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Publication Years
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1586
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Category
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279
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174
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Toolboxes
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More than 40% of the world population is 24 years old or younger, the vast majority of whom live in low- and lower middle–
...
income countries. Globally, a quarter of disability-adjusted life years (DALYs) for mental disorders and substance abuse is borne by this age group and about 75% of mental disorders diagnosed in adulthood have their onset before the age of
24 years . Most children and young people in developing countries, however, do not have access to mental health care.
more
Key facts
- Cardiovascular diseases (CVDs) are the leading cause of death globally.
- An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke.
- Over three quarters of CVD deaths take place in
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low- and middle-income countries.
- Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2019, 38% were caused by CVDs.
- Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol.
- It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin.
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Key facts
- An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two-thirds) living in low- and middle-
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income countries
- An estimated 46% of adults with hypertension are unaware that they have the condition.
- Less than half of adults (42%) with hypertension are diagnosed and treated.
- Approximately 1 in 5 adults (21%) with hypertension have it under control.
- Hypertension is a major cause of premature death worldwide.
- One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.
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Delivery of comprehensive arrhythmia care requires the simultaneous presence of many resources. These include complex hospital infrastructure, expensive implantable equipment, and expert personnel. In many low-
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and middle-income countries (LMICs), at least 1 of these components is often missing, resulting in a gap between the demand for arrhythmia care and the capacity to supply care. In addition to this treatment gap, there exists a training gap, as many clinicians in LMICs have limited access to formal training in cardiac electrophysiology. Given the progressive increase in the burden of cardiovascular diseases in LMICs, these patient care and clinical training gaps will widen unless further actions are taken to build capacity. Several strategies for building arrhythmia care capacity in LMICs have been described. Medical missions can provide donations of both equipment and clinical expertise but are only intermittently present and therefore are not optimized to provide the longitudinal support needed to create self-sustaining infrastructure. Use of donated or reprocessed equipment (eg, cardiac implantable electronic devices) can reduce procedural costs but does not address the need for infrastructure, including diagnostics and expert personnel. Collaborative efforts involving multiple stakeholders (eg, professional organizations, government agencies, hospitals, and educational institutions) have the potential to provide longitudinal support of both patient care and clinician education in LMICs.
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Anaemia is a global public health concern, especially afflicting adolescent girls, women 15–49 years of age, pregnant women, and children in low- and mi
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ddle-income countries. WHO estimates that in 2019 30% (571 million) of women aged 15–49 years, 37% (32 million) of pregnant women, and 40% (269 million) of children 6–59 months of age were affected by anaemia, with the WHO African Region and South-East Asia
Region being most affected(
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The document "Global Report on Diabetes" by the World Health Organization (WHO) provides an in-depth analysis of diabetes as a global health challenge. It covers the rising prevalence of the disease, the associated risk factors, and the increasing burden on healthcare systems, particularly in
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low- and middle-income countries. The report discusses strategies for preventing Type 2 diabetes, managing diabetes effectively, and reducing complications through integrated healthcare approaches. It emphasizes the need for global action, national policies, and collaboration across sectors to address diabetes and improve health outcomes worldwide.
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The World Health Organization's fact sheet on diabetes provides an overview of the disease, highlighting its increasing prevalence, particularly in low- and
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middle-income countries. It outlines the main types of diabetes—Type 1, Type 2, and gestational diabetes—detailing their characteristics and risk factors. The document emphasizes the importance of early diagnosis and management to prevent complications such as heart disease, kidney failure, and vision loss. Preventive measures include maintaining a healthy diet, regular physical activity, and avoiding tobacco use. The fact sheet also discusses WHO's initiatives aimed at monitoring, preventing, and controlling diabetes globally.
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The World Health Organization's fact sheet on diabetes provides an overview of the disease, highlighting its increasing prevalence, particularly in low- and
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middle-income countries. It outlines the main types of diabetes—Type 1, Type 2, and gestational diabetes—detailing their characteristics and risk factors. The document emphasizes the importance of early diagnosis and management to prevent complications such as heart disease, kidney failure, and vision loss. Preventive measures include maintaining a healthy diet, regular physical activity, and avoiding tobacco use. The fact sheet also discusses WHO's initiatives aimed at monitoring, preventing, and controlling diabetes globally.
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The document discusses physical inactivity as a major risk factor for non-communicable diseases (NCDs), which contribute to two-thirds of global deaths, primarily in low- and
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middle-income countries. It emphasizes the global prevalence of physical inactivity and its health risks, such as increased mortality and chronic diseases. The text advocates for simple, sustainable interventions to promote physical activity, such as public initiatives like car-free days, to prevent and manage NCDs. It highlights the importance of exercise in improving physical and mental health and calls for collaborative, comprehensive approaches to increase activity levels.
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Tobacco kills up to half of its users who don’t quit (1-3).
Tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke Around 80% of the world's 1.3 billion tobacco users live in
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low- and middle-income countries.In 2020, 22.3% of the world’s population used tobacco: 36.7% of men and 7.8% of women.
To address the tobacco epidemic, WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Currently 182 countries are Parties to this treaty.
The WHO MPOWER measures are in line with the WHO FCTC and have been shown to save lives and reduce costs from averted healthcare expenditure.
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Position statement on endoscopic lung volume reduction in South Africa: 2022 update
Koegelenberg, C.F.; Van Zyl-Smit, R.N.; Dheda, K. et al.
African Journal of Thoracic and Critical Care Medicine
(2022)
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The article from the African Journal of Thoracic and Critical Care Medicine provides updated guidelines on endoscopic lung volume reduction (ELVR) for treating advanced emphysema, a severe form of chronic obstructive pulmonary disease (COPD), which is prevalent in South Africa and other
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low- and middle-income countries. The guidelines focus on identifying suitable patients based on specific criteria, such as age, lung function, and the presence of hyperinflation, while ruling out contraindications like pulmonary hypertension and recent smoking.
ELVR aims to reduce lung volume in the most damaged areas, improving breathing mechanics and quality of life. Various devices, including endobronchial valves, intrabronchial valves, and coils, are reviewed with evidence from clinical trials supporting their use. The guidelines emphasize careful patient selection and recommend only performing ELVR in specialized centers due to its high cost and risk of complications, such as pneumothorax.
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The article "Time to Align: Development Cooperation for the Prevention and Control of Non-Communicable Diseases" argues for greater international cooperation and investment in addressing non-communicable diseases (NCDs), especially in low-
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and middle-income countries. Traditionally, global health funding has focused on infectious diseases, but the growing burden of NCDs—such as cardiovascular diseases, cancer, and diabetes—necessitates new approaches to development assistance.
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Under- and over-diagnosis of COPD: a global perspective
Ho T., Cusack R.P., Chaudhary N. et al.
Breathe, part of the European Respiratory Society (ERS)
(2019)
CC2
The article "Under- and over-diagnosis of COPD: a global perspective" reviews the worldwide variation in the prevalence of chronic obstructive pulmonary disease (COPD) and issues related to its misdiagnosis. It highlights that COPD is under-diagnosed due to factors such as limited access to spiromet
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ry and variable diagnostic criteria, especially in low- and middle-income countries. Conversely, over-diagnosis often results from reliance on non-standard criteria or inadequate spirometry use. The article discusses key risk factors, including age, gender, exposure to pollutants, and comorbidities, and emphasizes the need for standardized diagnostic practices to better address and manage COPD globally.
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BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low-
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and middle-income countries and remains under-recognised and poorly managed.
OBJECTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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Asthma is the most common chronic disease in children, imposing a consistent burden on health system. In recent years, prevalence of asthma symptoms became globally increased in children and adolescents, particularly in Low-Middle
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Income Countries (LMICs). Host (genetics, atopy) and environmental factors (microbial exposure, exposure to passive smoking and air pollution), seemed to contribute to this trend. The increased prevalence observed in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception. Asthma accounts for 1.1% of the overall global estimate of “Disability-adjusted life years” (DALYs)/100,000 for all causes. Mortality in children is low and it decreased across Europe over recent years. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality. Global asthma-related costs are high and are usually are classified into direct, indirect and intangible costs. Direct costs account for 50–80% of the total costs. Asthma is one of the main causes of hospitalization which are particularly common in children aged < 5 years with a prevalence that has been increased during the last two decades, mostly in LMICs. Indirect costs are usually higher than in older patients, including both school and work-related losses. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities and study performance. The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease.
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In 2014, the International Study of Asthma and Allergies in Childhood (ISAAC) reported that the highest prevalence of symptoms of severe asthma was found in the low- and
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middle-income countries (LMICs), including Nigeria. While exposure to biomass fuel use may be an important risk factor in the development of asthma, its association with asthma symptoms severity has not been well-established. The aim of this study is to extend the spectrum of environmental risk factors that may be contributing towards increasing asthma morbidity, especially asthma symptoms severity in rural schoolchildren in Nigeria and to examine possible asthma underdiagnosis among this population.
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Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-
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income countries (LMICs), which have disproportionately high asthma-related mortality relative to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma.
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This purpose of this guide is to inform robust evaluations of the WHO training package – a package aimed at personnel whose primary role in health-care facilities is environmental cleaning, hereafter referred to as cleaners.
The WHO training package – Environmental cleaning and infection prev
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ention and control in health-care facilities in low- and middle-income countries – was designed to improve the competencies of cleaners through a practical, educational approach for adult learners in low- and middle-income countries and comprises two volumes: trainer’s guide and modules and resources (1,2). An associated OpenWHO online course describes the essential preparations for trainers to deliver the WHO training package.
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Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-
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income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania.
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Ending Child Marriage: Child Marriage Laws ad Their Limitations
Wodon, Q., Tavares, P., Fiala, O., Nestour, A. & Wise, L.
Save the Children and The World Bank
(2017)
C1
Child marriage is defined as a formal or informal union before the age of 18. The practice affects mostly girls. While child marriage is especially prevalent in low and lower-
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middle income countries, it is also observed in other countries. It endangers the life trajectories of girls in multiple ways. Child brides are at greater risk of experiencing a range of poor health outcomes, having children at younger ages when they are not yet ready to do so, dropping out of school, earning less over their lifetimes and living in poverty compared to their peers who marry at later ages. Child brides may also be more likely to experience intimate partner violence, have restricted physical mobility, and limited decision making ability. M
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