Infectious diseases are bound by a complex interplay of factors related as much to the individual as to the physical, social, cultural, political and economic environments. Furthermore each of these factors is in a dynamic state of change, evolving over time as they interact with each other. Simple solutions to infectious diseases are therefore rarely sustainable solutions, this article argues. This calls for interdisciplinary approaches that address complexity. The article proposes that research and the largely biomedical interventions for neglected tropical diseases, largely neglect the social and ecological contexts that lead to the persistence of these diseases.
Monitoring equity and research policy
Social sciences research in neglected tropical diseases: The ongoing neglect in the neglected tropical diseases
Allotey P, Reidpath DD and Pokhrel S: Health Research Policy and Systems 8(32), 21 October 2010
What must be done to enhance capacity for health systems research?
Bennett S, Paina L, Kim C, Agyepong I, Chunharas S and McIntyre D: Global Symposium on Health Systems Research, 2010
This background paper was prepared for the Global Symposium on Health Systems Research, held from 16-19 November 2010 in Switzerland, and it is concerned with how best to enhance capacity for health systems research (HSR), with a particular focus on low- and middle-income countries (LMICs). A systematic review was conducted of initiatives and interventions that have sought to enhance capacity for health systems research, and 73 research papers were included - 49 papers from high-income countries (HICs) and 24 from low- and middle-income countries. The review found that capacity building initiatives focused primarily on the individual and organisational levels and paid less attention to the broader environment, such as national research funding systems and their links to HSR. Governments, donors and non-governmental organisations are urged to invest in co-ordinated efforts to develop additional capacity for health systems research, partly by re-directing funding that currently goes to short-term technical assistance towards longer-term institutional support.
Declining child mortality in northern Malawi despite high rates of infection with HIV
Jahn A, Floyd S, Crampin AC, Mvula H, Mwinuka V, Mwaiyeghele E et al: Bulletin of the World Health Organization 88(10): 746–753, October 2010
This study aimed to determine whether routine surveys, such as the Demographic and Health Surveys (DHS), have underestimated child mortality in Malawi. Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32,000. Between August 2002 and February 2006, 38,617 person-years of observation were recorded for 20,388 children aged < 15 years. There were 342 deaths. Re-census data, follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births, under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30% lower than those from national estimates as determined by routine surveys. The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates.
Measuring and correcting biased child mortality statistics in countries with generalised epidemics of HIV infection
Hallett TB, Gregson S, Kurwa F, Garnett GP, Dube S, Chawira G et al: Bulletin of the World Health Organization 88(10): 761–768, October 2010
In countries with generalized epidemics of human immunodeficiency virus (HIV) infection, standard statistics based on fertility history may misrepresent progress towards this target owing to the correlation between deaths among mothers and early childhood deaths from acquired immunodeficiency syndrome. To empirically estimate this bias, this study collected child mortality data and fertility history, including births to deceased women, through prospective household surveys in eastern Zimbabwe during 1998–2005. According to the empirical data, standard cross-sectional survey statistics underestimated true infant and under-5 mortality by 6.7% and 9.8%, respectively. These estimates were in agreement with the output from the model, in which the bias varied according to the magnitude and stage of the epidemic of HIV infection and background mortality rates. The bias was greater the longer the period elapsed before the survey and in later stages of the epidemic. Bias could substantially distort the measured effect of interventions to reduce non-HIV-related mortality and of programmes to prevent mother-to-child transmission, especially when trends are based on data from a single survey. A mathematical model with a user-friendly interface is available to correct for this bias when measuring progress towards Millennium Development Goal 4 in countries with generalised epidemics of HIV infection.
Monitoring the millennium development goals: The potential role of the INDEPTH Network
Bangha M, Diagne A, Bawah A and Sankoh O: Global Health Action 3(2010), 13 September 2010
The Millennium Declaration, adopted by the United Nations in 2000, set a series of Millennium Development Goals (MDGs) as priorities for UN member countries, committing governments to realising eight major MDGs and 18 associated targets by 2015. Progress towards these goals is being assessed by tracking a series of 48 technical indicators that have since been unanimously adopted by experts. This concept paper outlines the role member Health and Demographic Surveillance Systems (HDSSs) of the INDEPTH Network could play in monitoring progress towards achieving the MDGs. The unique qualities of the data generated by HDSSs lie in the fact that they provide an opportunity to measure or evaluate interventions longitudinally, through the long-term follow-up of defined populations.
Recruiting heterosexual couples from the general population for studies in rural South Africa: Challenges and lessons
McGrath N, Hosegood V, Chirowodza A, Joseph P, Darbes L, Boettiger M and van Rooyen H: South African Medical Journal 100(1): 658-660, October 2010
Couples should be included in HIV prevention research, but their recruitment in southern Africa is challenging given high levels of migration and non-cohabitation, according to the authors of this pilot study. The study describes the recruitment strategies and experiences in rural South Africa when conducting HIV research. With the aim of recruiting 20 couples at mobile voluntary counselling and testing (VCT) caravans and community venues, 75 index partners were screened with an average of four additional contacts required to schedule interviews. The study found that, despite the care taken to maximise recruitment, recruiting just 20 couples required a substantial investment of time and resources, so recruiting and interviewing couples is a feasible option, but requires substantial resources. Given the need to identify effective HIV behavioural interventions in South Africa, the authors believe that couples-focused studies and interventions can be one possible component in efforts to promote testing and reduce HIV transmission.
Small states: Economic review and basic statistics, volume 14
Commonwealth Secretariat: September 2010
This annual collection of key economic and statistical data on states with fewer than five million inhabitants is designed as a reference for economists, planners and policy-makers. The book contains fifty-four tables covering selected economic, social, demographic and Millennium Development Goal indicators culled from international and national sources and presents information unavailable elsewhere. A detailed parallel commentary on trends in Commonwealth small states, looking at growth, employment, inflation, human development, and economic policy, permits a deeper understanding of developments behind the figures. The book also includes three articles focusing on trade in services.
South African Child Gauge 2009/2010
Kibel M, Lake L, Pendlebury P and Smith C (eds): Children's Institute, University of Cape Town, May 2010
South Africa is one of only 12 countries that has failed to reduce child mortality since 1990, according to the South African Child Gauge 2009/2010, an annual review of the situation of children in the country. The review contains essays by child health experts from across the country. While South Africa is making progress towards meeting the Millennium Development Goal (MDG) target on sustainable access to safe drinking water, this has not trickled down to children: Only 64% of children have access to safe drinking water on site. Progress has been slow for access to basic sanitation, education and gender equality. On the MDG targets for reducing child hunger, HIV, tuberculosis and child mortality, South Africa is not making any progress. South Africa has also failed to submit its reports on progress in relation to implementing the United Nations Convention of the Rights of the Child – the key accountability mechanism aimed at monitoring South Africa’s progress in promoting the maximum survival and development of children. Improving child health outcomes requires concerted action from both within and outside the formal health care system. To reduce child mortality, governments should alleviate poverty and eliminate inequality, as well as improve the performance of its health services, and medical interventions should focus on prevention and encourage the participation of children.
Assessing equity in systematic reviews: Realising the recommendations of the Commission on Social Determinants of Health
Tugwell P, Petticrew M, Kristjansson E, Welch V, Ueffing E and Waters E et al: British Medical Journal 341(c4739), 13 September 2010
The Commission on Social Determinants for Health has recommended assessment of health equity effects of public policy decisions, and this study provides guidance on assessing equity for users and authors of systematic reviews of interventions. Particular challenges occur in seven components of such reviews: developing a logic model; defining disadvantage and for whom interventions are intended; deciding on appropriate study design(s); identifying outcomes of interest; process evaluation and understanding context; analysing and presenting data; and judging applicability of results. The study concludes that greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making.
Casebook on ethical issues in international health research
Cash R, Wikler D, Saxena A and Capron A (eds): World Health Organization, 2009
This compilation of case studies in research ethics is designed for use by course instructors and workshop leaders. The editors argue that the use of case studies in workshops and formal courses is an especially valuable teaching tool, as students and workshop participants can grapple with ethical dilemmas and uncertainties in concrete situations. The editors have collected 64 case studies, based on episodes that have occurred in global health research throughout the world. Eight chapters comprise the cases un¬der the following titles: Defining research; Issues in study design; Harm and benefit; Voluntary informed consent; Standard of care; Obligations to participants and communities; Privacy and confidential¬ity; and Professional ethics. Each chapter begins with an introduction that outlines the issues and provides some guidance for the topics addressed in the cases, and ends with a brief annotated list of suggested readings. Questions for discussion follow each case. In each chapter there is cross-referencing to cases in other chapters.