Onchocerciasis in the Cameroon-Chad border area after more than 20 years of annual mass ivermectin distribution

BACKGROUND

The main vectors of onchocerciasis in Africa are Simulium damnosum sensu lato, which transmit the causative agent Onchocerca volvulus. The force of transmission is driven by the vector density, hence influencing the disease prevalence and intensity. Onchocerciasis is currently targeted for elimination using mass drug administration (MDA) of ivermectin, a potent microfilaricide. MDA in Cameroon began in 1987 in the Vina Valley, an endemic cross-border area with Chad, known for high vector densities and precontrol endemicity. Evaluations in 2008-2010 in this area showed ongoing transmission, while border areas in Chad were close to interrupting transmission. This study aimed to evaluate transmission in this area after several rounds of MDA since the last evaluation surveys.

METHODS

Black flies were collected by human landing catches at seven border sites in Cameroon, twice a week, from August 2021 to March 2022. A fraction of the flies was dissected for parity assessment and identification of Onchocerca larval stages. The transmission indices were estimated. Black fly larvae were also collected from the breeding sites at the fly catching sites and identified to species level by cytotaxonomy.

RESULTS

A total of 14,303 female flies were collected, and 6918 were dissected. Of these, 4421 (64.0%) were parous. The total biting rates were high, reaching up to 16,407 bites/person/study period, and transmission potential (third-stage larvae (L3) from head/all L3) were 367/702, 146/506, 51/55, 20/32, 0/3, 0/0, and 0/0 infective larvae/person, respectively, for Mbere-Tchad, Babidan, Hajam/V5, Gor, Djeing, Touboro, and Koinderi. Infectivity rates (L3 from head) were 16.00, 12.75, 5.15, and 4.07 infective females (L3H)/1000 parous flies for Haijam, Mbere-Tchad, Babidan, and Gor, respectively. These values exceed the World Health Organization (WHO) thresholds of ≤ 20 annual transmission potential (ATP) or < 1 infective female/1000 parous females. The major vectors identified were Simulium damnosum sensu stricto, S. squamosum, and for the first time in the area, S. yahense.

CONCLUSIONS

More than 20 years of MDA has not eliminated onchocerciasis in the study area; hence, this area is a potential source of reintroduction of onchocerciasis in Chad and would require alternative treatment strategies. Many factors such as MDA efficiency, effectiveness of ivermectin, and cytospecies composition may be contributing to transmission persistence.

European policies for public health in border regions: no European mindset as yet

BACKGROUND

The sudden emergence of COVID-19 in 2020 demonstrated that Europe was not prepared for a public health crisis like this pandemic. In the European Union, matters of health have remained primarily under the jurisdiction of individual Member States. However, certain events, such as the Kohll-Decker ruling on free mobility of health services and the COVID-19 pandemic, compelled the EU to address health matters in border regions. This study examines how EU policies address public health in border regions. To that end, we have drawn from border studies, a field that provides insight into the fluidity and complexity of borders in everyday life. Besides that we used constructivist policy studies as a lens for the analysis of EU policy documents.

METHODS

A policy discourse analysis was conducted to explore how European policy addresses the development of a transnational, European public health in border regions. Key European policy documents published between 2002 and 2027 were analysed to understand how policies are constructed and problems are framed. The analysis was guided by research questions and the theoretical approach.

RESULTS

The analysis reveals that, while having limited competences in the field of health care, the EU is slowly developing a rationale and a knowledge base to increase its competences in health care. It also shows that in the field of public health, the EU argues for addressing health determinants and promoting healthy lifestyles, though it does not address health promotion in border regions. The EU's authority in public health in border regions revolves primarily around addressing physical, biological and chemical threats rather than social health problems.

CONCLUSION

Though the EU has carefully developed a transnational perspective on health care, the EU has not developed any authority with respect to transnational public health. Though public health and health promotion in border regions have been confronted with specific challenges, neither specific Member States nor the EU have a transnational collaborative perspective that does justice to the characteristics of border regions. When it comes to public health in border regions, there is no European mindset as yet.

Attribution of fine particulate matter and ozone health impacts in Canada to domestic and US emission sources

Exposure to ambient air pollution is associated with a wide range of adverse health effects such as respiratory symptoms, cardiovascular events, and premature mortality. Canada and the United States (US) have worked collaboratively for decades to address transboundary air pollution and its impacts across their shared border. To inform transboundary air quality considerations, we conducted modelling to attribute health impacts from ambient PM2.5 and O3 exposure in Canada to Canadian and US emission sources. We employed emissions, chemical transport, and health impacts modelling for 2015, 2025, and 2035 using a brute-force modelling approach whereby anthropogenic domestic and US emissions were reduced separately by 20 % or 100 %, and the resulting changes in health impacts were estimated across Canada. We find that transboundary PM2.5 and O3 related health impacts vary widely by region, with >80 % of impacts occurring in Central Canada, and most health impacts occurring within 200-300 km of the Canada-US border. The relative contribution of US sources to O3 in Canada is larger than for PM2.5, yet we find that the health impacts from transboundary PM2.5 exceeded those from transboundary O3. Nationally, we estimate that roughly one in five PM2.5 deaths in Canada is attributable to US sources (2000 deaths in 2015) and more than one in two O3 deaths are attributable to US sources (roughly 800 to 1200 deaths in 2015). We project health impacts from domestic and US sources to increase from 2025 to 2035 in Canada. Our results suggest that there are substantial benefits to be gained by domestic and international strategies to reduce PM2.5 in the Canada-US transboundary region.

Cross-border simulation training for German and Polish emergency medical teams is feasible: conception and evaluation of a bilingual simulation training

BACKGROUND

Cross-border cooperation of emergency medical services, institutions and hospitals helps to reduce negative impact of national borders and consecutive discrimination of persons living and working in border regions. This study aims to explore the feasibility and effectiveness of a cross-border bilingual simulation training for emergency medical services within an INTERREG-VA-funded project.

METHODS

Five days of simulation training for German and Polish paramedics in mixed groups were planned. Effectiveness of training and main learning objectives were evaluated as pre-post-comparisons and self-assessment by participants.

RESULTS

Due to COVID-19 pandemic, only three of nine training modules with n = 16 participants could be realised. Cross-border-simulation training was ranked more positively and was perceived as more useful after the training compared to pretraining. Primary survey has been performed using ABCDE scheme in 18 of 21 scenarios, whereas schemes to obtain medical history have been applied incompletely. However, participants stated to be able to communicate with patients and relatives in 10 of 21 scenarios.

CONCLUSION

This study demonstrates feasibility of a bilingual cross-border simulation training for German and Polish rescue teams. Further research is highly needed to evaluate communication processes and intra-team interaction during bilingual simulation training and in cross-border emergency medical services rescue operations.

Distributed rights protection: The 2000 Hague Convention on the International Protection of Adults and the challenge of securing fundamental rights across borders

The 2000 Hague Convention on the International Protection of Adults ('the 2000 Convention') entered into force on 1 January 2009, is cast as a private international law convention (i.e. one providing tools to minimise procedural, debates about cross-border matters affecting individuals). However, in little-known, and even less explored fashion, it has significant implications for the exercise of both administrative and legal powers by States over those in their territory in zones that are conventionally held close to the metaphorical heart of State power, for instance those experiencing mental ill health, or with impaired decision-making capacity. Even less explored are the consequences for the individuals at the centre of such situations, in particular as regards the protection of their fundamental rights. As we examine in this paper, focusing on both problems of abduction and of cross-border placement into circumstances of deprivation of liberty, such protection has to be distributed between jurisdictions; we suggest that this is a phenomenon which requires to be addressed in a transparent fashion, so that all concerned can be clear as to the implications for its effectiveness.

An observational study with cross-border German-Polish training

Aim of study

This study aims to investigate feasibility and quality of a bilingual cardiopulmonary resuscitation training with interprofessional emergency teams from Germany and Poland.

Methods

As part of a cross-border European Territorial Cooperation (Interreg-VA) funded project a combined communication and simulation training was organised. Teams of German and Polish emergency medicine personnel jointly practised resuscitation. The course was held in both languages with consecutive translation.Quality of chest compression was assessed using a simulator with feedback application. Learning objectives (quality of cardiopulmonary resuscitation, adherence to guidelines, closed loop communication), and team performance were assessed by an external observer. Coopeŕs Team Emergency Assessment Measure questionnaire was used.

Results

Twenty-one scenarios with 17 participants were analysed. In all scenarios, defibrillation and medication were delivered with correct dosage and at the right time. Mean fraction of correct hand position was 85.7% ± 25.7 [95%-CI 74.0; 97.4], mean fraction of compression depth 75.1% ± 21.0 [95%-CI 65.6; 84.7], compression rate 117.7 min-1 ± 7.1 [95%-CI 114.4; 120.9], and chest compression fraction 83.3% ± 3.8 [95%-CI 81.6; 85.0].Quality of cardiopulmonary resuscitation was rated as "fair" to "good", adherence to guidelines as "good", and closed loop communication as "fair". Bilingual teams demonstrated good situational awareness, but lack of leadership and suboptimal overall team performance.

Conclusion

Bilingual and interprofessional cross-border resuscitation training in German and Polish tandem teams is feasible. It does not affect quality of technical skills such as high-quality chest compression but does affect performance of non-technical skills (e.g. closed loop communication and leadership).

A data set of the crackdown on cross-border wildlife crimes in China, 2014-2020

Wildlife crimes that involve smuggling threaten national security and biodiversity, cause regional conflicts, and hinder economic development, especially in developing countries with abundant wildlife resources. Over the past few decades, significant headway has been made in combating wildlife smuggling and the related illegal domestic trade in China. Previous studies on the wildlife smuggling trade were mostly based on customs punishment and confiscation data. From the China Judgments Online website, we retrieved cases related to cross-border wildlife and wildlife products smuggling from 2014 to 2020. A total of 510 available cases and 927 records for more than 110 species were registered. We thoroughly studied each judgment and ruling file to extract information on cases, defendants, species, sentences, and origins and destinations of wildlife and wildlife products. Furthermore, frequency of origin-destination place occurrences and spatial patterns of cross-border wildlife crime in China were shown in this data paper. The main purpose of our data set is to make these wildlife and wildlife products trade data accessible for researchers to develop conservation studies. We expect that this data set will be valuable for network analysis of regional or global wildlife trafficking, which has attracted global attention. There are no copyright restrictions on the data; we ask that researchers please cite this paper and the associated data set when using the data in publications.

Regional industrial growth and biopharma patent networks: empirical insights from the UK

The COVID-19 pandemic has once again brought the significance of biopharmaceutical and medical technology sectors to the spotlight. Seeing that some of the most critical medical breakthroughs such as the speedy mRNA vaccine development were results of cross-border patenting collaboration, we have proposed in a previous work a new method to identify the cross-border collaborative regional centres in the patent networks, using a clustering comparison approach based on adjusted mutual information (AMI). In this paper, we focus on the UK industrial landscape. We use the UK bioscience and health technology sector statistics from 2015 to 2020 and look into the regional growth of each postcode area. We compare the top growth regions with the cross-border collaborative centres identified using AMI comparison at the postcode area level, and find that both long-term and short-term AMI gains show an increase in the correlation with regional annual growth rates of firm numbers in the studied sectors from 2016 to 2020, and the increase is more consistent with the short-term AMI gain. We also found that areas more central in the long-term cross-regional R&D collaboration demonstrate a stronger association with more developed industrial settings indicated by more firms and, potentially more employment and turnover in the field. However, AMI gains are found to have negative correlations with the industrial growths as a sign of possible trade-offs of being central.

Development of a mechanism for the rapid risk assessment of cross-border chemical health threats

BACKGROUND

Chemical incidents can result in harm to public health and the environment. Although most are localised and have little impact, some affect wide areas, a range of sectors and may lead to many casualties. A public health response to assess the risks and provide advice to authorities and the public is usually required. In some cases, incidents may affect more than one country and require effective cross-border communication and coordination.

OBJECTIVE

We describe tools and mechanisms to improve health security from cross-border chemical health threats and to support the implementation of the Decision of the European Parliament and the Council of the European Union (EU) on serious cross-border threats to health (Decision 1082/2013/EU).

METHODS

Experts were recruited to a network and their suitability was assessed by using a skills framework. Input by relevant stakeholders such as the World Health Organisation and the European Centre for Disease Prevention and Control, followed by EU-wide exercises, ensured that tools developed were fit for purpose.

RESULTS

A network of public health risk assessors and a methodology for providing rapid independent expert public health advice during a chemical emergency have been developed.

SIGNIFICANCE

We discuss the legacy of these mechanisms including their incorporation into the working arrangements for the EU Scientific Committee for Health, Environment and Emerging Risks and future developments in the field.

Monitoring the distribution of euro coins across borders (2002-2010): A dataset on the contents of 22,500 European citizens' wallet

The Euro Spatial Diffusion Observatory (ESDO) database records face-to-face questionnaire surveys conducted between March 2002 and December 2011 in France, in December 2003 in Belgium and in December 2005 in Germany. The data provides information on the coins contained in the respondents' wallets at the time of the survey, classified by country of origin and value. A series of control variables provide information on the socioeconomic profile of the respondents and the location of their place of residence at the NUTS 3 level. In total, more than 22,500 people opened their wallets and about 300,000 coins were registered allowing the tracking of euro coins circulation from their country of introduction on January 1, 2002 (or later for countries that joined the euro zone afterwards) to their place of observation at the time of the survey.

5G connected and automated driving: use cases, technologies and trials in cross-border environments

Cooperative, connected and automated mobility (CCAM) across Europe requires harmonized solutions to support cross-border seamless operation. The possibility of providing CCAM services across European countries has an enormous innovative business potential. However, the seamless provision of connectivity and the uninterrupted delivery of real-time services pose technical challenges which 5G technologies aim to solve. The situation is particularly challenging given the multi-country, multi-operator, multi-telco-vendor, multi-car-manufacturer and cross-network-generation scenario of any cross-border scenario. Motivated by this, the 5GCroCo project, with a total budget of 17 million Euro and partially funded by the European Commission, aims at validating 5G technologies in the Metz-Merzig-Luxembourg cross-border 5G corridor considering the borders between France, Germany and Luxembourg. The activities of 5GCroCo are organized around three use cases: (1) Tele-operated Driving, (2) high-definition map generation and distribution for automated vehicles and (3) Anticipated Cooperative Collision Avoidance (ACCA). The results of the project help contribute to a true European transnational CCAM. This paper describes the overall objectives of the project, motivated by the discussed challenges of cross-border operation, the use cases along with their requirements, the technical 5G features that will be validated and provides a description of the planned trials within 5GCroCo together with some initial results.

A participatory approach to address within-country cross-border malaria: the case of Menoreh Hills in Java, Indonesia

BACKGROUND

Malaria remains a significant public health issue in Indonesia. Most of the endemic areas are in the eastern parts of Indonesia, but there are a few remaining foci of persistent endemic malaria in Java, particularly in Menoreh Hills, a region bordering three districts of two provinces on this island. Despite a commitment to build a partnership to eliminate cross-border malaria, there is a lack of understanding of how this partnership might be translated into an implementable strategic plan. The study aims to provide evidence of how a participatory approach was used to strengthen the cross-border collaboration and stakeholders' capacity to develop a joint strategic, operational, and costing plan for cross-border malaria elimination.

METHODS

A participatory action research was conducted from January to August 2017, involving participants from the village, district, provincial, and national levels. This study was conducted in seven phases, including document review, focus group discussions (FGDs), planning and costing workshops, and a dissemination meeting. A total of 44 participants from primary health centres (PHC) and 27 representatives of affected villages in three districts, 16 participants from the district and provincial malaria programmes and planning bureaus, and 11 participants from the national level were involved in the processes. Data on priority issues, costing, programme coverage, and administration were collected. Thematic coding and feedback were used for analysis.

RESULTS

Problems identified by stakeholders included low community awareness and participation in malaria prevention, high mobility across three districts, lack of financial and human resources, lack of inter-district coordination, and poor implementation of migration surveillance. Cross-border strategies identified to address malaria were improving cross-border migration surveillance, strengthening the network, governance, and advocacy of malaria control implementation across borders, and developing the malaria information system. A working group composed of the three districts' representatives authorized to decide on cross-border issues will be created.

CONCLUSIONS

The participatory approach was applicable in cross-border malaria planning for within-country settings and useful in enhancing stakeholders' capacities as implementers. While done in a participatory way, the joint plan crafted was a non-binding agreement; stakeholders should advocate to ensure adequate funds are poured into mobilizing the programme.

Educating, training, and exercising for infectious disease control with emphasis on cross-border settings: an integrative review

INTRODUCTION

Points of entry and other border regions educate, train, and exercise (ETEs) their staff to improve preparedness and response to cross-border health threats. However, no conclusive knowledge of these ETEs' effectiveness exists. This study aimed to review the literature on ETEs in infectious disease control concerning their methods and effect, with an emphasis on cross-border settings and methods that enlarge ETEs' reach.

METHODOLOGY

We systematically searched for studies in the databases Embase, Medline, Web of Science, PsycInfo, ERIC, and Cinahl. After successively screening titles and abstracts, full-texts, and citations, 62 studies were included using in- and exclusion criteria. Data were extracted using a data-extraction form. Quality assessment was performed. We developed a theoretical framework based on which we analyzed the ETE context (target group, recruitment, autonomy, training needs), input (topic, trainers, development and quality of materials), process (design, duration, interval, goals), evaluation (pre-, post- follow-up tests), and outcome (reaction, learning, behavior, and system).

RESULTS

We found a limited number of published evaluations of ETEs in general (n = 62) and of cross-border settings (n = 5) in particular. The quality assessment resulted in seven ETE methodologies and 23 evaluations with a 'good' score. Both general studies and those in a cross-border setting contain a low-moderate detail level on context, input, and process. The evaluations were performed on reaction (n = 45), learning (n = 45), behavior (n = 9) and system (n = 4), mainly using pre- and post-tests (n = 22). Online learning methods have a high potential in enlarging the reach and are effective, particularly in combination with offline training. Training-of-trainer approaches are effective for learning; new ETEs were developed by 20-44% of participants until six months after the initial training.

CONCLUSION

Our study reveals a limited number of publications on ETEs in infectious disease control. Studies provide few details on methodology, and use mainly short-term evaluations and low level outcomes. We call for more extensive, higher-level evaluation standards of ETEs, and an easy and sustainable way to exchange evaluations within the workforce of infectious disease control in cross-border settings. The theoretical framework developed in this study could guide future development and evaluation of ETEs in infectious disease control.

Carbon emissions and carbon trade balances: International evidence from panel ARDL analysis

International trade plays crucial roles in the evolution of carbon emissions given the prevalence of complex global supply chains. Production reallocation across countries promotes the cross-border trade of emission-embodied products and is closely related to emission transfer or carbon trade balance, which is defined as the difference between territorial and consumption emissions. One important issue addressed in this study is how carbon trade balances relate to carbon emissions under a globalized world with fragmented production. By applying a panel-pooled mean group-autoregressive distributive lag (PMG-ARDL) model, we evaluate the long-run relevance between carbon emissions and carbon trade balances while considering the short-run dynamics over 58 countries during the period of 1990-2014. The main results reveal a positive relationship between carbon trade balances and carbon emissions for high-income countries but no clear evidence for low-income countries. Our analysis argues that a high-income country may achieve emission reduction not only by displacing production units to trading partners but also by transferring high emission-intensive production units to trading partners and by keeping low emission-intensive domestic production units. Our results provide some important implications about emissions embodied in trade and emission transfers via international trade. First, high-income countries, particularly emission importers, should have the greater responsibility for global emission issues and should continue to develop and improve energy-saving and less emission-intensive technology. Second and more importantly, high-income countries should promote spillovers of advanced green technology to trading partners when they outsource emission-intensive production units to low-income countries.

Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers' perspective

Background

Cross-border healthcare may promote the spread of multidrug-resistant microorganisms (MDRO) and is challenging due to heterogeneous antimicrobial resistance (AMR) prevention measures (APM). The aim of this article is to compare healthcare workers (HCW) from Germany (DE) and The Netherlands (NL) on how they perceive and experience AMR and APM, which is important for safe patient exchange and effective cross-border APM cooperation.

Methods

A survey was conducted amongst HCW (n = 574) in hospitals in DE (n = 305) and NL (n = 269), using an online self-administered survey between June 2017 and July 2018. Mann-Whitney U tests were used to analyse differences between answers of German and Dutch physicians (n = 177) and German and Dutch nurses (n = 397) on 5-point Likert Items and Scales.

Results

Similarities between DE and NL were a high awareness about the AMR problem and the perception that the possibility to cope with AMR is limited (30% respondents perceive their contribution to limit AMR as insufficient). Especially Dutch nurses scored significantly lower than German nurses on their contribution to limit AMR (means 2.6 vs. 3.1, p ≤ 0.001). German HCW were more optimistic about their potential role in coping with AMR (p ≤ 0.001), and scored higher on feeling sufficiently equipped to perform APM (p ≤ 0.003), although the mean scores did not differ much between German and Dutch respondents.

Conclusions

Although both German and Dutch HCW are aware of the AMR problem, they should be more empowered to contribute to limiting AMR through APM (i.e. screening diagnostics, infection diagnosis, treatment and infection control) in their daily working routines. The observed differences reflect differences in local, national and cross-border structures, and differences in needs of HCW, that need to be considered for safe patient exchange and effective cross-border APM.

Investigation of a cross-border case of Lassa fever in West Africa

Background

Infectious disease prevention and control strategies require a coordinated, transnational approach. To establish core capacities of the International Health Regulations (IHR), the World Health Organization (WHO) developed the Integrated Diseases Surveillance and Response (IDSR) strategy. Epidemic-prone Lassa fever, caused by Lassa virus, is an endemic disease in the West African countries of Ghana, Guinea, Mali, Benin, Liberia, Sierra Leone, Togo and Nigeria. It’s one of the major public health threats in these countries. Here it is reported an epidemiological investigation of a cross-border case of Lassa fever, which demonstrated the importance of strengthened capacities of IHR and IDSR.

Case presentation

On January 9th, 2018 a 35-year-old Guinean woman with fever, neck pain, body pain, and vomiting went to a hospital in Ganta, Liberia. Over the course of her illness, the case visited various health care facilities in both Liberia and Guinea. A sample collected on January 10th was tested positive for Lassa virus by RT-PCR in a Liberian laboratory.

The Guinean Ministry of Health (MoH) was officially informed by WHO Country Office for Guinea and for Liberia.

Conclusion

This case report revealed how an epidemic-prone disease such as Lassa fever can rapidly spread across land borders and how such threat can be quickly controlled with communication and collaboration within the IHR framework.

Notes on distribution of Simulium damnosum s. l. along Atbara River in Galabat sub-focus, eastern Sudan

Background

Onchocerciasis is caused by a nematode worm Onchocerca volvulus, which is transmitted in Sudan by black fly vectors of the Simulium damnosum sensu lato species complex. In Sudan, the disease is found in four foci where fast flowing rivers provide suitable breeding sites for the Simulium vector flies. The construction of dams and irrigation schemes for agricultural purposes has affected black fly breeding and distribution, such as in Merowe Dam in Abu-Hamed focus, where the perennially flowing water downstream of the Dam created new vector breeding sites, thereby, changing the pattern of disease transmission and creating public health problems. Based on this situation, this study was carried out to measure the effect of the Upper Atbara and Setit Dam complex on the distribution of Simulium damnosum s.l. breeding sites and on disease elimination in the Galabat sub-focus in eastern Sudan.

Methods

Aquatic stages of Simulium were collected between October and November 2009, prior to the construction of the dam complex, and again in 2013 and 2015 while the dam complex construction was ongoing.

Results

A total of 40 breeding sites were identified at the beginning of the study. After the construction of the dam complex in 2015, seventeen previously mapped breeding sites were inaccessible as they had been flooded by the dam complex’s lake when reach its maximum size. Three species were obtained from different locations: S. damnosum s.l., S. griseicolle, and S. adersi.

Conclusions

This study has shown a link between the construction of the dam complex and a reduction in the breeding sites of black fly vectors. This reduction has limited the Galabat sub-focus to a small area at the upper Atbara River which become the end of the focus. To sustain the success achieved in onchocerciasis control in the Galabat sub-focus, disease control and its vector control should be strengthened in the area cross-boarding Sudan and Ethiopia.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4113-1) contains supplementary material, which is available to authorized users.

"Nine Dimensions": A multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar

Background: In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar.

Methods: Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme.

Results: Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations.

Conclusions: Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation.

"Nine Dimensions": A multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar

Background: In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar. Methods: Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme. Results: Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations. Conclusions: Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation.

Onchocerciasis prevalence, human migration and risks for onchocerciasis elimination in the Upper Mouhoun, Nakambé and Nazinon river basins in Burkina Faso

Historically, the whole of Burkina Faso was considered to be endemic for onchocerciasis (except a small area in the far north of the country) with prevalence rates 60-80%, but all endemic areas were included in the World Health Organisation Onchocerciasis Control Programme, which operated a system of vector control by larviciding beginning in 1974. In Burkina Faso larviciding had been phased out by 1989 when it was considered that onchocerciasis had been reduced to levels below the transmission breakpoint (and any residual infections would disappear without further intervention). There was never any mass drug administration against onchocerciasis in Burkina Faso, except in the Bougouriba and Comoé river basins (from 1996 and 2011 to present respectively) because in each of these two areas there was a resurgence of infection, and in parts of the Nakambé River basin and Sissili River basin from 1992 to 1998. However, mass drug administration with ivermectin was also phased in across the whole country starting in 2000 using ivermectin against lymphatic filariasis and is currently being phased out (depending upon the epidemiological parameters). In this publication we report a new epidemiological survey for onchocerciasis which was carried out in 2014 in the Upper Mouhoun, Nakambé and Nazinon river basins in Burkina Faso to evaluate the prevalence and intensity of infection of onchocerciasis. A total of 11,195 people from 61 villages were examined across these three river basins, and onchocerciasis prevalence by skin-snip was below 5% in all villages, below 1% in 57 villages (93% of 61 villages) and zero in 47. In the 14 villages with positive skin snips, prevalence figures ranged from 0.31% to 3.50%. During the survey 31 infected individuals were found. All of them were Burkinabé, of whom 30 had a recent history of residence in Côte d'Ivoire (with a range of 0.5 to 73 microfilariae per skin-snip from two snips per person) and only one had no history of migration and presumably had an autochthonous infection (mean of 0.5 microfilariae per skin snip from two snips). According to parasitological indicators listed by the World Health Organization African Programme for Onchocerciasis Control in 2010, the situation for onchocerciasis was considered to be satisfactory in all three river basins and probably below the transmission threshold, in which case the disease should disappear naturally without the need for further intervention in the absence of continuing immigration. However, the results clearly indicate that infected persons coming from endemic zones of Côte d'Ivoire are settling in small communities which are otherwise nearly free from onchocerciasis in Burkina Faso. They are thus a source of continuing re-introduction of the parasite into the basins and could be a risk for the achievement of onchocerciasis elimination in all three basins. This would justify the continuation of periodic epidemiological surveys to monitor the possible recrudescence of the disease, and entomological (vector) surveys should be undertaken to assess and monitor the residual transmission.

Preparedness and response against diseases with epidemic potential in the European Union: a qualitative case study of Middle East Respiratory Syndrome (MERS) and poliomyelitis in five member states

Background

EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus).

Methods

Based on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration.

Results

Preparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State.

Conclusions

Infectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3326-0) contains supplementary material, which is available to authorized users.

Malaria control across borders: quasi-experimental evidence from the Trans-Kunene malaria initiative (TKMI)

BACKGROUND

The transmission of malaria through population inflows from highly endemic areas with limited control efforts poses major challenges for national malaria control programmes. Several multilateral programmes have been launched in recent years to address cross-border transmission. This study assesses the potential impact of such a programme at the Angolan-Namibian border.

METHODS

Community-based malaria prevention programmes involving bed net distribution and behaviour change home visits were rolled-out using a controlled, staggered (stepped wedge) design between May 2014 and July 2016 in a 100 × 40 km corridor along the Angolan-Namibian border. Three rounds of survey data were collected. The primary outcome studied was fever among children under five in the 2 weeks prior to the survey. Multivariable linear and logistic regression models were used to assess overall programme impact and the relative impact of unilateral versus coordinated bilateral intervention programmes.

RESULTS

A total of 3844 child records were analysed. On average, programme rollout reduced the odds of child fever by 54% (aOR: 0.46, 95% CI 0.29 to 0.73) over the intervention period. In Namibia, the programme reduced the odds of fever by 30% in areas without simultaneous Angolan efforts (aOR: 0.70, 95% CI 0.34 to 1.44), and by an additional 62% in areas with simultaneous Angolan programmes. In Angola, the programme was highly effective in areas within 5 km of Namibian programmes (OR: 0.37, 95% CI 0.22 to 0.62), but mostly ineffective in areas closer to inland Angolan areas without concurrent anti-malarial efforts.

CONCLUSIONS

The impact of malaria programmes depends on programme efforts in surrounding areas with differential control efforts. Coordinated malaria programming within and across countries will be critical for achieving the vision of a malaria free world.

Malakit: an innovative pilot project to self-diagnose and self-treat malaria among illegal gold miners in the Guiana Shield

BACKGROUND

Illegal gold miners in French Guiana, a French overseas territory ('département') located in Amazonia, often carry malaria parasites (up to 46.8%). While the Guiana Shield Region aims at malaria elimination, the high prevalence of Plasmodium in this hard-to-reach population in conjunction with frequent incorrect use of artemisinin-based anti-malarials could favour the emergence of resistant parasites. Due to geographical and regulatory issues in French Guiana, usual malaria control strategies cannot be implemented in this particular context. Therefore, new strategies targeting this specific population in the forest are required.

METHODS

Numerous discussions among health institutions and scientific partners from French Guiana, Brazil and Suriname have led to an innovative project based on the distribution of kits for self-diagnosis and self-treatment of Plasmodium infections. The kit-distribution will be implemented at "resting sites", which are areas across the border of French Guiana regularly frequented by gold miners. The main objective is to increase the appropriate use and complete malaria treatment after a positive malaria diagnosis with a rapid test, which will be evaluated with before-and-after cross-sectional studies. Monitoring indicators will be collected from health mediators at the time of kit distribution and during subsequent visits, and from illegal gold miners themselves, through a smartphone application. The project funding is multisource, including Ministries of Health of the three countries, WHO/PAHO, and the European Union.

RESULTS

This project will start in April 2018 as a 18 month pilot study led by the Clinical Investigation Centre of Cayenne. Results should be available at the end of 2019.

DISCUSSION

This innovative approach may have several limitations which should be taken into account, as potential side effects, kit misuse or resale, declarative main criteria, or no Plasmodium vivax curative treatment. Close monitoring is thus needed.

CONCLUSIONS

This project may be the best available solution to a specific and important public health challenge in the Guiana Shield. If the use of self-diagnosis and self-treatment approach is effective, this strategy could be sustained by health institutions in the region.

"Cross-border collaboration in onchocerciasis elimination in Uganda: progress, challenges and opportunities from 2008 to 2013"

Background

Until recently onchocerciasis was prevalent in 37 out of 112 districts of Uganda with at least 3.8 million people at risk of contracting the disease, but following the launching of community-directed treatment with ivermectin (CDTI) in 1996 and the adoption of an onchocerciasis elimination policy in 2007, the country has made significant progress in combating the disease. By 2015, interruption of transmission had been achieved in ten of the 17 onchocerciasis foci, but cross-border foci remained particularly problematic, and therefore within the onchocerciasis elimination framework, Uganda embarked upon addressing these issues with its neighbouring countries, namely the Democratic Republic of Congo (DRC) and South Sudan. This paper summarises the experience of Uganda in addressing cross-border issues on onchocerciasis elimination with DRC.

Main achievements and lessons learned

The key achievements comprise of the adoption of an elimination policy by the Government of Uganda, cross-border meetings, training DRC technical staff and entomological/ epidemiological surveys. The first strategy meeting was held in Kampala in 2008, but the second strategy meeting was not held in Kinshasa until 2013. The involvement of the high-level officials from the Ministry of Health of DRC was critical for the success of the second strategy meeting, and was precipitated by collaboration to control an outbreak of Ebola Virus. Both meetings demonstrated the political commitment of endemic countries and allowed the implementation of a joint action plan. Important steps in establishing a mutually respected elimination targets was agreed on during cross border meetings.

The African Programme for Onchocerciasis Control facilitated and funded these initial meetings, thus overcoming some political and financial challenges faced by both countries. This highlighted the need for multilateral organisations such as the Expanded Special Project for the Elimination of Neglected Tropical Diseases in cross-border activities for other Neglected Tropical Diseases.

The collaboration between both countries facilitated the training of technical staff from DRC in entomology which facilitated joint cross-border activities to update the epidemiological understanding of onchocerciasis in Beni and Mahagi districts in North Kivu and Ituri Provinces respectively. In Nebbi district, Uganda, 23.7% of crabs were infested by the vector Simulium neavei compared with 6.3% in Mahagi district, DRC. Rapid Epidemiological Assessment (REA) revealed nodule prevalence of 3.2% and onchodermatitis at 26.4% from five villages in DRC.

Conclusion

Political commitment of both countries and the support from APOC allowed two cross-border meetings which were critical for the implementation of initial cross border activities for onchocerciasis elimination.

Toxic metals biomonitoring based on prey-predator interactions and environmental forensics techniques: A study at the Romanian-Ukraine cross border of the Black Sea

Marine cross-border areas are ideal for monitoring pollutants so as to increase ecosystems protection. This study was conducted at the Romanian-Ukraine border of the Black Sea to reveal evidence of contamination with toxic metals based on biomonitoring of: cadmium, lead, total chromium, nickel and copper at different water depths and prey-predator interactions, combined with environmental forensics techniques of biological sampling and separation in witnesses size groups. The species used were Mytilus galloprovincialis L. and Rapana venosa V. collected at 17.5m, 28m and 35m depth. An atomic absorption spectrometer with a high-resolution continuum source and graphite furnace was used for toxic metals quantification in various samples: sediments, soft tissue, stomach content, muscular leg, hepatopancreas. The best sample type, based on the pathology of metal location and bioaccumulation, is the hepatopancreas from R. venosa that proved a significant decrease of cadmium and lead at lower depths.

Patterns of exchange of forensic DNA data in the European Union through the Prüm system

This paper presents a study of the 5-year operation (2011–2015) of the transnational exchange of forensic DNA data between Member States of the European Union (EU) for the purpose of combating cross-border crime and terrorism within the so-called Prüm system. This first systematisation of the full official statistical dataset provides an overall assessment of the match figures and patterns of operation of the Prüm system for DNA exchange. These figures and patterns are analysed in terms of the differentiated contributions by participating EU Member States. The data suggest a trend for West and Central European countries to concentrate the majority of Prüm matches, while DNA databases of Eastern European countries tend to contribute with profiles of people that match stains in other countries. In view of the necessary transparency and accountability of the Prüm system, more extensive and informative statistics would be an important contribution to the assessment of its functioning and societal benefits.

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Analysis of a full dataset of 5 year statistics of the Prüm exchange of DNA data

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Total match volume and several comparative ratios are examined.

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Higher volume of reported DNA matches concentrates in West and Central European countries.

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Argument for the need of extensive and informative statistics on Prüm DNA exchange

Effectiveness and impact of the cross-border healthcare model as implemented by non-governmental organizations: case study of the malaria control programs by health poverty action on the China-Myanmar border

BACKGROUND

In the Yunnan province of China, 18 counties in six prefectures border Myanmar. Due to its particular combination of geographic features, climate conditions, and cultural landscape, the area provides a suitable environment for the spread of insect-borne diseases such as malaria. In five identified Myanmar Special Regions along the China-Myanmar border, economic development is lagging, people live in extreme poverty, and the healthcare system is fragile. Coupled with political and other reasons, this precludes malaria control work to be effectively carried out in Myanmar, resulting in a heavy burden of the disease. Frequent population movements and favorable conditions for malaria transmission on the border fuel difficulties in controlling and eliminating the spread of the disease in the area.

CASE PRESENTATION

To reduce the prevalence of malaria in the China-Myanmar border area and improve healthcare services for local residents in this particular environment, Health Poverty Action (HPA) has provided malaria aid in the area since the beginning of 2006, as a sub-recipient of the China Global Fund Malaria Programs. In this case study, we examined HPA's activities as part of its malaria control programs in the area, analyzed and summarized the effectiveness and impact of the cross-border healthcare model as implemented by non-governmental organizations, and put forward suggestions for cross-border health aid models and for the prevention of malaria transmission in the Greater Mekong Subregion.

CONCLUSIONS

HPA had carried out a great quantity of successful malaria control activities in border areas between China and Myanmar, strengthened the partnership and established the collaboration, coordination and cooperation channels among stakeholders. HPA has laid good groundwork and developed its valuable model that could be highlighted and referenced.

Cross-border collaboration for neglected tropical disease efforts-Lessons learned from onchocerciasis control and elimination in the Mano River Union (West Africa)

Diseases don’t respect borders, so efforts to control and eliminate diseases must also be flexible and adaptable enough to effectively reach the populations that live in the areas around national frontiers. Onchocerciasis, commonly known as river blindness is a tropical disease that has historically affected millions of people in 35 countries in Africa and Latin America. In Africa, programs and partnerships to address river blindness through mass drug administration have been active for more than 25 years. While in many cases the disease is found in isolated foci that fall entirely within national boundaries, the geographic scope of many affected areas crosses country borders. National river blindness programs are the responsibility of each nation’s Ministry of Health, so in cross-border situations there is a need for effective country-country collaboration. Cross-border collaboration for onchocerciasis control efforts in the countries of the Mano River Basin illustrates the positive impact of a creative model, and offers lessons for expanded application for onchocerciasis elimination as well as other neglected tropical disease (NTD) control and elimination programs.

Towards malaria elimination in the MOSASWA (Mozambique, South Africa and Swaziland) region

The substantial impact of cross-border collaborative control efforts on the burden of malaria in southern Africa has previously been demonstrated through the successes of the Lubombo Spatial Development Initiative. Increases in malaria cases recorded in the three partner countries (Mozambique, South Africa, Swaziland) since termination of that programme in 2011 have provided impetus for the resuscitation of cooperation in the form of the MOSASWA malaria initiative. MOSASWA, launched in 2015, seeks to renew regional efforts to accelerate progress towards malaria elimination goals already established in the region. National malaria programmes, together with developmental partners, academic institutions and the private sector seek to harmonize policy, strengthen capacity, share expertise, expand access to elimination interventions particularly amongst migrant and border population groups, mobilize resources and advocate for long-term funding to ultimately achieve and sustain malaria elimination in the MOSASWA region.

Unresolved legal questions in cross-border health care in Europe: liability and data protection

OBJECTIVES

Directive 2011/24/EU was designed to clarify the rights of EU citizens in evaluating, accessing and obtaining reimbursement for cross-border care. Based on three regional case studies, the authors attempted to assess the added value of the Directive in helping clarify issues in to two key areas that have been identified as barriers to cross-border care: liability and data protection.

STUDY DESIGN

Qualitative case study employing secondary data sources including research of jurisprudence, that set up a Legal framework as a base to investigate liability and data protection in the context of cross-border projects.

METHODS

By means of three case studies that have tackled liability and data protection hurdles in cross-border care implementation, this article attempts to provide insight into legal certainty and uncertainty regarding cross-border care in Europe.

RESULTS

The case studies reveal that the Directive has not resolved core uncertainties related to liability and data protection issues within cross-border health care. Some issues related to the practice of cross-border health care in Europe have been further clarified by the Directive and some direction has been given to possible solutions for issues connected to liability and data protection.

CONCLUSIONS

Directive 2011/24/EU is clearly a transposition of existing regulations on data protection and ECJ case law, plus a set of additional, mostly, voluntary rules that might enhance regional border cooperation. Therefore, as shown in the case studies, a practical and case by case approach is still necessary in designing and providing cross-border care.