This issue of World Health & Population presents an interesting and varied set of papers that have been published online by WHP during the last quarter. They are selected here as representative of recent outstanding contributions to the journal and include three papers and a book review.

The initial paper in this issue, “Historical and Cultural Influences on HIV Prevention in Swaziland,” by Rachel Peterson, is interesting in its analysis of factors inhibiting HIV prevention efforts in Swaziland. Peterson bases her observations as a US Peace Corps Volunteer there. The Peace Corps (celebrating its 50th year in 2011) offers the observant volunteer a unique opportunity for an in-depth view of the impact of assistance programs and the cultural and historical facilitators and barriers to their success in achieving designated outcomes. It seems obvious that assistance programs should take the historical and cultural context of a setting into consideration in design, implementation and evaluation. However, the appropriate context is still commonly assumed to fit preconceptions, or is just entirely overlooked. Peterson provides some extremely interesting insights into the country’s history and culture, reasons why HIV prevention efforts have yet to take hold, and why Swaziland retains the sad distinction of having the highest HIV prevalence in the world.

“Breastfeeding in Cambodia: Mother Knowledge, Attitudes and Practices,” by Hillary Wren and Lori Chambers, is a classic and well-done knowledge, attitudes and practices (KAP) study of an important contributor to the Millennium Development Goals related to reduction of infant mortality, specifically MDG4. The benefits and importance of immediate and exclusive breastfeeding of newborns and infants up to the age of six months are well established, as described in the article. Wren, Chambers and colleagues designed and implemented a village-level survey to examine the status of this practice in a rural, impoverished area of Cambodia. Through interviews with 141 women with at least one child under 60 months, the survey gathered background demographics, information on breastfeeding knowledge, attitudes and behaviours, and feedback on existing breastfeeding support programs. The survey (with some benchmarking against the Cambodian Demographic and Health Survey) provides interesting and potentially actionable insights into cultural barriers to fully realizing the goal of immediate breastfeeding of newborns in Cambodia. More generally, the methodical and thoughtful approach taken by the authors in this study demonstrates that KAP surveys, even if retrospective, remain a useful tool for research in resource-constrained settings.

The third paper in this issue is a study of logistical and ethical issues surrounding the use of verbal autopsy for mortality surveillance in rural areas of Southern India. Verbal autopsy – asking family members and survivors regarding the details and circumstances surrounding the death of a family member – has become an important, if not critical, tool for healthcare planning and demography in areas with weak or non-existent vital registration systems and healthcare services.1 In their paper, Prem Mony and Mario Vaz from the National Academy of Health Sciences in Bangalore report on implementation issues surrounding verbal autopsy. Although there has been significant work examining the validity and reliability of verbal autopsy,2 Mony and Vaz contend that there has been insufficient focus on “process” issues, which they tackle through a qualitative study with 183 bereaved caregivers in a rural area of Andhra Pradesh, India. Important methodological, logistical and ethical issues are described, including informed consent, privacy and unsolicited information from non-family. The authors conclude that there is a significant need to not only strengthen the scientific validity of verbal autopsy methods but also the processes around its application.

We have also included a book review in this issue, which is a nice complement to the discussion of the importance of cultural context in the Peterson paper and of ethics in the Mony and Vaz paper. Emma McKim Mitchell, an assistant professor at the University of Miami, reviews Ethics in Health Services and Policy: A Global Approach by Dean M. Harris of the University of North Carolina at Chapel Hill. Harris’s book is intended as a text for graduate students in the health professions and employs a comparative, multicultural model that would feel familiar to most WHP readers. Both the review and the book are worth reading.

In conclusion, we hope that you find the papers (and the review) in this issue interesting and worthwhile, and that you will also consult others recently released online at www.worldhealthandpopulation.com. WHP remains committed to its mission to provide a forum for researchers and policy makers worldwide to publish and disseminate health- and population-related research, and to encourage applied research and policy analysis from diverse global and resource-constrained settings. WHP is indexed on MEDLINE and is accessible through PubMed.

Finally, we announce in this issue the 2009-2010 World Health & Population Best Paper Award for “Development of an Effective Public Health Screening Program to Assess Hearing Disabilities among Newborns in Shanghai: A Prospective Cohort Study,” WHP 11(4) 2009:5-14. Congratulations to co-authors Xiaoming Shen, David Zakus, Jun Lv, Zhengmin Xu, Hao Wu, William Hsiao, and Xiaoming Sun. This paper exemplifies the focus and goals of WHP: Rigorous health services research on a topic of global public health and public health policy importance, and a fruitful collaboration between researchers located in diverse global settings. Congratulations again to the authors, and appreciation as well from the editors and publishers of WHP.

We look forward to continued enthusiastic submission of manuscripts for consideration, peer review and publication. Finally, the editors and publishers of WHP are always interested in any comments or suggestions you might have on the papers or about the journal and our mission. Please feel free to write or email us.

About the Author

John E. Paul
Editor-in-Chief, World Health & Population

Footnotes

1. See, for example, Q.H. Tran, A. Johansson and H.L. Nguyen. 2007. “Reasons for Not Reporting Deaths in Rural Vietnam.” World Health & Population 9(1): 14–23. .

2. The first “Global Congress on Verbal Autopsy Methods and Applications” was held February 15–17, 2011, in Bali, Indonesia.