PLoS Medicine: An Unsupported Preference for Intravenous Antibiotics.

‘Belief in the superiority of intravenous antibiotics is widespread among health professionals and patients, but it is not supported by good evidence… reasons for the belief in the strength of intravenous therapy also need to be understood and addressed…’

These are some of the key points in an essay in the open-access journal PLoS Medicine.

The authors point out that ‘Intravenous therapy may result in harmful complications such as phlebitis, extravasation injury, thrombosis’. As a personal comment, in low resource settings there is also risk of HIV and hepatitis B due to re-use (inadvertent or deliberate) of needles. This is perhaps especially likely with intramuscular injections (which are not described in the essay).

As the authors conclude: ‘Clarity regarding the harms and benefits of intravenous antibiotics is needed. There is potential to change global clinical practice for the better, reducing health care costs and minimizing harm to patients.’

Citation: Li HK, Agweyu A, English M, Bejon P (2015) An Unsupported Preference for Intravenous Antibiotics. PLoS Med 12(5): e1001825. doi:10.1371/journal.pmed.1001825

Best wishes, Neil

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Check the archive of recorded Cochrane webinars on producing and using research for health

Cochrane Canada Live presents you with a variety of learning opportunities that you can experience online for free. Cochrane Canada released The Cochrane Collaboration’s first webinar series in 2009, and it has since proven to be a favourite medium of training among Cochrane members in Canada and internationally. We focus on a wide range of topics that are relevant to people with beginner or advanced knowledge of The Cochrane Collaboration, Cochrane Reviews and Cochrane Library. Webinars allow you to learn with renowned research experts from around the world without the time and expense of having to travel. All you need to participate is a computer with internet access and speakers.

Quality training and a sustainable workforce supply

Below is an editorial I wrote for the March issue of Africa Health journal. My understanding is that the international ground is starting to shift towards looking at financial models of support for institutions training health workers to work elsewhere in the world. It is a complex dynamic, but I understand the Organisation of Economic Cooperation and Development (OECD) based in Paris has been requested by a number of global health actors to actively look at potential models.

Maybe HIFA members could help with some added thoughts on the subject?

A point I missed in the piece below is that the financial injection to the training institutions would also make them much more attractive to senior diaspora health professionals, who can bring experience, knowledge… and international connections. Many would love to return, but the current resource-poor challenge is just too great. The expertise they could bring would be invaluable.

(Editorial from AH March 2015)

The right to roam

It is interesting to see the WHO Code on the International Recruitment of Health Personnel is back in the news again (see Francis Omaswa’s column on page 7). It was a hard fought campaign that brought it into being in 2010, as several African countries were suffering health system meltdown from huge migrations of their staff heading for pastures new in Europe, the USA, the Middle East or South Africa. At the time, the Code seemed to be of critical importance, and I can recall we hailed its advent strongly in the columns of this journal.

But equally I remember talking about it with health professional friends in different parts of Africa and noticing their guarded reticence towards it. Deep down it was clear that there was a struggle going on between the right to work wherever one wished, and the need to sustain health services at home. I was looking at the issue with one eye, not the two that they were using.

Although hailed initially as a ‘victory for Africa’ it is clear now that my friends were not alone in their uncertainty about the plan. That only one country (out of 47) in the African region of WHO has managed to respond to a request to submit a report to Geneva on progress in implementation of the voluntary code is testament to a wider unease and ambivalence towards the Code.

And yet, as Francis Omaswa predicts, the global health workforce shortages are only going to get more acute.

Maybe it is time for a further rethink? Why I wonder could it not be possible to develop a system whereby all graduates of accredited institutions be tagged with a licence number which references their country and institution. For the first six years (say) of practice this reference number triggers a payment by their employer to their training institution. If on home ground, no payment. But if in Dubai, Durban, or Derby, then a sum would be payable annually. These funds would then help establish the training institution as a centre of excellence, probably help improve the number of trainees they might take in each year, and in turn help to meet the global needs for physicians, nurses and paramedic staff.

Training would become an export. And the quality of the training which is currently under such pressure in many African countries, would rise through the added funding reaching the institution. Maybe we should develop these thoughts further to examine the finer practicalities?

What is increasingly evident is that just stopping people leaving their home country is not a solution to either the home problem, or the global problem. Fresh thinking is needed.

HIFA profile: Bryan Pearson is the publisher of Africa Health, a largely paper-based CME resource for senior health professionals in Africa. He is based near Cambridge, UK. bryan AT

Today is the International Day to End Fistula

Too many women are being left in obstructed labour for too long, resulting in maternal and/or newborn death. Those who survive are left, all too often, with vesico-vaginal fistula. Today 23 May is the International Day to End Fistula. It is a day to promote healthcare information to raise awareness among women, families and birth attendants about the dangers of prolonged labour, and the need to prepare for urgent referral if necessary. It is a day to raise global awareness of the importance of access to emergency obstetric care, including and especially caesarian section, for all women. Prevention is better than cure, but every woman with fistula should have access to corrective surgery. In the spirit of the world-famous fistula hospital in Ethiopia, excessive regulation and medical turf protection should, where appropriate, be replaced progressively by training of non-medical staff to conduct caesarians and/or fistula surgery. As we have heard previously on HIFA, ‘Many professionals are paranoid and far too defensive of their niches, and its pure arrogance to assume less educated workers are incapable of being trained in well demarcated tasks previously undertaken by tertiary trained professionals.’

I would like to invite comments from HIFA members on what is being done (or should be done) to provide the care women need to prevent and manage this debilitating and stigmatising complication of childbirth.

Best wishes,


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Breastfeeding video series just released

We have just released 8 new videos on breastfeeding. This set of videos has been developed for health workers so that they can learn about breastfeeding best practices, how to better observe mothers breastfeeding as well as manage common breastfeeding problems. The goal of these videos is to help health workers guide mothers so they are more effective and confident with breastfeeding with the aim of enabling more mothers to exclusively breastfeed until 6 months of age.

The series includes Early initiation of breastfeeding, Expressing and storing breast milk, Breastfeeding attachment, Breastfeeding positions, Helping a breastfeeding mother, Not enough milk, Nipple pain and Breast pain.

The videos can be viewed on-line as well as downloaded free-of-charge in 5 different sizes for use in workshops and on various mobile devices. They will be narrated in French, Spanish and Swahili and we have a similar set for mothers coming soon.

Here’s the link:

Please feel free to share these with your networks.

Thanks and kind regards,


Deborah Van Dyke, Director

Global Health Media Project

Strategies toward Ending Preventable Maternal Mortality report launch

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The Strategies toward Ending Preventable Maternal Mortality report will be officially launched on May 19 during a World Health Assembly event hosted by the delegations from Cameroon and Malawi.  

Strategies toward Ending Preventable Maternal Mortality report to be launched at the World Health Assembly

The Strategies toward Ending Preventable Maternal Mortality report will be officially launched on May 19 during a World Health Assembly event hosted by the delegations from Cameroon and Malawi.

The report proposes a global target for maternal mortality, supplemented by context-specific national-level targets. The targets and strategies are grounded in a human rights approach to maternal and newborn health, and focus attention on eliminating significant inequities that persist, resulting in disparities in access, quality, and outcomes of care within and between countries.

The Strategies toward Ending Preventable Maternal Mortality report is the result of a collaborative process led by the WHO in partnership with the Maternal Health Task Force (MHTF), UNICEF, UNFPA, USAID, Family Care International, Maternal Child Survival Program (MCSP), and the White Ribbon Alliance.

The launch event is co-sponsored by contributors to the Every Newborn Action Plan

and will feature a newborn health progress update for the one-year anniversary of the plan’s adoption.

Read the report

or learn more on the MHTF blog.

Copyright © 2015 Maternal Health Task Force, All rights reserved.

You are receiving this email because you subscribed to the Maternal Health Task Force.

Our mailing address is:

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HIFA profile: Kathryn Millar is Publication Coordinator and Technical Writer with the Maternal Health Task Force, United States . Professional interests: Maternal and newborn health. Email address: kmillar AT

Quality of care for pregnant women and newborns — the WHO vision

This is a really interesting discussion. The recent WHO recommendations on optimizing health worker roles for maternal and newborn health (OptimizeMNH: include a number of recommendations for lay or community health workers (which was defined to encompass trained TBAs), including misoprostol administration to prevent PPH, continuous support for women during labour and a range of health promotion activities (see ). The administration of oxytocin to prevent and treat post-partum haemorrhage was recommended in the context of rigorous research in this guidance.

Best wishes


World Health Statistics 2015

World Health Statistics 2015 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.

WHO presents World Health Statistics 2015 as an integral part of its ongoing efforts to provide enhanced access to comparable high-quality statistics on core measures of population health and national health systems.

Full report available at

BMJ: Antimicrobial resistance is a social problem requiring a social solution

‘Antimicrobial resistance is a social problem requiring a social solution’, says Prof Richard Smith, a professor of health systems economics in the BMJ.

Smith R. Antimicrobial resistance is a social problem requiring a social solution

BMJ 2015; 350 :h2682 (Published 19 May 2015) (restricted access)

Social factors are driving antimicrobial resistance, including ‘how the public and healthcare professionals understand, value, and use antimicrobials’.

‘The latest report from the O’Neill review recommends a global innovation fund of around $2bn (£1.3bn; €1.8bn) to boost “blue sky” research into drugs and diagnostics and says that a comprehensive package of interventions in this area could cost “as little as $16bn.” That may be true, but even with those investments there is a risk that nothing will result. And any results we do get may only be buying time. It would be more sustainable and effective to use such funds to support work to restructure our health systems and reverse our dependency on antibiotics, which ultimately we will need to do whether or not new antibiotics are discovered.’

I agree and would add that WHO has outlined 12 key interventions to promote rational use of antibiotics and other drugs ( ). Among these, prescribers and users must have easy access to reliable, independent, appropriate information on medicines. It is unacceptable that many prescribers continue to be dependent on drug promotion literature and 20-year old copies of the BNF. The HIFA Challenge Working Group on Information for Prescribers and Users of Medicines is continuing to work on this issue, leading one of HIFA’s SMART goals: Information on Medicines For All: “By 2016, every English-speaking prescriber and user worldwide with internet access will have free access to independent, reliable, understandable information on the full range of commonly prescribed medicines – and will know where to find it. By 2018, such information will be available in at least 6 other major languages.”

We have had discussions with the Essential Medicines Programme at WHO and with the BNF about what might be done to improve access globally, and we are planning a literature review and survey to get a better understanding of what is currently available and what is needed. If anyone would like more information, please get in touch.

Best wishes,


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J Med Internet Res: The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study

CITATION: Tunnecliff J, Ilic D, Morgan P, Keating J, Gaida JE, Clearihan L, Sadasivan S, Davies D, Ganesh S, Mohanty P, Weiner J, Reynolds J, Maloney S

The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study

J Med Internet Res 2015;17(5):e119


Background: Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections.

Objective: The aim of this study was to explore health researchers’ and clinicians’ current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence.

Methods: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey.

Results: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information.

Conclusions: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice.

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Study: High incidence of latent TB infection among South African health workers

Recently published in the International Journal of Tuberculosis and Lung Disease, this study aimed to evaluate the incidence of latent TB infection and risk factors for infection among 199 Johannesburg health workers. The study found that a high incidence of latent TB infection among the medical students, nurses, counsellors and doctors surveyed…. more ….see article

Cut shebeen hours to curb drinking

So said Savera Kalideen, senior advocacy manager at Soul City Institute for Heath and Development Communication.  Speaking at a Johannesburg press conference on licencing and law enforcement in the informal liquor sector yesterday, Kalideen said Soul City researchers working on the institute’s responsible drinking PhuzaWise campaign had been told by youth that drinking alcohol was “cheaper than going to the movies”. This easy access to alcohol meant abuse amongst youngsters was one of the country’s major problems, she said….more

Chiawelo Community Practice to be rolled out in other wards in Chiawelo


Members of the Chiawelo Community Practice take a group picture with the MEC for Health in Gauteng, Qedani Mahlangu. The MEC had requested a presentation by Dr Shabir Moosa on Chiawelo Community Practice (CCP) to the senior managers of Gauteng Department of Health on Wednesday 20th May 2015. She insisted that the model be rolled out to all township wards in Gauteng by March 2016. The resources required are expected to be minimal but the change management may require more effort. The MEC requested Dr Moosa to champion the WBOT in Johannesburg and join a team of champions in other Districts, Dr Victor Figeuroa and Prof Jannie Hugo, to ensure the rollout. The immediate plan was to expand CCP from just ward 11 to other wards around the CHC: Wards 10,12,13,14,15,16 & 19, setting more such community practices in the CHC and clinics around.

Wards Chiawelo CHC

BMJ: Televised medical talk shows – what they recommend and the evidence to support their recommendations

Citizens worldwide receive much if not most of their health information from the mass media (and, increasingly, from social media). This paper below relates to a Canadian medical talk show on television. Is anyone aware of any comparable research in low and middle income countries?

BMJ. 2014 Dec 17;349:g7346. doi: 10.1136/bmj.g7346.

Televised medical talk shows – what they recommend and the evidence to support their recommendations: a prospective observational study.

Korownyk C et al.


Objective: To determine the quality of health recommendations and claims made on popular medical talk shows.

Design: Prospective observational study.

Setting: Mainstream television media.

Sources: Internationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors).

Interventions: Investigators randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show.

Main outcomes measures: Percentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made.

Results: We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations.

Conclusions: Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows. Additional details of methods used and changes made to study protocol.

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