Results from the Malaysia 2022 report card on physical activity for children and adolescents.

Background: The Malaysia 2022 Report Card on Physical Activity for Children and Adolescents provides evidence-based assessment across 12 indicators of physical activity-related behaviors, individual characteristics, settings and sources of influence, and strategies and investments for children and adolescents. Methods: The development process follows the systematic steps recommended by the Active Healthy Kids Global Alliance was used. Nationally representative data from 2016 to 2021, government reports and unpublished data were reviewed and consolidated by a panel of experts. Letter grades were assigned based on predefined benchmarks to 12 indicators including 10 core physical activity indicators that are common to Global Matrix 4.0 and two additional indicators (Diet and Weight Status). The current grading was then compared against those obtained in 2016. Results: Four of six indicators in the Daily Behaviors category received D- or C grades [Overall Physical Activity, Active Transportation and Diet (D-); Sedentary Behaviors (C)], which remains poor, similar to the 2016 report card. School indicator was graded for the Settings and Sources of Influence category, which showed an improvement from grade B (2016) to A- (2022). As for the Strategies and Investments category, B was again assigned to the Government indicator. Two new indicators were added after the 2016 Report Card, and they were graded B (Physical Fitness) and B- (Weight Status). Four indicators (Organized Sports and Physical Activity, Active Play, Family and Peers, and Community and Environment) were again graded Incomplete due to a lack of nationally representative data. Conclusion: The 2022 Report Card revealed that Malaysian children and adolescents are still caught in the "inactivity epidemic". This warrants more engagement from all stakeholders, public health actions, and timely research, to comprehensively evaluate all indicators and drive a cultural shift to see Malaysian children and adolescents moving more every day.

Results from the Philippines' 2022 report card on physical activity for children and adolescents.

Background/Objective: The 2022 Philippine Report Card on Physical Activity for Children and Adolescents provides a comprehensive assessment of physical activity and other related behaviors, including the various factors and settings that influence these behaviors. It serves as an advocacy tool to increase awareness of the physical activity situation among children and young people in the country. This article describes the development and results of the first Philippine Report Card on Physical Activity for Children and Adolescents. Methods: Following a systematic process provided by the Active Healthy Kids Global Alliance, a team consisting of 25 sports and physical activity specialists identified and reviewed the best available nationally representative data related to physical activity indicators. These data were then used to inform the grades of the ten (10) physical activity indicators. Results: Sufficient data were identified to assign grades to five (5) indicators: Overall Physical Activity (F), Active Transportation (D), Sedentary Behavior (B), School (C-), and Government (B). Insufficient data existed to assign grades to the remaining five (5) indicators: Organized Sport and Physical Activity, Active Play, Physical Fitness, Family and Peers, and Community and Environment. Conclusion: Despite government policies related to physical activity in the country, the majority of children and adolescents in the Philippines do not meet the recommended amount of physical activity for health. More work is needed to improve the translation of these policies into measurable programs, highlighting the need to create better physical activity opportunities and develop national surveillance mechanisms.

Results from the Hong Kong's 2018 report card on physical activity for children and youth.

BACKGROUND/OBJECTIVE: The Active Healthy Kids 2018 Hong Kong Report Card provides evidence-based assessment across 12 indicators of physical activity behaviors, sleep, and related community and government initiatives for children and youth. METHODS: The systematic development process provided by the Active Healthy Kids Global Alliance was used. The best available data from the past 10 years were reviewed by a panel of experts. According to predefined benchmarks, letter grades were assigned to 12 indicators (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behaviors, Physical Fitness, Sleep, Family, School, Community and Environment, Government, and Obesity). RESULTS: Three of the five activity behaviors received C- or C grades: Overall Physical Activity (C-), Sedentary Behaviors (C-), and Organized Sport Participation (C). Active Transportation was graded B + . Same to the 2016 Hong Kong Report Card, Active Play could not be graded. School and Government were graded C. Family and Community and Environment was graded D- and B, respectively. Three new indicators were added after the 2016 Report Card and they were graded from C- (Sleep) to D (Physical Fitness) or D- (Obesity). CONCLUSIONS: Children and youth in Hong Kong have low physical activity and physical fitness levels and high sedentary behaviors despite a generally favorable community environment. A high prevalence of obesity and low levels of family support warrant more public health action. Researchers should address the surveillance gap in active play and peer support.

The role of non-governmental organisations in controlling rabies: the Global Alliance for Rabies Control, Partners for Rabies Prevention and the Blueprint for Rabies Prevention and Control.

Rabies control worldwide has been inadequate and neglected for many decades, and the disease continues to predominantly affect poor communities in Africa and Asia. As a zoonosis for which the main reservoir and vector, the domestic dog (Canis familiaris), is an economically non-viable species, the absence of cross-sectoral cooperation has been a major factor in the lack of effective control efforts. A shift in global focus is required to concentrate on the fact that rabies has the highest case fatality ratio of all infectious human diseases and that it still affects human health more significantly than many other infectious diseases that are perceived to pose more significant risks. Equally necessary is an acknowledgement that rabies control is complex and that the task of creating and executing a strategic plan for the disease can be overwhelming for those governments in the developing world where dog rabies is most problematic. Nonprofit organisations operate independently of governments and intergovernmental organisations and can play a dynamic role in inter-sectoral collaboration and the creation of approaches and strategies for the control of complex diseases such as rabies. In 2008, the Global Alliance for Rabies Control (GARC) established Partners for Rabies Prevention (PRP), a widely representative group of rabies stakeholders and experts, which endeavours to support public-private rabies control activities throughout the world. After a landscape analysis, the PRP proceeded to develop and launch the Blueprint for Rabies Prevention and Control (comprising the Blueprint for Canine Rabies Prevention and Control; the Blueprint for Fox Rabies Prevention and Control and the Rabies Surveillance Blueprint). Subsequently, the Stepwise Approach towards Rabies Elimination (SARE) was embedded into the Canine Rabies Blueprint. The SARE is a planning and self-assessment tool that countries can use to develop activities and monitor progress towards a national programme and strategy for sustainable rabies control and elimination. Each of the elements needed to execute the SARE-derived strategy is cross-linked to the Canine Rabies Blueprint, which provides the specific methods and tools required, supported by references and examples. Together, the Canine Rabies Blueprint and the SARE should be regarded as a novel and dynamic operational toolkit, and a resource that provides comprehensive information for the development and implementation of rabies control strategies, built entirely on the principles of 'One Health'.

Cela fait des dizaines d'années que la rage est une maladie négligée et que les efforts consacrés à la combattre à l'échelle mondiale sont insuffisants ; la maladie continue donc à sévir en plusieurs endroits de la planète en affectant surtout les communautés pauvres d'Afrique et d'Asie. La rage est une zoonose dont le principal réservoir et vecteur, le chien domestique (Canis familiaris), est une espèce ne présentant pas d'enjeu économique de sorte que c'est surtout l'absence de coopération intersectorielle qui est la principale cause du manque d'efficacité des activités de lutte. Il faut faire évoluer ces efforts à l'échelle mondiale à partir du constat que la rage est de toutes les maladies infectieuses humaines celle qui a le taux de létalité le plus élevé et que son impact sur la santé humaine reste supérieur à celui d'autres maladies infectieuses pourtant perçues comme présentant des risques plus significatifs. Il est tout aussi indispensable de prendre conscience du fait que la lutte contre la rage est une entreprise complexe et que la conception et l'exécution d'un plan stratégique contre cette maladie constituent des tâches écrasantes pour les gouvernements des pays en développement, où la rage canine pose le plus de problèmes. Les organisations à but non lucratif opérant indépendamment des gouvernements et des organisations intergouvernementales peuvent jouer un rôle pour dynamiser la collaboration intersectorielle et contribuer à la conception d'approches et de stratégies de lutte contre des maladies complexes telles que la rage. En 2008, l'Alliance mondiale contre la rage (GARC) a lancé l'initiative Partners for Rabies Prevention (PRP), un groupe formé d'un vaste éventail de parties prenantes et d'experts dans le domaine de la rage et ayant pour vocation de soutenir les activités relevant de partenariats public-privé pour lutter contre la rage partout dans le monde. Après une analyse globale de la situation, le partenariat a élaboré et mis en route le Plan directeur de prévention et de contrôle de la rage (doté de trois volets, à savoir les Plans directeurs pour la prévention et le contrôle de la rage canine et vulpine et le Plan directeur pour la surveillance de la rage). Par la suite, l'Approche raisonnée de l'élimination de la rage (SARE) a été intégrée au Plan directeur pour la prévention de la rage canine. SARE est un outil de planification et d'auto-évaluation mis à disposition des pays afin de les aider à concevoir leurs activités et à suivre les progrès enregistrés dans l'élaboration de leurs stratégies et programmes nationaux de lutte et d'élimination de la rage. Chaque élément opérationnel des stratégies élaborées sur la base de SARE est rattaché au Plan directeur pour la prévention et le contrôle de la rage canine, qui fournit les méthodes et les outils spécifiques nécessaires ainsi que des références et des exemples pertinents. Pris ensemble, le Plan directeur et SARE sont à envisager à la fois comme une boîte à outils opérationnelle innovante et dynamique et comme une base d'informations exhaustives pour l'élaboration et la mise en oeuvre de stratégies de lutte contre la rage, entièrement conçues dans une perspective « Une seule santé ¼.

La lucha antirrábica a escala mundial lleva muchos decenios de inadaptación y de relegación a un segundo plano, mientras la enfermedad sigue afectando principalmente a las comunidades pobres de África y Asia. Tratándose de una zoonosis cuyo principal reservorio y vector, el perro doméstico (Canis familiaris), es una especie económicamente inviable, la falta de cooperación intersectorial es uno de los principales factores que explican la ausencia de medidas de control eficaces. Es imperativo imprimir un giro a las líneas de trabajo mundiales para empezar a tener en cuenta que la rabia presenta la tasa de letalidad más alta de todas las enfermedades infecciosas del ser humano y que sigue afectando a la salud humana en mayor medida que otras muchas infecciones consideradas en cambio más peligrosas. También hay que tomar conciencia de que la lucha contra la rabia es compleja y de que los gobiernos de los países en desarrollo, donde la rabia es más problemática, a veces se ven superados por la titánica empresa de elaborar y aplicar un plan estratégico en la materia. Las organizaciones sin ánimo de lucro, que trabajan independientemente de gobiernos y organizaciones intergubernamentales, pueden cumplir una función dinámica de cara a la colaboración intersectorial y la creación de métodos y procedimientos de lucha contra enfermedades complejas como la rabia. Así, en 2008, la Alianza Mundial de Lucha contra la Rabia (GARC) estableció «Partners for Rabies Prevention¼ (PRP), amplio grupo representativo de los círculos de especialistas y otros interlocutores relacionados con la rabia que se dedica a respaldar en todo el mundo actividades de lucha antirrábica que federan a los sectores público y privado. Tras un análisis de la situación general, PRP procedió a elaborar y poner en práctica el «Plan maestro [Blueprint] de prevención y control de la rabia¼ (que a su vez se declina en un plan maestro de prevención y control de la rabia canina; un plan maestro de prevención y control de la rabia vulpina; y un plan maestro de vigilancia antirrábica). Ulteriormente, al plan maestro contra la rabia canina se le incorporó el «método progresivo para la eliminación de la rabia¼ (SARE, por sus siglas en inglés). El SARE es una herramienta de planificación y autoevaluación que los países pueden emplear para definir actividades y seguir de cerca la progresión hacia un programa y una estrategia nacionales de control y eliminación sostenibles de la rabia. Cada uno de los elementos necesarios para ejecutar la estrategia que se deriva del SARE guarda vínculos cruzados con el plan maestro contra la rabia canina, en el que se facilitan los métodos e instrumentos específicos necesarios, acompañados de referencias y ejemplos. El plan maestro contra la rabia canina y el SARE deben ser vistos conjuntamente como una novedosa y dinámica «caja de herramientas prácticas¼ y una fuente de información completa para definir y aplicar estrategias de lucha antirrábica, asentadas ambas por entero en los principios de «Una sola salud¼.

Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia.

BACKGROUND: Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia. Problem This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency. METHODS: An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values. RESULTS: Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden. CONCLUSIONS: The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child's life, cost is reasonable, and herd immunity is possible.

Leveraging a Global Partnership to Address COVID-19-Related Mental Health Challenges.

INTRODUCTION: The COVID-19 pandemic profoundly affected nurses globally. As frontline workers, nurses faced increased responsibilities amid challenges such as isolation, infection risks, family obligations and disrupted social support systems. Coping with these challenges was associated with adverse mental health outcomes. AIM/QUESTION: This perspective paper examines a collaboration between two schools of nursing in the United States and India to address these mental health challenges. METHODS: Faculty from both institutions identified key mental health topics, leading to five webinars that delved into topics such as acute and long-term impacts of COVID-19 on nurse mental health, coping mechanisms, caregiving responsibilities and children's needs during the pandemic. RESULTS: Impressively, over 11,000 nurses from 60 countries engaged, fostering a global platform for sharing evidence-based knowledge, experiences and strategies. IMPLICATIONS FOR PRACTICE: This partnership exemplifies the value of international collaboration. By pooling resources and expertise across cultural contexts, the initiative not only disseminated crucial knowledge but also cultivated a sense of global community among nurses. The success of this collaboration underscores the potential of such global partnerships for healthcare institutions worldwide, offering avenues to share best practices and enhance support systems for nurses confronting similar crises globally.

James Warden and the Global Alliance Partnership: A Pediatric Surgery Giant and His Enduring PAPS Landmark.

The discipline of pediatric surgery has honored many of the early giants through programs that bear their names. One of those programs is the M. James Warden Global Alliance Partnership, a landmark program celebrated at each annual meeting of the Pacific Association of Pediatric Surgeons since 1989. This article describes James Warden and his legacy as a surgeon and humanitarian and provides an update on the past, present, and future of the Global Alliance Partnership that bears his name. LEVEL OF EVIDENCE: 5.

Seizing the moment: The time for harnessing electronic patient-reported outcome measures for enhanced and sustainable metastatic breast cancer care is now.

The sustainability of healthcare systems is under pressure. Unlike care for many other chronic diseases, cancer care has yet to empower patients in effectively self-managing both the medical and emotional consequences of their condition, including adapting to changes in lifestyle and work, which is essential to achieve optimal health and recovery. Although proposed as a potential solution for sustainable healthcare and support for optimal health and recovery already decades ago, practical implementation of digital care lags behind. We believe electronic patient reported outcome measures (ePROMs) could play an important role in creating sustainable healthcare, both to guide complex treatment pathways and to empower survivors to self-manage consequences of diagnosis and treatment. That is, ePROMs can be used for screening and monitoring of symptoms, but also for treatment decision-making and to facilitate communication about quality of life. We therefore see opportunities for improvements in quality of care, quality of life, and survival of cancer patients, as well as research opportunities, as ePROMs collection can lead to better understanding of care needs. The '10 Actions for Change report' of the Advanced Breast Cancer Global Alliance stresses a critical need for improvement of care for metastatic breast cancer (MBC) patients. We therefore in this paper focus on MBC care and research.

Mapping MAVE data for use in human genomics applications.

The large-scale experimental measures of variant functional assays submitted to MaveDB have the potential to provide key information for resolving variants of uncertain significance, but the reporting of results relative to assayed sequence hinders their downstream utility. The Atlas of Variant Effects Alliance mapped multiplexed assays of variant effect data to human reference sequences, creating a robust set of machine-readable homology mappings. This method processed approximately 2.5 million protein and genomic variants in MaveDB, successfully mapping 98.61% of examined variants and disseminating data to resources such as the UCSC Genome Browser and Ensembl Variant Effect Predictor.

Eliminating Vertical Transmission of HIV in South Africa: Establishing a Baseline for the Global Alliance to End AIDS in Children.

To gain a detailed overview of vertical transmission in South Africa, we describe insights from the triangulation of data sources used to monitor the national HIV program. HIV PCR results from the National Health Laboratory Service (NHLS) were analysed from the National Institute of Communicable Diseases (NICD) data warehouse to describe HIV testing coverage and positivity among children <2 years old from 2017-2021. NICD data were compared and triangulated with the District Health Information System (DHIS) and the Thembisa 4.6 model. For 2021, Thembisa estimates a third of children living with HIV go undiagnosed, with NICD and DHIS data indicating low HIV testing coverage at 6 months (49%) and 18 months (33%) of age, respectively. As immunisation coverage is reported at 84% and 66% at these time points, better integration of HIV testing services within the Expanded Programme for Immunization is likely to yield improved case findings. Thembisa projects a gradual decrease in vertical transmission to 450 cases per 100,000 live births by 2030. Unless major advances and strengthening of maternal and child health services, including HIV prevention, diagnosis, and care, can be achieved, the goal to end AIDS in children by 2030 in South Africa is unlikely to be realised.

GA4GH Phenopackets: A Practical Introduction.

The Global Alliance for Genomics and Health (GA4GH) is developing a suite of coordinated standards for genomics for healthcare. The Phenopacket is a new GA4GH standard for sharing disease and phenotype information that characterizes an individual person, linking that individual to detailed phenotypic descriptions, genetic information, diagnoses, and treatments. A detailed example is presented that illustrates how to use the schema to represent the clinical course of a patient with retinoblastoma, including demographic information, the clinical diagnosis, phenotypic features and clinical measurements, an examination of the extirpated tumor, therapies, and the results of genomic analysis. The Phenopacket Schema, together with other GA4GH data and technical standards, will enable data exchange and provide a foundation for the computational analysis of disease and phenotype information to improve our ability to diagnose and conduct research on all types of disorders, including cancer and rare diseases.

An Atlas of Variant Effects to understand the genome at nucleotide resolution.

Sequencing has revealed hundreds of millions of human genetic variants, and continued efforts will only add to this variant avalanche. Insufficient information exists to interpret the effects of most variants, limiting opportunities for precision medicine and comprehension of genome function. A solution lies in experimental assessment of the functional effect of variants, which can reveal their biological and clinical impact. However, variant effect assays have generally been undertaken reactively for individual variants only after and, in most cases long after, their first observation. Now, multiplexed assays of variant effect can characterise massive numbers of variants simultaneously, yielding variant effect maps that reveal the function of every possible single nucleotide change in a gene or regulatory element. Generating maps for every protein encoding gene and regulatory element in the human genome would create an 'Atlas' of variant effect maps and transform our understanding of genetics and usher in a new era of nucleotide-resolution functional knowledge of the genome. An Atlas would reveal the fundamental biology of the human genome, inform human evolution, empower the development and use of therapeutics and maximize the utility of genomics for diagnosing and treating disease. The Atlas of Variant Effects Alliance is an international collaborative group comprising hundreds of researchers, technologists and clinicians dedicated to realising an Atlas of Variant Effects to help deliver on the promise of genomics.

Patient-Reported Outcome Measures to Improve the Care Continuum for Patients With Metastatic Breast Cancer: Opportunities and Implications for Nursing Practice.

OBJECTIVES: Albeit treatable, metastatic breast cancer (MBC) remains incurable. To achieve remaining life years lived well, extended survival should be balanced with optimal health-related quality of life (HRQoL) and timely initiated supportive, palliative, and end-of-life care. The Advanced Breast Cancer (ABC) Global Alliance identified 10 urgent and actionable goals for the decade between 2015 and 2025 to achieve substantial improvement in the lives of patients living with ABC, including MBC. Enhancements are needed for HRQoL, research, quality of care, and survival. We explore the potential of patient-reported outcome measures (PROMs) in addressing these gaps and aim to describe opportunities and current initiatives for improving the MBC care continuum through PROMs. DATA SOURCES: Narrative description of recent literature on MBC and PROMs. CONCLUSION: We believe PROMs can make valuable contributions to seven of the 10 goals described: 1) enhancing the understanding of MBC through high-quality data collection, 2) improving HRQoL and raising consideration of survival versus HRQoL, 2) prolonging survival, 4) increasing referral to nonclinical support services, 5) supporting patient-healthcare provider communication, 6) encouraging improvements in healthcare access, and 7) supporting meeting patients' informational needs. IMPLICATIONS FOR NURSING PRACTICE: Maximizing the benefits of PROMs requires effective implementation. Because nurses and nurse practitioners are at the forefront of care, they can offer a comprehensive understanding of patients' needs and play a crucial role in facilitating the integration of PROMs into routine care for MBC patients and ultimately optimizing patients' outcomes and life years and months left.

Results from Poland's 2022 Report Card on Physical Activity for Children and Youth.

This paper presents the methodology and results of Poland's 2022 Report Card on physical activity (PA) of children and adolescents, as part of the Global Matrix (GM) 4.0 project. The aim of this paper is to discuss the current state of PA of children and adolescents in Poland. Grades were assigned to ten indicators of behaviors, physical fitness and sources of influence or settings, based on a synthesis of the best available data. In Poland two indicators: Overall Physical Activity (OPA) and Active Play were not assessed. Out of the other indicators, School received the highest score B+, whereas the other indicators had generally moderate to weak scores (between C+ and D). Scores for Organized Sport and Physical Activity, School and Physical Fitness indicators were improved compared with the previous GM, whereas scores for Active Transport and Government were lower. No positive changes regarding OPA or Sedentary Behaviors were observed. One of the limitations of PA promotion in Poland is that government-level PA policies are overly focused on organized PA and sport. Recommendations for improving PA monitoring in Poland, influencing PA behaviors and strengthening PA settings and sources of influence are also discussed.

Parental Factors Associated With Physical Activity Among East Asian Children/Youth: A Meta-Analysis Based on the Active Healthy Kids Report Cards.

Insufficient physical activity (PA) is a leading risk factor for mortality. The Active Healthy Kids Report Cards provide comprehensive evidence related to PA in children/adolescents. Associations of (1) parental support for PA with amount of moderate-to-vigorous-intensity PA (MVPA) performed by children/adolescents and (2) amount of MVPA performed by parents with amount of MVPA performed by children/adolescents, as indicated by Report Cards, have not been critically synthesized in meta-analysis. We selected data in Asian countries/regions Report Cards and performed meta-analyses to assess pooled associations of influence indicators and behavior indicators among children/adolescents in Asian countries/regions. Our meta-analyses included five studies that assessed association of parental support or MVPA performance with child/adolescent MVPA performance. Positive association was observed between the amount of time spent by parents on MVPA per week, regardless of gender, and the amount of time spent by children and adolescents on MVPA per week (r = .11; I2 = 40%). In East Asia, the amount of MVPA performed by parents appears to be an important factor influencing the participation of children/adolescents in PA.

Analysis of health overseas development aid for internally displaced persons in low- and middle-income countries.

Background: There are an estimated 55 million internally displaced persons (IDPs) globally. IDPs commonly have worse health outcomes than host populations and other forcibly displaced populations such as refugees. Official development assistance (ODA) is a major source of the global financial response for health in low- and middle-income countries (LMICs), including for populations affected by armed conflict and forced displacement. Analysis of ODA supports efforts to improve donor accountability, transparency and the equitable use of ODA. The aim of this study is to examine international donor support and responsiveness to IDP health needs through analysis of ODA disbursements to LMICs between 2010 and 2019. Methods: ODA disbursement data to LMICs from 2010 to 2019 were extracted from the Creditor Reporting System (CRS) database and analysed with Stata software using a combination of: (i) text searching for IDP and refugee related terms; and (ii) relevant health and humanitarian CRS purpose codes. Descriptive analysis was used to examine patterns of ODA disbursement, and nonlinear least squared regression analysis was used to examine responsiveness of ODA disbursement to recipient country IDP population size and health system capacity and health characteristics. Findings: The study highlighted declining per IDP capita health ODA from USD 5.34 in 2010 to USD 3.72 in 2019 (with annual average decline of -38% from the 2010 baseline). In contrast, health ODA for refugees in LMICs increased from USD 18.55 in 2010 to USD 23.31 in 2019 (with an annual average increase of +14%). Certain health topics for IDPs received very low ODA, with only 0.44% of IDP health ODA disbursed for non-communicable diseases (including mental health). There was also weak evidence of IDP health ODA being related to recipient country IDP population size, and health system capacity and health characteristics. The paper highlights the need for increased investment by donors in IDP health ODA and to ensure that it is responsive to their health needs.

The one health landscape in Sub-Saharan African countries.

OBJECTIVES: One Health is transiting from multidisciplinary to transdisciplinary concepts and its viewpoints should move from 'proxy for zoonoses', to include other topics (climate change, nutrition and food safety, policy and planning, welfare and well-being, antimicrobial resistance (AMR), vector-borne diseases, toxicosis and pesticides issues) and thematic fields (social sciences, geography and economics). This work was conducted to map the One Health landscape in Africa. METHODS: An assessment of existing One Health initiatives in Sub-Saharan African (SSA) countries was conducted among selected stakeholders using a multi-method approach. Strengths, weaknesses, opportunities and threats to One Health initiatives were identified, and their influence, interest and impacts were semi-quantitatively evaluated using literature reviews, questionnaire survey and statistical analysis. RESULTS: One Health Networks and identified initiatives were spatiotemporally spread across SSA and identified stakeholders were classified into four quadrants. It was observed that imbalance in stakeholders' representations led to hesitation in buying-in into One Health approach by stakeholders who are outside the main networks like stakeholders from the policy, budgeting, geography and sometimes, the environment sectors. CONCLUSION: Inclusion of theory of change, monitoring and evaluation frameworks, and tools for standardized evaluation of One Health policies are needed for a sustained future of One Health and future engagements should be outputs- and outcomes-driven and not activity-driven. National roadmaps for One Health implementation and institutionalization are necessary, and proofs of concepts in One Health should be validated and scaled-up. Dependence on external funding is unsustainable and must be addressed in the medium to long-term. Necessary policy and legal instruments to support One Health nationally and sub-nationally should be implemented taking cognizance of contemporary issues like urbanization, endemic poverty and other emerging issues. The utilization of current technologies and One Health approach in addressing the ongoing pandemic of COVID-19 and other emerging diseases are desirable. Finally, One Health implementation should be anticipatory and preemptive, and not reactive in containing disease outbreaks, especially those from the animal sources or the environment before the risk of spillover to human.

Armed conflict, a neglected determinant of childhood vaccination: some children are left behind.

Vaccination is an indisputable intervention that has tremendously mitigated the global burden of vaccine-preventable diseases (VPDs). The number of armed conflicts globally seems to be at an all-time high, with devastating effects on vaccination coverage. This paper will examine how armed conflicts affect childhood vaccination and lead to the reemergence and spread of VPDs. Unarguably, socioeconomic factors, population demographics, the apparent long vaccination timetable, multiple vaccine doses, lack of trust in vaccination processes and the rumor of the adverse effects of some vaccines unnerve some parents and create a puzzle. By bringing under the global floodlight, the impact of armed conflicts which contextually affect vaccination coverage, this article will help strengthen the advocacy for vaccination, and call for the fortification of existing treaties on the rule of engagement during conflicts. In order to eliminate or eradicate VPDs, strategies to reach children that are left behind during conflicts is paramount.

Improving the quality of hospital care provided for asthma out-patients in a country in turmoil: a report from Syria.

BACKGROUND: In low resources settings, especially during periods of turmoil, asthma care becomes emergency-oriented, and adherence to international asthma management guidelines such as long-term inhaled corticosteroids (ICS) prescription is limited. The role of education for inhaler technique to guarantee treatment efficacy is neglected and follow up is hampered by war-related displacement. In Syria, asthma care is not included in primary care, and frequently, internal medicine general hospital outpatient clinics are the first contact. The main objective of our study was to evaluate the adequacy of prescription of controller medications (ICS/LABA) by residents on initial contact with patients, and the effect of regular onsite personalized supervision and coaching by a trainer pulmonologist on improving their practice. The second objective was to evaluate the efficacy of mobile training for inhaler technique, and asthma mobile follow up. METHODS: We developed an audit form to assess initial prescription of ICS/LABA by residents. Filled forms were reviewed by a trainer pulmonologist for compliance with international guidelines. When discrepancies were noted, onsite training was provided. Auditing of new presenting asthma patients is continual to evaluate improvement of initial prescription by the same residents. In parallel, video-mobile education of patients for inhaler technique, and mobile interviewing follow up were tested. RESULTS: Implementation of these strategies resulted in improved adherence of residents to ICS dosing guidelines (P=0.002), optimal inhaler technique by patients, and efficacy of mobile follow up. CONCLUSIONS: WHO programs for CRD in developing countries, especially in regions of conflict and war, should include auditing of care by residents with onsite coaching by trainer pulmonologists, and mobile education for technology of inhaler and patient follow up.

A rapid evidence appraisal of influenza vaccination in health workers: An important policy in an area of imperfect evidence.

INTRODUCTION: The World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a 'whole-of-system' perspective to consider possible benefits for HWs, employers and patients. METHODS: We executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases. RESULTS: Of 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination. CONCLUSIONS: The evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients.