eLetters

99 e-Letters

  • Syrian Healthcare Workers Choose the Wrong Destination

    Editor, the commentary highlights the sad situation the Levant region in the middle east has reached. The Syrian healthcare workers are most needed in Syria and not in Germany. It is their very country which is in most need for their services. Syria now has shortage of trained doctors and nurses to help fellow country men and women recover from war injuries and myriad of infectious and non-communicable diseases. Integrating in Europe is never easy for a people from Muslim countries, even if the were professionals (https://www.dailymail.co.uk/news/article-8854519/Muslim-doctor-refused-s...). I have lived in London for over 30 years and still feel an outsider in the UK. How will these refugees cope with the threat of their children losing their Arabic language or Muslim identity. Careers are not everything. It just baffles me why the Syrians who came to Europe could not seek refuge in rich Arab nations. Something terribly wrong is going on in the middle east and coming to Germany is not the answer. Syrian refugees are looking for a quick fix, but they should go back to their own country and tough it out to rebuild what was demolished before someone else comes and takes their places! Britons and Germans did not run away from their countries during the two world wars! Did millions of Britons leave to America to escape WWII? Why have did almost...

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  • Citation rates of Retracted Publications

    Candal-Pedreira and colleagues showed that for 304 retracted papers, overall citations increased not decreased following retraction, but citations did seem to decrease for retracted papers in higher impact journals and those with higher citation rates, although that decrease might have been temporary.1 It is disturbing that retracted papers continue to be cited.

    We approached the issue of changes in citations rates after retraction in a different way. We assessed citation rates of retracted and unretracted publications from individuals with more than one retracted publication in the Retraction Watch database.2 Using this approach, we found that, overall, citations for 989 retracted publications declined after the retraction and citations for 9671 unretracted papers also declined after the author’s first retraction, but the decline was greater for retracted papers. For example, for retracted publications, 671 papers had 3566 citations in the 3rd year before their retraction and 831 papers had 1575 citations in the 3rd year after their retraction. In contrast, 5311 unretracted papers had 17935 citations in the 3rd year before the author’s first retraction, and 7388 papers had 17252 citations in the 3rd year after the author’s first retraction.

    Part of the difficulty in conducting and interpreting such analyses is the different lengths of time pre-and post-retraction for different papers. To try to address that issue, we calculated the slope of the citations/yea...

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  • An integrated primary health care response to COVID-19 in Siaya, Kenya

    Title: An integrated primary health care response to COVID-19 in Siaya, Kenya

    Authors: Neema Kaseje, Andy Haines, Kennedy Oruenjo, Dan Kaseje, and Marcel Tanner.

    We note that the article makes a strong case for the critical role of community health workers (CHWs) in pandemics, and we would like to outline the experience of rapid scale up of a programme to support CHWs in Siaya, Western Kenya.

    On November 6th 2020, the Kenya Ministry of Health (MOH) reported a total of 59’595 COVID-19 cases and 1072 deaths due to COVID-19 (1).

    In the last 4 months, to respond to the COVID-19 pandemic, we deployed CHWs, equipped with mobile technology, and accompanied by young university graduates under 30 years old. They visited households door to door and screened community members for symptoms of COVID-19. They isolated, tested, and managed suspected cases of COVID-19. Symptomatic testing was performed at home (by the Siaya rapid response team) and in health facilities (by clinicians). Youth were included to build their capacity in health interventions and provide them with practical experience during the lockdown period in Kenya. They were selected based on their academic credentials, their interest in working with CHWs, and their ability to use digital tools. CHWs and youth educated households about preventive measures including frequent handwashing, universal mask wearing (indoors when visitors are present and outdoors), and home management of mild case...

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  • Response letter

    We thank Hanson and colleagues for their editorial response1 to our paper, Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap2. Reassessment of care models for childbirth in low-income countries is urgently needed to change stubbornly flat trajectories of maternal and newborn mortality. The central point of our paper is that the current childbirth care model that sends one-third or more of pregnant women to deliver in under-equipped, understaffed, low-volume health clinics in the highest mortality countries is not evidence-based, ethical or equitable and that convergence with global best practice—delivery in highly skilled facilities—is long overdue.

    Hanson and colleagues note that primary care facilities might perform better if they were “staffed and equipped to standard”, but evidence does not support this strategy3. For example, the most rigorous randomized study in this field, the Better Birth Study, showed that despite extensive coaching and support, primary care facilities in India failed to reduce mortality over control facilities4. High and middle-income countries have long determined that low birth volumes and lack of surgical and advanced care make primary care delivery unadvisable. This clinical reality is no different in low-income settings.

    Other points that Hanson and colleagues make align with the core arguments we offer for health system redesign. We agree that redesign should focus...

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  • Protecting Postnatal Care in the Pandemic

    We read with interest the article by Blanchet et al on Protecting essential health services in low-income and middle-income countries and humanitarian settings while responding to the COVID-19 pandemic. We concur with this paper’s message that essential health services in maternal and newborn health must be prioritised and protected during the pandemic, and welcome the priority list of 120 essential services which has been co-produced with context-specific expertise from Afghanistan, Ethiopia, Pakistan and Zanzibar. This list was based on the Disease Control Priorities, 3rd edition, Highest Priority Package (DCP3 HPP) which listed 108 key interventions thought most important to achieve essential universal health coverage(1).

    However, we were dismayed not to find a separate category of interventions to provide essential elements of postnatal care to women. Several components of this care are listed under other categories (e.g. safe blood transfusion to treat postpartum haemorrhage, management of maternal sepsis, manual removal of the placenta). However, the list does not distinguish which of these components relate directly to postnatal care and therefore conflates these components with other aspects of care within the broader obstetric continuum. There is additionally a lack of representation of key conditions that occur frequently and primarily in the postnatal period (e.g. lactational mastitis and postnatal depression), which exists within the WHO essential interv...

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  • Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

    It was interesting to read Roder-DeWan S et al.,(1) paper entitle Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.
    This paper focuses on problems with the current approach, discuss the feasibility of redesign, propose reforms to transform current health systems. We support the authors that health system redesign is needed to enhance people’s access to standard care and reduce newborn mortality rate especially in low- income country which is higher than in high-income countries about nine times(1). This is also in line with Sustainable Development Goal No.3 (SDGs) target 3.1 that by 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births(2). Gabrysch S et al,(2019) found in their study that giving birth in a health care facility does not necessarily gives assurance of a survival benefit for women or babies however it should be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safeguarding uncomplicated births(3).
    It is therefore important to reconsider the healthcare systems so that every pregnant woman receives the best of healthcare. Niyitegeka J et al,(2017) in a study conducted in Rwanda found out that women who had to travel more than 90 minutes to the nearest district hospital had significantly worse neonatal outcomes compared to those had Odds Ratio 5.12 times referred from health centers located on the same...

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  • Involving All for Covid-19 Prevention and Control

    Dear Editor,
    Gilmore. B., et al have highlighted that the community involvement is pivotal to improving on prevention and control of Covid-19. We believed that governments should implement strict policies, to foster a culture of compliance and trust, not infringing on human rights (B., 2009). Take Taiwan for example, who learned from their experiences with SARS in 2003, developed and implemented policies and infrastructure in 2004 to combat any similar outbreaks in future. In 2004, the year after the SARS outbreak, the Taiwan government established the National Health Command Center (NHCC). The NHCC is part of a disaster management center that focuses on large-outbreak response and acts as the operational command point for direct communications among central, regional, and local authorities (C. Jason Wang, Chun Y. Ng, & Robert H. Brook, 2020). Such a policy is able to encourage the dissemination of pertinent information to the people, increase transparency and build trust in the framework. Furthermore, the use of Info dynamics should take precedence to minimize the spread of misinformation among communities. In a 2020 issue, Tangcharoensathien V et al (Tangcharoensathien. V., 2020), the WHO presented a framework for managing the Covid-19 infodemic (G., 2020) which can continue strengthening on a trusting relationship among people and healthcare personnel. Therefore, rallying community members for various roles in disease prevention and control will be widely ac...

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  • Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.

    It was interesting to read Roder-DeWan S et al.,(1) paper entitle Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.
    This paper focuses on problems with the current approach, discuss the feasibility of redesign, propose reforms to transform current health systems. We support the authors that health system redesign is needed to enhance people’s access to standard care and reduce newborn mortality rate especially in low- income country which is higher than in high-income countries about nine times(1). This is also in line with Sustainable Development Goal No.3 (SDGs) target 3.1 that by 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births(2). Gabrysch S et al,(2019) found in their study that giving birth in a health care facility does not necessarily gives assurance of a survival benefit for women or babies however it should be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safeguarding uncomplicated births(3).
    It is therefore important to reconsider the healthcare systems so that every pregnant woman receives the best of healthcare. Niyitegeka J et al,(2017) in a study conducted in Rwanda found out that women who had to travel more than 90 minutes to the nearest district hospital had significantly worse neonatal outcomes compared to those had Odds Ratio 5.12 times referred from health centers located on the same...

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  • Under-5 mortality in sub-Saharan Africa has decreased, not increased, from 1990-2018

    I write a quick note to correct what is probably an editing error. Both the abstract and the text state that under-five mortality has increased in sub-Saharan Africa 1990-2018, while decreasing in the rest of the world. In fact, the Unicef data referenced in the paper (https://data.unicef.org/topic/child-survival/under-five-mortality/) indicate that under five mortality has decreased from 178 per 1000 live births in 1990 to 78 per 1000 in 2018, a reduction of 100 per 1000 or 56%. The UN inter-agency group for child mortality estimation (IGME) has similar estimates (https://childmortality.org/data/SDG%20Regions%20%3E%20Sub-Saharan%20Africa).

  • Need to generate data to make health politically relevant

    Arnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.

    The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track rac...

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