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    • The study reported high rates of antimicrobial resistance

    2019-06-06

    The study reported high rates of antimicrobial resistance and also reminds us of the paucity of new drugs to treat such infections, especially in neonates, as well as the paucity of data on antimicrobial pharmacokinetics in this population. Observational and interventional multicentre studies are needed to establish the safety and efficacy of new regimens and THZ531 (targeted at antimicrobial-resistant pathogens) compared with existing combinations, together with new strategies for using them wisely. Further study in low-income and middle-income countries is required and the DeNIS collaboration is a landmark step in this direction.
    In August, 2016, the Global Body-Mass Index (BMI) Mortality Collaboration published their work on BMI as a predictor of all-cause mortality. The investigators pooled individual participant data from 239 prospective studies, with none originating from Latin America or Africa. About two years ago, the Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration investigated the metabolic mediators of the effect of BMI on cardiovascular diseases using individual participant data from 97 prospective cohorts, including one cohort from Latin America. Despite these low numbers for Latin America and Africa, the NCD Risk Factors Collaboration reported the trend in adult BMI between 1975 and 2014 pooling individual participant data from 1698 population-based cross-sectional studies, including several from Latin America and Africa. The aforementioned studies are remarkable examples of ongoing global efforts to pool data to support more robust studies and to address globally relevant research questions. However, Latin America and Africa seem less accounted for in these efforts, so the resulting findings, particularly those from prospective studies, are less representative of the situation in these parts of the world. This Letter aims to make a global call to investigators in Latin America and Africa who have done or are doing population-based prospective studies, as well as cross-sectional studies, to join the efforts in individual participant data pooling. The resulting big data would provide much valuable information at the regional level and expand the current global knowledge. This effort should not apply only to BMI or non-communicable disease, but should also extend to all other medical research fields.
    In 2014, 306 polio cases were reported across Pakistan, which dropped to only 54 in 2015 and 16 as of Nov 16, 2016, in contrast to the 40 cases reported by the same time in 2015. The proportion of reported cases originating from the Federally Administered Tribal Areas (FATA), a WHO-declared polio-endemic block, has declined from 179 [58%] out of 306 in 2014 to 16 [30%] out of 54 in 2015 and 2 [5%] out of 40 as of Nov 16, 2016. These statistics show a heartening trend towards polio eradication in the largest remaining reservoir of the polio virus. Effective nationwide policies featuring improved immunisation infrastructures and increased awareness of polio and its prevention have accounted for the declining number of polio cases. A major hindrance to effective immunisation campaigns was the religious conservatism amongst some civilians, particularly in the FATA. In 2015, Pakistan\'s government arrested 471 non-conforming parents in a bid to coerce them into vaccinating their children, which would have increased resentment towards vaccination drives. Thankfully, this policy was replaced with counselling and peaceful persuasion of parents by enlisting the support of local clerics and religious scholars, who have been endorsing polio vaccination in their Friday sermons and accompanying health workers on polio drives to convince hesitant parents about vaccination. Due to the Taliban\'s killing of health workers, polio eradication teams were reluctant to tour high-conflict zones for vaccination drives. That is a major reason why peripheral zones of the country have remained inaccessible to immunisation campaigns. Although terrorism is still a looming threat, as evident by the suicide bombing outside a polio vaccination centre in Quetta in January, 2016, the army offensive launched against the militants and revamped security measures for polio teams have enabled health workers to become more actively engaged; the accessibility of remote areas has also improved. Furthermore, the Punjab Government has started using a smartphone application to register immunisations, collect and assess data regarding actual vaccinations, monitor dosages delivered to each child, and send out reminders to parents to notify them of the date of follow-up immunisations.