Global Reduction in HIV-related Maternal Mortality: ART as a Key Strategy

Dr. Holtz and colleagues present a synthesis of evidence from published studies over the previous decade on the collective impact of HIV-targeted interventions on maternal mortality. Amongst an assortment of interventions [that include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A and selenium), and antibiotics], only ART reduced maternal mortality among HIV-infected pregnant and post-partum mothers. These fi ndings have fundamental and global strategic implications. They are also timely since they provide the evidence that ART reduces HIV-related maternal mortality, and by further enhancing access to ART in HIV-challenged and poor regions of the world, signifi cant improvement in maternal morbidity and mortality indices could be attained. The paper bears good tidings and sound scientifi c proof that the fi nancial investment made globally by government and non-governmental organizations and agencies to reduce the global burden of HIV/AIDS primarily by making ART more accessible to regions of the world most affected by the epidemic is beginning to show benefi cial effects not only in terms of numerical reductions in the rates of new cases of HIV/AIDS among women, but also in maternal mortality levels. Key words: Maternal mortality • HIV-related maternal mortality • Pregnant mothers • Post-partum mothers • HIV-targeted interventions • Anti-retroviral therapy • Systematic review Copyright © 2015 Salihu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Global Reduction in HIV-related Maternal Mortality: ART as a Key Strategy

Dr. Holtz and colleagues present a synthesis of evidence from published studies over the previous decade on the collective impact of HIV-targeted interventions on maternal mortality. Amongst an assortment of interventions [that include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A and selenium), and antibiotics], only ART reduced maternal mortality among HIV-infected pregnant and post-partum mothers. These findings have fundamental and global strategic implications. They are also timely since they provide the evidence that ART reduces HIV-related maternal mortality, and by further enhancing access to ART in HIV-challenged and poor regions of the world, significant improvement in maternal morbidity and mortality indices could be attained. The paper bears good tidings and sound scientific proof that the financial investment made globally by government and non-governmental organizations and agencies to reduce the global burden of HIV/AIDS primarily by making ART more accessible to regions of the world most affected by the epidemic is beginning to show beneficial effects not only in terms of numerical reductions in the rates of new cases of HIV/AIDS among women, but also in maternal mortality levels

Place of Residence and Inequities in Adverse Pregnancy and Birth Outcomes in India

Background and Objectives: India, the second most populous country in the world, has two-thirds of its population living in rural areas. Rural women in developing countries like India have worse access to healthcare compared to their urban counterparts. We examined the association between place of residence and various pregnancy and birth outcomes among Indian women. Methods: We analyzed data from the 2015-2016 India Demographic and Health Survey (DHS). Sociodemographic and reproductive health-related information were obtained from Indian women of reproductive age. We calculated the prevalence of selected pregnancy and birth outcomes among the study participants. We conducted adjusted survey log binomial regression to determine the level of association between place of residence and various pregnancy and birth outcomes. Results: About 66.4% of the survey responders resided in villages. When adjusted for covariates, rural women had increased likelihood of experiencing miscarriage, stillbirth, early neonatal, late neonatal and infant mortality as compared to urban women. Urban women had 22% higher likelihood (PR = 1.22, 95% CI=1.10-1.35) of having an abortion as compared to rural dwellers. Conclusion and Global Health Implications: Despite India’s extensive efforts to improve maternal and reproductive health, wide geographical disparities exist between its urban and rural population. Interventions at various socio-ecologic and cultural levels, along with improved health literacy, access to improved health care and sanitation need attention when formulating and implementing policies and programs for equitable progress towards improved maternal and reproductive health. Key words: • India • Maternal and reproductive health • Pregnancy outcomes • Birth outcomes • Miscarriage • Stillbirth • Neonatal mortality • Infant mortality • Abortion • Health equity   Copyright © 2020 Dongarwar and Salihu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

COVID-19 Pandemic: Marked Global Disparities in Fatalities According to Geographic Location and Universal Health Care

Since its outbreak, COVID-19 pandemic has been the biggest global concern with exponentially increasing number of cases and associated deaths across all habitable continents. Various countries around the world with their diverse health care systems, have responded to the pandemic in very distinctive ways. In this paper, we: compared COVID-19 mortality rates across global geographic regions; and assessed differences in COVID-19-related case fatality rate (CFR) based on presence or absence of Universal Health Coverage (UHC). We found that as of May 6, 2020, Europe had experienced the highest CFR globally of 9.6%, followed by 5.9% in North America. Although the pandemic originated in Asia, the continent ranked second to the last in terms of CFR (3.5%). Countries with UHC had lower number of cases of 37.6%, but the CFR of countries with UHC was twice that of countries without UHC (10.5% versus 4.9%). In conclusion, UHC does not appear to protect against mortality in a pandemic environment such as with COVID-19. Key words: • COVID-19 • Global disparity • Universal Health Coverage • Case fatality rate

Third Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 9, 2020

This year’s summit was unique given the COVID-19 pandemic: a major global outbreak that has imposed severe restrictions in all aspects of our life. At the outset, we were faced with three mutually exclusive options. First option was to cancel the summit in its entirety: this was the easiest and most obvious choice once the COVID-19 pandemic forced a near total lockdown all over the country with unprecedented disruptions of normal daily activities as the disease announced its thunderous touchdown on United States (US) soil. It was also the most-logical response faced with uncertainty regarding summit logistics and expected poor attendance due to the raging pandemic. Second option was to conduct a digital summit restricted to local audiences at Baylor College of Medicine: this option entailed implementing a virtual summit with attendance restricted to participants from our institution only. It sounded like a reasonable choice but that would impede the presence of diversity of topics, perspectives, insights and experiential learning opportunities, which are what render the summit exciting and worth attending. And finally, the last option was to conduct a digital unrestricted summit open to all interested audiences throughout the US. The conduct of a virtual summit open to all participants from around the country was initially considered daunting given the likelihood of amplified technical problems associated with an array of internet access differentials around the country, which would require a strong Information Technology (IT) presence throughout the sessions. Nonetheless, the attractiveness of going national with a virtual summit, despite the pandemic and logistical challenges, slowly gained converts and became the dominant choice. The response and level of participation in this first virtual summit showed an unanticipated surge despite the increase in registration fees to cover IT costs. This year, we had attendees from all regions of the US as well as from the United Kingdom. The range of topics was quite diverse encompassing health disparities in relation to cancers, nutrition, musculo-skeletal disorders, amputation rates, vaccination uptakes and COVID-19 infections. Various solutions were passionately presented to address these disparities including novel health technologies, community engagement and partnerships, improvement in health literacy and alternative therapeutics. There were no hitches despite the complex breakout sessions, and above all, attendees were satisfied and offered outstanding evaluation scores. This was definitely a summit that metamorphosed from pessimism to a triumphant success!   Copyright © 2020 Salihu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0)which permits unre-stricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited

Current and Emerging Issues in Global Health: An Introduction to Special Journal Collection

We are thrilled to present this special collection of articles entitled “Current and Emerging Issues in Global Health.” This special collection pursued three main goals. First, the collection presents an opportunity for innovation. Second, it presents an opportunity to engage the field and community around a common theme. Finally, the collection provides a reality-check for the journal editors to support the field in evaluating the extent to which we have collectively attempted to confront the global maternal and child health (MCH) issues of our time regardless of where in the world we live. Unique to this special collection is the geographical spread of the article submissions. We have articles and contributions from researchers and research groups from three continents in a single edition: Africa, Asia and North America, making the articles opportunities for crossfertilization of ideas across the global North and South. Public health is passing through a seismic transformation. Whether at the global, national, state, and local levels, disease outbreaks, patient demographics, and health technology have changed the global health landscape in a way never imagined. Our hope is that papers in this special collection will spark new ideas for invention, improved patient care, and transform population health. Key words: • Global health • Maternal and child health • Father’s health • Mother’s health • Pediatrics • HIV/AIDS • MCH   Copyright © 2020 Salihu and Azuine. This is an open-access article distributed under the terms of the Creative Com - mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The Collective Impact Index (CII): A New Instrument to Evaluate and Foster Collaborative Partnership in Public Health practice

Background or Objectives: Collective Impact (CI) is the sum of collaborative actions through coalition building to examine and address issues that threaten public health. We sought to develop an instrument to measure CI across diverse health-related organizations. Methods: The study was performed in 5 phases initiated with a comprehensive literature review through the generation of candidate items using a deductive instrument development approach. A matrix was then created to map assembled items onto related CI domains. An one-hundred and nine (n=109) item questionnaire covering multiple items per domain was administered to 200 health-related organizations selected randomly throughout the United States. Survey data were evaluated using Principal Component Analysis and Kaiser criterion or eigenvalue-greater-than-one rule was the factor retention method utilized. Results: Based on Kaiser’s eigenvalue criteria and communality estimates, the number of items across the five domains of CI was reduced from 109 to 20, with 4 items populating each subdomain. All communality estimates in the final instrument had values > 0.6, which was sufficiently adequate as per Kaiser’s criterion. Conclusion and Global Health Implications: This pilot study demonstrates CI represents a multifactorial concept with domains that are multi-dimensional capturing diverse aspects of a construct. We developed the first measure of CI for public health practice. The index bears potential utility for assessing and monitoring areas of strengths and weaknesses within collaborative partnerships across the spectrum of population health. Key words: Collaborative Partnerships. CI. Federal Healthy Start. Program Evaluation. Index. Public Health Practice Copyright © 2018 Salihu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap

The COVID-19 pandemic threatens to set back major successes that have been achieved in global vaccine initiatives. We conducted a rapid review and synthesis of the literature on immunization provision and Utilization since the onset of the COVID-19 pandemic. A total of 11 papers comprising peer-reviewed articles and key policies and guidelines, published between January 1 and June 15, 2020, were analyzed. Widespread disruptions of routine immunization and vaccination campaigns were reported leaving millions of children worldwide at risk of measles outbreaks. We present an expanded model of the World Health Organization’s Global Routine Immunization Strategic Plan (GRISP) action areas as a tool to help countries quickly adapt to immunization challenges in the presence of COVID-19 and close the emerging immunization coverage gaps. Key words: • Immunization • Child health • Vaccination • COVID-19 • Essential health services • Corona virus   Copyright © 2020 Olorunsaiye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited

Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi

Objectives: To determine the association between access to health care among pregnant women in Malawi and occurrence of obstetric vesicovaginal fistula (VVF). Methods: This was a case-control study using data obtained from patients’ records documented by the ‘Fistula Care Center-Bwaila Hospital’ in Malawi. Socio-demographic characteristics of women with VVF (study arm, n=1046) and perineal tear (control arm, n=37) were examined. A composite variable called “Malawi Healthcare Access Index” (MHAI) was created through summation of scores related to three factors of access to care: (1) walking distance to closest health center; (2) presence of trained provider at delivery; and (3) receipt of antenatal care. Binomial logistic regression models were built to determine the association between the MHAI and presence of VVF. Results: Obstetric VVF was more common in women from rural areas, mothers delivering at extremes of age, those with less education, and patients with long labor (>12 hours). In adjusted models, women with “insufficient” health access based on the MHAI were at greater risk (OR = 2.64, 95%CI = 1.07 – 6.03) of obstetric VVF than women with “sufficient” score on the MHAI. Conclusion and Global Health Implications: Inadequate access to essential obstetric care increases the risk of VVF. Key words: • Health care index • Obstetric complications • Vesicovaginal fistula • Poverty • Malawi • Malawi Healthcare Access Index   Copyright © 2020 Rupley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Socio-ecological Model as a Framework for Overcoming Barriers and Challenges in Randomized Control Trials in Minority and Underserved Communities

Background:  Numerous barriers and challenges can hinder the successful enrollment and retention of study participants in clinical trials targeting minority populations. To conduct quality research, it is important to investigate these challenges, determine appropriate strategies that are evidence-based and continue seeking methods of improvement. Methods:  In this paper, we report such experiences in a registered clinical trial in an underserved minority population in the Southern part of United States. This research study is a randomized doubleblind controlled clinical trial that tests the efficacy of higher-strength as compared to low-strength/standard of care folic acid to prevent fetal body and brain size reduction in pregnant women who smoke.  A unique approach in this socio-behavioral, genetic-epigenetic clinical trial is that we have adopted the socio-ecological model as a functional platform to effectively achieve and maintain high participant recruitment and retention rates. Results:  We highlight the barriers we have encountered in our trial and describe how we have successfully applied the socio-ecological model to overcome these obstacles. Conclusions and Global Health Implications:  Our positive experience will be of utility to other researchers globally. Our findings have far-reaching implications as the socio-ecological model approach is adaptable to developed and developing regions and has the potential to increase recruitment and retention of hard-to-reach populations who are typically under-represented in clinical trials. Key words: Participant Enrollment • Recruitment • Genetic-Epigenetics • Socio-Ecological Model (SEM) • Clinical Trials • Retention • Challenges Copyright © 2015 Salihu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited