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The first Global Symposium on Health Systems Research was held in 2010 under the leadership of the World Health Organization and the Alliance for Health Policy and Systems Research. Since [...]

Problem The burden oftrauma and injuries in Uganda is substantial and growing.Two important gaps that need addressing are the shortage of trained people and a lack of national data on noncommunicable diseases and their risk factors in Uganda. Approach We developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. We also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability. Local setting The Chronic Consequences of Trauma, Injuries and Disability in Uganda programme was implemented In 2012 at Makerere University School of Public Health in Kampala, Uganda, in conjunction with Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America. Relevant changes Over the years 2012 to 2017 we supported four cohorts of master's students, with a total of 14 students (9 females and 5 males; mean age 30 years). Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums. Lessons learnt Institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme. Probleme La charge de morbidite liee aux traumatismes et aux blessures en Ouganda est importante et en augmentation. La penurie de personnes formees et le manque de donnees nationales sur les maladies non transmissibles et leurs facteurs de risque en Ouganda constituent deux lacunes importantes qui doivent etre comblees. Approche Nous avons elabore et mis en oeuvre un nouveau parcours au sein d'un master de sante publique existant, destine a developper des capacites de niveau universitaire et a promouvoir la recherche sur les principales priorites nationales relatives aux traumatismes et aux blessures. Nous avons egalement propose des possibilites deformation a un plus large public et organise un forum national de haut niveau sur les blessures pour encourager un dialogue national sur la charge induite par les traumatismes, les blessures et le handicap. Environnement local Le programme Consequences chroniques des traumatismes, des blessures et du handicap en Ouganda a ete mis en oeuvre en 2012 a l'Ecole de sante publique de l'Universite Makerere a Kampala, en Ouganda, en collaboration avec l'Ecole de sante publique Bloomberg de l'Universite Johns Hopkins a Baltimore, aux Etats-Unis d'Amerique. Changements significatifs Entre 2012 et 2017, nous avons soutenu quatre cohortes d'etudiants en master, pour un total de 14 etudiants (9 femmes et 5 hommes; age moyen 30 ans). Plus de 1300 personnes ont participe aux ateliers et seminaires du volet formation courte du programme. Le forum a accueilli trois symposiums de recherche et deux forums nationaux sur les blessures. Lecons tirees Le soutien institutionnel et l'engagement collaboratif sont importants pour elaborer et mettre en oeuvre avec succes des programmes de renforcement des capacites. L'integration des volets deformation aux structures universitaires existantes est essentielle pour leur viabilite. Un tutorat adapte pour les etudiants motives et brillants est utile pour les accompagner pendant toute la duree du programme. Problema La carga de traumatismos y lesiones en Uganda es notable y sigue creciendo. Dos deficiencias importantes que deben abordarse son la escasez de personal formado y la falta de datos nacionales sobre las enfermedades no contagiosas y sus factores de riesgo en Uganda. Enfoque Se ha desarrollado e implementado un nuevo curso dentro de un programa de master en salud publica existente, destinado a desarrollar la capacidad de nivel de postgrado y promover la investigacion sobre prioridades nacionales clave para traumatismos y lesiones. Tambien se ofrecieron oportunidades de formacion a un publico mas amplio y se establecio un foro nacional de alto nivel sobre lesiones para fomentar el dialogo nacional sobre la carga de los traumatismos, las lesiones y la discapacidad. Marco regional El programa Consecuencias cronicas de los traumatismos, las lesiones y la discapacidad en Uganda se implemento en 2012 en la Escuela de Salud Publica de la Universidad de Makerere en Kampala, Uganda, junto con la Escuela de Salud Publica Johns Hopkins Bloomberg en Baltimore, EE.UU. Cambios importantes Entre los anos 2012 y 2017 se respaldaron cuatro cohortes de estudiantes de master, con un total de 14 estudiantes (9 mujeres y 5 hombres, con una edad media de 30 anos). Mas de 1300 personas participaron en talleres y seminarios del componente de formacion a corto plazo del programa. El foro fue sede de tres simposios de investigacion y dos foros nacionales sobre lesiones. Lecciones aprendidas El apoyo institucional y el compromiso colaborativo son importantes para desarrollar e implementar programas de desarrollo de capacidades de exito. La integracion de los componentes de formacion dentro de las estructuras academicas actuales es clave para la sostenibilidad. Una tutoria apropiada para estudiantes muy motivados y con talento es valiosa para guiar a los estudiantes por el programa., Introduction Injuries are a leading cause of death in the African Region, where they claim over 900 000 lives annually, (1) and within Africa, Uganda has one of the highest [...]

The scientific community has succeeded in producing coronavirus disease 2019 (COVID-19) vaccines in record time; however, some countries are just receiving their first doses while others, such as the United [...]

Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--are currently undergoing a deep epidemiological transition that is mainly driven by rapid economic growth and technological change. The changes being observed in the distribution of the burden of diseases and injuries--such as recent increases in the incidence of road traffic injuries--are matters of concern. BRICS may need stronger institutional capacity to address such changes in a timely way. In this paper, we present data on road traffic injuries in BRICS and illustrate the enormous challenge that these countries currently face in reducing the incidence of such injuries. There is an urgent need to Improve road safety indicators in every country constituting BRICS. It is imperative for BRICS to invest in system-wide road safety interventions and reduce the mortality and morbidity from road traffic injuries. Le Bresil, la Federation de Russie, l'linde, la Chine et l'Afrique du Sud--les pays connus sous le nom de BRICS--connaissent actuellement une transition epidemiologique profonde qui s'explique principalement par la rapidite de la croissance economique et de Involution technologique. Les changements qui sont observes dans la distribution de la charge des maladies et des blessures, comme les hausses recentes de l'incidence des accidents de la route, suscitent des inquietudes. Le groupe BRICS peut avoir besoin de capacites institutionnelles renforcees pour repondre rapidement a ces changements. Dans cet article, nous presentons les donnees sur les accidents de la route dans le groupe BRICS et nous illustrons l'enorme defi que doivent actuellement relever ces pays dans la diminution de l'incidence de ces accidents. II est urgent d'ameliorer les indicateurs de la securite routiere dans chaque pays constituant le groupe BRICS. II est imperatif que le groupe BRICS investisse dans des interventions de securite routiere dans l'ensemble du systeme et qu'il reduise la mortalite et la morbidite dues aux accidents de la route. Brasil, la Federacion de Rusia, India, China y Sudafrica, los paises conocidos como BRICS, se encuentran en la actualidad en una transicion epidemiologica profunda impulsada principalmente por el rapido crecimiento economico y el cambio tecnologico. Los cambios que se observan en la distribucion de la carga de enfermedades y lesiones, como los aumentos recientes de la incidencia de los accidentes de trafico, son motivo de preocupacion. Es posible que los BRICS necesiten una capacidad institucional mas fuerte para hacerfrente a esos cambios de manera oportuna. En el presente articulo, presentamos datos sobre lesiones en accidentes de trafico de los BRICS e ilustramos el enorme desafio al que dichos paises se enfrentan actualmente para reducir la incidencia de las mismas. Hay una necesidad urgente de mejorar los indicadores de seguridad vial en todos los paises BRICS. Es imperativo que estos paises inviertan en intervenciones de seguridad vial en todo el sistema y reduzcan la mortalidad y morbilidad por accidentes de trafico., Introduction In recent years, five major emerging economies--Brazil, the Russian Federation, India, China and South Africa, which are known collectively as BRICS--have experienced not only considerable growth in their macroeconomic [...]

Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health.

Objective To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. Methods This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. Findings Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged [greater than or equal to] 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. Conclusion Hospitais in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues. Objectif Determiner la frequence et la nature des traumatismes touchant les enfants et etudier les facteurs de risque pour ces traumatismes dans des pays a faible revenu en utilisant les donnees de surveillance des services d&apos;urgence. Methodes Cette etude pilote represente la phase initiale d&apos;un projet multi-pays de surveillance des traumatismes non intentionnels de l&apos;enfant (GCUIS) era ete menee a partir d&apos;un echantillon sequentiel d&apos;enfants de moins de 11 ans de l&apos;un et l&apos;autre sexe, qui ont ete presentes dans des services d&apos;urgence selectionnes du Bangladesh, de Colombie, d&apos;Egypte et du Pakistan, sur une periode de 3-4 mois, variable selon les sites, au cours de rannee 2007. Resultats Parmi les 1559 enfants victimes de traumatisme accueillis sur l&apos;ensemble ales sites, 1010 (65%) etaient de sexe masculin, 941 (60%) etaient ages de 5 ans et plus et 32 (2%) avaient moins d&apos;un an. Les traumatismes etaient particulierement frequents (34%) pendant la matinee. Ilis se produisaient a l&apos;interieur et autour du domicile dans 56% des cas, a l&apos;exterieur pendant les jeux des enfants dans 63% des cas et au cours de deplacements dans 11% des cas. Sur l&apos;ensernble des traumatismes observes, 913 (56%) etaient lies a des chutes, 350 (22%) a des accidents de la circulation, 210 (13%) a des brulures, 66 (4%) a des empoisonnements et 20 (1%) a des << presque-noyades >> ou a des noyades. Les chutes impliquaient le plus souvent des escaliers ou des echelles et les accidents de la circulation des pietons, la majorite des brulures etaient dues a dos liquides chauds, les empoisonnements faisaient intervenir habituellement des medicaments et la plupart des noyades se produisaient au domicile. Le score de gravite moyen des traumatismes etait maximal pour les noyades et les presquenoyades (11), ce score etant suivi de pres par celui des accidents de la circulation (10). L&apos;etude a recense 6 deces, dont 2 resultant d&apos;une noyade, 2 d&apos;une chute et 2 d&apos;un accident de la circulation. Conclusion Les hopitaux des pays a faible revenu font face a une charge substantielle de traumatismes infantiles et une surveillance systematique est necessaire pour determiner la distribution epidemiologique de ces traumatismes et connaitre les facteurs de risque associes. La standardisation methodologique de la surveillance entre les pays permet de dresser des comparaisons internationales et d&apos;identifier des problemes communs. Objetivo Determinar la frecuencia y naturaleza de las lesiones infantiles y explorar sus factores de riesgo en paises de bajos ingresos, utilizando para ello los datos de vigilancia de los departamentos de urgencias (DU). Metodos Este estudio piloto representa la fase inicial de un proyecto plurinacional de vigilancia mundial de las lesiones infantiles no intencionales y se baso en una muestra secuencial de menores de 11 anos, de ambos sexos, que se presentaron en 2007 en DU seleccionados de Bangladesh, Colombia, Egipto y Pakistan alo largo de un periodo de 3 a 4 meses, variable segun el centro. Resultados De 1559 ninos lesionados observados en todos los centros, 1010 (65%) eran varones; 941 (60%) tenian [mayor que o igual a] 5 anos, y 32 (2%) < 1 ano. Las lesiones fueron especialmente frecuentes (34%) por la manana. En el 56% de los casos se produjeron dentro de casa o en sus alrededores, en el 63% fuera, mientras jugaban, y en el 11% en viaje. De todas las lesiones observadas, 913 (56%) consistieron en caidas; 350 (22%) en lesiones causadas por el trafico; 210 (13%) en quemaduras; 66 (4%) en intoxicaciones, y 20 (1%) en ahogamiento o casi ahogamiento. Las caidas mas frecuentes se produjeron en escaleras; en el caso de las lesiones causadas por el trafico, la mayoria de las victimas fueron peatones; la mayoria de las quemaduras se produjeron con liquidos calientes; las intoxicaciones mas frecuentes se debieron a medicamentos, y la mayoria de los ahogamientos se produjeron en casa. Las lesiones con mayores puntuaciones de gravedad fueron los ahogamientos o casi ahogamientos (11), seguidos de cerca por las lesiones causadas por el trafico (10). Hubo 6 casos mortales: 2 por ahogamiento, 2 por caidas y 2 por lesiones causadas por et trafico. Conclusion Los hospitales de los paises de bajos ingresos tienen una carga considerable de lesiones infantiles. Es necesaria una vigilancia sistematica para identificar la distribudion epidemiologica de esas lesiones y comprender sus factores de riesgo. La normalizacion metodologica de la vigilancia en los diferentes paises permite establecer comparaciones internacionales e identificar problemas comunes., Introduction Unintentional injuries are a leading cause of death among children and young adults. (1) Over 875 000 children [less than or equal to] 18 years of age die annually [...]

Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in valueladen concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective. Une traduction en francais de ce resume figure a la fin de l&apos;article. Al final del articulo se facilita una traduccion al espanol. Les progres scientifiques sont un prealable important a l&apos;evolution des politiques et des pratiques dans le domaine de la sante publique, mais sur le terrain, les individus investissent aussi dans des concepts charges de valeur et repondent quotidiennement a des preoccupations sociopolitiques, culturelles et evaluatives. Les concepts qui influent le plus sur les pratiques de sante publique sont ceux faconnes par les moeurs collectives et individuelles definissant les systemes sociaux. Le present article s&apos;efforce de decrire les processus ethiques en jeu lors de la mise en place de mecanismes de sante publique dans les pays a revenu faible et moyen, en se concentrant sur deux cas dans lesquels l&apos;ethique a influe de maniere cruciale sur l&apos;apparition d&apos;une evolution institutionnelle positive de la politique sanitaire. Nous commencons par donner une presentation generale de la relation entre ethique et sante publique ; en second lieu, nous apportons un cadre conceptuel pour l&apos;analyse ethique des evenements touchant les systemes de sante, en notant dans quelle mesure cette approche peut renforcer le pouvoir des cadres existants, et enfin, nous demontrons les interactions entre ces cadres a travers l&apos;analyse d&apos;un programme d&apos;amelioration de la securite routiere en Malaisie et d&apos;une initiative pour etablir un comite national d&apos;ethique au Pakistan. Nous parvenons a la conclusion que si l&apos;ethique est integree progressivement aux decisions de sante publique dans nombre de systemes de sante en developpement, l&apos;analyse ethique est souvent implicite et sous-evaluee Cet article attire l&apos;attention sur la necessite d&apos;analyser les decisions de sante publique sous un angle ethique. El progreso cientifico es un motor importante de la evolucien de las politicas y practicas de salud publica, pero en ese terreno se aplican tambien diversos valores y hay que responder diariamente a problemas sociopoliticos, culturales y evaluativos. Las ideas que orientan gran parte de las practicas de salud publica se vert conformadas por costumbres colectivas e individuales que definen Ios sistemas sociales. La finalidad de este articulo es describir los procedimientos eticos que entran en juego cuando se establecen mecanismos de salud publica en los paises de ingresos bajos y medios, centrando la atencien en dos casos en Ios que la etica contribuyo de forma decisiva a propiciar cambios institucionales positivos en las politicas de salud publica. En primer lugar presentamos una panoramica de las relaciones entre etica y salud publica; a continuacion, ofrecemos un marco conceptual para el analisis etico de eventos en Ios sistemas sanitarios, indicando como podria este enfoque reforzar las posibilidades de los marcos existentes; y, en tercer lugar, demostramos la interrelacion entre esos marcos analizando un programa de mejora de la seguridad vial en Malasia y una iniciativa de creacien de un comite nacional de etica en el Pakistan. Llegamos a la conclusien de que, si bien las decisiones de politica en materia de salud publica estan incorporando gradualmente principios eticos en muchos sistemas de salud en desarrollo, con frecuencia Ios analisis eticos se realizan de forma implicita y estan infravalorados. En este trabajo se subraya la necesidad de analizar la adopcien de decisiones de salud publica desde una perspectiva etica., Introduction High-income countries can learn vital lessons from low- and middle-income countries (LMICs) which, through persistence, manage to form much-needed public-health structures that harmonize with pre-existing local public-health systems. (1) [...]

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. Keywords Emergency medical services/organization and administration; Emergency treatment/organization and administration; Triage; Transportation of patients; Allied health personnel/education; Cost-benefit analysis; Evidence-based medicine; Developing countries (source: MeSH, NLM). Mots cles Service medical urgences/organisation et administration; Traitement urgence/organisation et administration; Orientation patients; Transport sanitaire; Personnel sante auxiliaire/enseignement; Analyse cout benefice; Medecine factuelle; Pays en developpement (source: MeSH, INSERM). Palabras clave Servicios medicos de urgencia/organizacion y administracion; Tratamiento de urgencia/organizacion y administracion; Triaje; Transporte de pacientes; Tecnicos medios en salud/educacion; Analisis de costo-beneficio; Medicina basada en evidencia; Paises en desarrollo (fuente: DeCS, BIREME)., Introduction The goal of an effective emergency medical system should be to provide universal emergency care--that is, emergency care should be available to all who need it. However, there are [...]

Introduction Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. Methods MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. Results The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. Discussion The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles. Keywords: developing countries; child nutrition disorders; communicable diseases, mortality; infantile diarrhea, mortality; measles, mortality; health planning; child health services. Bulletin of the World Health Organization, 2000, 78:1207-1221., Voir page 1218 le resume en francais. En la pagina 1219 figura un resumen en espanol. Introduction Approximately 12 million children younger than 5 years of age die every, year; [...]

Editor -- I am responding to Adnan Hyder (1), who says that "community-based health care has been plagued by principles which have become myths". It should be pointed out that [...]

Sir -- Health, especially the health of children, is a well-recognized entry point for development. There are myriad pathways for moving towards development from health interventions, as demonstrated by pilot [...]

Injuries and violence are a significant cause of child death and physical and psychological disability. Every year injuries and violence kill approximately 950 000 children (aged less than 18 years) [...]

Injuries and violence are a significant and growing cause of child death and disability, as well as having other health consequences including mental health, behavioural and reproductive health problems. Every [...]

Tikki Pang wrote a very welcome editorial that discusses what evidence is needed to strengthen the linkages between evidence generation and action in the developing world. (1) Dr Pang highlights [...]

This month WHO is taking a giant leap forward in global public health in the field of road traffic injuries, with two major events to promote action for saving lives [...]

Comments on the effort of the World Health Organization on global public health in the field of road traffic injuries. Conduction of major events to promote action for saving lives and preventing morbidity; Theme of the World Health Day; Discussion of road safety by the United Nations General Assembly.

The article offers information on the 2024 Global Symposium on Health Systems Research to be held in Nagasaki, Japan on November 18 to 22 which will focus on issues and developments in the science of health policy and systems.