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The first Global Symposium on Health Systems Research was held in 2010 under the leadership of the World Health Organization and the Alliance for Health Policy and Systems Research. Since [...]

Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases. The rise of cardiometabolic diseases in low- and middle-income countries is tied to a multitude of environmental, social and commercial determinants, which are discussed in this Review along with a strategy to counteract those factors., Author(s): J. Jaime Miranda [sup.1] [sup.2] , Tonatiuh Barrientos-Gutiérrez [sup.3] , Camila Corvalan [sup.4] , Adnan A. Hyder [sup.5] , Maria Lazo-Porras [sup.1] [sup.6] , Tolu Oni [sup.7] [sup.8] , [...]

Problem The burden oftrauma and injuries in Uganda is substantial and growing.Two important gaps that need addressing are the shortage of trained people and a lack of national data on noncommunicable diseases and their risk factors in Uganda. Approach We developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. We also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability. Local setting The Chronic Consequences of Trauma, Injuries and Disability in Uganda programme was implemented In 2012 at Makerere University School of Public Health in Kampala, Uganda, in conjunction with Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America. Relevant changes Over the years 2012 to 2017 we supported four cohorts of master's students, with a total of 14 students (9 females and 5 males; mean age 30 years). Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums. Lessons learnt Institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme. Probleme La charge de morbidite liee aux traumatismes et aux blessures en Ouganda est importante et en augmentation. La penurie de personnes formees et le manque de donnees nationales sur les maladies non transmissibles et leurs facteurs de risque en Ouganda constituent deux lacunes importantes qui doivent etre comblees. Approche Nous avons elabore et mis en oeuvre un nouveau parcours au sein d'un master de sante publique existant, destine a developper des capacites de niveau universitaire et a promouvoir la recherche sur les principales priorites nationales relatives aux traumatismes et aux blessures. Nous avons egalement propose des possibilites deformation a un plus large public et organise un forum national de haut niveau sur les blessures pour encourager un dialogue national sur la charge induite par les traumatismes, les blessures et le handicap. Environnement local Le programme Consequences chroniques des traumatismes, des blessures et du handicap en Ouganda a ete mis en oeuvre en 2012 a l'Ecole de sante publique de l'Universite Makerere a Kampala, en Ouganda, en collaboration avec l'Ecole de sante publique Bloomberg de l'Universite Johns Hopkins a Baltimore, aux Etats-Unis d'Amerique. Changements significatifs Entre 2012 et 2017, nous avons soutenu quatre cohortes d'etudiants en master, pour un total de 14 etudiants (9 femmes et 5 hommes; age moyen 30 ans). Plus de 1300 personnes ont participe aux ateliers et seminaires du volet formation courte du programme. Le forum a accueilli trois symposiums de recherche et deux forums nationaux sur les blessures. Lecons tirees Le soutien institutionnel et l'engagement collaboratif sont importants pour elaborer et mettre en oeuvre avec succes des programmes de renforcement des capacites. L'integration des volets deformation aux structures universitaires existantes est essentielle pour leur viabilite. Un tutorat adapte pour les etudiants motives et brillants est utile pour les accompagner pendant toute la duree du programme. Problema La carga de traumatismos y lesiones en Uganda es notable y sigue creciendo. Dos deficiencias importantes que deben abordarse son la escasez de personal formado y la falta de datos nacionales sobre las enfermedades no contagiosas y sus factores de riesgo en Uganda. Enfoque Se ha desarrollado e implementado un nuevo curso dentro de un programa de master en salud publica existente, destinado a desarrollar la capacidad de nivel de postgrado y promover la investigacion sobre prioridades nacionales clave para traumatismos y lesiones. Tambien se ofrecieron oportunidades de formacion a un publico mas amplio y se establecio un foro nacional de alto nivel sobre lesiones para fomentar el dialogo nacional sobre la carga de los traumatismos, las lesiones y la discapacidad. Marco regional El programa Consecuencias cronicas de los traumatismos, las lesiones y la discapacidad en Uganda se implemento en 2012 en la Escuela de Salud Publica de la Universidad de Makerere en Kampala, Uganda, junto con la Escuela de Salud Publica Johns Hopkins Bloomberg en Baltimore, EE.UU. Cambios importantes Entre los anos 2012 y 2017 se respaldaron cuatro cohortes de estudiantes de master, con un total de 14 estudiantes (9 mujeres y 5 hombres, con una edad media de 30 anos). Mas de 1300 personas participaron en talleres y seminarios del componente de formacion a corto plazo del programa. El foro fue sede de tres simposios de investigacion y dos foros nacionales sobre lesiones. Lecciones aprendidas El apoyo institucional y el compromiso colaborativo son importantes para desarrollar e implementar programas de desarrollo de capacidades de exito. La integracion de los componentes de formacion dentro de las estructuras academicas actuales es clave para la sostenibilidad. Una tutoria apropiada para estudiantes muy motivados y con talento es valiosa para guiar a los estudiantes por el programa., Introduction Injuries are a leading cause of death in the African Region, where they claim over 900 000 lives annually, (1) and within Africa, Uganda has one of the highest [...]

The scientific community has succeeded in producing coronavirus disease 2019 (COVID-19) vaccines in record time; however, some countries are just receiving their first doses while others, such as the United [...]

Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--are currently undergoing a deep epidemiological transition that is mainly driven by rapid economic growth and technological change. The changes being observed in the distribution of the burden of diseases and injuries--such as recent increases in the incidence of road traffic injuries--are matters of concern. BRICS may need stronger institutional capacity to address such changes in a timely way. In this paper, we present data on road traffic injuries in BRICS and illustrate the enormous challenge that these countries currently face in reducing the incidence of such injuries. There is an urgent need to Improve road safety indicators in every country constituting BRICS. It is imperative for BRICS to invest in system-wide road safety interventions and reduce the mortality and morbidity from road traffic injuries. Le Bresil, la Federation de Russie, l'linde, la Chine et l'Afrique du Sud--les pays connus sous le nom de BRICS--connaissent actuellement une transition epidemiologique profonde qui s'explique principalement par la rapidite de la croissance economique et de Involution technologique. Les changements qui sont observes dans la distribution de la charge des maladies et des blessures, comme les hausses recentes de l'incidence des accidents de la route, suscitent des inquietudes. Le groupe BRICS peut avoir besoin de capacites institutionnelles renforcees pour repondre rapidement a ces changements. Dans cet article, nous presentons les donnees sur les accidents de la route dans le groupe BRICS et nous illustrons l'enorme defi que doivent actuellement relever ces pays dans la diminution de l'incidence de ces accidents. II est urgent d'ameliorer les indicateurs de la securite routiere dans chaque pays constituant le groupe BRICS. II est imperatif que le groupe BRICS investisse dans des interventions de securite routiere dans l'ensemble du systeme et qu'il reduise la mortalite et la morbidite dues aux accidents de la route. Brasil, la Federacion de Rusia, India, China y Sudafrica, los paises conocidos como BRICS, se encuentran en la actualidad en una transicion epidemiologica profunda impulsada principalmente por el rapido crecimiento economico y el cambio tecnologico. Los cambios que se observan en la distribucion de la carga de enfermedades y lesiones, como los aumentos recientes de la incidencia de los accidentes de trafico, son motivo de preocupacion. Es posible que los BRICS necesiten una capacidad institucional mas fuerte para hacerfrente a esos cambios de manera oportuna. En el presente articulo, presentamos datos sobre lesiones en accidentes de trafico de los BRICS e ilustramos el enorme desafio al que dichos paises se enfrentan actualmente para reducir la incidencia de las mismas. Hay una necesidad urgente de mejorar los indicadores de seguridad vial en todos los paises BRICS. Es imperativo que estos paises inviertan en intervenciones de seguridad vial en todo el sistema y reduzcan la mortalidad y morbilidad por accidentes de trafico., Introduction In recent years, five major emerging economies--Brazil, the Russian Federation, India, China and South Africa, which are known collectively as BRICS--have experienced not only considerable growth in their macroeconomic [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.01.020 Byline: Lauren S. Blum (a), Rasheda Khan (a), Adnan A. Hyder (b), Sabina Shahanaj (a), Shams El Arifeen (a), Abdullah Baqui (b) Abstract: While reductions in infectious disease have resulted in impressive declines in child mortality in Bangladesh, drowning is becoming proportionately more important as a major cause of death, accounting for at least 19% of deaths of children between 1 and 4 years of age in trend analysis since 2000. Little is known about indigenous beliefs and behaviors associated with drowning, which may be critical to preventing child-related drowning deaths. Qualitative research was carried out over 13 months in Matlab, Bangladesh to describe the indigenous explanatory model of drowning and to identify behavioral factors increasing the risk for drowning deaths. Methods included cognitive mapping procedures as well as open-ended interviews with families who had lost a child or experienced a near-death due to drowning and families with at least one child under 5 years living near a body of water. Along with diarrhea, fever, and pneumonia, drowning is perceived as a leading cause of child death. Causal explanations are primarily associated with 'evil spirits' believed to entice young children to water or bewitch mothers so that they forget about the child. Another primary interpretation relates to a water goddess known to prey on small children. When a young child is discovered in water, parents refrain from rescuing the child due to a belief that if a parent touches a drowning child, the child will die. After the child is removed from the water, traditional practices that have no known benefit are employed. The research identified locally constructed beliefs and practices such as refraining from touching the child that may increase the incidence of drowning deaths. Future efforts are required to address these beliefs and assess the feasibility, cultural acceptability and effectiveness of strategies designed to prevent drowning. Author Affiliation: (a) Public Health Science Division, International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh (b) Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Objective To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. Methods This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. Findings Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged [greater than or equal to] 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. Conclusion Hospitais in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues. Objectif Determiner la frequence et la nature des traumatismes touchant les enfants et etudier les facteurs de risque pour ces traumatismes dans des pays a faible revenu en utilisant les donnees de surveillance des services d&apos;urgence. Methodes Cette etude pilote represente la phase initiale d&apos;un projet multi-pays de surveillance des traumatismes non intentionnels de l&apos;enfant (GCUIS) era ete menee a partir d&apos;un echantillon sequentiel d&apos;enfants de moins de 11 ans de l&apos;un et l&apos;autre sexe, qui ont ete presentes dans des services d&apos;urgence selectionnes du Bangladesh, de Colombie, d&apos;Egypte et du Pakistan, sur une periode de 3-4 mois, variable selon les sites, au cours de rannee 2007. Resultats Parmi les 1559 enfants victimes de traumatisme accueillis sur l&apos;ensemble ales sites, 1010 (65%) etaient de sexe masculin, 941 (60%) etaient ages de 5 ans et plus et 32 (2%) avaient moins d&apos;un an. Les traumatismes etaient particulierement frequents (34%) pendant la matinee. Ilis se produisaient a l&apos;interieur et autour du domicile dans 56% des cas, a l&apos;exterieur pendant les jeux des enfants dans 63% des cas et au cours de deplacements dans 11% des cas. Sur l&apos;ensernble des traumatismes observes, 913 (56%) etaient lies a des chutes, 350 (22%) a des accidents de la circulation, 210 (13%) a des brulures, 66 (4%) a des empoisonnements et 20 (1%) a des << presque-noyades >> ou a des noyades. Les chutes impliquaient le plus souvent des escaliers ou des echelles et les accidents de la circulation des pietons, la majorite des brulures etaient dues a dos liquides chauds, les empoisonnements faisaient intervenir habituellement des medicaments et la plupart des noyades se produisaient au domicile. Le score de gravite moyen des traumatismes etait maximal pour les noyades et les presquenoyades (11), ce score etant suivi de pres par celui des accidents de la circulation (10). L&apos;etude a recense 6 deces, dont 2 resultant d&apos;une noyade, 2 d&apos;une chute et 2 d&apos;un accident de la circulation. Conclusion Les hopitaux des pays a faible revenu font face a une charge substantielle de traumatismes infantiles et une surveillance systematique est necessaire pour determiner la distribution epidemiologique de ces traumatismes et connaitre les facteurs de risque associes. La standardisation methodologique de la surveillance entre les pays permet de dresser des comparaisons internationales et d&apos;identifier des problemes communs. Objetivo Determinar la frecuencia y naturaleza de las lesiones infantiles y explorar sus factores de riesgo en paises de bajos ingresos, utilizando para ello los datos de vigilancia de los departamentos de urgencias (DU). Metodos Este estudio piloto representa la fase inicial de un proyecto plurinacional de vigilancia mundial de las lesiones infantiles no intencionales y se baso en una muestra secuencial de menores de 11 anos, de ambos sexos, que se presentaron en 2007 en DU seleccionados de Bangladesh, Colombia, Egipto y Pakistan alo largo de un periodo de 3 a 4 meses, variable segun el centro. Resultados De 1559 ninos lesionados observados en todos los centros, 1010 (65%) eran varones; 941 (60%) tenian [mayor que o igual a] 5 anos, y 32 (2%) < 1 ano. Las lesiones fueron especialmente frecuentes (34%) por la manana. En el 56% de los casos se produjeron dentro de casa o en sus alrededores, en el 63% fuera, mientras jugaban, y en el 11% en viaje. De todas las lesiones observadas, 913 (56%) consistieron en caidas; 350 (22%) en lesiones causadas por el trafico; 210 (13%) en quemaduras; 66 (4%) en intoxicaciones, y 20 (1%) en ahogamiento o casi ahogamiento. Las caidas mas frecuentes se produjeron en escaleras; en el caso de las lesiones causadas por el trafico, la mayoria de las victimas fueron peatones; la mayoria de las quemaduras se produjeron con liquidos calientes; las intoxicaciones mas frecuentes se debieron a medicamentos, y la mayoria de los ahogamientos se produjeron en casa. Las lesiones con mayores puntuaciones de gravedad fueron los ahogamientos o casi ahogamientos (11), seguidos de cerca por las lesiones causadas por el trafico (10). Hubo 6 casos mortales: 2 por ahogamiento, 2 por caidas y 2 por lesiones causadas por et trafico. Conclusion Los hospitales de los paises de bajos ingresos tienen una carga considerable de lesiones infantiles. Es necesaria una vigilancia sistematica para identificar la distribudion epidemiologica de esas lesiones y comprender sus factores de riesgo. La normalizacion metodologica de la vigilancia en los diferentes paises permite establecer comparaciones internacionales e identificar problemas comunes., Introduction Unintentional injuries are a leading cause of death among children and young adults. (1) Over 875 000 children [less than or equal to] 18 years of age die annually [...]

Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in valueladen concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective. Une traduction en francais de ce resume figure a la fin de l&apos;article. Al final del articulo se facilita una traduccion al espanol. Les progres scientifiques sont un prealable important a l&apos;evolution des politiques et des pratiques dans le domaine de la sante publique, mais sur le terrain, les individus investissent aussi dans des concepts charges de valeur et repondent quotidiennement a des preoccupations sociopolitiques, culturelles et evaluatives. Les concepts qui influent le plus sur les pratiques de sante publique sont ceux faconnes par les moeurs collectives et individuelles definissant les systemes sociaux. Le present article s&apos;efforce de decrire les processus ethiques en jeu lors de la mise en place de mecanismes de sante publique dans les pays a revenu faible et moyen, en se concentrant sur deux cas dans lesquels l&apos;ethique a influe de maniere cruciale sur l&apos;apparition d&apos;une evolution institutionnelle positive de la politique sanitaire. Nous commencons par donner une presentation generale de la relation entre ethique et sante publique ; en second lieu, nous apportons un cadre conceptuel pour l&apos;analyse ethique des evenements touchant les systemes de sante, en notant dans quelle mesure cette approche peut renforcer le pouvoir des cadres existants, et enfin, nous demontrons les interactions entre ces cadres a travers l&apos;analyse d&apos;un programme d&apos;amelioration de la securite routiere en Malaisie et d&apos;une initiative pour etablir un comite national d&apos;ethique au Pakistan. Nous parvenons a la conclusion que si l&apos;ethique est integree progressivement aux decisions de sante publique dans nombre de systemes de sante en developpement, l&apos;analyse ethique est souvent implicite et sous-evaluee Cet article attire l&apos;attention sur la necessite d&apos;analyser les decisions de sante publique sous un angle ethique. El progreso cientifico es un motor importante de la evolucien de las politicas y practicas de salud publica, pero en ese terreno se aplican tambien diversos valores y hay que responder diariamente a problemas sociopoliticos, culturales y evaluativos. Las ideas que orientan gran parte de las practicas de salud publica se vert conformadas por costumbres colectivas e individuales que definen Ios sistemas sociales. La finalidad de este articulo es describir los procedimientos eticos que entran en juego cuando se establecen mecanismos de salud publica en los paises de ingresos bajos y medios, centrando la atencien en dos casos en Ios que la etica contribuyo de forma decisiva a propiciar cambios institucionales positivos en las politicas de salud publica. En primer lugar presentamos una panoramica de las relaciones entre etica y salud publica; a continuacion, ofrecemos un marco conceptual para el analisis etico de eventos en Ios sistemas sanitarios, indicando como podria este enfoque reforzar las posibilidades de los marcos existentes; y, en tercer lugar, demostramos la interrelacion entre esos marcos analizando un programa de mejora de la seguridad vial en Malasia y una iniciativa de creacien de un comite nacional de etica en el Pakistan. Llegamos a la conclusien de que, si bien las decisiones de politica en materia de salud publica estan incorporando gradualmente principios eticos en muchos sistemas de salud en desarrollo, con frecuencia Ios analisis eticos se realizan de forma implicita y estan infravalorados. En este trabajo se subraya la necesidad de analizar la adopcien de decisiones de salud publica desde una perspectiva etica., Introduction High-income countries can learn vital lessons from low- and middle-income countries (LMICs) which, through persistence, manage to form much-needed public-health structures that harmonize with pre-existing local public-health systems. (1) [...]

The purpose of this paper is to explore events and factors that lead to conflict in the home in the Afghan refugee setting, and the current status of the health sector's ability to respond to evidence of conflict. Qualitative interviews were conducted with 20 women of reproductive age and 20 health workers serving these women in an Afghan refugee camp near Peshawar, Pakistan, during the summer of 2004. In particular, this paper analyses women's explanations of how various marriage traditions may be linked to conflict in the home and how the interactions of different family members may be related to conflict. The relationships of women with their parents-in-law and husbands are highlighted in particular, and a model developed to explore the choreography of their relationships and the ways in which these dynamics may encourage or inhibit violence. The perspectives of health workers on the ways in which the health system responds to family conflict and violence are also presented. Finally, this paper provides information that helps to frame the issues of family violence and conflict in long-term refugee populations for intervention designers and those who are working to craft a health sector response to this problem. Keywords: Refugee violence; Violence against women; Health care; Pakistan; Afghanistan; Refugees

According to international guidelines [1,2] and several nations' laws [3-5], research with humans requires independent ethics committee review. In the United States, committees are called institutional review boards (IRBs) [6]; [...]

There are no official data on suicide from Pakistan, a conservative South Asian Islamic country with traditionally low suicide rates. Both suicide and attempted suicide are illegal acts, as well as socially and religiously condemned, making research in this area difficult. Recent reports suggest an increase in suicide rates. In this study, police data from the Sindh province were examined to provide a unique picture of trends of suicide over 15 years (1985-1999). During this period there were 2,568 reported suicides (71% men, 39% women; ratio 1.8). The lowest number was 90 in 1987 and maximum was 360 in 1999. Poisoning by organophosphates was the most common method followed by hanging. This study, although limited in scope, provides evidence of an increase in suicide rates in Pakistan, from one data source. There is urgent need for further research on suicide in Pakistan; interventions for suicide prevention in the country can then be planned.

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. Keywords Emergency medical services/organization and administration; Emergency treatment/organization and administration; Triage; Transportation of patients; Allied health personnel/education; Cost-benefit analysis; Evidence-based medicine; Developing countries (source: MeSH, NLM). Mots cles Service medical urgences/organisation et administration; Traitement urgence/organisation et administration; Orientation patients; Transport sanitaire; Personnel sante auxiliaire/enseignement; Analyse cout benefice; Medecine factuelle; Pays en developpement (source: MeSH, INSERM). Palabras clave Servicios medicos de urgencia/organizacion y administracion; Tratamiento de urgencia/organizacion y administracion; Triaje; Transporte de pacientes; Tecnicos medios en salud/educacion; Analisis de costo-beneficio; Medicina basada en evidencia; Paises en desarrollo (fuente: DeCS, BIREME)., Introduction The goal of an effective emergency medical system should be to provide universal emergency care--that is, emergency care should be available to all who need it. However, there are [...]

Health research generates knowledge that con be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health. Keywords Health services research/organization and administration; Knowledge; Information management: Models Theoretical; Review literature; Meta-analysis (source: MeSH, NLM). Mots cles Recherche en sante publique/organisation et administration; Connaissance; Gestion information; Modele theorique; Revue de la litterature; Meta-analyse (source: MeSH, INSERM). Palabras clave Investigacion sobre servicios de salud/organizacion y administracion. Conocimiento; Gerencia de la informacion; Modelos teoricos; Literatura de revision Meta-analisis (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII], Introduction Knowledge produced by health research, if disseminated widely, is a global public good. Knowledge contributes to the policies, activities, and performance of health systems (1-3), and to the improvement [...]

Byline: Christoph Benn (1), Adnan A. Hyder (2) Keywords: christianity; distribution of health care resources; equity; interreligious dialogue; Islam Abstract: Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community in terms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. Author Affiliation: (1) German Institute for Medical Mission, Paul-Lechler-Str.24, 72076, Tubingen, Germany (2) Johns Hopkins Bioethics Institute Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Suite E-8132, Baltimore, MD, 21205, USA Article History: Registration Date: 09/10/2004 Article note: This revised version was published online in October 2005 with corrections to the Cover Date.

Objectives. This paper presents the background and rationale for a composite indicator, healthy life-year (HeaLY), that incorporates mortality and morbidity into a single number. HeaLY is compared with the disability-adjusted life-year (DALY) indicator, to demonstrate the relative simplicity and ease of use of the former. Methods. Data collected by the Ghana Health Assessment team from census records, death certificates, medical records, and special studies were used to create a spreadsheet. HeaLYs lost as a result of premature mortality and disability from 56 conditions were estimated. Results. Two thirds of HeaLYs lost in Ghana were from maternal and communicable diseases and were largely preventable. The age weighting in DALYs leads to a higher value placed on deaths at younger ages than in HeaLYs. This spreadsheet can be used as a template for assessing changes in health status attributable to interventions. Conclusions. HeaLYs can aid in setting health priorities and identifying disadvantaged groups. The disaggregated approach of the HeaLY spreadsheet tool is simpler for decision makers and useful for country application. (Am J Public Health. 1998;88:196-202)

Background The volatile political history of Pakistan has led to problems with governance overall and in the health sector. Methods Governance is defined by six domains of concern: voice and accountability; political stability and absence of violence; government effectiveness; regulatory quality; rule of law; and control of corruption. A review of the literature concerning health sector in Pakistan is interpreted using this conceptual framework. Results and Discussion The domains of governance are illustrated with examples from Pakistan's health sector. Two case studies, the President's Primary Health Care Initiative and the Tawana Pakistan Program are used to help understand how poor governance undermines important and positive political initiatives. Globalization effects governance through an evolving relationship between donors, multilateral agencies, and client states. Conclusions Governance issues are major barriers to improving health in Pakistan. This study contributes to our understanding of governance and the role of donors and multilateral agencies. Keywords: governance | health systems | development | Pakistan, Background Failing states and the failure of aid have been associated with stagnation or deteriorations of health status in populations ( , ). Problems with governance, the poor performance of [...]

Introduction Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. Methods MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. Results The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. Discussion The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles. Keywords: developing countries; child nutrition disorders; communicable diseases, mortality; infantile diarrhea, mortality; measles, mortality; health planning; child health services. Bulletin of the World Health Organization, 2000, 78:1207-1221., Voir page 1218 le resume en francais. En la pagina 1219 figura un resumen en espanol. Introduction Approximately 12 million children younger than 5 years of age die every, year; [...]

Objectives. Disability-adjusted life-year (DALY) and healthy life-year (HeaLY) are composite indicators of disease burden that combine mortality and morbidity into a single measurement. This study examined the application of these methods in a developing country to assess the loss of healthy life from prevalent conditions and their use in resource-poor national contexts. Methods. A data set for Pakistan was constructed on the basis of 180 sources for population and disease parameters. The HeaLY approach was used to generate data on loss of healthy life from premature mortality and disability in 1990, categorized by 58 conditions. Results. Childhood and infectious diseases were responsible for two thirds of the burden of disease in Pakistan. Condition-specific analysis revealed that chronic diseases and injuries were among the top 10 causes of HeaLY loss. Comparison with regional estimates demonstrates consistency of disease trends in both communicable and chronic diseases. Conclusions. The burden of disease in countries such as Pakistan can be assessed by using composite indicators. The HeaLY method provides an explicit framework for national health information assessment. Obtaining disease- and population-based data of good quality is the main challenge for any method in the developing world. (Am J Public Health. 2000;90:1235-1240)

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