PNAS 119 (8) e2113947119 | https://doi.org/10.1073/pnas.2113947119
Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, m...easure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world’s rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.
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Health Policy and Planning, Volume 35, Issue 1, February 2020, Pages 47–57, https://doi.org/10.1093/heapol/czz122
Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and t...he mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015.
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Durante muchos años, la enfermedad de Chagas ha sido una entidad olvidada en nuestro medio, pese a que Colombia posee las condiciones apropiadas para que esta infección se desarrolle y se perpetúe en el tiempo.
Esto se refleja en el poco conocimiento de la enfermedad y en la existencia de muchos... individuos que sufren una pérdida significativa de su calidad y esperanza de vida, así como en costos importantes para el sistema de salud.
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Trypanosoma cruzi is the etiological agent of Chagas disease (CD), considered one of the most important parasitic infections in Latin America. Between 25 and 90 million humans are at infection risk via at least one of multiple infection mechanisms. Under natural conditions, the principal transmissio...n modes are transplacental or via one of more than 140 hematophagous triatomine bugs (Reduviidae: Triatominae). Triatomines acquire the parasite from mammal reservoirs due to their obligate blood-feeding (albeit triatomines can also feed on non-reservoir vertebrates such as birds and reptiles). The disease burden for CD in the Latin America and Caribbean region, based on disability-adjusted life-years (DALYs), is at least five times greater than that of malaria, and is approximately one-fifth that of HIV/AIDS. In recent decades, CD has extended to other continents outside natural reservoir or vector distributions due to human migration, with a minimum estimated 10 million individuals infected worldwide.
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Arsenical monotherapies were previously very successful for treating human African trypanosomiasis (HAT).
Melarsoprol resistance emerged as early as the 1970s and was widespread by the late 1990s.
Melarsoprol resistance represents the only example of widespread drug resistance in HAT patients wher...e the genetic mechanism has been established.
The current goal of elimination of HAT as a public health problem by 2020 may be undermined by the emergence and spread of resistance to current or new drugs.
Insights into potential resistance mechanisms for current and new drugs will facilitate predictions of the likelihood of resistance and will also facilitate rational approaches to minimizing, monitoring, and tackling the future emergence of resistance.
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Rabies is a disease of animals but too often the outcome is gauged in terms of human suffering and
death. Despite this, in areas of the world where rabies is endemic there is often a lack of communication between veterinary and medical professionals, to the extent that the disease continues to thri...ve and potential victims are not treated. The problem is partly
exacerbated by a lack of awareness and experience of the disease and of what to do when confronted by suspect cases. In these technologically advanced days, although it is possible to learn “all there is to know” about almost any subject, it is sometimes difficult to distil the essence.
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AidData has developed a set of open source data collection methods to track project-level data on suppliers of official finance who do not participate in global reporting systems. This codebook outlines the version 1.1 set of TUFF procedures that have been developed, tested, refined, and implemented... by AidData researchers and affiliated faculty at the College of William & Mary and Brigham Young University.
In the first iteration of this codebook, AidData's Media-Based Data Collection Methodology, Version 1.0, we referred to our data collection procedures as a “media-based data collection” (MBDC) methodology. The term “media-based” was misleading, as the methodology does not rely exclusively on media reports; rather, media reports are used only as a departure point, and are supplemented with case studies undertaken by scholars and non-governmental organizations, project inventories supplied through Chinese embassy websites, and grants and loan data published by recipient governments. In the interest of providing greater clarity, we now refer to our methodology for systematically gathering open source development finance information as the Tracking Underreported Financial Flows (TUFF) methodology. This codebook outlines the set of TUFF procedures that have been developed, tested, refined, and implemented by AidData staff and affiliated faculty at the College of William & Mary and Brigham Young University.
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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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Non-communicable diseases (NCDs) are of increasing concern for society and national governments, as well as globally due to their high mortality rate. The main risk factors of NCDs can be classified into the categories of self-management, genetic factors, environmental factors, factors of medical co...nditions, and socio-demographic factors.
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Asthma is the commonest chronic childhood disease and encompasses a spectrum of airway diseases with similar symptoms. Inaccurate diagnosis remains common, especially in younger children, with failure to characterize the different “asthmas.” Children worldwide repeatedly suffer symptoms which se...verely affect their everyday lives. Children die from asthma, especially in low and middle-income countries (LMICs). In many countries, asthma prevalence is rising. Access to effective care and changing environments are hugely variable and may explain the higher morbidity in inner-city children, in LMICs, and in deprived populations in high-income countries. Despite the disease being eminently controllable, morbidity and mortality persist.
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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 needs substantial improvement. From infancy to the tee...nage 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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Cystic fibrosis (CF) was earlier thought to be a disease prevalent in the West among Caucasians. However, quite a number of recent studies have uncovered CF cases outside of this region, and reported hundreds of unique and novel variant forms of CFTR. Here, we discuss the evidence of CF in parts of... the world earlier considered to be rare; Africa, and Asia. This review also highlighted the CFTR mutation variations and new mutations discovered in these regions. This discovery implies that the CF data from these regions were earlier underestimated. The inadequate awareness of the disease in these regions might have contributed towards the poor diagnostic facilities, under-diagnosis or/and under-reporting, and the lack of CF associated health policies. Overall, these regions have a high rate of infant, childhood and early adulthood mortality due to CF. Therefore, there is a need for a thorough investigation of CF prevalence and to identify unique and novel variant mutations within these regions in order to formulate intervention plans, create awareness, develop mutation specific screening kits and therapies to keep CF mortality at bay.
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The prevalence, availability, and use of antimalarial medicines (AMLs) were studied in six Cambodian provinces along the Thai-Cambodian border. The study was divided into two parts: the first looked at the quality of AMLs available in Pursat, Pailin, Battambang, Bantey Meanchey, Oddar Meanchey, and ...Preah Vihear and the second obtained information about the availability and use of AMLs.
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This report presents key findings from a study carried out on ‘Assessing the effectiveness of targeting mechanisms under PMJAY’. It provides a detailed analysis of potential inclusion and exclusion errors in two select states in India (Haryana a...nd Uttarakhand) to inform National Health Authority’s (NHA) policy
and approach around beneficiary targeting.
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This report presents key findings from a study carried out on the ‘Mainstreaming quality of care in empanelled hospitals under PMJAY’. It provides a detailed analysis of current coverage and perceptions of quality accreditation and certification... across PMJAY empanelled hospitals from three different states
(Haryana, Uttar Pradesh and Gujarat).
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Kangaroo mother care is a method of care of preterm infants. The method involves infants being carried, usually by the mother, with skin-to-skin contact. This guide is intended for health professionals responsible for the care of low-birth-weight an...d preterm infants. Designed to be adapted to local conditions, it provides guidance on how to organize services at the referral level and on what is needed to provide effective kangaroo mother care. The guide includes practical advice on when and how the kangaroo-mother-care method can best be applied.
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Groupe d'étude sur la douleur et les politiques / Centre collaborateur de l'OMS pour les politiques de soulagement de la douleur et de soins palliatifs
This guide provides standards and directions on how to carry out rapid needs assessment for Psychosocial Support (PSS) and Violence Prevention (VP) initiatives including child protection and sexual and gender-based violence. In particular, this rapi...d assessment tool is designed to help gather data in an efficient and effective way to help inform integration of PSS and VP issues, as minimum standards, into the broader disaster management action plans in response to an emergency.
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The sub-Saharan African region, carries 90% of the over 250 million cases of schistosomiasis occurring worldwide. In this region, after Nigeria, Tanzania is second country having the highest cases of schistosomiasis and approximately 51.5%0 of the T...anzanian population is either exposed or live in areas with high risk of exposure. The country is endemic to both Schistosoma mansoni and Schistosoma haematobium, these infections are common in communities characterised with limited access to water, sanitation, hygienic practices and health services. Schistosoma mansoni infection is associated with hepatosplenic disease characterised with hepatomegaly, splenomegaly, progressive periportal fibrosis (PPF) which can lead to portal hypertension and its related sequelae, mainly ascites, liver surface irregularities, oesophageal varices and haematemesis. The main consequences of S. haematobium infection are haematuria, dysuria, nutritional deficiencies, urinary bladder lesions, hydronephrosis, urinary bladder squamous cell carcinoma and in children, growth retardation. Preventive chemotherapy using mass drug administration (MDA) of praziquantel targeting primary school aged children is the main strategy for controlling schistosomiasis in Tanzania.
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Une mission d’appui d’experts diligentés par l’OMS et l’USAID s’est rendue du 17 au 24 novembre au Burkina Faso pour aider le pays dans la mise en place de son plan de prevention et de ri...poste à une éventuelle épidémie de maladie à virus Ebola. L’équipe a travaillé avec les acteurs du niveau national et les partenaires techniques et financiers du pays
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