Global Policy Recommendations Research Articles

Mapping of food environment policies in Zambia: a qualitative document analysis

BackgroundThe food environment in which people exercise food choices significantly impacts their dietary patterns. Policies that limit the availability, affordability, and access to unhealthy food while increasing that of healthier alternatives help build healthy food environments, which are required to address the double burden of malnutrition. This study aimed to assess the availability of food environment policies in Zambia.MethodWe applied a two-step qualitative document analysis to identify policy content relating to healthy food environments from global and Zambia-specific nutrition-related policy documents. In the first step, global policy documents were analyzed to develop a reference point for globally recommended policies for healthy food environments. In the second step, Zambia’s nutrition-related policies were analyzed to identify content relating to healthy food environments. The identified policy content was then mapped against the global reference point to identify food environment policy gaps.ResultsOur analysis of global policy recommendations identified five broad categories of policy provisions: information and education based; regulatory and legislative tools; strategies to promote production and access to healthy food production; social protection-based strategies and guiding principles for governments relating to multisectoral collaboration and governance. Our analysis found that Zambian Government policy documents in the health, agriculture, education, and national planning and development sectors have policy provisions for healthy food environments. While these policy provisions generally covered all five reference categories, we found policy gaps in the regulatory and legislative tools category relative to global recommendations.ConclusionZambia’s food environment policy landscape must include globally recommended regulatory and legislative policy measures like restricting the marketing of unhealthy foods and non-alcoholic beverages to children. Nutrition policy reforms are required to facilitate the introduction of regulatory and legislative policy measures that effectively address the double burden of malnutrition in Zambia.

Evaluation of global techno-socio-economic policies for the FEW nexus with an optimal control based approach

Inordinate consumption of natural resources by humans over the past century and unsustainable growth practices have necessitated a need for enforcing global policies to sustain the ecosystem and prevent irreversible changes. This study utilizes the Generalized Global Sustainability model (GGSM), which focuses on sustainability for the Food-Energy-Water (FEW) Nexus. GGSM is a 15-compartment model with components for the food-web, microeconomic framework, energy, industry and water sectors, and humans. GGSM shows that an increased per capita consumption scenario is unsustainable. In this study, an optimal-control theory based approach is devised to address the unsustainable scenario through policy interventions to evaluate sustainability by employing multiple global indicators and controlling them. Six policy options are employed as control variables to provide global policy recommendations to develop the multi-variate optimal control approach. Seven objectives are proposed to limit the human burden on the environment to ascertain sustainability from a lens of ecological, economic, and social wellbeing. This study observes the performance of the policy options toward seven sustainability indicators: Fisher Information, Green Net Product, Ecological Buffer, Carbon dioxide emissions, Nitrous oxide emissions, and Global Water Stress. The optimal control model assesses these multiple objectives by minimizing the variance in the Fisher Information. One significant result from this study is that optimizing for the Fisher Information based objective is adequate to attain sustainability and manage the other objectives under consideration. Thus, forgoing a multi-objective problem framework. The results show that cross-dimensional policy interventions such as increased vegetarianism and increased penalty on industrial discharge are shown to have a positive impact on scale.

Risk and Resilience of Somali Children in the Context of Climate Change, Famine, and Conflict

Climate change is an existential threat to all of humanity. Its impact on the children of Somalia provides insights into the severity of risks posed by climate change to current and future generations. Globally, there has been a continuous increase in mean annual temperatures since 1991 and scientists anticipate an increase of up to 4.3 degrees Celsius by the end of the century. Concomitantly, Somalia has experienced a decrease in annual rainfall, resulting in recurrent droughts. According to the UN’s emergency aid coordination office, these droughts have grown in frequency and intensity over the past three decades, fueling increased frequency of famine and contributing to internal conflict and civil war. In this article, the impact of climate change on children, exemplified by the plight of Somali children, is viewed through the lens of cumulative adversity and related consequences of poverty on malnutrition, illness, disruptions of family systems, and displacement, with a diaspora around the globe. The paper promotes a multi-systems resilience framework that guides strategies for addressing the complex, cascading crises that accompany climate change, exploring the construct of resilience from the individual/interpersonal level through family systems and communities, including a reframing of the Somali diaspora. The paper concludes with a series of global transnational policy recommendations based on children’s rights, the promotion of resilience, and approaching climate change from a child sensitive perspective, encouraging youth engagement and leadership, along with peace-building.

Hepatitis E in Bangladesh: Insights From a National Serosurvey.

BackgroundHepatitis E virus (HEV) genotypes 1 and 2 are a major cause of avoidable morbidity and mortality in South Asia. Despite the high risk of death among infected pregnant women, scarce incidence data has been a contributing factor to global policy recommendations against the introduction of licensed hepatitis E vaccines, one of the only effective prevention tools.MethodsWe tested serum from a nationally representative serosurvey in Bangladesh for anti-HEV immunoglobulin G and estimated seroprevalence. We used Bayesian geostatistical models to generate high-resolution maps of seropositivity and examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression.ResultsWe tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of 20% (95% confidence interval [CI], 17%–24%). Seropositivity increased with age and male sex (odds ratio, 2.2 male vs female; 95% CI, 1.8–2.8). Community-level seroprevalence ranged widely (0–78%) with higher seroprevalence in urban areas, including Dhaka, with a 3.0-fold (95% credible interval, 2.3–3.7) higher seroprevalence than the rest of the country.ConclusionsHepatitis E infections are common throughout Bangladesh. Strengthening surveillance for hepatitis E, especially in urban areas, can provide additional evidence to appropriately target interventions.

One Health Interdisciplinary Collaboration in Veterinary Education Establishments in Europe: Mapping Implementation and Reflecting on Promotion

One Health recognizes the interconnection of people, animals, and the environment and encourages a multidisciplinary approach. Several high-level European and global policy recommendations call for close intersectoral collaboration to better understand and manage health challenges faced today. Academic education has a fundamental role in preparing all health professionals in that respect. Our research investigates whether, and how, European Veterinary Education Establishments (VEEs) implement interdisciplinarity. We collected data on undergraduate education, post-graduate programs, and academic research through a pan-European survey. Our aim was to identify policy actions that could encourage cross-sectoral education and a culture of One Health at universities. Input from 41 VEEs showed that interdisciplinary education for undergraduates is still in the early stages. The models of academic structure, undergraduate curricula, and education policies established so far hinder interdisciplinarity. One Health interdisciplinary post-graduate education is easier, at least in some countries, while research successfully integrates multidisciplinary interdisciplinary and transdisciplinary approaches . To conclude, we propose five recommendations to promote interdisciplinary education in veterinary and other curricula and to further encourage the intersectoral cooperation in research: (1) the need for the development of One Health transdisciplinary competencies across different discipline curricula in the European Union (EU); (2) the need for an integrated strategy of university structures and policies (for undergraduates and post-graduates) to encourage and support interdisciplinarity; (3) the need for a harmonized approach to academic education via accreditation; (4) the need for appropriate legislation to facilitate interdisciplinary training; and (5) the need to encourage One Health research.

Action-oriented prospective policy analysis to inform the adoption of a fiscal policy to reduce diet-related disease in the Solomon Islands.

Fiscal tools are recommended as a part of a comprehensive approach to diet-related disease prevention, however, widespread adoption has been hampered by political and economic resistance. The aim of this study was to support an advocacy coalition in the Solomon Islands with evidence-based consideration of the development and implementation of a tax on sugar-sweetened beverages (SSBs), sensitive to local contextual factors and constraints. In 2017–19, we conducted a prospective policy analysis, including document analysis and qualitative interviews with key stakeholders to elicit policy-relevant data, a quantitative analysis to frame the policy problem and examine appropriate implementation mechanisms, and economic modelling to outline the potential benefits associated with different proposed policy solutions. Applying an action-oriented approach to prospective policy analysis enabled us as researchers to engage in the needs of a ‘pro-SSB tax’ advocacy coalition and prepare them to exploit policy opportunities created by the meeting of policy ‘streams’. Our analysis demonstrated that SSBs were being consumed in relatively large amounts, especially by children, and that there were likely to be substantial health and economic benefits associated with a SSB tax. Increasing fiscal uncertainty for key sectors had created an environment prime for the advocacy coalition to pursue the adoption of an SSB tax. However, we found that policymakers face a number of practical challenges in securing effective adoption and implementation of global food policy recommendations, including that it is difficult to demonstrate the potential efficacy of interventions in the local context. The development of a policy package based on local factors resulted in a policy product that was likely to be more persuasive for local policymakers and policy leaders. We suggest that there is substantial scope for researchers to more effectively engage with policy advocates to inform and shape real-world health policy improvements.

Increasing access to health workers in rural and remote areas: what do stakeholders\u2019 value and find feasible and acceptable?

BackgroundThe primary aim of this study is to assess stakeholders’ views of the acceptability and feasibility of policy options and outcome indicators presented in the 2010 World Health Organization (WHO) global policy recommendations on increasing access to health workers in remote and rural areas through improved retention.MethodsA survey on the acceptability, feasibility of recruitment and retention policy options, and the importance of their outcome indicators was developed. It followed a cross-sectional approach targeting health workers in rural and remote settings as well as policy- and decision-makers involved in the development of recruitment and retention policies for such areas. Respondents were asked their perception of the importance of the policy outcomes of interest, as well as the acceptability and feasibility of the 2010 WHO guidelines’ policy options using a 9-point Likert scale.ResultsIn total, 336 participants completed the survey. Almost a third worked in government; most participants worked in community settings and were involved in the administration and management of rural health workers. Almost all 19 outcomes of interests assessed were valued as important or critical. For the 16 guideline policy options, most were perceived to be "definitely acceptable" and "definitely feasible", although the policy options were generally considered to be more acceptable than feasible.ConclusionThe findings of this study provide insight into the revision and update of the 2010 WHO guideline on increasing access to health workers in remote and rural areas. Stakeholders’ views of the acceptability, feasibility of policy options and the importance of outcomes of interest are important for the development of relevant and effective policies to improve access to health workers in rural and remote areas.

Whistleblower protection: Theory and experimental evidence

Whistleblowing by employees plays a major role in uncovering corporate fraud. Recent laws and global policy recommendations aim at facilitating whistleblower protection to enhance the willingness to report and to increase the detection and deterrence of misbehavior. We study these issues in a theory-guided laboratory experiment. As expected, protecting whistleblowers leads to more reporting of misbehavior. However, the predicted improvements in detection and deterrence do not materialize in the experiment. This is mainly driven by prosecutors being less inclined to investigate upon a report when protection is in place.

The impact of e-government on economic growth in GCC countries

This study is the first to empirically examine the impact of e-government on economic growth in Gulf Cooperation Council countries. The dataset used in the study covers the period 2003-2018 and is obtained from the World Development Indicators and the United Nations E-Government knowledgebase. The conducted empirical analysis brings out many interesting findings. First, there is evidence that the e-government development stimulated economic growth in GCC during the last two decades. Second, when considering the different components of e-government, it has been shown that only the Online Service Index and the Telecommunication Infrastructure Index have positive effects on economic growth. Finally, it has been also revealed that out from six countries, the positive impact of e-government is proved in only four countries, namely Bahrain, Kuwait, Saudi Arabia and the United Arab Emirates. In Oman and Qatar, the effect is not statistically significant. Global and country-specific policy recommendations are accordingly presented.

Analysis of job satisfaction and factors affecting dentists' retention in rural and remote areas of indonesia

Background: Maldistribution of health workers, including dentists, is a global issue faced by not only poor and developing countries but also developed countries due to the mobility of health workers, who prefer working in urban areas. The World Health Organization (2012) released global policy recommendations that cover education, regulation, incentives, and personal and professional support to overcome this issue. However, they have not been able to completely solve the issue, as is shown by a description of Indonesia's Health Profile (2018), which highlights that 43.53% of public health center lack of dentists. The number of studies concerning the real condition experienced by dentists working in rural and remote areas of Indonesia is still limited. Objectives: To analyze job satisfaction and factors affecting dentists' retention in rural and remote areas of Indonesia. Methods: This study used questionnaire to collect data which was designed based on seven major themes and inserted in Google Form. The link was distributed to dentists who work in rural and remote areas of Indonesia. The sample was selected based on random sampling techniques. Result: The study showed that 45.90% of respondents were not satisfied working in rural and remote areas. Most of the respondents claimed that working conditions, incentives, career and professional development, living conditions, and personal characteristics influenced their interest in working permanently in remote and rural areas. However, political and cultural factors did not give a high impact. Conclusion: The description of job satisfaction and factors affecting dentists' retention in rural and remote areas of Indonesia is expected to have a positive impact on formulating policy regarding dentists' maldistribution.

How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention.

Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments.

Ethical issues in nursing home palliative care: a cross-national survey

ObjectivesWith an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed to identify the type...

Risk and Protective Factors for Intimate Partner Violence Against Women: Systematic Review and Meta-analyses of Prospective-Longitudinal Studies.

The estimated lifetime prevalence of physical or sexual intimate partner violence (IPV) is 30% among women worldwide. Understanding risk and protective factors is essential for designing effective prevention strategies. To quantify the associations between prospective-longitudinal risk and protective factors and IPV and identify evidence gaps. We conducted systematic searches in 16 databases including MEDLINE and PsycINFO from inception to June 2016. The study protocol is registered with PROSPERO (CRD42016039213). We included published and unpublished studies available in English that prospectively analyzed any risk or protective factor(s) for self-reported IPV victimization among women and controlled for at least 1 other variable. Three reviewers were involved in study screening. One reviewer extracted estimates of association and study characteristics from each study and 2 reviewers independently checked a random subset of extractions. We assessed study quality with the Cambridge Quality Checklists. When studies investigated the same risk or protective factor using similar measures, we computed pooled odds ratios (ORs) by using random-effects meta-analyses. We summarized heterogeneity with I2 and τ2. We synthesized all estimates of association, including those not meta-analyzed, by using harvest plots to illustrate evidence gaps and trends toward negative or positive associations. Of 18 608 studies identified, 60 were included and 35 meta-analyzed. Most studies were based in the United States. The strongest evidence for modifiable risk factors for IPV against women were unplanned pregnancy (OR = 1.66; 95% confidence interval [CI] = 1.20, 1.31) and having parents with less than a high-school education (OR = 1.55; 95% CI = 1.10, 2.17). Being older (OR = 0.96; 95% CI = 0.93, 0.98) or married (OR = 0.93; 95% CI = 0.87, 0.99) were protective. To our knowledge, this is the first systematic, meta-analytic review of all risk and protective factors for IPV against women without location, time, or publication restrictions. Unplanned pregnancy and having parents with less than a high-school education, which may indicate lower socioeconomic status, were shown to be risk factors, and being older or married were protective. However, no prospective-longitudinal study investigated the associations between IPV against women and any community or structural factor outside the United States, and more studies investigated risk factors related to women as opposed to their partners. Public health implications. This review highlights that prospective evidence for perpetrator- and context-related risk and protective factors for women's experiences of IPV outside of the United States is lacking and urgently needed to inform global policy recommendations. The current evidence base of prospective studies suggests that, at least in the United States, education and sexual health interventions may be effective targets for preventing IPV against women, with young, unmarried women at greatest risk.

Ebola Virus Epidemic in West Africa: Global Health Economic Challenges, Lessons Learned, and Policy Recommendations

The Ebola virus has spread across several Western Africa countries, adding a significant financial burden to their health systems and economies. In this article the experience with Ebola is reviewed, and economic challenges and policy recommendations are discussed to help curb the impact of other diseases in the future. The West African Ebola virus disease epidemic started in resource-constrained settings and caused thousands of fatalities during the last epidemic. Nevertheless, given population mobility, international travel, and an increasingly globalized economy, it has the potential to re-occur and evolve into a global pandemic. Struggling health systems in West African countries hinder the ability to reduce the causes and effects of the Ebola epidemic. The lessons learned include the need for strengthening health systems, mainly primary care systems, expedited access to treatments and vaccines to treat the Ebola virus disease, guidance on safety, efficacy, and regulatory standards for such treatments, and ensuring that research and development efforts are directed toward existing needs. Other lessons include adopting policies that allow for better flow of relief, averting the adverse impact of strong quarantine policy that includes exaggerating the aversion behavior by alarming trade and business partners providing financial support to strengthen growth in the affected fragile economies by the Ebola outbreak. Curbing the impact of future Ebola epidemics, or comparable diseases, requires increased long-term investments in health system strengthening, better collaboration between different international organizations, more funding for research and development efforts aimed at developing vaccines and treatments, and tools to detect, treat, and prevent future epidemics.

Plurality in understandings of innovation, sociotechnical progress and sustainable development: An analysis of OECD expert narratives.

Deterministic theory and discourse on sociotechnical progress ignore the existence of multiple and equally viable pathways towards progress, obscure socioeconomic and environmental conflicting interests and values, and overshadow socially inclusive deliberative choices about policy strategies. Demystifying techno-determinism, by incorporating a plurality of understandings to policy appraisal, becomes a matter of not only democratic accountability but also of analytical rigour. This article analyses the normative and ontological understandings on scientific and technological pathways among a group of experts interviewed at one key Directorate of the Organisation for Economic Cooperation and Development, using Q-methodology. The three main framings detected do not correspond exclusively to any single innovation and development theoretical framework - namely Innovation Systems, Learning Systems, Catch-Up models or the science, technology and society approach. Each narrative organizes an array of policy understandings based upon different theories and practices. As these forms of discourse highly influence global policy recommendations, their plurality should be made explicit, negotiated and integrated into policymaking.

Sustainable consumption and production – Research, experience, and development – The Europe we want

Since the publication of the Brundtland Report, production processes and consumption patterns towards sustainability have improved. This Special Volume Section of the Journal of Cleaner Production focuses on sustainable consumption and production (SCP), and identifies further challenges and provides solutions related to resource efficiency (ReE), sustainable water systems, sustainable management, cleaner production (CP), and sustainable urban development. In order to better understand the state of the SCP issues globally, existing policy directions have been explored within this paper, as well as six newly emerged sustainability terms, which have been integrated into the existing terminology classification to better describe and understand sustainable development concepts. In this Special Volume Section, the authors have demonstrated many valuable theoretical and practical contributions to the aspects of SCP, including a number of practical examples of achieving sustainability in companies, such as using bottom-up and a top-down approaches or by implementing theoretical models. There are also examples of achieving eco-efficiency in water systems (including urban), further requiring economic incentives and governmental support, and practical experiences, providing in-situ data and evidence of impacts of measures on processes and systems regarding resource efficiency, cleaner production, and also considering life cycle assessment (LCA). The examples of SCP research and development in the fields of ReE presented in this section of the SV indicate that existing production and service processes in companies and social (urban) environment could be more sustainable, using a holistic approach to the SCP and achieving global policy recommendations.

Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi

Global policy recommendations to scale up of male circumcision (MC) for HIV prevention tend to frame the procedure as a simple and efficacious public health intervention. However, there has been variable uptake of MC in countries with significant HIV epidemics. Kenya, for example, has embraced MC and has been dubbed a ‘leader’ by the global health community, while Malawi has been branded a ‘laggard’ in its slow adoption of a national programme, with a strong political discourse of resistance forming around MC. Regardless of any epidemiological or technical evidence, the uptake of international recommendations will be shaped by how a policy, and the specific artefacts that constitute that policy, intersect with local concerns. MC holds particular significance within many ethnic and religious groups, serving as an important rite of passage, but also designating otherness or enabling the identification of the social and political self. Understanding how the artefact of MC intersects with local social, economic, and political contexts, is therefore essential to understand the acceptance or resistance of global policy recommendations. In this paper we present an in-depth analysis of Malawi's political resistance to MC, finding that ethnic and religious divisions dominating recent political movements aligned well with differing circumcision practices. Political resistance was further found to manifest through two key narratives: a ‘narrative of defiance’ around the need to resist donor manipulation, and a ‘narrative of doubt’ which seized on a piece of epidemiological evidence to refute global claims of efficacy. Further, we found that discussions over MC served as an additional arena through which ethnic identities and claims to power could themselves be negotiated, and therefore used to support claims of political legitimacy.

Capital in the Twenty-First Century. By THOMAS PIKETTY

There are many excellent reviews and much commentary on Piketty’s powerful new study.1 This review seeks to put his principal global economic policy recommendation—a global wealth tax—into the larger context of ongoing debates within both political philosophy and international economic law on appropriate and effective responses to global inequality.2 Piketty observes in the opening lines of his chapter on a global wealth tax that if one is concerned about regulating a globalized form of patrimonial capitalism (capital accumulation through inheritance rather than innovation or entrepreneurship), it is not enough to use 20th-century tools—society must invent new ones. This trenchant observation summarizes both the essence of Piketty’s approach to global fiscal policy, and the focus of this review. Piketty’s approach may be new and his conclusions powerful and disturbing, but a global taxation scheme in response to inequality is not itself entirely new—which is very good news. From the perspective of international economic law and policy, Piketty’s chief contributions in this magisterial new book are to strengthen and reinvigorate the arguments in favor of a tax-based response to inequality, a key factor where the politics promise to continue to be quite difficult; and to enrich both the range of options and the number of strategies available to global tax advocates and anyone seeking, as he puts it, to reassert democratic control over capitalism.

Effect of neonatal vitamin A supplementation on mortality in infants in Tanzania (Neovita): a randomised, double-blind, placebo-controlled trial

Supplementation of vitamin A in children aged 6-59 months improves child survival and is implemented as global policy. Studies of the efficacy of supplementation of infants in the neonatal period have inconsistent results. We aimed to assess the efficacy of oral supplementation with vitamin A given to infants in the first 3 days of life to reduce mortality between supplementation and 180 days (6 months). We did an individually randomised, double-blind, placebo-controlled trial of infants born in the Morogoro and Dar es Salaam regions of Tanzania. Women were identified during antenatal clinic visits or in the labour wards of public health facilities in Dar es Salaam. In Kilombero, Ulanga, and Kilosa districts, women were seen at home as part of the health and demographic surveillance system. Newborn infants were eligible for randomisation if they were able to feed orally and if the family intended to stay in the study area for at least 6 months. We randomly assigned infants to receive one dose of 50,000 IU of vitamin A or placebo in the first 3 days after birth. Infants were randomly assigned in blocks of 20, and investigators, participants' families, and data analysis teams were masked to treatment assignment. We assessed infants on day 1 and day 3 after dosing, as well as at 1, 3, 6, and 12 months after birth. The primary endpoint was mortality at 6 months, assessed by field interviews. The primary analysis included only children who were not lost to follow-up. This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12610000636055. Between Aug 26, 2010, and March 3, 2013, 31,999 newborn babies were randomly assigned to receive vitamin A (n=15,995) or placebo (n=16,004; 15,428 and 15,464 included in analysis of mortality at 6 months, respectively). We did not find any evidence for a beneficial effect of vitamin A supplementation on mortality in infants at 6 months (26 deaths per 1000 livebirths in vitamin A vs 24 deaths per 1000 livebirths in placebo group; risk ratio 1·10, 95% CI 0·95-1·26; p=0·193). There was no evidence of a differential effect for vitamin A supplementation on mortality by sex; risk ratio for mortality at 6 months for boys was 1·08 (0·90-1·29) and for girls was 1·12 (0·91-1·39). There was also no evidence of adverse effects of supplementation within 3 days of dosing. Neonatal vitamin A supplementation did not result in any immediate adverse events, but had no beneficial effect on survival in infants in Tanzania. These results strengthen the evidence against a global policy recommendation for neonatal vitamin A supplementation. Bill & Melinda Gates Foundation to WHO.

Implementing Evidence-Based Mental Health Care in Low-Resource Settings: A Focus on Safety Planning Procedures.

Despite advances in global mental health evidence and policy recommendations, the uptake of evidence-based practices (EBP) in low- and middle-income countries has been slow. Lower resource settings have several challenges, such as limited trained personnel, lack of government resources set aside for mental health, poorly developed mental health systems, and inadequate child protection services. Given these inherent challenges, a possible barrier to implementation of EBP is how to handle safety risks such as suicide, intimate partner violence (IPV), and/or abuse. Safety issues are prevalent in populations with mental health problems and often over-looked and/or underreported. This article briefly reviews common safety issues such as suicide, IPV, and child abuse and proposes the use of certain implementation strategies which could be helpful in creating locally appropriate safety protocols. This article lays out steps and examples of how to create a safety protocol and describes and presents data on safety cases from three different studies. Discussion includes specific challenges and future directions, focusing on implementation.