When  : 1st February, 2017 : 12.00 - 13.00
Where : Building 44, Room 1087, University of Southampton, Highfield

What   : Preventable mortality of children has been targeted as one of the UN’s Sustainable Development Goals for the 2015-30 period. Global decreases in child mortality have been seen, although sub-Saharan Africa remains an area of concern, with child mortality rates remaining high relative to global averages or even increasing in some cases. Furthermore, the spatial distribution of child mortality in sub-Saharan Africa is highly heterogeneous. Thus, research that identifies primary risk factors and protective measures in the geographic context of sub-Saharan Africa is needed.

In this study, household survey data collected by The Demographic and Health Surveys (DHS) are used to evaluate the spatial distribution of child mortality (age 1 to 4) across 27 sub-Saharan Africa countries in relation to a number of demographic and health indicators collected in the DHS surveys. 

The study shows that socio-demographic factors such as birth interval, stunting, access to health facilities and literacy, along with geospatial factors such as prevalence of Plasmodium falciparum malaria, variety of ethnic groups, mean temperature, and intensity of lights at night can explain up to 60% of the variance in child mortality across 255 DHS sub-national areas in the 27 countries.

Additionally, three regions - Western, Central, and Eastern Africa - have markedly different mortality rates.
By identifying the relative importance of policy-relevant socio-demographic and environmental factors, this study highlights priorities for research and programs targeting child mortality over the next decade.

The  talk will be given by Drs Carla Pezzulo and Edson C. Utazi.

The event is organised by the Applied Spacial Modelling Group, University of Southampton. 

The next meeting will be on 1st March, 2017. 

More information from Jessica Steele 

 

Who works in remote settings?

Although doctors and nurses may work in quite isolated places, probably the most isolated are Community Health Workers. 

What is a Community Health Worker?

The umbrella term “community health worker” (CHW) embraces a variety of community health aides selected, trained and working in the communities from which they come.  

As a WHO commissioned report in 2007 (Community health workers: What do we know about them?) described - "While there are some broad trends, CHWs can be men or women, young or old, literate or illiterate. More important is an acknowledgement that the definition of CHWs must respond to local societal and cultural norms and customs to ensure community acceptance and ownership".

The roles and activities of community health workers are enormously diverse throughout their history, within and across countries and across programmes. While in some cases CHWs perform a wide range of different tasks that can be preventive, curative and/or developmental, in other cases CHWs are appointed for very specific interventions." 
 

What has happened since 2007?

Given the lack of doctors, some countries have developed more formal training for Community Health Workers. Zambia, for example, recognised that their existing informal Community Health Volunteers had no formal training and developed a Community Health Worker Strategy that includes a standard training programmes. 


CHWs are in isolated areas. What happens if they are unable to deal with a problem?

This is where difficulties can arise. The nearest doctor may be many miles away and travel may take a long time. Seeking a second opinion can be a difficult decision - you don't want to miss a serious problem, but you also don't want to refer unnecessarily. 


Is this where modern technology might help?

Yes - mHealth (mobile technology for health) does look promising but it is not straightforward and solutions are still emerging. There is a plethora of mHealth projects and a Lancet article has summarised many of the issues to be addressed. Not least of these is programming suitable content. As HealthCare Information for All points out, there is very little available for use by the general public. 


Does Zambia use mHealth to support its CHWs?

There is a project - The Virtual Doctors - based in Brighton that has developed a support system based on text. Its use is now part of CHW training and it provides a proforma for clinical information for the CHW to fill in. This is then sent to volunteer doctors in the UK who can give advice or seek more information by text. The evaluation is good and there has been a reduction in unnecessary referrals and the CHWs have found the experience educational. 
 

Are there other examples where mHealth projects are being used?

An article published in 2014 "Health Care Information for All by 2015" by Chris Hagar Heather Kartzinel reviewed many projects and listed the following as coming out well in their assessment : 
 

1. First Aid App: Produced by the British Red Cross provides advice on first aid situations in the form of videos, quizzes, and step-by-step guides, in additional to tips for emergency preparedness. http://www.redcross.org.uk/What-we-do/First-aid/Mobile-app

2. Health eVillages: Led by the Robert F. Kennedy Center for Justice and Human Rights, Health eVillages provides clinical reference information and decision-making support for medical professionals in numerous countries. http://www.healthevillages.org/

3. HealthPhone: a mobile-phone-based personal video reference library and guide to better health and nutrition practices, for families and communities. Videos are pre-loaded on a microSD memory card to insert in basic mobile feature phones and have been created specifically with the illiterate in mind, and in their language. Gives users direct access to knowledge, in rich multimedia, to learn, share, educate others and use at the time when they need to deal with a health problem, where they are, and as they are, without a connection or cost. http://www.healthphone.org

4. Malezi-Bora: Uses a pay-it-forward approach, relies on the relationships among African mothers to share and disseminate information about maternal and newborn health using low-cost handsets and audio content in the local language. http://www.savinglivesatbirth.net/summaries/34

5. mMitra: A cooperative effort between ARMMAN in India and the University of San Francisco in the USA, provides free mobile messages and animated videos for preventive and time-sensitive care of rural pregnant women and new mothers. The content is presented in the local language and is customized based on the user’s gestational age or age of her newborn. http://www.armman.org/mmitra

6. Newborn Care Series: Contains locally produced, instructional videos on newborn care, free for viewing and download from the internet to smartphones and tablets. Global Health Media and Translators Without Borders are working together to expand the reach of this program; voiced-over versions are available in Swahili and Spanish. http://globalhealthmedia.org/

7. One World: Partners with other NGOs to improve mobile, web, and media technology access and content for global justice. http://oneworld.org

8. Safe Pregnancy and Birth App: Hesperian Health Guides, provider of Where There Is No Doctor developed a free mobile app for health workers on pregnancy and birth control. Available in both English and Spanish. Topics include everyday maternal health as well as emergency care. http://hesperian.org/books-and-resources/safe-pregnancy-and-birth-mobile-app/

9. Scientific Animations Without Borders (SWABO): A non-profit animated video production group based at the University of Illinois at Urbana-Champaign, USA. One of the concentrations is health education. Present outreach spans 15 countries – videos are produced in local languages. http://sawbo-illinois.org/main.htm

What about Wessex?

• The work that began in Wessex with the Colleges to support the further training of doctors will be looking at how to provide support from a distance and electronically. 
• The University of Southampton has experience in e-learning and Dr Sunhea Choi is the Global eHealth Projects Lead. 
• The newly formed Global Health Centre, University of Winchester, has a group looking how to develop remote support and health information. If this is of interest to you then why not contact either 

           Chris Zielinski (Partnerships in Health Information) 

           Laura Broadhurst or Vanessa Emmett (Medicine in the Cloud)


If you know about other pieces of work taking place in Wessex on mHealth or providing remote support for health care staff in Low and Middle Income Countries, then please let us know. 
 

EVENTS
 

 

When  : 6th February, 2017 : 15.30
Where : BOND, London

We'll look at the short term and long term, the direct and indirect implications NGOs need to consider, and how NGOs can manage uncertainty as well as practical issues, such as currency management and the need to open offices in EU member states.

More information and to register
 

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Disability goes global :

The repercussions of the International Year of Disabled Persons (1981) for global health

When  : 9th February, 2017 : 12:45 to 14:00
Where : London School of Hygiene and Tropical Medicine

What   : The presentation seeks to reflect on the impact of the International Year up to the present day by raising the question as to how the concept of disability may be understood in a multicultural world.

1981 was designated by the United Nations the International Year of Disabled Persons, to be followed by the International Decade of Disabled Persons (1982-1993). It was the first occasion to place disability into a global context by endorsing it authoritatively as a human rights issue.

It was in preparation for the International Year that, in 1980 WHO produced the first classification of disability designed for universal application. This classification was based on an ideological framework which reflected the standards of the modern ‘Western world’. It focused on the individual and assumed that equality, independence, self-reliance and personal self-fulfilment are universally desirable and applicable values and that dependence constitutes a problem. 

The conscience of the international community was stirred during the International Year, spawning numerous governmental and non-governmental initiatives in ‘developing’ countries. These initiatives brought into sharp relief the notion that focusing on individual rights runs contrary to accepted norms and practices found in many developing countries, where the disabled person is seen as part of a larger whole: the care-giving family and kinship networks.

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Global health partnerships:

Buzzword or Breakthrough?

 

When  : 22nd February, 2017 : 18.30 – 21.00 9
Where : Royal Society of Medicine, London

What   :  The UK government has announced its intention to boost partnerships between UK institutions and their counterparts in the developing world, but do they really work? This meeting will hear speakers from the UK and low income countries talk about their experiences of DFID’s Health Partnership Scheme.

The event will discuss the pitfalls and opportunities of health partnerships and how they can contribute to health systems strengthening. The speakers will discuss their own experiences of the Health Partnership Scheme and a broader view of development partnerships in the coming year.

Chair for the evening will be Andy Leather (Director of the King’s Centre for Global Health)

Speakers will include 

• Dr Matt Halkes (Consultant Anaesthetist and Director of Education Torbay and South Devon NHS Foundation Trust)
• Opoku Ware Ampomah (Consultant Plastic Surgeon and Director of the National Reconstructive Plastic Surgery and Burns Centre at the Korle- Bu Teaching Hospital, Accra, Ghana)
• Darian Stibb, (Executive Director of The Partnering Initiative)

 

The upcoming election of the next Director-General of the World Health Organization poses a number of questions. Just how critical is this election for the future of the UN health agency? How will the member states choose among those vying for the job, and what kind of leader does this institution need at this moment? 

As WHO shortlists the candidates this week, trimming the field from six to three, David Heymann from Chatham House talks with three leading experts in global health governance about the election and its implications.

Listen to the podcast 
 

While there is great uncertainty about America’s foreign policy under the new president, the environment in which Donald Trump takes office is more concrete. This new report examines the most significant areas of foreign policy for the new administration: defence, economic policy, trade, energy and climate change, China, Russia, the Middle East and North Africa, Europe, Afghanistan and Latin America. It considers the international context, outlines the specific constraints under which Trump’s administration will operate and considers the likely paths the administration will take.

New report by CARE International describes 10 under-reported humanitarian crises in 2016. It features food crises in Eritrea, Madagascar, North Korea and Papua New Guinea; conflicts in Burundi, Lake Chad Basin, Democratic Republic of Congo, Central African Republic, Sudan and last year’s monsoon floods in Bangladesh.

WHO estimates an additional 250 000 mortalities between 2030 and 2050 will be attributable to climate-associated increases in malnutrition, malaria, diarrhoea, respiratory disease, water inaccessibility, and heat stress.1 Spillover effects on state and regional security are inevitable. The World Economic Forum has identified climate change as the single greatest threat to global stability because of its considerable consequences on the health and stability of developing nations.

After several decades of community-based interventions and surveillance, on Nov 15, 2016, Morocco was recognised by WHO as having eliminated trachoma as a public health problem.1 A formal ceremony, involving the handover of a letter of recognition from Margaret Chan, WHO's Director-General, marked the occasion.

Violence, insecurity, climate change and environmental degradation continue to converge in the Lake Chad Basin, creating Africa's most acute humanitarian crisis. An estimated 11 million people need humanitarian aid to survive in 2017, and US$1.5 billion is required to provide support in sectors such as food security, nutrition and health

Following the outbreak of conflict in the Central African Republic, more than 100,000 Chadians returned to their home country. Having fled Chad decades before, many had to settle in returnee sites in the south of the country. This photo story shows their plight and how the Central Emergency Response Fund is supporting returnees, refugees and host communities in Chad.

Elder Abuse 

Elder abuse prevalence in community settings: a systematic review and meta-analysis (Lancet) 

Infections 

Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study (Lancet) 
(Many causes and high mortality) 

Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (Simplified Antibiotic Therapy Trial [SATT]): a randomised, open-label, equivalence trial (Lancet) 

Ebola

First Newborn Baby to Receive Experimental Therapies Survives Ebola Virus Disease (The Journal of Infectious Diseases) 

Ebola virus disease: An update on current prevention and management strategies(Journal of Clinical Virology)  

HIV

Determinants of morbidity associated with infant male circumcision: community-level population-based study in rural Ghana (Journal of Tropical Medicine and International Health) 

Trachoma

In Morocco, the elimination of trachoma as a public health problem becomes a reality (Lancet) 

Respiratory Disease and Children

Inappropriate prescription of cough remedies among children hospitalised with respiratory illness over the period 2002–2015 in Kenya (Journal of Tropical Medicine and International Health) 

Nutrition and Development 

Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study (Lancet) 

Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9–12 years in Indonesia: follow-up of the SUMMIT randomised trial (Lancet)