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Integrating Clinical Research into Epidemic Response: The Ebola Experience
Gerald Keusch, Keith McAdam, Patricia Cuff, Michelle Mancher, and Emily R. Busta
National Academies of Sciences, Engineering, and Medicine
(2017)
C1
The 2014–2015 Ebola epidemic in western Africa was the longest and most deadly Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. The Ebola virus has been known since 1976, when two separate outbreaks were identified in the Democratic Repub
...
lic of Congo (then Zaire) and South Sudan (then Sudan). However, because all Ebola outbreaks prior to that in West Africa in 2014–2015 were relatively isolated and of short duration, little was known about how to best manage patients to improve survival, and there were no approved therapeutics or vaccines. When the World Heath Organization declared the 2014-2015 epidemic a public health emergency of international concern in August 2014, several teams began conducting formal clinical trials in the Ebola affected countries during the outbreak.
more
The document provides essential guidelines for managing cholera outbreaks. It includes instructions for preparing oral rehydration solutions (ORS) using simple ingredients like sugar and salt to treat dehydration caused by cholera. The text also emphasizes the importance of access to clean water, sa
...
nitation, and hygiene to prevent the spread of the disease. It is part of the World Health Organization's effort to provide clear, actionable steps for controlling cholera in affected areas.
more
The Lancet Global Health, published online 18 August 2017;
http://dx.doi.org/10.1016/S2214-109X(17)30332-7
The article "The Political Determinants of the Cholera Outbreak in Yemen" examines how the ongoing civil war has contributed to Yemen’s severe cholera outbreak. The 2017 epidemic was des
...
cribed as the worst in the world, with cholera spreading rapidly due to the collapse of health, water, and sanitation systems.
The analysis shows that Houthi-controlled areas were disproportionately affected, accounting for 77.7% of cases and 80.7% of deaths. The article highlights the role of the Saudi-led coalition in worsening conditions through airstrikes on infrastructure, blockades restricting medical and food supplies, and the overall humanitarian crisis. It criticizes UNICEF for accepting a $67 million donation from Saudi Arabia while the coalition contributed to the crisis.
The article underscores that political actions and conflict have been key factors in the outbreak’s severity, with both warring sides failing to protect civilians.
more
This document is a situation report (#6) from October 2, 2017, describing the cholera outbreak in Yemen. By October 1, 2017, there were 777,229 suspected cholera cases and 2,134 deaths across 22 of Yemen's 23 governorates. The response involves WASH partners providing hygiene supplies and water trea
...
tment, health cluster partners operating treatment centers, and communication campaigns reaching over 16 million people. Major challenges include limited supplies, security risks hindering access to affected communities, a weakened health system with over 55% of facilities closed or partially functional, and difficulties importing medicines and medical supplies. Children under 18 represent 60% of cases, while people over 60 report the highest death rates.
more
This guidance is intended for use in developing standalone TB strategic plans, or TB interventions as part of multidisease or health sector plans. It describes key considerations and steps for strategic planning for TB in line with the World Health Organization’s End TB strategy, and the proposed
...
structure of the NSP. The target audience of this publication are all stakeholders involved in national strategic planning for TB (e.g., ministry of health, other government ministries, private sector, civil society, affected communities, academic and research institutions, and technical and funding partners).
The current document is an update to the 2015 Toolkit to develop a national strategic plan for TB prevention, care and control.
more
According to the report:
More than 5,000 children have been killed or injured in the violence – an average of five children every day since March 2015.
More than 11 million children now need humanitarian assistance – nearly every child in Yemen.
More than half of the country’s
...
children don’t have access to safe drinking water or adequate sanitation.
An estimated 1.8 million children are acutely malnourished, including nearly 400,000 severe acutely malnourished children who are fighting for their lives.
Nearly 2 million children are out of school, including almost half a million who dropped out since the conflict escalated in March 2015.
Suspected cholera and acute watery diarrhea have affected over 1 million people, with children under 5 years old accounting for a quarter of all cases.
more
Now entering its ninth year, the crisis in north-east Nigeria has created vulnerabilities and humanitarian concerns. An estimated 7.7 million men, women, boys and girls are in acute need of protection and assistance. While the humanitarian community has provided life-saving assistance to over 5.6 mi
...
llion affected people in 2017 and helped stabilise living conditions for millions of people, reducing mortality and morbidity, significant humanitarian needs still remain.
The Humanitarian Response Plan at a glance:
STRATEGIC OBJECTIVE 1
Provide life-saving emergency assistance to the most vulnerable people in conflict-affected areas ensuring that assistance is timely and appropriate and meets relevant technical standards.
STRATEGIC OBJECTIVE 2
Ensure that all assistance promotes the protection, safety and dignity of affected people, and is provided equitably to women, girls, men and boys.
STRATEGIC OBJECTIVE 3
Foster resilience and early recovery, and strengthen the humanitarian development nexus by working towards collective outcomes.
more
A joint FAO/WFP update for the United Nations Security Council, January 2018. ISSUE N.3. Six months on from the last joint report for the United
Nations Security Council (UNSC), this report by the
Food and Agriculture Organization of the United
Nations (FAO) and the World Food Programme (WFP)
...
provides an update on the acute food insecurity
situation in most of the conflict-affected countries
currently being monitored by the UNSC.
more
Making education more inclusive requires schools and education authorities to remove the barriers to education experienced by the most excluded children - often the poorest, children with disabilities, children without family care, girls, or children from minority groups. Also included in the text a
...
re examples of children from very remote areas, girls excluded from school, children from ethnic groups, children with language barriers, and children in countries affected by conflict.
more
Erratum on the Rwanda Demographic and Health Survay 2010 final report | Date of correction: December 2, 2014 | Correction: Page 84, Table 6.6 - Table 6.6 has been rerun to correct an error in the total wanted fertility rate calculation. The corrected table is shown below. Only the total wanted ferti
...
lity rate is affected by this change; the total fertility rate remains unchanged.
more
Commissioned by Plan International the report draws on data from research conducted in Bangladesh in April 2018. It explores how adolescent girls within two age brackets (10-14 and 15-19) understand the unique impact the crisis has upon them, and how they have responded to the challenges they face.
... Despite the numbers of adolescent girls affected so profoundly by the ongoing Rohingya crisis, and of course, by many crises around the world, it is rare that either their own communities or the humanitarian sector at large pay much attention to them. This research is an attempt to rectify that: to acknowledge that girls and young women do have rights and that their ideas are worth listening to and acting upon.
Among the many learnings, we discovered that girls feel isolated. They have settled among strangers, and parents worry about their safety, keeping them even more trapped inside their new, makeshift homes.
75% of girls interviewed said they have no ability to make decisions about their own lives. more
... Despite the numbers of adolescent girls affected so profoundly by the ongoing Rohingya crisis, and of course, by many crises around the world, it is rare that either their own communities or the humanitarian sector at large pay much attention to them. This research is an attempt to rectify that: to acknowledge that girls and young women do have rights and that their ideas are worth listening to and acting upon.
Among the many learnings, we discovered that girls feel isolated. They have settled among strangers, and parents worry about their safety, keeping them even more trapped inside their new, makeshift homes.
75% of girls interviewed said they have no ability to make decisions about their own lives. more
A case study of the role of an Essential Health Benefit in the delivery of integrated health services in Zambia
Luwabelwa, M.; Banda, P; Palale M.; Chama-Chiliba, C.
Regional Network for Equity in Health in east and southern Africa (EQUINET)
(2017)
C1
Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 111
The health services delivery system in Zambia is pyramid in structure, with primary healthcare (PHC) services at community level, at the base, followed by first and second level hospitals at distric ... t and provincial levels, respectively, and third level (tertiary) services at national level. Notably, primary health services are free in Zambia and health service providers are either governmentowned or not-for-profit facilities.
Over the years, resource constraints have affected the quality and extent of healthcare services at all levels, requiring the mobilisation of additional resources for the sector. In doing so, prioritisation was high on the agenda of health sector reform. The EHB, therefore, prioritises interventions with the highest impact on the population, enabling policy makers to revisit priority diseases and conditions and to cost the services provided at each level of facility. Other key issues in developing the EHB in Zambia have included the need to have cost-effective services and cost per capita of services for more systematic budgeting, to rank interventions and to validate and cost the health benefit package as a whole. more
The health services delivery system in Zambia is pyramid in structure, with primary healthcare (PHC) services at community level, at the base, followed by first and second level hospitals at distric ... t and provincial levels, respectively, and third level (tertiary) services at national level. Notably, primary health services are free in Zambia and health service providers are either governmentowned or not-for-profit facilities.
Over the years, resource constraints have affected the quality and extent of healthcare services at all levels, requiring the mobilisation of additional resources for the sector. In doing so, prioritisation was high on the agenda of health sector reform. The EHB, therefore, prioritises interventions with the highest impact on the population, enabling policy makers to revisit priority diseases and conditions and to cost the services provided at each level of facility. Other key issues in developing the EHB in Zambia have included the need to have cost-effective services and cost per capita of services for more systematic budgeting, to rank interventions and to validate and cost the health benefit package as a whole. more
Every day, health-care providers are being attacked, patients discriminated against, ambulances held up at checkpoints, hospitals bombed, medical supplies looted and entire communities cut off from critical services around the world.
Between January 2012 and December 2014, the ICRC documented n ... early 2,400 violent incidents against health care in 11 countries experiencing armed conflict or other violence. In over 90% of cases, local health-care providers were affected, seriously threatening the effectiveness and sustainability of national health-care systems. These numbers might well just be the tip of the iceberg more
Between January 2012 and December 2014, the ICRC documented n ... early 2,400 violent incidents against health care in 11 countries experiencing armed conflict or other violence. In over 90% of cases, local health-care providers were affected, seriously threatening the effectiveness and sustainability of national health-care systems. These numbers might well just be the tip of the iceberg more
The guide is designed to help disaster managers in national Governments gain basic knowledge of how to use international tools and services. It aims to support the growing disaster response and disaster response preparedness capabilities that exist at national level across Asia and the Pacific.
... The guide is for national disaster management organizations (NDMOs) and line ministries involved in disaster response and disaster response preparedness. It is also a reference document for representatives of intergovernmental organizations, civilsociety actors and disaster-affected people.
The guide concentrates on key tools and services that can be helpful to disaster managers during the response and response preparedness phases of the disaster programme cycle. more
... The guide is for national disaster management organizations (NDMOs) and line ministries involved in disaster response and disaster response preparedness. It is also a reference document for representatives of intergovernmental organizations, civilsociety actors and disaster-affected people.
The guide concentrates on key tools and services that can be helpful to disaster managers during the response and response preparedness phases of the disaster programme cycle. more
Policy Note #2: Myanmar Health Systems in Transition Policy Notes Series
Myanmar is a country in which people’s access to health services is determined more by where they live than their need for care – a situation that is fundamentally inequitable. The challenge is to reduce levels of ineq ... uity between different groups in the population and different geographical areas, and most particularly to ensure that health services reach poor and disadvantaged groups, including minorities and those living in conflict-affected areas. more
Myanmar is a country in which people’s access to health services is determined more by where they live than their need for care – a situation that is fundamentally inequitable. The challenge is to reduce levels of ineq ... uity between different groups in the population and different geographical areas, and most particularly to ensure that health services reach poor and disadvantaged groups, including minorities and those living in conflict-affected areas. more
In April 2018, Refugees International (RI) conducted a mission to Bangladesh, to research the GBV (gender-based violence) response for Rohingya women and girls. RI found that the entire humanitarian system is struggling under tremendous constraints in Bangladesh, and protection and health actors do
...
deliver lifesaving services to survivors in an incredibly challenging environment. This report, however, focuses on key gaps and challenges in GBV programming, as communicated by practitioners deployed to Bangladesh at various stages of the emergency, by local organizations, and by the affected women and girls themselves.
In the analyses and recommendations provided in this report, RI draws in part from the framework of the international initiative to safeguard women and girls in emergencies — the Call to Action on Protection from Gender-Based Violence in Emergencies — and urges the donors and humanitarian organizations that are Call to Action partners to implement it more effectively and with urgency during this emergency. more
In the analyses and recommendations provided in this report, RI draws in part from the framework of the international initiative to safeguard women and girls in emergencies — the Call to Action on Protection from Gender-Based Violence in Emergencies — and urges the donors and humanitarian organizations that are Call to Action partners to implement it more effectively and with urgency during this emergency. more
Myanmar is prone to various natural hazards that include earthquakes, floods, cyclones, droughts, fires, tsunamis, some of whichhave the potential to impact large numbers of people. In the event that large numbers of people are affected (such as was
...
the case in 2008 following cyclone Nargis), the government may decide to request international assistance to respond to the disaster.
The overall goal of the ERPP is to mitigate the impact of disasters and save as many lives as possible from preventable causes. It aims to ensure that effective and timely assistance is provided to people in need through effective coordination and communication on emergency preparedness and humanitarian response between members of the HCTin Myanmar. The approach has been developed in collaboration with the Government, to facilitate a coordinated and effective support to people affected by humanitarian crises. more
The overall goal of the ERPP is to mitigate the impact of disasters and save as many lives as possible from preventable causes. It aims to ensure that effective and timely assistance is provided to people in need through effective coordination and communication on emergency preparedness and humanitarian response between members of the HCTin Myanmar. The approach has been developed in collaboration with the Government, to facilitate a coordinated and effective support to people affected by humanitarian crises. more
Myanmar is prone to various natural hazards that include earthquakes, floods, cyclones, droughts, fires, tsunamis, some of whichhave the potential to impact large numbers of people. In the event that large numbers of people are affected(such as was
...
the case in 2008 following cyclone Nargis), the government may decide to request international assistance to respond to the disaster.
The overall goal of the ERPP is to mitigate the impact of disasters and save as many lives as possible from preventable causes. It aims to ensure that effective and timely assistance is provided to people in need through effective coordination and communication on emergency preparedness and humanitarian response between members of the HCTin Myanmar. The approach has been developed in collaboration with the Government, to facilitate a coordinated and effective support to people affected by humanitarian crises.
more
In April and May 2015, Nepal was hit by two major earthquakes killing around 9,000 people and leaving many thousands more injured and homeless.
To optimize the speed and volume of critical humanitarian assistance, the HCT has developed this Plan to:
1. Reach a common understanding of earth ... quake risk to ensure early action is taken when required.
2. Establish a minimum level of earthquake preparedness across clusters.
3. Build the basis for a joint HCT response strategy to meet the needs of affected people in the first 6 weeks to 3 months of a response.
4. Define considerations for detailed contingency planning on the basis of the worst-case scenario, especially around access and logistics. more
To optimize the speed and volume of critical humanitarian assistance, the HCT has developed this Plan to:
1. Reach a common understanding of earth ... quake risk to ensure early action is taken when required.
2. Establish a minimum level of earthquake preparedness across clusters.
3. Build the basis for a joint HCT response strategy to meet the needs of affected people in the first 6 weeks to 3 months of a response.
4. Define considerations for detailed contingency planning on the basis of the worst-case scenario, especially around access and logistics. more
Torrential rains and the onset of Cyclone Komen triggered severe and widespread floods and landslides in July and August 2015 across 12 out of 14 states and regions in Myanmar. An estimated 1.6 million individuals were recorded as having been temporarily displaced from their homes by the disaster, a
...
nd 132 lost their lives. Up to 5.2 million people were exposed to the floods and landslides in the 40 most heavily affected townships. Within the 40 most-affected townships, 775,810 individuals have been displaced, accounting for approximately half of the total displaced population.
The Project recognizes that although the major target disaster is cyclones, the methodology of the Project activities to enhance the capacity of EWS, HRD and CBDRM is also applicable to mitigate the damage of floods. By analyzing the results of a survey based on the experience of the Project activities, the Project can contribute to describe tangible lessons learned and future recommendations for the counterpart agencies and disaster management related agencies of the Government of Myanmar. more
The Project recognizes that although the major target disaster is cyclones, the methodology of the Project activities to enhance the capacity of EWS, HRD and CBDRM is also applicable to mitigate the damage of floods. By analyzing the results of a survey based on the experience of the Project activities, the Project can contribute to describe tangible lessons learned and future recommendations for the counterpart agencies and disaster management related agencies of the Government of Myanmar. more
