Mosquito borne viruses are a major cause of mortality and morbidity, especially in the developing world.  As warmer weather increases the habitat for these disease vectors the problem is spreading to the developed world. A five-year study published today in Virology Journal shows for the first time the extent of mosquito-borne viruses (known as arboviruses) in diverse regions of Kenya.

The researchers surveyed almost half a million mosquitoes from varied habitats including savannah grassland, semi-arid Acacia thorn bushes, and mangrove swamps, and sequenced the genomes of the viruses they found. 83 different viruses were discovered, both known and unknown species that cause disease in humans and livestock. Predominant virus ...

Read more]]> Written by Ben Johnson, Senior Acquisitions and Development Editor, BioMed Central

Mosquito borne viruses are a major cause of mortality and morbidity, especially in the developing world.  As warmer weather increases the habitat for these disease vectors the problem is spreading to the developed world. A five-year study published today in Virology Journal shows for the first time the extent of mosquito-borne viruses (known as arboviruses) in diverse regions of Kenya.

The researchers surveyed almost half a million mosquitoes from varied habitats including savannah grassland, semi-arid Acacia thorn bushes, and mangrove swamps, and sequenced the genomes of the viruses they found. 83 different viruses were discovered, both known and unknown species that cause disease in humans and livestock. Predominant virus families were alphaviruses, flaviviruses and orthobunyaviruses; pathogenic West Nile virus, Ndumu, Sindbis, Bunyamwera, Pongola and Usutu virus were all found in diverse locations. Of particular interest was the isolation of Ngari virus, associated with hemorrhagic fever in northern Kenya in the late 1990s, from two sites in Kenya.

The authors, from United States Army Medical Research Unit, Kenya, Kenya Medical Research Institute, and the International Centre for Insect Physiology and Ecology in Nairobi, also found two previously unknown viruses, one with similarities to the newly discovered Chaoyang virus in China, and two more related to Quang Binh virus.

This study provides a hugely important resource for public health professionals in East Africa, identifying the habitat of these viruses and their insect vectors for the first time. Professor Linfa Wang, Editor-in-Chief of Virology Journal and an expert in emerging infectious diseases commented that “this important study highlights the need for on-going surveillance in animals and insect vectors, in order to prepare for potential virus outbreaks in humans.”

Initially motivated by the student anti-war movement, Nelson believed that if he could inspire the same ...

Read more]]> The seventies was a decade defined by its free-loving, environmentally aware, “hippie” culture, so it comes as no surprise that Earth Day, a day dedicated to environmental awareness, was created in the spring of 1970.  Founder Gaylord Nelson, U.S. Senator (1963 to 1981),  was so appalled by the ravages of the 1969 oil spill in Santa Barbara, California, he decided that it was time for a change. Along with support from Pete McCloskey, a conservation-minded Republican Congressman and Denis Hayes, who became the national coordinator, he announced to the media  the need for a “national teach-in on the environment.”

Initially motivated by the student anti-war movement, Nelson believed that if he could inspire the same energy and public consciousness that was seen at many protests towards an environmental cause, then it could force environmental awareness onto the political agenda.

As a result the first ever Earth day was born. On April 22^nd 1970, 20 million Americans demonstrated on the streets, in parks and auditoriums demanding a sustainable environment and the aiming to raise public awareness about how to look after our fragile planet.

Today, 46 years later, we celebrate Earth Day 2013 with the theme “The face of climate change.” With over 1 billion people taking part worldwide, they are granted the opportunity to voice their concerns and to take action. This is an issue that effects everyone across the globe, whether it is the effects of climate change on human health, or on the floods and droughts causing huge agricultural problems. This is our world for us to save.

For more information on Earth Day 2013, and how you can take part, please visit their website.

For research relevant to Earth Day and its objectives please visit BioMed Central’s open access journals, Agriculture and Food Security and Environmental Health. For more please visit the BioMed Central website.

In our culture, we use mobile phones everyday with little thought to the benefits they may provide outside of socialising. Yet in developing countries, mobile phones may be the key to improved healthcare and education. With the recent increase of mobile phone usage in developing countries, these areas may help influence the handheld market. Recent studies identified a good 64 per cent of users worldwide are from developing countries, and in Africa, mobile phone sales have increased by 550 per cent due to growing popularity.

According to a study in Malaria Journal by Wasif A Khan from iccddr,b, in a rural district of Bangladesh, mobile phones have proved ...

Read more]]> Written by James Balm, Social Media Intern, BioMed Central

In our culture, we use mobile phones everyday with little thought to the benefits they may provide outside of socialising. Yet in developing countries, mobile phones may be the key to improved healthcare and education. With the recent increase of mobile phone usage in developing countries, these areas may help influence the handheld market. Recent studies identified a good 64 per cent of users worldwide are from developing countries, and in Africa, mobile phone sales have increased by 550 per cent due to growing popularity.

Photograph by whiteafrican

According to a study in Malaria Journal by Wasif A Khan from iccddr,b, in a rural district of Bangladesh, mobile phones have proved beneficial in the diagnosis and treatment of malaria. This particular area is considered to have one of the highest rates of malaria, possibly due to its close proximity to forests which mosquitoes may use as a habitat.  The mobile phone was found to be an efficient method in the detection of malaria within remote areas, when combined with local knowledge and field support. Just over half (56.4%) of those who owned a phone had used them for medical purposes, and 11.9% had used their phone for malaria services. Due to the mobile phone, people were able to have access to rapid treatment and diagnosis. This reduced incorrect and potentially dangerous treatment (which can even lead to drug resistance) from being carried out by local medicine men or drug vendors.

Photo by Laura Elizabeth Pohl/Bread for the World

Mobile phones are also useful in data collection, as individuals and families can be more easily contacted, contributing to research and understanding of surrounding areas. Education has been provided via phone, using Internet modules, in various health areas such as cancer, HIV, and even eyecare awareness. Warnings can also be distributed via mobile when natural disasters occur to prevent injuries or death.

Examples of the use of mobile phones in public health are found across many developing countries. A study in BMC Research Notes by Kivuti-Bitok & colleagues (2013) in Kenya, finds that mobile phones have aided in identification of cervical cancer. Furthermore, it was felt that mobile phones could play a great role in advertising and encouraging screening, which many patients were reluctant to go through with due to embarrassment and cultural expectations. Health care managers stated that mobile phones had potential for health education, reminder alerts, and information management.

Photography by Ken Banks, kiwanja.net

However, they also found that there are some obstacles faced with using mobile phones. Treatment proved more effective in areas with  better transport routes, due to accessibility. Furthermore, signal is low in remote areas, and when users return to their village, they may be at risk of missing important messages.

Future strategies using mobile phones may involve geolocation, as described in The Guardian, where individuals can be identified via GPS in their mobile phone. This may prove especially vital for identifying the sick, and women during childbirth, in remote locations.

Overall, the use of mobile phones has expanded rapidly even into the most remote areas. They have been useful in the fight against malaria. The benefits of mobile phone use in developing countries could lead to new interventions involving education, awareness, & communication. According to The Atlantic developed countries like the US could learn from this. With these new strategies using simple mobile technology, developing countries are a step ahead. It seems for developing countries, improvement in healthcare is just one text away.

The 2013 meeting of the International Labour Organization found that even though apprenticeships are available in developing countries, they are frequently unpaid with no certainty of employed work after training is completed.

In contrast, the World Bank note that it is becoming easier for entrepreneurs in the developing world to set ...

Read more]]> Young people all over the world face challenges, but in the developing world there are additional pressures.  According to UNESCO 20% of young people in developing countries fail to finish primary school and consequently lack the necessary skills for finding employment and improving their lives. Despite this, many young people are forced to work to survive and end up working for very little money. Many are essentially self-employed.

The 2013 meeting of the International Labour Organization found that even though apprenticeships are available in developing countries, they are frequently unpaid with no certainty of employed work after training is completed.

In contrast, the World Bank note that it is becoming easier for entrepreneurs in the developing world to set up businesses, but only, according to the Wall Street Journal, if they are prepared to be flexible and innovative, compared to traditional developed world business strategies. Acting on this, communities like Business Fights Poverty aim to provide a framework so that the youth in developing countries, who are self-employed, can become self supporting.

In an article in BMC International Health and Human Rights, author Caroline Kabiru discusses the difficulties many young people face in their daily lives, and the lack of research into their health and well being. She points out that while we know the long term impacts of low education levels, there is a lack of research into how to increase access to education and keep children in school.

However, Caroline Kabiru also points out that education is not just a ‘heal-all’ plaster.  The impact of urbanization, with its overtones of poverty and overcrowding, negatively affects health. While globalization increases expectations and exposes youth in developing countries to western values and culture which they are not prepared to deal with. Other everyday issues include the impact of health care which often treats young people as adults while, oppositely, a lack of sex education increases the threat of HIV. Not least are the challenges of growing up in a war zone.  Young people are not only victims of war but frequently have to fight. The reintegration of these people back into society is an under researched topic both in terms of their social and economic needs.

African Economic Outlook predict that things are getting better, and that by 2030 more young people will not only be able to finish primary school but will be able to finish secondary school and even go on to further education. They envisage that 59% of 20-24 year olds will have had secondary education in 2030, compared to 42% today. Along with research and implementation of evidence into policies affecting youth this can only help in increasing employment and improving lives, while simultaneously addressing the health issues and well being of the young.

TB is an indiscriminate disease affecting people all over the world. Globally  a third of the world’s population is thought to be infected. According to the CDC year on year decreases mean that there were 3.4 cases per 100,000 people in the US in 2011, and the equivalent NICE statistic for the UK in 2008 was 14.1 per 100,000 people. However in Ethiopia, according to the World Health ...

Read more]]> World Tuberculosis Day was on the 24^th March  and this year’s focus of the Stop TB Partnership, a collective force of 1000 partners in more than 100 countries including the WHO, is to prevent the deaths of the 4000 people who lose their lives to Tuberculosis (TB) every day.

TB is an indiscriminate disease affecting people all over the world. Globally  a third of the world’s population is thought to be infected. According to the CDC year on year decreases mean that there were 3.4 cases per 100,000 people in the US in 2011, and the equivalent NICE statistic for the UK in 2008 was 14.1 per 100,000 people. However in Ethiopia, according to the World Health Organisation (WHO), the 2011 data shows an incidence of 250 cases per 100,000 people, a fifth of whom also have HIV. It was responsible for 29,000 deaths in 2010, ranking Ethiopia as seventh for TB burden in the world.

Diabetes has received increasing attention as a risk factor for TB. It weakens the immune system making it easier for people to succumb to infection by TB, increasing risk by two to three times. People with diabetes are also more likely to progress from latent to active TB. But what does this actually mean in countries such as Ethiopia where the incidence of TB is high?

A study published in the open access journal, Infectious Diseases of Poverty, looked at smear positive pulmonary TB (PTB) among diabetic patients at the Dessie referral hospital, in Northeast Ethiopia. Little has previously been explored about the prevalence and associated risk factors of PTB for those with diabetes in that area. In this study PTB occurred  more often among patients with diabetes at a rate of 6% compared to 0.4% of the general population – far higher than the global increased risk found by the WHO. Additional (independent) increased risk was found for patients with a history of TB, with history of contact with TB patients at home, or living in urban areas, as well as prolonged duration of their diabetes.

Discussing their work, the authors from Bahir Dar Regional Health Research Laboratory Center and University of Gondar, explain that active screening and treatment of PTB among patients with diabetes is especially relevant in TB-endemic countries, such as Ethiopia.

Both diabetes and TB are on the increase worldwide, bringing high death rates, high burden of care, and challenges associated with controlling both diseases at the same time. All of this makes additional knowledge about their interaction and implications for screening and treatment extremely valuable. This study shows that regional knowledge can be equally important is controlling the spread of TB and in identifying those at risk.

by Hilary Glover and Ruth King

A lack of food security is a daily problem faced by nearly 1.4 million people in Uganda, with changing climate and continuing socio- economic ...

Read more]]> Wetlands contribute significantly to strategies mitigating for food insecurity in Uganda, finds a new study published in Agriculture & Food Security today. Wetlands provide vital nutrients for crop farming and ensure water availability during dry seasons which is important for irrigation.  Because of this Ugandan wetlands have seen an influx of people using these resources over the last few years while climate has become increasingly unstable. Furthermore, wetlands are also used for income generation, for example by providing clay for pottery, reed and palm mats, baskets, beehives and cultivation of cash crops.

A lack of food security is a daily problem faced by nearly 1.4 million people in Uganda, with changing climate and continuing socio- economic strains this is likely to increase in the future.  Coping strategies are varied, and may have differing impacts on the environment; the use of wetlands for resources is just one such strategy. In a comprehensive analysis of food security and related coping strategies in Uganda, Turyahabwe et al find that around 83% of Ugandan households suffer from food insecurity, and over 80% of study participants reported using wetland resources to contribute to household food security. These findings emphasise the importance of wetlands in Ugandan households, and the devastating affect that limiting access to this vital resource could have.

Wetlands are also of significant importance for biodiversity conservation, as many species rely on these areas for resources such as food and water, particularly during the frequent droughts. Because of this, conservation measures may be put into place such as restricting use of wetlands by humans, and creation of nature reserves to protect these important habitats. Conflict therefore arises between conservation policies and food security strategies regarding the use of wetlands.

With these two considerable pressures on wetlands, this research highlights the importance of developing a sustainable use of wetland resources which can benefit biodiversity conservation as well as ensuring that land can continue to be used to ensure food security.

Written by Rhiannon Meaden, Journal Development Editor, Agriculture & Food Security

 In order to draw attention to the importance of available freshwater and to advocate the sustainable management of freshwater resources, The United Nations General Assembly (UNGA) designated the ...

Read more]]> Water is  “the driving force of nature”, said Leonardo da Vinci around 500 years ago. It is the most precious element our earth has to offer, yet in the western world, it  is taken for granted thanks to ease of accessibility. Elsewhere, in Africa, there are approximately 345 million without any access to water, and a further 780 million people worldwide who can only access unclean, contaminated water. It is unjust that in some countries this vital resource is so scarce whereas in others it’s endlessly available on tap.

 In order to draw attention to the importance of available freshwater and to advocate the sustainable management of freshwater resources, The United Nations General Assembly (UNGA) designated the 22^nd March 1993  as World Water Day by and this date has been celebrated annually ever since. Each year follows a different theme to try and highlight a specific aspect of freshwater. This year’s theme is the International  Year of Water Cooperation that aims to focus on water management and how with effective cooperation, at a local or international scale, there could be higher chance of being able to share this valuable resource across the globe.

Water cooperation involves multiple actors; whether that includes building a village water pump in sub-Saharan Africa, which would require local actors to cooperate, or bringing water from a river to irrigate farmland which would involve regional cooperation. However there can be obstacles preventing cooperation, such as cultural and perhaps conflicting needs when using water resources such as a transboundary river basin. If any of the people involved in water management are not harmonious, the ‘cooperation chain’ is then broken and water resources will not be managed in the most effective way and could lead to adverse effects on human lives and the economy.

 With more than 3.4 million people dying each year from water, sanitation, and hygiene-related causes and with nearly all of these deaths occurring in the developing world, it is crucial to raise awareness of how, with even the smallest amount of cooperation such as a shorter shower, we can all contribute to the number of water-related deaths can be prevented.

 For more information on World Water Day please visit the website.

BMC Medicine recently attended the Consortium of Universities for Global Health (CUGH 2013) conference on global health, which took place in Washington D.C. from the 14th-16th March. Around 1400 delegates participated, with a broad range of expertise, such as those involved in general medicine, surgery, policy making, and governance, reflecting the broad scope of this field.

The conference was particularly exciting because of the recently published Global Burden of Disease Study 2010 (GBD 2010) – a series of articles on how the international disease burden has changed since 1990. Although people are living longer due to decreases in the burden of infectious diseases and malnutrition, non-communicable diseases, such as cancer ...

Read more]]> Written by Lin Lee, Senior Editor, BMC Medicine

BMC Medicine recently attended the Consortium of Universities for Global Health (CUGH 2013) conference on global health, which took place in Washington D.C. from the 14^th-16^th March. Around 1400 delegates participated, with a broad range of expertise, such as those involved in general medicine, surgery, policy making, and governance, reflecting the broad scope of this field.

The conference was particularly exciting because of the recently published Global Burden of Disease Study 2010 (GBD 2010) – a series of articles on how the international disease burden has changed since 1990. Although people are living longer due to decreases in the burden of infectious diseases and malnutrition, non-communicable diseases, such as cancer and cardiovascular disease, are on the rise. Chris Murray, one of the lead authors of this landmark set of articles, gave an excellent presentation summarising the findings, and demonstrating his research facility’s visualisation tool of the data. One of the future aims of the study is to expand analysis of the data, add health forecasts and track health expenditure. It is hoped that this ambitious project will eventually be able to link the size of each disease burden with various risk factors, which one can then use to create policies in order to address the problem.

Global heath aims to improve health and achieve equity in the health status of all, regardless of their economic situation. This is of particular importance in resource-limited settings, and also in countries without sufficient health coverage, since healthcare expenditure due to disease or injury can often mean a family crossing into poverty, and healthcare systems may not have the resources needed to appropriately treat an individual.

How should we address such disparities in health? Universal healthcare, discussed in the opening keynote lecture, is an obvious strategy, but this has limitations with regards to the resources of that country. One such resource is the healthcare system itself, created by the body of healthcare professionals.  Unfortunately, ‘brain drain’ has become a problem in, for instance, African countries, where healthcare professionals will leave their country for better financial opportunities, creating a healthcare void. This was discussed in a session on the Medical Education Partnership Initiative (MEPI) – a medical education program aiming to increase physician retention in African countries. Fitzhugh Mullan and colleagues discussed the challenges and results from this intervention.

Dispersion of knowledge is a powerful way in which to improve health, but this, too, is subject to inequality. Agnes Binagwaho, who is Minister for Health in Rwanda, gave a series of excellent lectures on global health policy. One of the issues raised, and particularly important for global health, was access of evidence based medicine for resource-limited settings. She highlighted that such evidence should be freely accessible for all, and advocated that global health articles should be published in Open Access journals.

As an Open Access journal itself, BMC Medicine is committed to providing ‘knowledge for all’. We have recently launched our Medicine for Global Health article collection, which aims to explore health care innovations and policies, health economics and implementation, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health. Articles offering novel insights into public health initiatives, health care policies, economics, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health are invited to be submitted to BMC Medicine as part of this article collection.

Many ...

Read more]]> Care of vulnerable populations constitutes a sizeable proportion of those in need of medical resources, and there exists considerable disparity between those who can, and can’t afford access to medical services. Although, these issues have always existed, concerns over global health and health inequities have been emphasized over recent years. For instance, few will forget the devastation caused by Hurricane Sandy in November 2012, where much of the focus was on the U.S., despite the fact that the devastation caused by the hurricane was far more severe in Haiti. As a country that is much more restricted in terms of resources, the impact on livelihood and medical facilities was far greater to the residents of this area.

Many researchers and physicians from a wide variety of disciplines are engaged in bringing awareness to, and improving global health, which is an area of medicine that ‘places a priority on improving health and achieving equity in health of all people worldwide’. This growing interest in also apparent from the Global Burden of Disease study (GBD 2010), which published a series of articles exploring the worldwide distribution of disease using global data from the past decade,with an aim to better understand the health priorities for the global community.

In light of this hugely important area of medicine and research, BMC Medicine has launched the Medicine for Global Health article collection, with guest editors Gretchen Birbeck and Raymond Hutubessy. This collection aims to explore public health initiatives, health care policies, health economics, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health.

Gretchen Birbeck launches our article collection with an editorial, discussing the increasing relevance of medicine in resource-limited settings, highlighting that simple interventions may help to lessen the global burden of disease. Gretchen, who is based in southern Africa for half of the year, has first-hand experience of managing epilepsy in resource-limited settings, and in an interview, she talks about her personal experiences in this area.

You can also listen to Lin Lee’s interview with Gretchen Birbeck in this podcast:

Raymond Hutubessy, based at the World Health Organization (WHO), is a health economist who specializes in economic analyses underlying decisions on whether or not to introduce vaccines against, for example, Human papillomavirus (HPV). In his Q&A  for the launch of the article collection, he discusses why this is of particular importance in resource-limited settings.

Ethical issues associated with global health research are discussed by James Giordano in an interview. He highlights that low- and middle- income countries are often the ones in most need of modern medical care, yet there exists an asymmetry in terms of research needs and research funds.

You can also listen to Sabina Alam’s interview with James Giordano in this podcast:

Often, the main concern is whether or not the intervention or research required is sustainable in the host country. This subject is touched upon in a bibliometric analysis by Charles Wiysonge and colleagues. They find that since the onset of the Expanded Program on Immunization, vaccine research productivity in Africa has skewed towards those funded by private means, with researchers from Africa having less research input, suggesting a need for better communication between all stakeholders.

The article collection also includes a research paper by Kathryn Maitland et al., who previously published extremely surprising results from the Fluid Expansion as Supportive Therapy (FEAST) study. Here, African children with severe febrile illnesses given the intervention of rapid fluid bolus exhibited excess mortality compared with controls – the opposite result to what was expected. In a secondary analysis of this data published in BMC Medicine, the authors explored the mechanisms behind the excess mortality, finding that it was due to cardiovascular collapse rather than fluid overload. Clarifying the mechanisms behind death in this population of patients has implications for fluid resuscitation practices in other populations of critically ill patients, an issue that is further emphasized in a linked commentary by John Myburgh and Simon Finfer.

It is hoped that the Medicine for Global Health article collection will highlight and ultimately help to resolve some of the medical concerns affecting global health. Articles offering novel insights into public health initiatives, health care policies, economics, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health are invited to be submitted to BMC Medicine as part of this article collection.

Every year the lack of access to contraceptives leads to 60 million unwanted pregnancies, 22 million unsafe abortions and 3 million infant deaths; the majority of which occur in developing countries. Women all around the globe are unable to choose when they fall pregnant, nor control the size of their family, because contraception is simply not accessible. Reducing fertility would not only prevent maternal deaths each year but could significantly contribute to eradicating extreme poverty, promoting the empowerment of women and ensure environmental and economic sustainability. Initiatives like Every Woman, Every Child and the 5th Millennium  Development Goal advocate wider access to contraception in developing ...

Read more]]> Written by Rosie Smith, Journal Development Editor, Reproductive Health

Every year the lack of access to contraceptives leads to 60 million unwanted pregnancies, 22 million unsafe abortions and 3 million infant deaths; the majority of which occur in developing countries. Women all around the globe are unable to choose when they fall pregnant, nor control the size of their family, because contraception is simply not accessible. Reducing fertility would not only prevent maternal deaths each year but could significantly contribute to eradicating extreme poverty, promoting the empowerment of women and ensure environmental and economic sustainability. Initiatives like Every Woman, Every Child and the 5^th Millennium  Development Goal advocate wider access to contraception in developing nations and providing women with the opportunity to work, learn new skills and ultimately generate income.

With the population of the world rapidly growing, the social and economic benefits of contraception have never been so imperative. The barriers to knowledge and the successfully supply of contraception varies from country to country. A study recently published in Reproductive Health highlighted the potential for scaling up family planning services to address these barriers, such as, weaknesses in commodities, logistic management, geographical inaccessibility, limitations in health worker skills and numbers, legislation, and religious and cultural ideologies. Upscale modelling of initiatives such as task shifting and local staff recruitment, streamlining supply chains and establishment of integrated community health teams demonstrated a potential reduction in maternal mortality of up to 28%.

One of the most direct repercussions of projects such as family planning initiatives is the direct effect on maternal and newborn mortality. Increased contraception has reduced maternal mortality and is if contraception is provided. (Source: ‘The economic consequences of reproductive health and family planning’, The Lancet).

The procurement of family planning for all women through the breaking of barriers to contraception will have far reaching effects. By reducing the number of pregnancies, complications associated with parturition are naturally reduced,  in turn diminishing death through unsafe abortion practices and the associated dangers of high parities.

To read more on this topic and for other studies of this nature, please visit BioMed Central’s open access journal Reproductive Health.