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No AccessWorld Development Report1 Feb 2013World Development Report 1992Development and the EnvironmentAuthors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1952-0876-5AboutView ChaptersPDF (31.8 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This is the fifteenth in the annual series assessing major development issues. The World Development Report 1992 explores the links between economic development and the environment. The 1990 report on poverty, last year's report on development strategies, and this report constitute a trilogy on the goals and means of development. The main message of this year's report is the need to integrate environmental considerations into development policymaking. The report argues that continued, and even accelerated, economic and human development is sustainable and can be consistent with improving environmental conditions, but that this will require major policy, program, and institutional shifts. A twofold strategy is required. First, the positive links between efficient income growth and the environment need to be aggressively exploited. Second, strong policies and institutions need to be put in place which cause decision makers to adopt less damaging forms of behavior. Where tradeoffs exist between income growth and environmental quality, the report argues for a careful assessment of the costs and benefits of alternative policies. This approach will result in much less environmental damage. Like its predecessors, this report includes the World Development Indicators, which offer selected social and economic statistics on 125 countries. Previous bookNext book FiguresreferencesRecommendeddetailsCited byDoes Inequality Affect Climate Change? 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Poor-quality medicines and medical products, both substandard and falsified, cause avoidable morbidity, mortality, drug resistance, and loss of faith in health systems, especially in low-income and middle-income countries.1Newton PN Green MD Mildenhall DC et al.Poor quality vital anti-malarials in Africa—an urgent neglected public health priority.Malaria J. 2010; 10: 352Crossref Scopus (88) Google Scholar, 2Institute of MedicineCountering the problem of falsified and substandard drugs. The National Academies Press, Washington, DC2013Google Scholar, 3Attaran A Barry D Basheer S et al.How to achieve international action on falsified and substandard medicines: a consensus statement.BMJ. 2012; 345: e7381Crossref PubMed Scopus (109) Google Scholar We report the analysis of two falsified medicines from Angola and discuss what lessons such a discovery could hold. The tablets were seized at Luanda docks in June, 2012, after failing Minilab testing.4Faucon B Murphy C Whalen J Africa's malaria battle: fake drug pipeline undercuts progress.Wall Street Journal. May 29, 2013; (accessed April 18, 2014).http://online.wsj.com/article/SB10001424127887324474004578444942841728204.htmlGoogle Scholar, 5WHOFalsified batches of Coartem recently circulating in Cameroon.http://www.who.int/medicines/publications/drugalerts/drugalertindex/en/Google Scholar The seized shipment was enormous (1·4 million packets), and hidden in loudspeakers in a container from China.4Faucon B Murphy C Whalen J Africa's malaria battle: fake drug pipeline undercuts progress.Wall Street Journal. May 29, 2013; (accessed April 18, 2014).http://online.wsj.com/article/SB10001424127887324474004578444942841728204.htmlGoogle Scholar One sample was labelled as an adult course of the vital antimalarial drug artemether-lumefantrine, and as being manufactured by “Novartis Pharmaceutical Corporation”; it also bore an Affordable Medicines Facility—malaria logo (figure). Another sample was labelled as the broad-spectrum anthelmintic mebendazole, and as being manufactured by “Janssen-Cilag SpA”. We analysed the tablets with an array of analytical platforms, including high-performance liquid chromatography, ambient ionisation mass spectrometry, Raman spectroscopy, Xray powder diffraction (XRD) analysis, nuclear magnetic resonance spectroscopy, isotope-ratio mass spectrometry (IRMS), and botanical assays. Packaging was analysed with the portable counterfeit detection device CD-3 (see appendix for detailed methods). No artemether, lumefantrine, or other active pharmaceutical ingredients were detected in the “artemether-lumefantrine” tablets by any of the chemical assay techniques. Brushite and three different yellow dyes (pigment yellow 3, pigment yellow 81, and pigment yellow 151) were detected. No mebendazole was detected in the “mebendazole” tablets, but the active ingredient levamisole (270 mg/tablet) was. XRD analysis revealed the presence of calcite (CaCO3), with IRMS data suggesting that it was either hydrothermal or medical in origin. The CD-3 ultraviolet-visible and infrared images of the falsified and genuine packaging readily showed substantial differences between them. Language errors on the “mebendazole” packages were common, suggesting that the forger may have had some knowledge of English but little of French and Spanish. Falsified artemether-lumefantrine has also been described across central and west Africa.5WHOFalsified batches of Coartem recently circulating in Cameroon.http://www.who.int/medicines/publications/drugalerts/drugalertindex/en/Google Scholar Such products will inevitably cause increased morbidity, mortality, and transmission, and could falsely indicate that artemisinin resistance had arrived. Additionally, modelling strongly suggests that underdosing is an important contributor to resistance.6White NJ Pongtavornpinyo W Maude RJ et al.Hyperparasitaemia and low dosing are an important source of anti-malarial drug resistance.Malaria J. 2009; 8: 253Crossref PubMed Scopus (130) Google Scholar Therefore, if patients consume co-circulating falsified and substandard medicines sequentially, so that heavy parasite burdens encounter low drug concentrations, the risks of engendering resistance are high. The presence of the anthelmintic levamisole is also worrying because it has been withdrawn from many markets for human use owing to its association with agranulocytosis. The recent epidemic of necrotising vasculitis resulting from “cutting” cocaine with levamisole7Lee KC Ladizinski B Federman DG Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge.Mayo Clin Proc. 2012; 87: 581-586Summary Full Text Full Text PDF PubMed Scopus (107) Google Scholar suggests links between criminals who produce narcotics and those who produce falsified medicines. These examples illustrate the major obstacles to improving the global medicine supply. First, there is no global system for the mandatory reporting, assessment, and dissemination of information on suspicious medicines. The seizure in Angola was first brought to public attention on Facebook after 5 months, and in the printed press after 11 months.4Faucon B Murphy C Whalen J Africa's malaria battle: fake drug pipeline undercuts progress.Wall Street Journal. May 29, 2013; (accessed April 18, 2014).http://online.wsj.com/article/SB10001424127887324474004578444942841728204.htmlGoogle Scholar It was Facebook who first alerted those responsible for malaria control liaison at WHO. Although such reporting is commendable, it is grossly inadequate for tropical public health what proportion of African malaria patients and their families reads Facebook and the Wall Street Journal? Until 2011–12 (when it was invoked for the USA and EU), no nation had legislation requiring the pharmaceutical industry (which is often the first to know) to inform the relevant medicines regulatory authority (MRA) of drug falsification. It is extraordinary that, in 2014, such systems are widely in place for suspicious aircraft parts but not for suspicious medicines.8Cockburn R Newton PN Agyarko EK Akunyili D White NJ The global threat of counterfeit drugs: why industry and governments must communicate the dangers.PLoS Med. 2005; 2: e100Crossref PubMed Scopus (243) Google Scholar WHO's new Rapid Alert System facilitates information sharing on poor-quality medicines between medicines regulatory authorities (MRAs).5WHOFalsified batches of Coartem recently circulating in Cameroon.http://www.who.int/medicines/publications/drugalerts/drugalertindex/en/Google Scholar It should be mandatory and included in the International Health Regulations.1Newton PN Green MD Mildenhall DC et al.Poor quality vital anti-malarials in Africa—an urgent neglected public health priority.Malaria J. 2010; 10: 352Crossref Scopus (88) Google Scholar When pharmaceutical companies and others encounter suspicious medicines or medical products, there remains tension between commercial interests, the need to investigate, and the requirement to act quickly to safeguard public health. There is no consensus mechanism to adjudicate these decisions from a public health perspective. This stagnant system must change. All reports of suspect medicines known to the pharmaceutical industry and others should be reported to the WHO and MRA within 1 week for investigation, risk assessment, and appropriate dissemination. If those reporting wish delayed onward dissemination, an advisory committee of MRAs and WHO with independent advice should perform a rapid public health risk assessment. Compliance should be reported through a mechanism such as the Access to Medicine Index. Second, recent inaction regarding medicine quality has involved disputes over definitions from a trade and political perspective. These disputes must have damaged public health. The acronym NATO (no action—talk only), sadly reflects recent history. Extended discussion at World Health Assemblies culminated in 2011 with the formation of a Member State mechanism. However, chairmanship disagreements then apparently delayed discussion for 6 months.9Taylor N WHA deal breaks poor quality drugs deadlock.Securing Industry. June 3, 2013; (accessed April 18, 2014).http://www.securingindustry.com/pharmaceuticals/wha-deal-breaks-poor-quality-drugs-deadlock/s40/a1746/Google Scholar The group now has meetings just once per year. The terminology remains confused—for example, a recent US Institute of Medicine report on medicine quality2Institute of MedicineCountering the problem of falsified and substandard drugs. The National Academies Press, Washington, DC2013Google Scholar did not state clearly what term should be used for medicines that are poor quality but not falsified. Here we have used the distinction between falsified (or counterfeit or spurious medicines—ie, those deliberately and fraudulently mislabelled with respect to identity or source) and substandard medicines (ie, genuine medicines produced by authorised manufacturers that do not meet quality specifications set for them by national standards).3Attaran A Barry D Basheer S et al.How to achieve international action on falsified and substandard medicines: a consensus statement.BMJ. 2012; 345: e7381Crossref PubMed Scopus (109) Google Scholar To avoid any intellectual property connotations, the term falsified is used here instead of counterfeit.3Attaran A Barry D Basheer S et al.How to achieve international action on falsified and substandard medicines: a consensus statement.BMJ. 2012; 345: e7381Crossref PubMed Scopus (109) Google Scholar We believe that this is the clearest way forward. Third, the extradition and prosecution of criminals, such as those trading in falsified medicines between China and Angola, is extremely difficult as falsification of medicine or medical products is not an international crime, and definitions and laws are inconsistent. An international public health convention could assist in combating criminal networks and provide a financing mechanism for MRA and factory support (ie, detecting and reducing factory errors or negligence).3Attaran A Barry D Basheer S et al.How to achieve international action on falsified and substandard medicines: a consensus statement.BMJ. 2012; 345: e7381Crossref PubMed Scopus (109) Google Scholar The Insitute of Medicine favours soft-law solutions,2Institute of MedicineCountering the problem of falsified and substandard drugs. The National Academies Press, Washington, DC2013Google Scholar but the lack of legally binding force would neuter action. Fourth, the enormous investment in accessible medicines and medical products without investment in checking their quality is profoundly illogical. WHO estimates that only 7% of sub-Saharan countries had a “moderately functioning MRA”.10WHO Regional Office for AfricaFirst African Medicines Regulatory Authorities Conference: Final report. Oct 31– Nov 3, 2005; Addis Ababa, Ethiopia.http://apps.who.int/medicinedocs/en/d/Js17809en/Google Scholar We cannot expect the world's medicine supply to improve without coordinated functional MRAs. They are essential for the interventions needed, and to ensure that the benefits of increased accessibility to free or inexpensive internationally financed medicines and inexpensive generics are translated effectively into improved public health. The Access to Medicines movement has been very important in improving access to essential medicines; however, much more emphasis is needed now on access to good quality medicines. PN and NW are supported by Wellcome Trust of Great Britain. FMF would like to thank the NSF MRI grant #0923179 and the NSF/NASA Center for Chemical Evolution CHE-1004570 for the use of equipment acquired under these projects, and the GT School of Chemistry and Biochemistry for a Vasser-Wooley faculty fellowship that provided resources for this work. PD and MJC were supported by the ACT Consortium via an award from the Bill & Melinda Gates Foundation to the London School of Hygiene and Tropical Medicine. PT was supported by the Institut de Recherche sur l'Asie du Sud-Est Contemporaine (IRASEC) through funding from the French Ministry of Foreign and European Affairs (FSP Mekong Project). We are extremely grateful to the US Food and Drug Administration and to Nicola Ranieri for lending a CD-3 device and for all their assistance. We thank David Hawksworth and Patricia Wiltshire for the identification of fungal spores, Mayfong Mayxay for “NATO”, and Johnson & Johnson Companies and Novartis International AG for their assistance. We declare no competing interests. Download .pdf (6.05 MB) Help with pdf files Supplementary appendix Falsified medicines in AfricaIn their letter on falsified medicines in Africa (September issue),1 Paul Newton and colleagues lament obstacles to improving the global supply of drugs, especially in unregulated informal markets in Africa. We share their concerns, but the authors do overlook important efforts to curb the flood of fake and substandard malaria medicines. The US President's Malaria Initiative, for one, is teaming up with local police, customs agents, national medicines regulatory authorities, and drug sellers to help reduce the availability of counterfeit drugs in informal private sector outlets and marketplaces. Full-Text PDF Open Access

OBJECTIVE: To quantify the public health and economic burden of endemic canine rabies in Africa and Asia. METHODS: Data from these regions were applied to a set of linked epidemiological and economic models. The human population at risk from endemic canine rabies was predicted using data on dog density, and human rabies deaths were estimated using a series of probability steps to determine the likelihood of clinical rabies developing in a person after being bitten by a dog suspected of having rabies. Model outputs on mortality and morbidity associated with rabies were used to calculate an improved disability-adjusted life year (DALY) score for the disease. The total societal cost incurred by the disease is presented. FINDINGS: Human mortality from endemic canine rabies was estimated to be 55 000 deaths per year (90% confidence interval (CI) = 24 000-93 000). Deaths due to rabies are responsible for 1.74 million DALYs lost each year (90% CI = 0.75-2.93). An additional 0.04 million DALYs are lost through morbidity and mortality following side-effects of nerve-tissue vaccines. The estimated annual cost of rabies is USD 583.5 million (90% CI = USD 540.1-626.3 million). Patient-borne costs for post-exposure treatment form the bulk of expenditure, accounting for nearly half the total costs of rabies. CONCLUSION: Rabies remains an important yet neglected disease in Africa and Asia. Disparities in the affordability and accessibility of post-exposure treatment and risks of exposure to rabid dogs result in a skewed distribution of the disease burden across society, with the major impact falling on those living in poor rural communities, in particular children.

INTRODUCTION BACKGROUND TO METABOLOMICS: Metabolomics is the comprehensive study of the metabolome, the repertoire of biochemicals (or small molecules) present in cells, tissues, and body fluids. The study of metabolism at the global or "-omics" level is a rapidly growing field that has the potential to have a profound impact upon medical practice. At the center of metabolomics, is the concept that a person's metabolic state provides a close representation of that individual's overall health status. This metabolic state reflects what has been encoded by the genome, and modified by diet, environmental factors, and the gut microbiome. The metabolic profile provides a quantifiable readout of biochemical state from normal physiology to diverse pathophysiologies in a manner that is often not obvious from gene expression analyses. Today, clinicians capture only a very small part of the information contained in the metabolome, as they routinely measure only a narrow set of blood chemistry analytes to assess health and disease states. Examples include measuring glucose to monitor diabetes, measuring cholesterol and high density lipoprotein/low density lipoprotein ratio to assess cardiovascular health, BUN and creatinine for renal disorders, and measuring a panel of metabolites to diagnose potential inborn errors of metabolism in neonates. OBJECTIVES OF WHITE PAPER—EXPECTED TREATMENT OUTCOMES AND METABOLOMICS ENABLING TOOL FOR PRECISION MEDICINE: We anticipate that the narrow range of chemical analyses in current use by the medical community today will be replaced in the future by analyses that reveal a far more comprehensive metabolic signature. This signature is expected to describe global biochemical aberrations that reflect patterns of variance in states of wellness, more accurately describe specific diseases and their progression, and greatly aid in differential diagnosis. Such future metabolic signatures will: (1) provide predictive, prognostic, diagnostic, and surrogate markers of diverse disease states; (2) inform on underlying molecular mechanisms of diseases; (3) allow for sub-classification of diseases, and stratification of patients based on metabolic pathways impacted; (4) reveal biomarkers for drug response phenotypes, providing an effective means to predict variation in a subject's response to treatment (pharmacometabolomics); (5) define a metabotype for each specific genotype, offering a functional read-out for genetic variants: (6) provide a means to monitor response and recurrence of diseases, such as cancers: (7) describe the molecular landscape in human performance applications and extreme environments. Importantly, sophisticated metabolomic analytical platforms and informatics tools have recently been developed that make it possible to measure thousands of metabolites in blood, other body fluids, and tissues. Such tools also enable more robust analysis of response to treatment. New insights have been gained about mechanisms of diseases, including neuropsychiatric disorders, cardiovascular disease, cancers, diabetes and a range of pathologies. A series of ground breaking studies supported by National Institute of Health (NIH) through the Pharmacometabolomics Research Network and its partnership with the Pharmacogenomics Research Network illustrate how a patient's metabotype at baseline, prior to treatment, during treatment, and post-treatment, can inform about treatment outcomes and variations in responsiveness to drugs (e.g., statins, antidepressants, antihypertensives and antiplatelet therapies). These studies along with several others also exemplify how metabolomics data can complement and inform genetic data in defining ethnic, sex, and gender basis for variation in responses to treatment, which illustrates how pharmacometabolomics and pharmacogenomics are complementary and powerful tools for precision medicine. CONCLUSIONS KEY SCIENTIFIC CONCEPTS AND RECOMMENDATIONS FOR PRECISION MEDICINE: Our metabolomics community believes that inclusion of metabolomics data in precision medicine initiatives is timely and will provide an extremely valuable layer of data that compliments and informs other data obtained by these important initiatives. Our Metabolomics Society, through its "Precision Medicine and Pharmacometabolomics Task Group", with input from our metabolomics community at large, has developed this White Paper where we discuss the value and approaches for including metabolomics data in large precision medicine initiatives. This White Paper offers recommendations for the selection of state of-the-art metabolomics platforms and approaches that offer the widest biochemical coverage, considers critical sample collection and preservation, as well as standardization of measurements, among other important topics. We anticipate that our metabolomics community will have representation in large precision medicine initiatives to provide input with regard to sample acquisition/preservation, selection of optimal omics technologies, and key issues regarding data collection, interpretation, and dissemination. We strongly recommend the collection and biobanking of samples for precision medicine initiatives that will take into consideration needs for large-scale metabolic phenotyping studies.

Human African trypanosomiasis (HAT), or sleeping sickness, is caused by Trypanosoma brucei gambiense, which is a chronic form of the disease present in western and central Africa, and by Trypanosoma brucei rhodesiense, which is an acute disease located in eastern and southern Africa. The rhodesiense form is a zoonosis, with the occasional infection of humans, but in the gambiense form, the human being is regarded as the main reservoir that plays a key role in the transmission cycle of the disease. The gambiense form currently assumes that 98% of the cases are declared; the Democratic Republic of the Congo is the most affected country, with more than 75% of the gambiense cases declared. The epidemiology of the disease is mediated by the interaction of the parasite (trypanosome) with the vectors (tsetse flies), as well as with the human and animal hosts within a particular environment. Related to these interactions, the disease is confined in spatially limited areas called "foci", which are located in Sub-Saharan Africa, mainly in remote rural areas. The risk of contracting HAT is, therefore, determined by the possibility of contact of a human being with an infected tsetse fly. Epidemics of HAT were described at the beginning of the 20th century; intensive activities have been set up to confront the disease, and it was under control in the 1960s, with fewer than 5,000 cases reported in the whole continent. The disease resurged at the end of the 1990s, but renewed efforts from endemic countries, cooperation agencies, and nongovernmental organizations led by the World Health Organization succeeded to raise awareness and resources, while reinforcing national programs, reversing the trend of the cases reported, and bringing the disease under control again. In this context, sustainable elimination of the gambiense HAT, defined as the interruption of the transmission of the disease, was considered as a feasible target for 2030. Since rhodesiense HAT is a zoonosis, where the animal reservoir plays a key role, the interruption of the disease's transmission is not deemed feasible.

Introduction: The availability and affordability of safe, effective, accessible, and high-quality essential medicines is a critical benchmark for achieving the right to good health, and it is also one of the goals of the global health development agenda. To that end, it is critical to conduct rigorous studies to identify the major challenges confronting developing countries, particularly those in Africa. Objective: The purpose of this review was to identify the major challenges that Africans face in obtaining reasonably priced and readily available essential medicines. Methods: Generally the Boolean operators "AND" and "OR" were employed. Making progress also involves using duplicate checks, field definitions, and comparisons of articles and criteria. The analysis included all English-language papers published in any African country between 2005 and 2022, depending on the year of publication. The technique searches electronic databases for key phrases related to essential medication availability and affordability, such as PubMed, Web of Science, Scopus, Science Direct, Plos Medicine, and Google Scholar. Results: A total of 91 articles; by using search engines and handpicking including duplicates, were primarily searched. The electronic database search earned 78 articles while only eleven studies met the criteria for review and were reviewed of which 5 (50%) were from East African countries. Inadequate human resources, financial constraints, high cost of available medications on the market, poor inventory management, manual consumption forecasting, inefficiencies in drug registration, and trade-related aspects of intellectual property rights agreement regulations are all obstacles to the availability of essential medicines in African nations. Conclusion: This review revealed that in Africa, the availability and affordability of essential medicines face numerous challenges. The primary challenge, according to the review research, is a lack of adequate financing to pay for an appropriate set of essential medications, which account for a significant portion of household spending.

Using the Scopus dataset (1996-2007) a grand matrix of aggregated journal-journal citations was constructed. This matrix can be compared in terms of the network structures with the matrix contained in the Journal Citation Reports (JCR) of the Institute of Scientific Information (ISI). Since the Scopus database contains a larger number of journals and covers also the humanities, one would expect richer maps. However, the matrix is in this case sparser than in the case of the ISI data. This is due to (i) the larger number of journals covered by Scopus and (ii) the historical record of citations older than ten years contained in the ISI database. When the data is highly structured, as in the case of large journals, the maps are comparable, although one may have to vary a threshold (because of the differences in densities). In the case of interdisciplinary journals and journals in the social sciences and humanities, the new database does not add a lot to what is possible with the ISI databases.

Overlay journals are characterised by their articles being published on open access repositories, often already starting in their initial preprint form as a prerequisite for submission to the journal prior to initiating the peer-review process. In this study we aimed to identify currently active overlay journals and examine their characteristics. We utilised an explorative web search and contacted key service providers for additional information. The final sample consisted of 34 overlay journals. While the results show that new overlay journals have been actively established within recent years, the current presence of overlay journals remains diminutive compared to the overall number of open access journals. Most overlay journals publish articles in natural sciences, mathematics or computer sciences, and are commonly published by groups of academics rather than formal organisations. They may also rank highly within the traditional journal citation metrics. None of the investigated journals required fees from authors, which is likely related to the cost-effective aspects of the overlay publishing model. Both the growth in adoption of open access preprint repositories and researcher

A citation-based indicator for interdisciplinarity has been missing hitherto among the set of available journal indicators. In this study, we investigate network indicators (betweenness centrality), journal indicators (Shannon entropy, the Gini coefficient), and more recently proposed Rao-Stirling measures for "interdisciplinarity." The latter index combines the statistics of both citation distributions of journals (vector-based) and distances in citation networks among journals (matrix-based). The effects of various normalizations are specified and measured using the matrix of 8,207 journals contained in the Journal Citation Reports of the (Social) Science Citation Index 2008. Betweenness centrality in symmetrical (1-mode) cosine-normalized networks provides an indicator outperforming betweenness in the asymmetrical (2-mode) citation network. Among the vector-based indicators, Shannon entropy performs better than the Gini coefficient, but is sensitive to size. Science and Nature, for example, are indicated at the top of the list. The new diversity measure provides reasonable results when (1 - cosine) is assumed as a measure for the distance, but results using Euclidean distances w

BACKGROUND: Obesity is a well recognized risk factor for various chronic diseases such as cardiovascular diseases, hypertension, and type 2 diabetes mellitus. The aim of this study was to shed light on the patterns of overweight and obesity in sub-Saharan Africa, with special interest in differences between the urban poor and the urban non-poor. The specific goals were to describe trends in overweight and obesity among urban women; and examine how these trends vary by education and household wealth. METHODS: The paper used Demographic and Health Surveys data from seven African countries where two surveys had been carried out with an interval of at least 10 years between them. Among the countries studied, the earliest survey took place in 1992 and the latest in 2005. The dependent variable was body mass index coded as: Not overweight/obese; Overweight; Obese. The key covariates were time lapse between the two surveys; woman's education; and household wealth. Control variables included working status, age, marital status, parity, and country. Multivariate ordered logistic regression in the context of the partial proportional odds model was used. RESULTS: Descriptive results showed that the prevalence of urban overweight/obesity increased by nearly 35% during the period covered. The increase was higher among the poorest (+50%) than among the richest (+7%). Importantly, there was an increase of 45-50% among the non-educated and primary-educated women, compared to a drop of 10% among women with secondary education or higher. In the multivariate analysis, the odds ratio of the variable time lapse was 1.05 (p < 0.01), indicating that the prevalence of overweight/obesity increased by about 5% per year on average in the countries in the study. While the rate of change in urban overweight/obesity did not significantly differ between the poor and the rich, it was substantially higher among the non-educated women than among their educated counterparts. CONCLUSION: Overweight and obesity are on the rise in Africa and might take epidemic proportions in the near future. Like several other public health challenges, overweight and obesity should be tackled and prevented early as envisioned in the WHO Global strategy on diet, physical activity and health.

Using "Analyze Results" at the Web of Science, one can directly generate overlays onto global journal maps of science. The maps are based on the 10,000+ journals contained in the Journal Citation Reports (JCR) of the Science and Social Science Citation Indices (2011). The disciplinary diversity of the retrieval is measured in terms of Rao-Stirling's "quadratic entropy." Since this indicator of interdisciplinarity is normalized between zero and one, the interdisciplinarity can be compared among document sets and across years, cited or citing. The colors used for the overlays are based on Blondel et al.'s (2008) community-finding algorithms operating on the relations journals included in JCRs. The results can be exported from VOSViewer with different options such as proportional labels, heat maps, or cluster density maps. The maps can also be web-started and/or animated (e.g., using PowerPoint). The "citing" dimension of the aggregated journal-journal citation matrix was found to provide a more comprehensive description than the matrix based on the cited archive. The relations between local and global maps and their different functions in studying the sciences in terms of journal lit

We compare the network of aggregated journal-journal citation relations provided by the Journal Citation Reports (JCR) 2012 of the Science and Social Science Citation Indexes (SCI and SSCI) with similar data based on Scopus 2012. First, global maps were developed for the two sets separately; sets of documents can then be compared using overlays to both maps. Using fuzzy-string matching and ISSN numbers, we were able to match 10,524 journal names between the two sets; that is, 96.4% of the 10,936 journals contained in JCR or 51.2% of the 20,554 journals covered by Scopus. Network analysis was then pursued on the set of journals shared between the two databases and the two sets of unique journals. Citations among the shared journals are more comprehensively covered in JCR than Scopus, so the network in JCR is denser and more connected than in Scopus. The ranking of shared journals in terms of indegree (that is, numbers of citing journals) or total citations is similar in both databases overall (Spearman's \r{ho} &gt; 0.97), but some individual journals rank very differently. Journals that are unique to Scopus seem to be less important--they are citing shared journals rather than bein

In addition to science citation indicators of journals like impact and immediacy, social network analysis provides a set of centrality measures like degree, betweenness, and closeness centrality. These measures are first analyzed for the entire set of 7,379 journals included in the Journal Citation Reports of the Science Citation Index and the Social Sciences Citation Index 2004, and then also in relation to local citation environments which can be considered as proxies of specialties and disciplines. Betweenness centrality is shown to be an indicator of the interdisciplinarity of journals, but only in local citation environments and after normalization because otherwise the influence of degree centrality (size) overshadows the betweenness-centrality measure. The indicator is applied to a variety of citation environments, including policy-relevant ones like biotechnology and nanotechnology.

OBJECTIVES: To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. DESIGN: Prospective cohort study. SETTING: Rural villages in the Central Region of the Limpopo Province, South Africa. SUBJECTS: One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. RESULTS: Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96-4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17-0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46-34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24-38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7-12.10). CONCLUSION: The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.

Using three years of the Journal Citation Reports (2011, 2012, and 2013), indicators of transitions in 2012 (between 2011 and 2013) are studied using methodologies based on entropy statistics. Changes can be indicated at the level of journals using the margin totals of entropy production along the row or column vectors, but also at the level of links among journals by importing the transition matrices into network analysis and visualization programs (and using community-finding algorithms). Seventy-four journals are flagged in terms of discontinuous changes in their citations; but 3,114 journals are involved in "hot" links. Most of these links are embedded in a main component; 78 clusters (containing 172 journals) are flagged as potential "hot spots" emerging at the network level. An additional finding is that PLoS ONE introduced a new communication dynamics into the database. The limitations of the methodology are elaborated using an example. The results of the study indicate where developments in the citation dynamics can be considered as significantly unexpected. This can be used as heuristic information; but what a "hot spot" in terms of the entropy statistics of aggregated cit

An exploratory, descriptive analysis is presented of the national orientation of scientific, scholarly journals as reflected in the affiliations of publishing or citing authors. It calculates for journals covered in Scopus an Index of National Orientation (INO), and analyses the distribution of INO values across disciplines and countries, and the correlation between INO values and journal impact factors. The study did not find solid evidence that journal impact factors are good measures of journal internationality in terms of the geographical distribution of publishing or citing authors, as the relationship between a journal's national orientation and its citation impact is found to be inverse U-shaped. In addition, journals publishing in English are not necessarily internationally oriented in terms of the affiliations of publishing or citing authors; in social sciences and humanities also USA has their nationally oriented literatures. The paper examines the extent to which nationally oriented journals entering Scopus in earlier years, have become in recent years more international. It is found that in the study set about 40 per cent of such journals does reveal traces of internati

BACKGROUND: Low back pain (LBP) is the most prevalent musculoskeletal condition and one the most common causes of disability in the developed nations. Anecdotally, there is a general assumption that LBP prevalence in Africa is comparatively lower than in developed countries. The aim of this review was to systematically appraise the published prevalence studies conducted on the African continent to establish the prevalence of LBP in Africa. METHODS: A comprehensive search was conducted in April 2006. The following databases PEDro, Psychinfo, Science Direct, SportsDiscus, PubMed, CINAHL, Biblioline Pro-African Wide NiPAD and SA ePublications were individually searched using specifically developed search strategies for epidemiological research conducted on LBP amongst the African population. Two reviewers independently evaluated the methodological quality of the studies reviewed. RESULTS: A total of 27 eligible epidemiological studies were included in this review. The majority of the studies (63%) were conducted in South Africa (37%) and Nigeria (26%). The most common population group involved workers (48%), while scholars comprised 15% of the population. 67% of the studies were found to be methodologically sound, and the LBP prevalence of these were analyzed. The mean LBP point prevalence among the adolescents was 12% and among adults was 32%. The average one year prevalence of LBP among adolescents was 33% and among adults was 50%. The average lifetime prevalence of LBP among the adolescents was 36% and among adults was 62%. CONCLUSION: The findings support the global burden of disease of LBP, in addition to suggesting that LBP prevalence among Africans is rising and is of concern. Further research into the most effective strategies to prevent and manage LBP in Africa is warranted.