219 Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1
caused by sharp objects. They often leads to retrorectal,
retroperitoneal and vascular injuries. Trasanal intraperitoneal
injuries are directed anteriorly and may lead to damage of
rectum, bladder, urethra, bowel and even the solid organs.
But in our case there was sigmoid perforation, mesenteric
tear and impairment of vascularity of a part of jejunum
with impaction of object into retroperitoneum. Perineal
extraperitoneal wounds are uncommon and are usually caused
by sharp objects but more commonly associated with damage
to anal sphincter, vagina and urethra.
The fi rst step in the management is the evaluation of
patient with rectal foreign body to determine whether
or not perforation has occurred and stability of patient.
Plain radiograph should be done to know the location
of foreign body and free gas. If free gas or frank feature
of peritonitis is present, no further workup is required
and urgent laparotomy is warranted after adequate
resuscitation of patient. Various options of management
are fecal diversion, surgical debridement, wound closer if
feasible, rectal stump irrigation, presacral drainage and
broad spectrum antibiotics. Several paths and algorithms
are mentioned in the literature but all are based on adult
injury. Nonetheless, management by anatomic distinction
allows for omission of colostomy in most intraperitoneal
injuries and selected extraperitoneal injuries, while
diminishing the risk of retrorectal abscess in extraperitoneal
injuries with judicious application of presacral drainage.
In our case there was peritonitis and the steel bar was very
much inside the peritoneal cavity on X-ray abdomen with
no external injuries, laparotomy was an obvious indication.
As the peritoneal cavity was heavily contaminated with fecal
material and upper jejunum was also necrosed, resection and
anastomosis with exteriorization of the perforated sigmoid
was done. Patient was discharged on stoma uneventfully on
day 7 after surgery. Sigmoid colostomy closure was done
after 8 weeks and patient is doing well thereafter.
1. Grisoni ER, Hahn E, Marsh E, Volsko T, Dudgeon D. Pediatric
perineal impalement injuries. J Pediatr Surg 2000;35:702-4.
2. Bronkhorst MW, Wilde JC, Hamming JF, HeÄ³ HA. Anorectal
impalement in a pediatric patient with transanal evisceration of
small bowel. J Pediatr Surg 2007;42:E23-5.
3. Wang LT, Wu CC, Hsiao CW, Feng CC, Chang CF, Jao SW.
Steel bar penetrating injury of rectum and vertebral body
without severe morbidities: Report of a case. Dis Colon Rectum
4. Kim S, Linden B, Cendron M, Puder M. Pediatric anorectal
impalement with bladder rupture. Case report and review of the
literature. J Pediatr Surg 2006;41:E1-3.
5. Scheidler MG, Schultz BL, Schall L, Ford HR. Mechanisms of
blunt perineal injury in female pediatric patients. J Pediatr Surg
6. El-Ashaal YI, Al-Olama AK, Abu-Zidan FM. Trans-anal rectal
injuries. Singapore Med J 2008;49:54-6.
7. Farbin S, Davisdon P, Shockiey L. Perforation of sigmoid colon
by hydrostatic pressure of public water fountain. J Emerg Med
8. Beiler HA, Zachariou Z, Daum R. Impalement and anorectal injury
in childhood: A retrospective study of 12 cases. J Pediatr Surg
9. Weinberg JA, Fabian TC, MagnoÄ´ i LJ, Minard G, Bee TK,
Edwards N, et al. Penetrating rectal trauma: Management by anatomic
distinction improves outcome. J Trauma 2006;60:508-14.
10. Maxwell RA, Fabian TC. Current management of colon trauma.
World J Surg 2003;27:632-9.
How to cite this article: Gupta D, Yadav DK, Panda SS, Panda M,
Bagga D, Acharya SK, et al. Transanal impalement of double J steel bar
with colonic and jejunal injury: A unique pediatric case report. J Nat Sc Biol
Source of Support: Nil. Confl ict of Interest: None declared.
Access this article online
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Corporate social responsibility in public health:
A case-study on HIV/AIDS epidemic by Johnson &
Johnson company in Africa
Vijay Kumar Chattu
Lecturer- Faculty of Medical Sciences, University of West Indies, St. Augustine, Trinidad & Tobago
Address for correspondence:
Dr. Vijay Kumar Chattu, MD, MPH, Public Health & Primary Care, Faculty of Medical Sciences,
University of West Indies, St. Augustine, Trinidad & Tobago.
E-mail: [email protected]
Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1 220
HIV/AIDS has claimed millions of lives in the global workforce and continues to remain a threat to many businesses. An estimated
36.5 million of working people are living with HIV; the global workforce has lost 28 million people from AIDS since the beginning of the
epidemic. In the absence of access to treatment, this number could grow to 74 million by 2015. The epidemic continues to affect the
working population through absenteeism, sickness and death. Corporate Social Responsibility (CSR) is an obligation that corporates have
toward their employees, community and society. A review and documentation of one such CSR by Johnson & Johnson (a multinational
company) for HIV/AIDS in Africa is presented here. Johnson & Johnson Company is involved in numerous projects around the world to
combat the HIV/AIDS epidemic. The company is working to fi ght the spread of the disease and improve the quality of life for those living
with the illness through various donations of its products and sponsorship of local programs. This case study also highlights different
categories of CSR activities such as Cause Promotion, Cause related Marketing, Corporate Philanthropy, Corporate Social Marketing,
Corporate Volunteering and Socially responsible business practices, which are discussed with specifi c examples from different countries
in Africa. Conclusions: CSR of any business encompasses the economic, legal, ethical & discretionary expectation placed on the
organization by society at a given point of time. CSR is therefore the obligation that corporations have toward their stakeholders and
society in general which horizons beyond what is prescribed by law or union contracts. Johnson & Johnson has a proved history of
being committed to caring for people and a good example of a company with a long history of citizenship and sustainability.
Key words: Corporate social responsibility, cause promotion, corporate volunteering, HIV/AIDS, Johnson & Johnson,
philanthropy, social marketing
Key Messages: HIV epidemic has a tremendous affect on labor, setting back economic activity and social development.
Majority of the people living with HIV worldwide are between 15 and 49 years in the prime of their working lives. Corporates
should protect and improve the welfare of its employees and society along with its own interests on making profi ts. Satisfying
and responding to societyâ€™s needs and expectations will lead to successful business
HIV/AIDS has claimed millions of lives in the global
workforce and continues to remain a threat to businesses. An
estimated 36.5 million of working people are living with HIV;
the global labor force has lost 28 million people from AIDS
since the beginning of the epidemic. In the absence of access
to treatment, this number could grow to 48 million by 2010
and 74 million by 2015. The epidemic continues to affect the
working population through absenteeism, sickness and death.
Corporate Social Responsibility can be defi ned or understood
simply as a process in which the corporates contribute for
the improvement of the community through their different
methods or ways of business practices and by providing the
resources. It is also defi ned as â€œOperating a business in a
manner that meets or exceeds the ethical, legal commercial
and public expectations that society has of business.â€
Basically CSR is a common platform and an interaction
for the corporates or companies and its stakeholders. To
state it rightly CSR is an obligation that corporates have
toward their employees, community and society. Since
the social contribution of corporates includes broader
expectations the society, they effect both the external and
internal environment of the employees and their working
conditions. If a corporation takes proper care and sensitive
enough to address the issues of environment, then it is
more likely to be labeled as a â€œsocially responsible.â€
Johnson & Johnson Company is involved in numerous
projects around the world to combat the HIV/AIDS
epidemic. The company is working to fi ght the spread of
the disease and improve the quality of life for those living
with the illness through various donations of its products,
and sponsorship of local programs. The company has
various units over the globe which is operated under a
decentralized management approach. Johnson & Johnson
is broadly based in human health care and with a Credo
with foundation of character, ethics and values which
guides to be â€œresponsible to our employees, the men
and women who work with us throughout the world.â€
The company has partnerships with different corporations
and NGOs to bring a great impact on health. It has also
emphasized the importance of contribution of Small &
Medium scale enterprises (SMEs) in the supply chain and
has taken many initiatives to empower them and assist them
in HIV/AIDS prevention activities by:
1. Directly supporting work place program set-up.
2. Enabling workplace program set-up.
3. Leverage infl uence with enabling institutions.
4. Leverage infl uence directly with SMEs.
Johnson & Johnson Company (J&J) has taken the
initiative to emphasize its role in attacking the NTDs
(neglected Tropical diseases) through its global partnerships
in Africa and Asia. The company is continuously conscious
of the impact on the environment and has taken variety
of initiatives to reduce waste and advocate environment
221 Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1
friendly products. The priority for the Company is to
invest in health, safety and well-being of the employees.
The company has very strong commitment for social
responsibility and done a signifi cant work in the area of
HIV/AIDS especially in Africa.
J&J supports the efforts in more than 25 countries in Africa
(Botswana, Kenya, Sierra Leone, Zambia, Cameroon,
Liberia, Senegal, Zimbabwe, Cape Verde, Malawi, Somalia,
DRC, Morocco, South Africa, Egypt, Mozambique, Sudan,
Eritrea, Namibia, Swaziland, Ethiopia, Nigeria, Tanzania,
Ghana, Rwanda, Uganda) in different projects in health and
development sector. It partners with different National
and International NGOs that have interventions in Africa
focusing on health issues mainly on HIV/AIDS, MCH,
Capacity building, Stigma, etc.
Broad categories of CSR responses of Johnson & Johnson
The company is actively involved in supporting ongoing
health care, educational and cultural programs. The
company is committed to healthy environment through
a reduction in environmental impacts and participation
in conservation projects. It has also ensured the high
standards and safety to its employees and has worked
with others in the community to share their knowledge in
this area. The CSR activities of Johnson & Johnson can
be broadly divided into three main categories depending
upon the target of interventions as shown in Table 1 below.
Corporate social responsibility (CSR) initiatives and Johnson
Initiative 1- cause promotion
Through this social initiative, J&J contributes for the
1. Raising awareness and concern about a social cause.
2. Supporting fundraising activities.
3. By participation.
4. By recruiting volunteers.
This initiative is a common form of corporate giving
along with philanthropy and employee volunteerism.
The distinctive feature of cause promotion is that more
emphasis is laid on promotional strategies without any
linkage to the sales of products or consumer response.
Mothers2mothers is an NGO that works in few countries
in Africa that is dedicated to impart knowledge and educate
the positive mothers to prevent the mother to child
transmission. As a result the educated mother will in turn
mentor the others and these programs are implemented
successfully in Swaziland, South Africa, Lesotho and
Malawi. As per the statistics there are thousands of women
who got educated and benefi ted from this program.
In Mozambique and South Africa (Soweto), Johnson &
Johnson supports â€œInternational Humana People to People
Movementâ€ which is engaged in training the community
leaders/workers to impart education about HIV to everyone
exposed or living in the high risk areas. They started a doorto-door Total Control of the Epidemic (TCE) where they
give 1:1 sessions and help to develop plans for local residents
and prevent the spread of infection.
J&J supported â€œSociety for Women Against AIDS in
Africaâ€ to build the capacity for preventing, controlling
and address the problem of HIV epidemic by increasing
the awareness about HIV and providing access to female
condoms through the 40 network organizations in Ghana.
In many African countries including Kenya, Uganda,
Tanzania and Nigeria, J&J supports an NGO namely
Global Fund for Women to support maternal &
reproductive health care.
Initiative 2: Cause-related marketing (CRM)
In CRM, the corporate contributes by making a commitment
to donate some percentage of revenues to a cause, which is
linked to the sales of the product. This is again limited and
specifi c for the product and duration and charity. Through
this CRM, Johnson & Johnson contributes additionally
which depends on the sales and consumer dynamics.
This initiative involves more promotion, paid advertising
and often requires formal agreements and coordination
with charity for advertising, tracing purchases, etc. Some
examples from the fi eld are:
Table 1: Social responsibilities & activities
of Johnson & Johnson
Responsibilities for Activities
Communities Saving and improving life
Capacity building of health staff
Emphasizing prevention & fi ghting against
Healthy habits for healthy life
Employees Workplace safety/ healthy working
Employee assistance program
Resiliency training & energy management
Environment Paper and packaging
Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1 222
1. In 2012, J&J joined hands with Save the Children to
safeguard the lives of every baby and ensure to have a
healthy start and future in their lives. This has reached
over 40 million US households and triggered donation
through Johnsonâ€™s Baby CARE cards and has resulted
in 3.44 million impressions.
2. J&J with its strong brand for the family products also has
joined hands with Make a Wish where the whole family
is made stronger through the granting of the wish.
The J&J/March of Dimes partnership asked the users
to commit to treasure their everyday experience with
the children in their lives by taking an online pledge in
addition to making an online donation/ contribution.
3. J&J has also joined hands with (RED) which is a
group of global renowned brands like Coca Cola, etc.
which committed to donate 50% of the profi ts to
fi ght the HIV/AIDS epidemic. This Cause marketing
advertisement is on Pinterest and other social
networking sites where Johnson & Johnson pays $1
for â€œevery like it, tweet it or pin itâ€ to the Global Fund.
Social initiative 3: Corporate social marketing (CSM)
In this initiative, the main objective is to implement or
support a behavior change campaign by the company. The
area of work can be anything ranging from community
health, education, and environment or introduce safe
practices, etc. It is different from other social initiatives
because the main expected outcome is change in behavior,
which is not as simple or speedy as we think.
1. J&J supports, HIVSAâ€™s home based care program reaches
30 CBOs (community based organizations) which cater
services to 3500 households in Johannesburg.
2. PlaySoccer is a grossroots community program
designed to serve the disadvantaged communities &
vulnerable children. J&J supports this program in and
3. J&J supports Mothers2mothers an NGO which works
in various countries of Africa namely Lesotho, South
Africa, Malawi and Swaziland. The new HIV mothers
are trained to mentor the others and they provide
the information on treatment, nutrition, feeding with
formula. Apart from that they also provide information
on how to combat stigma, discrimination and pressures
from the society.
4. J&J works with â€œSafety Kids Worldwideâ€ to encourage
parents to teach their children safety practices like
wearing a seat belt or bicycle helmets that will reduce
the prevalence of accidents.
5. In Zimbabwe, the Company also has a peer-counseling
program for HIV positive industrial workers in its
property in collaboration with Zimbabwe Hope
Initiative 4: Johnson & Johnsonâ€™s philanthropy
It is basically a contribution by a corporate body to a charity
in various forms ranging from cash to services. The causes
can be health, education or environment. Following options
of giving are in practice by J&J over decades:
1. Donating cash.
2. Granting scholarships.
3. Providing some services or products.
4. Giving technical guidance or support.
5. Offering equipment.
Examples from Africa:
1. J&J supports the Hospital Leaders Program (HLP)
which is started by partnership with UCTâ€™s Business
School to build the capacities in Leadership &
Managerial skills of health staff of South Africa.
This program is similar to other J&J programs run in
Europe, USA, South America & Asia.
2. J&J supports the SOS, which is an international NGO
dedicated to care for orphans & abandoned children.
It also runs the educational institutions and medical/
health centers apart from skill training centers. It also
fi ghts for the rights of the child and J&J provides
the general support & help the family strengthening
projects in South Africa.
3. Joined hands with Elizabeth Glaser Pediatric AIDS
Foundation on a long term commitment and pursued
a comprehensive strategy to reduce the burden of
HIV on Women & their families by strengthening
community health systems, providing counseling
services to the women and tackling the social
issues like stigma, discrimination and other serious
In Africa, MDI (Management Development Institute) has
resulted with the association of AMREF, Ghana Institute
of Management & Public Administration, UCT & UCLA
Anderson held annually at Kenya, Ghana & Cape Town for
the HIV program leaders working in different organization
with an objective to improve both the quality & quantity
of the services catered for HIV/AIDS infected & affected
groups. This innovative approach is supported by J& J
In Partnership with Aga Khan Development Network, J&J
has taken the issues of Nursing, community health andearly
childhood development and to raise their capabilities in
East Africa namely Kenya, Uganda and Tanzania.
In Nigeria, J&J also supports American Jewish World
Service for its two programs to teach the health workers
religious leader and community workers on counseling
skills, and to fi ght against the stigma & discrimination faced
223 Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1
In Malawi, Lesotho, Swaziland and South Africa, J&J
supports sites of mothers2mothers (m2m) which has
focused interventions for prevention of HIV infections.
Till date thousands of women have taken part and benefi ted
from this organization in different African countries where
its presence is there.
Initiative 5: Community volunteering
It is a very good way for a corporate to get involved in the
community development activities by encouraging their
employees and franchise members to volunteer their time to
support the cause. The type of projects can be any of those
ranging from service to local communities to improving the
health & safety and protecting the environment. In this regards
J&J have taken various projects under community volunteering:
1. Community projects.
2. Health and Safety related projects.
3. Environmental volunteering.
The employees of the company in all the global locations
are encouraged to take part in community development
programs and in turn they are also paid for their volunteering.
J&J company has also done a research among its employees
and found that there is a great correlation between community
volunteering and employee engagement which has resulted
in incorporating volunteering as a normal practice at the
organization and empower the communities around.
It also provides the Medical Mission packs for the volunteer
medical doctors who go on a mission to deliver the care
Initiative 6: Socially responsible business practices
These are certain initiatives taken by the corporates where
they adapt and conduct different business practices to
support community and save environment.
Some of the examples are:
1. Providing increased access for disabled populations.
2. Choosing manufacturing & packing materials that are
3. Developing programs to support employee wellbeing.
4. Ensuring environment friendly and following the safety
5. Protecting the privacy of consumer information.
In Malawi, J&J supports AmeriCares which is an
International NGO specialized in health and disaster relief
working for the vulnerable women & children who are
displaced refugees. J&J products like sutures and pain killers
are vital for emergency obstetric care and AmeriCares
purchases the products of J&J since 2004.
In Nigeria in 2005, J&J has initiated a new partnership to
address the issues of gender based violence and HIV/
AIDS. This partnership which is between UNIFEM, J&J
and Global Coalition on Women and AIDS will sanction
grants/awards for the CBOs to strengthen the linkages
with the above mentioned theme.
Also in Botswana too, J&J supports the Department of
Womenâ€™s Affairs, Home Affairs and Home Affairs to
support the HIV prevention programs.
CSR of business encompasses the economic, legal, ethical
and discretionary expectation placed on the organization
by society at a given point of time. CSR is therefore the
obligation that corporations have toward their stakeholders
and society in general which goes beyond what is prescribed
by law or union contracts. Johnson & Johnson has a
proved history of being committed to caring for people
and a good example of a company with a long history of
citizenship and sustainability. It has well demonstrated its
social responsibility to improve human health and wellbeing, sustain the planet, support the communities thereby
enhancing the greater economic opportunity and societal
1. Source: UNAIDS. Available from: hÄ´ p://www.unaids.org/en/
GetStarted/BusinessAndLabour.asp [Last accessed on 25/07/2014].
2. Kotler P, Lee N. The Case for Doing at Least Some Good. In: Kotler P,
editor. Corporate Social Responsibility. New Jersey: John Wiley &
Sons Inc.; 2005. p. 2-3.
3. Johnson & Johnson. Citizenship & Sustainability Report 2012. p. 2-5
4. World Economic Forum: Global Health Initiative. Beyond Big Business:
Guidelines to support your supply chain against HIV/AIDS. 2005. p. 28.
5. Johnson & Johnson. Our Community work in Africa Report. 2010.
6. Source: Save the children. Available from: hÄ´ p://www.
accessed on 28/07/2014].
How to cite this article: Chattu VK. Corporate social responsibility in public
health: A case-study on HIV/AIDS epidemic by Johnson & Johnson company in Africa. J Nat Sc Biol Med 2015;6:219-23.
Source of Support: Nil. Confl ict of Interest: None declared.
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