Snakebite envenoming is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900–78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5–1.0) per 100,000 and represents a 36% (2–49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3—5.0). We forecast mortality will continue to decline, but not sufficiently to meet WHO’s goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress.
Read the full paper published in Nature Communications (Open Access ) here
Snakebite is a public health problem in rural areas of South Asia, Africa and South America presenting mostly in primary care. Climate change and associated extreme weather events are expected to modify the snake-human-environment interface leading to a change in the burden of snakebite. Understanding this change is essential to ensure the preparedness of primary care and public health systems.
An evidence synthesis to better understand this aspect was published in Journal of Family Medicine and Primary Care and is available (open acess) here.
Global health as a field has its epistemological roots in related fields of tropical medicine and international health.1 2 These fields are not only products of colonialism, they also enabled imperialism through the destruction of traditional knowledge and consequent capture of the knowledge ecosystem.2–4 Efforts to decolonise global health are therefore much needed. Calls to reform global health institutions, global health education, agenda setting, resource allocation, the problem in ‘gaze’ and equitable institutional partnerships have been made.1 5–7 Unfortunately, diversity, equity and inclusion (DEI) remains a dominant framing of ongoing discussions on decolonising global health.5
Efforts around DEI are indeed necessary—as a part of anti-racism and other social movements promoting inclusiveness of all forms of minorities in decision-making8 9; but they do not effectively address the structural imbalance of power between high-income countries (HICs) and low/middle-income countries (LMICs). To undo the persistence of colonialism in global health, it is necessary to understand how feudal structures helped imperial forces to sustain political colonisation.
In this editorial, Dr Soumyadeep Bhaumik and his colleague highlight the similarities of those feudal structures to the current global health ecosystem, and why DEI efforts alone may only strengthen this feudal structure. Moving forward, dismantling the feudal structure of global health should be a target for efforts to decolonise global health.
Read the full article (open access ) in BMJ Global Health here (click).
On the eve of the United Nations High-Level Political Forum, Kent Buse, Soumyadeep Bhaumik and colleagues argue that the health of people and planet can only be rescued through government led, structural transformations—but for that to happen we need to re-frame the narrative away from indivividual efforts.
To maximize the efficiency of resources and reduce redundancy, organizations and countries may decide to adapt an existing practice guideline rather than developing a new one. The RIGHT (Reporting Items for practice Guidelines in HealThcare) statement currently informs the reporting of the guideline development; however, it does not cover reporting of steps that are specific to guideline adaptation.
A scientific workgroup, filled this gap and developed a new reporting tool designed to improve standardization and transparency of adapted health care guidelines. Called the RIGHT-Ad@pt Checklist, the tool focuses on improving the clarity and explicitness of recommendations that have been adapted for use in different health care systems, and of the guideline development process.
The RIGHT-Ad@pt Checklist was developed as an extension of the RIGHT statement through a multi-step process involving literature reviews and consensus building involving a range of stakeholders including guideline adaptation experts, users, journal editors, and policy makers. The checklist was designed to be used to guide the reporting of adapted guidelines, including adaptation process and the adapted recommendations. It can also be applied to assess the completeness of reporting and, in combination with available adaptation frameworks, to inform adaptation processes. Different audiences may use the RIGHT-Ad@pt checklist for different purposes:
Guideline developers could use the checklist to report their adapted guidelines;
Journal editors and reviewers could use the checklist to ensure the completeness and transparency of the reporting in the publication of adapted guidelines;
Clinicians could accurately identify and apply adapted recommendations to their clinical practice based on detailed and clear reporting; and
Policymakers could evaluate the feasibility of adapted recommendations for local implementation based on the reporting contents suggested by the checklist.
The checklist was published in Annals of Internal Medicine and is available here
Syntheses of evidence are of immense importance to clinical medicine, health systems and policy decision-making as well as in program implementation. The synthesis of evidence in a timely manner, using a fit-for-purpose approach, with clear articulation of purpose and proposed use, is a crucial component the global health ecosystem. Evidence syntheses can not only effectively illuminate global health problems but can also help challenge policy assumptions and offer implementation recommendations across diverse contexts. This seminar is one of a series on evidence synthesis for global health. The first seminar hosts Dr Zohra Lassi, who would deliver a lecture on how evidence synthesis shaped the space of child and adolescent primary care followed by audience interaction and a fireside chat hosted with Dr Devaki Nambiar. Dr Soumyadeep Bhaumik will deliver the welcome note for the series. The seminar is free to attend : https://www.georgeinstitute.org.in/events/evidence-synthesis-for-global-health
Community medicine training consists of a bit of family medicine and a bit of public health- with no advanced competencies on either. Family medicine is now an established discipline with its own scholarly niche, a clear generalist approach towards clinical care rooted in the philosophy of primary care. Public health developed outside medical universities, and global scholarly work has meant it has a strong but continually evolving philosophical basis. Both family medicine and public health have some commonalities – they do not shy away from integrating concepts from various disciplines; are collaborative in nature; and its post-graduates are job-ready. Community medicine on the other end has been not able to move away from the clinical lens and has no clear philosophical leanings. Surely teaching medical students alone cannot be an enough justification for continued investment on community medicine.
The full article in Journal of Family Medicine & Primary Care is available open access here .
Drowning is a public health problem globally, with over 90% of deaths occurring in low- and middle-income countries . Unintentional drowning was estimated to cause about 295,210 deaths in 2017worldwide. The true burden of drowning is expected to be much higher owing to challenges in classification, reporting and data collection. The World Health Organization has identified several interventions to prevent deaths due to unintentional drowning, including the use of life jacket in high-risk recreational and occupational settings.
Despite substantial evidence on the effectiveness of life jackets and the subsequent adoption of laws in several countries, the use of life jackets has largely remained low, including in high-income countries.However, there has been no qualitative synthesis of evidence to understand the context and internal perceptions and experiences that may influence life-jacket use. The study, published in Journal of Safety Research this week filled this important knowledge gap and found :
Life jacket use was shaped through complex interactions between lived experience and cultural norms which influenced the risk-perception of life jacket utility in preventing deaths.
The high cost of life jackets was almost always a barrier for its usage
Adoption of laws and its subsequent enforcement was perceived to be an important facilitator for life jacket use.
Design issues around comfort, fashion-sense, and shelf life influenced usage of life-jackets
The World Health Organization(WHO) has released a special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policy makers, calling on them to act with urgency on the current climate and health crises today (11th October 2021). The report lists 10 recommendations for priority action and is available here.
Prior to the publication a public consultation was conducted by the WHO in which I provided feedback in individual capacity (acknowledged in WHO report) . The feedback revolved around the following themes(full submission available for download):
need for developing global, regional and national agendas for climate crisis preparedness, support for more interdisciplinary/transdisciplinary collaboration,
recognition of rights and dignity of health workforce in our path to climate resilience,
greater recognition of the impact of climate change on non-communicable diseases and injuries, particularly chronic kidney disease, snakebite, and cardiovascular diseases needs priority attention.
higher taxation of app-based food delivery business which has higher carbon footprint;
stop promotion of vegetarian diets which amounts to cultural imperialism by suppression of food practices of minorities, tribal, Adivasi and Indigenous populations who are being being attacked for their traditional meat-based food practices by removing words like “eating less meat” & “largely plant-based diet”;
ensure food security of vulnerable people by providing guarantee against price fluctuations through development of appropriate investment and legal mechanisms.
It is pleasing to note that the WHO has involved stakeholders meaningfully and inculcated feedback in letter and spirit. The removal of terms “eating less meat” is welcome, but more work needs to be done to prevent climate action being used as an opportunity for cultural imperialism. Continuing to work with stakeholders to understand the several issues better, as evidence evolves will be key to climate action. We have to grapple the defining issue of our generation together.
The International Snakebite Awareness Day has taken place annually on Sept 19 since 2018. Snakebites kill an estimated 137 880 people each year and three times as many survivors live with life-changing disabilities. ,,Since 2018, there has been some increased funding for research and development of antivenoms and other therapies. But there is a pressing need to additionally focus on the chronic aspects of snakebite care. The WHO strategy for snakebite envenoming aims to decrease not only mortality but also morbidity by 50% by 2030.
In a comment piece in The Lancet , Soumyadeep Bhaumik & colleagues propose a system-oriented approach with multi-component interventions to address chronic aspects of snakebite care, together with social support and investments in multidisciplinary research to end the neglect of snakebite. It highlights that the NTD community’s goal to “end the neglect” can be truly achieved in the snakebite domain only if snakebite survivors are at the centre of the response here (free but needs registration by e-mail) .