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Mottla ME, Bowler ME, Asgary R. Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review. J Glob Health 2023; 13:04173. [PMID: 38154015 PMCID: PMC10754493 DOI: 10.7189/jogh.13.04173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Background There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs. Methods We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis. Results Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management. Conclusions The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings. Registration PROSPERO: CRD42022315686.
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Affiliation(s)
- Mary Elizabeth Mottla
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Mary-Ellis Bowler
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Ramin Asgary
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Montel L, Ssenyonga N, Coleman MP, Allemani C. How should implementation of the human right to health be assessed? A scoping review of the public health literature from 2000 to 2021. Int J Equity Health 2022; 21:139. [PMID: 36138460 PMCID: PMC9502920 DOI: 10.1186/s12939-022-01742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/28/2022] [Indexed: 11/12/2022] Open
Abstract
The human right to health is a critical legal tool to achieve health justice, and universal health coverage is included among the Sustainable Development Goals. However, the content and meaning of the right to health may not be used adequately in public health research. We conducted a scoping review of the literature to discover the extent to which the legal principles underlying the right to health are used in public health. We mapped the various attempts to assess implementation of this right since its legal content was clarified in 2000. The first studies emerged in 2006, with an increase and a wider variety of investigations since 2015. We observe that some key principles do form the basis of right-to-health assessments, but some concepts remain unfamiliar. Critically, public health academics may have limited access to human rights research on health, which creates a gap in knowledge between the two disciplines.
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Affiliation(s)
- Lisa Montel
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Centre for Health, Law and Society, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK.
| | - Naomi Ssenyonga
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Sisay M, Amare F, Hagos B, Edessa D. Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology. J Pharm Policy Pract 2021; 14:57. [PMID: 34225781 PMCID: PMC8256563 DOI: 10.1186/s40545-021-00339-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023] Open
Abstract
Background Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia. Methods A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen. Results The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings (p < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined. Conclusion Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.
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Affiliation(s)
- Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Bisrat Hagos
- Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Severo PP, Furstenau LB, Sott MK, Cossul D, Bender MS, Bragazzi NL. Thirty Years of Human Rights Study in the Web of Science Database (1990-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2131. [PMID: 33671671 PMCID: PMC7926733 DOI: 10.3390/ijerph18042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
The study of human rights (HR) is vital in order to enhance the development of human beings, but this field of study still needs to be better depicted and understood because violations of its core principles still frequently occur worldwide. In this study, our goal was to perform a bibliometric performance and network analysis (BPNA) to investigate the strategic themes, thematic evolution structure, and trends of HR found in the Web of Science (WoS) database from 1990 to June 2020. To do this, we included 25,542 articles in the SciMAT software for bibliometric analysis. The strategic diagram produced shows 23 themes, 12 of which are motor themes, the most important of which are discussed in this article. The thematic evolution structure presented the 21 most relevant themes of the 2011-2020 period. Our findings show that HR research is directly related to health issues, such as mental health, HIV, and reproductive health. We believe that the presented results and HR panorama presented have the potential to be used as a basis on which researchers in future works may enhance their decision making related to this field of study.
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Affiliation(s)
- Priscilla Paola Severo
- Graduate Program in Law, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Leonardo B. Furstenau
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Michele Kremer Sott
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Danielli Cossul
- Department of Psychology, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Mariluza Sott Bender
- Multiprofessional Residency Program in Urgency and Emergency, Santa Cruz Hospital, Santa Cruz do Sul 96810-072, Brazil;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
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Perehudoff K. Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators. Glob Health Action 2020; 13:1699342. [PMID: 33131456 PMCID: PMC7605313 DOI: 10.1080/16549716.2019.1699342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/14/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Access to essential medicines for the world's poor and vulnerable has made little progress since 2000, except for a few specific medicines such as antiretrovirals for HIV/AIDS. Human rights principles written into national law can create a supportive environment for universal access to medicines; however, systematic research and policy guidance on this topic is lacking. OBJECTIVE To examine how international human rights law and WHO's essential medicines policies are embedded in national law for medicines affordability and financing, and interpreted and implemented in practice to promote universal access to essential medicines. METHODS This thesis consists of (1) a cross-national content analysis of 192 national constitutions, 71 national medicines policies, and legislation for universal health coverage (UHC) from 16 mostly low- and middle-income countries; (2) a case study of medicines litigation in Uruguay, and (3) a follow-up report of eight right to health indicators for access to medicines from 195 countries. RESULTS Some, but not all, of the 12 principles from human rights law and WHO's policy are embedded in national UHC law and medicines policies (part 1). Even the most rights-compliant legislation for access to medicines is subject to the unique and inconsistent interpretation of domestic courts, which may be inconsistent with the right to health in international law (part 2). Many national health systems for which data were available still fail to meet the official targets for eight indicators of access to medicines (part 3). CONCLUSIONS International human rights law and WHO policy are embedded in national law for essential medicines and practically implemented in national health systems. Law makers can use these findings and the example texts in this thesis as a starting point for writing and monitoring governments' rights-based legal commitments for access to medicines. Future research should study the effect of national law on access to medicines and population health.
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Affiliation(s)
- Katrina Perehudoff
- Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- International Centre for Reproductive Health- WHO Collaborating Centre, Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
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Rocha MDM, de Andrade EP, Alves ER, Cândido JC, Borio MDM. Access to innovative medicines by pharma companies: Sustainable initiatives for global health or useful advertisement? Glob Public Health 2020; 15:777-789. [PMID: 32070242 DOI: 10.1080/17441692.2020.1729391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Research & Development on new medicines plays an important role in life and well-being, making pharmaceutical companies important players in global health. Accessibility and financing new medicines, however, poses challenges for governments and patients around the world. Due to pricing and aggressive patent policy issues, pharma companies started to adopt access to medicines as a strategy to not only improve their public image but also to increase their economic performance. More than a useful institutional advertisement to attract new business, initiatives to improve access to medicines must be socially responsible and sustainable. Using content analysis methodology from CSR reports, the present study evaluated how 44 global companies are positioning themselves regarding access, whether these initiatives are aligned to existing access programmes and whether the actions disclosed on behalf of access are sustainable. We have identified 13 major access to medicines approaches that were classified into intrinsic, potentially sustainable and robust actions. We concluded that companies overvalue the term access to medicine. This can generate initiatives focused on advertisements rather than long-term actions and highlights the need for clear global criteria for companies and programmes that want to effectively publicise access to medicines as a social responsibility strategy.
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Perehudoff SK, Alexandrov NV, Hogerzeil HV. Legislating for universal access to medicines: a rights-based cross-national comparison of UHC laws in 16 countries. Health Policy Plan 2019; 34:iii48-iii57. [PMID: 31816073 PMCID: PMC6910076 DOI: 10.1093/heapol/czy101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 11/14/2022] Open
Abstract
Universal health coverage (UHC) aims to ensure that all people have access to health services including essential medicines without risking financial hardship. Yet, in many low- and middle-income countries (LMICs) inadequate UHC fails to ensure universal access to medicines and protect the poor and vulnerable against catastrophic spending in the event of illness. A human rights approach to essential medicines in national UHC legislation could remedy these inequities. This study identifies and compares legal texts from national UHC legislation that promote universal access to medicines in the legislation of 16 mostly LMICs: Algeria, Chile, Colombia, Ghana, Indonesia, Jordan, Mexico, Morocco, Nigeria, Philippines, Rwanda, South Africa, Tanzania, Turkey, Tunisia and Uruguay. The assessment tool was developed based on WHO's policy guidelines for essential medicines and international human rights law; it consists of 12 principles in three domains: legal rights and obligations, good governance, and technical implementation. Relevant legislation was identified, mapped, collected and independently assessed by multi-disciplinary, multi-lingual teams. Legal rights and State obligations toward medicines are frequently codified in UHC law, while most good governance principles are less common. Some technical implementation principles are frequently embedded in national UHC law (i.e. pooled user contributions and financial coverage for the vulnerable), while others are infrequent (i.e. sufficient government financing) to almost absent (i.e. seeking international assistance and cooperation). Generally, upper-middle and high-income countries tended to embed explicit rights and obligations with clear boundaries, and universal mechanisms for accountability and redress in domestic law while less affluent countries took different approaches. This research presents national law makers with both a checklist and a wish list for legal reform for access to medicines, as well as examples of legal texts. It may support goal 7 of the WHO Medicines & Health Products Strategic Programme 2016-30 to develop model legislation for medicines reimbursement.
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Affiliation(s)
- S Katrina Perehudoff
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Nikita V Alexandrov
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Hans V Hogerzeil
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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Perehudoff SK, Alexandrov NV, Hogerzeil HV. The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries. PLoS One 2019; 14:e0215577. [PMID: 31251737 PMCID: PMC6599146 DOI: 10.1371/journal.pone.0215577] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/04/2019] [Indexed: 11/18/2022] Open
Abstract
Persistent barriers to universal access to medicines are limited social protection in the event of illness, inadequate financing for essential medicines, frequent stock-outs in the public sector, and high prices in the private sector. We argue that greater coherence between human rights law, national medicines policies, and universal health coverage schemes can address these barriers. We present a cross-national content analysis of national medicines policies from 71 countries published between 1990-2016. The World Health Organization's (WHO) 2001 guidelines for developing and implementing a national medicines policy and all 71 national medicines policies were assessed on 12 principles, linking a health systems approach to essential medicines with international human rights law for medicines affordability and financing for vulnerable groups. National medicines policies most frequently contain measures for medicines selection and efficient spending/cost-effectiveness. Four principles (legal right to health; government financing; efficient spending; and financial protection of vulnerable populations) are significantly stronger in national medicines policies published after 2004 than before. Six principles have remained weak or absent: pooling user contributions, international cooperation, and four principles for good governance. Overall, South Africa (1996), Indonesia and South Sudan (2006), Philippines (2011-2016), Malaysia (2012), Somalia (2013), Afghanistan (2014), and Uganda (2015) include the most relevant texts and can be used as models for other settings. We conclude that WHO's 2001 guidelines have guided the content and language of many subsequent national medicines policies. WHO and national policy makers can use these principles and the practical examples identified in our study to further align national medicines policies with human rights law and with Target 3.8 for universal access to essential medicines in the Sustainable Development Goals.
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Affiliation(s)
- S. Katrina Perehudoff
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Nikita V. Alexandrov
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Hans V. Hogerzeil
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Bissell K, Ellwood P, Ellwood E, Chiang CY, Marks GB, El Sony A, Asher I, Billo N, Perrin C. Essential Medicines at the National Level: The Global Asthma Network's Essential Asthma Medicines Survey 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E605. [PMID: 30791442 PMCID: PMC6406388 DOI: 10.3390/ijerph16040605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013⁻2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013⁻2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses-41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.
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Affiliation(s)
- Karen Bissell
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Chen-Yuan Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney 2085, Australia.
| | - Asma El Sony
- The Epidemiological Laboratory (Epi-Lab), for Public Health and Research, Khartoum, Sudan.
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Nils Billo
- Independent Consultant, 80220 Joensuu, Finland.
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