Have you ever felt like you had a cold that wouldn’t go away?  If it hangs around for more than 10 days, or gets worse after it starts getting better, there’s a good chance you have sinusitis, a condition where infection or inflammation affects the sinuses.


Sinuses are hollow spaces in the bones around the nose that connect to the nose through small, narrow channels. The sinuses stay healthy when the channels are open, which allows air from the nose to enter the sinuses and mucus made in the sinuses to drain into the nose.


Sinusitis, also called rhinosinusitis, affects about 1 in 8 adults annually and generally occurs when viruses or bacteria infect the sinuses (often during a cold) and begin to multiply. Part of the body’s reaction to the infection causes the sinus lining to swell, blocking the channels that drain the sinuses. This causes mucus and pus to fill up the nose and sinus cavities….more

More search results


Rethinking Video Content For Your NGO

I’d just like you to take a moment think back to a time your perception of the world was changed, a moment where all that you believed in was challenged and you felt motivated to change the world. When you think back to these moments, there’s most likely a familiar thread – you either watched something incredibly thought-provoking or maybe you were in the field and witnessed something with your own eyes.I’d just like you to take a moment think back to a time your perception of the world was changed, a moment where all that you believed in was challenged and you felt motivated to change the world.

Either way there’s only one surefire way to recreate this feeling for an audience and although there are many well-written and descriptive articles out there which have worked as call to actions, no form of media in the contemporary world can now challenge the power of video. ….more

Cochrane: Beta blockers of limited use in treatment hypertension

Wiysonge CS, Bradley HA, Volmink J, et al. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2017 Jan 20;1:CD002003. doi: 10.1002/14651858.CD002003.pub5. (Review) PMID: 28107561

BACKGROUND: Beta-blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties. They have shown long-term beneficial effects on mortality and cardiovascular disease (CVD) when used in people with heart failure or acute myocardial infarction. Beta-blockers were thought to have similar beneficial effects when used as first-line therapy for hypertension. However, the benefit of beta-blockers as first-line therapy for hypertension without compelling indications is controversial. This review is an update of a Cochrane Review initially published in 2007 and updated in 2012.

OBJECTIVES: To assess the effects of beta-blockers on morbidity and mortality endpoints in adults with hypertension.

SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to June 2016: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 6), MEDLINE (from 1946), Embase (from 1974), and We checked reference lists of relevant reviews, and reference lists of studies potentially eligible for inclusion in this review, and also searched the the World Health Organization International Clinical Trials Registry Platform on 06 July 2015.

SELECTION CRITERIA: Randomised controlled trials (RCTs) of at least one year of duration, which assessed the effects of beta-blockers compared to placebo or other drugs, as first-line therapy for hypertension, on mortality and morbidity in adults.

DATA COLLECTION AND ANALYSIS: We selected studies and extracted data in duplicate, resolving discrepancies by consensus. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and conducted fixed-effect or random-effects meta-analyses, as appropriate. We also used GRADE to assess the certainty of the evidence. GRADE classifies the certainty of evidence as high (if we are confident that the true effect lies close to that of the estimate of effect), moderate (if the true effect is likely to be close to the estimate of effect), low (if the true effect may be substantially different from the estimate of effect), and very low (if we are very uncertain about the estimate of effect).

MAIN RESULTS: Thirteen RCTs met inclusion criteria. They compared beta-blockers to placebo (4 RCTs, 23,613 participants), diuretics (5 RCTs, 18,241 participants), calcium-channel blockers (CCBs: 4 RCTs, 44,825 participants), and renin-angiotensin system (RAS) inhibitors (3 RCTs, 10,828 participants). These RCTs were conducted between the 1970s and 2000s and most of them had a high risk of bias resulting from limitations in study design, conduct, and data analysis. There were 40,245 participants taking beta-blockers, three-quarters of them taking atenolol. We found no outcome trials involving the newer vasodilating beta-blockers (e.g. nebivolol).There was no difference in all-cause mortality between beta-blockers and placebo (RR 0.99, 95% CI 0.88 to 1.11), diuretics or RAS inhibitors, but it was higher for beta-blockers compared to CCBs (RR 1.07, 95% CI 1.00 to 1.14). The evidence on mortality was of moderate-certainty for all comparisons.Total CVD was lower for beta-blockers compared to placebo (RR 0.88, 95% CI 0.79 to 0.97; low-certainty evidence), a reflection of the decrease in stroke (RR 0.80, 95% CI 0.66 to 0.96; low-certainty evidence) since there was no difference in coronary heart disease (CHD: RR 0.93, 95% CI 0.81 to 1.07; moderate-certainty evidence). The effect of beta-blockers on CVD was worse than that of CCBs (RR 1.18, 95% CI 1.08 to 1.29; moderate-certainty evidence), but was not different from that of diuretics (moderate-certainty) or RAS inhibitors (low-certainty). In addition, there was an increase in stroke in beta-blockers compared to CCBs (RR 1.24, 95% CI 1.11 to 1.40; moderate-certainty evidence) and RAS inhibitors (RR 1.30, 95% CI 1.11 to 1.53; moderate-certainty evidence). However, there was little or no difference in CHD between beta-blockers and diuretics (low-certainty evidence), CCBs (moderate-certainty evidence) or RAS inhibitors (low-certainty evidence). In the single trial involving participants aged 65 years and older, atenolol was associated with an increased CHD incidence compared to diuretics (RR 1.63, 95% CI 1.15 to 2.32). Participants taking beta-blockers were more likely to discontinue treatment due to adverse events than participants taking RAS inhibitors (RR 1.41, 95% CI 1.29 to 1.54; moderate-certainty evidence), but there was little or no difference with placebo, diuretics or CCBs (low-certainty evidence).

AUTHORS’ CONCLUSIONS: Most outcome RCTs on beta-blockers as initial therapy for hypertension have high risk of bias. Atenolol was the beta-blocker most used. Current evidence suggests that initiating treatment of hypertension with beta-blockers leads to modest CVD reductions and little or no effects on mortality. These beta-blocker effects are inferior to those of other antihypertensive drugs. Further research should be of high quality and should explore whether there are differences between different subtypes of beta-blockers or whether beta-blockers have differential effects on younger and older people.

How to bridge community and health systems

Do read our editorial from 14 papers on Community health workers in different contexts published in Human Resources for Health: “Close-to-community providers of health care: increasing evidence of how to bridge community and health systems” available at:

This outlines range of close to community providers including CTC providers are known by different names and titles in different contexts as well as synthesising findings on:

  • – Strategies to support CTC providers’ interface role between communities and the health system
  • – The role of the community in the selection and support of CTC providers
  • – The need to move to supportive, structured relationships in CTC supervision
  • – The critical role of programme design, motivation and incentives in responsive and people-centred health systems
  • – Negotiating trusting relationships
  • – Power relationships and gender roles shape CTC interactions at multiple levels.
  • Many thanks


Prof. Sally Theobald

Professor in Social Science and International Health

Department of International Public Health

Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA

Visiting Fellow Institute of Development Studies, Sussex

Tel: +44 (0)151 7053197

Skype: sally.theobald


Proud hosts of HSG 2018

Ethics and power in north-south public health research

CITATION: Walsh A.; Brugha R.; Byrne E. “The way the country has been carved up by researchers”: ethics and power in north-south public health research. International Journal for Equity in Health. 15 (1) (pp 1-11), 2016.


Background: Despite the recognition of power as being central to health research collaborations between high income countries and low and middle income countries, there has been insufficient detailed analysis of power within these partnerships. The politics of research in the global south is often considered outside of the remit of research ethics. This article reports on an analysis of power in north-south public health research, using Zambia as a case study. Methods: Primary data were collected in 2011/2012, through 53 in-depth interviews with: Zambian researchers (n = 20), Zambian national stakeholders (n = 8) and northern researchers who had been involved in public health research collaborations involving Zambia and the global north (n = 25). Thematic analysis, utilising a situated ethics perspective, was undertaken using Nvivo 10.

Results: Most interviewees perceived roles and relationships to be inequitable with power remaining with the north. Concepts from Bourdieu’s theory of Power and Practice highlight new aspects of research ethics: Northern and southern researchers perceive that different habituses exist, north and south – habituses of domination (northern) and subordination (Zambian) in relation to researcher relationships. Bourdieu’s hysteresis effect provides a possible explanation for why power differentials continue to exist. In some cases, new opportunities have arisen for Zambian researchers; however, they may not immediately recognise and grasp them. Bourdieu’s concept of Capitals offers an explanation of how diverse resources are used to explain these power imbalances, where northern researchers are often in possession of more economic, symbolic and social capital; while Zambian researchers possess more cultural capital.

Conclusions: Inequities and power imbalances need to be recognised and addressed in research partnerships. A situated ethics approach is central in understanding this relationship in north-south public health research.

Best wishes, Neil

Coordinator, HIFA Project on Health Partnerships

Community Health Assistants in Zambia

CITATION: Shelley KD;  Belete YW;  Phiri SC;  Musonda M;  Kawesha EC;  Muleya EM; Chibawe CP;  van den Broek JW;  Vosburg KB. Implementation of the Community Health Assistant (CHA) Cadre in Zambia: A Process Evaluation to Guide Future Scale-Up Decisions. Journal of Community Health.  41(2):398-408, 2016 Apr.


Universal health coverage requires an adequate health workforce, including community health workers (CHWs) to reach rural communities. To improve healthcare access in rural areas, in 2010 the Government of Zambia implemented a national CHW strategy that introduced a new cadre of  healthcare workers called community health assistants (CHAs). After 1 year of training the pilot class of 307 CHAs deployed in September 2012. This paper presents findings from a process evaluation of the barriers and facilitators of implementation of the CHA pilot, along with how evidence was used to guide ongoing implementation and scale-up decisions.

Qualitative inquiry was used to assess implementation during the first 6 months of the program rollout, with 43 in-depth individual and 32 small group interviews across five respondent types: CHAs, supervisors, volunteer CHWs, community members, and district leadership. Potential ‘implementation moderators’ were explored using deductive coding and thematic analysis of participant perspectives on community acceptance of CHAs, supervision support mechanisms, and coordination with volunteer CHWs, and health system integration of a new cadre. Community acceptance of CHAs was generally high, but coordination between CHAs and existing volunteer CHWs presented some challenges. The supervision support system was found to be inconsistent, limiting assurance of consistent quality care delivered by CHAs. Underlying health system weaknesses regarding drug supply and salary payments furthermore hindered incorporation of a new cadre within the national health system. Recommendations for implementation and future scale based on the process evaluation findings are discussed.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Cultural and health beliefs of pregnant women in Zambia

Cultural beliefs around health and illness are vitally important and HIFA includes many anthropologists and social scientists who can help us  understand and explore these beliefs, and to consider whether and how to challenge beliefs that may be harmful to health. One key area is around pregnancy and child birth. This open-access paper explores beliefs among pregnant women in Zambia.

CITATION: M’soka, N.C., Mabuza, L.H. & Pretorius, D., 2015, ‘Cultural and health beliefs of pregnant women in Zambia regarding pregnancy and child birth’, Curationis 38(1), Art. #1232, 7 pages.


BACKGROUND: Health beliefs related to pregnancy and childbirth exist in various cultures globally. Healthcare practitioners need to be aware of these beliefs so as to contextualise their practice in their communities.

OBJECTIVES: To explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia.

METHOD: This was a descriptive, cross-sectional survey of women attending antenatal care(n = 294) who were selected by systematic sampling. A researcher-administered questionnaire was used for data collection.

RESULTS: Results indicated that women attending antenatal care at Chawama Clinic held certain beliefs relating to diet, behaviour and the use of medicinal herbs during pregnancy and post-delivery. The main beliefs on diet related to a balanced diet, eating of eggs, okra, bones, offal, sugar cane, alcohol consumption and salt intake. The main beliefs on behaviour related to commencement of antenatal care, daily activities, quarrels, bad rituals, infidelity and the use of condoms during pregnancy. The main beliefs on the use of medicinal herbs were on their use to expedite the delivery process, to assist in difficult deliveries and for body cleansing following a miscarriage.

CONCLUSION: Women attending antenatal care at the Chawama Clinic hold a  number of beliefs regarding pregnancy and childbirth. Those beliefs that are of benefit to the patients should be encouraged with scientific explanations, whilst those posing a health risk should be discouraged respectfully.


‘Regarding the belief that eating eggs can cause a baby to be born without hair, it is of concern that almost a third of the women interviewed were of this opinion.’

‘Approximately one in three of the participants believed that ingesting okra during pregnancy caused excessive salivation of the child.’

‘Since almost three quarters of the respondents agreed with the belief that salt should be avoided during pregnancy, this needs to be addressed by healthcare practitioners. Salt is essential for the body to function normally’

‘The belief on the effect of using condoms during pregnancy was of great concern: about one in four respondents held the belief that using condoms during pregnancy could lead to a weak child, whilst only about half disagreed, and one in five were neutral on this belief.’

Working together for health in Zambia – Join HIFA-Zambia:

WONCA News February 2017

2017 – a new year and this weekend, best wishes for the Chinese New Year. In the news this month, are a number of reports from Working Parties and Special Interest Groups after meetings in Rio. Our featured doctors are two of the chairs of these groups: Thomas Kühlein (WICC) and Domingo Orozco-Beltran (NCDs).

This year WONCA brings you a number of wonderful opportunities for professional development and networking at WONCA conferences. Coming to Abu Dhabi in March (EMR), Cairns in April (Rural Health), Strasbourg in April (young doctors), Prague in June (Europe), Pretoria in August (Africa), Lima in August (Iberoamericana), Pattaya Beach in November (Asia Pacific), and finally Kathmandu in November (South Asia).

We hope you consider attending at least one WONCA conference in 2017. More information on all WONCA conferences here.

Dr Karen Flegg. WONCA Editor.

From the President: Behind the scenes

Life as the new President has been quiet geographically but busy online. There is an odd tension between leadership and service, where the responsibility to ‘keep moving and improving’ is set against the ordinary repetitions of daily life. In fact, as family doctors our most important work is that which we do again and again, in our consulting rooms and clinics, with patients and colleagues

From the CEOs desk: new special interest groups

WONCA is blessed with many Working Parties (WPs) and SIGs which work between world council meetings to progress specific areas of interest to WONCA and its members around the globe. This month and next I will feature some of the seven new SIGs, to give members a flavor of where their interest lies, and give details of how to join the groups for anyone who shares their interests.

Policy bite from Canada : Advocating for Family Medicine internationally.

This month’s Policy Bite is our first ‘external invite’ and has been written by Professor Katherine Rouleau of the Besrour Centre, which is linked with our WONCA Member Organization – the College of Family Physicians of Canada. Prof Rouleau’s submission shows how a member organization can try to impact on government through participating in an official consultation.

Anna Stavdal’s vision for WONCA Europe

Anna Stavdal of Norway is the new president of WONCA Europe. She outlines her plans for the region for the coming two years. – To provide our populations with primary medical care of high quality, we need to be recognized by colleagues and politicians as key players of the primary care team.

WONCA Awards 2016 – winners

At the WONCA World conference in Rio, various WONCA award winners were announced. Many winners are well known leaders in WONCA and family medicine.

Vasco da Gama presidential handover – Reflections

Peter Sloane writes – Having had the huge privilege to serve as President of the Vasco da Gama Movement for two and a half years, it gives me a deep sense of pride to look back on what was an extremely challenging and exciting period, but ultimately one which proved to be tremendously rewarding, engaging, stimulating and invigorating. A time I will never forget.

PDF version

CHWs in the US and prevention of diabetes

CDC’s MMWR [*] posted a link to the Community Preventive Services Task Force 2016 publication:  Diabetes Prevention: Interventions engaging Community Health Workers :

Jean Sack

HIFA profile: Jean C Sack is a Public Health Informationist at Jhpiego – an affiliate of Johns Hopkins University, Baltimore, MD, USA.      Jean.sack AT

[*Note from HIFA moderator (Neil PW):

CDC = Centers for Disease Control (US)

MMWR = Morbidity and Mortality Weekly Report]

Lancet Commission: Essential medicines for universal health coverage

This week’s print issue of The Lancet (28 January) contains a 73-page Lancet Commission on Essential medicines for universal health coverage. It also contains five Comments on this  subject.

Lancet Commission: Essential medicines for universal health coverage

Veronika J Wirtz et al.

The Lancet 2017; Volume 389, No. 10067, p403–476, 28 January 2017


‘Appropriate use of medicines depends on behaviours of many stakeholders

  • – Patients must take the medicines that are clinically appropriate for their illnesses, in the right doses and dosage forms, at the right time, and for the recommended duration. Patients and their caregivers require: knowledge about symptoms and information to decide when and where to seek care; convenient access to quality medicines at affordable costs; and knowledge, motivation, and skills to use the recommended medicines as directed.
  • – Prescribers must prescribe clinically appropriate, cost-effective products. They require: diagnostic and therapeutic decision-making skills; up-to-date, evidence-based treatment guidelines that are consistent with medicines available and reimbursed in their systems; reliable, valid diagnostic tools in facilities; professionalism, training, time, and appropriate incentives to act in the interests of patients and caregivers…
  • – Consumer organisations and pharmaceutical manufacturers provide information to health professionals, and in some settings directly to the public. They require: regulatory oversight to provide unbiased, evidence-based information.’

We know from WHO that ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO, 2011. “Appropriate use of antibiotics [and other medicines] is only possible if healthcare workers and the public have access to reliable, unbiased information on medicines. Universal access to reliable information on medicines is readily achievable and should be a cornerstone of efforts to promote rational prescribing. There is an urgent need for concerted action.” WHO:

The causes of incoreect use of medicines are multifaceted and WHO advocates 12 key interventions accordingly:

  • 1. Establishment of a multidisciplinary national body to coordinate policies on medicine use
  • 2. Use of clinical guidelines
  • 3. Development and use of national essential medicines list
  • 4. Establishment of drug and therapeutics committees in districts and hospitals
  • 5. Inclusion of problem-based pharmacotherapy training in undergraduate curricula
  • 6. Continuing in-service medical education as a licensure requirement
  • 7. Supervision, audit and feedback
  • 8. Use of independent information on medicines
  • 8. Public education about medicines
  • 9. Avoidance of perverse financial incentives
  • 10. Use of appropriate and enforced regulation
  • 11. Sufficient government expenditure to ensure availability of medicines and staff.

The Lancet Commission adds to our understanding but its recommendations are off-target. ‘The Commission proposes three recommendations to governments and the main public or private payers to operationalise this focus while implementing health system reforms toward UHC:

  • 1. Governments and the main public or private payers should establish independent pharmaceutical analytics units (or equivalent)…
  • 2. Pharmaceutical analytics units must collaborate with multiple stakeholders…
  • 3. Engaged stakeholder groups, led by data produced by the pharmaceutical analytics unit, should identify and prioritise local medicines use problems, identify contributing factors across the system, and develop and implement sustainable, long-term, multifaceted interventions…

Arguably, the above can provide further data on the local and national causes of poor quality prescribing.

But let’s not forget the basics. Prescribers and users of medicines need access to reliable unbiased information, not only on individual, commonly used medicines but also on diagnostics and on appropriate selection of medicines (as given in formularies such as the BNF). ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ As for patients, we know that they are often given no information at all, or the information is in a language they do not understand.

The HIFA Project on Access to Information for Prescribers and Users of Medicines is currently exploring these issues, including a global literature review on the information needs of prescribers in LMICs.  We invite you to contribute.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Lancet: A new Berlin Declaration for STM publishing

This week’s print issue of The Lancet (28 January 2017) carries an important article by Richard Horton, Editor-in-Chief. He has just returned from Berlin where he attended the Academic Publishing in Europe conference.

He writes: ‘We talked about important issues, to be sure: our collectively poor reputation, improving peer review, gender discrimination. But we didn’t talk about how we might address emerging epidemics, climate change, or conflict and war. Academic publishing has lost touch with the concerns of the very society it is supposed to serve. It has become so wrapped up in its own technical preoccupations and internecine struggles that the global predicaments that publishers should be addressing have been forgotten or ignored…’

‘In 2003, the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities was published. It was a self-declared milestone in the open access movement. 2017 demands another Berlin Declaration, one directed to the crises we face today. The Declaration I offer is a proposal only, but I hope you might consider signing up to it. It says, for example: “We, the undersigned, are concerned that the potential contributions made by academic publishing to human prosperity and advance, as well as to the protection of our planet’s rich but vulnerable ecological and cultural resources, have not been fully realised. In accordance with the spirit of the Sustainable Development Goals, launched on January 1, 2016, and with a target date for completion of December 31, 2030, we wish to commit ourselves to using the publishing resources at our disposal to accelerate progress towards the fulfilment of these internationally agreed goals.” Academic publishers: let’s do something important. Together.’

The full text of Richard’s article is freely available here:

And the Declaration is here:

I have read and signed it and invite you to do so also. The text includes the words ‘We, scholarly publishers in and across Europe…’ because this reflects the first signatories at the Berlin meeting. However, the Declaration can I think be signed by anyone who agrees with it, whether you describe yourself as an academic publisher or not, and wherever you happen to be based.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

‘People’s Science’ – How West African Communities Fought the Ebola Epidemic and Won

Below are extracts from a new item on the AllAfrica website (with thanks to Tropical Health Update). You can read the full article here:

London — Three years on from the start of the West African Ebola epidemic, lessons are still being learned. And the most surprising are not coming from the scientists, but from the affected communities themselves; about how, with hardly any help, they tackled the virus and won.

One of the curious aspects of the epidemic, which shook Guinea, Liberia, and Sierra Leone, was the way in which the number of cases started dropping before the main international response was in place. In one area after another, the infection arrived, spread rapidly, and then – apparently spontaneously – began to decline.

Ebola first crossed over from Guinea into Liberia’s Lofa County in March 2014. A rapidly erected treatment centre at Foya, on the border, was soon full to overflowing. In September, it was treating more than 70 patients at a time. But by late October, the centre was empty.

Paul Richards, a veteran British anthropologist, now teaching at Njala University in Sierra Leone, has been worrying away at this phenomenon. He is convinced the main driver of the reduction was what he calls “People’s Science”; the fact that people in the affected areas used their experience and common sense to figure out what was happening, and began to change their behaviour accordingly.

He told a recent meeting at London’s Chatham House: “One of the pieces of evidence which makes me think that local response was significant is that the decline first occurred where the epidemic began, so that the longer the experience you had of the disease, the more likely you are to see tumbling numbers. So, someone was learning… People ask me, ‘How long does it take to learn?’ And we don’t know, but on the basis of this case study, it’s about six weeks.”

A lot of national and international effort was put into public health education, and the messages broadcast on radio were very widely heard. But initially they were not very helpful, with a lot of emphasis on the origin of the disease, and warnings not to handle dead animals or eat bushmeat…

American anthropologists, who interviewed people in urban areas of Liberia during the outbreak, found a sense of frustration that the information campaigns told them about the origin of Ebola, how it was spread, but didn’t give them practical advice on how to care for sick relatives, how to transport them safely to hospital, and what to do with corpses when the burial teams didn’t arrive…

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Trump Prepares Orders Aiming at Global Funding and Treaties

The Trump administration is preparing executive orders that would clear the way to drastically reduce the United States’ role in the United Nations and other international organizations, as well as begin a process to review and potentially abrogate certain forms of multilateral treaties. The first of the two draft orders, titled “Auditing and Reducing U.S. Funding of International Organizations” and obtained by The New York Times, calls for terminating funding for any United Nations agency or other international body that meets any one of several criteria.

Those criteria include organizations that give full membership to the Palestinian Authority or Palestine Liberation Organization, or support programs that fund abortion or any activity that circumvents sanctions against Iran or North Korea. The draft order also calls for terminating funding for any organization that “is controlled or substantially influenced by any state that sponsors terrorism” or is blamed for the persecution of marginalized groups or any other systematic violation of human rights.

The order calls for then enacting “at least a 40 percent overall decrease” in remaining United States funding toward international organizations. The order establishes a committee to recommend where those funding cuts should be made. It asks the committee to look specifically at United States funding for peacekeeping operations; the International Criminal Court; development aid to countries that “oppose important United States policies”; and the United Nations Population Fund, which oversees maternal and reproductive health programs.

If President Trump signs the order and its provisions are carried out, the cuts could severely curtail the work of United Nations agencies, which rely on billions of dollars in annual United States contributions for missions that include caring for refugees.

As a general observation in considering this issue, it is worth remembering what proportion of the WHO budget comes from the USA.

WHO’s total approved budget for 2016-2017 was $4,385 million. This comes from two sources: 1) assessed contributions from the member countries (including the USA), which totalled $929 million (or 21.2% of the total) and voluntary contributions from a wide variety of donors, which amounted to $3456 million (or 78.8% of the total). So the overwhelming majority of WHO’s funding comes from voluntary, not government, sources.

The bills before Congress and other US executive decisions can only affect the assessed contributions – the government contribution. In 2016/17, the US is due to provide 21.18% ($227 million) of WHO’s assessed contributions. This is only about 5.2% of WHO’s overall budget.

A President can stop the flow of US government money to the UN system, but probably not – at least not without extreme measures –  other US money. To take the largest example, in 2015 the US-based Gates Foundation contributed more to the WHO budget than the entire US government.

I should stress that this is purely a financial argument. The loss of US government support to WHO (and the rest of the UN system) would be devastating politically and technically. Many government institutions – such as the National Library of Medicine (NLM) and the Centers for Disease Control and Prevention (CDC) – provide crucial technical support to many of WHO’s programmes.Presumably these institutions could be compelled to withdraw their technical support.

So cutting US government contributions to WHO would not be a financial killer. But if the US were to pull out completely, it would still be a disaster for global health.

To get an impression of what Trump can do to national agencies he doesn’t like take a look at

If he applies such strictures to US government organizations like the NLM or CDC, it would seriously impact global health. If he reins in USAID, PEPFAR, and the like, African health would be set back decades…

Cheers, Chris Zielinski

Blogs: and

Research publications:

Health Information during the 2014-2016 Ebola Outbreak: A Twitter Content Analysis

‘Due to ongoing health information deficiencies, resulting in fear and frustration, social media was at times an impediment and not a vehicle to support health information needs.’ This is the conclusion of a new paper in BioRxiv (an open access biology journal).

CITATION: Health Information Needs and Health Seeking Behavior during the 2014-2016 Ebola Outbreak: A Twitter Content Analysis

Michelle Odlum, Sunmoo Yoon



Introduction. For effective public communication during major disease outbreaks like the 2014-2016 Ebola epidemic, health information needs of the population must be adequately assessed. Through content analysis of social media data, like tweets, public health information needs can be effectively assessed and in turn provide appropriate health information to effectively address such needs. The aim of the current study was to assess health information needs about Ebola, at distinct epidemic time points, through longitudinal tracking.

Methods. Natural language processing was applied to explore public response to Ebola over time from the beginning of the outbreak (July 2014) to six month post outbreak (March 2015). A total 155,647 tweets (unique 68,736, retweet 86,911) mentioning Ebola were analyzed and visualized with infographics.

Results. Public fear, frustration, and health information seeking regarding Ebola-related global priorities were observed across time. Our longitudinal content analysis revealed that due to ongoing health information deficiencies, resulting in fear and frustration, social media was at times an impediment and not a vehicle to support health information needs.

Discussion. Content analysis of tweets effectively assessed Ebola information needs. Our study also demonstrates the use of Twitter as a method for capturing real-time data to assess ongoing information needs, fear, and frustration over time.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Lancet Global Health: Establishing the Africa Centres for Disease Control and Prevention

CITATION: Establishing the Africa Centres for Disease Control and Prevention: responding to Africa’s health threats

John N Nkengasong, Olawale Maiyegun, Matshidiso Moeti

Lancet Global Health, Published: 17 January 2017


‘On Jan 31, 2017, heads of states and governments of the African Union and the leadership of the African Union Commission will officially launch the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia…’

The new website is available here:

Comment (Neil PW): I am still not clear about the logic of creating a second regional body ‘safeguarding Africa’s health’ as compared with strengthening what is universally recognised as an underfunded WHO Regional Office for Africa. It’s also not clear how the Africa CDC will be financially supported, in the short and long term, especially with the new Trump Administration in the US. Can anyone advise?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

WHO Executive Board announces the names of the 3 nominees for the post of WHO Director-General

Just to bring everyone up to date on the WHO DG selection process, today (24 January), the WHO Executive Board will select five of the six candidates for interviews on Wednesday, 25 January. The three candidates that will stand in the May election will then be announced on Wednesday evening. The decision will be made by WHO’s Executive Board, made up of representatives of 34 member states, and will be followed in May by a final vote by WHO’s 194 member states.

According to Science Magazine ( “Six countries have fielded candidates to succeed Margaret Chan, the former Hong Kong, China, health official who is stepping down after 10 years at the helm. Among the top contenders, many say, is former Ethiopian Health Minister Tedros Adhanom Ghebreyesus. The African Union has declared its support for him and some observers have suggested it’s time for WHO’s first director-general from the African continent. Another candidate widely seen as having good chances is David Nabarro, a physician nominated by the United Kingdom who has worked at WHO in various positions and was appointed the United Nations’ senior coordinator on Ebola in 2014. The other candidates are Pakistani cardiologist Sania Nishtar; former French Health Minister Philippe Douste-Blazy; Hungary’s former minister of health, Miklós Szócska; and WHO’s assistant director-general for family, women’s and children’s health, Flavia Bustreo from Italy.


The WHO Executive Board selected by vote the following 3 candidates to be presented to World Health Assembly as nominees for the post of Director-General of WHO.

Five candidates were interviewed by Member States today prior to the vote. The names of the 3 nominees were announced at a public meeting on Wednesday evening, 25 January 2017.

Dr Tedros Adhanom Ghebreyesus

Dr David Nabarro

Dr Sania Nishtar

Further details of the selection process and result and biographies of the candidates are available on the WHO website at


Chris Zielinski

Blogs: and

Research publications:

Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

Charles A Uzondu, Henry V Doctor, Sally E Findley, Godwin Y Afenyadu, and Alastair Ager.

Glob Health Sci Pract. 2015 Mar; 3(1): 97–108.


Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services.

Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model.

Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years.

Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas.