Geneva Health Forum Archive

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GHF2014 – PS22 – Monitoring ProgressTowards Universal Health Coverage at Country and Global Levels: A Framework

Monitoring Progress Towards Universal Health Coverage
at Country and Global Levels: A Framework

Dr. David B. Evans
Director, Department of Health Systems Financing, World Health Organization, Switzerland
Mrs. Ceri Averill
Health Policy Advisor, Oxfam, United Kingdom
Prof. Irene Akua Agyepong
Health Systems Global Board Chair and former Regional Director of Health Services in the Ghana Health Service Greater Accra region, School of Public Health, University of Ghana, Ghana
Dr. Raoul Bermejo
Researcher, Department of Clinical Epidemiology, University of the Philippines College of Medicine, Philippines

GHF2014 – PS18 – Improving Health Information Systems for Better Decision Making

Improving Health Information Systems for Better Decision Making
Mr. Hazim Timimi
Data Manager, Tuberculosis Monitoring and Evaluation, World Health OrganizationSwitzerland
Best Practices for Building an Integrated National Health Information System: Rwanda
Dr. Caricia Catalani
Senior Researcher, Innovative Support to Emergency, Disease, & Disaster (InSTEDD) & University of California, Berkeley, School of Public Health, United States
Prof. Don De Savigny
Head, Health Systems Interventions Research Unit, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Switzerland

PS18_Catalani_squareDr. Caricia Catalani

I am a researcher, focusing on digital innovations for health.  I started working in the health field at age 16, as a physician’s assistant in our family-run urgent care clinic in the rainy Pacific Northwest of the United States. Since then, I’ve worked in an emergency room in a tough neighborhood in New York City, a sex workers’ union in the Dominican Republic, devastated neighborhoods in New Orleans after hurricane Katrina, US government health departments across the coasts, a cigar factory in Cuba, one of the world’s biggest private health insurance companies, a women’s health advocacy powerhouse in Washington, DC, a milky-eyed shamanic healer’s hut on the border of Cameroon, a teen health and empowerment center in San Francisco low-income housing, and clinics with mud floors and tin roofs throughout the African continent.  These days, I spend most of my time as a research consultant to eHealth, mHealth, and digital innovation projects at ministries of health, hospitals, and non-governmental organizations around the world (especially in Rwanda, Cambodia, Kenya, India, Canada, and the USA). I am faculty at the University of California, Berkeley, where I teach courses on digital innovations for health.  Awesome comedy improv and freestyle rap give me a lot of joy.  I spend countless hours learning from my four-month old and three-year old daughters, as we grow up together in the San Francisco Bay Area.

Don de Savigny_squareProf. Don de Savigny

Professor de Savigny is an epidemiologist and public health specialist and currently Head of the Health Systems Research Unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, University of Basel.  He has extensive experience in conducting and facilitating health research in developing countries and has lived and worked for many years in Africa.  He chairs or is a member of a number of WHO, RBM, Global Fund, and TDR advisory committees and networks such as COHRED, the Health Metrics Network and the INDEPTH Network.  His current research focuses on interventions to strengthen health systems in developing countries, and on the health system effects of Global Health Initiatives for scaling up access.

GHF2014 – PS17 – Antimicrobial Resistance: A Global Health Challenge. What Are the Integrated Solutions?

Antimicrobial Resistance: A Global Health Challenge.
What Are the Integrated Solutions?

Prof. Didier Pittet
Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Dr. Benedetta Allegranzi
Service Delivery and safety department, WHO, Switzerland
Dr. Dominique Monnet
Senior Expert & Head of Programme, Antimicrobial Resistance & Healthcare-Associated Infections (ARHAI)
Office of the Chief Scientist,
European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
Dr. Benedikt Huttner
Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
Dr. Jean Pierre Bru
Hôpital de Annecy, France

Didier_Pittet_squareProf. Didier Pittet

Didier Pittet, MD, MS, is the Hospital Epidemiologist and the Director of the Infection Control Programme at the University of Geneva Hospitals and Clinics (2500 beds), Geneva, Switzerland; Professor of Medicine and Hospital Epidemiology at the University of Geneva; and Attending Physician in Adult and Paediatric Infectious Diseases, University of Geneva Hospitals. He is also Visiting Professor, Division of Investigative Sciences and School of Medicine, Imperial College London, London, UK. Professor Pittet serves on the editorial boards of the American Journal of Infection Control, the American Journal of Respiratory and Critical Care Medecine, The Lancet Infectious Diseases and Infection Control and Hospital Epidemiology. He is also an editorial consultant of the Lancet. Professor Pittet currently leads the First Global Patient Safety Challenge “Clean Care is Safer Care” of the WHO World Alliance for Patient Safety. He was awarded the CBE in 2007 by Her Majesty Queen Elisabeth II for services to the prevention of healthcare-associated infection in the UK. Current major research interests include the epidemiology and prevention of nosocomial infections, methods for improving compliance with hand hygiene practices, and methods for improving the quality of patient care and patient safety.

Allegranzi PhotoDr. Benedetta Allegranzi

Benedetta Allegranzi, MD, is a specialist in infectious diseases, tropical medicine, infection control and hospital epidemiology. She currently works at the World Health Organization (WHO) HQ (Service Delivery and Safety department), leading the “Clean Care is Safer Care” programme ( focused on hand hygiene, infection control and antimicrobial resistance in health care. Since 2013, Dr Allegranzi has gathered the title of full professor of infectious diseases in the official Italian professorship list and is adjunct professor of public health at the Faculty of Medicine, University of Geneva, Switzerland. She closely collaborates with the team at the Infection Control Programme and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals (Geneva, Switzerland), as well as with the Armstrong Institute for Patient Safety and Quality, John Hopkins University, (Baltimore, USA) for clinical research projects. She has experience in clinical management of infectious diseases and tropical medicine, and clinical research in healthcare settings in both developing and developed countries. She has thorough skills and experience in training and education.

She is the author or coauthor of more than 150 scientific publications, including articles published in high-profile medical journal such as the Lancet, Lancet Infectious Diseases, New England Journal of Medicine and the WHO Bulletin, and six book chapters.

Dominique_Monnet_squareDr. Dominique Monnet

Dr. Monnet received his degrees in pharmacy (PharmD) and clinical microbiology (PhD) from the University of Lyon, France, and then obtained further education as a hospital infection control specialist and epidemiologist.

Before joining ECDC in 2007, he worked in French hospitals, at the US Centers for Disease Control and Prevention (1993-1995) and at the Danish Statens Serum Institut (1997-2007) where he was coordinating surveillance of antimicrobial resistance and antimicrobial consumption in humans in Denmark.

His research interests include surveillance of antimicrobial resistance and antimicrobial consumption, the relationship between consumption of antimicrobials and resistance, and the factors that affect antimicrobial usage, both in hospitals and in primary care.

SONY DSCDr. Benedikt Huttner

Dr Benedikt Huttner is an infectious disease physician at the Infection Control Program of Geneva University Hospitals.

After medical studies in Munich (Germany) and Nice (France) he came to Switzerland in 2002 to train in internal medicine (Ticino) and infectious diseases (Zurich and Geneva). After a short stay in pediatrics he joined the infection control of Geneva University Hospitals (Prof. Didier Pittet) in 2007. Between 2010 and 2012 Benedikt was a research fellow at the division of epidemiology of the University of Utah (Prof. Matthew Samore) and the VA Salt Lake City Health Care System.  Benedikt’s research focuses on antibiotic stewardship and antimicrobial resistance, in the inpatient and outpatient setting. He is also an infectious disease consultant for the university’s geriatric hospital in Geneva.

Bru_squareDr. Jean Pierre Bru

MD, infectious diseases clinician, head of ID department at Annecy Hospital, a 1200 non-teaching French hospital.

Has experience in the management of infectious diseases, antimicrobial stewardship programs, and clinical research both in developing and developed countries.

Was expert in the field of antimicrobial treatments for twelve years at the French agency for medicine and health product safety.

Is editor in chief of ANTIBIOGARDE, a hospital digital guide that offer the particular feature to allow customization to serve as local frame of reference.

GHF2014 – PS12 – Integrating Neonatal Care in Low Income Countries: the Big Place of the Very Small Babies

Integrating Neonatal Care in Low Income Countries:
the Big Place of the Very Small Babies

Dr. Marie-Claude Bottineau
Pediatrician, Neonatology, Pediatrics Intensive Care, MSF CH, Geneva, Switzerland
Dr. Anne Pittet, Pediatrician, Hôpital de l’Enfance à Lausanne and MSF CH, Geneva, Switzerland
Dr. Jean-Marie Choffat, Pediatrician, CHUV, Lausanne, Switzerland
 Worldwide experience on the way to promote neonatal care in remote settings, humanitarian emergencies, post emergency programs, LIC… including policy and strategic planning, implementation, integration into MoH structures, task shifting, training course and handover.

PS12_Dr_Marie_BottineauDr. Marie-Claude BOTTINEAU is a French Pediatrician with a DESS in Neonatology, a competency in Pediatrics Intensive Care and a Master Degree in Public Health and Tropical Medicine. She did the first part of her carrier working in General and University Hospitals in France as Pediatrician in Pediatrics, Pediatrics and Neonatal Intensive Care in Nantes, Nancy, Le Havre and Paris and her Tropical Medicine Degree in Pitié Salpêtrière Hospital, Paris, with Pr Gentilini and Pr Duflo. She also studied Bio-Ethics in Paris as free auditor getting an equivalence of Master Degree.

In parallel, she was doing some regular missions around the world with several Humanitarian Organizations including MSF- France in Kosovo; Vietnam (Ho-Chi-Minh); Madagascar (Antananarivo); Nicaragua (Leon and Managua), during civil war; Nepal (Pokhara-Jomoson); India (Calcutta, slums of Howrah-Pilkhana) and Cameroon (Mpoundou, Abong-Mbang district).

From 1990 to 1996, she dedicated her carrier to the humanitarian action working exclusively in expatriation in different humanitarian contexts of which in Benin with Terre Des Hommes-Lausanne and in Angola with MSF-France (Uige and Benguela provinces during civil war).

After an urgent medical repatriation in December 1995, time for recovering, few months in HQ MSF-France in Paris and few years in Robert Debré Hospital (Pediatrics Emergencies and Neonatal SMUR), she was to the United States in order to complete her Master Degree in Public Health (2000). Then, she worked 2 years as Public Health Medical Specialist at CRED (Center for Research on the Epidemiology of Disasters), UCL, Brussels, Belgium. At the same time she made several missions to Cambodia for the Belgium Cooperation and some consultancies as Evaluator within the European Commission for INCO-DEV and INCO-MED programs.

From 2001 to 2003 she made regular consultancies for WHO Geneva in Switzerland (Geneva) on GAVI (Global Alliance for Vaccines & Immunizations); Chad (Tanjile), Mali (Bamako) and Indonesia (Djakarta, Bali and Iles de la Sonde) on Maternal and Neonatal Tetanus Elimination (MNTE) including Lot Quality Assurance Surveys (LQAS).

From January 2003 to July 2007 she worked as UNHCR Senior Regional Health/Nutrition/HIV – AIDS Co-ordinator for West Africa based in Sierra Leone (Freetown) and Ghana (Accra), then the Great Lakes Region based in Burundi (Bujumbura) and at least Chad – Darfour Emergency, based in Chad (Abéché).

Mid July 2007, she was appointed as Pediatrics Referent in MSF-CH to develop pediatrics vision, policy and strategic approach and to give adequate support to pediatrics fields. In April 2011, she took the coordination and leadership of the MSF International Pediatrics Working Group and early 2014 the coordination of the Mother, Neonatal and Child pool including nutrition.

She taught extensively (H.E.L.P Course, in MSF, UNHCR, Universities...) and participated actively in international congresses making some abstracts, publications, posters, and/or oral communications.

She contributed for many years to the work of Amnesty International against Torture, acting with the Medical Commission. After different professional affiliations, she is currently active member of the Target Advisory Group (TAG) of the International Pediatrics Association (IPA) on Children in Humanitarian Disasters, of the Partnership for Maternal, Newborn and Child Health (PMNCH) (WHO, UNICEF, Save The Children...) and of the Group of Tropical Pediatrics (Société Francaise de Pédiatrie).

She got certificates of recognition from CDC Atlanta, H.E.L.P Course and the UNAM of Nicaragua for her action in emergency settings and/or her contribution to the teaching.



After a pediatric specialization in Switzerland, I joined MSF OCG in 1999 for several field missions in Africa and Asia. I participated also to clinical studies in South Sudan and Myanmar. In 2005 I worked one year in Vietnam to help in the development of a neonatal project and I continue to follow up these activities.

Since 2006 I’m working 6 months a year with MSF and 6 months a year in the Pediatric Department of the University Hospital of Lausanne. Since 2011 I work with the Medical Department of MSF in Geneva and the Training Unit, performing formal training sessions, coaching, supervision and field visits in different countries of Africa, Asia and Haïti.

Dr. Jakob Zinsstag

Jakob Zinsstag graduated with a doctorate in veterinary medicine (Dr. med. vet.) on Salmonella diagnosis at the Veterinary Faculty of the University of Berne in 1986. After his studies he worked in rural practice and as post doctoral fellow on trypanosomiasis research at the Swiss Tropical Institute. From 1990 to end of 1993 he led a livestock helminthosis project for the University of Berne at the International Trypanotolerance Centre in The Gambia. From 1994 to 1998 he directed the Centre Suisse de Recherches Scientifiques in Abidjan, Côte d’Ivoire. Since 1998 he leads a research group at the Swiss Tropical and Public Health Institute (Swiss TPH) in Basel on the interface of human and animal health with a focus on health of nomadic people and control of zoonoses in developing countries under the paradigm of  “one medicine”. He holds a PhD in Tropical Animal Production from the Prince Leopold Institute of Tropical Medicine of Antwerp, Belgium. Since 2004 he is Assistant Professor and since 2010 Professor of Epidemiology at the University of Basel. He is a diplomate of the European College of Veterinary Public Health (ECVPH) and member of the scientific advisory board of the Prince Leopold Institute of Tropical Medicine of Antwerp, Belgium. Jakob Zinsstag has been elected president of the International Association for Ecology and Health in 2012.

Variation in Dietary Intake and Pre-eclampsia and Eclampsia in Indian women: Findings from the National Family Health Survey.

Author(s) Sutapa Agrawal1, Jasmine Fledderjohann2, David Stuckler3, Sukumar Vellakkal 4, Shah Ebrahim 5
Affiliation(s) 1South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, 2Deaprtment of Sociology, University of Oxford, Oxford, United Kingdom, 3Department of Sociology, Oxford University, Oxford, United Kingdom, 4SANCD, PHFI, New Delhi, India, 5Non communicable Disease Epidemiology, LSHTM, London, United Kingdom.
Country - ies of focus India
Relevant to the conference tracks Women and Children
Summary Pre-eclampsia/eclampsia is responsible for upwards of 20% of maternal morbidity and mortality in developing countries. We examine the relationship between food intake and symptoms of pre-eclampsia and eclampsia among Indian women aged 15-49 (n=39,657) for the most recent live birth in the five years preceding the National Family Health Survey-3 (2005-06). Daily consumption of milk, vegetables, chicken/meat and weekly pulses/beans consumption are associated with substantially lower risk of pre-eclampsia. Eclampsia risk is higher among those who consumed fruit and chicken/meat occasionally, and lower among those consuming vegetables daily.
Background Pre-eclampsia and eclampsia pose significant threats to maternal health, particularly in developing countries. In low-and middle-income settings, these two conditions affect approximately 8% of all pregnancies, causing an estimated 15%-20% of maternal morbidity and mortality. Pre­eclampsia is a life threatening complication of pregnancy that typically starts after the 20th week of gestation. Women with pre-eclampsia may present with symptoms such as headache, upper abdominal pain, or visual disturbances and have raised blood pressure, ankle oedema and proteinuria. When pre-eclampsia is left untreated or is severe, giving rise to seizures/convulsions which cannot be attributed to other causes (such as epilepsy), the condition is known as eclampsia. Although several studies have found that micronutrient deficiencies, such as iron, vitamin A, vitamin C, and calcium, contribute to pre-eclampsia risks, few studies have evaluated the potential role of different food types.
Objectives Existing nutritional evidence is highly variable. Dietary patterns may influence maternal antioxidant levels, mediating the link between pre-eclampsia and oxidative stress, an established risk factor. However, consumption of high-energy diets may increase risk of pre-eclampsia by inducing abnormal lipid metabolism, while consumption of dietary fibre may regulate these metabolic processes, thereby reducing risk. However, studies which have attempted to test these links empirically have not been conducted in high burden countries, nor have they employed appropriate multivariate models. To our knowledge, there has not been any previous large-scale report concerning the dietary risk factors for pre-eclampsia and eclampsia in Indian women. Here, we evaluate potential dietary risk factors of pre-eclampsia and eclampsia, using a large representative sample of Indian mothers in the third National Family Health Survey conducted during 2005-06.
Methodology Data were taken from the most recent wave of the National Family Health Survey (NFHS-3, 2005–2006), India’s Demographic and Health Surveys. NFHS-3 collected demographic, socioeconomic and health information from a nationally representative probability sample of 124,385 women aged 15–49. The sample is a multistage cluster sample with an overall response rate of 98%. All states of India are represented in the sample (except the small Union Territories), covering more than 99% of the country’s population. The analysis presented here focuses on 39,657 women in the sample who report being married and who have had a live birth in the five years preceding the survey. The survey was conducted using an interviewer-administered questionnaire in the native language of the respondent. To assess the occurrence of pre-eclampsia, mothers were asked if at any time during their last pregnancy they experienced relevant symptoms, including difficulty with vision during daylight, night blindness, convulsions (not from fever), swelling of the legs, body or face, excessive fatigue, or vaginal bleeding. Women who reported difficulty with vision during daylight, swelling of the legs, body, or face, or excessive fatigue were coded as having symptoms of pre-eclampsia, whereas those who reported experiencing convulsions (not from fever) were coded as symptomatic of eclampsia. Data on blood pressure and proteinuria during pregnancy were not available in the NFHS. Dietary intake variables were based on the self-reported frequency of consumption of milk or curd, green leafy vegetables, fruits, pulses and beans, eggs, fish, chicken or meat, categorised into daily, weekly, occasionally, or never. Potential confounders and covariates were selected on the basis of previous knowledge of their association with pre-eclampsia/eclampsia. We used multiple logistic regression to estimate the association between variation in dietary intake and pre-eclampsia and eclampsia risk after adjusting for maternal factors, biological and lifestyle factors and socio-demographic characteristics of the mothers. Models were adjusted for sampling weights (IIPS & Macro International 2007). All analyses were conducted using the SPSS statistical software package Version 19.
Results Overall 55.6% of mothers reported pre-eclampsia symptoms, and 10.3% reported eclampsia. Table 1 reports the results of our statistical models. After adjusting for maternal, biological, and chronic disease risk factors, as well as socio-demographic characteristics, we found that the risk of pre-eclampsia was significantly lower among women who consumed milk daily (OR:0.88;95%CI:0.81-0.96), green leafy vegetables daily/weekly (OR: 0.69 to 0.76), pulses or beans at least weekly/occasionally (ORs ranges from 0.84 to 0.92), fruits daily (OR:0.92), eggs weekly/occasionally, consumes fish (OR:0.90) or chicken/meat daily or occasionally, with added reference to those who never consumed them. However, a greater risk of pre-eclampsia was found among women consuming fruits weekly/occasionally (OR:1.11), eggs daily (OR:1.23) and fish weekly (OR:1.22). The risk of eclampsia was lower among those consuming green leafy vegetables (ORs ranges from 0.74 to 0.79), consuming fish weekly or occasionally (ORs ranges from 0.44 to 0.62), eggs weekly or occasionally (Ors ranges from 0.61 to 0.76), but was higher among those who consumed fruits (ORs ranges from 1.18 to 1.44), chicken/meat occasionally (OR:1.28;95%CI:1.11-1.48) with reference to those who never consumed them.
Conclusion Our study provides empirical evidence of an association between the frequency of intake of specific food items and prevalence of pre-eclampsia/eclampsia in a large nationally representative sample of Indian women. Findings suggest that variation in the frequency of consumption of specific foods has a substantial effect on the occurrence of symptoms suggestive of pre-eclampsia/eclampsia in this population. The strengths of our study include the large nationally representative study sample and the population-level focus on the predictors of pre-eclampsia and eclampsia. However, due to the general challenges of measuring hypertensive disorders in population-based studies, the information of the symptoms of pre-eclampsia and eclampsia presented here is based on self-reports and should therefore be interpreted with care. Although we adjusted for several confounding variables, we cannot exclude the possibility of residual confounding. In these analyses, the cross-sectional design precludes causal inferences and we were limited to the questions used to elicit lifestyle and dietary information. Few population level studies exist which assess the dietary determinants of pre-eclampsia and eclampsia. This study is important because few others have reported pre-eclampsia/eclampsia prevalence rates based on population-level data. Our study implicates that modifiable risk factors for pre-eclampsia/eclampsia exists and thus there is a need for replication of findings given that the dietary patterns are modifiable. Our study findings may serve as an important call for health care providers to heighten their awareness of the increased population-level risk for pre-eclampsia and eclampsia disease originating in pregnancy. With the target of the Millennium Development Goals in sight, pre-eclampsia/eclampsia should be identified as one of the priority areas in reducing maternal mortality in India. However, further research involving the use of a more comprehensive dietary measure, pre-pregnancy assessment of all the risk factors and ascertainment of dietary intake prior to the development of pre-eclampsia and eclampsia and accuracy of reporting of the symptoms of pre-eclampsia and eclampsia are needed in a developing country setting.

Cataloguing New York City Legislation Relevant to Chronic Disease Prevention, 2002-2013.

Author(s) Brennan Rhodes-Bratton1, Gina Lovasi2, Ryan Demmer3
Affiliation(s) 1Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health , New York , United States, 2Department of Epidemiology, Columbia University, Mailman School of Public Health , New York, United States, 3Department of Epidemiology, Columbia University, Mailman School of Public Health , New York, United States.
Country - ies of focus United States
Relevant to the conference tracks Governance and Policies
Summary The overall aim of this project is to systematically detail the timing and substance of health-relevant New York City (NYC) policies and initiatives from 2002-2013. This is the initial phase of research proposing to evaluate the effectiveness of these efforts in reducing chronic disease morbidity and mortality rates. Local governments around the United States have taken policy action to mitigate the adverse effects of health determinants beyond the health care sector, such as tobacco smoke, physical inactivity, low dietary quality, and air pollution. NYC has been at the vanguard of municipal efforts to decrease the chronic disease using a multi-sectorial approach.
Background Chronic diseases represent the leading causes of death and disability among developing and developed nations (Yach et al, 2004; Beaglehole & Bonita, 2008). Among the most deadly chronic diseases, are atherosclerotic cardiovascular disease (CVD) and cancer, accounting for >65% of global mortality in 2002. This is projected to remain stable through the year 2020 at which point CVD and cancer together will account for nearly 40 million global deaths – nearly twice the number of deaths projected due to injuries and infectious disease combined (Yach et al, 2004). Respiratory diseases including emphysema and chronic obstructive pulmonary disease (COPD) are projected to become the third most common cause of death by 2020, accounting for another 10% of global mortality. It is well established that leading modifiable risk factors for chronic disease development include tobacco use, excess adiposity, low dietary quality, and exposure to particulate air pollution. The increasing concentration of populations in urban centres, while previously discussed as potentially contributing to risk (Vlahov, 2002), also represents an opportunity to enhance the public’s health through the enactment of local health promotion efforts in densely populated cities such as New York City.
Objectives Over the past twelve years, NYC has been led by the Michael Bloomberg administration, which has prioritized public health initiatives in response to the chronic disease burden of New Yorkers. Bloomberg worked closely with Health Commissioners, but the efforts were not limited to Department of Health and Mental Hygiene. A variety of governmental approaches including taxation, regulation, marketing/advertising campaigns, and infrastructure investments were proposed and implemented throughout the five boroughs. If the Bloomberg administration significantly decreased the chronic disease burden of the city dwellers, such policies can guide the nation to similar results. Currently, a comprehensive catalogue of all health-related NYC policy proposals, enacted laws and implemented initiatives does not exist.The aim of this research project was to systematically catalogue the nature and deployment of policies and initiatives relevant to public health. We will specifically focus on policies and programs enacted in NYC during the Bloomberg Administration, 2002-2013, related to the following four chronic disease risk factors: 1) tobacco, 2) obesity, 3) diet quality, and 4) air quality.
Methodology This study identifies policies and initiatives relevant to public health proposed and enacted in NYC. Specifically, it addresses the following research questions: (1) How many policies and initiatives related to public health were proposed and enacted in NYC legislation during 2002-2013 (2) Which local governmental agencies and departments were involved in the enact of such efforts.The systematic development of the catalogue of relevant policies and initiatives was generated in three phases. First, online state and city legislative record portals (,, and the PubMed database have been used with search terms for each of the selected chronic disease risk factors. Secondly, the searches were narrowed by selecting specific terms for each of the four chronic disease risk factors. For example, when searching legislation in regards to air pollution, the following terms, (air quality, air pollution, and greenhouse gases) were systematically used to provide consistency and a thorough assessment of relevant policies. Lastly, the search was restricted to include only the years of 2002-2013, the Bloomberg Administration’s term in office. The final catalogue includes the policy legislation number, date created, date enacted (if applicable), data enforced (if applicable), current status (as of August 2013), the primary agency that sponsored the bill, and a brief description. Note only citywide policies and regulations were included in the final catalogue.
Results Overall during 2002-2013 there were a total of 113 policies relevant to public health that were introduced and 33 enacted. Legislation that reduced the risk factor of tobacco included 33 introduced and 7 enacted policies. The New York City Council’s committee of health sponsored the majority of this legislation. The most notable legislated passed includes: Smoke Free Act of 2002, Cigarette Tax Increase, Smoking Ban at Abatement Sites, Smoking Ban at Construction Sites, Smoking Ban at Hospitals, Tobacco Product Regulation, and Smoke Free Act of 2002 (Amendment). Legislation that reduced the risk factor of air quality included 32 introduced and 12 enacted policies. The New York City Council’s committee of environmental protection sponsored the majority of this legislation. The most notable legislation passed includes: Use of clean heating oil in New York City, Requiring retrofitting and the use of ultra-low sulphur diesel fuel for school buses that transport fewer than 10 students at one time, and City's purchase of cleaner vehicles. Legislation that reduced the risk factor of physical activity included 13 introduced and 2 enacted policies. The New York City Department of Health and Mental Hygiene sponsored the majority of this legislation. The most notable initiatives include the increase of bike lanes throughout the city as well as the Citi Bike public bike sharing system. Legislation that reduced the risk factor of diet quality included 35 introduced and 12 enacted policies. The New York City Council’s committee of health sponsored the majority of this legislation. The most notable legislated proposed was the Sugary Drink Size Ban and Minimally nutritious food ban in schools. The most notable legislation passed includes Maximizing the enrolment of eligible New Yorkers in the food stamp program and the Trans fats ban.The process of developing the catalogue of public health related polices and initiatives is limited by the information that was available on the online city and state portal as of August 2013. In addition, some citywide initiatives were programs that did not require legislation thus those projects and programs are not included in the presented catalogue. Moreover, at this time the health outcome data has not been analysed thus it is not possible to quantify the impact of such polices on the health of New Yorkers which is our overall goal.
Conclusion This initial effort has highlighted that changing temporal trends in chronic disease outcomes may be attributed to one or many of the concurrent efforts, and evaluations of any one approach should be at once cautious and clever. The catalogue presented is the preliminary phase of an on-going research project to identify the magnitude and effect municipal policies impact health outcomes. Our future research includes strategies to place the temporal patterns of legislation relevant to each risk factor (Figure 2) in the broader context of other local or citywide efforts. Through this work, it will be possible to describe the cumulative “dose-response” relationship of municipal policy initiatives with population health outcomes. Strategies are also proposed using outcome specificity, differential latency periods, and multiple control comparisons that may help us to distil some evidence on the relative effectiveness of particular policies or risk factor targets. Further, we hope through an examination of scientific citation networks to shed light on the evidence base supporting such efforts. This consensus building analysis aims to provide a clearer picture of the stages at which scientific knowledge may inform decision-making, and the opportunities for municipal policies to serve as natural experiments to foster the generation of new scientific knowledge. Upon the completion of this research information about how local policies are developed, implemented can be applied to the future development of disease prevention polices.

Inequalities in health care utilization in Mexico.

Author(s) Christine Göppel1, Linus Grabenhenrich2, Peter Tinnemann3.
Affiliation(s) 1Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany, 2Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany, 3Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany.
Country - ies of focus Mexico
Relevant to the conference tracks Social Determinants and Human Rights
Summary Mexico´s way towards Universal Health Coverage: Are the Mexican poor still at a disadvantage in health care utilization?
Background The cornerstone of the Mexican health reform towards Universal Health Coverage is the 2003 introduction of a voluntary Popular Health Insurance (Seguro Popular). It aims to ensure access to health care services for vulnerable population groups and to address inequities in health care utilization for those facing financial hardship through sickness.
Objectives To quantify the Mexican health reforms success we identified the characteristics of population subgroups that contribute attributably to disparities in health care utilization of older adults and evaluated socio-economic inequities considering the distribution of needs for health services across the income groups.
Methodology Data of the WHO “Study on global AGEing and adult health” (SAGE) Wave1, conducted 2009/10 in Mexico, was examined for determinants of health care utilization. The concentration curve and index of health care utilization were used to measure socioeconomic inequalities in health care utilization and standardized for health needs to assess inequities in health care utilization.
Results Among the SAGE Wave1 participants from Mexico, less than half of the population saw a doctor in the 12 months prior to the survey. Income is by far the strongest determinant of an older person´s probability of using health care services. Other associated factors are chronic conditions, rural residence and education of the household head respectively. Achieved access of health care services is concentrated on the richer quintiles of the population. Poor population subgroups use outpatient services less frequently, despite presenting worse health conditions. Pro-rich-inequalities in health care service utilization appear as a matter of inequity and reflect, at least partly,  inequitable distribution of health care services utilization.
Conclusion The study measures specific indicators of the Mexican health system performance as it moves towards Universal Health Coverage. Ongoing socio-economic inequalities in health care utilization are confirmed. No evidence is found that insurance coverage increases health care utilization among the elderly poor. Mexican health policy makers should address prevailing financial obstacles and improve policies to further promote equitable and sustainable access to health services.

Health-Related Quality of Life in Adults with Metabolic Syndrome: A Systematic Review and Meta-Analysis

Author(s) Asiandi Asiandi1, Miaofen Yen2
Affiliation(s) 1Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Tainan City, Taiwan, 2Department of Nursing and Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
Country - ies of focus Indonesia
Relevant to the conference tracks Chronic Diseases
Summary This study found new evidence in the measurement of health related quaity of life in adult with metabolic syndrome (MetS). The main result found that there was a difference in HRQoL results measuring with SF-36 and EQ-5D and EQ-VAS.
Background The interrelationship between metabolic syndrome (MetS) and risk of diseases has consequences in that the impaired health-related quality of life (HRQOL) can become a burden.
Objectives The objective of this review was to estimate the HRQOL in adults with MetS measured with SF-36 and EQ-5D/EQ-VAS.
Methodology This systematic review and meta-analysis was conducted by following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) as a guideline. Articles published from 1983 to 2013 were searched from four databases: PubMed, Medline (Ovid), Scopus, and Web of Science. Two reviewers independently assessed the eligibility of the studies for inclusion in the review on the basis of the strength and quality of articles and extracts of eligible studies.
Results The seven studies which met the criteria of appraisal were included in the systematic review and meta-analysis. All of studies included used a cross-sectional study design with the quality of the evidence A or high quality (n = 3) and B or good quality (n = 4). Based on inverse variance of random effect model test, the results showed that four of SF-36 domains in HRQOL measurements were not significant in heterogeneity (physical functioning, general health, social functioning, and physical components summary), however showed a significant in effect size. Conversely, other SF-36 domains (role emotional, role physical, body pain, vitality, mental health, and mental component summary) showed a significant heterogeneity but did not illustrate a significant effect size. Overall, MetS was associated with significantly reduced HRQOL measured using SF-36 (SMD -0.23; 95% CI -0.29, -0.17; pp <0.00001). Test of heterogeneity was significant (I2 = 72%; p < 0.00001). However, the test for subgroup differences was not significant (I2 = 1.3%; p = 0.43).  MetS was not associated with significantly reduced EQ-5D (SMD -5.65; 95% CI -16.06, 4.43; p = 0.27) with a significant high heterogeneity (I2 = 100%; p <0.00001). Similarly, MetS was not associated with significantly reduced EQ-VAS (SMD -5.63; 95% CI -16.29, 5.02; p = 0.30) with a significant high heterogeneity (I2 = 100%; p <0.00001).
Conclusion The evidence illustrated that MetS was associated with significantly reduced HRQOL measured using SF-36. However, MetS was not associated with significantly reduced HRQOL measured using EQ-5D and EQ-VAS. The greater heterogeneity in this meta-analysis has confirmed the need to avoid the generalizability of study results.

Community Case Management of Malaria in Trained Role Model Caregivers of Under Fives, Kaduna Northwestern Nigeria

Author(s) Aisha Ahmed Abubakar1, Kabir Sabitu2, Andreas Jansen3, Nykiconia Preacely 4, Mu'awiyya Sufiyan 5, Suleman Hadejia Idris6, Ikeoluwapo Ajayi7.
Affiliation(s) 1Department of Community Medicine, Faculty of Medicine, , Ahmadu Bello University/ African Program for Advanced Research Epidemiology Training, Zaria, Nigeria, 2Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria, 3Scientific Advice Co-ordination Section, European Centre for Disease Control and Prevention, Stockholm, Sweden, 4Division of Global Health, Centres for Disease Control and Prevention, Atlanta, United States, 5Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria, 6Department of Community Medicine, Ahmadu Bello University Zaria, Zaria, Nigeria, 7Department of Epidemiology and Biostatistics, University of Ibadan, Ibadan, Nigeria.
Country - ies of focus Nigeria
Relevant to the conference tracks Infectious Diseases
Summary Use of Role Model Caregivers for Community Case Management of Malaria achieved the 80% treatment target of malaria within 24 hours of onset of symptoms. Continuing training and supervision are necessary for correct dosage to be given.
Background Malaria is Africa’s leading cause of under five mortality, constituting 10% of the overall disease burden. A major strategy for reducing the burden of malaria is prompt access to effective antimalarials. Community Case Management of malaria (CCMm) can be used to achieve the 80% treatment target of uncomplicated malaria within 24 hours of the onset of symptoms. CCMm aims to train selected community members to recognize symptoms of malaria and give appropriate early and prompt treatment.
Objectives This study was conducted to assess CCMm in trained Role Model caregivers (RMCs) of under fives in Kaduna state, Nigeria.
1. To assess knowledge of malaria amongst role model caregivers trained in CCMm trained in Kaduna state
2. To assess treatment practices of malaria in CCMm trained role model caregivers in Kaduna state
3. To assess the relationship between knowledge and treatment practices of malaria in CCMm trained role model caregivers in Kaduna state
Methodology • What is the current knowledge of malaria in Community Case Management of malaria trained role model caregivers in Kaduna state?
• What are the malaria treatment practices of CCMm trained role model caregivers in Kaduna state?A descriptive cross sectional survey was conducted in Kaduna state. A sample of 308 RMCs were selected by multistage sampling and interviewed using a standardized questionnaire. The questionnaire had questions on sociodemographics, malaria transmission and treatment. Focus Group Discussions with RMCs were also conducted.
Results Mean age of RMCs was 35.34 years (±8.67). Females were 294(95.5%) and 285(92.5%) were literate. Out of 308, 294 (95.5%) correctly identified malaria was transmitted by mosquitoes. Two hundred and sixty three (85.4%) RMCs had treated a child under five years in the two weeks preceding the survey. Age range of children treated for malaria was 4-59 months, mean 26.9 months (±12.41). Out of 263 children, 232 (88.2%) received the correct dose of antimalarials and 220(84.3%) were treated within 24 hours of onset of symptoms. Level of education and literacy level were not significantly found to affect receiving the correct dose of antimalarials.
The baseline knowledge of the trained role model caregivers is not available so change in knowledge cannot be assessed
Conclusion Use of RMCs achieved the 80% treatment target of malaria within 24 hours of onset of symptoms. Continuing training and supervision are necessary for correct dosage to be given. The results would be disseminated to the Kaduna state Malaria Control Program and the Department of Public Health of the Kaduna state Ministry of Health.