What is global health?Key concepts and clarification of misperceptions Report of the 2019 GHRP editorial meeting

The call for“Working Together to Build a Community of Shared Future for Mankind”requires us to improve people’s health across the globe,while global health development entails a satisfactory answer to a fundamental question:“What is global health?”To promote research,teaching,policymaking,and practice in global health,we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy,convened in July 2019 in Wuhan,China.The meeting functioned as a platform for free brainstorming,indepth discussion,and post-meeting synthesizing.Through the meeting,we have reached a consensus that global health can be considered as a general guiding principle,an organizing framework for thinking and action,a new branch of sciences and specialized discipline in the large family of public health and medicine.The word“global”in global health can be subjective or objective,depending on the context and setting.In addition to dual-,multicountry and global,a project or a study conducted at a local area can be global if it(1)is framed with a global perspective,(2)intends to address an issue with global impact,and/or(3)seeks global solutions to an issue,such as frameworks,strategies,policies,laws,and regulations.In this regard,global health is eventually an extension of“international health”by borrowing related knowledge,theories,technologies and methodologies from public health and medicine.Although global health is a concept that will continue to evolve,our conceptualization through group effort provides,to date,a comprehensive understanding.This report helps to inform individuals in the global health community to advance global health science and practice,and recommend to take advantage of the Belt and Road Initiative proposed by China.

Can Africa achieve herd immunity?

The World Health Organization described herd immunity,also known as population immunity,as the indirect fortification from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous exposure to infection.The emergence of COVID-19 vaccine is a step towards the achievement of herd immunity.Over one billion people across the globe have been vaccinated and Africa recorded only 2%.The objective of this article was to develop a forecast of the number of people to be vaccinated to achieve herd immunity in the 13 WHO-identified priority African countries for COVID-19.Herd immunity is achieved when one infected person in a population causes less than one secondary case on average,corresponding to the effective basic reproduction number(R_(0)).Vaccine delivery and distribution infrastructure including the cold chain remains weak.Vaccine hesitancy is also one of the limiting factors that may hinder herd immunity in Africa.In order to achieve herd immunity globally,African countries should not be excluded in fair and equal distribution of vaccines.Relevant stakeholders should foster commitment as well as community sensitization on COVID-19 vaccines and integration of COVID-19 vaccines in existing healthcare services.

Occupational,physical,sexual and mental health and violence among migrant and trafficked commercial fishers and seafarers from the Greater Mekong Subregion(GMS):systematic review

Background:Little is known about the health of GMS commercial fishers and seafarers,many of whom are migrants and some trafficked.This systematic review summarizes evidence on occupational,physical,sexual and mental health and violence among GMS commercial fishers/seafarers.Methods:We searched 5 electronic databases and purposively searched grey literature.Quantitative or qualitative studies reporting prevalence or risk of relevant outcomes were included.Two reviewers independently screened articles.Data were extracted on nationality and long/short-haul fishing where available.Results:We identified 33 eligible papers from 27 studies.Trafficked fishers/seafarers were included in n=12/13 grey literature and n=1/20 peer-reviewed papers.Among peer-reviewed papers:11 focused on HIV/AIDS/sexual health;nine on occupational/physical health;one study included mental health of trafficked fishers.Violence was quantitatively measured in eight papers with prevalence of:11-26%in port convenience samples;68-100%in post-trafficking service samples.Commercial fishers/seafarers whether trafficked or not worked extremely long hours;trafficked long-haul fishers had very limited access to care following injuries or illness.Lesser-known risks reported among fishers included penile oil injections and beriberi.We found just one work safety intervention study and inconclusive evidence for differences in the outcomes by nationality.Findings are limited by methodological weaknesses of primary studies.Conclusion:Results show an absence of high-quality epidemiological studies beyond sexual health.Formative and pilot intervention research on occupational,physical and mental health among GMS commercial fishers and seafarers is needed.Future studies should include questions about violence and exploitation.Ethical and reporting standards of grey literature should be improved.

Assessment of awareness and knowledge of schistosomiasis among school-aged children(6-13 years)in the Okavango Delta,Botswana

Background:Schistosomiasis is a global health problem affecting 250 million people,with 90%in Sub-Saharan Africa.In Botswana,the burden is high in the Okavango delta because of the water channels.WHO recommends integrated measures,including access to clean water,sanitation,health education,and drugs to control and eliminate schistosomiasis.Gauging knowledge and awareness of schistosomiasis for School-Aged Children(SAC)is crucial.Our study aimed at assessing knowledge and awareness of schistosomiasis among SAC in the Okavango Delta.Methods:A cross-sectional survey assessing awareness and knowledge of schistosomiasis in schools was conducted.480 questionnaires were administered to gather demographic profiles,awareness,and knowledge of risky behaviors.Chi-square and descriptive analysis determined the differences in SAC`s awareness and knowledge levels based on localities,gender,age,and health education.Results:The results showed a low awareness level,with only(42%)of respondents having heard about the disease and(52%)knowing its local name.Younger children from Sekondomboro(83%)and Samochima lacked awareness,while children from Mohembo(77%)and those who had health education(70%)demonstrated significant awareness levels(P≤0.001).Seventy-two percent(72%)lacked knowledge of the cause and(95%)did not know the disease life-cycle.Children from Xakao(91%),(85%)Sepopa,and(75%)of younger children did not know haematuria is a symptom of the disease.Older and SAC with health education were more likely to know that swimming is a risk factor(P≤0.001)and(P≤0.05)respectively.Conclusions:Although respondents from four schools demonstrated some level of awareness of the disease,and knowledge of risky behaviors,the study showed a lack of in-depth knowledge on the life-cycle and cause of the diseases.We,therefore,recommend the implementation of an integrated approach to health education and improvement in access to clean water and sanitation in all study areas.

Current efforts and challenges facing responses to 2019-nCoV in Africa

The novel coronavirus is a pandemic that has started to creep into Africa thus making the virus a truly global,health security threat.The number of new 2019-nCoV cases has been rising in Africa,though currently lower than the cases reported outside the region.African countries have activated their Emergency Operations Centres to coordinate responses and preparedness activities to the pandemic.A series of measures such as restricting travel,case detection and contact tracing,mandatory quarantine,guidance and information to the public among other efforts are being implemented across Africa.However,the presence of porous borders,the double burden of communicable and noncommunicable diseases,poverty,poor health literacy,infodemic and family clustering,and most of all,weak health systems,may make containment challenging.It is important for African countries to continue to intensify efforts and address the challenges to effectively respond to the uncertainty the pandemic poses.

Achieving herd immunity in South America

South America,once an epicenter of COVID-19,has stayed on the road of continued management of the pandemic.The region initially struggled to cope with the pandemic as it experienced spiraling numbers of infections and overwhelmed public health systems.South America has risen in its pandemic response to be the region with the highest global vaccination rate.The region posed a strong vaccination drive,with over 76%of its population fully vaccinated with the initial protocol.South America leveraged its deeply rooted vaccination culture and public health confidence among its population.Herd immunity is an integral concept in population infectious disease management.Attaining herd immunity is presently not feasible with available vaccines,but the high vaccination rate in the region depicts the acceptance of vaccination as a strategy for population protection.The availability of effective transmission-blocking vaccines,the continuous implementation of strategies that will enable the undisrupted supply of the vaccines,equity in access to the vaccines,improved vaccine acceptance,and trust in the vaccination and public health systems will help shepherd the region towards herd immunity.Local vaccine production backed with investment in infrastructure and international collaboration for research and knowledge development will also drive population safety.

A mixed method analysis of the Botswana schistosomiasis control policy and plans using the policy triangle framework

Background The present goal of the World Health Organization(WHO)2021-2030 roadmap for Neglected Tropical Diseases is to eliminate schistosomiasis as a public health problem,and reduce its prevalence of heavy infections to less than 1%.Given the evolution and impact of schistosomiasis in the Ngamiland district of Botswana,the aim of this study was to analyze the control policies for the district using the Policy Triangle Framework.Methods The study used a mixed method approaches of an analysis of policy documents and interviews with 12 informants who were purposively selected.Although the informants were recruited from all levels of the NTD sector,the analysis of the program was predominantly from the Ngamiland district.Data were analyzed using Braun and Clarke’s approach to content analysis.Results The study highlights the presence of clear,objectives and targets for the Ngamiland control policy.Another theme was the success in morbidity control,which was realized primarily through cycles of MDA in schools.The contextual background for the policy was high morbidity and lack of programming data.The implementation process of the policy was centralized at the Ministry of Health(MOH)and WHO,and there was minimal involvement of the communities and other stakeholders.The policy implementation process was impeded by a lack of domestic resources and lack of comprehensive policy content on snail control and no expansion of the policy content beyond SAC.The actors were predominately MOH headquarters and WHO,with little representation of the district,local level settings,NGOs,and private sectors.Conclusions The lack of resources and content in the control of environmental determinants and exclusion of other at-risk groups in the policy,impeded sustained elimination of the disease.There is a need to guide the treatment of preschool-aged children and develop national guidelines on treating foci of intense transmission.Moreover,the dynamic of the environmental transmissions and reorientation of the schistosomiasis policy to respond to the burden of schistosomiasis morbidity,local context,and health system context are required.