By Catrin Morgan

‘There is no tool for development more effective than the empowerment of women’ – Kofi Annan

The leading cause of death worldwide for a young woman is HIV. (1) The literature shows that teenage girls and young women are twice as likely to be at risk of HIV infection than teenage boys and young men.  In some countries the prevalence of HIV in adolescent girls is up to seven times greater than that of adolescent boys. (2)

The utilisation of healthcare services is also important when it comes to gender inequality. Studies have shown that gender inequality can affect the use of maternal health care services especially in rural areas. Women who live in areas of rural Africa, where gender norms include tolerance to violence against women are less likely to attend antenatal care and use birthing facilities. (3)

In context

The case report ‘Pregnancy complicated by haemorrhagic ascites in a woman with newly diagnosed HIV’ tells the story of a Zambian woman of low socioeconomic status and the healthcare inequalities she faced. (4) This pregnant 24-year-old presented to Lusaka, Zambia’s capital having traveled on the public bus for over eight hours from a rural region of Zambia.  She was 15 weeks pregnant and presented with a gross ascites that she had noticed for over a month.  This was her third pregnancy and she had received no antenatal care. On routine testing she was found to be HIV positive and was unaware of this diagnosis.  This woman was unemployed, illiterate and could only speak her local dialect.  She then went on to have surgery where a giant haemangioma measuring 21cm was excised.

This woman’s story demonstrates the barriers to healthcare millions of women in developing countries face every day.  The combination of gender discrimination, lack of education and low socioeconomic status results in these women presenting at a later stage of illness, less likely to access routine healthcare and at a greater risk of contracting HIV infection.

Figure 1: An image showing the excised specimen taken from: Morgan C, Nicholls K, Gangat N, et al. Pregnancy complicated by haemorrhagic ascites in a woman with newly diagnosed HIV. BMJ Case Rep. 2016 Jul 29;2016:10.1136/bcr,2016-216346.

What can be done?

With the emergence of many powerful female leaders over the past few years, now is the time to empower young women and girls across the world and to put a stop to gender inequality, that our patient faced in this case report. This could have a huge impact on healthcare across the world with the reduction of infections such as HIV and ultimately putting an end to AIDS epidemic across Africa. 

References

1. World Health Organisation. Women’s Health [Internet].
2. Ramjee G, Daniels B. Women and HIV in sub-saharan africa. AIDS Res Ther [Internet]. 2013 Dec 13;10(1):30,6405-10-30.
3. Adjiwanou V, LeGrand T. Gender inequality and the use of maternal healthcare services in rural sub-saharan africa. Health Place [Internet]. 2014 Sep;29:67-78.
4. Morgan C, Nicholls K, Gangat N, Sansome S. Pregnancy complicated by haemorrhagic ascites in a woman with newly diagnosed HIV. BMJ Case Rep [Internet]. 2016 Jul 29;2016:10.1136/bcr,2016-216346.

Events are to be held all over the world today as we mark World Humanitarian Day.

At BMJ Case Reports we look back at our Global Health case reports and thousands of clinical cases from across the globe that remind us of the place of Medicine in the alleviation of suffering, advocacy for human rights and rights to health for the world’s most vulnerable communities.

From mental health in Ethiopia to rural medicine in Trinidad, from appendicitis in Greenland to dementia in the Dominican Republic, we are reminded of the enormous investment of resources necessary to bring essential care to our patients. Sir Michael Marmot writes “most racial/ethnic inequalities in health can be attributed to social determinants of health, as can socioeconomic inequalities”and “given that the causes of disease and violence are likely to be the same wherever we find them, it follows that the remedies should be similar”. He lists the solutions: “early child development, education and lifelong learning, employment and working conditions, minimum income for healthy living, healthy and sustainable communities, and social determinants approach to prevention” [1]

BMJ Case Reports is a world renowned resource for the management of complex or challenging medical conditions but we are also documenting efforts to tackle the social determinants of health and assist communities in meeting their health needs. We celebrate the tireless work of our colleagues today as we focus our attention again on the plight of people in need of the most basic and compassionate care.

BMJ Case Reports is launching a call for Global Health Associate Editors. We are looking for medical students and junior doctors in their internship years to join our Editorial Team. For more information, see our website or get in touch: bmjcases@bmj.com

References

[1]  Michael G. Marmot.  Empowering Communities. American Journal of Public Health: February 2016, Vol. 106, No. 2, pp. 230-231. doi: 10.2105/AJPH.2015.302991
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302991

By Hemali Bedi

It is with great pleasure that we announce the winners of the 2015 BMJ Case Reports Student Elective Competition! Each entry has been carefully reviewed and judged by our expert Editorial Team. It was a difficult task to judge all of our excellent entries, and the Editorial Team thoroughly enjoyed reading each case.

The winners are:

1^st Place:
Nathan Douthit
Social Determinants of Health: Poverty, National Infrastructure and Investment

Runners-up:

• Laura Santoso
  HIV-associated dementia in the Dominican Republic: a consequence of stigma, domestic abuse, and limited health literacy
• Johnathan Amkraut
  Navigating Care for Bedouin Patients with Diabetes
• Johannes Scheurer
  The tale tell thigh
• Rajan Singh
  Chyluria – A Scourage of our region

Our grand prize winner will receive a £500 travel bursary to be used toward the cost of attending a global health conference or event of their choice. In addition, all of our winners will be featured in our special BMJ Case Reports 2016 print edition.

Congratulations to all our winners. We want to say a big thank you to everyone who participated in our competition and helped make it a success.

Student Elective Competition 2016: A call for entries

We are now launching the 2016 competition for students and interns. Write up your experiences as a global health case report and you could be the winner of a position as a Global Health Associate Editor for BMJ Case Reports. Your case report will also be included in the 2017 special edition print journal.

All authors must be students or interns at the time of submission. Your entry will undergo the same treatment that all our journal submissions do, including the peer review process, so be sure to check out our Instructions for Authors for guidance before you start writing. If you’ve never written a global health case report before, you may find our template useful to help you get started.

Winners will be selected for interview to become a Global Health Associate Editor. We welcome submissions from all over the world. Patients may be anyone seen on the ward or at home, in medical school or on elective. Winners will be announced in September 2017.

If you’re interested in writing a global health case report, we’re here to help. Seema Biswas, Editor in Chief of BMJ Case Reports, guides you through the writing process in a recent article featured in The Student BMJ. You can also visit the BMJ Case Reports website for examples of previously published global health case reports and look at the annotated example.

Read our guidance, join our global health blog and get writing! We look forward to receiving many interesting global health case reports.

By Hemali Bedi

Honduras has had one of the highest rates of urban violence in the world since 2010. [1] With an average of one violent death per hour in 2013, rates of lethal violence exceed those in many war-affected countries. [2] As well as having humanitarian implications, the violence in Honduras also presents a critical public health problem.

Seema Biswas, Editor in Chief of BMJ Case Reports, discusses her experience of being deployed as a British Red Cross surgeon working with the International Committee of the Red Cross (ICRC) in Honduras in a new article published in the Guardian.

Seema Biswas comments: “Local doctors and nurses keep working. They are well organised, well informed, resourceful and committed to dealing with the continuous emergency of an overburdened health service. They are not silent, but they are considerate in their thoughts and measured in their comments. They explain the situation to me: there are complex problems here. The most vulnerable are the poor. To address their health, communities need to be safe and they need access to education and employment that pays a regular salary sufficient to feed their families.” [3]

Many factors are thought to contribute to the growing violence in Honduras, including political instability, corruption, inequality, organised crime and gang related activity. [2] Universal strategies to reduce violence in Latin  America are featured in the United Nations’ 2030 Agenda for Sustainable Development [4]. The top 10 recommendations to improve safety in Latin America are: [4]

1. Align national efforts to reduce crime and violence, based on existing experiences and lessons learned.
2. Prevent crime and violence, promoting inclusive, fair and equitable.
3. Reduce impunity by strengthening security and justice institutions while respecting human rights.
4. Generate public policies oriented to protect the people most affected by violence and crime.
5. Promote the active participation of society, especially in local communities, to build citizen security.
6. Increase real opportunities of human development for young people.
7. Comprehensively address and prevent gender violence within the home and in public environments.
8. Actively safeguard the rights of victims.
9. Regulate and reduce “triggers” of crime such as alcohol, drugs and firearms, from a comprehensive, public health perspective.
10. Strengthen mechanisms of coordination and assessment of international cooperation.

What are your thoughts?  For more information about global health and the social determinants of health, browse through our global health case reports, which focus the causes of ill health and access to healthcare services in all parts of the world.

References

[1] OSAC. Honduras 2016 Crime & Safety Report. https://www.osac.gov/pages/ContentReportDetails.aspx?cid=19281, published online March 2013
[2] B-Lajoie M, et al. The need for data in the world’s most violent country Bulletin of the World Health Organization 2014;92:698. doi:http://dx.doi.org/10.2471/BLT.14.136713 http://www.who.int/bulletin/volumes/92/10/14-136713/en/
[3] Biswas S. Field post: ‘Honduras has one of the world’s highest rates of urban violence’. https://www.theguardian.com/global-development-professionals-network/2016/jul/27/honduras-urban-violence-hospitals-highest-rates#comments, published online 27 July 2016
[4] United Nations Development Programme (UNDP) (2013) Citizen security with a human face: evidence and proposals for Latin America. Human development report for Latin America. UNDP, New York. http://hdr.undp.org/sites/default/files/citizen_security_with_a_human_face_-executivesummary.pdf, published 2013