Annotated Bibliography Week 6

Correspondence

www.thelancet.com Vol 387 April 30, 2016 1811

No universal health coverage without primary health care

U n i v e r s a l h e a l t h c o v e r a g e i s currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues1 for analysing lessons learned from different country experiences, but we believe there is a crucial element n e g l e c t e d w i t h i n t h e o n g o i n g universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall f r a m e w o r k f o r o r g a n i s i n g a n d delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality.2 Strong orientation towards primary health care and its core principles (often outlined as fi rst contact, continuous, comprehensive, and coordinated care)3 is shown to be stable over time 4 and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today.5 This observed stability makes the lack of focus on primary health care within the current universal health coverage debate an urgent issue.

This is where universal health coverage should be reconnected with primary health care. To aim for universal health coverage and better population health should not remain a laudable intention. People living in countries presently moving towards universal health coverage—irrespective of their income level—should not suffer for decades because of an avoidable failure to secure a strong primary health-care orientation from the very beginning. We believe that the time to move the universal health coverage debate towards primary health care is now.

We declare no competing interests.

*Florian L Stigler, James Macinko, Luisa M Pettigrew, Raman Kumar, Chris van Weel fl [email protected]

Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz 8010, Austria (FLS); Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK (FLS, LMP); Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA (JM); Academy of Family Physicians of India, New Delhi, India (RK); Radboud University Medical Center, Nijmegen, Netherlands (CvW); and Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT, Australia (CvW)

1 Reich MR, Harris J, Ikegami N, et al. Moving towards universal health coverage: lessons from 11 country studies. Lancet 2016; 387: 811–16.

2 Starfi eld B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457–502.

3 Starfi eld B. Is primary care essential? Lancet 1994; 344: 1129–33.

4 Macinko J, Starfi eld B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 2003; 38: 831–65.

5 Stevens R. The evolution of healthcare systems in the United States and the United Kingdom. Similarities and diff erences. Open University Press, 1995: 262–68.

Positive IgM for Zika virus in the cerebrospinal fl uid of 30 neonates with microcephaly in Brazil

The epidemic of microcephaly in Brazil has been declared a Public Health Emergency of International Concern by WHO .1 The declaration states that a causal relationship between Zika virus infection during pregnancy and microcephaly is strongly suspected, although not yet scientifi cally proven.1 The hesitancy to accept causation in the presence of much epidemiological circumstantial evidence is due to the paucity of laboratory confi rmation of Zika virus in aff ected neonates. Here, we report the serological confi rmation

of Zika virus infection in the CNS of 30 neonates with microcephaly.

From Oct 21 to Oct 30, 2015, we collected blood and cerebrospinal fl uid (CSF) samples from 31 neonates with microcephaly in the state of Pernambuco, Brazil, most of whom were born between Sept 12 and Oct 27, 2015, in public maternity

Published Online April 18, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)30253-7

Serum IgM CSF IgM

Zika virus

Dengue virus type 1–4 mixture

Zika virus

Dengue virus type 1–4 mixture

Interpretation

1 day 17·0 2·7 12·1 1·5 Positive for Zika virus

1 day 20·6 2·9 16·1 2·4 Positive for Zika virus

1 day 20·6 7·8 14·8 4·2 Zika virus cross-reacting with dengue virus

1 day 5·2 0·7 9·3 1·0 Positive for Zika virus

1 day 8·2 1·7 16·3 3·4 Zika virus cross-reacting with dengue virus

2 days 6·2 0·9 15·0 1·5 Positive for Zika virus

2 days 6·2 0·9 14·5 2·7 Positive for Zika virus

2 days 7·5 0·9 16·1 2·9 Positive for Zika virus

2 days 4·7 0·9 14·2 1·7 Positive for Zika virus

2 days 12·7 1·2 15·9 2·9 Positive for Zika virus

2 days 10·5 1·7 15·8 2·1 Positive for Zika virus

3 days 10·5 1·1 14·8 2·4 Positive for Zika virus

3 days 15·6 2·6 14·8 2·4 Positive for Zika virus

3 days 16·0 1·6 16·4 1·9 Positive for Zika virus

4 days 3·2 0·6 13·5 1·9 Positive for Zika virus

5 days 3·9 0·8 9·3 0·8 Positive for Zika virus

5 days 11·4 5·5 15·5 4·6 Zika virus cross-reacting with dengue virus

7 days 5·9 0·7 13·1 1·2 Positive for Zika virus

7 days 2·1 0·9 15·0 0·9 Positive for Zika virus

7 days 15·4 2·2 13·5 1·6 Positive for Zika virus

8 days 9·6 1·8 15·7 1·7 Positive for Zika virus

10 days 4·0 1·5 14·5 6·6 Zika virus cross-reacting with dengue virus

11 days 0·9 1·8 0·6 1·9 Negative for Zika virus

12 days 16·1 6·2 15·7 5·0 Zika virus cross-reacting with dengue virus

13 days 15·3 2·6 12·1 1·3 Positive for Zika virus

17 days 6·4 1·8 16·1 1·4 Positive for Zika virus

17 days 16·0 2·8 14·8 3·0 Positive for Zika virus

22 days 4·1 1·2 15·5 2·7 Positive for Zika virus

23 days 3·4 2·6 16·1 5·7 Zika virus cross-reacting with dengue virus

36 days 2·1 0·9 15·6 1·9 Positive for Zika virus

40 days 12·2 1·1 13·3 0·8 Positive for Zika virus

ELISA values are patient optical densities divided by negative control densities (P/N); values less than 2 were considered negative, 2–3 equivocal, and more than 3 positive. CSF=cerebrospinal fl uid.

Table: IgM against Zika virus and dengue virus in the serum and CSF of neonates with microcephaly, Pernambuco State, Brazil, 2015, by age (days) at testing

This online publication has been corrected. The corrected version first appeared at thelancet.com on May 19, 2015