Should outbreak response immunization be recommended for measles outbreaks in middle- and low-income countries? An update.

Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals

How climate change affects human health

Climate change is not only a problem for future generations – it's already happening. Higher mean temperatures are recorded each year, and more people are being affected by disasters, climate-sensitive diseases and other health conditions. Climate change exacerbates some existing health threats and creates new public health challenges

Learning lessons from the 2011 Van Earthquake to enhance healthcare surge capacity in Turkey

Historically, Turkey has adopted a reactive approach to natural hazards which resulted in significant losses. However, following the 1999 Kocaeli Earthquake, a more proactive approach has been adopted. This study aims to explore the way this new approach operates on the ground. A multi-national and multi-disciplinary team conducted a field investigation following the 2011 Van Earthquake to identify lessons to inform healthcare emergency planning in Turkey and elsewhere. The team interviewed selected stakeholders including, healthcare emergency responders, search and rescue services, ambulance services, and health authority representatives, in addition to conducting a focus group. Data were analysed according to an open coding process and SWOT analysis. The findings suggest that the approach succeeded in developing a single vision by consolidating official efforts in a more structured way, mobilising many governmental and non-governmental organisations, securing significant amounts of resources including physical and human, and increasing the resilience and flexibility of infrastructure to expand its capacity. However, more attention is required to the development of stronger management procedures and acquisition of further resources

Rapid assessment of the performance of malaria control strategies implemented by countries in the Amazon subregion using adequacy criteria: case study

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to implement a rapid assessment of the performance of four malaria control strategies (indoor spraying, insecticide-treated bed nets, timely diagnosis, and artemisinin-based combination therapy) using adequacy criteria. The assessment was carried out in five countries of the Amazon subregion (Bolivia, Colombia, Ecuador, Guyana, and Peru).</p> <p>Methods</p> <p>A list of criteria in three areas was created for each of the four strategies: preliminary research that supports the design and adaptation of the control strategies, coverage of the control strategies and quality of the implementation of the strategies. The criteria were selected by the research team and based on the technical guidelines established by the World Health Organization. Each criterion included in the four lists was graded relative to whether evidence exists that the criterion is satisfied (value 1), not satisfied (value 0) or partially satisfied (value 0.5). The values obtained were added and reported according to a scale of three implementation categories: adequate, intermediate and deficient.</p> <p>Results</p> <p>Implementation of residual indoor spraying and timely diagnosis was adequate in one country and intermediate or deficient in the rest. Insecticide-treated bed nets ranged between deficient and intermediate in all the countries, while implementation of artemisinin-based combination therapy (ACT) was adequate in three countries and intermediate in the other two countries evaluated.</p> <p>Conclusions</p> <p>Although ACT is the strategy with the better implementation in all countries, major gaps exist in implementation of the other three malaria control strategies in terms of technical criteria, coverage and quality desiredThe countries must implement action plans to close the gaps in the various criteria and thereby improve the performance of the interventions. The assessment tools developed, based on adequacy criteria, are considered useful for a rapid assessment by malaria control authorities in the different countries.</p

Strengthening climate resilient health systems in the Caribbean

Programme Overview. The 11th European Development Fund is financing this five-year regional programme, 2020-2025. Beneficiary: Caribbean Forum of ACP States (CARIFORUM) + Cuba. Implementing Agency: Pan American Health Organization (PAHO). Using a one-health approach, within the Caribbean Cooperation in Health Phase IV (CCH IV) Framework, this programme will contribute to reduced mortality and morbidity from expected health consequences of climate change in Caribbean countries. It includes linkages to the environmental determinants of health, and COVID-19 prevention and control

Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

BackgroundThere is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.Methods/DesignIntervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.DiscussionSalt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.<br /

Benchmarking scientific performance by decomposing leadership of Cuban and Latin American institutions in Public Health

This is a post-peer-review, pre-copyedit version of an article published in Scientometrics. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11192-015-1831-z”.Comparative benchmarking with bibliometric indicators can be an aid in decision-making with regard to research management. This study aims to characterize scientific performance in a domain (Public Health) by the institutions of a country (Cuba), taking as reference world output and regional output (other Latin American centers) during the period 2003–2012. A new approach is used here to assess to what extent the leadership of a specific institution can change its citation impact. Cuba was found to have a high level of specialization and scientific leadership that does not match the low international visibility of Cuban institutions. This leading output appears mainly in non-collaborative papers, in national journals; publication in English is very scarce and the rate of international collaboration is very low. The Instituto de Medicina Tropical Pedro Kouri stands out, alone, as a national reference. Meanwhile, at the regional level, Latin American institutions deserving mention for their high autonomy in normalized citation would include Universidad de Buenos Aires (ARG), Universidade Federal de Pelotas (BRA), Consejo Nacional de Investigaciones Cientı´ficas y Te´cnicas (ARG), Instituto Oswaldo Cruz (BRA) and the Centro de Pesquisas Rene Rachou (BRA). We identify a crucial aspect that can give rise to misinterpretations of data: a high share of leadership cannot be considered positive for institutions when it is mainly associated with a high proportion of non-collaborative papers and a very low level of performance. Because leadership might be questionable in some cases, we propose future studies to ensure a better interpretation of findings.This work was made possible through financing by the scholarship funds for international mobility between Andalusian and IberoAmerican Universities and the SCImago GroupPeer reviewe

The efficacy of chemical agents in cleaning and disinfection programs

BACKGROUND: Due to the growing number of outbreaks of infection in hospital nurseries, it becomes essential to set up a sanitation program that indicates that the appropriate chemical agent was chosen for application in the most effective way. METHOD: For the purpose of evaluating the efficacy of a chemical agent, the minimum inhibitory concentration (MIC) was reached by the classic method of successive broth dilutions. The reference bacteria utilized were Bacillus subtilis var. globigii ATCC 9372, Bacillus stearothermophilus ATCC 7953, Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923. The strains of Enterobacter cloacae IAL 1976 (Adolfo Lutz Institute), Serratia marcescens IAL 1478 and Acinetobactev calcoaceticus IAL 124 (ATCC 19606), were isolated from material collected from babies involved in outbreaks of infection in hospital nurseries. RESULTS: The MIC intervals, which reduced bacteria populations over 08 log(10), were: 59 to 156 mg/L of quaternarium ammonium compounds (QACs); 63 to 10000 mg/L of chlorhexidine digluconate; 1375 to 3250 mg/L of glutaraldehyde; 39 to 246 mg/L of formaldehyde; 43750 to 87500 mg/L of isopropanol or ethanol; 1250 to 6250 mg/L of iodine in polyvinyl-pyrolidone complexes, 150 to 4491 mg/L of chlorine-releasing-agents (CRAs); 469 to 2500 mg/L of hydrogen peroxide; and, 2310 to 18500 mg/L of peracetic acid. CONCLUSIONS: Chlorhexidine showed non inhibitory activity over germinating spores. A. calcoaceticus, was observed to show resistance to the majority of the agents tested, followed by E. cloacae and S. marcescens

National and sub-national under-five mortality profiles in Peru: a basis for informed policy decisions

BACKGROUND: Information on profiles for under-five causes of death is important to guide choice of child-survival interventions. Global level data have been published, but information at country level is scarce. We aimed at defining national and departmental trends and profiles of under-five mortality in Peru from 1996 through 2000. METHODS: We used the Ministry of Health registered under-five mortality data. For correction of under-registration, a model life-table that fitted the age distribution of the population and of registered deaths was identified for each year. The mortality rates corresponding to these model life-tables were then assigned to each department in each particular year. Cumulative reduction in under-five mortality rate in the 1996–2000 period was estimated calculating the annual reduction slope for each department. Departmental level mortality profiles were constructed. Differences in mortality profiles and in mortality reduction between coastal, andean and jungle regions were also assessed. RESULTS: At country level, only 4 causes (pneumonia, diarrhoea, neonatal diseases and injuries) accounted for 68% of all deaths in 1996, and for 62% in 2000. There was 32.7% of under-five death reduction from 1996 to 2000. Diarrhoea and pneumonia deaths decreased by 84.5% and 41.8%, respectively, mainly in the andean region, whereas deaths due to neonatal causes and injuries decreased by 37.2% and 21.7%. For 1996–2000 period, the andean, coast and jungle regions accounted for 52.4%, 33.1% and 14.4% of deaths, respectively. These regions represent 41.0%, 46.4% and 12.6% of under-five population. Both diarrhoea and pneumonia constitute 30.6% of under-five deaths in the andean region. As a proportion, neonatal deaths remained stable in the country from 1996 to 2000, accounting for about 30% of under-five deaths, whereas injuries and "other" causes, including congenital anomalies, increased by about 5%. CONCLUSION: Under-five mortality declined substantially in all departments from 1996 to 2000, which is explained mostly by reduction in diarrhoea and pneumonia deaths, particularly in the andean region. There is the need to emphasize interventions to reduce neonatal deaths and emerging causes of death such as injuries and congenital anomalies