Global Health Initiatives Building a Healthier World
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Global Health Initiatives Building a healthier world UN Sustainable Development Goal 3 Good Health and Wellbeing Global Health Initiatives Building a healthier world Special global health article collection celebrating the 40th anniversary of the Declaration of Alma-Ata FOREWORD 1 Achieving universal health coverage in an era of emerging global health threats Kieran Walsh, Lalitha Bhagavatheeswaran, Mitali Wroczynski, Elisa Roma RESEARCH REPORT 2 Socioeconomic inequalities in child vaccination in low/middle-income countries: what accounts for the differences? From Journal of Epidemiology and Community Health Mohammad Hajizadeh RESEARCH 9 Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: a qualitative systematic review From BMJ Global Health Charlotte Christiane Hammer, Julii Brainard, Paul R Hunter 19 Evaluation of a programme for ‘Rapid Assessment of Febrile Travelers’ (RAFT): a clinic-based quality improvement initiative From BMJ Open Farah Jazuli, Terence Lynd, Jordan Mah, Michael Klowak, Dale Jechel, Stefanie Klowak, Howard Ovens, Sam Sabbah, Andrea K Boggild SHORT RESEARCH REPORT 26 Prevalence and factors associated with the use of antibiotics in non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa From Archives of Disease in Childhood Asa Auta, Brian O Ogbonna, Emmanuel O Adewuyi, Davies Adeloye, Barry Strickland-Hodge SHORT REPORT 30 Infectious disease outbreaks: how online clinical decision support could help From BMJ Simulation & Technology Enhanced Learning Kieran Walsh ANALYSIS AND EDITORIALS 33 Emerging and re-emerging infectious disease threats in South Asia: status, vulnerability, preparedness, and outlook From The BMJ Ramanan Laxminarayan, Manish Kakkar, Peter Horby, Gathsaurie Neelika Malavige, Buddha Basnyat 38 Health workers are vital to sustainable development goals and universal health coverage From The BMJ Lara Fairall, Eric Bateman 40 Implementing One Health as an integrated approach to health in Rwanda From BMJ Global Health Thierry Nyatanyi, Michael Wilkes, Haley McDermott, Serge Nzietchueng, Isidore Gafarasi, Antoine Mudakikwa, Jean Felix Kinani, Joseph Rukelibuga, Jared Omolo, Denise Mupfasoni, Adeline Kabeja, Jose Nyamusore, Julius Nziza, Jean Leonard Hakizimana, Julius Kamugisha, Richard Nkunda, Robert Kibuuka, Etienne Rugigana, Paul Farmer, Philip Cotton, Agnes Binagwaho 45 Building resilient health systems: a proposal for a resilience index From The BMJ Margaret E Kruk, Emilia J Ling, Asaf Bitton, Melani Cammett, Karen Cavanaugh, Mickey Chopra, Fadi el-Jardali, Rose Jallah Macauley, Mwihaki Kimura Muraguri, Shiro Konuma, Robert Marten, Frederick Martineau, Michael Myers, Kumanan Rasanathan, Enrique Ruelas, Agnès Soucat, Anung Sugihantono, Heiko Warnken C OMMENTARY 51 Productive disruption: opportunities and challenges for innovation in infectious disease surveillance From The BMJ Caroline O. Buckee, Maria I E Cardenas, June Corpuz, Arpita Ghosh, Farhana Haque, Jahirul Karim, Ayesha S. Mahmud, Richard J Maude, Keitly Mensah, Nkengafac Villyen Motaze, Maria Nabaggala, Charlotte Jessica Eland Metcalf, Sedera Aurélien Mioramalala, Frank Mubiru, Corey M. Peak, Santanu Pramanik, Jean Marius Rakotondramanga, Eric Remera, Ipsita Sinha, Siv Sovannaroth, Andrew J Tatem, Win Zaw ©BMJ Publishing Group Ltd 2018 All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any other means, electronic, mechanical, photocopying, recoding, or otherwise, without prior permission, in writing, of BMJ.UN Sustainable Development Goal 3 Good Health and Wellbeing FOREWORD Achieving universal health coverage in an era of emerging global health threats he Alma-Ata Declaration of 1978 was a pivotal moment becoming pandemics.10 More specifically, a health system which in public health, stating primary health care would be provides comprehensive primary healthcare and integrates all essential to obtaining the goal of “Health for All” by the relevant interventions can help respond to these emerging threats year 2000.1 There was much enthusiasm around the as well as various coinciding health challenges, such as the rise in world to work towards “Health for All” through primary non-communicable diseases.9 Thealth care. But soon after this, the goal of comprehensive primary As we approach the 40th anniversary of the Declaration of Alma- health care was criticised as being idealistic, too broad and having Ata, we renew our own commitment to advancing healthcare an unrealistic timetable.2 This idea of comprehensive primary health worldwide by sharing knowledge and expertise to improve care, as promoted by the Declaration, was quickly overshadowed experiences and outcomes for patients and populations. Our by the idea of “selective primary health care” just a short time later. global health initiatives focus on health systems strengthening Despite criticism that selective primary health care neglects the through workforce development, research capacity building, root causes of disease, significant progress was made in tackling the and knowledge translation. In this supplement, we are delighted prevailing causes of morbidity and mortality in children.3 By 1989, to present articles which we hope will advance the global health the World Health Organization stated that over half of children in discourse and confirm our commitment to the vision of a healthier Low and Middle Income countries were receiving immunisation world. each year. In 2015, world leaders met at the United Nations in New Contributing authors: York, to commit to the Sustainable Development Goals (SDGs). The Lalitha Bhagavatheeswaran, BMJ Clinical Outreach and Engagement Manager; SDGs address interconnected global challenges related to poverty, Mitali Wroczynski, BMJ Head of Strategic Partnerships; Dr Elisa Roma, BMJ Partnerships and Programmes Manager inequality, climate, environmental degradation and justice.4 In Competing interests: The authors work for BMJ, which produces a range of edu- order to make progress towards SDG Goal 3 (ensure healthy lives cational and clinical decision support resources in infectious and non-infectious and promote well-being for all at all ages), countries must ensure diseases. that everyone has access to high quality, safe and resilient health References: For full references, see page 55 services. An integrated, people-centred approach is fundamental to health systems that can respond to the various health challenges and emerging threats of today’s world.5 These include urbanization, the double burden of communicable diseases and noncommunicable diseases, aging populations, rising health care costs, antimicrobial resistance, and new and emerging infectious disease outbreaks.5 Antimicrobial resistance is one of the most challenging public health threats of our time. In 2015, the WHO launched a Global Action Plan on antimicrobial resistance to address the overuse and misuse of antimicrobials.6 The emergence and spread of pathogens resistant to antimicrobials is occurring worldwide, compromising our ability to treat infectious diseases. Furthermore, there have been 15 serious zoonotic or vector-borne global outbreaks, both viral (e.g., Hanta, Ebola, Marburg, H5N1 avian influenza) and bacterial (e.g., E coli, plague, and anthrax) over the past two decades.7 Epidemics of the 21st century have the ability to spread faster and further across the national borders, making all countries vulnerable and damaging their social and economic environment.8 The influenza pandemic of 2009 reached all continents in less than nine weeks. The West African Ebola outbreak was critical in showing us how connected we are globally and brought attention to the importance of a One Health approach. One Health is the “collaborative effort of multiple disciplines—working locally, nationally, and globally—to attain optimal health for people, animals and [the] environment through policy, research, education, and practice”.9 Strong and resilient health systems can help countries better Dr Kieran Walsh detect and respond to diseases and prevent outbreaks from Clinical Director, BMJ BMJ Global Health Initiatives 1 RESEARCH Socioeconomic inequalities in child vaccination in low/middle- income countries: what accounts for the differences? Mohammad Hajizadeh School of Health Administration, ABSTRACT status group were less likely to receive all the four Faculty of Health, Dalhousie BACKGROUND core vaccines than their lower socioeconomic University, Halifax, Nova Scotia, Socioeconomic inequalities in child vaccination status counterparts. Meta-regression analyses Canada continue to be a global public health concern. suggested that, across countries, the concentration Correspondence to: Dr Mohammad Hajizadeh This study aimed to measure and identify factors of antenatal care visits among wealthier mothers School of Health Administration, associated with socioeconomic inequalities in full was positively associated with the concentration Faculty of Health, Dalhousie immunisation coverage against the four core vaccine- of vaccination coverage among wealthier children University, Halifax, NS B3H 4R2, Canada; m. hajizadeh@ dal. ca preventable diseases (ie, bacille Calmette-Guérin, (coefficient=0.606, 95% CI 0.301 to 0.911). Additional material is published diphtheria-tetanus-pertussis (three doses), polio CONCLUSIONS online only. To view please visit (three doses) and measles vaccines) in 46 low/ Pro-rich distribution of child