Tech will heavily shape Myanmar’s internal conflict

Significance On the contrary, since May, when the anti-junta National Unity Government (NUG) formed a military wing, fighting has spread nationwide. The most critical arena in the conflict is online space: both sides have effectively weaponised mobile technology and the internet. Impacts Internet shutdowns will impede COVID-19 public health programmes, risking further transmission of infection across borders. International human rights groups will not call for sanctions against tech companies because that would further hinder the opposition. Chinese surveillance technology will be a critical resource for the junta.

Epidemiological Principles

This chapter reviews the basic epidemiological concepts and principles that are relevant for all primary health care workers. It describes patterns of disease frequency in populations and quantifies diseases, disability, and deaths with the use of health indicators. It measures causes and risk factors that influence disease frequency and the use of epidemiology in improving the effectiveness of health interventions in health services and public health programmes. Epidemiology is also essential for local health planning, management, and evaluation of these services at the district level.

Practical Epidemiology

We focus on the importance of using epidemiological concepts and skills needed to investigate, plan and deliver primary health care services and to strengthen district level public health programmes. We illustrate these with examples from LMICs and for a hypothetical district population of 200,000 people.

Transdisciplinarity of India's Master's Level Public Health Programmes: Evidence from Admission Criteria of the Programmes Offered Since 1995

BackgroundIn Indian subcontinent, Master's level public health (MPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MPH admissibility criteria 1995 to 2021. MethodsUsing a search strategy, we abstracted information available in the public domain on MPH and their admissibility criteria. We classified disciplines specified for admission into Science, Social sciences and Arts, Health and Non-health categories. We described the MPH programmes by location, type of institutions, course duration, pedagogical methods, specialisations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for admission to MPH programmes. ResultsOverall, 74 Indian institutions offered 88 MPH programmes. We included 85 for review. These programmes represent 50% increase (n=44) from that of 2016-17. They are mostly concentrated in 21 provinces and union territories of India. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "three-year bachelors degree in any discipline", “graduation from any Indian universities”, and "graduation in any discipline". Of the 72 institutions, 14 admit multidisciplinary academic graduates in their 16 programmes. Except three institutions from public sector, 69 provide MPH admission opportunities to multidisciplinary health and non-health academic graduates. ConclusionOur review suggests that India's MPH programmes are less transdisciplinary. India's Master's level public health programmes should transcend to be more inclusive and admit graduates of various academic educational backgrounds.

Repackaging Primary Healthcare in Odisha: Can ‘Task Shifting’ to AYUSH Doctors Address Human Resources Deficit?

Provision of primary healthcare in India received thrust of National Health Policy 2017. Vacancy, chronic absenteeism and non-availability of allopathic doctors is a chronic problem of the public health system. Engagement of alternative human resources could get the ailing health system rid of this shortage. AYUSH doctors in Odisha are involved in clinical and public health activities since 1970s. This study aims to examine perspectives of key stakeholders on ‘task shifting’ as a possible policy alternative. We reviewed the policies and guidelines of government of Odisha on human resources deployment, recruitment, retention and terms of reference of their engagement in the public health sector. Further, 76 AYUSH doctors and 30 key informants were interviewed. Ethical clearance was obtained beforehand. Most AYUSH doctors were involved in monitoring and supervising community-based public health programmes and village-level health service providers, respectively. Their involvement in the implementation of national health programmes was found to range from 8% to 62%. A sizeable proportion of AYUSH doctors had not been trained on management of national vector borne disease control, Tuberculosis control, immunisation (RI) and disease surveillance. More than 70% of respondents showed interest in implementing and managing public health programmes. Almost all key informants recommended for improved involvement of AYUSH doctors in public health activities. Inadequate logistics support, insufficient training on public health and unequal administrative authorities was perceived to be systemic bottlenecks. Job enrichment, management capacity development, and pre-deployment orientation of AYUSH doctors may precede the opportunity of ‘task-shifting’ of public health functions.

How to Achieve Indigenous Self-sufficiency in Vaccine Development? A Roadmap

For every nation state with a large population (Pakistan being the 5 largest), it is imperative to have indigenouscapability to meet one's own requirement of vaccines for one's own set of prevailing diseases. Imports arecostly and not always readily available as became evident globally during the ongoing COVID-19 pandemic.Microbial antigenicity may also vary significantly from region to region on account of mutations. Henceefficiency of vaccine too can vary accordingly.Vaccines have dramatically reduced the burden of numerous infectious diseases, promoted individual andsocial growth, prosperity and wellbeing across the globe. In the coming decade, vaccines are likely to savetwenty-five million lives1 , and will continue to be the cornerstone of public health programmes. It is estimatedthat six out of every ten infectious diseases in humans are transmitted by animals and 70% of emerging and reemergingdiseases are either spread from animals to humans or infected animals to the healthy ones throughinsects.2 The role of vaccines in human health is therefore not only limited to humans but is vital to controldisease transmission from animals to humans as well.

Transdisciplinarity of India's Master's Level Public Health Programmes: Evidence from Admission Criteria of the Programmes Offered Since 1995

Background In Indian subcontinent, Master's level public health (MPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MPH admissibility criteria 1995 to 2021. Methods Using a search strategy, we abstracted information available in the public domain on MPH and their admissibility criteria. We classified disciplines specified for admission into Science, Social sciences and Arts, Health and Non-health categories. We described the MPH programmes by location, type of institutions, course duration, pedagogical methods, specialisations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for admission to MPH programmes. Results Overall, 74 Indian institutions offered 88 MPH programmes. We included 85 for review. These programmes represent 50% increase (n = 44) from that of 2016-17. They are mostly concentrated in 21 provinces and union territories of India. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "three-year bachelors degree in any discipline", “graduation from any Indian universities”, and "graduation in any discipline". Of the 72 institutions, 14 admit multidisciplinary academic graduates in their 16 programmes. Except three institutions from public sector, 69 provide MPH admission opportunities to multidisciplinary health and non-health academic graduates. Conclusion Our review suggests that India's MPH programmes are less transdisciplinary. India's Master's level public health programmes should transcend to be more inclusive and admit graduates of various academic educational backgrounds.

The Development of a Multilevel Intervention to Optimise Participant Engagement with an Obesity Prevention Programme Delivered in UK children’s Centres

Poor participant engagement threatens the potential impact and cost-effectiveness of public health programmes preventing meaningful evaluation and wider application. Although barriers and levers to engagement with public health programmes are well documented, there is a lack of proven strategies in the literature addressing these. This paper details the development of a participant engagement intervention aimed at promoting enrolment and attendance to a community-based pre-school obesity prevention programme delivered in UK children’s centres; HENRY (Health, Exercise, Nutrition for the Really Young). The Behaviour Change Wheel framework was used to guide the development of the intervention. The findings of a coinciding focused ethnography study identified barriers and levers to engagement with HENRY that informed which behaviours should be targeted within the intervention to promote engagement. A COM-B behavioural analysis was undertaken to identify whether capability, opportunity or motivation would need to be influenced for the target behaviours to occur. APEASE criteria were used to agree on appropriate intervention functions and behaviour change techniques. A multi-level participant engagement intervention was developed to promote adoption of target behaviours that were proposed to promote engagement with HENRY, e.g. ensuring the programme is accurately portrayed when approaching individuals to attend and providing ‘taster’ sessions prior to each programme. At the local authority level, the intervention aimed to increase buy-in with HENRY to increase the level of resource dedicated to engagement efforts. At the centre level, managers were encouraged to widen promotion of the programme and ensure that staff promoted the programme accurately. HENRY facilitators received training to increase engagement during sessions, and parents that had attended HENRY were encouraged to recruit their peers. This paper describes one of the first attempts to develop a theory-based multi-level participant engagement intervention specifically designed to promote recruitment and retention to a community-based obesity prevention programme. Given the challenges to implementing public health programmes with sufficient reach, the process used to develop the intervention serves as an example of how programmes that are already widely commissioned could be optimised to enable greater impact.

Before the whistle blows: developing new paradigms in tuberculosis screening to maximise benefit and minimise harm

We summarise recent emerging evidence around tuberculosis (TB) transmission and its role in tuberculosis epidemiology, and in novel TB screening and diagnostic tests that will likely become available in low-resource settings in the near future. Little consideration has been paid to how these novel new tests will be implemented, nor what the consequences for individuals, communities and health systems will be. In particular, because of low specificity and consequent false-positive diagnoses, and the low percentage of people who “screen positive” that will go onto develop active pulmonary disease, there is significant potential for inappropriate initiation of TB treatment, as well as stigmatisation, loss of livelihoods and in some setting institutionalisation, with uncertain benefit for individual health or community transmission. We use analogy to prompt consideration of how and where new TB screening tests could be implemented in TB screening programmes in low-resource settings. Acceptance and confidence in TB screening programmes depends on well-functioning public health programmes that use screening algorithms that minimise harms and balance population benefits with autonomy and respect for individuals. Before new TB screening tests and algorithms are introduced, more evidence for their effectiveness, costs, benefits and harms under real-world conditions are required.