PEPFAR and Partners Launch Pediatric Initiative
01 December 2014
On the occasion of World AIDS Day 2014, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Pediatric HIV Treatment Initiative (PHTI) and the Global Fund to Fight AIDS, Tuberculosis and Malaria announced a new Global Pediatric Antiretroviral (ARV) Commitment-to-Action.” The Commitment-to-Action brings together leading organizations to accelerate the development of new, high-priority pediatric ARV co-formulations for first- and second-line treatment by 2017.

“PEPFAR is deeply committed to expanding children’s access to HIV/AIDS treatment and we need better products for children as fast as possible to succeed,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator. “The prevailing treatment gap between adults and children is unacceptable, and we must all act with urgency to fill it. PEPFAR is pleased to work with the Pediatric HIV Treatment Initiative, the Global Fund, and other partners to accelerate innovation and save children’s lives.”

National governments, international agencies, non-profit product developers, non-governmental organizations, the private sector, and donors are mobilizing around a global effort to accelerate children’s access to HIV/AIDS treatment with the ultimate aim of ending pediatric HIV/AIDS. “The new collaboration between the PHTI, PEPFAR and the Global Fund now provides a real chance to end pediatric AIDS. It brings together all necessary players to achieve the goal: PHTI is focused on developing new effective and easy-to-take medicines, with PEPFAR and the Global Fund poised to make them widely available,” said Lelio Marmora, UNITAID’s Executive Director.

Building on this momentum, the Global Pediatric Antiretroviral Commitment-to-Action aims to accelerate the development and introduction of sufficient quantities of optimal ARV formulations for children globally. This can be achieved by mobilizing and incentivizing originator and generic drug manufacturers to develop and supply ARV medicines, while ensuring affordability, facilitating access, and promoting rapid uptake by national HIV/AIDS programs.
“By working together, we can protect the lives of more children,” said Dr. Mark Dybul, Executive Director of the Global Fund. “Treating children with HIV is a priority that we all agree on.”

PEPFAR, PHTI, and the Global Fund, working together with participating originator and generic pharmaceutical companies, will develop an Operational Framework for the Global Pediatric Antiretroviral Commitment-to-Action by March 31, 2015. Expected outcomes by 2017 include: the development of highest priority pediatric co-formulations for first- and second-line treatment; Public Recognition Awards for relevant generic and originator pharmaceutical companies; and rapid and harmonized regulatory approval of new pediatric ARV formulations.

World Development Report 2015 – Mind, Society, and Behavior
World Bank Group Flagship Report
December 2, 2014 :: 236 pages
:: Download Full Report
:: Website
:: Press Release
:: Infographic
:: Live Event

[Excerpt from World Bank “Feature Story”]
The WDR 2015 holds new insights on how people make decisions; it provides a framework to help development practitioners and governments apply these insights to development policy.

Research in the WDR suggests that poverty constitutes a cognitive tax that makes it hard for poor people to think deliberatively, especially in times of hardship or stress.

When used with existing policy approaches, new tools ranging from simple, low-cost changes such as better framing of messages and changing the timing of aid, can significantly improve outcomes.

Real people are rarely as coherent, forward-looking, strategic or selfish as typically assumed in standard economic models—they sometimes do not pursue their own interests, and can be unexpectedly generous. Such dynamics should be factored more carefully into development policies, a point made in the World Development Report 2015: Mind, Society, and Behavior.

The newly launched report argues that development policies based on new insights into how people actually think and make decisions will help governments and civil society more readily tackle such challenges as increasing productivity, breaking the cycle of poverty from one generation to the next, and acting on climate change.

Drawing from a wealth of research that suggests ways of diagnosing and solving the psychological and social constraints to development, the WDR identifies new policy tools that complement standard economic instruments.

For instance, an experiment in Colombia modified a cash transfer program by automatically saving a part of the funds on behalf of beneficiaries, and then disbursing them as lump a sum at the time when decisions about school enrollment for the next year were being made. This tweak in timing resulted in increased enrollments for the following year.

“Marketers and politicians have long understood the role of psychology and social preferences in driving individual choice,” said Kaushik Basu, Senior Vice President and Chief Economist of the World Bank, “This Report distills new and growing scientific evidence on this broader understanding of human behavior so that it can be used to promote development. Standard economic policies are effective only after the right cognitive propensities and social norms are in place. As such, this WDR can play a major role in enhancing the power of economic policymaking, including standard fiscal and monetary policies. My only worry is that it will be read more diligently by private marketers selling wares and politicians running for office than by people designing development interventions.”

To inspire a fresh look at how development work is done, the Report outlines three principles of human decision making: thinking automatically, thinking socially, and thinking with mental models. Much of human thinking is automatic and depends on whatever comes to mind most effortlessly. People are deeply social and are influenced by social networks and norms. Finally, most people do not invent new concepts; rather they use mental models drawn from their societies and shared histories to interpret their experiences.

Because the factors affecting decisions are local and contextual, it is hard to predict in advance which aspects of program design and implementation will drive the choices people will make. Interventions therefore need to take account of the insights found in the report and be designed through a ‘learning by doing’ approach.

The Report applies the three principles to multiple areas, including early childhood development, productivity, household finance, health and health care, and climate change…

Adding It Up 2014: The Costs and Benefits of Investing in Sexual and Reproductive Health
UNFPA, Guttmacher Institute
2014 :: 56 pages
ISBN: 978-1-934387-18-4
pdf: English
The 2014 edition of Adding It Up expands the scope of the report and provides new estimates of the needs for and costs and benefits of sexual and reproductive health interventions in the following key areas: contraceptive services; maternal, newborn and other pregnancy-related care; selected services related to HIV prevention; and treating women for four other common STIs.

[Excerpt from press release]
Prioritizing sexual and reproductive health will save millions of lives, says new report
4 December 2014
UNITED NATIONS, New York – A staggering 225 million women in developing countries want to avoid pregnancy but are not using modern contraceptives, and tens of millions of women do not receive the basic pregnancy and delivery care they need. These are the findings of Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014, a report released today by the Guttmacher Institute and UNFPA….

…The benefits of family planning and other essential sexual and reproductive health services – such as pregnancy and newborn care, services for pregnant women living with HIV, and treatment for four other sexually transmitted infections – can dramatically improve maternal and newborn survival, reduce rates of unsafe abortion and nearly eliminate the transmission of HIV from mothers to newborns…

Global Wage Report 2014/15 – Wages and income Equality
The Global Wage Report 2014/15 analyses the evolution of real wages around the world, giving a unique picture of wage trends and relative purchasing power globally and by region.
ILO – International Labour Organization
05 December 2014 :: 137 pages
978-92-2-128664-6[ISBN]
:: Summary (PDF)
:: Full report (PDF)
:: Asia and the Pacific supplement (PDF)

The 2014/15 edition examines the link between wages and inequality at the household level. It shows that wages constitute the largest single source of income for households with at least one member of working age in most countries and points to changes in wages and paid employment as key factors underlying recent trends in inequality. The report also considers wage gaps between certain groups, such as those between women and men, migrants and nationals, and workers in the informal and formal economy.

Inequality can be addressed through policies that affect wage distribution directly or indirectly, as well as through fiscal redistribution. However, increasing inequality in the labour market places a heavier burden on efforts to reduce inequality through taxes and transfers. The report thus emphasizes the need for combined policy action that includes minimum wages, strengthened collective bargaining, interventions to eliminate wage gaps, the promotion of paid employment and redistribution through taxes and transfers.

[Excerpt from media release]
Global wage growth stagnates, lags behind pre-crisis rates
The latest ILO Global Wage Report warns of stalled wages in many countries and points to the labour market as a driver of inequality.
GENEVA (ILO News) – Wage growth around the world slowed in 2013 to 2.0 per cent, compared to 2.2 per cent in 2012, and has yet to catch up to the pre-crisis rates of about 3.0 per cent…

Even this modest growth in global wages was driven almost entirely by emerging G20 economies, where wages increased by 6.7 per cent in 2012 and 5.9 per cent in 2013.
By contrast, average wage growth in developed economies had fluctuated around 1 per cent per year since 2006 and then slowed further in 2012 and 2013 to only 0.1 per cent and 0.2 per cent respectively.

“Wage growth has slowed to almost zero for the developed economies as a group in the last two years, with actual declines in wages in some,” said Sandra Polaski, the ILO’s Deputy Director-General for Policy. “This has weighed on overall economic performance, leading to sluggish household demand in most of these economies and the increasing risk of deflation in the Eurozone,” she added.

Kristen Sobeck, economist at the ILO and one of the authors of the report observed that, “the last decade shows a slow convergence of average wages in emerging and developing countries towards those of developed economies, but wages in developed economies remain on average about three times higher than in the group of emerging and developing economies.”…

Landmine Monitor Report 2014
International Campaign to Ban Landmines
[Monitoring and Research Committee, ICBL-CMC Governance Board: Handicap International, Human Rights Watch, Mines Action Canada, Norwegian People’s Aid]
December 2014 :: 74 pages

About this report
This is the 16th annual Landmine Monitor report. It is the sister publication to the Cluster Munition Monitor report, first published in November 2010. Landmine Monitor 2014, launched on the 17th anniversary of the Mine Ban Treaty’s opening for signature, provides a global overview of the landmine situation. Chapters on developments in specific countries and other areas are available in online Country Profiles at http://www.the-monitor.org/cp
Landmine Monitor covers mine ban policy, use, production, trade, and stockpiling in every country in the world, and also includes information on contamination, clearance, casualties, victim assistance, and support for mine action. The report focuses on calendar year 2013, with information included

Excerpt from Media Release
According to the 2014 report, landmines caused fewer casualties in 2013 compared to previous years. Last year, landmine explosions resulted in 3,308 casualties—the lowest figure since 1999, when the Landmine Monitor published its first report. The victims were mostly civilians (79%), and among them 1,065 people died.

:: The use of landmines has almost completely disappeared. This trend indicates that the Ottawa Treaty has been a success.

:: The treaty counts 162 States Parties. Only 35 states have not signed the agreement. The latest violation of the treaty by one of its members dates to 2011, and concerns Yemen. Observers have reported the existence of stockpiles relating to the conflict between Ukrainian government forces and pro-Russian rebels. Ukraine is a State Party to the treaty.

:: Almost 50 million antipersonnel landmines have been destroyed since 1999.

:: The United States announced in June 2014, that it was putting an end to the production and acquisition of anti-personnel mines, saying it would work to comply with the Ottawa Convention in order to eventually join it. In September, the U.S. also announced that it would stop using anti-personnel mines (except on the Korean Peninsula) and would destroy its stockpiles.

:: During the last ten years, very few mines have been transferred globally. The use of landmines was reported in Sudan and Yemen, however, indicating a residual form of the market.

:: However, 56 states, including 32 States Parties to the Treaty, are still contaminated with landmines. Of these, 40 are in a position to clear their territory of mines within a four-year period.

:: At the Maputo Conference in June 2014, the States Parties have set the goal of clearing the world of anti-personnel mines by 2025.

The African Report on Children with Disabilities: Promising starts and persisting challenges
The African Child Policy Forum (ACPF)
December 2014 :: 157 pages

Excerpt from Executive Summary
The overarching aim of ACPF’s The African Report on Children with Disabilities: Promising starts and persisting challenges is to provide description, analysis and synthesis of the situation of children with disabilities across Africa, and to provide concrete recommendations for future policy and programme reform.

The report reviews the situation of children with disabilities from a pan-African perspective, and presents recommendations to promote inclusive and accessible laws, policies, and programmes for children with disabilities throughout Africa. The report is based on extensive research and evidence generated by ACPF and other institutions.

The lack of reliable and appropriately disaggregated data on children with disabilities is an impediment to the formulation of legal frameworks and their implementation. The lack of reliable data stems in part from a lack of standardised definitions of disability and a general lack of nationally representative data. Existing ambiguities in data are also a result of no distinction being made between degrees of severity of impairment.

In addition, data is affected by the fact that parental stigma exacerbates low birth registration of children with disabilities. For example, more than 79 per cent of children with visual impairments and 24 per cent of children with multiple disabilities are not registered in Ethiopia, while in Uganda, about 79 per cent of children with multiple disabilities and 58 per cent of children with intellectual impairments are not registered at birth.

Key Findings
:: Law and policies to promote and protect the rights of children with disabilities are not in place or are poorly monitored or implemented.
:: Data and statistics on children with disabilities are not credible or reliable, are not appropriately disaggregated on the basis of disability, gender and age where needed, and do not accurately capture the number of children with disabilities or their needs.
:: Children with disabilities and their families encounter stigma and discrimination.
:: Multiple barriers create inaccessible infrastructure, information, and communication systems, thus impacting the realisation of rights for children with disabilities.
:: Children with disabilities have limited access to early childhood development, education, health care, rehabilitation, and justice systems.
:: Children with disabilities experience various forms of exploitation, violence and abuse.

The African Child Policy Forum (ACPF) describes itself as an independent, not-for-profit, pan-African institution of policy research and dialogue on the African child. ACPF “was established with the conviction that putting children first on the public agenda is fundamental to the realisation of their rights and wellbeing, and to bringing about lasting social and economic progress in Africa.” http://www.africanchildforum.org http://www.africanchild.info

Editorial
Changing attitudes to child disability in Africa
The Lancet
Nov 29, 2014 Volume 384 Number 9958 p1901 – 1998 e58 – 61
It is a punishment from God, witchcraft, the fault of the mother, reincarnation. These are all frequently stated causes for disability in children in Africa. Such false beliefs are deeply rooted in tradition and culture. In truth, most children with disabilities in Africa have been disabled by the sad predicaments that continue to haunt the continent: war, poverty, and inadequate access to health care. A new report released this week by the African Child Policy Forum draws attention to the challenges facing children with disabilities in Africa.

Africa has a large population of children with disabilities; the prevalence of moderate to severe disability in children aged younger than 14 years is 6•4%. These children are largely invisible in society because of stigma and discrimination by most people, including their parents. They face many physical barriers in daily life, discriminatory practices, and even direct abuse and violence. For example, children with speech impairments are at five times greater risk of neglect and physical abuse than children without disabilities, and three times greater risk of sexual abuse, according to the report. Mortality in children younger than 5 years with disabilities in some African countries is as high as 80%.

The report calls for five priority actions for African nations: put in place and implement appropriate legislation, policy, and programmes in line with the UN Convention on the Rights of Persons with Disabilities; develop and implement effective child protection measures; ensure provision of basic services in a disability-friendly manner; improve physical accessibility of the built environment; and generate evidence and promote evidence-based advocacy and learning.
Children with disabilities have valuable contributions to make to society but are kept from realising their full potential because of people’s attitudes to disability. As Shuaib Chalklen, UN Special Rapporteur on Disability, states in the report, the hope is that its findings will “re-orient society’s thinking and its treatment of children with disabilities, moving from an attitude of rejection and neglect to one of respect and inclusion”. Prominent, respected members of African society have a vital part to play in aiding this reorientation.

UNDP United Nations Development Programme [to 6 December 2014]
http://www.undp.org/content/undp/en/home/presscenter.html

Payment of Ebola workers essential for successful response and recovery, says UNDP
01 Dec 2014
UNDP is helping to coordinate payments to thousands of frontline responders
New York – To strengthen the battle against Ebola, the United Nations Development Programme (UNDP) is working with the authorities in Guinea, Liberia and Sierra Leone to coordinate payments for thousands of treatment centre staff, lab technicians, contacts tracers and burial teams.

“Success in the response, down to the district level, depends on these women and men who are risking their lives every day to fight the disease,” said Helen Clark, the Administrator of UNDP.

“Paying them in a timely manner is crucial. That helps to sustain them and their families, and it ensures a steady inflow of personnel who can help stop this disease outbreak,” she said.

Recognising the commitment of the respective national authorities leading this response, UNDP, working with the UN Mission for Ebola Emergency Response (UNMEER), is tracking payments and improving existing systems through which payments are being delivered to the Ebola response workers.

The objective is not only to support governments – which handle payrolls – and partners to continue to pay the workers’ salaries and incentives on time, but also to strengthen and develop systems that will expand access to affordable financial services after this medical emergency is over.

Reinforcing existing services can help expand the creation of markets, improve poverty reduction and resilience, boost economic growth and recovery, develop livelihoods of people with low incomes and empower women over time.

In Sierra Leone, UNDP technical advisors already assisted the government with two nationwide payments in November of more than 12,000 Ebola response workers, while in Guinea and Liberia, efforts are underway to check lists of workers and reinforce existing payment systems.

Beyond the immediate response, UNDP will also make welfare payments to vulnerable communities affected by the disease, focusing on survivors and families who lost relatives or are helping orphaned children, as well as groups who lost their livelihoods as a result of the crisis.

The socio-economic impact of the Ebola medical emergency will be felt long after the crisis has ended. It is already affecting the means of making a living of millions of the poorest and most vulnerable people in these countries, as well as the ability of governments to provide basic services to their populations.

As part of the broader UN family, UNDP is working to identify and trace people with Ebola; assisting with social mobilization and community engagement; strengthening security agency capacity to prevent further spread of the disease; assessing the socio-economic impact of the outbreak and working with governments on recovery plans.

UNCTAD [to 6 December 2014]
http://unctad.org/en/Pages/Home.aspx

Occupied Palestinian Territory loses at least $306 million per year in public revenue leakage to Israel, new study finds
UNCTAD/PRESS/PR/2014/063
Geneva, Switzerland, (03 December 2014)

The Occupied Palestinian Territory loses at least $306 million annually in leakage of customs, purchase and value added tax revenues that are not transferred to the Palestinian treasury by Israel, a new UNCTAD study suggests.

The study says that fiscal revenue loss amounts to 3.6 per cent of gross domestic product (GDP) and 18 per cent of the tax revenue of the Palestinian National Authority.
The study, Palestinian Fiscal Revenue Leakage to Israel under the Protocol on Economic Relations, indicates that the leaked Palestinian public revenue would give the Palestinian National Authority greater ability to stimulate the economy and increase annual GDP by four percentage points and create additional 10,000 jobs per year.
In order for this leakage to be stemmed, the study makes recommendations to transform it into a more balanced framework consistent with Palestinian economic realities that have greatly changed since 1994. For example, it suggests modifying the Paris Protocol (1994), which remains the general framework governing Palestinian trade relations and economic and tax policies…

IMF [to 6 December 2014]
http://www.imf.org/external/index.htm

FINANCE & DEVELOPMENT – A QUARTERLY PUBLICATION OF THE INTERNATIONAL MONETARY FUND
December 2014 :: Volume 51 :: Number 4
FEATURES – THE FIGHT FOR GLOBAL HEALTH
Overview
The December issue of the IMF’s Finance and Development magazine looks at the serious health issues the world faces today, including infectious diseases such as Ebola fever and noncommunicable diseases such as cancer and mental health disorders. But any look at global health must include more than diseases. The latest issue of F&D magazine examines a panoply of global health concerns—among them the growing importance of regional and local governments in health care delivery, the need for more efficient delivery of health services and for better functioning health systems, and the increasing number of organizations involved in the provision or health services—an area once almost solely the province of the WHO.

World Bank [to 6 December 2014]
http://www.worldbank.org/en/news/all

New Guide Takes Aim at Violence Against Women and Girls
WASHINGTON, December 3, 2014—Violence against women and girls poses a major obstacle to ending poverty, but development agencies and international financial institutions are uniquely positioned to tackle this global epidemic, according to a new resource guide released Wednesday.

“Violence against women and girls is an outrage,” World Bank Group President Jim Yong Kim said. “It demands urgent attention as a violation of fundamental human rights. Along with terrible individual suffering, it also imposes steep, avoidable economic costs on families, communities, and economies—helping keep some of the world’s most vulnerable people in poverty.”

Such violence is widely recognized as hindering social and economic development as well as achievement of internationally agreed targets such as the anti-poverty Millennium Development Goals (MDGs), according to the guide—published by the World Bank Group, the Global Women’s Institute at George Washington University, and the Inter-American Development Bank.

:: Event: Global Launch: Violence Against Women and Girls Resource Guide
:: Violence Against Women and Girls Resource Guide

ECPAT [to 6 December 2014]

International Day for the Abolition of Slavery
Posted on 12/02/2014, 13:40
Today is the International Day for the Abolition of Slavery, which marks the date of the adoption of the UN Convention for the Suppression of the Traffic in Persons and of the Exploitation of the Prostitution of Others on 2 December 1949.
Unfortunately, modern slavery persists across the globe with an estimated 35.8 million people still subjected to contemporary forms of slavery. Millions of children are trafficked for sexual purposes each year, enslaved to the worst forms of child labour and held captive in forced, early and child marriages. The focus of this day is on eradicating present-day slavery in all of its manifestations.
ECPAT works in 78 countries around the world with the goal to end the commercial sexual exploitation of children…

International Rescue Committee [to 6 December 2014]

05 Dec 2014
International Rescue Committee Expands Fight against Ebola; Pioneers Ebola Care with Robust Electronic Medical Records
:: Increasingly commonplace in the West, the IRC is rolling out first-of-its-kind Electronic Medical Records (EMR) in treatment of Ebola
:: To date, most health care workers have used make-shift approaches to keep Ebola patients’ records: scanning files, calling results across a room, relying on individuals’ memories
:: Organization plans to pilot technology when Monrovia Ebola Treatment Unit opens later this month

New York, Dec. 5, 2014 — The International Rescue Committee (IRC) today announced that it is testing and plans to deploy electronic medical records in the fight against Ebola.
IRC teams in West Africa currently are preparing and testing the technology, which is aimed at improving Ebola patients’ care, clinicians’ decision-making, staff safety, and learning for possible future outbreaks. EMRs also will enable the IRC to systematically document the quality of care if provides to patients.

Maintaining health records in an Ebola Treatment Unit is complex:
:: The wet zone is sanitized several times a day with high concentrated chlorine, and no materials can leave the wet zone, and
:: Health care workers dressed in personal protective equipment have reduced time with patients due to the heat, which means written records are hard to keep.
In addition, records from past outbreaks are virtually non-existent, having been incinerated to prevent infection.

Recognizing the challenges and shortcomings of the system, the IRC put information technology, data, business development and medical teams to work to build an approach that improves the quality and efficiency of care. The result is a system that has the potential to dramatically alter the Ebola response in West Africa and which can pave the way for use of electronic health systems in sub-Saharan Africa generally…

MSF/Médecins Sans Frontières [to 6 December 2014]

Press release
Ebola To Be Added to List of Neglected Diseases Eligible for US Government R&D Incentive
December 03, 2014
bbbNEW YORK—A United States government program meant to reward pharmaceutical companies for investing in research and development (R&D) for neglected diseases, and which will soon include Ebola on its list of eligible diseases, is enriching drug companies without ensuring that patients, treatment providers, or governments have access to these lifesaving drugs at an affordable price, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) Monday.

Press release
Ebola: International Response Slow and Uneven
December 02, 2014
BRUSSELS — The international response to the Ebola crisis in West Africa has been slow and uneven leaving local people, national governments and non-governmental organizations (NGOs) to do most of the practical, hands-on work, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, warning that the international community risks failing to adapt to the outbreak after initially failing to respond quickly enough.

ODI [to 6 December 2014]
http://www.odi.org/media

Morocco and Mexico are the big winners from international climate funds, while many poor countries are left behind – new ranking
News – 2 December 2014
The most detailed study yet of international funding to adapt to climate change and cut emissions reveals that half of the US$7.6 billion approved to date is targeted at just ten countries.

In the new report Climate finance: is it making a difference? the Overseas Development Institute (ODI) analyses a decade of contributions and spending to nine major international and two national funds set-up to tackle climate change.

It finds that the top recipients of finance were Morocco, Mexico, and Brazil, receiving half a billion dollars in loans each. Mexico and Brazil are among the top 10 emitters of greenhouse gases, and with Morocco, all have huge renewable energy potential.

Whilst rich oil states in the Middle East have received very little from international climate funds, the report finds that they also have contributed almost nothing to the pot. This is despite being major emitters of greenhouse gases, and the clear link between burning fossil fuels and climate change which is provoking extreme weather conditions and impacting poor countries.

The report includes the first comprehensive breakdown of how climate finance has been spent in 135 countries. It argues that getting climate financing right is crucial to securing an ambitious global agreement on climate change in Paris in 2015…

American Journal of Tropical Medicine and Hygiene
December 2014; 91 (6)
http://www.ajtmh.org/content/current

Modular Laboratories—Cost-Effective and Sustainable Infrastructure for Resource-Limited Settings
Daniel J. Bridges*, James Colborn, Adeline S. T. Chan, Anna M. Winters, Dereje Dengala,
Christen M. Fornadel and Barry Kosloff
Author Affiliations
Akros, Cresta Golfview Grounds, Lusaka, Zambia; President’s Malaria Initiative, U.S. Centers for Disease Control and Prevention, Mozambique; Entomology Branch, Centers for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Abt Associates Inc., Bethesda, Maryland; President’s Malaria Initiative, U.S. Agency for International Development, Washington, DC; London School of Hygiene and Tropical Medicine, Faculty of Tropical Infectious Diseases, Department of Clinical Research, London, United Kingdom; ZAMBART Project, University of Zambia School of Medicine, Lusaka, Zambia
Abstract.
High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world.

Evaluation of Targeted Mass Cholera Vaccination Strategies in Bangladesh: A Demonstration of a New Cost-Effectiveness Calculator
Christopher Troeger, David A. Sack and Dennis L. Chao*
Author Affiliations
Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Abstract
Growing interest in mass vaccination with oral cholera vaccine in endemic and epidemic settings will require policymakers to evaluate how to allocate these vaccines in the most efficient manner. Because cholera, when treated properly, has a low case fatality rate, it may not be economically feasible to vaccinate an entire population. Using a new publicly available calculator for estimating the cost-effectiveness of mass vaccination, we show how targeting high-risk subpopulations for vaccination could be cost-effective in Bangladesh. The approach described here is general enough to adapt to different settings or to other vaccine-preventable diseases.

Economic and Disease Burden of Dengue Illness in India
Donald S. Shepard, Yara A. Halasa, Brij Kishore Tyagi, S. Vivek Adhish, Deoki Nandan, K. S. Karthiga, Vidya Chellaswamy, Mukul Gaba, Narendra K. Arora*, the INCLEN Study Group
Author Affiliations
Brandeis University, Waltham, Massachusetts; Centre for Research in Medical Entomology, Madurai, India; National Institute of Health and Family Welfare, New Delhi, India; INCLEN Trust International, New Delhi, India
Abstract
Between 2006 and 2012 India reported an annual average of 20,474 dengue cases. Although dengue has been notifiable since 1996, regional comparisons suggest that reported numbers substantially underrepresent the full impact of the disease. Adjustment for underreporting from a case study in Madurai district and an expert Delphi panel yielded an annual average of 5,778,406 clinically diagnosed dengue cases between 2006 and 2012, or 282 times the reported number per year. The total direct annual medical cost was US$548 million. Ambulatory settings treated 67% of cases representing 18% of costs, whereas 33% of cases were hospitalized, comprising 82% of costs. Eighty percent of expenditures went to private facilities. Including non-medical and indirect costs based on other dengue-endemic countries raises the economic cost to $1.11 billion, or $0.88 per capita. The economic and disease burden of dengue in India is substantially more than captured by officially reported cases, and increased control measures merit serious consideration.

BMC Infectious Diseases
(Accessed 6 December 2014)
http://www.biomedcentral.com/bmcinfectdis/content

Research article
Persistent low carriage of serogroup A Neisseria meningitidis two years after mass vaccination with the meningococcal conjugate vaccine, MenAfriVac
Paul A Kristiansen1*, Absatou Ky Ba2, Abdoul-Salam Ouédraogo3, Idrissa Sanou34, Rasmata Ouédraogo5, Lassana Sangaré4, Fabien Diomandé67, Denis Kandolo6, Inger Marie Saga1, Lara Misegades7, Thomas A Clark7, Marie-Pierre Préziosi89 and Dominique A Caugant110
Author Affiliations
BMC Infectious Diseases 2014, 14:663 doi:10.1186/s12879-014-0663-4
Published: 4 December 2014
Abstract (provisional)
Background
The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, is currently being introduced throughout the African meningitis belt. In repeated multicentre cross-sectional studies in Burkina Faso we demonstrated a significant effect of vaccination on NmA carriage for one year following mass vaccination in 2010. A new multicentre carriage study was performed in October-November 2012, two years after MenAfriVac mass vaccination.
Methods
Oropharyngeal samples were collected and analysed for presence of N. meningitidis (Nm) from a representative selection of 1-29-year-olds in three districts in Burkina Faso using the same procedures as in previous years. Characterization of Nm isolates included serogrouping, multilocus sequence typing, and porA and fetA sequencing. A small sample of invasive isolates collected during the epidemic season of 2012 through the national surveillance system were also analysed.
Results
From a total of 4964 oropharyngeal samples, overall meningococcal carriage prevalence was 7.86%. NmA prevalence was 0.02% (1 carrier), significantly lower (OR, 0.05, 95% CI, P?=?0.005, 0.006-0.403) than pre-vaccination prevalence (0.39%). The single NmA isolate was sequence type (ST)-7, P1.20,9;F3-1, a clone last identified in Burkina Faso in 2003. Nm serogroup W (NmW) dominated with a carriage prevalence of 6.85%, representing 87.2% of the isolates. Of 161 NmW isolates characterized by molecular techniques, 94% belonged to the ST-11 clonal complex and 6% to the ST-175 complex. Nm serogroup X (NmX) was carried by 0.60% of the participants and ST-181 accounted for 97% of the NmX isolates. Carriage prevalence of serogroup Y and non-groupable Nm was 0.20% and 0.18%, respectively. Among the 20 isolates recovered from meningitis cases, NmW dominated (70%), followed by NmX (25%). ST-2859, the only ST with a serogroup A capsule found in Burkina Faso since 2004, was not found with another capsule, neither among carriage nor invasive isolates.
Conclusions
The significant reduction of NmA carriage still persisted two years following MenAfriVac vaccination, and no cases of NmA meningitis were recorded. High carriage prevalence of NmW ST-11 was consistent with the many cases of NmW meningitis in the epidemic season of 2012 and the high proportion of NmW ST-11 among the characterized invasive isolates.

Research article
Identifying an appropriate PCV for use in Senegal, recent insights concerning Streptococcus pneumoniae NP carriage and IPD in Dakar
Fatim Ba1, Abdoulaye Seck1, Mamadou Bâ2, Aliou Thiongane2, Moussa Fafa Cissé2, Khady Seck3, Madeleine Ndour4, Pascal Boisier5 and Benoit Garin16*
Author Affiliations
BMC Infectious Diseases 2014, 14:627 doi:10.1186/s12879-014-0627-8
Published: 4 December 2014
Abstract (provisional)
Background
Since 2000, the Global Alliance for Vaccines and Immunization (GAVI) and WHO have supported the introduction of the Pneumococcal Conjugate Vaccine (PCV) in the immunization programs of developing countries. The highest pneumococcal nasopharyngeal carriage rates have been reported (40-60%) in these countries, and the highest incidence and case fatality rates of pneumococcal infections have been demonstrated in Africa.
Methods
Studies concerning nasopharyngeal pneumococcal carriage and pneumococcal infection in children less than 5?years old were conducted in Dakar from 2007 to 2008. Serotype, antibiotic susceptibility and minimum inhibitory concentrations were determined. In addition, among 17 overall publications, 6 manuscripts of the Senegalese literature published from 1972 to 2013 were selected for data comparisons.
Results
Among the 264 children observed, 132 (50%) children generated a nasopharyngeal (NP) positive culture with Streptococcus pneumoniae. The five most prevalent serotypes, were 6B (9%), 19?F (9%), 23?F (7.6%), 14 (7.6%) and 6A (6.8%). Fifteen percent of the strains (20/132) showed reduced susceptibility to penicillin and 3% (4/132) showed reduced susceptibility to anti-pneumococcal fluoroquinolones. Among the 196 suspected pneumococcal infections, 62 (31.6%) Streptococcus pneumoniae were isolated. Serogroup 1 was the most prevalent serotype (21.3%), followed by 6B (14.9%), 23?F (14.9%) and 5 (8.5%). Vaccine coverage for PCV-7, PCV-10 and PCV-13, were 36.2% (17/47), 66% (31/47) and 70.2% (33/47) respectively. Reduced susceptibility to penicillin and anti-pneumococcal fluoroquinolones was 6.4% and 4.3%, respectively, and the overall lethality was 42.4% (14/33).
Conclusions
This study confirms a high rate of carriage and disease caused by Streptococcus pneumoniae serotypes contained within the current generation of pneumococcal conjugate vaccines and consistent with reports from other countries in sub-Saharan Africa prior to PCV introduction. Antimicrobial resistance in this small unselected sample confirms a low rate of antibiotic resistance. Case-fatality is high. Introduction of a high valency pneumococcal vaccine should be a priority for health planners with the establishment of an effective surveillance system to monitor post vaccine changes.

BMC Medical Ethics
(Accessed 6 December 2014)
http://www.biomedcentral.com/bmcmedethics/content

Research article
Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care
Marit Helene Hem, Bert Molewijk and Reidar Pedersen
Author Affiliations
BMC Medical Ethics 2014, 15:82 doi:10.1186/1472-6939-15-82
Published: 4 December 2014
Abstract (provisional)
Background
In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?
Methods
We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a ‘bricolage’ approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals’ administrations and all health care professionals who participated in the focus group interviews.
Results
Health care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated “moral enterprise”.
The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital.

BMC Public Health
(Accessed 6 December 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Stigmatizing attitudes towards people living with HIV/AIDS: validation of a measurement scale
Marianne Beaulieu, Alix Adrien, Louise Potvin and Clément Dassa
Author Affiliations
BMC Public Health 2014, 14:1246 doi:10.1186/1471-2458-14-1246
Published: 4 December 2014
Abstract (provisional)
Background
Although stigmatization has long been recognized as a major obstacle to HIV prevention. The lack of a valid and reliable measurement tool for stigmatization is a major gap in the research. This study aimed to: 1) develop a scale of stigmatizing attitudes towards people living with HIV (SAT-PLWHA-S) and 2) demonstrate its reliability and validity.
Methods
French and English-speaking experts (n = 21) from different professional communities (academics, practitioners) assessed the clarity and relevance of the proposed items. The psychometric properties of the SAT-PLWHA-S were assessed with a random digit dial population based telephone survey (n = 1,500) of respondents in Quebec, Canada. Analyses included exploratory and confirmatory factor analyses, correlations, multiple linear regressions, t-tests, hypothesis testing of factorial structure invariance, and Cronbach’s alpha.
Results
Confirmatory factor analysis (CFA) supported a 27-item structure with seven factors: 1) concerns about occasional encounters; 2) avoidance of personal contact; 3) responsibility and blame, 4) liberalism, 5) non-discrimination, 6) confidentiality of seropositive status, and 7) criminalization of HIV transmission. Cronbach’s alphas indicate satisfactory internal consistency. An assessment of concurrent validity using Pearson’s correlation and multiple linear regression shows that homophobia and HIV transmission knowledge are significant determinants of stigmatizing attitudes toward PLHIV. Discriminant validity (t-test) results suggest that the SAT-PLWHA-S can differentiate attitudes between different groups and indicates invariant factor structure across language.
Conclusions
The results of this study suggest that the SAT-PLWHA-S is a reliable and valid tool for measuring stigmatizing attitudes toward PLHIV and that it can contribute to a deeper understanding of HIV stigma.

Bulletin of the World Health Organization
Volume 92, Number 12, December 2014, 849-924
http://www.who.int/bulletin/volumes/92/12/en/

Health-system resilience: reflections on the Ebola crisis in western Africa
Marie-Paule Kieny a, David B Evans a, Gerard Schmets a & Sowmya Kadandale a
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2014;92:850. doi: http://dx.doi.org/10.2471/BLT.14.149278
Disease outbreaks and catastrophes can affect countries at any time, causing substantial human suffering and deaths and economic losses. If health systems are ill-equipped to deal with such situations, the affected populations can be very vulnerable.1

The current Ebola virus disease outbreak in western Africa highlights how an epidemic can proliferate rapidly and pose huge problems in the absence of a strong health system capable of a rapid and integrated response. The outbreak began in Guinea in December 2013 but soon spread into neighbouring Liberia and Sierra Leone.2 In early August 2014, Ebola was declared an international public health emergency.2

At the time the outbreak began, the capacity of the health systems in Guinea, Liberia and Sierra Leone was limited. Several health-system functions that are generally considered essential were not performing well and this hampered the development of a suitable and timely response to the outbreak. There were inadequate numbers of qualified health workers.3 Infrastructure, logistics, health information, surveillance, governance and drug supply systems were weak. The organization and management of health services was sub-optimal. Government health expenditure was low whereas private expenditure – mostly in the form of direct out-of-pocket payments for health services – was relatively high.4

The last decade has seen increased external health-related aid to Guinea, Liberia and Sierra Leone. However, in the context of Millennium Development Goals 4, 5 and 6, most of this aid has been allocated to combat human immunodeficiency virus infection, malaria and tuberculosis, with much of the residual going to maternal and child health services. Therefore, relatively little external aid was left to support overall development of health systems.5 This lack of balanced investment in the health systems contributes to the challenges of controlling the current Ebola outbreak. Weak health systems cannot be resilient.6–8 A strong health system decreases a country’s vulnerability to health risks and ensures a high level of preparedness to mitigate the impact of any crises.

Frequently, the response by governments and external partners to a health crisis posed by a communicable disease, such as Ebola, is to focus solely on reducing transmission and the effect of the disease. However, such a response is insufficient. Febrile individuals need to be screened for Ebola – even if most of them have fevers caused by other infections – and those found to be negative for Ebola still need to be treated rather than simply turned away. Even in the worst-affected areas, women still need antenatal services, safe delivery and postnatal care. Many people will travel to seek care for unrelated conditions in areas that they perceive to be Ebola-free, putting enormous strain on the health system in so-called “non-Ebola” areas. Routine services need to be assured while dealing with the direct effects of an epidemic. Otherwise, more people may die – of unrelated causes – from a general breakdown of health services than as a direct result of the epidemic.

If this Ebola outbreak does not trigger substantial investments in health systems and adequate reforms in the worst-affected countries, pre-existing deficiencies in health systems will be exacerbated. The national governments, assisted by external partners, need to develop and implement strategies to make their health systems stronger and more resilient. Only then can they meet the essential health needs of their populations and develop strong disaster preparedness to address future emergencies. In the short-term, nongovernmental organizations, civil society and international organizations will have to bolster the national health systems, both to mitigate the direct consequences of the outbreak and to ensure that all essential health services are being delivered. However, this assistance should be carefully coordinated under the leadership of the national governments and follow development effectiveness principles. We expect health systems in the worst-affected areas to be left in a very weak state once the outbreak has ended. Hopefully, after the epidemic has ended, economic growth and government health spending will eventually rebound, with increased domestic investments in health systems. For the foreseeable future however, the negative economic impact on the affected countries9 means that substantial external financing will be needed to build stronger national and subnational health systems.
References

Systematic Review
Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review
Ana LP Mateus, Harmony E Otete, Charles R Beck, Gayle P Dolan & Jonathan S Nguyen-Van-Tam
Abstract
Objective
To assess the effectiveness of internal and international travel restrictions in the rapid containment of influenza.
Methods
We conducted a systematic review according to the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Health-care databases and grey literature were searched and screened for records published before May 2014. Data extraction and assessments of risk of bias were undertaken by two researchers independently. Results were synthesized in a narrative form.
Findings
The overall risk of bias in the 23 included studies was low to moderate. Internal travel restrictions and international border restrictions delayed the spread of influenza epidemics by one week and two months, respectively. International travel restrictions delayed the spread and peak of epidemics by periods varying between a few days and four months. Travel restrictions reduced the incidence of new cases by less than 3%. Impact was reduced when restrictions were implemented more than six weeks after the notification of epidemics or when the level of transmissibility was high. Travel restrictions would have minimal impact in urban centres with dense populations and travel networks. We found no evidence that travel restrictions would contain influenza within a defined geographical area.
Conclusion
Extensive travel restrictions may delay the dissemination of influenza but cannot prevent it. The evidence does not support travel restrictions as an isolated intervention for the rapid containment of influenza. Travel restrictions would make an extremely limited contribution to any policy for rapid containment of influenza at source during the first emergence of a pandemic virus.

Post-licensure deployment of oral cholera vaccines: a systematic review
Stephen Martin, Anna Lena Lopez, Anna Bellos, Jacqueline Deen, Mohammad Ali, Kathryn Alberti, Dang Duc Anh, Alejandro Costa, Rebecca F Grais, Dominique Legros, Francisco J Luquero, Megan B Ghai, William Perea & David A Sack
Abstract
Objective
To describe and analyse the characteristics of oral cholera vaccination campaigns; including location, target population, logistics, vaccine coverage and delivery costs.
Methods
We searched PubMed, the World Health Organization (WHO) website and the Cochrane database with no date or language restrictions. We contacted public health personnel, experts in the field and in ministries of health and did targeted web searches.
Findings
A total of 33 documents were included in the analysis. One country, Viet Nam, incorporates oral cholera vaccination into its public health programme and has administered approximately 10.9 million vaccine doses between 1997 and 2012. In addition, over 3 million doses of the two WHO pre-qualified oral cholera vaccines have been administered in more than 16 campaigns around the world between 1997 and 2014. These campaigns have either been pre-emptive or reactive and have taken place under diverse conditions, such as in refugee camps or natural disasters. Estimated two-dose coverage ranged from 46 to 88% of the target population. Approximate delivery cost per fully immunized person ranged from 0.11–3.99 United States dollars.
Conclusion
Experience with oral cholera vaccination campaigns continues to increase. Public health officials may draw on this experience and conduct oral cholera vaccination campaigns more frequently.

PERSPECTIVES
Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda
Lynn P Freedman, Kate Ramsey, Timothy Abuya, Ben Bellows, Charity Ndwiga, Charlotte E Warren, Stephanie Kujawski, Wema Moyo, Margaret E Kruk & Godfrey Mbaruku
doi: 10.2471/BLT.14.137869

Dilemmas of evaluation: health research capacity initiatives
Donald C Cole, Garry Aslanyan, Alison Dunn, Alan Boyd & Imelda Bates
doi: 10.2471/BLT.14.141259