Global mortality of snakebite envenoming between 1990 and 2019

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

The feudal structure of global health and its implications for decolonisation

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).

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Individual responsibility: a red herring that lets the fossil fuel industry off the climate catastrophe hook

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.

Read the article in BMJ (open access) here.

A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist

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

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Facilitators and barriers of life jacket use for drowning prevention: qualitative evidence synthesis

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 :

  1. 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.
  2. The high cost of life jackets was almost always a barrier for its usage
  3. Adoption of laws and its subsequent enforcement was perceived to be an important facilitator for life jacket use.
  4. Design issues around comfort, fashion-sense, and shelf life influenced usage of life-jackets

Read the full study here.

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Mitigating the chronic burden of snakebite: turning the tide for survivors

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) .

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Stronger together: a new pandemic agenda for South Asia

The global increase in COVID-19 cases in 2021 has primarily been due to an uncontrolled surge in South Asia. It is estimated that by 1 September 2021, approximately 1.4 million in South Asians will die due to COVID-19 alone. The total number of excess deaths will be much higher—including non-COVID causes, as health systems are on the brink of collapse. With 33.4% of South Asians being extremely poor and the large-scale loss of livelihood being reported, the region faces a potentially catastrophic future for the ongoing decade. However, countries in South Asia continue to remain divisive. This differs from other geographic ‘blocs’ that frequently cooperate on mutual interest issues. Tensions in South Asia are shaped by complex domestic, bilateral, intra-regional and international geopolitical factors, despite the region’s obvious geographic, economic and cultural interdependence. A key lesson from the current pandemic is that countries need to share lessons and actively coordinate, complement and supplement each other’s public health responses, especially between neighbours.

Read the Editorial published in BMJ Global Health with Dr Soumyadeep and his colleagues which presents a pragmatic ‘Stronger Together’ agenda on critical areas of concern for political, social, medical and public health leaders in South Asia to consider and build on here (open access)

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Ethical issues for e-cigarette control policies in Australia

Australia has seen a sustained decrease in smoking for many decades by implementing a comprehensive multi-level tobacco control strategy . The proportion of Australians who smoke tobacco daily has decreased from 24% in 1991 to 12.2% in 2016, and 11.0% in 2019 . However, it is seen that proportion of Australians who have ever used electronic cigarettes (e-cigarettes) has increased from 8.8% in 2016 to 11.3% in 2019. The policy and regulatory space around e-cigarette is currently evolving in Australia, even amidst the Covid-19 pandemic.

Policy critique and analysis of evidence on e-cigarettes is substantial, but analysis of the ethical issues in Australia is scant. Previous analysis of ethical issues control e-cigarettes in Australia has been either based on principlism (the ethical principles of autonomy, beneficence, non-maleficence, and justice) or through the prism of harm reduction. Principlism is not well suited to analysing ethical issues around public health policies. Public health decision making is inherently more complex, involves larger numbers of stakeholders with different value systems, and is contextual in nature. Harm reduction, though a key tenet to guide e-cigarette policies, has its roots in libertarianism, a value system which might fundamentally not align with the moral beliefs of many stakeholders. As such, using a single philosophical lens for analysing public policy is not desirable.

This article analyses ethical issues around all aspects of e-cigarette control in Australia using a three-step public health ethics framework . The three-step framework does not presume superiority of any set of moral norms over another and helps clarify ethical issues contextually and comprehensively. The approach in brief consists of analysing ethics and contexts around the issue at hand, analysing ethical dimensions of alternative courses of action and a final stage of justification for a particular public health decision. The need for a comprehensive policy framework to tackle e-cigarette use has been identified, and as such, an ethical analysis of all aspects of control is necessary. To ensure comprehensive coverage of e-cigarette control policies, the ethical analysis is structured within the World Health Organization’s WHO-MPOWER framework of tobacco control. The WHO-MPOWER (Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco) is a comprehensive framework to monitor implementation of control policies . To the best of my knowledge, such a comprehensive approach for understanding ethical issues around e-cigarette control policies has not been undertaken globally.

Read the full article published in Indian J Med Ethics here (open access)

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Evidence informed standardised prescription: home care for mild COVID

A vast majority of those with COVID have mild to moderate symptoms- and can appropriately be managed at home. In most cases people seek care from registered medical practitioners . But many clinicians and consultants are prescribing a cocktail of drugs which are known to have little or no value in improvement of patients. On the other hand it adds unnecessarily to costs, causes anxiety and makes diagnosis of progressive symptoms difficult ( progression of disease, complication or drug reactions) . To help clinicians tide over and have a tool which is backed by evidence, the evidence-informed standardised prescription has been developed for modern medicine doctors treating mild or moderate COVID cases at home (in-person or telemedicine).

Access is free but restricted to only modern medicine doctors (anywhere in the world) and organisations on a peer-to-peer basis and is available here . Apart from the prescription it provides an inventory of external resources to enable better clinical decision making. The standardised prescription is licensed under CC BY-NC-SA 4.0 license . This means it is free to use, adapt and mix provided the original source is cited/attributed appropriately, the use is for non-commercial use and further derivates are also licensed similarly.

Access, can be requested through an email to : work [at the rate of] soumyadeepbhaumik [dot] in

For individual modern medicine doctors please send either of the following:

  1. link to institutional webpage which demonstrated your medical degree
  2. information on medical council registration

Organizations working in providing modern medicine might write a mail to the same address providing link to their website and mention the specific potential use of the prescription.

The standardised evidence-informed telemedicine prescription has already been used by more than 30 doctors in India and a more stable Version 2.0 is now available. The passcode changes when a new version is available and requests can be made in a similar fashion as above. Link to access remains same.

Requests from practitioners of other forms of medicine will not be responded to.

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Community health workers for pandemic response

The COVID-19 outbreak that originated in Wuhan City, China, in December 2019 now affects 213 countries or territories across the globe. Better health workforce utilisation and support are key pillars to enhance health systems capacity. Community health workers (CHWs) constitute a significant proportion of frontline health workforce in many countries and play an important role in control and prevention of pandemics like COVID-19.

A rapid evidence synthesis was conducted to understand what role CHWs can play in pandemics. The study found that in previous pandemics, CHWs have played several roles including for generating community awareness countering stigma and contact tracing. CHW engagement in contact tracing might hamper routine primary service delivery. Policies, guidance and training for these had to be developed. Disruption in supply chain, logistics and supportive supervision for CHWs have been common in pandemic scenarios. CHWs have been at increased risk for contracting disease. In the course of pandemics, CHWs have experienced stigmatisation, isolation and socially ostracisation. Improved remuneration, additional incentives, public recognition countering societal stigma, provision of psychosocial support and personal protective equipment were reported to be enablers. There is not much evidence about initialisation of new CHW programmes during pandemics. Considering the complexity of barriers faced even in contexts with well-integrated programmes, ambitious programmes need to be considered with caution.

Read the full study in BMJ Global Health here (open access)

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