After enduring the fight of his life, miracle baby NIRVAAN is finally going home following  132 days in the Neonatal Intensive Care Unit (NICU) at the Surya Hospital, Mumbai. It was a dream come true for the parents and team of  Dr Nandkishor Kabra, Neonatologist and Director of NICU, Dr Sejal Desai, Dr Sejal Desai, Obstetrician & Gynaecologist, Dr Hari Balasubramanian, Neonatologist & Dr. Bhupendra Avasthi with other 14 doctors and 50 nursing staff at Surya NICU  who spent several sleepless nights in managing this tiny tot all are happy to see nirvana go home healthy and happy.

The frightening dream transformed to reality for Mumbai couple – Retika and Vishal, when their baby boy NIRVAAN was born during the 22^nd week of pregnancy with a birth weight of 610 gms, head size of 22cm and length of 32cm. the infant has proved to be a miracle microman. India’s Tiniest surving infant by gestational age maturity of 22 weeks at birth.

The celebration of first pregnancy was short lived for the career oriented biomedical engineer, when her waters broke suddenly on 12^thMay. It was almost certain that she would deliver in few hours time. In Retika’s case adversity never came alone-she delivered within few seconds of admission to the labour ward of Surya mother and child care. There was neither time to prepare for a caesarean section nor an opportunity for maternal steroid treatment, each of which could have improved the survival outcome. Despite all odds, Nirvaan received timely attention by a skilled neonatal team during the ‘golden’ initial 10 minutes of life and was swiftly transferred to the Neonatal intensive care unit within 15 minutes of age where he was meticulously monitored and managed over the past 4 months.

Dr. Bhupendra Avasthi Said “Nirvaan had immature lungs at birth requiring ventilatory support right from the labour room. He required respiratory support for 12 weeks which included 6 weeks of ventilator support. Multiple doses of surfactant injections were instilled into the breathing tube to expand his lungs. He survived life threatening events such as Pneumothorax (air accumulation around the lungs) and brain bleeds to emerge as a crusader. A month long steroid treatment was needed to help him breathe on his own. The steroid treatment also increased his risk of having infection and high blood sugars which required antibiotic and insulin therapy. Multiple blood transfusions, LASER treatment of eyes and hernia surgery were also required during this period. Oral feeds could be given only after 3 months of age.”

“It took at least 6 weeks for the medical team to see the winner in Nirvaan. That was when he was taken off the ventilatory support and weighed 1kg while on complete milk feeds. He was however continued on non invasive respiratory support for the next 6 weeks. Oral feeds and breast feeding could be initiated only after 3 months of age. Multidisciplinary management in the form of heart and brain scans, bone integrity checks, hearing assessments, skin care, physiotherapy, lactation support was required. The family also was provided emotional support through rigorous counselling by the medical team” Said Dr Avasti.

“Sheltered in a closed incubator and in the midst of tubes, circuits, iv lines, probes, dressings, eye pads, etc. Nirvaan was virtually invisible in the initial days. All team of doctor & nurses are happy to see nirvana go home healthy and happy. Nirvana is on breast feeding and  with a weight of 3.72kg head size of 34 cm and length of 50 cm. The most important is going home, with an intact brain, vision, hearing and potential for normal long term neurological development.” said Dr Avsati.

Infants born between 22 and  24 weeks of pregnancy are considered perceivable infants or infants born at the limits of viability, as a foetus may not exist independent of the mother prior to 22 weeks. To a neonatologist and paediatrician, there could be no bigger challenge than managing a 22 weaker ultra micro premature new-born baby. To our knowledge, there is no report of a surviving 22 week newborn baby from our country. There is also limited experience with managing such babies.

When it comes to 22 weekers gestation premature infants, 40-50% of them are born dead (still born) worldwide. Among those that are born alive, less than 5% continue to survive. The United States – NICHD (National Institute of Child Health and Human Development) Neonatal research network has reported that only 2% of the live born babies have survived to discharge, and only 1% survived with normal neurodevelopmental outcome. A large population based study from France( EPIPAGE 2) has reported 0% survival in  such babies.

The surviving infants are at high risk of having serious neuro developmental disability such as cerebral palsy, mental retardation, hearing loss, visual impairment, epilepsy. Hence, even in developed countries, only 20% of infants born at 22 weeks would be offered active resuscitation or life saving interventions at birth. About 80% of the babies would be provided comfort care in the delivery room

Nirvaan’s story highlights the fact that periviable infants born in developing countries not only have a chance, but also the right to survive and live a normal life.  In utero transfer of newborns to an advanced maternity cum neonatal hospital for delivery, sophisticated neonatal care and team work could make that happen. Surya mother and child care has served as a standalone newborn hospital in the heart of Mumbai city for the past 25 years. The country’s first surviving 24 week newborn baby SURYA was discharged from Surya on March 2011). SAKSHI – India’s first surviving 23 week baby was also discharged from the same. Having broken our own record after nearly 2 years, it is evident that intact survival of such micro premmies  may be a  daunting task, but not impossible.

A survey of policymakers across five countries – Colombia, Kenya, India, Indonesia and Senegal—on gender equality in their respective countries has show how little they actually know.

When asked about their awareness of the SDGs – which contain ambitious commitments to achieve gender equality by 2030, including a specific gender equality goal (Goal 5) and references to gender equality throughout the SDG framework (13 out of 17 goals), the awareness of policymakers of the SDGs was quite high – nearly eight in ten policymakers either knew “a great deal” or “a fair amount” about the SDGs, though it varied by country.

However, the highest proportion of policymakers with not much or no knowledge of the SDGs was found in India (38%). In Kenya, 65% of policymakers reported knowing “a great deal” about the SDGs, compared to 29% in Senegal, India (27%) and Colombia (20%).

When asked to estimate the rate of maternal deaths in their country (the number of women dying from causes related to pregnancy and childbirth), only 6% of policymakers came within 20% of the most recently available figure.

On the rates of early marriage for girls, just a quarter of policymakers came within 20% of the most recently available figure with the Columbian policymaker’s estimates of the percentage of girls married before the age of 18 ranged from 4% to 80% (the most recently available data says 23%).

In Kenya, when asked to estimate what percentage of parliamentary seats are held by women, the policymakers’ estimates ranged from 6% to 90% (the most recently available data says 21%).

Indian policymakers’ estimates of the percentage of women in the labour force ranged from 20% to 70% (the most recently available data says 27%).

The wide variation in responses raises questions about whether policymakers are aware, have access to or are sufficiently guided by the relevant, current data needed to assess progress for girls and women towards the Sustainable Development Goals (SDGs), according to the survey  “Policymakers and Gender Equality: What They Know and How They Know It, ” carried out by Equal Measures 2030, a civil society and private sector led partnership that aims to connect data and evidence with advocacy and action, helping to fuel progress towards gender equality.

By surveying policymakers in five countries, this research seeks to shed light on the following questions: How do policymakers perceive progress on gender equality in their countries? What most needs to change in order to improve gender equality? What data and evidence do they rely on to make their decisions? How confident are they in their understanding of the major challenges affecting girls and women in their countries?

Across the five countries researchers found that half of the policymakers felt that gender equality gets too little attention in policymaking in their country, with considerable variation in the views of the men and women surveyed (67% of women stated this, compared with 33% of men).

One in five men felt there was too much attention to gender equality in policymaking. Gender equality concerns are seen to be given much more importance in some policy areas than others. For example, four fifths of policymakers thought that gender equality concerns were given a “high” or “very high” priority when setting policy on education, whereas just 38% thought gender was given a “high” or “very high” priority when making decisions about public finance.

Regarding perception of data and evidence on gender equality in policymaking, policymakers surveyed said they often use government data (79%), international data, such as from the United Nations (47%) and academic or research institution data (41%). Just under half of policymakers rated government data sources as “very useful” (47%).

When asked about their perceptions of progress on gender equality, the policymakers spoken to were fairly positive with 66% believing that men and women in their country were more equal than five years ago. But the answers to this question varied widely by sex: While nearly eight in ten men thought that progress had been made on gender equality in the past five years, only 55% of women agreed this was the case. More than twice the number of women than men felt the situation had not changed or worsened (44% of women compared with 19% of men).

About 617 million children and adolescents worldwide are not achieving minimum proficiency levels in reading and mathematics, signalling “a learning crisis” that could threaten progress on global development goals, a report from the United Nations Educational, Scientific and Cultural Organization (UNESCO) shows.

“The figures are staggering both in terms of the waste of human potential and for the prospects of achieving sustainable development,” said Silvia Montoya, Director of the UNESCO Institute of Statistics, in a press release.

The report suggests some 387 million children of primary school age (or 56 per cent) and 230 million adolescents of lower secondary school age (or 61 per cent) will not achieve minimum proficiency levels in reading and math.

Across Sub-Saharan Africa, 202 million children and adolescents are not learning these fundamental subjects. Nearly 90 per cent of children between the ages of about 6 and 14 will not meet minimum proficiency levels in reading and math.

Central and Southern Asia has the second highest rate, with 81 per cent, or 241 million, not learning.

Surprisingly, two-thirds of the children who are not learning are in school. Of the 387 million primary-age children unable to read proficiently, 262 million are in classrooms. There are also about 137 million adolescents of lower secondary age who are in classrooms, but unable to meet minimum proficiency levels in reading.

The report indicates that along with a lack of access to school and a failure to retain children in school, the poor quality of education in the classroom is among the three common problems.

Ms. Montoya said the new data was a “wake-up call” for far greater investment in the quality of education.

The global goals for education are clear: Sustainable Development Goal 4 (SDG 4) signals a commitment from governments to ensure an “inclusive and equitable quality education and the promotion of lifelong learning opportunities for all.”

NEW DELHI : The 11th World Congress on Adolescent Health, ‘Investing in Adolescent Health – the Future is Now’ will be held in New Delhi from October 27-29. The Congress is held every four years by the International Association for Adolescent Health.

The world is home to 1.2 billion adolescents, and India has the largest population of adolescents in the world – 253 million.

The mortality of adolescents globally stands at staggering 1.3 million deaths per year. Unintended injuries such as road traffic accidents and drowning are the leading causes of death among adolescents, together with self-harm, interpersonal violence, communicable diseases and teenage pregnancy.

Tobacco, alcohol and other substance use contribute to health concerns among adolescents. These are associated with unemployment, accidents, depression and suicide during adolescence. Yet, rather than a passing phase, these behaviours and states risk reverberate across the life-course, contributing to the future burden of disease in adults and to that of the next generation.

Globally, adolescence is a period which encapsulates tremendous change in relation to critical life events such as transitions from education to employment, and formation of families and parenting. Adolescence is also the period in which individuals experience the greatest change in health and health-related behaviours across their lifetime. Well recognized as a time of risk for health, increasingly adolescence is now accepted as a period of opportunity for health, in which individuals gain the assets and resources to sustain health across the life-course.

The agenda for Sustainable Development Goals 2030 and the new Global Strategy on Women’s Children’s and Adolescents’ Health have brought adolescence to the centre-stage. These agendas recognize the opportunities and contribution of adolescence to achieving a wide array of global health priorities including improvements in communicable diseases (e.g. HIV) and non-communicable diseases, women’s health, mental health, nutrition, and more.

The World Congress is being organized with the support of the Ministry of Health & Family Welfare (MoHFW) and MAMTA Health Institute for Mother and Child is hosting the World Congress with a consortium of partners.

The World Congress is anticipating around 800 international and national delegates including adolescent health experts from across the globe, academia, representatives from MoHFW, national and global representatives of UN organizations, youth leaders from several countries including India who have made a difference in their communities, national and international NGOs, donor organizations, policy makers and corporates.

India has avoided about 1 million (10 lakh) deaths of children under age five between 2005 and 2015, primarily as a result of significant reductions in mortality from pneumonia, diarrhea, tetanus and measles, according to new research published today. A steeper decline in the number of girls dying narrowed a previously observed girl boy mortality gap. An almost equal number of boys and girls under age five died in 2015.

Nearly three times that number could have been saved if national progress in child health matched that reached in some States, Dr. Prabhat Jha, head of the Centre for Global Health Research of St. Michael’s Hospital in Toronto, wrote in the latest issue of The Lancet.  This research is part of the Million Death Study, one of the largest studies of premature deaths in the world.

Dr. Jha is the lead investigator of the survey, based in India, where most deaths occur at home and without medical attention. Hundreds of specially trained census staff in India knocked on doors of more than 1.3 million homes to interview household members about deaths. Two physicians independently examined these “verbal autopsies” to establish the most probable cause of death. “You get the truth when you knock on doors and talk to parents,” said Dr. Jha. “We knocked on the doors of 100,000 homes where children died. If the health system failed these families, they will tell you all about it. These are far more reliable numbers than models or projections from small studies.”

The study found a 3.3 per cent annual decline in mortality rates of neonates (infants less than one month old) and 5.4 per cent for those ages one month to 59 months. The declines accelerated starting in 2005 and were fastest between 2010 and 2015, and in urban areas and richer states. Per 1,000 live births, the mortality rates among neonates fell from 45 in 2000 to 27 in 2015. The one-59 month mortality rate fell from 45.2 to 19.6. Looking at specific causes of death, mortality rates from neonatal tetanus and measles fell by at least 90 per cent, neonatal infection and birth trauma fell more than 66 per cent. For children ages one to 59 months, mortality rates from pneumonia and diarrhea fell more than 60 per cent. About 6 million children die around the world each year and progress in reducing that number depends greatly on India, which accounts for about a fifth of the deaths. About 29 million Indian children died between 2000 and 2015. Had the mortality rates of 2000 continued unchanged, about 39 million children would have died, according to The Lancet paper.

The authors noted that in the last decade the government of India has modestly increased its traditionally low level of public spending on health. The government launched a program to encourage women to give birth in hospitals and for children to have a second dose of measles vaccine. Dr. Jha said that to meet the United Nation’s Sustainable Development Goals of halving its child mortality rates by 2030, India must maintain its current trajectory for children ages one to 59 months and accelerate declines in neonatal mortality. Reducing the number of neonatal deaths will require efforts to reduce deaths caused by premature delivery and low birth weights, especially in poorer states, he said. Both are strongly linked to largely modifiable maternal and prenatal factors such as health care during pregnancy, education, nutrition, anemia and tobacco use.

Photo – Engineers at the Johns Hopkins University Advanced Physics Laboratory in Laurel, Maryland, work on NASA’s Parker Solar Probe spacecraft. Parker Solar Probe will be the first-ever mission to fly directly through the Sun’s atmosphere. Credits: JHU/APL

NASA’s Parker Solar Probe will be humanity’s first-ever mission to explore the Sun’s outer atmosphere. The spacecraft, about the size of a small car, will launch in mid-summer 2018. It will travel directly through the Sun’s atmosphere about four million miles from our star’s surface – facing heat and radiation unlike any spacecraft in history – and make critical observations to answer decades-old questions about how stars work. Mission data ultimately will improve forecasts of major space weather events that affect life on Earth, as well as satellites and astronauts in space.

In order to unlock the mysteries of the sun’s atmosphere, Parker Solar Probe will use Venus’ gravity during seven flybys over nearly seven years to gradually bring its orbit closer to the sun. The spacecraft will fly through the sun’s atmosphere as close as 3.9 million miles to our star’s surface, well within the orbit of Mercury and more than seven times closer than any spacecraft has come before. (Earth’s average distance to the sun is 93 million miles.)

Flying into the outermost part of the sun’s atmosphere, known as the corona, for the first time, Parker Solar Probe will employ a combination of in situ measurements and imaging to revolutionize our understanding of the corona and expand our knowledge of the origin and evolution of the solar wind. It will also make critical contributions to our ability to forecast changes in Earth’s space environment that affect life and technology on Earth.

Know More About 

Parker Solar Probe: Humanity’s First Visit to a Star

NASA’s historic Parker Solar Probe mission will revolutionize our understanding of the sun, where changing conditions can propagate out into the solar system, affecting Earth and other worlds. Parker Solar Probe will travel through the sun’s atmosphere, closer to the surface than any spacecraft before it, facing brutal heat and radiation conditions — and ultimately providing humanity with the closest-ever observations of a star.

Parker Solar Probe is part of NASA’s Living With a Star program to explore aspects of the sun-Earth system that directly affect life and society. The Living With a Star flight program is managed by the agency’s Goddard Space Flight Center in Greenbelt, Maryland, for NASA’s Science Mission Directorate in Washington. The Johns Hopkins University Applied Physics Laboratory in Laurel, Maryland, manages the mission for NASA. APL is designing and building the spacecraft and will also operate it.

Lockheed Martin is in jet speed to make the latest variant of its F 16 Block 70 in India.

During the Paris Air Show in June, the company announced a coproduction agreement with the Tata Advanced Systems Ltd (TATA), and now it has disclosed that in anticipation of a contract from the Indian Air Force (IAF) for a single engine aircraft manufacturing facility, it has already initiated steps to create the required ecosystem in the country. Diplomatic sources indicate that the US Government is also aggressively backing the Lockheed Martin proposal in Government-to-Government (G-2-G) talks with the Indian Government.

Mr Abhay Paranjpe, Executive Director, International Business Development and Mr Randall L Howard, Business Development head for F 16 said during a recent interaction with India Strategic here  that the company had already worked out the best available systems that could be integrated in the aircraft, assuring: “We will provide whatever the IAF asks for, and our technology will be unmatched and unprecedented.”
Recently, IAF chief Air Chief Marshal BS Dhanoa, had said that IAF now logically expects better specifications than were asked for in the 2007 tender for the Medium Multi Role Combat Aircraft (MMRCA). The F 16, which was the first to bring a powerful Active Electronically Scanned Array (AESA) radar on board in its Block 60 aircraft delivered to the United Arab Emirates (UAE) way back in 2004, does not yet have the Infra Red Search and Track (IRST) system.

IRST, which is there on board the French Rafale already taken by IAF, is a passive system and can detect hostile aircraft and targets between 60 to 100 km or so without being detected itself, unlike any radar system including the AESA. As the world’s biggest military hardware company, “We will be able to offer whatever the IAF wants, on time and cost,” said Mr. Paranjpe, adding that the Lockheed Martin proposal will include assured periodic upgrades.

AESA is a key component for contemporary and future aircraft, and can look up to 400 km depending upon the radar’s power and aircraft’s height.

Mr. Paranjpe also said that the new AESA, to be acquired from Northrop Grumman which had made it first for F 16 Block 60 and later for F 22 and F 35, will be of a new 4th generation, and compared to the earlier versions which are liquid cooled, will be air cooled and still perform better. It will be multimode, able to lock onto 20 targets simultaneously, and a pilot can priorities which targets to engage first.

Mr. Howard said that the company will meet any specs required by the IAF. The aircraft is comfortable in power and weight and can accommodate whatever is needed. Lockheed Martin will leverage some future technologies from its F 35.

“As the F 16 Block 70 will be a new generation aircraft, it will also share some components and latest technologies with those of the F 35 to the extent of 70-75 percent. The Block 70 will also have conformal fuel tanks for longer range.”

The company will shift the entire factory and production line from Fort Worth in Texas to India if – repeat if – the Ministry of Defence (MoD) selects the aircraft.

Notably, the global standard for aircraft availability is about 70 percent. This, or whatever is required by IAF, will be matched, Randall Howard said.

Paranjpe pointed out that IAF’s urgency in aircraft requirement is no secret, and the Indian order for a minimum of 100 first to be followed by many more later will be huge. “We have a great partnership with TASL, and we should be able to produce three to four aircraft every month for Indian and global requirements. We will create a big defence industrial base, a supply chain for not only India but for the world, and that will include spares.”

Asked about how much investment the company will put in, Mr. Panajpe and Randall Howard said that they hoped that India will follow the US business model. There, a runway is shared by the US Air Force (USAF) and industry, the two being on either side of it, and that will determine how much Lockheed Martin will have to invest. Sharing facilities will help save costs and production and testing time.

Mr. Panajpe added: “We are also ready to pass on the required knowledge and know-how to local partners.”

Randall Howard said that Lockheed Martin had produced nearly 4,600 aircraft in 138 variants and sold to 27 countries, including the US. Sixteen of these countries placed repeat orders.

He also pointed out, significantly, that while the India’s Ministry of Defence is yet to place the order under its new policy of Make in India and having a Strategic Partner, Lockheed Martin is doing its homework in anticipation of winning it. We have worked out the technologies onboard, Display Systems, Software, Air to Air and Air to ground Targeting Systems, and what to do with whom as part of our effort to create an enabling ecosystem and move literally at jet speed.  

New Delhi – MDI study has found that the Prime Minister’s Employment Generation Programme (PMEGP) has been able to provide Sustainable Employment.

Management Development Institute in its study found that the units set up under the scheme provided employment throughout year and for large number of years. The institute was entrusted with the task of conducting Evaluation Study of PMEGP in January, 2017.

The aim of the study was to examine the impact of the scheme in terms of employment generation and improvement in income of the rural and urban artisans and unemployed youth, major problems in implementation of Scheme and ways to resolve them and to make recommendations on making further improvements in the Scheme.

To conduct the study, the sample size was selected on stratified random sampling basis. The total number of micro units setup from 2012-013 to 2015-16 was 2,00,885 units. This units were taken into consideration, out of these a sample coverage of five per cent i.e. about 10,108 units were sought listed on random basis from among the three implementing agencies viz. KVIC, KVIB and DIC in proportion of 30:30:40.

Minister of State (Independent Charge) for Micro, Small and Medium Enterprises (MSME) Giriraj Singh was presented with evaluation study of the PMEGP. 

The following were the key observations of the Study:

• Scheme has been able to provide Sustainable Employment. Units set up under the scheme provided employment throughout year and for large number of years.
• Scheme has good reach, it has targeted at almost all sections of the society (based on social background, education background, location etc)
• Average Employment per Project Â– 7.62
• Average Cost of Generating Unit Employment  Â– Rs 96,209
• Maximum Cost of Generating Unit Employment Â– Rs  2,75,621 (Nagaland)
• Minimum Cost of Generating Unit Employment  – Rs 64,735 (Tamil Nadu)
• Average Cost per Project –  Rs 7,33,423

Problem areas:

•      Delay in the process of sanctioning of loans at different stages.

•      Hypothecation & collaterals asked for.

•      Physical verifications & delay in adjustment of margin money.

•      Records keeping, hand holding, access of data & reporting by implementing agencies.

•      Marketing for products.

Key recommendations:

• Increased availability of field officers (They are a key connect between beneficiary and agencies and are currently sparse)
• EDP Training content needs to be more relevant and rigorous. On line EDP could be encouraged.
• Content partnership/Integration with MOOCs (Massive Open Online Coursewares) of recognized reputational technical and managerial institutes (such as IITs and IIMs)
• Agencies could consider hiring interns from leading management institutions (India/Abroad) to further handholding of beneficiaries
• Integration with Aadhar to authenticate the trainee identity and progress.
• For motivating beneficiaries to repay loans – The people whose Margin Money has been successfully adjusted, need to be rewarded with an option of 2nd round of subsidized loans (at say 15 per cent of subsidy).
• Enforcement of deadlines (either of 60 or 90 days) on banks to decide about decision (acceptance or rejection) of the loan application

viii.     Cash credit account (CCA) component of the loan could be reduced. Maximum CCA may range up to 40 per cent of total loan.

Laboratory worker testing antibiotics on a resistant infection. Photo: PAHO/Joshua Cogan

The report released today by the World Health Organization (WHO) says most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions.

“Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine,” said WHO Director-General Tedros Adhanom.

The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250,000 people each year.

“There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery,” Mr. Adhanom said.

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only eight are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

The report also found that although oral antibiotics are essential for treatment outside hospitals or in resource-limited settings, few are in the pipeline.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” said Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up a research and development partnership.

According to Mario Raviglione, Director of the WHO Global Tuberculosis Programme, research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years.

“If we are to end tuberculosis, more than $800 million per year is urgently needed to fund research for new anti-tuberculosis medicines,” he said.

Whether you are child in Baltimore, Beijing, Nairobi or New Delhi, The onset of adolescence triggers a surprisingly common set of rigidly enforced gender expectations that are linked to increased lifelong risks of everything from HIV and depression to violence and suicide. 

This is the key finding from a groundbreaking 15-country study released today by the Global Early Adolescent Study, a collaboration between the Johns Hopkins Bloomberg School of Public Health and the World Health Organization (WHO) as a collection of articles in the Journal of Adolescent Health. 

Whether the adolescent is in Baltimore, Beijing, Nairobi or New Delhi, public health experts across the globe who collaborated to learn how an assortment of culturally enforced gender stereotypes long associated with an increased risk of mental and physical health problems become firmly rooted between the ages of 10 and 14. “We found children at a very early age—from the most conservative to the most liberal societies—quickly internalize this myth that girls are vulnerable and boys are strong and independent,” said Robert Blum, director of the Global Early Adolescent Study based at Johns Hopkins University. “And this message is being constantly reinforced at almost every turn, by siblings, classmates, teachers, parents, guardians, relatives, clergy and coaches.” 

The findings emerged from a series of comprehensive interviews conducted over the last four years with approximately 450 early adolescents matched with a parent or guardian (totaling nearly 900) in Bolivia, Belgium, Burkina Faso, China, the Democratic Republic 2 of Congo, Ecuador, Egypt, India, Kenya, Malawi, Nigeria, Scotland, South Africa, the United States and Vietnam. Blum said the work shows a need to rethink adolescent health interventions, which typically focus on youth 15 years or older, so that they target a much younger age group. 

“Adolescent health risks are shaped by behaviors rooted in gender roles that can be well established in kids by the time they are ten or 11 years old,” said Kristin Mmari, DrPH, associate professor and lead researcher for the qualitative research at the Global Early Adolescent Study. “Yet we see billions of dollars around the world invested in adolescent health programs that don’t kick in until they are 15, and by then it’s probably too late to make a big difference.” 

The Perils of Outfitting Adolescents with a “Gender Straitjacket” the conversations conducted by the researchers revealed that, around the world, young boys and girls are outfitted with “gender straitjackets” at a very early age, with lifelong negative consequences that are particularly perilous for girls. The researchers found that gender-based restrictions rationalized as “protecting” girls actually made them more vulnerable by emphasizing subservience and implicitly sanctioning even physical abuse as punishment for violating norms. They observed that “in many parts of the world” these stereotypes leave girls at greater risk of dropping out of school or suffering physical and sexual violence, child marriage, early pregnancy, HIV and other sexually transmitted infections. 

For example, the researchers found boys in both New Delhi and Shanghai talked about being encouraged to spend time outside of the home in unsupervised exploration of their environment, while girls said they were advised to stay home and do chores. Shaming and beatings for those who sought to cross the divide was reported by girls and boys in both cities. 

In all but one city, Edinburgh, Scotland, both boys and girls were clear that it was the boy who had to take the initiative in any relationship. Across all settings, young girls reported a constant emphasis on their physical appearance and their bodies as their key asset. “In New Delhi, the girls talked about their bodies as a big risk that needs to be covered up, while in Baltimore girls told us their primary asset was their bodies and that they need to look appealing—but not too appealing,” Mmari said. The researchers noted that their findings bore out conclusions from previous work that “during adolescence, the world expands for boys and contracts for girls.” 

But the researchers note that boys do not emerge unscathed. They point out that the stereotypes they learn in early adolescence—the emphasis on physical strength and independence—make them more likely to be the victims of physical violence and more prone to tobacco and other substance abuse, as well as homicide. Also, when researchers examined attitudes about gender roles among young adolescents in China, India, Belgium and the United States, they found a growing acceptance for girls pushing against certain gender boundaries, but almost zero tolerance for boys who do. 

In all four countries, it appeared to be increasingly acceptable—to varying degrees—for girls to engage in certain stereotypically male behaviors, like wearing pants, playing sports and pursuing careers. But the researchers report that “boys who challenge gender norms by their dress or behavior were by many respondents seen as socially inferior.” Both boys and girls told researchers that the consequences for boys who were perceived as adopting feminine behavior, like painting their nails, ranged from being bullied and teased with harsh epithets to being physically assaulted. “We know from research studies and programmatic experience that unequal gender norms can be changed, but this takes carefully planned and implemented interventions that target both young people and the environment they are growing and developing in,” said V. Chandra Mouli, MBBS, MSc, co-director and scientist at the Adolescents and at Risk Populations Team, Reproductive Health and Research Department, World Health Organization. While many of the gender stereotypes documented in the study are not surprising, the fact they are so common across cultures and economic status— and ingrained in children at such a relatively young age—is unexpected. She said the research could help shape new initiatives that foster greater awareness of the health consequences of gender stereotypes and focus on the critical “transitional” years of early adolescence. 

Over the past six years, an international consortium of fifteen countries has been working on the Global Early Adolescent Study (GEAS). The GEAS aims to understand how gender norms are formed in early adolescence and how they predispose young people to subsequent sexual and other health risks. As children move into early adolescence and start to develop into young men and women, they also start to take up social roles that are linked to masculinity and femininity. The roles they take on have huge implications for their own health and well-being and that of people around them. Hence, this is a critically important period to study. The GEAS has generated valuable information from fifteen countries around the world, and developed a tool kit to assess gender norms in early adolescents. 

Studies undertaken at Delhi and Shanghai suggest that parents teach their children to adhere to inequitable gender norms in both the places. However, education and career expectations for boys and girls in the two sites differed. Although gender norms varied by site according to the particular cultural and historical context, similar patterns of gender inequity reflect the underlying patriarchal system in both settings. The tendency of parents to pass on the norms they grew up with is evident, yet these results illustrate the social construction of gender through children’s interaction with the social ecology, including evolving political and economic systems. Efforts to bend gender norms toward greater equality can build on these results by empowering children and parents to reflect critically on inequitable gender norms and roles and by mobilizing economic and social support at key turning points in adolescents’ lives.

Their findings reveal that boys and girls growing up in the same community are socialized differently during their transition from early to later adolescence. In both sites, for example, boys, in contrast to girls, spent time outside their home in undirected activities, taking advantage of the opportunity to explore their environment and develop dominant behaviors. Gender inequitable norms related to dress, demeanour, roles (education and career) and boy-girl relationships are transmitted by instruction, beating and scolding, as well as positive reinforcement and mitigation. 

Interactions with the opposite sex were tightly controlled for boys and girls in both countries during early adolescence. This may be due to the fear of pregnancy, which would jeopardize family honor and may put in play a series of lifelong negative physical and emotional consequences. Adolescents and their parents identified mothers as the primary socialization agent, but fathers, siblings, extended families, and peers also played important roles. These results are consistent with early cross-cultural research on socialization which demonstrated the influential roles of parents, siblings, peers, and task assignment on learning gender and suggested that socialization processes operating throughout the life course can increase, reduce, or eliminate gendered behavioural differences.