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  • BEZ 235 manufacturer br Tara Mangal and colleagues document


    Tara Mangal and colleagues document the struggle to eliminate polio in northern Nigeria. However, they overlook the importance of routine immunisation to polio eradication efforts. The investigators identified an association between the risk of contracting polio and oral polio vaccine unavailability. Systemic problems with routine immunisation distribution, supply chain, and staffing result in missed immunisation opportunities and, as findings from their study show, can lead to increases in the prevalence of polio. Nigeria launched its routine immunisation strategic plan in 2013, but will need sustained funding and vaccine availability to reach its goals. To increase population immunity, Mangal and colleagues recommend more polio doses for northern Nigerian children. In 2013, even after 13 rounds of polio immunisation, thousands of children were missed. The Independent Monitoring Board of the Global Polio Eradication Initiative recommended strengthening campaign management to improve coverage. Our experience indicates that better health education, BEZ 235 manufacturer engagement, and robust routine immunisation will effectively reach missed children and thereby increase coverage.
    Tara Mangal and colleagues quantitatively analysed the key factors that sustain transmission of polio in Nigeria. Although poor vaccine coverage and refusal of vaccine contributes to suboptimum population immunity, their finding of low vaccine efficacy is concerning. The reasons proposed for this finding deserve careful assessment because they might have implications beyond the elimination of polio in Nigeria.
    We congratulate Neil Pearce and colleagues on their Comment about the 25×25 strategy. This strategy is a global target of a 25% relative reduction in mortality from non-communicable diseases by the year 2025. Global policy should be updated to show the current and future global health scenario with inclusion of non-communicable diseases that reach beyond the traditional top broad-cause groups (ie, cardiovascular disease, stroke, chronic lung diseases, cancer, and diabetes), and which also take into account non-fatal burden. More than anywhere, this issue is crucial for low-income and middle-income countries where in the recent Global Burden of Disease study, 2010, in terms of broadcause non-communicable disease groups, mental and behavioural disorders and musculoskeletal disease rank in the top four groups (). In the case of musculoskeletal diseases, of all 291 conditions, three of the top ten disorders in developing countries, in terms of both burden and disability, were musculoskeletal disorders. Good musculoskeletal health and mobility is fundamental for the prevention of other non-communicable diseases and essential for independent and productive lives at all ages. Musculoskeletal problems are common comorbidities with other non-communicable diseases, and this combination further reduces function, and impedes efforts to prevent further damage (eg, efforts such as increased physical activity). Many opportunities exist for global health policy and programmes to include and address the burden of non-communicable diseases beyond the traditional broadcause groups. Research is needed on how to best deal with all non-communicable diseases in a way that addresses the broader determinants, adheres to principles of development effectiveness, and explores and promotes collaboration and integration with work that is already being done on the traditional top broadcause non-communicable disease groups and health systems generally. We are at a crucial point in time when the burden from musculoskeletal diseases and other non-communicable diseases can be mitigated, but urgent action is needed. Pearce and colleagues make important and sensible recommendations for this through inclusion in strategies such as the 25×25 strategy.
    Recent changes in act to further the burden of discrimination towards lesbian, gay, bisexual, and transgender (LGBT) populations. As of 2014, 81 jurisdictions criminalise consensual sexual conduct between adults of the same sex, 38 of which are in Africa. Homosexuality is a capital offence in five countries. According to the UN Universal Declaration on Human Rights, criminalisation on the basis of gender or sexual identity is a breach of human rights. The UN Special Rapporteur on Health has observed that “criminal laws concerning consensual same-sex conduct, sexual orientation and gender identity often infringe on…the right to health”. The UN Secretary General, UN Human Rights Council, and UNAIDS have drawn attention to the negative effect of criminalisation on health.