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Global Health: Science and Practice

Dedicated to what works in global health programs

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More articles from Editorials

  • Open Access
    At Last! Universal Health Coverage That Prioritizes Health Impact: The Latest Edition of Disease Control Priorities (DCP3)
    James D. Shelton
    Global Health: Science and Practice June 2018, 6(2):232-236; https://doi.org/10.9745/GHSP-D-18-00193

    Sadly, we face a vast sea of health problems in global health. Universal health coverage programming should prioritize interventions with the most health impact, but instead largely succumbs to emphasizing less impactful clinical curative services. In contrast, DCP3 provides an evidence-based template that prioritizes impact. Yet even the most basic and realistic DCP3 package comes at a formidable price.

  • Open Access
    Long-Lasting Insecticidal Nets for Malaria Control in Myanmar and Nigeria: Lessons From the Past, Tools for the Future
    Michael B. Macdonald
    Global Health: Science and Practice June 2018, 6(2):237-241; https://doi.org/10.9745/GHSP-D-18-00158

    While having saved many lives over the past decade, continued dependence on mass distribution of free long-lasting insecticidal nets (LLINs) is not sufficient and may not be sustainable. Programs must be enabled with flexible policy and technical options to place LLINs within a larger context of multisectoral partnerships and integrated vector management, avoiding what happened in the DDT era, where there was overreliance implementing a uniform solution to a complex problem.

  • Open Access
    Is It Time to Move Beyond Visual Inspection With Acetic Acid for Cervical Cancer Screening?
    Shannon L. Silkensen, Mark Schiffman, Vikrant Sahasrabuddhe and John S. Flanigan
    Global Health: Science and Practice June 2018, 6(2):242-246; https://doi.org/10.9745/GHSP-D-18-00206

    Newly emerging low-cost molecular assays and improved visual tests for cervical cancer screening call into question the role of visual inspection with acetic acid (VIA). VIA-based screening continues to offer a low-cost, single-visit approach for screening. However, VIA is highly rater-dependent and has problematic accuracy. RNA, DNA, and protein tests are now available. They offer greater accuracy and the option for self-sampling, but the testing kits are expensive. As these new options continue to improve, the time to move beyond VIA is fast approaching.

  • Open Access
    Human Resources for Health: The Best Learning, the Best Skill Mix, and the Most Impact
    James D Shelton
    Global Health: Science and Practice March 2018, 6(1):6-7; https://doi.org/10.9745/GHSP-D-18-00092

    Acting in a difficult environment, constructive efforts to improve medical education in Zimbabwe included revised curricula, investing in faculty and improved teaching skills, competency-based learning, and modern technology. But an ideal approach to health systems strengthening would put more emphasis on primary care and prevention, equity, and the many other vital health cadres besides physicians.

  • Open Access
    The Coming-of-Age of Subcutaneous Injectable Contraception
    Kimberly Cole and Abdulmumin Saad
    Global Health: Science and Practice March 2018, 6(1):1-5; https://doi.org/10.9745/GHSP-D-18-00050

    DMPA-SC is a contraceptive injectable formulation that provides women and couples another important voluntary family planning option. It offers characteristics that many women like, including cost and time savings, and has the potential to be delivered by a range of health care cadres in a variety of service delivery channels.

  • Open Access
    Effective LARC Providers: Moving Beyond Training (Republication)
    James D Shelton and Anne E Burke
    Global Health: Science and Practice September 2016, 4(3):356-358; https://doi.org/10.9745/GHSP-D-16-00258

    Effective and productive providers are the key to successful provision of long-acting reversible contraceptives (LARCs). But LARCs demand more of providers than short-acting resupply methods. In addition to sound training, key elements to developing highly productive providers of LARCs include a thorough understanding of the service delivery system context; selecting providers with the most potential, especially from mid-level cadres; strong mentoring and supportive supervision; and attention to the supply chain and to demand-side support.

  • Open Access
    Oxytocin: taking the heat
    Stephen Hodgins
    Global Health: Science and Practice August 2014, 2(3):259-260; https://doi.org/10.9745/GHSP-D-14-00102

    Oxytocin-in-Uniject satisfied the standards of its temperature-time indicator (TTI) in severe home storage conditions, although that required resupply every 30 days—a logistically onerous programmatic standard. Possible advances include: (1) incorporating TTIs with packaged batches of less expensive and more widely used conventional vials of oxytocin; (2) using TTIs calibrated more closely to the actual temperature sensitivity of oxytocin; and (3) researching whether a lower dose of oxytocin would be equally efficacious in preventing postpartum hemorrhage.

  • Open Access
    Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale
    James D Shelton
    Global Health: Science and Practice August 2014, 2(3):253-258; https://doi.org/10.9745/GHSP-D-14-00066

    Because public health must operate at scale in widely diverse, complex situations, randomized controlled trials (RCTs) have limited utility for public health. Other methodologies are needed. A key conceptual backbone is a detailed “theory of change” to apply appropriate evidence for each operational component. Synthesizing patterns of findings across multiple methodologies provides key insights. Programs operating successfully across a variety of settings can provide some of the best evidence. Challenges include judging the quality of such evidence and assisting programs to apply it. WHO and others should shift emphasis from RCTs to more relevant evidence when assessing public health issues.

  • Open Access
    Urban health: it's time to get moving!
    Victor K Barbiero
    Global Health: Science and Practice May 2014, 2(2):139-144; https://doi.org/10.9745/GHSP-D-14-00071

    The global health community should mainstream urban health and implement urban health programs to address the triple health burden of communicable diseases, noncommunicable diseases, and injuries in low- and middle-income countries.

  • Open Access
    Taking Exception. Reduced mortality leads to population growth: an inconvenient truth
    James D Shelton
    Global Health: Science and Practice May 2014, 2(2):135-138; https://doi.org/10.9745/GHSP-D-14-00062

    Reduced mortality has been the predominant cause of the marked global population growth over the last 3/4 of a century. While improved child survival increases motivation to reduce fertility, it comes too little and too late to forestall substantial population growth. And, beyond motivation, couples need effective means to control their fertility. It is an inconvenient truth that reducing child mortality contributes considerably to the population growth destined to compromise the quality of life of many, particularly in sub-Saharan Africa. Vigorous child survival programming is of course imperative. Wide access to voluntary family planning can help mitigate that growth and provide many other benefits.

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US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

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