183 e-Letters

  • 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- 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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  • 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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  • 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

  • Re: Through a quantitative study design, could this lead to more answers from scientists?

    A very informative and well-round study that gives a somewhat comprehensive explantation (as a pioneer study) on how scientists from different fields interact with policymakers during the COVID19-pandemic. It gives a good explanation of how difficult the “sandwich position” seems to be when you have to work in a field requiring interdisciplinary competencies.
    Some critique points might include the fact that one of the interviewed scientists mentioned, that wearing a mask was not effective (P4, the Netherlands on page 5). Given the view from a very European perspective, a view over to the Asian neighbours would have or could have clarified this point. (1)
    The European point is another thing that needs to be taken into consideration. Although the authors mentioned that the result might not apply to other parts of the world, it is crucial to mention that this issue needs to be addressed if we talk about a better interdisciplinary workforce globally during a pandemic.
    Moreover, could a quantitative approach would have led to different results? Maybe the purview or range among scientists would have been more applicable with a fitting survey so that more scientists in related fields and positions could have been reached.
    Fears and reservations about anonymity could be eradicated by this study design over a potentially large(r) study population.
    However, I would like to thank you for this paper and hope that broader research on the field could bring...

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  • Will vaccine passports ease international travels?

    Vaccines are our only promising key to minimizing the spread of the virus and returning to a normal life. Lockdowns and quarantines have a negative impact on people’s mental health and social lives. Vaccine passports can allow us to participate in certain activities such as traveling without having to go through extreme channels such as quarantining for weeks when you travel into or outside of a country. This can helps us transition back to life before COVID-19 while minimizing the fears of spreading the virus globally.

  • what about animal reservoir of covid-19

    Dear Authors, very interesting and convincing study. It is known that smallpox and polio have no human reservoirs (only infecting Humans) making the vaccine strategy very efficient. However, what about the animal reservoirs of covid-19 ? If such animal reservoirs of covid-19 exists it (highly likely, and proposed as the initial step of the pandemy: infection of an human from an animal carrying covid-19 in Wuhan...) will make the eradication of the virus impossible, except if you vaccinate those animals also or kill them simply...Did you take into account animal reservoirs in your study (the big difference with smallpox and polio used as exemple). Regards. M Maresca

  • Lockdowns and Climate Change: A Spur to Action

    In the BMJ Global Health article, “Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19“, Meyerowitz-Katz et al. (1) seek to assess the impact of lockdowns on population health. However, any comprehensive evaluation of the impacts of lockdown may benefit from including the broader effects that such restrictions may have on health due to environmental changes - particularly in regard to air pollution and greenhouse gas (GHG) emissions and the flow-on effects these have on human health due to climate change.

    As described by the authors, lockdowns are associated with broad detriments to human health and are generally undesirable. However, there is now considerable evidence that lockdowns result in noticeable decreases in air pollution. The 6th IPCC Assessment Report deems with high confidence that air quality improved as a result of COVID-19 lockdowns (2). When global lockdowns reached their most widespread point in April 2020, global CO2 emissions decreased by 17% (3), while global NOx emissions decreased by 30% (4), representing reductions in both long-lived and short-lived climate forcers.

    Unfortunately, though these variations are measurable, the effect of such fluctuations on climate change are likely to be negligible (4) and transitory in nature (5, 6). Despite the popular perception that “nature is healing” as a result of lockdowns, the effects are unlikely to mitigate climate change on their own.

    Yet even so...

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  • Commentary on “The Merit Privilege” by Dr. Prashanth N Srinivas

    Since long, the debate on meritocracy has been in the academic circle which originated from academicians, researchers, professionals and students belonging to ‘lower and/or backward’ castes. However, not much attention was paid to such discussions by the privileged and elite majorly because of their vested interests associated with it or due to the fact that we considered this caste as an uneducated, uncivilized and voiceless community unless they are educated and speak for themselves their voice become a part of the politicization of caste system.

    This uncomfortable point is time and again raised by many on several instances like suicide of Rohith Vemula (Leonard, 2019: 52), hurling abuses by Prof Seema Singh to the marginalized caste students in IIT Kg (Datta, 2021), etc. however, meritocracy becomes a topic of intense discussion when a globally recognized political philosopher Michael Sandel put them into words and problematizing the way the elites think.

    Once again, the lateral entry in UPSC was criticised at various fronts ranging from students’ protests to policy researchers. The connection of meritocracy with public policy and public health is due to technocracies and the policy decisions which were not so fruitful in the recent past. However, this was the same danger which dissenters were warning the world. That reminds us of Avengers Endgame when Tony Stark said to Steve Rogers that we are Avengers and not “pre-vengers”.

    Similarly, scien...

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  • Age difference and changing marriage age can add to male surplus

    An additional factor of importance in the perception of a gender imbalance is the consequence of an age difference between partners (e.g. groom and bride) and the growth rate of the respective society. If, for example, there was a constant age difference of 5 years between (older) men and (younger) woman, and around 2% of annual population growth, leading to an increase of 10% in the number of births over each 5 years, that in its effect would just counterbalance a 10:9 sex imbalance (around 47.5% women to 52.5% men). In a shrinking society with a similar preference for younger women, the two effects would add and the imbalance in birth rates would feel even worse for men.

    The imbalance would ultimately affect the “market power” of the respective genders in partnerships and/or the “marriage market”. If women actually prefer a partner of similar age, and woman of one cohort can start to pursue that preference due to the “oversupply” of men, this would further enhance the marriage squeeze for men, as even more of the older bachelors would be left out while the women turn to the younger competitors of the older men. Certainly, in the advent of such transition, some men will overlook that effect and thus be left out unmarried once the patterns have changed.

    A gradual increase of the age of marriage may also trigger or enhance that effect: Young women (or their parents, to the extent they are participating in the choice of their daughters partner or life partner)...

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