Promoting equitable global health research: a policy analysis of the Canadian funding landscape.

BACKGROUND: Recognising radical shifts in the global health research (GHR) environment, participants in a 2013 deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadian funding polices. This study examined the existing funding structures and policies of Canadian and international funders to inform the future design of a responsive GHR funding landscape. METHODS: We used a three-pronged analytical framework to review the ideas, interests and institutions implicated in publically accessible documents relevant to GHR funding. These data included published literature and organisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and other comparator funders. We then used a deliberative approach to develop recommendations with the research team, advisors, industry informants and low- and middle-income country (LMIC) partners. RESULTS: In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008 re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy. Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of America invest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health, some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outside of Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and cost burden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effective governance mechanisms. There were, however, some Canadian innovations in funding research that demonstrated both unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promising were found in the International Development Research Centre and the (no longer active) Global Health Research Initiative. CONCLUSION: Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions by multiple stakeholders, including government, funding agencies, academic institutions and researchers. Greater cooperation and collaboration among these stakeholders in the context of recent political shifts present important opportunities for advancing funding policies that enable and encourage more equitable investments in GHR.

'WE CAN'T GET WORMS FROM COW DUNG': REPORTED KNOWLEDGE OF PARASITISM AMONG PASTORALIST YOUTH ATTENDING SECONDARY SCHOOL IN THE NGORONGORO CONSERVATION AREA, TANZANIA.

Records at the Endulen Hospital in the Ngorongoro Conservation Area (NCA), Tanzania, reveal that soil-transmitted helminth infections and protozoa are consistently in the top ten diagnoses for Maasai pastoralists, indicating a significant public health concern. Nevertheless, Maasai pastoralist adaptations to life in close proximity to livestock and to unreliable access to water raise important questions about experiences of, and resiliency to, parasitic infections. Though these infections are particularly prevalent among youth in low- and middle-income countries (LMIC), a focus on resiliency highlights local capacity to recover from and prevent illness. For instance, how is human parasitism perceived and experienced among communities displaying behaviours that studies have associated with transmission of diarrhoeal diseases, such as open defecation? Among these communities, how is parasitism seen to impact the health and development of children? And, what resources are available to endure or mitigate this heavy disease burden among affected communities? This study draws on formative research carried out in May 2014 in anticipation of an innovative school-based and youth-driven water, sanitation and hygiene education intervention rolled out in two boarding schools in the NCA in subsequent months. The initiative is grounded in a One Health approach to health promotion, drawing on partnerships in medicine, public health and veterinary medicine to appreciate the unique interactions between humans, animals and the environment that shape well-being among pastoralist communities. Qualitative data generated through group discussions with secondary school youth (n=60), Maasai teachers (n=6) and a women's group (n=8) in the NCA convey existing knowledge of the prevalence, prevention and treatment of human parasitism. An underlying principle of the larger initiative is to engage youth as creative agents of change in developing and sustaining locally relevant health promotion strategies. Findings highlight practical knowledge around certain 'neglected tropical diseases', namely helminths, among pastoralist communities in the NCA, in turn feeding into the development of the science fair and related interventions.

Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging.

OBJECTIVE: To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta. METHODS: A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta's plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors. RESULTS: The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05). CONCLUSION: Advice to vary infants' head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.

OBJECTIF: Déterminer les facteurs de risque potentiels de plagiocéphalie positionnelle chez les nourrissons de sept à 12 semaines à Calgary, en Alberta. MÉTHODOLOGIE: Dans une cohorte prospective, des nourrissons à terme et en santé (n=440) de sept à 12 semaines provenant de cliniques d'enfants en santé de quatre centres de santé communautaire de Calgary, en Alberta, ont été évalués par l'auteur principal et une infirmière adjointe à la recherche au moyen de l'outil d'évaluation de la plagiocéphalie d'Argenta. Les parents ont rempli un questionnaire pour déterminer les facteurs de risque. RÉSULTATS: L'incidence de plagiocéphalie positionnelle a été évaluée à 46,6 %. Les facteurs de risque suivants ont été déterminés au moyen de la régression logistique multiple : préférence positionnelle de la tête à droite (RC 4,66 [95 % IC 2,85 à 7,58]; P<0,001), préférence positionnelle de la tête à gauche (RC 4,21 [95 % IC 2,45 à 7,25]; P<0,001), position de sommeil en décubitus dorsal (RC 2,67 [95 % IC 1,58 à 4,51]; P<0,001), accouchement assisté par ventouses ou forceps (RC 1,88 [95 % IC 1,02 à 3,49]; P=0,04) et sexe masculin (RC 1,55 [95 % IC 1,00 à 2,38]; P=0,05). CONCLUSION: Il faut conseiller aux parents ou aux tuteurs de modifier la position de la tête du nourrisson bien avant le rendez-vous à la clinique pour enfants en santé à deux mois. Ces conseils pourraient être donnés pendant la période prénatale par les dispensateurs ou les éducateurs de soins prénatals ou par des infirmières postnatales ou des infirmières de santé publique pendant la période néonatale. On peut donner des conseils de prévention aux parents ou aux tuteurs des nourrissons de sexe masculin et de ceux qui ont eu un accouchement assisté.

Animal-human connections, "one health," and the syndemic approach to prevention.

A syndemic involves two or more afflictions that, by interacting synergistically, contribute to excess burdens of disease. A syndemic approach to prevention, meanwhile, focuses on connections among health-related problems, considers those connections when developing health policies, and aligns with forces for social change. In this short report, we expand the syndemic concept to acknowledge the extent to which animal health connects with human health and, with reference to existing publications, we demonstrate the pertinence of this expanded definition for a syndemic approach to prevention. Our demonstration assumes practical importance in relation to the concept of 'one health', which many prominent veterinary and human health scientists have recently endorsed as a sound basis for redressing human diseases, animal diseases, and environmental degradation worldwide. While social scientists have mostly ignored animal health, few 'one health' proponents have emphasized social conditions or involved social scientists. By explicitly accommodating animal-human connections in our expanded conceptualization of a syndemic, we hope to help create a space in which human health, veterinary, and social scientists may learn from one another, collaborate in research, and cooperate to clear the way for innovations in prevention.

Academic Institutions and One Health: Building Capacity for Transdisciplinary Research Approaches to Address Complex Health Issues at the Animal-Human-Ecosystem Interface.

To improve health at the human, animal, and ecosystem interface, defined as One Health, training of researchers must transcend individual disciplines to develop a new process of collaboration. The transdisciplinary research approach integrates frameworks and methodologies beyond academic disciplines and includes involvement of and input from policy makers and members of the community. The authors argue that there should be a significant shift in academic institutions' research capacity to achieve the added value of a transdisciplinary approach for addressing One Health problems. This Perspective is a call to action for academic institutions to provide the foundations for this salient shift. The authors begin by describing the transdisciplinary approach, propose methods for building transdisciplinary research capacity, and highlight three value propositions that support the case. Examples are provided to illustrate how the transdisciplinary approach to research adds value through improved sustainability of impact, increased cost-effectiveness, and enhanced abilities to mitigate potentially harmful unintended consequences. The authors conclude with three key recommendations for academic institutions: (1) a focus on creating enabling environments for One Health and transdisciplinary research, (2) the development of novel funding structures for transdisciplinary research, and (3) training of "transmitters" using real-world-oriented educational programs that break down research silos through collaboration across disciplines.