Lost in translation: the importance of addressing language inequities in global health security

Language inequities in global health stem from colonial legacies, and global health security is no exception. The International Health Regulations (IHRs), a legally binding framework published by the WHO, lay the foundation for global health security and state the roles and responsibilities States Parties are compelled to follow to improve their capabilities to prevent, detect and respond to potential public health emergencies of international concern. It includes the submission of a mandatory status report that assesses a nation's implementation of IHRs. Known as the States Party Self-Assessment Annual Report (SPAR) tool, WHO has made its guidance document available in all six WHO official languages (Arabic, Chinese, English, French, Russian and Spanish). The Republic of Iraq (Iraq) experienced significant challenges during the completion and submission of the 2022 SPAR. This experience demonstrated that translation of English materials to other languages, such as Arabic, is not prioritised and further underscored how scoring of a country's global health security capacities can be significantly impacted by users' ability to read and comprehend the materials in English. Not only can this lead to inaccurate SPAR scoring, but it can also lead to the improper allocation of resources and prioritisation of policy developments and/or amendments. By drawing attention to this issue, we aim to inform and advocate for global health security decision-makers to consider opportunities for increasing inclusion and accessibility, especially for requirements under legally binding international instruments.

Mortality trends in Erbil, Iraq, 2007-2011

BACKGROUND

Reliable and valid information on trends of mortality and common causes of death is essential to guide priorities for the allocation of resources within the health sector in order to improve health services for the population, increase longevity and improve quality of life.

AIMS

This study aimed to determine crude, gender, age and cause specific death rates and to examine mortality trends in a five-year period between 2007 and 2011 in Erbil City, Iraq.

METHODS

This study researched 16 780 deaths registered at the statistical unit of the Directorate of Health, Irbil City. Data were reviewed and cleared for the purpose of analysis. Causes of deaths were classified according to body systems.

RESULTS

The average crude death rate was 3.1 per 1000 population with male predominance over females in all the years of study (3.5 and. 2.7, respectively). The age-specific death rates were high in the old and middle age groups in addition to the under 5 years age group. Accidents and circulatory diseases were the leading causes of deaths with rates of 65.2 and 58.3/100 000 population, respectively.

CONCLUSIONS

An accurate identification of cause of death suggests that the only use of the death certificate in Erbil is for the purpose of burial and legal issues, and therefore it is imperative for educational efforts to achieve a complete and comprehensive death registration.

Outbreak of Clinical Listeriosis in Sheep: Evaluation from possible Contamination Routes from Feed to Raw Produce and Humans

We report the results of clinical and microbiological investigations on Listeria monocytogenes infections in a flock of 55 sheep and describe the implications for the safety of the raw milk and raw-milk cheeses produced in the on-farm dairy. The outbreak was caused by feeding grass silage, which was contaminated with 5 log10 CFU L. monocytogenes/g. Clinically, although having been fed from the same batch of silage, abortive (nine ewes), encephalitic (one ewe) and septicaemic (four ewes) forms of listeriosis were observed during the outbreak phase. As the starting point of feeding the contaminated silage was known we could calculate an incubation period of 18+/-2 and 26 days for the abortive and the encephalitic form of listeriosis, respectively. Pathologically, the septicaemic cases suffered from Listeria accumulation at comparable numbers in visceral organs but not in the brain. Only a single ewe developed central nervous symptoms and a rhomb-encephalitis was immunohistologically confirmed. In this case the infection proceeded from the nasal mucosa into the brain, with no infections of the liver, spleen and other visceral organs. Sampling of the cheese production chain, the farm environment and the persons living at the farm revealed the exposure of a farm-worker to an isolate genetically indistinguishable from the outbreak clone, obviously through the consumption of faecally contaminated bovine raw milk. The cheese under processing was free of Listeria because, as a result of intensive consultations, the farmer ensured a proper acidification of the cheese. The epidemiological findings suggest that food safety matters should be assessed in any case where infection of food-producing animals with potential human pathogens is observed.