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  • Delegates emphasised the urgent need for

    2019-05-13

    Delegates emphasised the urgent need for a consensus regarding the standards and guidelines among stakeholders in Kenya and Uganda. In addition, a common interpretation of the legal environment was considered crucial, and therefore the constitution and penal code would need to be harmonised in both countries. In east Africa, the shortage of health-care providers trained in comprehensive abortion care is severely restricting women\'s access to care, and thus updated in-service comprehensive abortion-care training and quality pre-service training is imperative. Efforts to expand access to comprehensive abortion care through task sharing or shifting should also be prioritised, as they have been shown to be safe, effective, and highly acceptable to women. The harm vorapaxar model, already in use within some settings in east Africa, was acknowledged as an important strategy to prevent unsafe abortions. The delegates also emphasised the opportunity for prevention of unintended pregnancies, which comprehensive abortion care entails. However, quality improvement of contraceptive services is needed to increase use of effective methods and ensure informed decision making. Quality comprehensive abortion care is also dependent on factors such as availability of misoprostol and effective contraceptives, known to be heavily affected by stock-outs in Kenya and Uganda within public facilities. Stock-outs at national dispensaries are unacceptable and should be addressed alongside the control of counterfeit misoprostol. Sensitisation and support for misoprostol and addressing of misconceptions at community, health-care, and decision-making levels were recognised as central to the implementation process.
    In a passionate Editorial, defends a human rights approach to Zika virus, and includes mosquito control as part of the “sound recommendations, duly relayed by health authorities”. We would like to argue the case for a rights-based approach to mosquito control, which would be aimed not at small-scale tinkering in the environment but at large-scale urban transformation, as proposed in the early drafts of the . Such an approach encompasses, among others, the right to the city, the right to health, and the right to freedom of movement. Faria and colleagues suggest that large-scale patterns in human mobility, including the role of mega-events, should be assessed to understand the epidemiology of the virus. Since 2010, Brazil has hosted a series of mega-events, with delegations from all over the world. These have included the 2011 Military Games, the 2013 Salesian Youth Movement world meeting (with the Pope\'s visit), the 2013 Fédération Internationale de Football Association (FIFA) Confederations\' Cup, the 2014 FIFA World Cup, and all the preparatory games for the 2016 Olympics. Beyond changes in human mobility, there are other effects of hosting mega-events that should be discussed. Families living in well located informal settlements have been displaced from their homes to make way for mega-event structures and urban gentrification projects. By 2013, approximately 40 000 people had been removed from their homes in Rio de Janeiro as a direct consequence of mega-event stadium construction, and a greater number of these have been forced to move from informal settlements in areas with reasonable infrastructure to the outskirts of the cities on account of increased real estate valuation. They will join many already living in poor areas—where sanitary conditions and waste management are worse—increasing the proportion of the population forced to store water and the amount of garbage thrown in water streams, blocking water flow, both of which favour the proliferation of , the vector of Zika, dengue, and chikungunya viruses. Despite being highly beneficial for its partners and organisers—the highest profit in history for FIFA occurred in the 2014 World Cup in Brazil—mega-events in Brazil have not conformed to the guidelines of the New Urban Agenda, resulting in clear health and societal harms, and have contributed to the increased circulation of Zika virus in the Americas. Governments and societies must take the New Urban Agenda into consideration if they wish to seriously engage in controlling whenever deciding to host mega-events; and, if such events take place, preparations should respect this new agenda.