eLetters

89 e-Letters

published between 2019 and 2022

  • Should academic journals appoint ethics experts to their editorial boards?

    Dear Editor,

    It is with great interest that I read Doherty et al.’s commentary in which the authors express concern about the ethical appropriateness of a randomised controlled trial that had received ethical approval. Doherty et al.’s study serves as a valuable reminder that a study is not ethical simply because it has received ethical approval, as previous studies have also emphasised.1 One might also add that just because a study has reported having obtained ethical approval, it cannot be assumed that the study has adhered to the recommendations of the research ethics committee or informed the committee of its plans in full. Doshi (2020) reported on bioethicist Charles Wiejer’s concern that a randomised controlled trial of malaria vaccine Mosquirix had waived the requirement of informed consent.2 Weijer was quoted as saying “It is difficult to see how a research ethics committee could have approved a waiver of consent for the WHO malaria vaccine pilot cluster randomized trial.”2 These studies raise the question of whether academic journals should play a greater role in scrutinising the ethical appropriateness of studies submitted for publication?

    As a doctoral student with a keen interest in public health ethics, I previously attended weekly editorial board meetings of a major scientific journal with the sole purpose of interrogating the submitted studies for ethical issues. In these meetings, I raised serious questions about some of the studies that had r...

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  • Commentary on how to use heat stable carbetocin and tranexamic acid for postpartum haemorrhage in practice

    How to use heat stable carbetocin and tranexamic acid for postpartum haemorrhage in practice

    A. Metin Gülmezoglu1, Sara Rushwan1
    1 Concept Foundation, Geneva, Switzerland
    We welcome the paper by Tran et al [1]. There are increasing number of options for postpartum haemorrhage (PPH) prevention and management as recommended by WHO and the context is important. We agree that at the national level the first step is to update the national policies including the guidelines and essential medicine lists (EMLs). Since 2019, Concept Foundation and its partners have been working in 14 East and West African sub-Saharan countries to facilitate those updates [2]. We are pleased to report that in 10 out of the 14 countries – Burkina Faso, DRC, Ethiopia, Ghana, Ivory Coast, Liberia, Rwanda, Sierra Leone, South Sudan, and Uganda – the national guideline and/or EML were updated during this period.
    The strength of the project lies in the engagement with policy makers, Ministry of Health officials, clinicians, professional associations, and civil society organizations concurrently. However, competing national policy priorities such as COVID-19, timing of the previous updates, political instability and national capacity and leadership (or lack of) can make the updating process long and challenging even when there is an agreement to update. Secondly, even when the updates happen, proactive dissemination and training within the country can also take time. Thirdly, in the...

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  • Names of villages

    It is a humble request if you could kindly specify the names of villages and areas that you surveyed, as it would be of immense help and guidance.
    Thank you

  • Gap in Analysis Misses Benefits of Laws Regulating Pre-Abortion Screening and Counseling

    Dear Editor,

    I am extremely puzzled by the lack of any response regarding my proposed comments regarding this article. I've submitted my comments twice, but they have not been published. I cannot imagine why. It appears to be a discretionary censorship, which is of course contrary to BMJ's published editorial policies which generally favor respectful discourse. I would greatly appreciate an explanation and an appeal to a larger panel of BMJ editors.

    To repeat...for the third time,... regarding this article:

    There is a growing interest in developing evidenced based standards for public health policy initiatives.[1] In response to this effort, Burris et al have put forward their own initial effort to identify the potential effects of laws regulating abortion on women’s health.[2] Unfortunately, they apparently failed to include in their research team anyone with familiarity with the literature regarding the negative physical and psychological effects of coerced and unnecessary abortions. This is not a minor oversight.

    Regarding the issue of women’s autonomy, increasing legal access to abortion is a double-edged sword. Easier access makes it easier for women to choose abortion for their own self-interests, but it also makes it easier for those pressuring women into unwanted abortions to abuse women’s rights.[3]

    Coerced abortions are especially common among women enslaved in sex trafficking.[4,5] But it is also common within...

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  • Covid 19- collateral damage on nutrition of women and children, in Maharashtra, India

    Dear sir,
    We herewith report effects of disruptions on maternal and child health services in Maharashtra, India.
    Covid 19- collateral damage on nutrition of women and children, in Maharashtra, India

    Phadke M1,Nair R2,Menon P3,Jotkar R4, Saunik S5

    India has been battling the Covid 19 pandemic like most other countries of the world. The first two waves, particularly the second wave produced devastating effects on many aspects of human health and welfare .Disease mortality and morbidity was unparalleled. In addition to these direct effects of Covid 19 disease itself, a number of indirect effects of Covid 19 on women, adolescent girls and children occurred. Lockdowns, loss of jobs, decrease in salaries, migration, supply chain disruption, inadequacy and inaccessibility of foods, green vegetables, stoppage of midday meals due to school closures, inadequate distribution of iron folic acid tablets from anganwadis impacted women and children’s nutrition.
    Disruptions in maternal health services have been reported 1. We report two observations on occurrence of Neural tube defects and severe acute malnutrition in children during the years from 1st January to 31st December of 2020 and 2021. A team of doctors under the national health program of RBSK(Rashtriya Bal Swasthya Karyakram), examined children for '4Ds' i.e. Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including disabilities. The year...

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  • Premature program release negatively impacts program sustainability, placing maternal and perinatal outcomes at risk

    To the editor,

    With interest we read the recent paper by Caviglia et al, describing the relation between prehospital ambulance time and outcome in terms of maternal and perinatal outcomes in the setting of Sierra Leone1. Sierra Leone has one of the highest rates of maternal (1360 in 100.000 life births) and infant (87 in 1.000 births) mortality worldwide2. The National Emergency Medical Service (NEMS) was designed and started in this country, an effort by or in collaboration with part of the authors of the current manuscript3. The results show that longer prehospital ambulance times are associated with poor outcome. Furthermore, only in the capital and its surroundings the 2-hour target is met in a high percentage of patients, with only 24-65% of patients meeting this mark in the more rural areas of the country. The authors conclude that there are still major geographical barriers for timely access to care, and that any intervention to strengthen the existing primary health system may help reduce maternal and perinatal mortality.

    The elaborate NEMS system, including 81 fully equipped and staffed ambulances with a centralized operations centre, was operational since 2018, with the last districts connected to the service in 2019. The system was managed by the local ministry of health and sanitation (MoHS) and funded through the governmental budget, with help from the World Bank, Doctors with Africa (CUAMM, Padua, Italy), the Regional Government of Veneto (Ita...

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  • Covid-19 vaccination in Africa: a call for equity (and not equality)

    Dear Editor,

    We agree with Sam-Agudu et al. on the importance of equity in public health (1), and for these reasons raise major concerns regarding the remainder of the Commentary’s focus, and similar view prevalent in this Journal (2) and the wider global health community. We respectfully outline these here, as they affect the current health focus being applied to over a billion people in sub-Saharan countries.

    Sam-Agudu and co-authors state that ‘Global, equitable access to safe and effective vaccines for all age groups is critical to ending the COVID-19 pandemic’. This statement, reflecting those of the COVAX programme of the World Health Organization (WHO) and other agencies, is flawed. Equity in health means opportunity for good health, based on individual need, not measured by access to a particular pharmaceutical. A vaccine that does not significantly reduce transmission (3,4) will not end a pandemic, and where risk of severity is low from intrinsic or acquired immune status, will not significantly change outcomes. This flawed assertion also ignores costs of vaccination, both in potential adverse effects, and in resource diversion from other health programmes (public health programmes do not operate in isolation).
    Regarding the evidence base used to support their argumentation, and related expected benefits of vaccination, much of Sam-Agudu et al.’s arguments are based on the African Forum for Research and Education in Health (AFREhealth) study r...

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  • Disruptions in maternal health Covid 19, Women's health-occurrence of neural tube defects

    Covid 19- women’s health, occurrence of neural tube defects and severe acute malnutrition in children

    Phadke M1,Nair R2,Menon P3,Jotkar R4, Saunik S5
    Dear sir,

    We read with interest the article on ‘Disruptions in maternal health service use during Covid 19 pandemic by Zeus Aranda, Thierry Binde et.al that has appeared in the B.M. J. Global Health Vol7. Issue 1,2021(http://dx.doi.org/10.1136/bmjgh-2021-007247) and wish to respond to it.
    India has been battling the Covid 19 pandemic like most other countries of the world. The first two waves, particularly the second wave produced devastating effects on many aspects of human health and welfare .Disease mortality and morbidity was unparalleled. In addition to these direct effects of Covid 19 disease itself, one had to face a number of indirect effects of Covid 19 on women, adolescent girls and children. Lockdowns, loss of jobs, decrease in salaries, migration, supply chain disruption, inadequacy and inaccessibility of foods, green vegetables, stoppage of midday meals due to school closures, inadequate distribution of iron folic acid tablets from anganwadis to children, adolescents and antenatal women will probably impact women and children’s nutrition.
    In the article by Zeus Aranda 1, they have predicted enormous disruptions in maternal health services1. We have observed the same in Maharashtra, a state in India.’
    India has now...

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  • Ethical Committees a must for grass-root filed research

    Dear authors,
    Since I have worked in remotest of PHCs in Himachal Pradesh, India and now am supervising them, the most unfavorable atmosphere for embedded research at grass roots is non availability of ethical committees and due to that either doctor fail to do research in field conditions or their research is hijacked by the medical colleges as PIs . Most of the medical colleges don't allow outside field doctors to get ethical clearance and have condition that medical college faculty would be PI for any research proposal/project, only then anyone can get research proposal listed in IEC.
    I am trying to have an ethical committee notified at the level of Directorate of health so that PHC doctors can also get ethical clearance for their research this paper is talking about.
    Thanks for raising this issue at global level.
    Regards,
    Dr. Omesh Kumar Bharti, Field Epidemiologist
    bhartiomesh@yahoo.com

  • Risk of bias

    Hi,
    Its more of a doubt. I would like to know what risk of bias tool was used by the team? What were the findings on risk of bias, since I couldn't find anywhere in the article reporting the same.

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