Government Health Authorities Research Articles

Facade of media and social media during COVID-19: A review

A novel coronavirus (COVID-19) arose in Wuhan, China, in December 2019. Soon it spread to other countries worldwide to become a pandemic. Globally, governments enforced quarantine and social distancing measures to prevent the spread of the infection. Mass media and social media platforms played a crucial role in providing information regarding the Coronavirus. Since little is known about COVID-19, various fake news, misinformation and rumours spread across the digital media that panicked people into making panic decisions. The rapid spread of misinformation and stories via social media platforms such as Twitter, Facebook and YouTube became a vital concern of the government and public health authorities. Medical misinformation and unverifiable content about the COVID-19 pandemic are spreading on social media at an unprecedented pace. Mitigating the advent of rumours and misinformation during the COVID-19 epidemic is crucial, since misinformation and fake news creates panic, fear and anxiety among people, predisposing them to various mental health conditions. Instead of considering social media as a secondary medium, it should be utilised to convey important information. Besides, it allows citizens to address their queries directly. Several governments across the world have taken actions to contain the pandemic of misinformation, yet measures are required to prevent such communication complications.

Digital surveillance in post-coronavirus China: A feminist view on the price we pay.

In this piece, I look at the question — are we worth saving and if so at what cost? — through a Foucault‐inspired feminist lens on surveillance. I examine a case that illustrates how digital surveillance, despite being perceived as a successful development in China’s response to COVID‐19, reinforces the country’s gender‐biased discourses on contagious disease and sexuality. In doing so, I want to emphasize that the states of exception that governments can establish and extend are not gender‐neutral. Given the feminist interest in and responsibility for life, this fact compels us to react to states of exception from a freedom‐enabled gender perspective. It is to be hoped that this perspective would then help to promote socio‐political practices that allowed society to challenge the normalizing male gaze induced by digital surveillance.

Global Vegetable Intake and Supply Compared to Recommendations: A Systematic Review.

Low vegetable intake is associated with higher incidence of noncommunicable diseases. Data on global vegetable intake excluding legumes and potatoes is currently lacking. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to assess vegetable consumption and supply in adult populations and to compare these data to the existing recommendations (≥240 g/day according to World Health Organization). For vegetable intake data online, websites of government institutions and health authorities, European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, STEPwise approach to surveillance (STEPS) and Pubmed/Medline databases were searched from March 2018 to June 2019. Vegetable supply data was extracted from Food Balance Sheets, Food and Agriculture Organization Corporate Statistical Database (FAOSTAT), 2013. Vegetable intake was expressed as means and 95% confidence intervals. Data were summarized for each region by calculating weighted means. Vegetable intake and supply data were available for 162 and 136 countries, respectively. Weighted mean vegetable intake was 186 g/day (56–349 g/day). Weighted mean vegetable supply was 431 g/day (71–882 g/day). For 88% of the countries vegetable intake was below the recommendations. Public health campaigns are required to encourage vegetable consumption worldwide. In the 61% of the countries where vegetable supply is currently insufficient to meet the recommendations, innovative food system approaches to improve yields and decrease post-harvest losses are imperative.

Using Behavioral Science to help fight the Coronavirus

This rapid, narrative review summarizes useful evidence from behavioral science for fighting the COVID-19 outbreak. We undertook an extensive, multi-disciplinary literature search covering five issues: handwashing, face touching, self-isolation, public-spirited behavior, and responses to crisis communication. The search identified more than 100 relevant papers. We find effective behavioral interventions to increase handwashing, but not to reduce face touching. Social supports and behavioral plans can reduce the negative psychological effects of isolation, potentially reducing the disincentive to isolate. Public-spirited behavior is more likely with frequent communication of what is “best for all”, strong group identity, and social disapproval of noncompliance. Effective crisis communication involves speed, honesty, credibility, empathy, and promoting useful individual actions. Risks are probably best communicated through numbers, with ranges to describe uncertainty – simply stating a maximum may bias public perception. The findings aim to be useful not only for government and public health authorities, but for organizations and communities.

COVID-19 and Mental Health

The infection caused by the novel coronavirus (COVID-19) started from China and reached the whole world and was declared as pandemic by WHO. The COVID 19 poses challenges in all aspects of life including mental health for the entire human race. In the disturbed and crisis situation, the mental health care of people at different levels carries great importance: promotion, prevention and clinical care. First of all, we should not refer “COVID-19 case,” “victim,” “COVID-19 family,” but “person who have COVID-19,” “people who are being treated for COVID-19”, etc. Social distancing is a public health strategy to limit the spread of COVID-19. There may be a feeling of ostracism, abandonment and being neglected in people, particularly the elderly when they are isolated. Older adults, especially in isolation and those with cognitive decline or dementia, may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak or while in quarantine. These people need emotional support through informal networks (families) and health professionals. Maintaining social networks in situations of isolations is essential for mental health. The treating physician should ensure basic emotional and practical support to affected people. Children need special attention to express their fear and sadness. Media has highlighted COVID-19 as a unique threat, rather than one of many, which has added to panic, stress, and the potential for hysteria. Information should be sought from WHO website and government health authorities’ platforms, in order to distinguish facts from rumours. Individuals with mental illness may be particularly vulnerable to the effects of widespread panic and threat. Instead of harassment, people with COVID 19 should be offer compassion, support via phone and texts, and assistance as appropriate, but never hostility or judgment. How to cite this article:Jiloha RC. COVID-19 and Mental Health. Epidem Int 2020; 5(1): 7-9. DOI: https://doi.org/10.24321/2455.7048.202002

Communicating Recommendations in Public Health Emergencies: The Role of Public Health Authorities.

Adherence to public health recommendations is critical for public safety and well-being. Effective and appropriate communication plays an important role in whether populations trust government and public health authorities, and the extent to which people follow public health recommendations. Poor trust in communication from public health authorities can pose significant challenges for mitigating public health emergencies and maintaining health security. This study aimed to explore the importance of trust in and understanding of communication from public health authorities in improving adherence to public health recommendations, and how that communication can be improved to develop and maintain public trust, particularly in the context of public health emergencies. To understand which factors are important for public trust in communication from public health authorities, we conducted in-depth interviews (n = 25) with a racially and demographically diverse group of individuals living in Baltimore. We found that communication source and communication transparency, such as timeliness, completeness, and clarity of information, were critical constructs of trust in communication from public health authorities. We also found that many participants misunderstood the flow of information from public health authorities to news media, and many were unaware that public health authorities provide the most reliable source of health information and recommendations during a public health emergency. To ensure adherence to public health recommendations, the public needs to trust that public health authorities are providing accurate, practical, and prudent recommendations. Drawing on these results, we provide several recommendations for developing and optimizing communication from various public health authorities.

COVID-19 Forecasts for Cuba Using Logistic Regression and Gompertz Curves.

INTRODUCTION On March 11, 2020, WHO declared COVID-19 a pandemic and called on governments to impose drastic measures to fi ght it. It is vitally important for government health authorities and leaders to have reliable estimates of infected cases and deaths in order to apply the necessary measures with the resources at their disposal. OBJECTIVE Test the validity of the logistic regression and Gompertz curve to forecast peaks of confi rmed cases and deaths in Cuba, as well as total number of cases. METHODS An inferential, predictive study was conducted using lo-gistic and Gompertz growth curves, adjusted with the least squares method and informatics tools for analysis and prediction of growth in COVID-19 cases and deaths. Italy and Spain-countries that have passed the initial peak of infection rates-were studied, and it was inferred from the results of these countries that their models were ap-plicable to Cuba. This hypothesis was tested by applying goodness-of-fi t and signifi cance tests on its parameters.RESULTS Both models showed good fi t, low mean square errors, and all parameters were highly signifi cant. CONCLUSIONS The validity of models was confi rmed based on logis-tic regression and the Gompertz curve to forecast the dates of peak infections and deaths, as well as total number of cases in Cuba. KEYWORDS COVID-19, SARS-CoV-2, logistic models, pandemic, mortality, Cuba.

Emergency preparedness for infant and young child feeding in emergencies (IYCF-E): an Australian audit of emergency plans and guidance

BackgroundAustralia experiences a high incidence of natural emergencies and Australian governments have committed significant investment into emergency preparedness and response. Amongst the population groups most vulnerable to emergencies are infants and young children with their vulnerability centering around their specific food and fluid needs. For this reason, the World Health Assembly has urged all member states to develop and implement infant and young child feeding in emergency (IYCF-E) plans in line with international guidance. This study aimed to determine the degree to which Australia has complied with this direction by conducting an audit of Australian emergency plans and guidance.MethodsAustralian Federal, State/Territory and a sample of Local government emergency plans and guidance were located via web searches. Documents were searched for key words to identify content dealing with the needs of infants and young children. Plans and guidance were also searched for content dealing with the needs of animals as a comparison.ResultsWhile plans and guidance contained numerous pointers to the desirability of having plans that address IYCF-E, there was a dearth of planning at all levels of government for the needs of infants and young children. Guidance related to heat waves contained information that could prove dangerous to infants. No agency at Federal or State/Territory had designated responsibility for IYCF-E or children in general. This was in stark contrast to the situation of animals for which there was widespread and comprehensive planning at all levels of government with clear designation of organisational responsibility.ConclusionsLack of planning for IYCF-E in Australia places infants and young children at serious risk of adverse health consequences in emergencies. Australian Federal, State/Territory and Local governments need to take action to ensure that IYCF-E plans and guidance are developed and deployed in line with international standards. The pathway to successful integration of animal welfare plans provides a method for a similar integration of IYCF-E plans. Government health authorities are best placed to lead and be responsible for IYCF-E in Australia. National governments internationally should similarly take action to ensure that their youngest, most vulnerable citizens are protected in emergencies.

G-105 Academic institutional impact on global HIV pandemic response: A decade of Implementing PEPFAR programs by University of Maryland Baltimore

Background: The global HIV burden remains high with nearly 40 million persons living with HIV (PLWH) to date. Encouragingly HIV incidence and AIDS-related mortality have dropped significantly over the past 20 years due in part to availability of antiretroviral treatment in all parts of the world most especially in resource-limited countries. Global interventions such as U.S President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight TB, Malaria and AIDS (GFATM) are credited for this unprecedented response. As a result, to date more than 22 million are receiving antiretroviral treatment. The Center for International Health, Education and Biosecurity (CIHEB) and its predecessors within the Institute of Human Virology (IHV) at the University of Maryland Baltimore (UMB) has played a key role in the global HIV response since PEPFAR inception. Methods: Under PEPFAR 1.0 which focused on decreasing the high mortality rate due to HIV our interventions aimed at enhancing provider competencies and health facility care processes to deliver quality HIV services. PEPFAR 2.0 placed emphasis on transition of health programs to local ownership for sustainability, and we shifted our focus to building technical stewardship capacity to sustain key programmatic interventions. PEPFAR 3.0 has focused on achievement of epidemic control and likewise our strategies have evolved to implementation of targeted health-systems strengthening and community-owned innovations for achievement and sustenance of HIV epidemic control. Our approaches have included: using data and evidence to inform decisions, policy and practice; ensuring effectiveness and competence of highly trained multi-disciplinary teams; building robust data and information systems; modeling care delivery; and institutionalization of continuous quality improvement to enhance service delivery. It is imperative that we assess the impact of these interventions in order to optimize future academic institutions' engagement in global health. Results: From 2004 to 2018, our programs have implemented models of care for delivering HIV/AIDS and related services for rural, peri-urban and the urban poor in 10 countries. These programs have resulted in: (1) provision of antiretroviral treatment to over 1 million PLWH including 285,000 who are enrolled in current programs; (2) reduced mother-to-child HIV transmission from 7.8% in 2010 to less than 2.5% by September 2016 in Kenya; (3) increased access to prevention of mother-to-child transmission (PMTCT) interventions, (4) trained more than 50,000 healthcare providers in resource-limited settings; (5) increased comprehensive combined prevention services to key and priority populations; (6) implementation of novel electronic health records solutions; (7) led HIV and health policy and guidelines development; and 8) institutionalized data and evidence use as part of continuous quality improvement initiatives in more than 1500 health facilities. Significantly, these programs have improved key patient and population health outcomes including achieving more than 90% virologic suppression among PLHIV receiving antiretroviral treatment in CIHEB programs. Conclusions: Currently, CIHEB implements programs in 7 countries as a key partner to local government health authorities. Working through local systems and with national institutions has been critical to our achievements, while the application of academic principles of inquiry to program interventions and adaptation of innovations to new settings has provide a template for success. We present the CIHEB model as an optimal framework for global health involvement that allows for integration of global best practices and local knowledge throughout the implementation process.

Ethical classification of ME/CFS in the United Kingdom.

Few conditions have sparked as much controversy as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Professional consensus has long suggested that the condition should be classified as psychiatric, while patients and advocacy groups have insisted it is a serious biological disease that requires medical care and research to develop it. This longstanding debate shifted in 2015, when U.S. governmental health authorities fully embraced medical classification and management. Given that some globally respected health authorities now insist that ME/CFS is a serious biological disease, this paper asks whether it can be ethical for the U.K. practice guideline now in development to characterize the condition as a mental health disorder. Following a brief history of ME/CFS controversy, I offer three arguments to show that it would be unethical for the U.K. to now characterize ME/CFS as a mental health condition, considering the relevance of that conclusion for ME/CFS guidelines elsewhere and for other contested conditions.

A site-specific standard for comparing dynamic solar ultraviolet protection characteristics of established tree canopies

A standardised procedure for making fair and comparable assessments of the ultraviolet protection of an established tree canopy that takes into account canopy movement and the changing position of the sun is presented for use by government, planning, and environmental health authorities. The technique utilises video image capture and replaces the need for measurement by ultraviolet radiometers for surveying shade quality characteristics of trees growing in public parks, playgrounds and urban settings. The technique improves upon tree shade assessments that may be based upon single measurements of the ultraviolet irradiance observed from a fixed point of view. The presented technique demonstrates how intelligent shade audits can be conducted without the need for specialist equipment, enabling the calculation of the Shade Protection Index (SPI) and Ultraviolet Protection Factor (UPF) for any discreet time interval and over a full calendar year.•Tree shade UPF measurements are presented using video capture analysis of moving canopies•A standard method for making accurate assessments of tree shade has been developed•Tree shade comparisons are made without the need for specialist equipment

Estimation and validation of hybrid choice models to identify the role of perception in the choice to cycle

Cycling is one of the most sustainable and ecofriendly modes of travel and a good form of exercise. Many government and public health authorities recommend cycling to stay fit as well as to reduce air and noise pollution, CO2 emissions, traffic congestion, and other negative consequences of car use. In light of these benefits, a major challenge for researchers today is how to promote cycling. However, in countries where cycling is not common, apart from the need for proper cycling facilities, one major issue concerns people’s perception of cycling for sport or recreational activities rather than as a mode of transport. The aim of this paper is to explore the role of perception in the likelihood of the bike being used for utilitarian purposes. We focus on the perception of: the bicycle as a means of transport; bikeability (in terms of usefulness and safety) and of bike infrastructure. Hybrid Choice Models (HCMs) have been used to estimate the effect of people’s perception on the propensity to bike. The HCM also accounts for the serial correlation between error terms in the discrete and latent perceptions, to allow for agent-common unknown factors. Furthermore, we also validate the model results using a hold-out sample and discuss some policy measures aimed at changing travel behavior. The results suggest that, besides individual characteristics, latent aspects related to the perception of the context and of the bicycle as a means of transport strongly affect the propensity to cycle.

Geography of Microcephaly in the Zika Era: A Study of Newborn Distribution and Socio-environmental Indicators in Recife, Brazil, 2015-2016.

We assessed sociodemographic and health care factors of mothers and newborns during a 2015-2016 outbreak of microcephaly in Recife, Brazil, and we analyzed the spatial distribution and incidence risk of newborns with microcephaly in relation to socio-environmental indicators. We collected data from August 2015 through May 2016 from Brazil's Live Birth Information System and Bulletin of Microcephaly Notification, and we geocoded the data by maternal residence. We constructed thematic maps of districts, according to socio-environmental and vector indicators. We identified spatial aggregates of newborns with microcephaly by using the Bernoulli model. We performed logistic regression analyses to compare the incidence risk of microcephaly within socio-environmental indicator groups. We geocoded 17 990 of 19 554 (92.0%) live births in Recife, of which 202 (1.1%) newborns were classified as having microcephaly, based on a head circumference of ≥2 standard deviations below the mean. Larger proportions of newborns with microcephaly (compared with newborns without microcephaly) were born to mothers who delivered in a public hospital, did not attend college, were aged ≤19, or were black or mixed race. A higher risk of microcephaly (incidence rate ratio [IRR] = 3.90; 95% confidence interval [CI], 1.88-8.06) occurred in districts with the lowest (vs highest) Municipal Human Development Index (ie, an index that assesses longevity, education, and income). The risk of microcephaly was significantly higher where rates of larvae density (IRR = 2.31; 95% CI, 1.19-4.50) and larvae detection (IRR = 2.04; 95% CI, 1.05-4.00) were higher and rates of sewage system (IRR = 2.20; 95% CI, 1.16-4.18) and garbage collection (IRR = 1.96; 95% CI, 0.99-3.88) were lower. Newborns with microcephaly lived predominantly in the poorest areas and in a high-risk cluster (relative risk = 1.89, P = .01) in the north. The disproportionate incidence of microcephaly in newborns in poor areas of Recife reinforces the need for government and public health authorities to formulate policies that promote social equity and support for families and their children with microcephaly.

Improving health through addressing nutrition and sanitation in the Thar Desert, India

Abstract Background The Thar Desert of India is a severely drought-prone and impoverished region. As a result of water scarcity, communities live in deep-rooted poverty, which has a major impact on health status. Lack of nutritious foods leads to malnutrition and the scarcity of water also poses sanitation challenges. Nutrition and sanitation are therefore two critical health challenges in the region. GRAVIS, a non-governmental organisation, has launched an intervention known as Improving Health through addressing Nutrition and Sanitation (IHNS) in Thar. Methods The programme has two main focuses. First, to address nutrition, a community-based nutrition curriculum has been designed to enhance knowledge on nutritional facts. The curriculum is used in schools for children and in the community for adults. Further, the concept of Household Horticulture Units has been developed whereby domestic waste water is used for growing fruits and vegetables. Second, on sanitation, low-cost, low-water-use toilets have been designed. Various toilet models have been studied to produce the optimum design for desert conditions. Bio-sand-water filters have been designed that provide rural people with potable water. A cadre of village health workers has been developed that constantly educates communities. In the past 5 years, GRAVIS has covered over 4000 people with these interventions with a holistic approach. GRAVIS conducts an annual review of the programme to understand outcomes. The annual review is done through a participatory approach in which communities are fully involved, and inputs are taken from concerned local government health authorities. GRAVIS and an external reviewer do a beneficiary survey with the help of a questionnaire and focus group discussions with key informants from the communities to understand the progress made and challenges encountered. The review report helps us analyse the outcomes and plan future interventions. In the annual review, we cover at least 20% of our beneficiaries. The selection is done on a random basis. The last annual review was done in January, 2017. Findings About 60% of beneficiaries report significant improvement in their general health, as reported in a health study by GRAVIS in 2017, which included about 200 households and about 1400 individuals. In the project area, which included more than 250 school children, more than 90% of school children were fully aware of their nutritional requirements. According to outpatient records from the GRAVIS hospital in the area, the incidence of diarrhoeal disease has decreased by 20% in the past 2 years. The interventions are low cost, well accepted, and sustainable. Interpretation Moving forward, GRAVIS envisions scaling up the IHNS model. It will be an effective approach to combat nutrition- and sanitation-related health issues, particularly in arid settings. GRAVIS foresees for itself a role as educator and provider of resources to help other organisations implement IHNS. We will explore resources and funding partnerships for replication and scale up. Funding Government of Finland and People for Progress in India, USA.

An appraisal of practice guidelines for smoking cessation in people with severe mental illness.

To review the quality of current smoking cessation guidelines that include recommendations for people with severe mental illness. A systematic search of scientific databases, central government health authority websites, psychiatry peak bodies, guideline clearing houses and Google was undertaken for relevant smoking cessation guidelines. Three reviewers independently assessed guideline quality using the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) instrument. Two reviewers extracted recommendations specific to smokers with severe mental illness. Thirteen guidelines met the inclusion criteria. Seven guidelines scored ⩾60% in at least four domains. Median scores for 'Editorial independence', 'Rigour of development', 'Stakeholder Involvement' and 'Applicability' were less than 60%. The highest median scores were for 'Scope and purpose' (87%, 69-96%) and 'Clarity of presentation' (87%, 56-98%). 'Editorial independence' (33.3%, 0-86%) and 'Rigour of development' (54%, 11-92%) had the lowest median domain scores. The guidelines varied greatly in their recommendations but the majority recommended nicotine replacement therapy, bupropion or varenicline as first-line pharmacotherapy, along with behavioural support. Many guidelines did not adequately report their methods or the competing interests of the authors. Future guidelines development may benefit from more specifically addressing AGREE II criteria and the needs of smokers with severe mental illness.

Perceptions of caregivers and providers regarding the potential introduction of the varicella vaccine to the childhood immunisation schedule in New Zealand: A qualitative exploratory study.

The varicella vaccine has been proposed to be added to the childhood immunisation schedule in New Zealand as the fourth injectable at the 15-month event. We sought to understand the perceptions of caregivers and health-care providers regarding the potential introduction of routine varicella vaccination. A qualitative exploratory study was conducted using semi-structured interviews with caregivers and providers (N = 20) in Auckland. Key themes from the interviews were identified through thematic analysis using a combination of deductive and inductive coding. All of the participants were aware of varicella but levels of awareness varied among caregivers regarding the varicella vaccine. Participants expressed positive support towards universal varicella vaccination and a high intention to vaccinate if available as a routine vaccine. However, many concerns were raised about multiple injections at a single immunisation visit, and participants suggested alternative scheduling options. The results indicated a need to raise awareness among caregivers about the varicella vaccine, focusing on positive health beliefs about vaccination in terms of protecting the child's health and reducing the impact of a child getting varicella on the family. Health-care providers and government health authorities may play an important role in increasing positive health beliefs about the varicella vaccine. Should the varicella vaccine be introduced as proposed, our findings recommend an educational campaign to address both caregiver and provider concerns about multiple injections and how to manage alternative immunisation schedules. These insights may help inform national strategies for the proposed addition to increase acceptance of the varicella vaccination.

Evaluation of the daycare mangers’ knowledge, attitude, and practice on lead in drinking water at daycares licensed by the Fraser Health Authority


 Background: Daycares in BC fall under the Community Care and Assisted Living Act which require all daycare facilities to provide a safe environment, including drinking water. Young children who have been exposed to lead in drinking water at schools and daycares can incur serious health effects, including damage to cognitive development. Previous research has demonstrated that even low levels of blood lead concentration are associated with intellectual disability, slowed growth and development, lowered ability to concentrate, decreased academic achievement and behavioural problems. Individuals’ knowledge, attitude and practice (KAP) on drinking water can influence on how the children consume drinking water and potentially cause adverse health effects. This study evaluated daycare managers’ knowledge, attitude, and practice (KAP) on lead in drinking water related to this issue. Method: This study was conducted by collecting 106 responses from a KAP survey to evaluate the knowledge, attitude, and practices regarding drinking water contaminants. The survey was distributed to daycare managers in Fraser Health region. The responses were analyzed with regression and correlation, one-way ANOVA, and chi-square tests. Results: There was a statistically significant correlation between the age of daycare manger and their knowledge (t-test = 0.0309). All other tests showed no statistical correlation, difference, and/or association (p-value greater than significance level of 0.05 on all parameters) between managerial experiences, age of managers, types of daycares in their knowledge, attitude, and practice regarding lead in drinking water in daycare facilities. The data of KAP questionnaires indicated that most daycare mangers do not fully understand and not are sufficiently educated regarding lead toxicity in drinking water. Conclusions: The results of KAP surveys showed that an educational intervention by the government or local health authorities is highly recommended and needed to improve the daycare managers’ knowledge, attitude, and practice regarding lead in drinking water. Additional research is required to confirm this.

Development of human resources for health in Tanzania

Introduction
 The Mzumbe University MSc Health Monitoring and Evaluation (M&E) Program, launched in 2013, is aimed at building human resources capacity in Tanzania and East Africa by developing high-caliber M&E professionals to provide leadership in public health systems and the private sector. This case study aimed to describe the process of establishing the program and report results of an interim evaluation.
 Case
 The program’s innovative curriculum focuses on enabling graduates to implement M&E systems that respond to organizational challenges. Program content was driven by results of a training needs assessment, which sought input from stakeholder organizations. The curriculum is competency-based with content determined by learning objectives established for each course. It is delivered over three academic semesters followed by a fourth semester during which students implement field projects that serve as their master’s dissertations. The program draws on outside faculty and M&E practitioners to assure that student learning is balanced between theory and practice. Graduates are expected to assume influential positions in their workplaces, including public and private health organizations, hospitals, central and local government health authorities as well as international health organizations.
 Discussion
 The MSc Health M&E Program at Mzumbe University serves as a model for sustainable human resources for health M&E capacity and development in the East African region and beyond. The interim evaluation validated the success of the methods used in program development and implementation. Student feedback indicates that they have acquired the required skills to serve successfully in M&E leadership positions post-graduation.

Current State of Training and Evaluation of Laparoscopic Surgical Skills

__Objective:__ The aim of this study is to understand the current state of training practices and evaluation in laparoscopic surgery in a global context. __Design:__ An open-ended three part questionnaire was designed to gather the opinions about the current state of, adequacy of, and the need for a standard in laparoscopic surgical training. __Participants:__ Members of the European Association for Endoscopic Surgery (EAES), Endoscopic and Laparoscopic Surgeons of Asia (ELSA) and Association of Surgeons of India (ASI) were asked to participate in the survey. __Results:__ Of the 663 responses received, 83.6% were surgeons (64.6% in a teaching position) and 12.6% were surgical residents in training. Most respondents (75.4%) had performed over 200 laparoscopic procedures. Most (72.1%) training programs were approved/endorsed by local surgical associations or government health authorities and of the courses taught by surgical associations the majority had certified trainers (71.1%). In lower Human Development Index (HDI) countries significantly less courses are taught by certified trainers (68.2% versus 54.6%, p<0.001). Only 26.8% stated that their respective government health authorities participated in the certification of laparoscopic surgery; certification was considered important by 63.6%. However, only 17.8% of government health authorities contributed to ensure the quality of laparoscopic training, mostly in very high HDI. Only 3.3% of respondents considered the laparoscopic training and education in their country to be optimal and 51.9% rated it insufficient. Most respondents (86.3%) stated that there is a need for the standardization of laparoscopic training and 88.3% stated that standardization of laparoscopic training is important. __Conclusion:__ Regardless of demographic and experience factors, there was a general consensus that that there is a need for standardisation in mandatory training of laparoscopic surgical skills, although currently not obligatory in most countries.

A Content Analysis of Arabic and English Newspapers before, during, and after the Human Papillomavirus Vaccination Campaign in the United Arab Emirates.

Cervical cancer is the fourth most common cancer among females in the United Arab Emirates (UAE) with an estimated incidence of 7.4 per 100,000 persons per year. In March 2008, the Health Authority of Abu Dhabi launched a free school-based campaign to provide all female Emirati students aged 15-17 years in the emirate of Abu Dhabi with the human papillomavirus vaccine (HPVV). Despite the proven efficacy of the HPVV in clinical trials, there has been limited research exploring the acceptance of this vaccine within a conservative Islamic society. The media plays a key role in changing beliefs and attitudes toward specific public health initiatives, such as vaccination programs. The primary aim of this study was to explore the content and communication style of the UAE newspapers (both Arabic and English) before, during, and after the HPV vaccination program. A systematic literature search was conducted on six national newspapers with the highest circulation figures in the UAE (Arabic: Al Ittihad, Al Khaleej, and Emarat El Youm; English: Khaleej Times, The National, and Gulf News) to retrieve articles related to cervical cancer prevention from January 2000 to May 2013. One bilingual researcher (Arabic-English) utilized content analysis to study the subject matter of communication in each article. A total of 79 newspaper articles (N = 31 Arabic) were included in the study. Content analysis coding revealed five main themes: (i) "HPV Screening or Vaccination Programmes in the UAE" (N = 30); (ii) "Cervical Cancer Statistics in the UAE" (N = 22); (iii) "Aetiology of Cervical Cancer and HPVV Efficacy" (N = 12); (iv) "Cultural Sensitivity and Misconceptions Surrounding HPVV in School-Aged Females" (e.g., promoting promiscuity) (N = 8); and (v) "Cost-Effectiveness, Efficacy, and Safety" (N = 7). The UAE media is playing an important role in raising public awareness about cervical cancer and specific governmental health initiatives such as the HPVV program. Governmental health authorities may want to consider collaborating with the UAE media to develop a communication strategy to reduce the fears and misconceptions surrounding HPVV. Improved parental and adolescent knowledge on the HPVV may lead to increased acceptance and uptake in the UAE society.