HelpAge International [to 25 October 2014]
125 years on – world’s first state pension still shaping lives across the globe
Berlin, October, 2014 – On the 125th anniversary of Otto von Bismarck’s creation of the world’s first state pension, a conference assessing his international legacy and the future of pensions globally will be held in Berlin.
Posted: 24 October 2014
International Rescue Committee [to 25 October 2014]
October 23, 2014
The plight of unaccompanied children [IRC REPORT]
The arrival of tens of thousands of unaccompanied children from Honduras, El Salvador and Guatemala at the Texas-Mexico border this summer sparked a media frenzy and a political backlash around the country. With mounting evidence that many of these children are fleeing gang-related violence in their home countries, the International Rescue Committee expressed concern early on that the message of “illegal immigration” did not tell the whole story.
In order to understand the situation first-hand, in July and August the IRC undertook a fact-finding mission to Texas and Arizona. This report shares what the IRC learned about why children from Central America are fleeing, what problems and needs they have upon arrival in the United States, and what steps the U.S. government should take to improve the response in the future.
Download the report: The arrival of unaccompanied minors from Central America to the U.S. border (October 2014) [PDF]
Ebola in New York: Here are the facts [COMMENTARY]
October 23, 2014 by The IRC ntelligence, not panic, will win the fight against Ebola says International Rescue Committee senior health director Emmanuel d’Harcourt in an opinion piece published yesterday on Ebola Deeply.
Even as a new case of Ebola is confirmed in the United States — a Manhattan physician recently returned from treating patients with the virus in Guinea — it is important to remember that Ebola in New York is not the same as Ebola in West Africa. “The chances of an Ebola outbreak in the U.S. or Europe are extremely low,” says Dr. d’Harcourt, “much lower than events we don’t worry about as much, such as extreme weather conditions or the flu.”
Setting out the facts about Ebola and what’s needed to prevent its spread, Dr. d’Harcourt explains that the only way we can protect the U.S. is by containing the epidemic at its source in West Africa. In hard-hit Liberia and Sierra Leone, the IRC is working to do just this by supporting Ebola response efforts across all fronts: treatment, surveillance, aid agency coordination, and community engagement. Learn more about the IRC’s Ebola response.»
Read Dr. d’Harcourt’s Oct. 22 Ebola Deeply op-ed in full: Intelligence, Not Panic, Will Win the Fight Against Ebola By Emmanuel d’Harcourt
ICRC – International Committee of the Red Cross [to 25 October 2014]
http://www.icrc.org/eng/resources/index.jsp
The Geneva Conventions 150 years later … still relevant?
Article
23 October 2014
State representatives from 16 African countries gathered in Pretoria in September to reflect on the development of the law of war and the continued relevance of the Geneva Conventions.
The discussions took place at the 14th Annual Southern Africa Regional Seminar on International Humanitarian Law (IHL), an annual event co-hosted by the Department of International Relations and Cooperation (DIRCO) of the government of South Africa and the ICRC. This year it brought together government representatives from Angola, Botswana, Comoros, Democratic Republic of the Congo, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, Swaziland, South Africa Zambia and Zimbabwe to review the current status of ratification and implementation of IHL in their countries…
Status of additional protocols relating to the protection of victims of armed conflicts: ICRC statement to the United Nations, 2014
Statement
21 October 2014
Status of the Protocols Additional to the Geneva Conventions of 1949 and relating to the protection of victims of armed conflicts, United Nations, General Assembly, 69th session, Sixth Committee, item 79 of the agenda, statement by the ICRC, New York, 21 October 2014.
In light of the forthcoming 32nd International Conference of the Red Cross and Red Crescent, we would like to focus today on the implementation of the outcomes of the 31st International Conference in 2011 by the International Committee of the Red Cross (ICRC). As you recall, the ICRC was invited to identify and propose concrete options and recommendations for enhancing the effectiveness of international humanitarian law (IHL) compliance mechanisms, and to work towards strengthening the legal protection of persons deprived of their liberty in relation to non-international armed conflict (NIAC). This work is proceeding on two tracks…
IRCT [to 25 October 2014]
News
Finnish ratification of OPCAT welcomed
23 October 2014
The IRCT welcomes the Finnish government’s ratification of the UN’s Optional Protocol to the Convention Against Torture (OPCAT).
The treaty was ratified on 8 October 2014 and will come into force on 7 November 2014.
The Protocol aims to strengthen the protection of persons deprived of their liberty against torture and other cruel, inhuman or degrading treatment or punishment, as well as to emphasise the duty of States to prevent torture.
News
Sub-Saharan African IRCT members discuss regional strategy in Rwanda
Twenty IRCT members from the Sub-Saharan Africa region are meeting in the Rwandan capital Kigali for their annual regional meeting from 21-24 October.
Alongside representatives from the 20 member centres, attendees include representatives from local, regional and global non-governmental organisations and human rights groups.
The four-day event, held at the Hotel Lemigo in Kigali, is a forum to discuss subjects related to the prevention of torture and rehabilitation of torture victims in the sub-Saharan Africa region. Topics include migration, sexual violence, detention and the current obstacles to torture rehabilitation….
SOS-Kinderdorf International [to 25 October 2014]
Syria: War has denied children their right to education
Three years of brutal conflict in Syria have reversed more than a decade of progress in children’s education. Today over two million of Syria’s 4.8 million school-aged children are not in school and are missing out on their right to an education.
21 October 2014 – Before 2011, when the war began in Syria, basic education was free and more than 90% of primary school-aged children were enrolled in school – one of the highest rates in the Middle East…
But three years of brutal conflict in Syria have reversed more than a decade of progress in children’s education. Today 2.2 million of Syria’s 4.8 million school age children are not in school as a result of the conflict, and more than half a million Syrian refugee children now living outside of Syria are not in school either.
The collapse of Syria’s education system has been most profound in areas hit hardest by violence. In Al Raqqa, Idleb, Aleppo, Deir Azzour, Hama and Daraa less than half of all children today attend school. Idleb and Aleppo have lost a quarter and a sixth of their schools respectively – with attendance plunging below 30 per cent.
Since the war began, more than 4,000 schools across Syria have been destroyed, damaged or turned into shelters for displaced people. The right to a quality education is guaranteed to all children under the UN Convention on the Rights of the Child, but Syria’s children are not able to enjoy it….
SOS for students
SOS Children’s Villages Syria has focused on helping schools serving orphaned and displaced children.
Before the new school year started in mid-September, SOS emergency teams distributed 6,600 school bags and stationary to needy children in and around Damascus. During 2013, SOS Children’s Villages donated 16,000 school bags and stationery.
SOS Children’s Villages’ emergency relief in Syria has also included the delivery food and essential household supplies, potable water, and warm winter coats for children.
Tostan [to 25 October 2014]
October 22, 2014
Tostan’s Annual Report 2013 Published
Today we are thrilled to announce that Tostan’s 2013 Annual Report has been published and is available in the Annual Reports and Financials section of our website. 2013 …
October 20, 2014
Press Release: Tostan involved in awareness raising activities on Ebola in Guinea
Over the past couple of months, Guinea has been confronted with the serious Ebola epidemic which, due to the surprising apparition of the disease and the unpreparedness of …
Start Network [Consortium of British Humanitarian Agencies] [to 25 October 2014]
http://www.start-network.org/news-blog/#.U9U_O7FR98E
October 22, 2014
The unexpected impact of insecurity, access and health facility closures
From July to September 2014, the Start Fund responded to humanitarian needs following conflict and displacement in Yemen. International Medical Corps implemented a health intervention, integrated with some nutrition activities. Insecurity and access issues posed challenges during implementation, as did health facility closures in the targeted areas. IMC’s longer-term approach and presence in Yemen have helped staff to respond to these challenges.
MacArthur Foundation
http://www.macfound.org/
Publication
Youth Perspective on Being Tried as Adults
Published October 24, 2014
A report from the John Howard Association of Illinois, a nonpartisan prison watchdog group and MacArthur grantee, explores how young people who have been tried, convicted and imprisoned as adults understand and perceive the process, and makes a number of recommendations for improving it. The report chronicles six young offenders’ experiences with the system and offers steps that policymakers can take to improve the fairness and effectiveness of the criminal justice system’s response to youth prosecuted for serious offenses.
– See more at: http://www.macfound.org/press/publications/youth-perspective-being-tried-adults/#sthash.uKwHuUEI.dpuf
MSF/Médecins Sans Frontières
:: Ebola: MSF Urges Immediate Action on Vaccines and Treatments for Frontline Workers
October 24, 2014
[Excerpts]
Geneva—Following a high-level meeting on access and funding for Ebola vaccines convened yesterday by World Health Organization (WHO), Doctors Without Borders/Médecins Sans Frontières (MSF) has urged that plans to get forthcoming Ebola vaccines and treatments to frontline workers must be rapidly implemented. Significant investment and incentives are needed now to accelerate these steps.
“The message we heard from WHO that the people fighting the epidemic will be among the first to test Ebola vaccines and treatments is exactly the one we needed to hear,” said Dr. Bertrand Draguez, medical director for MSF. “Now urgent action is needed to get those promises delivered in West Africa as soon as possible. This needs to be followed by massive roll out of vaccines to the general population once their efficacy is proven.”
“It crucial that people from Ministries of Health, aid agencies, and communities who are holding the response to the epidemic together, and ensuring access to essential health care, are protected,” Dr. Draguez added. “Resources everywhere are stretched to almost breaking point; everyone is at capacity, but it is extremely hard for the people treating and sustaining the response to do it with absolutely no safety net. Safe and effective treatments and vaccines could offer just that.”
Staff who should be prioritized to test the vaccines include health care workers, community workers, and people who support the Ebola response such as hygiene personnel, ambulance drivers, health promoters, contact tracers, and people in charge of funerals. Medical staff providing care for other diseases than Ebola should also be prioritized to receive test vaccines.
While the focus of the WHO meeting was on Ebola vaccines, new treatments and diagnostics for the disease are also urgently needed to allow people treating the epidemic to do their jobs effectively and efficiently.
“The rapid development and deployment of safe and effective experimental treatments is also critical,” said Dr. Draguez. “Today, doctors and nurses involved in the struggle against Ebola are getting more and more frustrated as they have no treatment for patients with a disease that kills up to 80 percent of them.”…
…Large-scale investment in all front-running vaccines, drugs, and diagnostics is vital and sufficient resources for clinical trials and post-trial access need to be mobilized by donors now. The scientific data generated for each product under clinical trials should be published in real time, and a pooled bank of samples should be established to facilitate open research. But the lack of approved Ebola products to this point highlights a key issue that must be urgently addressed; the lack of sufficient investment and incentives to develop them.
“Appropriate incentives that give industry a reason to develop these vital tools for Ebola are needed now—government and donors must line up to help here,” Dr. Balasegaram said. “We need researchers and developers to conduct clinical trials in parallel with scaling up production supply, which we know has its inherent risks. Governments and donors must help incentivize this risk, and the path to regulation in getting approved, safe and effective vaccines and treatments on the ground in West Africa needs to be a smooth one.”
BMC Medical Ethics
(Accessed 25 October 2014)
http://www.biomedcentral.com/bmcmedethics/content
Research article
Attitude towards informed consent practice in a developing country: a community-based assessment of the role of educational status
Kenneth Amaechi Agu, Emmanuel Ikechukwu Obi, Boniface Ikenna Eze and Wilfred Okwudili Okenwa
Author Affiliations
BMC Medical Ethics 2014, 15:77 doi:10.1186/1472-6939-15-77
Published: 22 October 2014
Abstract (provisional)
Background
It has been reported by some studies that the desire to be involved in decisions concerning one’s healthcare especially with regard to obtaining informed consent is related to educational status. The purpose of this study, therefore, is to assess the influence of educational status on attitude towards informed consent practice in three south-eastern Nigerian communities.
Methods
Responses from consenting adult participants from three randomly selected communities in Enugu State, southeast Nigeria were obtained using self- / interviewer-administered questionnaire.
Results
There were 2545 respondents (1508 males and 1037 females) with an age range of 18 to 65 years. More than 70% were aged 40 years and below and 28.4% were married. More than 70% of the respondents irrespective of educational status will not leave all decisions about their healthcare to the doctor. A lower proportion of those with no formal education (18.5%) will leave this entire decision-making process in the hands of the doctor compared to those with tertiary education (21.9%). On being informed of all that could go wrong with a procedure, 61.5% of those with no formal education would consider the doctor unsafe and incompetent while 64.2% of those with tertiary education would feel confident about the doctor. More than 85% of those with tertiary education would prefer consent to be obtained by the doctor who will carry out the procedure as against 33.8% of those with no formal education. Approximately 70% of those who had tertiary education indicated that informed consent was necessary for procedures on children, while the greater number of those with primary (64.4%) and no formal education (76.4%) indicated that informed consent was not necessary for procedures on children. Inability to understand the information was the most frequent specific response among those without formal education on why they would leave all the decisions to the doctor.
Conclusion
The study showed that knowledge of the informed consent practice increased with level of educational attainment but most of the participants irrespective of educational status would want to be involved in decisions about their healthcare. This knowledge will be helpful to healthcare providers in obtaining informed consent.
Conflict and Health
[Accessed 25 October 2014]
http://www.conflictandhealth.com/
Case study
Engaging frontline health providers in improving the quality of health care using facility-based improvement collaboratives in Afghanistan: case study
Rahimzai M, Naeem AJ, Holschneider S and Hekmati AK Conflict and Health 2014, 8:21 (22 October 2014)
Research
The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states
Hill PS, Pavignani E, Michael M, Murru M and Beesley ME Conflict and Health 2014, 8:20 (22 October 2014)
Review
Health systems and gender in post-conflict contexts: building back better?
Percival V, Richards E, MacLean T and Theobald S Conflict and Health 2014, 8:19 (22 October 2014)
Health Policy and Planning
Volume 29 Issue 7 October 2014
http://heapol.oxfordjournals.org/content/current
Acceptability of conditions in a community-led cash transfer programme for orphaned and vulnerable children in Zimbabwe
Morten Skovdal1,2, Laura Robertson3, Phyllis Mushati4, Lovemore Dumba5, Lorraine Sherr6,
Constance Nyamukapa3,4 and Simon Gregson3,4
Author Affiliations
1Institute of Social Psychology, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK, 2Save the Children, 1 St John’s Lane, EC1M 4AR, London, UK, 3Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Praed Street, W2 1NY, London, UK, 4Biomedical Research and Training Institute, No. 10 Seagrave Road, Avondale, Harare, Zimbabwe, 5Catholic Relief Services, 95 Park Lane, Harare, Zimbabwe and 6Department of Infection and Population Health, Royal Free Hospital, Rowland Hill Street, NW3 2PF, University College London, London, UK
Accepted July 8, 2013.
Abstract
Evidence suggests that a regular and reliable transfer of cash to households with orphaned and vulnerable children has a strong and positive effect on child outcomes. However, conditional cash transfers are considered by some as particularly intrusive and the question on whether or not to apply conditions to cash transfers is an issue of controversy. Contributing to policy debates on the appropriateness of conditions, this article sets out to investigate the overall buy-in of conditions by different stakeholders and to identify pathways that contribute to an acceptability of conditions.
The article draws on data from a cluster-randomized trial of a community-led cash transfer programme in Manicaland, eastern Zimbabwe. An endpoint survey distributed to 5167 households assessed community members’ acceptance of conditions and 35 in-depth interviews and 3 focus groups with a total of 58 adults and 4 youth examined local perceptions of conditions. The study found a significant and widespread acceptance of conditions primarily because they were seen as fair and a proxy for good parenting or guardianship. In a socio-economic context where child grants are not considered a citizen entitlement, community members and cash transfer recipients valued the conditions associated with these grants. The community members interpreted the fulfilment of the conditions as a proxy for achievement and merit, enabling them to participate rather than sit back as passive recipients of aid.
Although conditions have a paternalistic undertone and engender the sceptics’ view of conditions being pernicious and even abominable, it is important to recognize that community members, when given the opportunity to participate in programme design and implementation, can take advantage of conditions and appropriate them in a way that helps them manage change and overcome the social divisiveness or conflict that otherwise may arise when some people are identified to benefit and others not.
Health and access to care for undocumented migrants living in the European Union: a scoping review
Aniek Woodward1,2,*, Natasha Howard1 and Ivan Wolffers3
Author Affiliations
1Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, 2King’s International Development Institute and King’s Centre for Global Health, King’s College London, London, WC2R 2LS, UK and 3Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
Accepted July 11, 2013.
Abstract
Background
Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990–2012), thus clarifying what is known, key gaps, and potential next steps.
Methods
Authors used Arksey and O’Malley’s six-stage scoping framework, with Levac, Colquhoun and O’Brien’s revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights.
Results
Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005–2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels.
Conclusions
This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.
Does the distribution of healthcare utilization match needs in Africa?
Igna Bonfrer1,*, Ellen van de Poel1, Michael Grimm2,3 and Eddy Van Doorslaer1,4
Author Affiliations
1Institute of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands, 2Department of Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany, 3International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, 2518 AX, The Hague, The Netherlands and 4Erasmus School of Economics, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
Accepted September 9, 2013.
Abstract
An equitable distribution of healthcare use, distributed according to people’s needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). We examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities we find that wealth is the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that our findings are likely to even underestimate actual inequities in health care. At a macro level, we find that a better match of needs and use is realized in those countries with better governance and more physicians. Given the absence of social health insurance in most of these countries, policies that aim to reduce inequities in access to and use of health care must include an enhanced capacity of the poor to generate income.
International Journal of Sustainable Development & World Ecology
Volume 21, Issue 5, 2014
http://www.tandfonline.com/toc/tsdw20/current#.U_nO92MXxyI
Higher education level teaching of (master’s) programmes in sustainable development: analysis of views on prerequisites and practices based on a worldwide survey
Walter J.V. Vermeulena*, Margien C. Bootsmaa & Maurice Tijma
DOI:10.1080/13504509.2014.944956
pages 430-448
Received: 4 Dec 2013
Accepted: 29 Jun 2014
Published online: 20 Aug 2014
Abstract
The concept of sustainable development (SD) has highly been debated since it was presented 25 years ago, with ‘hard science’ approaches on one side and more process-oriented approaches on the other side. Academic teaching in SD has emerged in response to this in very different contexts, partly mirroring this academic debate. Some master’s programmes in SD take a strong science approach, while other programmes focus on the process of implementing sustainability projects, sometimes connected with forms of action research and teaching. In this article, we identify diverse views on the concept of SD as well as views on most relevant modes of teaching. We discuss core competencies required for sustainability professionals in their working practices and we organise them in three main clusters: Know, Interact and Be (KIB). The article presents the results of a worldwide survey, which addresses these visions on the concept of SD, the capabilities needed for ‘sustainable development professionals’ and the teaching approach needed. The analysis is based on the responses of 54 lecturers and 287 students active in 34 SD master’s programmes on all continents. The results of this worldwide survey are discussed. We observe in practice some gaps between preferences and practice. Looking at what both lecturers and students see as essential topics to address, some topics get relatively less attention (like the population issue). The identified core competencies (KIB) are supported and all addressed in practice, while the ‘Be’ competencies receive relatively less attention. Suggested consequences for academic teaching include a further matching of programmes with perceived needs and bridging the gap between the experienced teaching approaches in practice with such identified needs
Knowledge Management for Development Journal
Vol 10, No 2 (2014)
http://journal.km4dev.org/journal/index.php/km4dj/index
Editorial
Knowledge management for development in Africa
Charles Dhewa, Kingo MChombu, Jean Mège, Gwen Wilkins
This issue of the Knowledge Management for Development Journal focuses on what has happened in Africa in the field of knowledge management for development (KM4D). During the last couple of years, there has been a significant increase in knowledge management interventions in development programmes across the African continent and a strong engagement of practitioners in Africa, members of the Knowledge Management for Development (KM4Dev)1 community, to develop national KM4Dev groups. Lately, the following groups have been active: Ethiopia KM4Dev group, Senegal KM4Dev group and Burkina Faso KM4Dev group, and there is also a KM4DESA for Eastern and Southern Africa…
The Lancet
Oct 25, 2014 Volume 384 Number 9953 p1477 – 1548
http://www.thelancet.com/journals/lancet/issue/current
Editorial
National armies for global health?
The Lancet
October, 2014, has seen unprecedented deployment of both US and British military personnel to support the efforts in west Africa against the Ebola crisis. Up to 4000 US troops could be deployed in Liberia as part of Operation United Assistance. The British Army commenced Operation Gritrock with the departure of a medical team on Oct 16 to Sierra Leone. “This unit has been the Vanguard medical regiment for the past 20 months which means we are on high readiness to deploy at short notice to anywhere in the world”, said Lieutenant Colonel Alison McCourt from 22 Field Hospital in Aldershot. This capacity to rapidly assemble highly trained personnel experienced in operating in extreme and dangerous conditions is just one factor that makes the military well suited to respond in such humanitarian crises, along with resources, expertise in logistics, transportation, and command and control.
Although countries like the UK and Australia contribute to humanitarian missions, by far the bulk of global support comes from the USA. Involvement of US military personnel in global health activities has increased substantially during the past decade, according to a report published on Oct 8 by the Center for Strategic and International Studies. The report, entitled Global Health Engagement: Sharpening a Key Tool for the Department of Defense, highlights the key role that the military health system could play in “the nation’s health, diplomacy and development goals”, but also criticises previous activities in global health engagement carried out by the US Department of Defense (DoD).
Much of this criticism focuses on the poor coordination of DoD efforts alongside other civilian agencies, which still provide the vast majority of humanitarian global aid. Before the Ebola effort, DoD spending on global health engagement was estimated at US$600 million, compared with $9 billion from civilian agencies. The report describes an ad-hoc short-term focus, and accuses the DoD’s global health efforts of poor appreciation of local cultural norms, little high-level oversight, and failure to properly assess effectiveness. However, the report acknowledges that since 2010, when a mandate for “promoting global health” was introduced into the US National Security Strategy, substantial developments have occurred in internal organisation, quality control, and inter-agency coordination. Specific examples include the formation of the new military position of DoD’s global health engagement coordinator and efforts to undertake extensive outreach to civilian agencies.
The DoD has also released a report which discusses the increasing demands on the DoD to provide humanitarian assistance as a consequence of climate change. The report 2014 Climate Change Adaptation Roadmap describes climate change as a “threat multiplier”, with the potential to exacerbate existing challenges to US national security. This is the first report from the DoD that acknowledges that climate change-related global extreme weather events are already creating unstable conditions that affect national security, creating demands for more frequent disaster relief because of hunger, poverty, conflict, and population displacement.
The stated aims of the DoD have moved from just protecting the health of US forces and US citizens from security threats to “partnering with other nations to achieve security cooperation and build partner capacity”. But this concept reflects the challenges posed by placing military personnel in sites of public health emergencies: the goals of deployments are in support of military strategy rather than as a purely humanitarian action. The use of the military for humanitarian operations is not militarily, politically, or legally neutral. Peacekeeping with combat troops has often proved to be a complicated arrangement and at times at odds with humanitarian needs and sometimes a precursor to hostility.
The 2007 UN Oslo Guidelines clearly state that military assets should only be used as a last resort in situations where “there is no comparable civilian alternative…to meet a critical humanitarian need”—a position reinforced by AJP-9, NATO’s doctrine on civil military cooperation. This situation is clearly the case with the Ebola epidemic, the scale and severity of which has outstripped the capacity of the humanitarian global health community. But should this involvement challenge the current position on military involvement in humanitarian catastrophes or prompt us to strengthen civilian global health systems?
As the DoD has recognised, the security of one nation’s citizens is inextricably linked to others through both global health and climate change. Therefore, the military seem set to play a greater part in global civilian health in the future. The question is what should this role look like in the 21st century?
Comment
Polio endgame management: focusing on performance with or without inactivated poliovirus vaccine
Kimberly M Thompson
Preview |
In The Lancet, Jacob John and colleagues1 report results from a randomised trial of 450 children from Vellore, India, aged 1–4 years that assessed the effects of giving a dose of inactivated poliovirus vaccine (IPV) to children previously immunised with five or more doses of oral poliovirus vaccine (OPV) at least 6 months before the study. The results confirm that an extra dose of IPV in this population increases serum antibodies.2 The study goes further to show that the IPV dose boosts individual intestinal immunity in OPV-vaccinated children, at least for a short period of time.
Effect of a single inactivated poliovirus vaccine dose on intestinal immunity against poliovirus in children previously given oral vaccine: an open-label, randomised controlled trial
Jacob John MD a *, Sidhartha Giri MD a *, Arun S Karthikeyan MSc a, Miren Iturriza-Gomara PhD a b, Prof Jayaprakash Muliyil DrPH a, Prof Asha Abraham PhD a, Prof Nicholas C Grassly DPhil a c Prof Gagandeep Kang PhD a
Summary
Background
Intestinal immunity induced by oral poliovirus vaccine (OPV) is imperfect and wanes with time, permitting transmission of infection by immunised children. Inactivated poliovirus vaccine (IPV) does not induce an intestinal mucosal immune response, but could boost protection in children who are mucosally primed through previous exposure to OPV. We aimed to assess the effect of IPV on intestinal immunity in children previously vaccinated with OPV.
Methods
We did an open-label, randomised controlled trial in children aged 1—4 years from Chinnallapuram, Vellore, India, who were healthy, had not received IPV before, and had had their last dose of OPV at least 6 months before enrolment. Children were randomly assigned (1:1) to receive 0•5 mL IPV intramuscularly (containing 40, 8, and 32 D antigen units for serotypes 1, 2, and 3) or no vaccine. The randomisation sequence was computer generated with a blocked randomisation procedure with block sizes of ten by an independent statistician. The laboratory staff did blinded assessments. The primary outcome was the proportion of children shedding poliovirus 7 days after a challenge dose of serotype 1 and 3 bivalent OPV (bOPV). A second dose of bOPV was given to children in the no vaccine group to assess intestinal immunity resulting from the first dose. A per-protocol analysis was planned for all children who provided a stool sample at 7 days after bOPV challenge. This trial is registered with Clinical Trials Registry of India, number CTRI/2012/09/003005.
Findings
Between Aug 19, 2013, and Sept 13, 2013, 450 children were enrolled and randomly assigned into study groups. 225 children received IPV and 225 no vaccine. 222 children in the no vaccine group and 224 children in the IPV group had stool samples available for primary analysis 7 days after bOPV challenge. In the IPV group, 27 (12%) children shed serotype 1 poliovirus and 17 (8%) shed serotype 3 poliovirus compared with 43 (19%) and 57 (26%) in the no vaccine group (risk ratio 0•62, 95% CI 0•40—0•97, p=0•0375; 0•30, 0•18—0•49, p<0•0001). No adverse events were related to the study interventions.
Interpretation
The substantial boost in intestinal immunity conferred by a supplementary dose of IPV given to children younger than 5 years who had previously received OPV shows a potential role for this vaccine in immunisation activities to accelerate eradication and prevent outbreaks of poliomyelitis.
Funding
Bill & Melinda Gates Foundation.
Effectiveness of maternal pertussis vaccination in England: an observational study
Gayatri Amirthalingam MFPH a, Nick Andrews PhD b, Helen Campbell MSc a, Sonia Ribeiro BA a, Edna Kara MBBS a, Katherine Donegan PhD d, Norman K Fry PhD c, Prof Elizabeth Miller FRCPath a, Mary Ramsay FFPH a
Summary
Background
In October, 2012, a pertussis vaccination programme for pregnant women was introduced in response to an outbreak across England. We aimed to assess the vaccine effectiveness and the overall effect of the vaccine programme in preventing pertussis in infants.
Methods
We undertook an analysis of laboratory-confirmed cases and hospital admissions for pertussis in infants between Jan 1, 2008, and Sept 30, 2013, using data submitted to Public Health England as part of its enhanced surveillance of pertussis in England, to investigate the effect of the vaccination programme. We calculated vaccine effectiveness by comparing vaccination status for mothers in confirmed cases with estimates of vaccine coverage for the national population of pregnant women, based on data from the Clinical Practice Research Datalink.
Findings
The monthly total of confirmed cases peaked in October, 2012 (1565 cases), and subsequently fell across all age groups. For the first 9 months of 2013 compared with the same period in 2012, the greatest proportionate fall in confirmed cases (328 cases in 2012 vs 72 cases in 2013, −78%, 95% CI −72 to −83) and in hospitalisation admissions (440 admissions in 2012 vs 140 admissions in 2013, −68%, −61 to −74) occurred in infants younger than 3 months, although the incidence remained highest in this age group. Infants younger than 3 months were also the only age group in which there were fewer cases in 2013 than in 2011 (118 cases in 2011 vs 72 cases in 2013), before the resurgence. 26 684 women included in the Clinical Practice Research Datalink had a livebirth between Oct 1, 2012 and Sept 3, 2013; the average vaccine coverage before delivery based on this cohort was 64%. Vaccine effectiveness based on 82 confirmed cases in infants born from Oct 1, 2012, and younger than 3 months at onset was 91% (95% CI 84 to 95). Vaccine effectiveness was 90% (95% CI 82 to 95) when the analysis was restricted to cases in children younger than 2 months.
Interpretation
Our assessment of the programme of pertussis vaccination in pregnancy in England is consistent with high vaccine effectiveness. This effectiveness probably results from protection of infants by both passive antibodies and reduced maternal exposure, and will provide valuable information to international policy makers.
Funding
Public Health England.
Series
Homelessness
The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations
Seena Fazel, John R Geddes, Margot Kushel
Homelessness
Health interventions for people who are homeless
Stephen W Hwang, Tom Burns
The Lancet Global Health
Nov 2014 Volume 2 Number 11 e616 – 671
http://www.thelancet.com/journals/langlo/issue/current
Editorial
Polio: is the end in sight?
Zoë Mullan
Preview |
World Polio Day, on October 24, is an annual opportunity to revitalise attention and efforts towards the global eradication of this now rare but still fatal and devastatingly disabling infectious disease. 2014 has not felt like a good year for infectious disease control, yet just 3 months from now, a major date in the Polio Eradication and Endgame Strategic Plan 2013–18 will be reached. The first objective of the plan, launched in April last year, was “to stop all [wild poliovirus] transmission by the end of 2014”.
Comment
Inactivated polio vaccine launch in Nepal: a public health milestone
Andreas Hasman, Hendrikus C J Raaijmakers, Douglas J Noble
Preview |
On Sept 18, 2014, as part of the Global Polio Eradication Initiative (GPEI), Nepal became the first GAVI-supported country in the world to introduce one dose of inactivated poliomyelitis vaccine (IPV) into routine immunisation schedules at 14 weeks. The launch at Tribhuvan University Teaching Hospital, Kathmandu, is a significant step, but there are challenges ahead.
Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study
Shefali Oza, Simon N Cousens, Joy E Lawn
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Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial
Thomas Clasen, Sophie Boisson, Parimita Routray, Belen Torondel, Melissa Bell, Oliver Cumming, Jeroen Ensink, Matthew Freeman, Marion Jenkins, Mitsunori Odagiri, Subhajyoti Ray, Antara Sinha, Mrutyunjay Suar, Wolf-Peter Schmidt
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Effect of antenatal multiple micronutrient supplementation on anthropometry and blood pressure in mid-childhood in Nepal: follow-up of a double-blind randomised controlled trial
Delan Devakumar, Shiva Shankar Chaube, Jonathan C K Wells, Naomi M Saville, Jon G Ayres, Dharma S Manandhar, Anthony Costello, David Osrin
Preview | Summary | Full Text | PDF
New England Journal of Medicine
October 23, 2014 Vol. 371 No. 17
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Doing Today’s Work Superbly Well — Treating Ebola with Current Tools
François Lamontagne, M.D., Christophe Clément, M.D., Thomas Fletcher, M.R.C.P., Shevin T. Jacob, M.D., M.P.H., William A. Fischer, II, M.D., and Robert A. Fowler, M.D.C.M., M.S.(Epi)
N Engl J Med 2014; 371:1565-1566
October 23, 2014
DOI: 10.1056/NEJMp1411310
The Ebola outbreak that is ravaging West Africa is a daily staple of the lay press and of scholarly medical publications. Ebola evokes fear among both the public and clinicians. It also evokes a sort of therapeutic nihilism — after all, if there is no treatment, what can be done? And without an Ebola-specific antiviral medication, of what use are infectious-disease clinicians? Without oxygen, let alone mechanical ventilators, how can acute and critical care clinicians possibly contribute?
We have traveled several times to West Africa and done primary patient care in treatment centers and hospitals in Guinea (Conakry and Guéckédou), Sierra Leone (Kenema, Bo, and Daru), and Liberia (Monrovia, Bong, and Foya). Before each trip, as we prepared to go to the front lines of Ebola medical care as part of World Health Organization and Médecins sans Frontières clinical teams, we, too, felt a certain unease about treating a highly transmissible infection for which there is no vaccine, no specific therapy, and a high mortality rate. Yet we also appreciated that most viral illnesses, and certainly most critical illnesses, have no specific therapy. And after spending much of the past 5 months treating patients with Ebola virus disease (EVD), we are convinced that it’s possible to save many more patients. Our optimism is fueled by the observation that supportive care is also specific care for EVD — and in all likelihood reduces mortality. Unfortunately, many patients in West Africa continue to die for lack of the opportunity to receive such basic care…
PLoS One
[Accessed 25 October2014]
http://www.plosone.org/
Research Article
The Complex Emergency Database: A Global Repository of Small-Scale Surveys on Nutrition, Health and Mortality
Chiara Altare mail, Debarati Guha-Sapir
Published: October 21, 2014
DOI: 10.1371/journal.pone.0109022
Abstract
Evidence has become central for humanitarian decision making, as it is now commonly agreed that aid must be provided solely in proportion to the needs and on the basis of needs assessments. Still, reliable epidemiological data from conflict-affected communities are difficult to acquire in time for effective decisions, as existing health information systems progressively lose functionality with the onset of conflicts. In the last decade, health and nutrition humanitarian agencies have made substantial progress in collecting quality data using small-scale surveys. In 2002, a group of academics, non-governmental organizations, and UN agencies launched the Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology. Since then, field agencies have conducted thousands of surveys. Although the contribution of each survey by itself is limited by its small sample and the impossibility to extrapolate results to national level, their aggregation can provide a more stable view of both trends and distributions in a larger region. The Complex Emergency Database (CEDAT) was set up in order to make best use of the collective force of these surveys. Functioning as a central repository, it can provide valuable information on trends and patterns of mortality and nutrition indicators from conflict-affected communities. Given their high spatial resolution and their high frequency, CEDAT data can complement official statistics in between nationwide surveys. They also provide information of the displacement status of the measured population, pointing out vulnerabilities. CEDAT is hosted at the Centre for Research on the Epidemiology of Disasters, University of Louvain. It runs on voluntary agreements between the survey implementer and the CEDAT team. To date, it contains 3309 surveys from 51 countries, and is a unique repository of such data.
PLoS Neglected Tropical Diseases
(Accessed 25 October 2014)
http://www.plosntds.org/
A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka
Barbara Häsler, Elly Hiby, Will Gilbert, Nalinika Obeyesekere, Houda Bennani, Jonathan Rushton Research Article | published 23 Oct 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003270
Abstract
Background
One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.
Methodology/Principal Findings
A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.
Conclusions
The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.
Author Summary
Successful rabies control generates benefits in terms of improved human and animal health and well-being and safer environments. A key requirement of successful and sustainable rabies control is empowering policy makers to make decisions in an efficient manner; essential to this is the availability of evidence supporting the design and implementation of the most cost-effective strategies. Because there are many, at times differing, stakeholder interests and priorities in the control of zoonotic diseases, it is important to assess intervention strategies in a holistic way. This paper describes how different methods and data from multiple disciplines can be integrated in a One Health framework to provide decision-makers with relevant information, and applies it to a case study of rabies control in Colombo City, Sri Lanka. In Colombo City, a new comprehensive intervention was initiated in 2007 based on vaccination, sterilisation, education, and dog managed zones. Results showed that for the four year time period considered, the new measures overall cost approximately US $ 1 million more than the previous programme, but achieved a reduction in dog rabies cases and human distress due to dog bites, reduced animal suffering and stimulated a perception of positive changes in society. All these achievements have a value that can be compared against the monetary cost of the programme to judge its overall worth.
From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
North American Journal of Medical Sciences
2014 | Volume : 6 | Issue : 10 |
Thimerosal-containing hepatitis b vaccination and the risk for diagnosed specific delays in development in the united states: A case-control study in the vaccine safety Datalink
David A Geier1, Janet K Kern2, Brian S Hooker3, Paul G King4, Lisa K Sykes4, Mark R Geier1
1 Institute of Chronic Illnesses, Inc, Silver Spring, Maryland, USA
2 Institute of Chronic Illnesses, Inc, Silver Spring, Maryland; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
3 Biology Department, Simpson University, Redding, California, USA
4 CoMeD, Inc, Silver Spring, Maryland, USA
DOI: 10.4103/1947-2714.143284
Page : 519-531
Abstract
Background: Within the first 3 years of life, the brain develops rapidly. Its development is characterized by critical developmental periods for speech, vision, hearing, language, balance, etc.; and alteration in any of the processes occurring in those critical periods can lead to specific delays in development.
Aims: The present study evaluated the potential toxic effects of organic-mercury exposure from Thimerosal (49.55% mercury by weight) in childhood vaccines and its hypothesized possible relationship with specific delays in development.
Materials and Methods: A hypothesis testing case-control study was undertaken to evaluate the relationship between exposure to Thimerosal-containing hepatitis B vaccines administered at specific intervals in the first 6 months among cases diagnosed with specific delays in development and controls born between 1991-2000, utilizing data in the Vaccine Safety Datalink database.
Results: Cases were significantly more likely than controls to have received increased organic-mercury from Thimerosal-containing hepatitis B vaccine administered in the first, second, and sixth month of life.
Conclusion: Though routine childhood vaccination may be an important public health tool to reduce the morbidity and mortality associated with infectious diseases, the present study supports an association between increasing organic-mercury exposure from Thimerosal-containing childhood vaccines and the subsequent risk of specific delays in development among males and females.
Ethics & Behavior
Volume 24, Issue 6, 2014
http://www.tandfonline.com/toc/hebh20/current#.VEvAPBZ4WF8
Peruvian Female Sex Workers’ Ethical Perspectives on Their Participation in an HPV Vaccine Clinical Trial
Brandon Browna*, Mariam Davtyana & Celia B. Fisherb
DOI: 10.1080/10508422.2014.950269 Accepted author version posted online: 14 Aug 2014
Summary:
We examined FSW’s evaluation of social and health risks and benefits, informed consent, incentives, fair treatment, and post-trial care following their participation in an HPV vaccine phase IV clinical trial (Sunflower Study), in which all 200 participants received quadrivalent HPV vaccine and 92% completed all 3 vaccine doses. Sixteen FSWs aged 23-29 years from Lima, Peru were administered semi-structured interviews to assess perceptions of study participation.
Broad themes emerging from content analysis included respect, concerns about privacy protections, absence of stigma, access to healthcare, and abandonment. Most participants reported that staff treated them with empathy, fairness, and dignity, participation provided protection from cancer and an opportunity to privately receive quality sexual health care, they were well prepared by consent procedures, participation was voluntary, and incentives were appropriate. Of note, one participant responded, “If nothing else, they always treated me as a human”. Some participants experienced feelings of desertion when the study ended.
Participants were generally content with all aspects of the study and emphasized its protective and non-coercive attributes. Balancing fear and trust was the most notable broad theme. Participants expressed gratitude for the professional treatment despite normalized stigma regarding their FSW status. Researchers may also need to develop navigation plans to properly transition participants out of research projects once studies have ended to reduce feelings of abandonment. Additional research on perceptions of clinical trial participation is needed to ensure ethical treatment of research participants
Special Focus Newsletters
Dengue Vaccine Imitative Newsletter – October 2014
