AMA Publishing Group: Global Health Theme Issue Topic Collection

Influence of Prenatal and Postnatal Growth on Intellectual Functioning in School-aged Children Intellectual Functioning in School-Aged Children

Pongcharoen T, Ramakrishnan U, DiGirolamo AM, et al. — Tue, 01 May 2012 00:00:00 GMT

Objective

To assess the relative influence of size at birth, infant growth, and late postnatal growth on intellectual functioning at 9 years of age.

Design

A follow-up, cross-sectional study.

Setting

Three districts in Khon Kaen province, northeast Thailand.

Participants

A total of 560 children, or 92% of former participants of a trial of iron and/or zinc supplementation during infancy.

Main Exposures

Prenatal (size at birth), early infancy (birth to 4 months), late infancy (4 months to 1 year), and late postnatal (1 to 9 years) growth. Multiple-stage least squares analyses were used to generate uncorrelated residuals of postnatal growth.

Main Outcome Measures

Intellectual functioning was measured at 9 years using the Wechsler Intelligence Scale for Children and the Raven's Colored Progressive Matrices (Pearson). Analyses included adjustment for maternal, household, and school characteristics.

Results

Significant relationships were found between growth and IQ (Wechsler Intelligence Scale for children, third edition, Thai version), but only up to 1 year of age; overall, growth was not related to the Raven's Colored Progressive Matrices. The strongest and most consistent relationships were with length (birth, early infancy, and late infancy); for weight, only early infancy gain was consistently related to IQ. Head circumference at birth was not collected routinely; head circumference at 4 months (but not head circumference growth thereafter) was related to IQ. Late postnatal growth was not associated with any outcome.

Conclusion

Physical growth in early infancy (and, to a lesser extent, physical growth in late infancy and at birth) is associated with IQ at 9 years of age. Early infancy may be a critical window for human development.

Preschool Micronutrient Supplementation Effects on Intellectual and Motor Function in School-aged Nepalese Children Intellectual and Motor Function of Nepalese Children

Murray-Kolb LE, Khatry SK, Katz J, et al. — Tue, 01 May 2012 00:00:00 GMT

Objective

To examine intellectual and motor functioning of children who received micronutrient supplementation from 12 to 35 months of age.

Design

Cohort follow-up of children 7 to 9 years of age who participated in a 2 × 2 factorial, placebo-controlled, randomized trial from October 2001 through January 2006.

Setting

Rural Nepal.

Participants

A total of 734 children 12 to 35 months of age at supplementation and 7 to 9 years of age at testing.

Interventions

Children received iron plus folic acid (12.5 mg of iron and 50 μg of folic acid); zinc (10 mg); iron plus folic acid and zinc; or placebo.

Main Outcome Measures

Intellectual, motor, and executive function.

Results

In both the unadjusted and adjusted analyses, iron plus folic acid supplementation had no effect overall or on any individual outcome measures being tested. In the unadjusted analysis, zinc supplementation had an overall effect, although none of the individual test score differences were significant. In the adjusted analysis, the overall difference was not significant.

Conclusion

In rural Nepal, we found that iron plus folic acid or zinc supplementation during the preschool years had no effect on aspects of intellectual, executive, and motor function at 7 to 9 years of age, suggesting no long-term developmental benefit of iron or zinc supplementation during 12 to 35 months of age.

Multicenter Study of Infliximab for Refractory Uveoretinitis in Behçet Disease Infliximab for Behçet Disease Uveoretinitis

Okada AA, Goto H, Ohno S, et al. — Tue, 01 May 2012 00:00:00 GMT

Objective

To describe the effects of infliximab on refractory uveoretinitis in patients with Behçet disease during the first year of treatment.

Methods

Data were collected prospectively at 8 tertiary uveitis centers. Safety was analyzed in 63 patients. Efficacy was analyzed in 50 patients, after exclusion of those who had received infliximab for various reasons before the study.

Results

Eighty-nine percent (56 of 63) of the patients were male, with 70% (44 of 63) of the patients aged 25 to 44 years. The safety analysis demonstrated that 34 episodes of adverse effects occurred in 46% (29 of 63) of patients during 1 year, including 3 episodes of infusion reactions. No adverse effects were deemed serious. The efficacy analysis at 1 year showed that uveoretinitis had improved in 69% (33 of 48), had improved somewhat in 23% (11 of 48), was unchanged in 8% (4 of 48), and had worsened in no patients. The mean number of ocular attacks per 6-month period decreased from 2.66 at baseline to 0.44 during months 1 through 6 of infliximab therapy and to 0.79 during months 7 through 12. Forty-four percent (21 of 48) of patients had no ocular attacks during the 1-year period. Efficacy was best for patients with uveoretinitis duration of less than 5 years. The mean best-corrected visual acuity improved logarithm of the minimum angle of resolution from 0.736 at the first infliximab infusion to 0.616 at the end of 1 year (P = .01).

Conclusions

Infliximab treatment for Behçet disease uveoretinitis was well tolerated, with nonserious adverse effects occurring in about half of the patients. At the end of 1 year, uveoretinitis had improved or improved somewhat in 92% (44 of 48) of patients, accompanied by improvement in the mean visual acuity.

Trends in the Indications for Corneal Graft Surgery in the United Kingdom 1999 Through 2009 Corneal Graft Surgery in the United Kingdom

Keenan TL, Jones MA, Rushton S, et al. — Tue, 01 May 2012 00:00:00 GMT

Objective

To examine trends in the indications for corneal graft surgery in the United Kingdom.

Methods

National Health Service Blood and Transplant data were analyzed for keratoplasty operations performed in the United Kingdom between April 1, 1999, and March 31, 2009, distinguishing the type of graft and the surgical indication.

Results

The total number of annual keratoplasty operations increased from 2090 in 1999-2000 to 2511 in 2008-2009. Among these, the annual number of grafts performed for endothelial failure increased from 743 (35.6%) in 1999-2000 to 939 (37.4%) in 2008-2009. The performance of penetrating keratoplasty (PK) for endothelial failure decreased from 98.3% of all grafts in 1999-2000 to 46.6% of all grafts in 2008-2009, while the performance of endothelial keratoplasty increased from 0.3% of all grafts in 1999-2000 to 51.2% of all grafts in 2008-2009. The annual number of grafts performed for keratoconus increased from 514 (24.6%) in 1999 to 564 (22.5%) in 2008-2009. The performance of PK for keratoconus decreased from 88.4% of all grafts in 1999-2000 to 57.1% of all grafts in 2008-2009, while the performance of deep anterior lamellar keratoplasty increased from 8.8% of all grafts in 1999-2000 to 40.1% of all grafts in 2008-2009. The number of annual regraft operations increased from 249 (11.9%) in 1999-2000 to 401 (16.0%) in 2008-2009, most commonly for endothelial failure. In 2008-2009, PK regrafts (78.1%) far outnumbered endothelial keratoplasty regrafts (17.0%).

Conclusions

Endothelial failure is the most common indication for keratoplasty in the United Kingdom, and endothelial keratoplasty is performed more commonly than PK for this indication. The number of grafts performed for pseudophakic bullous keratopathy has remained stable, while the number of grafts performed for Fuchs endothelial dystrophy is likely to continue increasing. Keratoconus is the second most common indication for keratoplasty, and deep anterior lamellar keratoplasty numbers are approaching those for PK. Regraft surgery is the third most common indication for keratoplasty, required in most cases because of endothelial failure.

Global Burden of Visual Impairment and Blindness Global Burden of Visual Impairment and Blindness

Bourne R, Price H, Stevens G, et al. — Tue, 01 May 2012 00:00:00 GMT

Vision loss and age-related eye diseases are major global public health problems. The Global Burden of Diseases, Injuries, and Risk Factors Study (hereafter referred to as the GBD Study) was commissioned by the World Bank in 1991 to provide a comprehensive assessment of the burden of 107 diseases and injuries, and 10 selected risk factors, for the world, specifically including data from 8 major regions. The methods of the original GBD Study (hereafter referred to as the GBD 1990 Study) created a common metric, the disability-adjusted life-year, which extends the concept of potential years of life lost due to premature death to include equivalent years of “healthy” life lost by virtue of being in poor health or disability. The number of disability-adjusted life-years caused by a disease or injury are calculated as the sum of the years of life lost due to premature mortality in the population and the years lost due to disability (YLD) for incident cases of the disease or injury.

Health Services Utilization and Cost of Retinitis Pigmentosa Cost of Retinitis Pigmentosa

Frick KD, Roebuck M, Feldstein JI, et al. — Tue, 01 May 2012 00:00:00 GMT

Objective

To estimate annual per-patient health services utilization and costs of retinitis pigmentosa (RP) in the United States.

Methods

A retrospective claims analysis of patients with RP (N = 2990) and a 1:1 exactly matched cohort of non-RP patients was conducted using the MarketScan Commercial and Medicare Supplemental Databases. Individuals were continuously enrolled in a commercial health plan or employer-sponsored health insurance for at least 1 year. The following annual outcomes were analyzed using nonlinear multivariate models: inpatient hospital admissions, inpatient hospital days, emergency department visits, outpatient physician visits, and prescription drug refills and inpatient and outpatient medical, pharmacy, and total health care costs.

Results

Patients with RP had 0.04 more hospital admissions (P < .001), 0.19 more inpatient hospital days (P < .02), 0.05 more emergency department visits (P < .01), 2.74 more outpatient visits (P < .001), and 2.18 additional prescription drug fills (P < .001) annually compared with their non-RP counterparts. Health care expenditures were significantly higher for patients with RP, who cost $894, $4855, and $452 more for inpatient, outpatient, and pharmacy services, respectively (P < .001). Overall health care costs were $7317 more per patient per year in the RP cohort, with expenditures varying considerably by age.

Conclusions

Patients with RP consume substantially greater amounts of health services with significantly higher health care costs.

Clinical Relevance

Treatments that slow, halt, or possibly restore RP-related vision loss may prove cost-effective for payers and society.

Dimensions of Global Health , 2012

Frieden TR, Garfield RM. — Wed, 16 May 2012 00:00:00 GMT

Human health has improved more in our lifetimes than it did in the preceding thousand years. Since 1970, the number of infants who die has decreased by more than half worldwide, and maternal mortality has fallen dramatically in virtually every region of the world. Facing today's enormous global health challenges, we often lose sight of such advances. Health has improved for several reasons. First and foremost, economic growth improves people's life chances. In 1970, close to half the world's population lived in extreme poverty; now one in seven people lives in poverty. More people have access to clean water, immunizations, and basic health services because of the work of governments, charitable groups including faith-based organizations, international organizations, the private sector, and public and private development assistance. Wider dissemination of information and increasing citizen participation make it possible for many lower-income people to make better-informed decisions about their health.

Food, Micronutrients, and Birth Outcomes Food, Micronutrients, and Birth Outcomes

Christian P, Black RE. — Wed, 16 May 2012 00:00:00 GMT

In this issue of JAMA, Persson et al describe the effects of early (approximately 9 weeks) vs usual (approximately 20 weeks) food supplementation alone or in combination with multiple micronutrient supplementation (MMS) vs iron-folic acid (using 60-mg and 30-mg iron formulations) during pregnancy on outcomes of maternal anemia, birth size, gestational age, and infant mortality, using a 3×2 factorial experimental design. The main, rather complex, findings were that there was no effect of either early food supplementation or MMS interventions on birth size or gestational duration at birth. Instead, both a positive and negative interaction between food supplementation and MMS were observed related to the outcome of offspring mortality. Early food supplementation combined with MMS significantly reduced the outcomes of neonatal, infant, and under 5-year child mortality compared with the standard of care of antenatal iron (60 mg) and folic acid supplements with a food supplement starting midgestation. Neither intervention nor their combination reduced stillbirth or perinatal mortality.

PEPFAR and Maximizing the Effects of Global Health Assistance PEPFAR and the Effects of Global Health Assistance

Emanuel EJ. — Wed, 16 May 2012 00:00:00 GMT

Between 1995 and 2008, worldwide global investment in improving health in developing countries increased from $8 billion to nearly $25 billion. A main reason for this substantial increase was the creation of new institutions including the Gates Foundation; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the GAVI Alliance; and, most importantly, the President's Emergency Plan for AIDS Relief (PEPFAR) program.

China's Air Quality Dilemma Reconciling Economic Growth With Environmental Protection Economic Growth vs Environmental Protection

Dominici F, Mittleman MA. — Wed, 16 May 2012 00:00:00 GMT

Before 2008, concentrations of air pollutants in the city of Beijing, China, site of the 2008 Olympic Games, far exceeded acceptable standards, which caused serious concerns in the international community about the health and performance of Olympic athletes. To ensure acceptable air quality during the Olympics (held from August 8-24) and the Paralympics (held from September 6-16), the Chinese government launched a series of aggressive measures to reduce pollutant emissions. To reduce industrial emissions, the operations of combustion facilities were restricted in smelters, cement plants, power plants, nonattainment boilers, and construction and petro-chemical industries. To reduce traffic emissions, certain vehicles and trucks were banned, 70% of government-owned vehicles were kept off the streets, and other vehicles could travel through the city only on alternating days.

The Question of Improvement

Berwick DM. — Wed, 16 May 2012 00:00:00 GMT

In this issue of JAMA, Berwanger and colleagues report a teaching-case–perfect cluster-randomized trial demonstrating the positive effects of a “multifaceted intervention” to improve the reliability of evidence-based management of acute coronary systems in general hospitals in Brazil. With a combination of reminders, a checklist, case management, and staff education, the intervention hospitals used all eligible acute therapies in the first 24 hours after admission 37% more often than control hospitals (67.9% vs 49.5%) and used all evidence-based therapies (ie, not just acute management) 67% more reliably (50.9% vs 31.9%).

Health, Economics, and the 2012 G8 Summit

Bauchner H, Frenk J. — Wed, 16 May 2012 00:00:00 GMT

Health and economics are inextricably linked. Health constitutes a vigorous sector of the economy, with effects on inflation, employment, and competitiveness. The World Health Organization estimates that health systems worldwide absorb approximately 10% of the world economy—about US $6 trillion. Differences in health expenditures, however, are huge. For instance, the United States spends more than $7000 per capita on health, whereas Eritrea spends less than US $10. For low- and middle-income countries, committing more financial resources to health is a complicated and difficult decision, because most nations face many competing priorities. Nor will improving the health of the world's population be possible unless there is global economic recovery. Enlightened ministers of finance realize that better health contributes to sustainable economic growth through its effects on improved productivity.

Changes in Prevalence of Girl Child Marriage in South Asia

Raj A, McDougal L, Rusch MA. — Wed, 16 May 2012 00:00:00 GMT

To the Editor: Girl child marriage (ie, <18 years of age) affects more than 10 million girls globally each year and is linked to maternal and infant morbidities (eg, delivery complications, low birth weight) and mortality. Half (46%) of child marriages occur in South Asia. This study assessed whether prevalence of girl child marriage has changed over the past 2 decades in 4 South Asian nations with a girl child marriage prevalence of 20% or greater.

Recent Advances in Mobile Technology Benefit Global Health, Research, and Care

Hampton T. — Wed, 16 May 2012 00:00:00 GMT

Now that more than 5 billion people worldwide have a cell phone, mobile technology sits poised to revolutionize the way medical care and health information are delivered, particularly in the developing world. A number of efforts are under way to leverage mobile technology's tools to align with pressing health priorities through a field called mobile health (mHealth).

IOM Report Lays Out a Blueprint for Improving Regulatory Systems Worldwide

Mitka M. — Wed, 16 May 2012 00:00:00 GMT

The emergence of the global economy is affecting the supply chains of food and medical products, raising public health and safety concerns throughout the world. To combat the situation, governments are looking at improving regulatory systems to ensure that medical products and foods are safe regardless of where they are produced or consumed.

Effect of a Multifaceted Intervention on Use of Evidence-Based Therapies in Patients With Acute Coronary Syndromes in Brazil The BRIDGE-ACS Randomized Trial Evidence-Based Therapies in Acute Coronary Syndromes

Berwanger O, Guimarães HP, Laranjeira LN, et al. — Wed, 16 May 2012 00:00:00 GMT

Context

Studies have found that patients with acute coronary syndromes (ACS) often do not receive evidence-based therapies in community practice. This is particularly true in low- and middle-income countries.

Objective

To evaluate whether a multifaceted quality improvement (QI) intervention can improve the use of evidence-based therapies and reduce the incidence of major cardiovascular events among patients with ACS in a middle-income country.

Design, Setting, and Participants

The BRIDGE-ACS (Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes) trial, a cluster-randomized (concealed allocation) trial conducted among 34 clusters (public hospitals) in Brazil and enrolling a total of 1150 patients with ACS from March 15, 2011, through November 2, 2011, with follow-up through January 27, 2012.

Intervention

Multifaceted QI intervention including educational materials for clinicians, reminders, algorithms, and case manager training, vs routine practice (control).

Main Outcome Measures

Primary end point was the percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours in patients without contraindications.

Results

Mean age of the patients enrolled was 62 (SD, 13) years; 68.6% were men, and 40% presented with ST-segment elevation myocardial infarction, 35.6% with non–ST-segment elevation myocardial infarction, and 23.6% with unstable angina. The randomized clusters included 79.5% teaching hospitals, all from major urban areas and 41.2% with 24-hour percutaneous coronary intervention capabilities. Among eligible patients (923/1150 [80.3%]), 67.9% in the intervention vs 49.5% in the control group received all eligible acute therapies (population average odds ratio [OR_PA], 2.64 [95% CI, 1.28-5.45]). Similarly, among eligible patients (801/1150 [69.7%]), those in the intervention group were more likely to receive all eligible acute and discharge medications (50.9% vs 31.9%; OR_PA,_, 2.49 [95% CI, 1.08-5.74]). Overall composite adherence scores were higher in the intervention clusters (89% vs 81.4%; mean difference, 8.6% [95% CI, 2.2%-15.0%]). In-hospital cardiovascular event rates were 5.5% in the intervention group vs 7.0% in the control group (OR_PA, 0.72 [95% CI, 0.36-1.43]); 30-day all-cause mortality was 7.0% vs 8.4% (OR_PA, 0.79 [95% CI, 0.46-1.34]).

Conclusion

Among patients with ACS treated in Brazil, a multifaceted educational intervention resulted in significant improvement in the use of evidence-based therapies.

Trial Registration

clinicaltrials.gov Identifier: NCT00958958

Effects of Prenatal Micronutrient and Early Food Supplementation on Maternal Hemoglobin, Birth Weight, and Infant Mortality Among Children in Bangladesh The MINIMat Randomized Trial Prenatal Micronutrient and Early Food Supplementation

Persson L, Arifeen S, Ekström E, et al. — Wed, 16 May 2012 00:00:00 GMT

Context

Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences.

Objectives

To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes.

Design, Setting, and Participants

A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009.

Interventions

Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation).

Main Outcome Measures

Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed.

Results

Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, −0.9 g/L; 95% CI, −1.7 to −0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5-year mortality rate of 18 per 1000 live births (54 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid; HR, 0.34; 95% CI, 0.18-0.65). Usual invitation with MMS group had the highest incidence of spontaneous abortions and the highest infant mortality rate.

Conclusion

Among pregnant women in poor communities in Bangladesh, treatment with multiple micronutrients, including iron and folic acid combined with early food supplementation, vs a standard program that included treatment with iron and folic acid and usual food supplementation, resulted in decreased childhood mortality.

Trial Registration

isrctn.org Identifier: ISRCTN16581394

A Train of Hope, and a Chance to Train

Prasad C. — Wed, 16 May 2012 00:00:00 GMT

I was struck by her eyes as we appraised each other from across the crowded hall. They were big, beautiful black eyes, looking at me with a mixture of fear, curiosity, and awe. They belonged to a young girl, with a bright, lively face. I know my eyes must have mirrored hers, for I too was filled with the same emotions.

A Framework Convention on Global Health Health for All, Justice for All A Framework Convention on Global Health

Gostin LO. — Wed, 16 May 2012 00:00:00 GMT

Health inequalities represent perhaps the most consequential global health challenge and yet they persist despite increased funding and innovative programs. The United Nations is revising the Millennium Development Goals (MDGs) that will shape the world for many years to come. What would a transformative post-MDG framework for global health justice look like? A global coalition of civil society and academics—the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI)—has formed an international campaign to advocate for a Framework Convention on Global Health (FCGH). Recently endorsed by the UN Secretary-General, the FCGH would reimagine global governance for health, offering a new post-MDG vision. This Special Communication describes the key modalities of an FCGH to illustrate how it would improve health and reduce inequalities. The modalities would include defining national responsibilities for the population's health; defining international responsibilities for reliable, sustainable funding; setting global health priorities; coordinating fragmented activities; reshaping global governance for health; and providing strong global health leadership through the World Health Organization.

Policy Making With Health Equity at Its Heart Policy Making With Health Equity

Marmot MG. — Wed, 16 May 2012 00:00:00 GMT

In India, there is a cabinet minister for social justice. Would that it were catching, and spread to all government ministers. What a thought: social justice at the heart of all government policy. It would be a radical change from the current set of arrangements, in which many governments are unashamed apostles of self-interest—of their countries, of their partisan supporters or, indeed, of self-interest as a political creed. Given the link between social and economic policy and the health of populations, all ministers should see themselves as ministers of health. Putting these arguments—health and social justice—together implies that health equity should be at the heart of all policy making, national and global.

Noncommunicable Diseases A Global Health Crisis in a New World Order Noncommunicable Diseases

Marrero SL, Bloom DE, Adashi EY. — Wed, 16 May 2012 00:00:00 GMT

In September 2011, the United Nations General Assembly (UNGA) held—for the first time—a High-Level Meeting on the Prevention and Control of Non-communicable Diseases. In taking this unusual step, the UNGA, home to 193 member states and the principal decision-making organ of the United Nations (UN), has affirmed not only the global importance of the noncommunicable diseases (NCDs) but also the imperative of concerted remedial action. In this Viewpoint we discuss the outcomes of the high-level meeting (HLM) and the aftermath thereof and affirm that the heretofore unrecognized NCD epidemic has at last acquired a voice. However, the HLM, accompanied by a severe international economic downturn, exposed a new world order wherein erstwhile global health donors play a more limited role, aid recipients assume greater responsibility for developmental progress, and UN agencies increasingly integrate NCDs into their programmatic and budgetary constructs.

Primary Health Care in Low-Income Countries Building on Recent Achievements Primary Health Care in Low-Income Countries

Sachs JD. — Wed, 16 May 2012 00:00:00 GMT

Small investments in improved health of the poor have a remarkable return in reduced morbidity and mortality. While the developed economies grapple with health systems that cost several thousand dollars per person per year and often spend hundreds of thousands of dollars on a treatment to eke out an additional few months of life, outlays of just a few dozen dollars per person per year in impoverished countries can add several years to life expectancy. In the least developed countries, approximately 112 of every 1000 children die before their fifth birthday, as opposed to 8 per 1000 in the developed countries. With a concerted science-based effort, the under-5 mortality rate of the least developed countries could be reduced to less than 30 per 1000 by 2020. Such low under-5 mortality rates have already been achieved, for example, by the Dominican Republic (28 per 1000), Mexico (17 per 1000), and Thailand (13 per 1000).

Achieving Equity in Global Health So Near and Yet So Far Achieving Equity in Global Health

Bhutta ZA, Reddy K. — Wed, 16 May 2012 00:00:00 GMT

Few issues have generated as much passion and imagination over the last few decades as the challenge of global health. From major studies on the global burden of disease to the recognition of the global epidemic of human immunodeficiency virus, AIDS, and tuberculosis, health has been center stage of the global development debate. Issues, which once remained within the purview of health advocacy and policy circles, found their way into the center stage of debates in the World Economic Forum and onto agendas for G8 and G20 summit meetings. The groundbreaking reports from the Commission for Macroeconomics in Health and Social Determinants of Health highlighted the importance of appropriate resource allocations for health as well as focusing on issues that determine population health, but are frequently beyond the purview of ministries of health. Even as the world contends with a worldwide recession, there is clear recognition that health of populations everywhere must be protected and promoted, not only as a developmental commitment to equity but also as an imperative for economic growth and security.

Artemisinin-Resistant Malaria

Friedrich MJ. — Wed, 16 May 2012 00:00:00 GMT

Artemisinin resistance has increased rapidly in the malaria-causing parasite, Plasmodium falciparum, along the border of Thailand and Myanmar, according to researchers from Thailand, the United Kingdom, and the United States (Phyo AP et al. Lancet. doi:10.1016/S0140-6736(12)60484-X [published online April 5, 2012]).

Reducing Maternal Morbidity

Friedrich MJ. — Wed, 16 May 2012 00:00:00 GMT

A new report from US researchers outlines key actions to address maternal morbidity in the developing world (Hardee K et al. Global Public Health. doi:10.1080/17441692.2012.668919 [published online March 16, 2012]).

Global Burden of Hepatitis E Virus

Friedrich MJ. — Wed, 16 May 2012 00:00:00 GMT

The first estimate of the global effect of infection with the hepatitis E virus (HEV) reveals that as many as 20.1 million people were infected with HEV genotypes 1 and 2 in 2005 in 9 regions in Asia and Africa defined for the Global Burden of Diseases, Injuries, and Risk Factors Study, report researchers from the World Health Organization and the United States (Rein DB et al. Hepatology. 2012;55[4]:988-997).

Dementia Should Be a Priority

Friedrich MJ. — Wed, 16 May 2012 00:00:00 GMT

Recognizing and addressing the impact of dementia should be a public health priority around the world, according to a new report published by the World Health Organization and Alzheimer's Disease International (http://tinyurl.com/cwu7syc).

Progress Toward Global Polio Eradication—Africa, 2011

Wed, 16 May 2012 00:00:00 GMT

Morbidity and Mortality Weekly Report

Nodding Syndrome—South Sudan, 2011

Wed, 16 May 2012 00:00:00 GMT

Morbidity and Mortality Weekly Report

Ethical Conduct of Humanitarian Medical Missions I. Informed Consent Ethical Conduct of Humanitarian Medical Missions

Holt G. — Tue, 01 May 2012 00:00:00 GMT

Altruistic and socially conscious physicians are dedicating a portion of their professional lives to humanitarian relief of disadvantaged populations in increasing numbers. These efforts are primarily carried out through short-term medical missions (STMMs) throughout the international community. There is a great deal of professional and personal reward to physicians who participate in medical missions, and their experiences as related to colleagues may serve to encourage others to participate as well. Indeed, there is an increasing interest in, and enthusiasm for, medical students to participate in international volunteer electives during medical school, particularly in developing countries. Their positive experiences often shape their future commitment to volunteerism as a physician.

US Military Medical Missions in Iraq and Southeast Asia US Military Medical Missions in Iraq and SE Asia

Holt G. — Tue, 01 May 2012 00:00:00 GMT

Following the liberation of Iraq in 2003, the Coalition Provisional Authority and the US Department of Defense convened a group of 24 American consultants, one from each of the medical and surgical specialty societies, to assist in the reconstruction and modernization of the Iraqi medical profession. The Department of Defense, through the direct effort of US Army Surgeon General LTG James Peake, MC USA, was an important collaborator in this effort, for there was still an urgent need to provide security and protection to both the Iraqi and the American physicians in their collegial efforts. I was fortunate to represent the specialty of otolaryngology–head and neck surgery in this alliance, which was headed by a former president of the American Academy of Ophthalmology, Michael Brennan, MD. The initial meeting with Iraqi physicians was in the so-called Green Zone of central Baghdad, where plans for the reconstitution of the Iraqi Society of Physicians and the specialty societies were discussed, along with issues of the development of an effective emergency medical transport system; modernization of emergency centers, operating rooms, and surgical suites; and the improvement of public health in the country. Efforts by this group, known as the Medical Alliance for Iraq (MAI), have been widely successful, resulting in an improvement of emergency patient care, introduction of contemporary therapeutics, and the development of 2 continuing medical education centers in the country, which were initially staffed by MAI physicians (including a team of facial plastic, general plastic, and oculoplastic surgeons) but are now staffed by Iraqi physicians for their own self-education. The country's medical education and residency training programs are now more regulated and consistent. It has been a successful program for all of the specialties, but particularly for otolaryngology–head and neck surgery, since we now have new colleagues who were previously isolated.

Evolution of US Military Humanitarian Assistance Evolution of US Military Humanitarian Assistance

Crabtree TG. — Tue, 01 May 2012 00:00:00 GMT

The US military is a lead actor on the global stage of humanitarian assistance. It was not always this way. It took a number of supporting roles and even some miscast productions to secure this preeminent position. Like it or not, and there are many in both camps, the US Department of Defense (DoD) is now a go-to player for not only logistical might but also for far more nuanced development efforts around the world.

US Military Medical Support After the Earthquake in Managua, Nicaragua US Military Medical Support in Managua, Nicaragua

Larrabee WF. — Tue, 01 May 2012 00:00:00 GMT

On December 21, 1972, at 12:29 AM, Managua, Nicaragua, was devastated by a 6.2-magnitude earthquake. Eighty percent of the city was damaged, 5000 individuals died, and 20 000 more were injured. At that time, I was Director of Civic Action and Disaster Relief for the US Military Southern Command headquartered in the Panama Canal Zone. Later that morning our initial team arrived to survey the damage and initiate relief efforts. That Saturday still stands out in my mind because of the rapid and efficient response of the US military. Requests were communicated to the United States, and by the next morning transport planes were landing to bring operating rooms, medical equipment and supplies, drugs, and additional personnel. Hours after the planes landed, facilities were in place to begin treatment of the injured. Medical staff from the United States integrated easily with local medical physicians and military medical staff from the Southern Command, as well as international volunteers such as Peace Corps nurses.