Setting research priorities to improve global newborn health and prevent stillbirths by 2025.

BACKGROUND: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. METHODS: We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. RESULTS: Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. CONCLUSION: These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.

[The discovery of the leprosy bacillus]. / Oppdagelsen av leprabasillen.

Gerhard Henrik Armauer Hansen (1841-1912) worked on leprosy throughout his career. Following his discovery of the leprosy bacillus in 1873, he proposed legislation that, when enacted in 1877 and 1885, established preventive measures aimed at isolating infectious patients. Around 1920, leprosy was more or less eradicated in Norway after a period of decline starting in 1850. Over this period, more than 8,000 cases were registered. Armauer Hansen's unique research achievement was based on a scientific and medical infrastructure in place long before he started his work. This context had several implications, though the discovery of the leprosy bacillus holds a particular fascination, with bearings on the interaction between medicine and the community even today.

Isolation of non-cultivable acid-fast bacilli in sphagnum and moss vegetation by foot pad technique in mice

In the former leprosy-endemic coastal area of Norway, 122 samples of sphagnum and moss vegetation were collected from 6 biotopes and examined for non-cultivable AFB by foot pad inoculation. Of the 759 foot pads examined, 20% contained non-cultivable AFB. A significantly higher frequency was found in a habitat where Sphagnum cuspidatum was preponderant, the sphagnum species from which the maximum yield was obtained. The bacteria were polymorphous, solidly staining AFB, which multiplied in passage in foot pads while they could not be cultivated on the conventional media for mycobacteria. Efforts are continuing to identify these AFB by biochemical methods and by inoculation into nine-banded armadillos

Secular trends in age at onset, sex ratio, and type index in leprosy observed during declining incidence rates

Epidemiologic surveillance in Norway, the United States, Nigeria, Japan, Venezuela, India, and China, covering periods from 1851 to 1981, demonstrates a consistent decline in incidence rates of leprosy. At the same time, secular trends have been observed which imply an increasing age at onset, an increasing male excess, and an increasing fraction of new cases represented by multibacillary leprosy. Theoretically, an increasing age at onset may be caused by two mechanisms, namely postponement of infection to a later age and/or an increasing fraction of patients with long incubation periods. Cohort analyses have shown no increase in age at onset in subsequent birth cohorts, but rather have shown a decrease. The latter mechanism, the increasing importance of long incubation periods, is consistent with the shift toward multibacillary cases in which the incubation period is longer than that in paucibacillary cases. Apparently, this mechanism has also been present during the decline of tuberculosis. An increasing fraction of new patients with long incubation periods, resulting in an increasing age at onset, is proposed as a general principle to be expected in any disease in rapid decline which also has a long and varying incubation period. This theory offers a basis for assessment of secular trends

Disappearance of leprosy from Norway: an exploration of critical factors using an epidemiological modelling approach

BACKGROUND: By the middle of the 19th century, leprosy was a serious public health problem in Norway. By 1920, new cases only rarely occurred. This study aims to explain the disappearance of leprosy from Norway. METHODS: Data from the National Leprosy Registry of Norway and population censuses were used. The patient data include year of birth, onset of disease, registration, hospital admission, death, and emigration. The Norwegian data were analysed using epidemiological models of disease transmission and control. RESULTS: The time trend in leprosy new case detection in Norway can be reproduced adequately. The shift in new case detection towards older ages which occurred over time is accounted for by assuming that infected individuals may have a very long incubation period. The decline cannot be explained fully by the Norwegian policy of isolation of patients: an autonomous decrease in transmission, reflecting improvements in for instance living conditions, must also be assumed. The estimated contribution of the isolation policy to the decline in new case detection very much depends on assumptions made on build-up of contagiousness during the incubation period and waning of transmission opportunities due to rapid transmission to close contacts. CONCLUSION: The impact of isolation on interruption of transmission remains uncertain. This uncertainty also applies to contemporary leprosy control that mainly relies on chemotherapy treatment. Further research is needed to establish the impact of leprosy interventions on transmission.