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Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence
...
of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
more
Over the ages, human societies have altered local ecosystems and modified regional climates. Today the human influence has attained a global scale. This reflects the recent rapid increase in population size, energy consumption, intensity of land use
...
, international trade and travel, and other human activities. These global changes have heightened awareness that the long-term good health of populations depends on the continued stability of biosphere's ecological, physical and socioeconomic systems.
The world's climate system is an integral part of the complex of life-supporting processes. Like other large systems, the global climate system is coming under pressure from human activities.
This book seeks to describe the context and process of global climate change, its actual or likely impacts on health, and how human societies and their governments should respond with particular focus on the health sector.
more
A year ago, the second Special Session of the World Health Assembly (WHASS) unanimously agreed to start a diplomatic process for a new binding instrument aimed at ensuring the international communit
...
y is better prepared for the next health emergencies. The establishment of an Intergovernmental Negotiating Body (INB) at the WHO paved the terrain for a proper negotiation, which has started to unfold. The INB will be releasing the “conceptual zero draft” of the treaty text in early December 2022.
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Beat the heat: child health amid heatwaves in Europe and Central Asia finds that half of these children died from heat-related illnesses in their first year of life. Most children died during the su
...
mmer months.
"Around half of children across Europe and Central Asia – or 92 million children – are already exposed to frequent heatwaves in a region where temperatures are rising at the fastest rate globally. The increasingly high temperatures can have serious health complications for children, especially the youngest children, even in a short space of time. Without care, these complications can be life-threatening,” said Regina De Dominicis UNICEF Regional Director for Europe and Central Asia.
Heat exposure has acute effects on children, even before they are born, and can result in pre-term births, low birth weight, stillbirth, and congenital anomalies. Heat stress is a direct cause of infant mortality, can affect infant growth and cause a range of paediatric diseases. The report also notes that extreme heat caused the loss of more than 32,000 years of healthy life among children and teenagers in the region.
As the temperatures continue to rise, UNICEF urges governments across Europe and Central Asia to:
- Integrate strategies to reduce the impact of heatwaves including through National Determined Contributions (NDC), National Adaptation Plans (NAP), and disaster risk reduction and disaster management policies with children at the centre of these plans
Invest in heat health action plans and primary health care to more adequately support heat-related illness among children
- Invest in early warning systems, including heat alert systems
- Adapt education facilities to reduce the temperatures in the areas children play in and equip teachers with skills to respond to heat stress
- Adapt urban design and infrastructure including ensuring buildings, particularly those housing the most vulnerable communities are equipped to minimize heat exposure
- Secure the provision of safe water, particularly in countries with deteriorating water quality and availability.
UNICEF works with governments, partners and communities across the region to build resilience against heatwaves. This includes equipping teachers, community health workers and families with the skills and knowledge to respond to heat stress.
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A Wake-Up Call: Lessons from Ebola for the world’s health systems
recommended
Save the Children
(2015)
Almost 30 countries vulnerable to a new Ebola-style Epidemic, jeopardising the future of millions of Children. The report ranks the world’s poorest countries on the state
...
of their public health systems, finding that 28 have weaker defences in place than Liberia where, alongside Sierra Leone and Guinea, the current Ebola crisis has already claimed 9,000 lives, and provoked an extraordinary international response to help contain it.
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Inerim Guidance. These guidelines have been developed in recognition that infection with Zika virus may present a risk to blood safety, and in consideration of the declaration on 1 February 2016 by the WHO Director-General
...
of a Public Health Emergency of International Concern with regard to clusters of microcephaly and other neurological disorders, potentially associated with Zika virus. Currently there is limited knowledge of Zika virus biology and lack of definitive evidence of a link between infection and potential complications
more
The Global Vaccine Action Plan (GVAP) 2011-2020, endorsed by Member States during the May 2012 World Health Assembly, has set ambitious targets to improve access to immunization and tackle vaccine-preventable diseases. This responsibility has been t
...
ranslated into firm commitments in February 2016, through the signature of the Addis Declaration on Immunization (ADI) by African Ministers and subsequently endorsed by the Heads of States from across Africa at the 28th African Union Summit held in January 2017. This commitment from the highest level of government comes as a catalyst to immunization efforts on the continent to deliver on the promise of universal immunization
more
In where under-five mortality is high and vitamin A deficiency is a public health problem, two high-dose supplements of vitamin A per year, spaced four to six months apart, can strengthen children’s immune systems and improve their chances
...
of survival.
During much of early childhood – from 6 months to 5years of age – two high doses of vitamin A every year can prevent blindness and hearing loss, boost children’s immunity against diseases like measles and diarrhoea and provide critical protection against death. Like all forms of malnutrition, vitamin A deficiency is a marker of inequality. In countries where diets are lacking in vitamin A and infections and deaths are prevalent, supplementation programmes give vulnerable children a better chance to survive, develop and thrive. more
During much of early childhood – from 6 months to 5years of age – two high doses of vitamin A every year can prevent blindness and hearing loss, boost children’s immunity against diseases like measles and diarrhoea and provide critical protection against death. Like all forms of malnutrition, vitamin A deficiency is a marker of inequality. In countries where diets are lacking in vitamin A and infections and deaths are prevalent, supplementation programmes give vulnerable children a better chance to survive, develop and thrive. more
SDG Costing & Financing for Low-Income Developing Countries
Sachs, J.; G. McCord; N. Maennling et al.
UN Sustainable Development Solutions Network (SDSN)
(2019)
CC
The Sustainable Development Goals (SDGs) call for major societal transformations that will require significant fiscal outlays as well as private investments. The fiscal outlays cover public investments, the public provision of social services, and s
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ocial protection for vulnerable populations. The key message of this paper, building on recent reports by the IMF and SDSN (IMF, 2019b; SDSN, 2018) is that the governments of Low-Income Developing Countries (LIDCs) will require a substantial increase in fiscal (budget) revenues, far beyond what they can achieve by their own fiscal reforms. For this reason, SDG financing will require substantial international cooperation to enable the LIDCs to finance their SDG fiscal outlays. One important source of increased revenues should be the globally coordinated taxation of ultra-high-net worth assets. Today’s ultra-rich should help to pay for the survival and basic needs of the world’s poorest people.
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These guidelines provide a recommendation on iodine thyroid blocking (ITB), via oral administration of stable iodine, as an urgent protective action in responding to a nuclear accident. This recommendation aims to support emergency planners, policy
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makers, public health specialists, clinicians and other relevant stakeholders, in order to strengthen public health preparedness for radiation emergencies in WHO Member States as required by the International Health Regulations (IHR) and in line with the international safety standards (GSR Part 7). The scope of the guidelines is confined to public health aspects of planning and implementation of ITB before and during a radiation emergency, such as dosage and timing of ITB administration, adverse effects of stable iodine, its packaging, storage, and distribution.
These guidelines supersede the 1999 WHO Guidelines for Iodine Prophylaxis following Nuclear Accidents.
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This document builds on the Background document prepared for the September 4-5, 2014 Consultation. It includes proposed elements to consider during the development of a framework to assist decision-making at global and national level.
The aim
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of the document is to assist Member States and relevant partners in their discussions to identify the best approaches to ensure the accelerated evaluation and use of available or near-term therapies and vaccines for the treatment and prevention of EVD. The document calls for a coordinated effort by the international community to remove unnecessary obstacles towards this goal.
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Laboratory diagnosis of Buruli ulcer
recommended
A manual for health care providers.
This manual provides expert guidance on the laboratory techniques and procedures used in the diagnosis of Buruli ulcer, a disease caused by Mycobacterium ulcerans. Aimed at laboratory technicians and scientists w
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orking on this disease, the manual details the exact procedures to follow when performing a range of diagnostic tests. Recommended procedures, intended for use throughout the health system, are presented at levels appropriate for peripheral, district and central services and in accordance with the varying resources, skills and equipment typically found in countries where Buruli ulcer is endemic.
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This document focuses on making recommendations for the diagnosis and treatment of Chagas disease, an infection caused by Trypanosoma cruzi, the protozoan agent of a systemic parasitic disease. Meth
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odology: These clinical practice guidelines were prepared following the WHO handbook for guideline development (5). A multidisciplinary development group was formed, comprised of thematic experts, epidemiologists, methodologists, and users. Since there were no existing guidelines that could be adapted, the guidelines were developed from scratch.
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Research and Reports in Tropical Medicine 2022:13 25–40.
Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central, South America, Mexico and the South of the United States. It is an important cause
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of early mortality and morbidity, and it is associated with poverty and stigma. A third of the cases evolve into chronic cardiomyopathy and gastrointestinal disease. This review proposes strategies to address challenges faced by non-endemic countries
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There is paucity of data on the burden and specific drivers operative in the pathogenesis of chronic obstructive pulmonary disease (COPD) in the African setting and populations. Lack
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of awareness and inadequate knowledge on the aetio-pathogenesis of the disease together with inadequate capacity for COPD care contributes to preventive and management challenges. Thus, the majority of patients with COPD are misdiagnosed, misclassified and mismanaged or undertreated. With the struggling improvement in the quality of healthcare in Africa, studies conducted over the last 10 years indicates the rising trends in both the risk factors and the burden of COPD. The role of new risk factors such as indoor pollution, infections with human immunodeficiency virus (HIV) and pulmonary tuberculosis (TB), in the pathogenesis of COPD in Africa is increasingly being recognized. This literature review attempts to collect and synthesize information that could be useful in improving COPD care and informing the governments to take appropriate actions for prevention, diagnosis and management of COPD in Africa.
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Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still nee
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ds substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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This guideline for the prevention and control of chikungunya fever
(CF) is intended for use by all peripheral health workers in the Region and
is based on the strategy outlined above. This document will focus mainly
on preventing, predicting and
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detecting outbreaks, and after detection,
investigating and containing them.
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BMJ Glob Health 2017;2:e000345. doi:10.1136/bmjgh-2017-000345. WHO's 2020 milestones for Chagas disease include having all endemic Latin American countries certified with no intradomiciliary Trypanosoma cruzi transmission, and infected patients under care. Evaluating the variation in historical expo
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sure to infection is crucial for assessing progress and for understanding the priorities to achieve these milestones.
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Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to
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accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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While epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by challenges in diagnosis and management. These challeng
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es, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in subSaharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region. Methods We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and selfmanagement, and barriers and facilitators for accessing T1D care.
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