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1
Maternal mortality has fallen significantly in recent years, especially in countries that have emphasized the prevention of its main causes, such as hemorrhagic and infectious complications and hypertension , including in the Region of the Americas. In its final report on the Plan of Action to Accel
...
erate the Reduction of Maternal Mortality and Severe Maternal Morbidity, the Pan American Health Organization (PAHO) reported a continuing downward trend in maternal mortality, with an 18.1% reduction in the maternal morbidity ratio during the period 2010-2015 . From a pathophysiological perspective, death events are a common end result of a wide spectrum of complications leading to multi-organ dysfunction. However, there is a group of women in this situation who survive, despite the seriousness of their condition. This high number of patients––who were in serious condition
but did not die––reflects the actual health conditions in an institution or a country. For this reason, there is a need to create indicators to estimate morbidity in women due to diseases and incidents that occur during pregnancy, childbirth, and the puerperium. To this end, we propose conducting epidemiological surveillance of an indicator that includes women who survived after presenting a potentially fatal complication during pregnancy, childbirth, or the puerperium, reflecting quality medical attention and care (5, 6). This indicator
is maternal near-miss (MNM), which refers to extremely severe maternal morbidity––cases of a severity that
brings women very close to the death event. After adjusting the definition to a specific population and time,
MNM is defined as a case in which a woman nearly died, but survived a complication that occurred during
pregnancy, childbirth, or within 42 days of termination of pregnancy
more
The Arab region in the Middle East and North Africa (MENA) represents a substantial area of the terrestrial landmass encompassing several countries and ecosystems. This area is generally drier and warmer compared to the rest of the world and has extreme resource limitations that are highly vulnerabl
...
e to a changing climate, geopolitical instability and land degradation (Slimani & Aidoud, 2004). Agriculture (crops and livestock) is a critical source of employment and a potential option for engaging rural youth. However, environmental degradation coupled with declining and variable agricultural productivity may pose a massive challenge already beset by instability and declining oil reserves (Tagliapietra, 2017). The Arab region is also subjected to short and long-duration climate extreme events, and the overall impact of their cascading effects on ecosystems, societies and economies is still an open question. Climate change, along with post-war geopolitical complexities, has greatly affected the Arab region in terms of its economy and social balance. Climate change has penetrating effects on the region’s agriculture sector and hence its economy. These are mainly manifested via changes in water resources and extreme weather conditions such as heatwaves and a drastic decline in precipitation.
more
Abstract: Chagas disease is caused by infection with the protozoan Trypanosoma cruzi, and although over 100 years have passed since the discovery of Chagas disease, it still presents an increasing problem for global public health. A plethora of information concerning the chronic phase of human Chaga
...
s disease, particularly the severe cardiac form, is available in the literature. However, information concerning events during the acute phase of the disease is scarce. In this review, we will discuss the current status of acute Chagas disease cases globally, the immunological findings related to the acute phase and their possible influence in disease outcome, and reactivation of Chagas disease in immunocompromised individuals, a key point for transplantation and HIV invection management.
more
Human African trypanosomiasis (HAT), or sleeping sickness, is a painful and protracted disease transmitted through the bite of infected tsetse flies and it is found in rural parts of sub-Saharan Africa. Sleeping sickness has two clinical phases but this review focuses only on treatment of the second
...
-stage, which is characterized by neurological changes and almost invariably fatal without treatment. There are only a few drugs currently available for second-stage sleeping sickness, all with considerable adverse events and variable efficacy.
The review includes nine trials with 2577 participants. Each trial reported different comparisons of the drugs currently available to treat second stage HAT (melarsoprol, eflornithine, nifurtimox) so no meta-analysis was possible.
more
The WHO health advisory provides guidance to countries on adapting all existing preparedness and response plans and procedures for natural hazards such as cyclones, tropical storms, tornadoes, floods, earthquakes and potential outbreaks of other diseases to their existing COVID-19 strategic prepared
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ness and response plans. It advises countries to sustain all established public health and social measures to prevent and control COVID-19 while simultaneously preparing for responding to and effectively manage other disaster risks and events. It highlights WHO’s call for local, national, regional and global solidarity to support countries and communities with high levels of vulnerability to natural hazards during the COVID-19 pandemic.
more
Forests and Trees for Human Health: Pathways, Impacts, Challenges and Response Options
Cecil Konijnendijk, Dikshya Devkota, Stephanie Mansourian & Christoph Wildburger (eds.)
International Union of Forest Research Organizations (IUFRO)
(2023)
C2
Forests, trees and green spaces, hereinafter ‘forests and trees’ for short, provide multiple goods and services that contribute to human health. These include medicines, nutritious foods and other non-wood forest products (NWFPs). Globally, at least 3.5 billion people use NWFPs, including medici
...
nal plants, which are particularly important for vulnerable groups and Indigenous Peoples and local communities (IPLCs).
During periods of crises, such as the COVID-19 pandemic, demand for forest products typically increases amongst these groups. Forests and trees also contribute to better health by playing a role in climate change
mitigation and adaptation, contributing to regulating the carbon cycle, but also moderating the micro-climate, filtering pollutants from the air and protecting settlements against the effects of extreme events such as droughts and flash floods.
more
Issue Brief 33: Since 21 June 2023, 57 024 new cholera cases, including 399 new death have been reported worldwide (European Center for Disease Prevention and Control). In total, 25 countries have reported cases since the beginning of 2023. The major underlying causes of potential outbreaks are poor
...
environmental infastructure, lack of health care services, lack of save water and sanitation as well as increase population movement. Climate change becomes an additional trigger, as extreme climate events like cyclones,floods and droughts reduce access to clean water and create an ideal environment for cholera to thrive. The overall capacity to respond to the multiple outbreaks is obstructed by a global lack of resources.
This issue brief provides an overview of the current outbreaks, treatment guidelines, information material, countries strategies and more.
more
This is the fifth report of the Global Evidence Review on Health and Migration (GEHM) series. The publication focuses on the mental health needs of refugees and migrants by providing an overview of the available evidence on patterns of risk and protective factors and of facilitators and barriers to
...
care at all levels (individual, family, community and national government). It identifies five high-level themes, each of which has implications for research and policy and is relevant across refugee and migrant groups, contexts and stages of the migration process: self-identity and community support; basic needs and security; cultural concepts of mental health as well as stigma; exposure to adversity and potentially traumatic events; navigating mental health and other systems and services.
more
Daily news report natural catastrophies more and more frequently. The reports include earthquakes, floods, volcanos, famines and droughts. The number of fatalities from natural disasters can vary grately from year to year. Looking at the average over the last ten years, about 45,000 people died each
...
year worldwide from natural disasters. This issue brief summarizes important facts and guidelines to prepare, prevent and assess future events.
more
This report describes the results of the Lao People's Democratic Republic (LAO PDR) National WASH Survey 2021. The survey examined water, sanitation and hygiene (WASH) and waste management services, as well as climate resilience, in Lao PDR health-care facilities. The survey reveals that while
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most facilities (70%) have basic water services, there are significant gaps in the delivery of sanitation, hygiene and health-care waste services, and few facilities are climate resilient, despite a majority being impacted by extreme weather events. Based on these results, the report presents a monitoring framework and national- and HCF-level measures to further enhance WASH services and climate resilience in the country.
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Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisector
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al population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
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Africa CDC Institute of Pathogen Genomics (IPG) was launched in November 2019 and operates under the Division of Laboratory Systems and Networks.
IPG coordinate the implementation of molecular diagnostics, pathogen genomics and bioinformatics in National Public Health Institutions (NPHIs) and/or Re
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fe-
-rence Laboratories (NRLs) across Africa.
Africa CDC and APHF are coordinating a continental initiative to maximize the benefits of molecular approaches and pathogen genomics for more effective
outbreak preparedness, prevention, response, and for the control and elimination of endemic diseases in Africa. One of Africa CDC’s flagship initiative is the Africa
Pathogen Genomics Initiative (Africa PGI), a partnership that aims to strengthen laboratory systems and enhance genomic surveillance by equipping the continent’s
public health institutions with the tools, training, and data infrastructure.
About the Project
In 2023, 166 outbreaks and public health events were reported in Africa. This calls for a resilient laboratory systems for timely detection and reporting of current and future outbreaks. This project aims to scale up molecular diagnostic and genomic sequencing-based detection and characterization of outbreaks.
Africa CDC is working with Member States to develop guidance, diagnostic algorithm, training and capacity building to enable outbreak detection, and reporting to inform public health response.
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At the global, national, and regional levels, there are several guidelines and guides regarding the preparedness, prevention, surveillance, and control of diseases caused by respiratory viruses; most initiatives focus on specific virus events or cas
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es. During the coronavirus disease 2019 (COVID-19) pandemic, it has been found that even when there are strategies designed and planned for pandemics, it is necessary to strengthen and improve them. Planning for imminent threats, including those posed by respiratory viruses, contributes to strengthening the core capacities of the International Health Regulations (IHR [2005])
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INTRODUCTION: Lower extremity peripheral artery disease (PAD) is increasing in prevalence in low- and middle-income countries creating a large health care burden. Clinical management may require substantial resources but little consideration has been given to which treatments are appropriate for les
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s advantaged countries.
EVIDENCE ACQUISITION: The aim of this review was to systematically appraise published data on the costs and effectiveness of PAD treatments used commonly in high-income countries, and for an international consensus panel to review that information and propose a hierarchy of treatments relevant to low- and middle-income countries.
EVIDENCE SYNTHESIS: Pharmacotherapy for intermittent claudication was found to be expensive and improve walking distance by a modest amount. Exercise and endovascular therapies were more effective and exercise the most cost-effective. For critical limb ischemia, bypass surgery and endovascular therapy, which are both resource intensive, resulted in similar rates of amputation-free survival. Substantial reductions in cardiovascular events occurred with use of low cost drugs (statins, ACE inhibitors, anti-platelets) and smoking cessation.
CONCLUSIONS: The panel concluded that, in low- and middle-income countries, cardiovascular prevention is a top priority, whereas a lower priority should be given to pharmacotherapy for leg symptoms and revascularisation, except in countries with established vascular units.
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Cardiovascular disease is a major cause of disability and premature death throughout the world, and contributes substantially to the escalating costs of health care. The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, genera
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lly in middle age. Acute coronary and cerebrovascular events frequently occur suddenly, and are often fatal before medical care can be given. Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease.
This publication provides guidance on reducing disability and premature deaths from coronary heart disease, cerebrovascular disease and peripheral vascular disease in people at high risk, who have not yet experienced a cardiovascular event. People with established cardiovascular disease are at very high risk of recurrent events and are not the subject of these guidelines. They have been addressed in previous WHO guidelines.
Several forms of therapy can prevent coronary, cerebral and peripheral vascular events. Decisions about whether to initiate specific preventive action, and with what degree of intensity, should be guided by estimation of the risk of any such vascular event. The risk prediction charts that accompany these guidelinesb allow treatment to be targeted accord-
ing to simple predictions of absolute cardiovascular risk.
Recommendations are made for management of major cardiovascular risk factors through changes in lifestyle and prophylactic drug therapies. The guidelines provide a framework for the development of national guidance on prevention of cardiovascular disease that takes into account the particular political, economic, social and medical circumstances.
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Patients with diabetes are at increased risk of developing cardiovascular disease (CVD) with its manifestations of coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), and stroke, as well as aortic and peripheral artery diseases. In addition, diabetes is a major risk factor f
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or developing chronic kidney disease (CKD), which in itself is associated with developing CVD. The combination of diabetes with these cardio-renal comorbidities enhances the risk not only for cardiovascular (CV) events but also for CV and all-cause mortality. The current European Society of Cardiology (ESC) Guidelines on the management of cardiovascular disease in patients with diabetes are designed to guide prevention and management of the manifestations of CVD in patients with diabetes based on data published until end of January 2023. Over the last decade, the results of various large cardiovascular outcome trials (CVOTs) in patients with diabetes at high CV risk with novel glucose- lowering agents, such as sodium–glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), but also novel non-steroidal mineralocorticoid receptor antagonists (MRAs), such as finerenone have substantially expanded available therapeutic op-
tions, leading to numerous evidence-based recommendations for the management of this patient population.
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This document is the second in a series of global reports describing progress towards the 2030 targets set in Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. It describes a wide range of activities, accomplishments and challenge
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s across the portfolio of NTDs and across all six WHO regions. The report presents epidemiological and programmatic data for 2022, which were gathered, compiled and analysed in 2023. In some cases, 2023 data are available and presented; in other cases, less recent information is included, when 2022 data are not available. In addition, it presents the main facts or events that occurred in 2023.
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The website for the COPD Foundation in South Africa provides information and resources dedicated to raising awareness, improving education, and supporting individuals affected by Chronic Obstructive Pulmonary Disease (COPD). Managed by the C.A.R.E.S. Group (COPD Advocacy, Research, Education, Suppor
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t), the site aims to advocate for better COPD management and care. It includes guidance for patients, caregivers, and healthcare professionals, along with updates on research, events, and programs to enhance COPD treatment and support throughout South Africa.
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The aim of the GOLD Report is to provide a non-biased review of the current evidence for the assessment, diagnosis and treatment of people with COPD. One of the strengths of GOLD reports is the treatment objectives. These have stood the test of time, and are organized into two groups: objectives tha
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t are directed towards relieving and reducing the impact of symptoms, and objectives that reduce the risk of adverse health events that may affect the patient at some point in the future (exacerbations are an example of such events). This emphasizes the need for clinicians to focus on both the short-term and long-term impact of COPD on their patients.
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About one fourth of the world’s population is estimated to have been infected with the tuberculosis (TB) bacilli, and about 5–10% of those infected develop TB disease in their lifetime. The risk for TB disease after infection depends on several factors, the most important being the person’s im
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munological status. TB preventive treatment (TPT) given to people at highest risk of progressing from TB infection to disease remains a critical element to achieve the global targets of the End TB Strategy, as reiterated by the second UN High Level Meeting on TB in 2023. Delivering TPT effectively and safely necessitates a programmatic approach to implement a comprehensive package of interventions along a cascade of care: identifying individuals at highest risk, screening for TB and ruling out TB disease, testing for TB infection, and choosing the preventive treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance.
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