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Kerala state is moving towards achieving the Sustainable Development Goals
(SDG), adopted by the United Nations General Assembly on 25th September 2015.
Goal 3 of the SDG addresses “Ensuring healthy lives and promoting well-being for
all at all ages”. The sub-goal 3.4 of the SDG has the targe
...
t “By 2030, reduce by one
third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and wellbeing”.
more
This integrated operational framework provides an overview of the connections between mental health, neurological and substance use (MNS) conditions, and their links to health, well-being and the broader public health and sustainable development agenda. The need for integrated approaches is increasi
...
ngly recognized as critical to address the complex interactions between mental health, brain health, substance use, and physical health, particularly in light of global threats such as the COVID-19 pandemic. The framework also provides a series of actions for governments and health service planners and advisors to achieve integration across four domains: leadership and governance; care services; promotion and prevention; and health information systems, evidence generation and research.
more
The guide aims to provide health and DRM practitioners, planners and policymakers across sectors with targeted information to help them strengthen national health systems and integrate the risks of disease outbreaks in national DRR strategies
The following are some of the principles and approache
...
s that have been based on lessons learned to date and may be considered to ensure effective all-hazards health EDRM, including prevention and preparedness for disease outbreaks, are addressed as part of the multihazard, multisectoral approach to developing or updating DRR strategies
more
Module appartenant à la série d’évaluations des capacités des services de santé dans le cadre de la pandémie de COVID-19: orientations provisoires, 12 mai 2021. L'outil d'évaluation de la continuité des services de santé essentiels : Facility Assessment Tool peut être utilisé par les pa
...
ys pour évaluer rapidement la capacité des établissements de santé à maintenir la prestation des services de santé essentiels pendant la pandémie de COVID-19. Il peut aider à alerter les autorités et les autres parties prenantes sur les points où la prestation et l'utilisation des services peuvent nécessiter des modifications et/ou des investissements. Cet outil d'évaluation couvre les aspects suivants des services de santé essentiels :
le personnel de santé (effectifs, absences, infections au COVID-19, gestion du personnel de santé, formation et soutien) ;
gestion financière et obstacles ;
prestation et utilisation des services (fermetures d'établissements, changements dans la prestation des services, campagnes de communication communautaires, changements dans l'utilisation des services et stratégies de rattrapage) ;
capacités en matière de prévention des infections (protocoles, mesures de sécurité, directives et disponibilité d'équipements de protection individuelle (EPI) pour le personnel) ;
la disponibilité des thérapeutiques, des diagnostics et des fournitures, et la disponibilité des vaccins ; et
la fourniture de services de soins primaires COVID-19.
more
This publication presents the Agenda for the Americas on Health, Environment, and Climate Change 2021–2030 (the Agenda). The Agenda is a call to action to the health sector to lead the charge to address environmental determinants of health in the Americas. The Pan American Health Organization (PAH
...
O) will work with Member States to achieve its goal and objective to ensure healthy lives and promote well-being for all at all ages using a sustainable and equitable approach that places a priority on reducing health inequity. The Agenda has been developed under the umbrella of the WHO Global Strategy on Health, Environment, and Climate Change, and builds upon the commitments set forth in the Sustainable Health Agenda for the Americas 2018–2030 and the PAHO Strategic Plan 2020–2025. The Agenda was developed in consultation with the Technical Advisory Group and through a consensus-driven decision-making process with Member States during the 2019–2020 period. Looking toward the achievement of Sustainable Development Goal 3, the Agenda focuses on: improving the performance of environmental public health programs and institutions; fostering environmentally resilient and sustainable health systems; and promoting environmentally healthy and resilient cities and communities. Its implementation will be context-specific, based on the needs and realities of the countries. It will benefit countries and territories by promoting good governance practices, strengthening the leadership and coordination roles of the health sector, fostering cross-sectoral action, focusing on primary prevention, and enhancing evidence and communication. It will facilitate access to human, technical, and financial resources necessary to address environmental determinants of health and ensure that the Region is fully engaged in global health, environment, and climate change processes and agreements. The objective of the Agenda is to strengthen the capacity of health actors in the health and non-health sectors to address and adapt to environmental determinants of health (EDHs), prioritizing populations living in conditions of vulnerability, in order to meet Outcome 18 of the PAHO Strategic Plan 2020–2025 directly and several other outcomes of the Plan indirectly. To address and adapt to the challenges of EDHs in the Region, an integrated and evidence-informed approach within the health sector and across sectors will be needed, one enabled, and supported by good governance practices, adequate management mechanisms, high-level political will, and adequate human, technical, technological, and financial resources.
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Cette publication présente le Programme sur la santé, l’environnement et les changements climatiques pour les Amériques 2021-2030. Le Programme est un appel à l’action au secteur de la santé pour qu’il prenne l’initiative d’agir sur les déterminants environnementaux de la santé dans
...
les Amériques. L’Organisation panaméricaine de la Santé (OPS) travaillera avec les États Membres pour atteindre son but et son objectif, qui consistent à permettre à tous de vivre en bonne santé et à promouvoir le bien-être de tous à tout âge, en employant une approche durable et équitable qui accorde la priorité à la réduction des iniquités en matière de santé. Le programme a été élaboré sous l’égide de la Stratégie mondiale de l’OMS sur la santé, l’environnement et les changements climatiques et s’appuie sur les engagements énoncés dans le Programme d’action sanitaire durable pour les Amériques 2018-2030 et le Plan stratégique de l’OPS 2020-2025. Le programme a été élaboré en consultation avec le groupe consultatif technique et par un processus décisionnel consensuel avec les États Membres au cours de la période 2019-2020. En vue de la réalisation de l’objectif de développement durable 3, le programme se concentre sur l’amélioration de la performance des programmes et des institutions de santé publique environnementale, la promotion de systèmes de santé résilients et durables sur le plan environnemental et la promotion de villes et de communautés saines et résilientes sur le plan environnemental. Sa mise en œuvre sera adaptée au contexte, en fonction des besoins et des réalités des pays. Il profitera aux pays et aux territoires en encourageant les pratiques de bonne gouvernance, en renforçant les rôles de leadership et de coordination du secteur de la santé, en favorisant l’action intersectorielle, en se concentrant sur la prévention primaire et en améliorant les données probantes et la communication. Il facilitera l’accès aux ressources humaines, techniques et financières nécessaires pour agir sur les déterminants environnementaux de la santé et fera en sorte que la Région soit pleinement engagée dans les processus et les accords mondiaux en matière de santé, d’environnement et de changements climatiques.
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Our target end-users are those with limited literacy. It is a challenging task to achieve success in this group as so much of what is "obvious" to those of us with good literacy skills is totally obscure to those who have never had the opportunity to learn the meaning of e.g. an arrow shape and what
...
it is meant to represent. Our pictograms have been tested mainly in our local Xhosa population, so we cannot guarantee universal generalisability (as is the case for any other pictograms). Categories in the database include Dosage and frequency; Route of administration; Additional medicine instructions; Side effects or indications; Storage of medicines; Tablets, capsules, bottles, droppers; Miscellaneous; TB-related pictograms
A common application relates to their use with medicines where they may serve to convey instructions, precautions, storage requirements, warnings, as well as medicine indication or side effects to patients or consumers. Many examples of diverse application of pictograms in the health literature have been described including health promotion materials, wound care instructions, asthma prevention and treatment, injury prevention, discharge instructions, self-care guidance, paediatric anaphylaxis plan, organ and body donation, CT scan risks and benefits, driving risks, safety symbols, decision aids for treatment, and patient-reported outcomes dashboards, amongst others.
more
Monkeypox virus is an orthopoxvirus that causes human monkeypox, a viral disease with symptoms similar to smallpox, including fever and rash. Following the worldwide eradication of smallpox in 1980, monkeypox emerged as the most significant orthopoxvirus infection in humans. Cases are most often rep
...
orted from rural areas of Central and West African countries, particularly in regions close to tropical rainforest where people may have contact with infected animals. Someone can become infected through direct contact with respiratory droplets of another person who has monkeypox in the home or in a health facility, or with contaminated materials such as bedding. Although these are the main modes of person-to-person transmission, monkeypox outbreaks tend to occur in small clusters of a few cases without leading to widespread community transmission. For this reason, outbreaks can be easily controlled when responded to rapidly. On several occasions, monkeypox has been reported in other regions due to importation by travelers or infected animals. This course provides a general introduction to the disease through a video and accompanying downloadable presentation that can be reviewed at your own pace. It is intended for health personnel responsible for prevention and control of monkeypox, and for the general public.
The content and scope of this course on monkeypox have been tailored for outbreaks in African countries where the disease is endemic. The course material was last updated in 2020 and may not reflect most recent WHO guidance issued for the multi-country outbreak in 2022.
more
Int. J. Environ. Res. Public Health 2022, 19, 9313. https://doi.org/10.3390/ijerph19159313. A mixed-methods study, using an online survey and in-depth interviews, was conducted. Participants included Mental Health Focal Points at the Ministries of Health, the World Health Organization (WHO) country
...
and regional offices, and civil society representatives. Responses were received from 28 countries out of 55 contacted. The implementation level, based on standard guidelines, of MHPSS activities was below 50% in most countries. The most implemented MHPSS activities were establishing coordination groups (57%) and developing MHPSS strategy (45%), while the least implemented activities included implementing the developed MHPSS strategy (32%) and establishing monitoring and evaluation mechanisms (21%). Key factors that hindered implementing MHPSS activities included lack of political commitment and low prioritisation of mental health during emergencies, as it was seen as a “less important” issue during the COVID-19 pandemic, when more importance was given to infection prevention and control (IPC)
more
Evidence-based guidelines are one of the most useful tools for improving public health and clinical practice. Their purpose is to formulate interventions based on strong evidence of efficacy, avoid unnecessary risks, use resources efficiently, reduce clinical variability and, in essence, improve hea
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lth and ensure quality care, which is the purpose of health systems and services. These guidelines were developed following the GRADE methodology, with the support of a panel of clinical experts from different countries, all convened by the Pan American Health Organization. By responding to twelve key questions about the clinical diagnosis and treatment of dengue, chikungunya, and Zika, evidence-based recommendations were formulated for pediatric, youth, adult, older adult, and pregnant patients who are exposed to these diseases or have a suspected or confirmed diagnosis of infection. The purpose of the guidelines is to prevent progression to severe forms of these diseases and the fatal events they may cause. The recommendations are intended for health professionals, including general, resident, and specialist physicians, nursing professionals, and medical and nursing students, who participate in caring for patients with suspected dengue, chikungunya, or Zika. They are also intended for health unit managers and the executive teams of national arboviral disease prevention and control programs, who are responsible for facilitating the process of implementing these guidelines.
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African regional progress and status of the programme to eliminate lymphatic filariasis: 2000–2020
Deribe K., Bakajikaa D. K., Zourea H. MG. et al
The royal society of tropical medicine and hygiene
(2021)
C2
To eliminate lymphatic filariasis (LF) by 2020, the World Health Organization (WHO) has launched a campaign against the disease. Since the launch in 2000, significant progress has been made to achieve this ambitious goal. In this article we review the progress and status of the LF programme in Afric
...
a through the WHO neglected
tropical diseases preventive chemotherapy databank, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) portal and other publications. In the African Region there are 35 countries endemic for LF. The Gambia was reclassified as not requiring preventive chemotherapy in 2015, while Togo and Malawi eliminated LF as a public health problem in 2017 and 2020, respectively. Cameroon discontinued mass drug administration (MDA) and transitioned to post-MDA surveillance to validate elimination. The trajectory of coverage continues to accelerate; treatment coverage increased from 0.1% in 2000 to 62.1% in 2018. Geographical coverage has also significantly increased, from 62.7% in 2015 to 78.5% in 2018. In 2019, 23 of 31 countries requiring MDA achieved 100% geographic coverage. Although much remains to be done, morbidity management and disability prevention services have steadily increased in recent years. Vector control interventions conducted by other programmes, particularly malaria vector control, have had a profound effect in stopping transmission in some endemic countries in the region. In conclusion, significant progress has been made in the LF programme
in the region while we identify the key remaining challenges in achieving an Africa free of LF.
more
Principaux faits
D’après les estimations, 6 à 7 millions de personnes dans le monde sont infectées par Trypanosoma cruzi (T. Cruzi), le parasite responsable de la maladie de Chagas. La plupart de ces personnes vivent en Amérique latine.
La transmission à l’être humain se fait principalem
...
ent, en Amérique latine, par l’intermédiaire d’un insecte appelé triatome, qui peut être porteur de T. cruzi.
Parmi les autres modes de transmission de la maladie de Chagas, figurent : la transmission orale (par voie alimentaire), la transfusion de sang ou de produits sanguins, la transmission mère-enfant (congénitale), la transplantation d’organes et les accidents de laboratoire.
La maladie de Chagas ne touchait auparavant que des zones rurales de la Région des Amériques, et surtout de l’Amérique latine. Ces dernières décennies, toutefois, les mouvements de population ont fait que la plupart des personnes infectées sont des habitants de zones urbaines (urbanisation) et que la maladie s’est propagée à d’autres continents (où T. cruzi se transmet par des voies non vectorielles).
L’infection à T. cruzi est curable si un traitement est instauré rapidement après l’infection.
Chez les personnes infectées de façon chronique, un traitement antiparasitaire peut éventuellement prévenir ou enrayer la progression de la maladie, et éviter sa transmission, notamment de la mère à l’enfant.
Jusqu’à 30 % des personnes infectées de façon chronique présentent des troubles cardiaques, et jusqu’à 10 % d’entre elles souffrent de troubles digestifs et/ou neurologiques, ce qui peut imposer un traitement particulier.
Les principales méthodes de prévention de la maladie de Chagas en Amérique latine sont la lutte antivectorielle ainsi que d’autres stratégies visant à réduire la transmission vectorielle.
Dans le monde entier, le dépistage sanguin joue un rôle crucial dans la prévention de l’infection par transfusion ou transplantation d’organes.
Il est essentiel de détecter et de traiter l’infection chez les femmes et les filles en âge de procréer, ainsi que de soumettre tout nouveau-né et ses frères et sœurs à un dépistage dans le cas où la mère est infectée et n’a jamais reçu de traitement antiparasitaire.
Certains facteurs socio-économiques et environnementaux influent fortement sur la maladie de Chagas, dont la propagation et les différentes dimensions interdépendantes justifient la nécessité de mettre en œuvre des stratégies de lutte multisectorielles.
Quelques pays ont mis en place la notification et la surveillance des cas aigus et chroniques et des voies de transmission actives, qui sont essentielles à la lutte contre la maladie de Chagas.
more
Antimicrobial resistance (AMR) is a global human, animal, plant and environment health threat that needs to be addressed by every country. The impacts of AMR are wide-ranging in terms of human health, animal health, food security and safety, environmental effects on ecosystems and biodiversity, and
...
socioeconomic development. Just like the climate crisis, AMR poses a significant threat to the delivery of the 2030 Agenda for Sustainable Development. The response to the AMR crisis has been spearheaded through the global action plan on antimicrobial resistance (GAP-AMR), developed by the World Health Organization (WHO) in 2015, in close collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH), and formally endorsed by the three organizations’ governing bodies and by the Political Declaration of the high-level meeting of the United Nations General Assembly on AMR in 2016. In 2022, the three organizations officially became the Quadripartite by welcoming the United Nations Environment Programme (UNEP) into the alliance “to accelerate coordination strategy on human, animal and ecosystem health”.
The aim of the GAP-AMR is to ensure the continuity of successful treatment with effective and safe medicines.
Its strategic objectives include:
• improving the awareness and understanding of AMR;
• strengthening the knowledge and evidence base through surveillance and research;
• reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures; optimizing the use of antimicrobial medicines in human and animal health; and
• developing the economic case for sustainable investment that takes account of the needs of all countries and increasing investment in new medicines, diagnostic tools, vaccines and other interventions.
With the adoption of the GAP-AMR, countries agreed to develop national action plans (NAPs) aligned with the GAP-AMR to mainstream AMR interventions nationally. Individually, the Quadripartite took action to advance AMR interventions in their respective sectors. FAO adopted a resolution on AMR recognizing that it poses an increasingly serious threat to public health and sustainable food production, and developed an AMR action plan to support the resolution’s implementation. For its part, WOAH developed a strategy on AMR aligned with the GAP-AMR, acknowledging the importance of a One Health approach to AMR. Similarly, more recently, UNEP’s governing body, the United Nations Environment Assembly, recognized that AMR is a current and increasing threat and a challenge to global health, food security and the sustainable development of all countries, and welcomed the GAP-AMR and the NAPs developed in accordance with its five overarching strategic objectives
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WHO today released its first roadmap to tackle postpartum haemorrhage (PPH) – defined as excessive bleeding after childbirth - which affects millions of women annually and is the world’s leading cause of maternal deaths.
Despite being preventable and treatable, PPH results in around 70 000 de
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aths every year. For those who survive, it can cause disabilities and psychological trauma that last for years.
“Severe bleeding in childbirth is one of the most common causes of maternal mortality, yet it is highly preventable and treatable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This new roadmap charts a path forward to a world in which more women have a safe birth and a healthy future with their families.”
The Roadmap aims to help countries address stark differences in survival outcomes from PPH, which reflect major inequities in access to essential health services. Over 85% of deaths from PPH happen in sub-Saharan Africa and South Asia. Risk factors include anaemia, placental abnormalities, and other complications in pregnancy such as infections and pre-eclampsia.
Many risk factors can be managed if there is quality antenatal care, including access to ultrasound, alongside effective monitoring in the hours after birth. If bleeding starts, it also needs to be detected and treated extremely quickly. Too often, however, health facilities lack necessary healthcare workers or resources, including lifesaving commodities such as oxytocin, tranexamic acid or blood for transfusions.
“Addressing postpartum haemorrhage needs a multipronged approach focusing on both prevention and response - preventing risk factors and providing immediate access to treatments when needed - alongside broader efforts to strengthen women’s rights,” said Dr Pascale Allotey, WHO Director for Sexual and Reproductive Health and HRP, the UN’s special programme on research development and training in human reproduction. “Every woman, no matter where she lives, should have access to timely, high quality maternity care, with trained health workers, essential equipment and shelves stocked with appropriate and effective commodities – this is crucial for treating postpartum bleeding and reducing maternal deaths.”
more
Cardiovascular diseases (CVD) represent the highest burden of disease globally. Medicines are a critical intervention used to prevent and treat CVD. This review describes access to medication for CVD from a health system perspective and strategies that have been used to promote access, including pro
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viding medicines at lower cost, improving medication supply, ensuring medicine quality, promoting appropriate use, and managing intellectual property issues. Using key evidence in published and gray literature and systematic reviews, we summarize advances in access to cardiovascular medicines using the 5 health system dimensions of access: availability, affordability, accessibility, acceptability, and quality of medicines. There are multiple barriers to access of CVD medicines, particularly in low- and middle-income countries. Low availability of CVD medicines has been reported in public and private healthcare facilities. When patients lack insurance and pay out of pocket to purchase medicines, medicines can be unaffordable. Accessibility and acceptability are low for medicines used in secondary prevention; increasing use is positively related to country income. Fixed-dose combinations have shown a positive effect on adherence and intermediate outcome measures such as blood pressure and cholesterol. We have a new opportunity to improve access to CVD medicines by using strategies such as efficient procurement of low-cost, quality-assured generic medicines, development of fixed-dose combination medicines, and promotion of adherence through insurance schemes that waive copayment for long-term medications. Monitoring progress at all levels, institutional, regional, national, and international, is vital to identifying gaps in access and implementing adequate policies.
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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide
...
miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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Background: Worldwide, maternal hypertensive disorders complicate one in ten pregnancies. As a result of changes in the life styles of society, currently, it is becoming a common public life encounter. However, Ethiopia lacks comprehensive and comparable maternal hypertensive disorders, causing burd
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en and health loss to inform policy and practice.
Objective: To describe the incidence and prevalence of maternal hypertensive disorders and deaths, Disability Adjusted Life Years, and Years Life Lost attributable to maternal hypertensive disorders in Ethiopia and its regional distributions from 1990 to 2019 as part of a collaborative Global Burden of Diseases, (2019) Study.
Methods: The data for this study were collected from surveys, demographic surveillances, medical record reviews, health facility observations and interviews socio-demographic, health care service utilization, and other data sources such as case notifications, scientific literature, and unpublished data as per the Global Burden of Disease protocol and analysis techniques to produce national and regional estimates of maternal hypertensive disorders in Ethiopia. Cause of death ensemble modeling and Bayesian meta-regression disease modeling was employed to ascertain cause of death and morbidity. Each metric was estimated per 100,000 populations with a 95% uncertainty interval (UI).
Results: In the last thirty years, in Ethiopia, , the incidence of maternal hypertensive disorders among young women was raised by 52,596 cases per 100,000 population [199,707 (95% UI 150,261-267,221) to 252,303 (95% UI 191,335-332,524)], while decreased among adolescent women from 67,206 (95% UI 46,887-90,883) to 64, 622 (95% UI; 47,587-84,664) per 100,000 population. The prevalence among women of reproductive age had increased from 94, 818 (95% UI 59,434-135,332) in 1990 to 138, 263 (95% UI 88,447-196,029) in 2019. Between 1990 and 2019, deaths attributable to maternal hypertensive disorders among adolescents and young women had increased by 1.5 and 1.17 times, respectively. In 2019, disability adjusted life years among adolescent, young women and women of reproductive age due to maternal hypertensive disorders was 8,493 (UI 95% 5,370-12,849), 21,812 (UI 95% 14,682-32,139) and 57,867 (UI 95% 41,751-79,165) respectively. The highest daily adjusted life years due to maternal hypertensive disorders had occurred among young women, 13,319 (UI 95% 8,592-19,931) which was higher than 1990 whereas the young women years of life lost had increased.
Conclusions: Based on the finding, increasingly high new cases, prevalence and burden of maternal hypertensive disorders and significant health loss were observed in the last three decades in Ethiopia. Hence, prevention of cases, disabilities, deaths and health losses caused by maternal hypertensive disorders can be prevented by properly advocating lifestyle modifications with specifically designed age-specific interventions. On the top of continuing prevention efforts with newly devised magnesium sulphate administration in the new ANC initiative of the ministry, contextualized, need based, localized, and targeted interventions could be reconstituted. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
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Cholera is a transmissible diarrhoeal infection caused by Vibrio cholerae. Endemic and/or epidemic in over 40 countries (mainly in Africa and Asia), cholera continues to be a major global public health issue.
The World Health Organization (WHO) estimates that the number of cases reported worldwid
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e represents in reality only 5 to 10% of actual cases.
This guide is intended for medical and non-medical staff responding to a cholera outbreak. It attempts to provide concrete answers to the questions and problems faced by staff, based on the recommendations of reference organisations, such as WHO and UNICEF, as well as Médecins Sans Frontières’ experience in the field.
It is divided into 8 chapters. Chapter 1, Cholera overview, outlines the epidemiological and clinical features of cholera. Chapter 2, Outbreak investigation, explains the method and stages of a field investigation, from the alert to implementation of initial activities. Chapter 3, Cholera control measures, details measures and tools to prevent and/or control cholera transmission and mortality in populations affected, or at risk of being affected, by an epidemic (curative care, prevention means and health promotion activities). Chapter 4, Strategies for epidemic response, addresses the roll-out strategies of the measures described in Chapter 3 which depend on context (e.g. urban, rural, endemic, non-endemic setting, etc.), resources and particular constraints. Chapter 5, Cholera case management, details the different stages of cholera treatment, from diagnosis through to cure.
Chapter 6, Setting up cholera treatment facilities, focuses on the installation of treatment facilities that vary in size and complexity according to operational requirements (treatment centres and units and oral rehydration points). Chapter 7, Organisation of cholera treatment facilities, describes the organisation of these specialized facilities in terms of human resources, supply, water, hygiene and sanitation, etc. Chapter 8, Monitoring and evaluation, presents the key data to be collected and analysed during an epidemic to facilitate a tailored response and evaluate its quality and effectiveness.
The guide includes various practical tools in the appendices to facilitate activities (e.g. water quality tests, job descriptions, documents, etc.). Moreover, the toolbox also contains additional tools in editable formats (individual patient file, cholera case register, pictograms).
Despite all efforts, it is possible that certain errors may have been overlooked in this guide. Please inform the authors of any errors detected.
To ensure that this guide continues to evolve while remaining adapted to field realities, please send any comments or suggestions.
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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests t
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hat SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
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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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