 2014 Vol. 371 No. 24
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Ebola Vaccine — An Urgent International Priority
Rupa Kanapathipillai, M.D., Ana Maria Henao Restrepo, M.D., Patricia Fast, M.D., Ph.D., David Wood, Ph.D., Christopher Dye, D.Phil., Marie-Paule Kieny, Ph.D., and Vasee Moorthy, B.M., B.Ch., Ph.D.
N Engl J Med 2014; 371:2249-2251 December 11, 2014
DOI: 10.1056/NEJMp1412166
This article was published on October 7, 2014, at NEJM.org.

PLOS Currents: Disasters
[Accessed 13 December 2014]
http://currents.plos.org/disasters/

Communicable Diseases Surveillance System in East Azerbaijan Earthquake: Strengths and Weaknesses
December 8, 2014 • Research article
Background:
A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the established SS.
Methods:
This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the principles suggested by Strauss and Corbin.
Results:
Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non estimated denominator for calculating the rates (incidence & prevalence), non-participation of the private sector and hospitals, rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established disease SS.
Conclusion:
During the time when surveillance system was active, no significant outbreak of communicable diseases was reported. However, the surveillance system had some weaknesses. Thus, considering Iran’s susceptibility to various natural hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 13 December 2014)

Assessment of the Risk of Ebola Importation to Australia
December 10, 2014 • Research
Objectives:
To assess the risk of Ebola importation to Australia during the first six months of 2015, based upon the current outbreak in West Africa.
Methodology:
We assessed the risk under two distinct scenarios: (i) assuming that significant numbers of cases of Ebola remain confined to Guinea, Liberia and Sierra Leone, and using historic passenger arrival data into Australia; and, (ii) assuming potential secondary spread based upon international flight data. A model appropriate to each scenario is developed, and parameterised using passenger arrival card or international flight data, and World Health Organisation case data from West Africa. These models were constructed based on WHO Ebola outbreak data as at 17 October 2014 and 3 December 2014. An assessment of the risk under each scenario is reported. On 27 October 2014 the Australian Government announced a policy change, that visas from affected countries would be refused/cancelled, and the predicted effect of this policy change is reported.
Results:
The current probability of at least one case entering Australia by 1 July 2015, having travelled directly from West Africa with historic passenger arrival rates into Australia, is 0.34. Under the new Australian Government policy of restricting visas from affected countries (as of 27 October 2014), the probability of at least one case entering Australia by 1 July 2015 is reduced to 0.16. The probability of at least one case entering Australia by 1 July 2015 via an outbreak from a secondary source country is approximately 0.12.
Conclusions:
Our models suggest that if the transmission of Ebola remains unchanged, it is possible that a case will enter Australia within the first six months of 2015, either directly from West Africa (even when current visa restrictions are considered), or via secondary outbreaks elsewhere. Government and medical authorities should be prepared to respond to this eventuality. Control measures within West Africa over recent months have contributed to a reduction in projected risk of a case entering Australia. A significant further reduction of the rate at which Ebola is proliferating in West Africa, and control of the disease if and when it proliferates elsewhere, will continue to result in substantially lower risk of the disease entering Australia.

PLoS Medicine
(Accessed 13 December 2014)
http://www.plosmedicine.org/

Open Access
Policy Forum
From Joint Thinking to Joint Action: A Call to Action on Improving Water, Sanitation, and Hygiene for Maternal and Newborn Health
Yael Velleman mail, Elizabeth Mason, Wendy Graham, Lenka Benova, Mickey Chopra, Oona M. R. Campbell, Bruce Gordon, Sanjay Wijesekera, Sennen Hounton, Joanna Esteves Mills, Val Curtis, Kaosar Afsana, Sophie Boisson, [ … ], Oliver Cumming , [ view all ]
Published: December 12, 2014
DOI: 10.1371/journal.pmed.1001771
Summary Points
:: There is sufficient evidence that water, sanitation, and hygiene (WASH) may impact maternal and newborn health (MNH) to warrant greater attention from all stakeholders involved in improving MNH and achieving universal WASH access.
:: Enabling stronger integration between the WASH and health sectors has the potential to accelerate progress on MNH; this should be accompanied by improving monitoring of WASH in health care facilities providing MNH services as part of routine national-level monitoring, and at the global level through international instruments.
:: Global and national efforts to reduce maternal and newborn mortality and morbidity should adequately reflect WASH as a pre-requisite for ensuring the quality, effectiveness, and use of health care services.
:: The Post-2015 development framework is an opportunity for a stronger, more inter-sectoral response to the MNH challenge, and the goals and targets aimed at maximizing healthy lives and increasing access to quality health care should adequately embed WASH targets and success indicators.
:: Further implementation research is needed to identify effective interventions to improve WASH at home and in health care facilities, and to impact on MNH in different health system contexts.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 13 December 2014)

Global Programme to Eliminate Lymphatic Filariasis: The Processes Underlying Programme Success
Kazuyo Ichimori, Jonathan D. King, Dirk Engels, Aya Yajima, Alexei Mikhailov, Patrick Lammie, Eric A. Ottesen
Policy Platform | published 11 Dec 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003328

Global Programme to Eliminate Lymphatic Filariasis: The Processes Underlying Programme Success
Kazuyo Ichimori, Jonathan D. King, Dirk Engels, Aya Yajima, Alexei Mikhailov, Patrick Lammie, Eric A. Ottesen
Policy Platform | published 11 Dec 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003328

PLoS One
[Accessed 13 December 2014]
http://www.plosone.org/

Research Article
The Link between Inequality and Population Health in Low and Middle Income Countries: Policy Myth or Social Reality?
Ioana van Deurzen mail, Wim van Oorschot, Erik van Ingen
Published: December 11, 2014
DOI: 10.1371/journal.pone.0115109
Abstract
An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women’ experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals’ wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country’s level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services.

Social Science & Medicine
Volume 126, In Progress (February 2015)
http://www.sciencedirect.com/science/journal/02779536/126

Latent and manifest empiricism in Q’eqchi’ Maya healing: A case study of HIV/AIDS
Original Research Article
Pages 9-16
James B. Waldram, Andrew R. Hatala
Abstract
Highlights
:: Develops a framework for understanding the empirical nature of Indigenous healing.
:: Argues for compatibility of traditional medicine and biomedicine.
:: Presents ethnographic case study of treatment of HIV/AIDS by Q’eqchi’ Maya healers.
:: Argues the need for communication between traditional medicine and biomedicine.

Inequalities in social capital and health between people with and without disabilities
Original Research Article
Pages 26-35
Johanna Mithen, Zoe Aitken, Anne Ziersch, Anne M. Kavanagh
Abstract
Highlights
:: Australian adults with disabilities have less access to social capital.
:: Australian adults with disabilities have poorer self-rated health.
:: Lower levels of social capital explain little of the health inequalities.
:: People with psychological and intellectual impairments fare worst.

Stability: International Journal of Security & Development
[accessed 13 December 2014]
http://www.stabilityjournal.org/articles

Losses of Humanity in Times of War: The Actions of Alternative Subjects of Justice
Julia Monárrez
10 Dec 2014
Abstract
This article discusses loss of humanity due to violence in Ciudad Juarez (2008–2014) and the actions of alternative subjects of justice – the organized civil society – seeking to address it. This paper resonates with theoretical currents of feminism and humanism, both of which have created a critical apparatus for thinking about social inequality in the context of life, death, and injustice. The discussion draws on the theoretical concepts of discourse societies, necropolitics, private government and actions. With this theoretical structure, the paper seeks to understand the political actions of eight civil society organizations aiming to recover the right to the body, to space and to be a political subject for a community shattered by violence. The paper argues that, through these actions, they helped to prevent crime, enhance public safety and stabilise a society suffering from continued violence due in large part to the war on drugs.

Tropical Medicine & International Health
January 2015 Volume 20, Issue 1 Pages 1–119
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2014.20.issue-1/issuetoc

Original Article
Participation in medical research as a resource-seeking strategy in socio-economically vulnerable communities: call for research and action
Raffaella M. Ravinetto1,2,*, Muhammed O. Afolabi3,4, Joseph Okebe3,4, Jennifer Ilo Van uil5,6,
Pascal Lutumba7,8, Hypolite Muhindo Mavoko8, Alain Nahum9, Halidou Tinto10, Adamu Addissie11, Umberto D’Alessandro3,4,12 and Koen Peeters Grietens12,13,14
Article first published online: 10 OCT 2014
DOI: 10.1111/tmi.12396
Abstract
The freedom to consent to participate in medical research is a complex subject, particularly in socio-economically vulnerable communities, where numerous factors may limit the efficacy of the informed consent process. Informal consultation among members of the Switching the Poles Clinical Research Network coming from various sub-Saharan African countries, that is Burkina Faso, The Gambia, Rwanda, Ethiopia, the Democratic Republic of Congo (DRC) and Benin, seems to support the hypothesis that in socio-economical vulnerable communities with inadequate access to health care, the decision to participate in research is often taken irrespectively of the contents of the informed consent interview, and it is largely driven by the opportunity to access free or better quality care and other indirect benefits. Populations’ vulnerability due to poverty and/or social exclusion should obviously not lead to exclusion from medical research, which is most often crucially needed to address their health problems. Nonetheless, to reduce the possibility of exploitation, there is the need to further investigate the complex links between socio-economical vulnerability, access to health care and individual freedom to decide on participation in medical research. This needs bringing together clinical researchers, social scientists and bioethicists in transdisciplinary collaborative research efforts that require the collective input from researchers, research sponsors and funders.

Ebola/EVD: Additional Coverage

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse
UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and what it titles “developments.” We present a composite below from the week ending 13 December 2014.

UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Response Efforts and Health
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present highly-selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

12 December 2014 |
Key Political and Economic Developments
1. UN Secretary-General Ban Ki-moon yesterday announced the appointment of Ismail Ould Cheikh Ahmed of Mauritania as his new Special Representative and Head of UNMEER. Mr. Ould Cheikh Ahmed will succeed Anthony Banbury, who will return to New York in early January 2015. The Secretary-General expressed his gratitude to Mr. Banbury for his vision and leadership of UNMEER, and for his commitment to fighting this unprecedented EVD outbreak. Bringing more than 28 years of development and humanitarian assistance experience with the United Nations in Africa, the Middle East and Eastern Europe, Mr. Ould Cheikh Ahmed is currently Deputy Special Representative of the Secretary-General and Deputy Head of the United Nations Support Mission in Libya (UNSMIL), United Nations Resident Coordinator, Humanitarian Coordinator and United Nations Development Programme (UNDP) Resident Representative. He served as Resident Coordinator, Humanitarian Coordinator and UNDP Resident Representative in Syria (2008-2012) and Yemen (2012-2014).
2. The Red Cross warned on Thursday of a possible rise in the rate of EVD infections in West Africa as people travel across the region during the festive holidays. Urging people to take extra care to limit the spread of the virus, International Federation of the Red Cross and Red Crescent Societies (IFRC) Secretary General Elhadj As Sy said increasing rates were not inevitable but were a real risk. “Now is the time to be even more vigilant,” he told an audience at the Royal Institute of International Affairs in London. “We all welcome the plateauing and the signs of declines we are seeing in some places, but that should not be a reason for complacency.”
Response Efforts and Health
5. The Liberian Ministry of Health and Social Welfare (MOHSW) and UNDP visited eleven out of the fifteen counties to verify, and in some cases create, lists of Ebola response workers that are still to be paid. The MOHSW committed to paying eight of the counties this week for three months back-dated pay, though payments are yet to be verified with the Ministry of Finance. Challenges to making payments continue to emerge, including that in several counties individuals refuse to open bank accounts because they have never had bank accounts before and are not comfortable opening one for the first time.
Resource Mobilisation
11. Saudi Arabia’s King Abdullah has granted US$ 35 million to fight EVD, the Islamic Development Bank said Thursday. The grant will provide schools and airports in West Africa with heat sensors and medical equipment to help prevent and treat the illness, Ahmed Mohamed Ali, president of the Jeddah-based IDB, said in a statement. The funds will also help to establish specialized treatment centers in the most affected countries — Sierra Leone, Guinea and Liberia.
12. The OCHA Ebola Virus Outbreak Overview of Needs and Requirements, now totaling US$ 1.5 billion, has been funded for $ 1.05 billion, which is around 70 percent of the total ask.
13. The Ebola Response Multi-Partner Trust Fund currently has US$ 108.2 million in commitments. In total $ 131 million has been pledged.
Outreach and Education
15. According to WHO, on 9 December there were a total of 21 sub-prefectures across Guinea where EVD response efforts are facing community resistance. These sub-prefectures are located in the three main areas affected by the epidemic: the Forest Region; central-northern Guinea and Conakry and adjacent prefectures. Resistance is often due to insufficient sensitization, lack of trust stemming from the non-delivery on promises by EVD responders (such as ambulance transportation or kit distribution) and the fact that many patients admitted to the ETCs are not surviving. The National Ebola Response Cell (NERC), with UNMEER support, is taking action to resolve bottlenecks in the delivery of hygiene and supply kits and the establishment of Community Watch Committees which are critical to stop transmission and lift resistance.

11 December 2014 |
Key Political and Economic Developments
2. US magazine TIME has declared the Ebola fighters their “Person of the Year 2014”. In explaining its choice, the magazine noted: “The rest of the world can sleep at night because a group of men and women are willing to stand and fight. For tireless acts of courage and mercy, for buying the world time to boost its defenses, for risking, for persisting, for sacrificing and saving, the Ebola fighters are TIME’s 2014 Person of the Year.” The magazine also notes the importance of learning from this outbreak, to strengthen healthcare and response services and be better prepared in future.
Response Efforts and Health
4. Sierra Leonean authorities have imposed a two-week lockdown in Kono district, where a major EVD flare-up has gone largely unreported until now. Although rapid reaction has helped contain the virus to about half of the 15 chiefdoms in Kono, WHO teams that arrived in the area 10 days ago were taken aback at the situation they encountered. In the space of 11 days, two WHO teams buried 87 victims, including a nurse and an ambulance driver enlisted to help dispose of corpses piling up in the local hospital. 25 people had died in a hastily cordoned off section of the hospital in the five days before the team arrived. “We are only seeing the ears of the hippo,” said Dr. Amara Jambai, Sierra Leone’s Director of Disease Prevention and Control, expressing concern that the official figures underrepresent the size of the outbreak in Kono district.
5. UNDP has completed 2 prison isolation units for incoming prisoners in Freetown, Sierra Leone. The two facilities will serve as observation centers for new inmates (male and female separately) in Freetown’s correctional centers, to help prevent an outbreak among the prison population. The units will open officially on Friday 12 December. Further, UNDP is scaling up a nationwide prison sensitization and equipment campaign to improve conditions and strengthen protection against the spread of EVD inside detention facilities.

10 December 2014 |
Key Political and Economic Developments
1. The government of Liberia, with the support of UNMEER and regional participation from Sierra Leone, Guinea, Mali and Nigeria, organized a technical meeting on cross-border coordination on the prevention and control of EVD. In her opening statement, President Johnson Sirleaf emphasized the need to pool shared regional resources to counter EVD across the whole region. She also mentioned the cross-country coordination of specialized national institutions and the need for ease of access to resources available in border areas, as well as managing the porous borders. UNMEER SRSG Banbury stated the clear commitment of the UN to support the regional counter-EVD initiatives. A Strategic Framework for Cross-Border Collaboration on EVD Prevention and Control was elaborated at the meeting.
2. More foreign health workers are needed to help tackle the epidemic, which is spreading quickly in western Sierra Leone and deep in the forested interior of Guinea, Special Envoy Nabarro said in Geneva on Tuesday, adding that the outbreak is still flaming strongly in western Sierra Leone and some parts of the interior of Guinea. “We don’t yet have the full number of functioning treatment centers and places where people who are ill can be kept away from others,” he said. Dr. Nabarro expressed confidence that there will be an improvement in Freetown in the next few weeks. The rise in the spread of EVD in western Sierra Leone reflects the fact that tribal-led communities have yet to fully accept the outbreak and take action to avoid infection, he said.
3. EVD is still “running ahead” of efforts to contain it, WHO Director General Margaret Chan said, warning against complacency. The risk to the world “is always there” while the outbreak continues, Dr. Chan said. “It’s not as bad as it was in September. But going forward we are now hunting the virus, chasing after the virus. Hopefully we can bring the number of cases down to zero.” She said a key part of bringing the outbreak under control was ensuring communities understood EVD, as teams going into some areas were still facing resistance. Community participation is a critical success factor for EVD control, Dr. Chan said. “In all the outbreaks that WHO were able to manage successfully, that was a success element and this is not happening in this current situation.”
Response Efforts and Health
6. Several doctors in Sierra Leone were on strike for a second day on Tuesday to demand better care for medical workers who catch EVD, after a spate of recent deaths. The doctors want assurances that they will have access to life saving equipment, like dialysis machines, if they become infected.
Outreach and Education
15. Yesterday, on Anti-Corruption Day, UNDP in collaboration with Liberia’s Anti-Corruption Commission and the Carter Center set up public conversations on community radio stations in Bong, Lofa, Rural Montserrado and Nimba counties regarding how EVD response funds are used locally. County task forces collected and shared data for the wider public on who the donors are, how much they are funding, what activities and equipment they are contributing to, and which groups are being targeted. Community members made suggestions on existing gaps and possible priorities. To encourage people to listen to the shows in remote areas, 1,200 solar radios manufactured by South Africa based NGO Lifeline Energy were distributed across the four counties. UNDP plans to scale up the initiative and distribute another 3,000 radios targeting patients in ETUs, survivors and others.

9 December 2014 |
Response Efforts and Health
4. Yesterday UNMEER received 20,000 sets of Personal Protective Equipment (PPE) from the Japan Disaster Relief Team. This is the first batch of 700,000 sets of PPEs committed by the government of Japan to UNMEER to help provide critical protection to healthcare workers in Guinea, Liberia, Sierra Leone and Mali. At the official handover ceremony in Accra, SRSG Banbury thanked the government of Japan and stressed the need for continued contributions from partners around the world to keep up the fight against EVD.
6. Community resistance increased in the past week in certain areas of Guinea, even leading to violent actions by local communities against EVD responders — including a UNICEF contractor. At the same time, resistance has been overcome in other areas.
Essential Services
17. Two EVD-waste management machines have arrived in Freetown, Sierra Leone. The machines will be installed in two EVD treatment facilities: in a military hospital in Freetown and the Hastings Treatment Centre in Waterloo. Two medical waste advisors and two machinists will ensure the machines are installed properly, work effectively, and that staff are trained on how to use them safely. The sterilizing machines, known as autoclaves, decontaminate and compress used medical equipment and waste through several cycles of high-pressure steam and vacuuming, allowing for their safe disposal. The machines are the first of their kind in any of the Ebola-affected countries. UNDP expects a total of 11 autoclaves for ETCs across the country.

8 December 2014 |
Key Political and Economic Developments
1. Liberia’s Supreme Court on Sunday lifted a government order suspending campaigning in and around the capital for next week’s senate election, imposed on the grounds that campaigning risks spreading EVD. President Ellen Johnson Sirleaf’s government imposed the executive order last week, banning the holding of political rallies in Montserrado County, which includes the capital. It was contested by her son, Robert Sirleaf, who is running as an independent candidate for the senate. He had appealed for a temporary lifting of the ban, arguing that to stop campaigning in just one part of the country is discriminatory. The court will hear a petition on Monday by some political parties, civil society groups and others to postpone national senate polls until EVD is defeated.
2. The National Coordinator of Guinea’s National Ebola Response Cell (NERC) informed UNMEER that, on instructions from President Condé, a number of cabinet ministers left for the field to meet with local authorities and the population in sub-prefectures featuring community resistance. The ministers were instructed to sensitize and inform the population about the government’s response strategy, reinforce the authority of the prefectural EVD response coordinators, and ensure the swifter deployment of comités de veille (community watch committees), which President Condé has criticized as progressing too slowly. President Condé has also instructed the NERC and its pillar heads to start undertaking field missions from 8 December to show the government’s resolve to intensify response efforts.
Human Rights
3. WHO informed that EVD contact tracing efforts had to be suspended in the village of Sanassia in Sanguiana sub-prefecture (Kouroussa prefecture, Guinea) as well as in the sub-prefecture of Watanga (Macenta prefecture) due to local community resistance, including alleged death threats against EVD response workers.
5. Around 20 United Nations peacekeepers placed under quarantine in Mali after they were potentially exposed to EVD more than three weeks ago have been released. The soldiers were being treated at a clinic in the capital Bamako for injuries sustained while serving in MINUSMA, when a nurse working at the facility died of EVD. The MINUSMA solders were then placed under quarantine, but have not presented symptoms of illness and have therefore been released. Mali has registered eight cases of EVD so far: 7 confirmed and 1 probable. 6 patients have died.
7. An UNMIL peacekeeper who contracted EVD has arrived in the Netherlands for treatment on Saturday. The Nigerian man was admitted to the University Medical Center in Utrecht. The Netherlands follows Germany, France and Switzerland in taking on EVD patients at the request of the World Health Organization.
Essential Services
19. UNICEF released essential drugs and supplies to three ngo partners to cover 40% of health facilities, as part of the restoration of essential health services effort in Liberia.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 6 December 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 6 December 2014

blog edition: comprised of the 35+ entries to be posted below on 7 December 2014

Editor’s Note: SDG Milestone
The UN Secretary General addressed the General Assembly on 4 December 2014 to present the Synthesis Report below. The Report attempts to distill the SGD work to date, and speak to the current 17 goals and 169 targets identified. At the end of this edition we present the full text of the section of the report which outlines six, newly-drafted, “essential elements for delivering on the SDGs” which will likely provide a new focus for GA debate and a new conceptual platform for the SDG work ahead. This was also distributed as a special edition of The Sentinel on 4 December 2014]

The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet – Synthesis Report of the Secretary-General On the Post-2015 Agenda
United Nations
New York
December 2014 :: 47 pages
pdf:http://sustainabledevelopment.un.org/content/documents/5527SR_advance%20unedited_final.pdf
[p.20]
3.3. Six essential elements for delivering on the SDGs
:: Dignity: to end poverty and fight inequalities
:: People: to ensure healthy lives, knowledge, and the inclusion of women and
children
:: Prosperity: to grow a strong, inclusive, and transformative economy
:: Planet: to protect our ecosystems for all societies and our children
:: Justice: to promote safe and peaceful societies, and strong institutions
:: Partnership: to catalyse global solidarity for sustainable development

Announcing New Synthesis Report on Post-2015 Development Agenda, Secretary-General Tells General Assembly Future Goals Must Focus on Human Rights, Prosperity
4 December 2014
SG/SM/16396-GA/11596-DEV/3155
Following are UN Secretary-General Ban Ki-moon’s remarks to the General Assembly on the Synthesis Report on the Post-2015 Development Agenda, in New York, on 4 December:
December 2014…