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The second WHO report on neglected tropical diseases builds on the growing sense of optimism_x000D__x000D_ generated by the 2012 publication of the WHO Roadmap. Commitments on the_x000D__x000D_ part of ministries of health in endemic countries global health initiatives funding_x000D__x000D_ agencies and philanthropists have escalated since 2010 as have donations of_x000D__x000D_ medicines from pharmaceutical companies and the engagement of the scientific_x000D__x000D_ community. _x000D__x000D_ This report marks a new phase and assesses opportunities and obstacles in the_x000D__x000D_ control elimination and eradication of several of these diseases. Unprecedented_x000D__x000D_ progress over the past two years has revealed unprecedented needs for_x000D__x000D_ refinements in control strategies and new technical tools and protocols. The_x000D__x000D_ substantial increases in donations of medicines made since the previous report_x000D__x000D_ call for innovations that simplify and refine delivery strategies. _x000D__x000D_ However some diseases including especially deadly ones like human African_x000D__x000D_ trypanosomiasis and visceral Leishmaniasis remain extremely difficult and costly_x000D__x000D_ to treat. The control of Buruli ulcer Chagas disease and yaws is hampered by_x000D__x000D_ imperfect technical tools although recent developments for yaws look promising._x000D__x000D_ The report highlights progress against these especially challenging diseases _x000D__x000D_ being made through the development of innovative and intensive management_x000D__x000D_ strategies. _x000D__x000D_ Innovations in vector control deserve more attention as playing a key part in_x000D__x000D_ reducing transmission and disease burden especially for Dengue Chagas disease_x000D__x000D_ and the Leishmaniases. _x000D__x000D_ Achieving universal health coverage with essential health interventions for_x000D__x000D_ neglected tropical diseases will be a powerful equalizer that abolishes distinctions_x000D__x000D_ between the rich and the poor the young and the old ethnic groups and women_x000D__x000D_ and men.

Inadequate nutrient intakes are prevalent among many populations in sub‐Saharan Africa and increasing fish consumption among pregnant/lactating women and children is one strategy to improve diets and address nutrient deficiencies. We report the nutrient content of two fish‐based recipes—fish powder and fish chutney—that contain dried small fish available in local markets in Zambia. The contribution of a serving of each recipe to the recommended daily intakes of iron, zinc, calcium and docosahexaenoic acid (DHA) for pregnant/lactating women and children 6–24 months was calculated because these nutrients are commonly deficient in African diets. We found that one 10‐g serving of fish powder provides 20% or more of the daily calcium recommendation and 37% or more of the daily DHA recommendation for both pregnant/lactating women and children. A 30‐g serving of fish chutney provides over 40% of the daily calcium recommendation for pregnant women and over 50% for lactating women. Additionally, we investigated the nutrient density (nutrients per kilocalorie) of the fish powder and compared it with the nutrient density of a small‐quantity lipid‐based nutrient supplement plus (SQ‐LNS‐plus). SQ‐LNS‐plus is designed to enhance children's diets by providing micronutrients and DHA. Fish powder is similar to SQ‐LNS‐plus in iron and zinc density and even higher in calcium and DHA density. Consuming dried small fish as part of a daily meal can be a viable strategy for combatting nutrient deficiencies in the first 1000 days.

A Development Emergency: the title of this year's Global Monitoring Report, the sixth in an annual series, could not be more apt. The global economic crisis, the most severe since the Great Depression, is rapidly turning into a human and development crisis. No region is immune. The poor countries are especially vulnerable, as they have the least cushion to withstand events. The crisis, coming on the heels of the food and fuel crises, poses serious threats to their hard-won gains in boosting economic growth and reducing poverty. It is pushing millions back into poverty and putting at risk the very survival of many. The prospect of reaching the Millennium Development Goals (MDGs) by 2015, already a cause for serious concern, now looks even more distant. A global crisis must be met with a global response. The crisis began in the financial markets of developed countries, so the first order of business must be to stabilize these markets and counter the recession that the financial turmoil has triggered. At the same time, strong and urgent actions are needed to counter the impact of the crisis on developing countries and help them restore strong growth while protecting the poor. Global Monitoring Report 2009, prepared jointly by the staff of the World Bank and the International Monetary Fund, provides a development perspective on the global economic crisis. It assesses the impact on developing countries, their growth, poverty reduction, and other MDGs. And it sets out priorities for policy response, both by developing countries themselves and by the international community. This report also focuses on the ways in which the private sector can be better mobilized in support of development goals, especially in the aftermath of the crisis.

A comprehensive resource describing innovative technologies and digital health tools that can revolutionize the delivery of health care in low- to middle-income countries, particularly in remote rural impoverished communities  Revolutionizing Tropical Medicine offers an up-to-date guide for healthcare and other professionals working in low-resource countries where access to health care facilities for diagnosis and treatment is challenging. Rather than suggesting the expensive solution of building new bricks and mortar clinics and hospitals and increasing the number of doctors and nurses in these deprived areas, the authors propose a complete change of mindset. They outline a number of ideas for improving healthcare including rapid diagnostic testing for infectious and non-infectious diseases at a point-of-care facility, together with low cost portable imaging devices. In addition, the authors recommend a change in the way in which health care is delivered. This approach requires task-shifting within the healthcare provision system so that nurses, laboratory technicians, pharmacists and others are trained in the newly available technologies, thus enabling faster and more appropriate triage for people requiring medical treatment. This text: * Describes the current burden of communicable and non-communicable diseases in low- to middle-income countries throughout the world * Describes the major advances in healthcare outcomes in low-to middle-income countries derived from implementation of the United Nations/World Health Organisation's 2000 Millennium Development Goals * Provides a review of inexpensive rapid diagnostic point-of-care tests for infectious diseases in low-resource countries, particularly for people living in remote rural areas * Provides a review of other rapid point-of-care services for assessing hematological function, biochemical function, renal function, hepatic function and status including hepatitis, acid-base balance, sickle cell disease, severe acute malnutrition and spirometry * Explores the use of low-cost portable imaging devices for use in remote rural areas including a novel method of examining the optic fundus using a smartphone and the extensive value of portable ultrasound scanning when x-ray facilities are not available * Describes the use of telemedicine in the clinical management of both children and adults in remote rural settings * Looks to the future of clinical management in remote impoverished rural settings using nucleic acid identification of pathogens, the use of nanoparticles for water purification, the use of drones, the use of pulse oximetry and the use of near-infrared spectroscopy * Finally, it assesses the potential for future healthcare improvement in impoverished areas and how the United Nations/World Health Organization 2015 Sustainable Development Goals are approaching this. Written for physicians, infectious disease specialists, pathologists, radiologists, nurses, pharmacists and other health care workers, as well as government healthcare managers, Revolutionizing Tropical Medicine is a new up-to-date essential and realistic guide to treating and diagnosing patients in low-resource tropical countries based on new technologies.

Stakeholder participation is relevant in strengthening priority setting processes for health worldwide, since it allows for inclusion of alternative perspectives and values that can enhance the fairness, legitimacy and acceptability of decisions. Low-income countries operating within decentralized systems recognize the role played by sub-national administrative levels (such as districts) in healthcare priority setting. In Uganda, decentralization is a vehicle for facilitating stakeholder participation. Our objective was to examine district-level decision-makers’ perspectives on the participation of different stakeholders, including challenges related to their participation. We further sought to understand the leverages that allow these stakeholders to influence priority setting processes. We used an interpretive description methodology involving qualitative interviews. A total of 27 district-level decision-makers from three districts in Uganda were interviewed. Respondents identified the following stakeholder groups: politicians, technical experts, donors, non-governmental organizations (NGO)/civil society organizations (CSO), cultural and traditional leaders, and the public. Politicians, technical experts and donors are the principal contributors to district-level priority setting and the public is largely excluded. The main leverages for politicians were control over the district budget and support of their electorate. Expertise was a cross-cutting leverage for technical experts, donors and NGO/CSOs, while financial and technical resources were leverages for donors and NGO/CSOs. Cultural and traditional leaders’ leverages were cultural knowledge and influence over their followers. The public’s leverage was indirect and exerted through electoral power. Respondents made no mention of participation for vulnerable groups. The public, particularly vulnerable groups, are left out of the priority setting process for health at the district. Conflicting priorities, interests and values are the main challenges facing stakeholders engaged in district-level priority setting. Our findings have important implications for understanding how different stakeholder groups shape the prioritization process and whether representation can be an effective mechanism for participation in health-system priority setting.

The prevalence of overweight/obesity in adolescents has increased globally, including in low‐ and middle‐income countries. Early adolescence provides an opportunity to develop and encourage positive health and behavioural practices, yet it is an understudied age group with limited information to guide and inform appropriate interventions. This study aims to determine the prevalence of overweight/obesity in young adolescents, aged between 10 and 14 years attending public schools in Addis Ababa, Ethiopia, and to explore the contributing factors. A cross‐sectional school‐based study was conducted. Adolescents completed individual questionnaires. Weight (kg) and height (m) measurements were converted to BMI‐for‐age and gender z‐scores. Multivariate regression analysis was conducted to determine the associated factors. The overall prevalence of overweight/obesity was 8% among adolescents aged 10–14 years and it was significantly higher in females (13%) than males (2%). The diet quality for the majority of the adolescents was inadequate, putting them at risk for poor health outcomes. The contributors to overweight/obesity were different between males and females. Age and no access to a flush toilet were negatively associated with overweight/obesity in males and access to a computer, laptop or tablet was positively associated. In females, menarche was positively associated with overweight/obesity. Living with only their mother or another female adult and an increase in physical activity were negatively associated with overweight/obesity. There is a need to improve the diet quality of young adolescents in Ethiopia and understand the reasons why females are less physically active to limit the risk of poor diet‐related health outcomes. Key messages Prevalence of overweight/obesity in young Ethiopian adolescents was 8% with a significantly higher rate in females (13%) than in males (2%). Despite no association between diet and overweight/obesity, the diet quality for the majority was inadequate putting them at risk for poor health outcomes. Many of the contributors to overweight/obesity were biological (menarche, age) or related to the household (parent lived with), factors individual adolescents cannot control, unlike physical activity or diet. Physical activity was negatively associated with overweight/obesity in females who were less active than males. Understanding reasons and barriers to physical activity may assist in reducing overweight/obesity prevalence.

Exclusive breastfeeding (EBF) for the first 6 months of life improves survival, growth and development. In Kenya, recent legislation and policies advocate for maternity leave and workplace support for breastfeeding and breast milk expression. We conducted a qualitative study to describe factors influencing EBF for 6 months among mothers employed in commercial agriculture and tourism. We interviewed employed mothers (n = 42), alternate caregivers and employed mothers' husbands (n = 20), healthcare providers (n = 21), daycare directors (n = 22) and commercial flower farm and hotel managers (n = 16) in Naivasha, Kenya. Despite recognizing the recommended duration for EBF, employed mothers describe the early cessation of EBF in preparation for their return to work. Managers reported supporting mothers through flexible work hours and duties. Yet, few workplaces have lactation spaces, and most considered adjusting schedules more feasible than breastfeeding during work. Managers and healthcare providers believed milk expression could prolong EBF but thought mothers lack experience with pumping. The most frequently suggested interventions for improving EBF duration were to expand schedule flexibility (100% of groups), provide on‐site daycare (80% of groups) and workplace lactation rooms (60% of groups), improve milk expression education and increase maternity leave length (60% of groups). Returning to work corresponds with numerous challenges including lack of proximate or on‐site childcare and low support for and experience with milk expression. These factors currently make EBF for 6 months unattainable for most mothers in these industries. Interventions and supports to improve breastfeeding upon return to work are recommended to strengthen employed mothers' opportunity for EBF.

Background Out-of-hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery. Methods We performed a systematic review of the peer reviewed literature from January 2005 to March 2015 in PubMed, Embase, Cochrane, and Web of Science. All articles referencing research from low and low-middle income countries addressing OHEC, emergency medical services, or transport/transfer of patients were included. We identified themes in the literature to form six categories of OHEC barriers. Data were collected using an electronic form and results were aggregated to produce a descriptive summary. Results A total 1927 titles were identified, 31 of which met inclusion criteria. Barriers to OHEC were divided into six categories that included: culture/community, infrastructure, communication/coordination, transport, equipment and personnel. Lack of transportation was a common problem, with 55% (17/31) of articles reporting this as a hindrance to OHEC. Ambulances were the most commonly mentioned (71%, 22/31) mode of transporting patients. However, many patients still relied on alternative means of transportation such as hired cars, and animal drawn carts. Sixty-one percent (19/31) of articles identified a lack of skilled personnel as a key barrier, with 32% (10/31) of OHEC being delivered by laypersons without formal training. Forty percent (12/31) of the systems identified in the review described a uniform access phone number for emergency medical service activation. Conclusions Policy makers and researchers seeking to improve OHEC in low and low-middle income countries should focus on increasing the availability of transport and trained providers while improving patient access to the OHEC system. The review yielded articles with a primary focus in Africa, highlighting a need for future research in diverse geographic areas.