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  • Data on chloroquine resistance from Pakistan is scarce even

    2019-06-28

    Data on chloroquine resistance from Pakistan is scarce, even in the most recent global analysis. Nevertheless, in 2013, the emergence of the F1076L mutant of the gene—the EI1 responsible for chloroquine resistance—in in Pakistan highlights the imminent threat of resistant . In 2015, the first case of resistance was identified in a pregnant woman, and it was cured after switching to a combination of artemether and lumefantrine. Implementation of the Roll Back Malaria initiative by Pakistan\'s Directorate of Malaria Control is the latest government attempt to eradicate malaria. It includes key elements of malaria control and prevention, but there is no mention of facilitating research on the gene polymorphisms in our population. We have reached an age of resistance, in which monotherapies and simple prevention are insufficient to combat the new generation of genetically diverse microorganisms armed with mutations that we have not prepared for. Our national malaria policy addresses chloroquine-resistant , first identified 30 years ago, but has no mention of resistant or management guidelines for resistant infections. Given the bleak future in the presence of a malaria parasite that is resistant to the most common drug, relevant government-funded research is necessary to understand the burden of resistant malaria in Pakistan, and old guidelines have to be revised before an epidemic takes control.
    Approximately 7000 stillbirths occur daily worldwide, and the vast majority of them (98%) take place in low-income and middle-income countries (LMICs). Despite this enormous burden, progress to reduce the death toll is slow and insufficient. WHO released its guide in 2016, which includes strategies aimed at addressing the challenge of stillbirths. Given the flurry of activity and attention on stillbirths from the Stillbirth Epidemiology investigator group and WHO, we expect that the wealth of information about stillbirths that is generated will filter down in a timely manner to where it is needed most: the general public. As is often the case for Wikipedians, we found that the stillbirth page on the English language Wikipedia was missing important information—eg, the major causes of stillbirth (malaria and syphilis) were not mentioned, and details on epidemiological aspects were scarce. Unsurprisingly, the Wikipedia pages on stillbirth in about 20 other languages were less detailed than the English language version. This worried us because not only is Wikipedia the world\'s most used source of health information online, but it is also one of the most widely used sources by medical students, doctors, and other health-care providers. It is not difficult to imagine that the first online port of call for a woman, her partner, or her family following a stillbirth would be Wikipedia. Furthermore, many policy makers and other key stakeholders also read Wikipedia. Wikipedia is particularly relevant for LMICs, where internet access is often slow and expensive. We have been involved in developing mobile apps for offline use which contain all of Wikipedia\'s anatomy, pharmacology, medicine, and sanitation content in an attempt to address this issue. We have seen tens of thousands of downloads of the apps, with the majority from LMICs. There is clearly a huge unmet need for health-related information, to the extent that some mobile network operators in LMICs do not charge for data costs when users are accessing Wikipedia (Wikipedia Zero). However, this generous practice has been cautioned against because some people feel it infringes upon internet neutrality (the principle that internet providers should treat all data equally). In addition to the stillbirth article there are many others on Wikipedia associated with global health that require further attention. Wikipedia has the potential of being bolstered as a key tool for global public health promotion. However, Wikipedia struggles to attract medical doctors or other trained health professionals as editors. We echo previous authors in inviting the medical community—and in particular medical journals—to incentivise Wikipedia editing with the goal of bringing about increased access to reliable, understandable, and up-to-date health information in multiple languages. , for example, encourages its authors to post topics on Wikipedia. Promoting inclusive and equitable learning opportunities for all speaks to the aspirations of the Sustainable Development Goals. We suggest that medical journals actively promote and incentivise Wikipedia editing by the health-care community so that the most commonly used source of online health information is as reliable as possible.