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 expan...ding 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.
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The combined effects from ambient (outdoor) air pollution and indoor (household, in particular) air pollution cause approximately 7 million premature deaths every year, largely as a result of increased mortality from stroke, IHD, COPD, lung cancer and acute respiratory infections (1). Air pollution ...can occur in both the outdoor and indoor environments. Cook-stoves in homes, motor vehicles, industrial facilities and forest fires are common sources of air pollution. Air pollutants with the strongest evidence for adverse health outcomes include particulate matter (PM; both PM 2.5 (i.e. particles with an aerodynamic diameter
equal to or less than 2.5 μm) and PM10 (i.e. particles with an aerodynamic diameter equal to or less than 10 μm), ozone (O 3), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and carbon monoxide (CO). Air pollution is however composed of many more pollutants (1).
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Introduction Pharmacovigilance (PV) systems to monitor drug and vaccine safety are often inadequate in sub-Saharan
Africa. In Malawi, a PV enhancement initiative was introduced to address major barriers to PV.
Objective The objective of this initiative was to improve reporting of adverse events (A...Es) by strengthening passive safety
surveillance via PV training and mentoring of local PV stakeholders and healthcare providers (HCPs) at their own healthcare
facilities (HCFs).
Methods An 18-month PV training and mentoring programme was implemented in collaboration with national stakeholders,
and in partnership with the Ministry of Health, GSK and PATH. Two-day training was provided to Expanded Programme on
Immunisation coordinators, identified as responsible for AE reporting, and four National Regulatory Authority representa-
tives. Abridged PV training and mentoring were provided regularly to HCPs. Support was given in upgrading the national
PV system. Key performance indicators included the number of AEs reported, transmission of AE forms, completeness of
reports, serious AEs reported and timeliness of recording into VigiFlow.
Results In 18 months, 443 HCPs at 61 HCFs were trained. The number of reported AEs increased from 22 (January 2000 to
October 2016) to 228 (November 2016 to May 2018), enabling Malawi to become a member of the World Health Organization
Programme for International Drug Monitoring. Most (98%) AE report forms contained mandatory information on reporter,
event, patient and product, but under 1% were transmitted to the national PV office within 48 h.
Conclusion Regular PV training and mentoring of HCPs were effective in enhancing passive safety surveillance in Malawi,
but the transmission of reports to the national PV centre requires further improvement.
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Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income countries (LMICs) due to well documented factors including decreased access to screening, trained health professionals, and therapies for disease manageme...nt. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
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On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of Marburg virus disease (MVD). Blood samples taken from people showing symptoms were tested by real-time reverse transcription polymerase chain reaction (RT-PCR) at the National Reference Laboratory of the Rwanda Biomedi...cal Center and were positive for Marburg virus. As of 29 September 2024, a total of 26 confirmed cases, including eight deaths have been reported. The cases are reported from seven of the 30 districts in the country. Among the confirmed cases, over 70% are healthcare workers from two health facilities in Kigali.
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The coronavirus outbreak that began in 2019 (COVID-19) threatens to reverse years of hard-won gains in preventing and treating HIV. Fragile health systems are further stressed as health workers navigate an increased client load and demands at work while also being concerned for their own health and ...that of their families. Health facilities have been redesigned to care for patients with COVID-19, posing challenges to other services. Governments and civil society organizations have redirected scarce resources and shifted programming priorities to respond to the pandemic. Several countries have reported intermittent declines in HIV testing and diagnosis, antenatal care visits, collection of antiretroviral medicines (ARVs) by people living with HIV, and attendance at clinic appointments. Community-based education and support programmes have had to rapidly adapt to restrictions on movement and public gatherings. Children, adolescents, and women have experienced multiple deprivations due to the adverse impact of the pandemic.
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The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services i...n all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.
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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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This inventory has been compiled by WHO/Europe to help facilitate monitoring and reporting of national policies for the prevention of violence and injuries, in close collaboration with national focal persons officially nominated by ministries of health and with support from the European Commission (...EC).
The documents in the inventory reflect policy initiatives undertaken at national level in countries across the Region by different sectors involved in the prevention of violence and injuries, such as health, justice, interior, social affairs, transport.
Information can be viewed and searched on a country basis or in a summary table, listing all countries, by clicking one of the tabs above. This facilitates the sharing of information by Member States and comparisons across the WHO European Region.
This inventory is one of the products of a joint WHO/EC project on preventing injury and promoting safety in Europe.
More information about prevention of violence and injuries can be found in the WHO/Europe website on violence and injury prevention.
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The Rethabile positive parenting activity is being run by 4Children Lesotho with caregivers and teens ages 9 to 24 for the purpose of reducing harsh parenting practices (i.e., violence) and improving positive parenting practices. By promoting adult–child communication around topics such as HIV a...nd AIDS prevention, and exploring models of family-focused violence prevention and support, the program facilitates disclosure of HIV status, promotes greater treatment seeking and adherence, and helps to reduce HIV stigma.lesoth
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Community-based approaches to Mental Health and Psychosocial Support (CB MHPSS) in emergencies are based on the understanding that communities can be drivers for their own care and change and should be meaningfully involved in all stages of MHPSS responses. Emergency-affected people are first a...nd foremost to be viewed as active participants in improving individual and collective well-being, rather than as passive recipients of services that are designed for them by others. Thus, using community-based MHPSS approaches facilitates families, groups and communities to support and care for others in ways that encourage recovery and resilience. These approaches also contribute to restoring and/or strengthening those collective structures and systems essential to daily life and well-being. An understanding of systems should inform community-based approaches to MHPSS programmes for both individuals and communities.
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This document provides an updated list of “best buys” and other recommended interventions to address noncommunicable diseases (NCDs). It is based on Appendix 3 of the Global action plan for the prevention and control of noncommunicable diseases 2013–2020, which was first approved in 2013 and l...ast updated in 2017. The global action plan, which was extended to 2030 by a World Health Assembly decision in 2019 has 6 objectives, the implementation of which at country level supports the attainment of the 9 voluntary NCD targets, and facilitates the realization of Sustainable Development Goal (SDG) 3 on good health and well-being.
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Since 2016, the Pan American Health Organization (PAHO) has been promoting the implementation of the HEARTS Initiative in the Americas as a regional adaptation of the World Health Organization's Global HEARTS Initiative. During this time, 33 countries in the Region of the Americas have committed to ...implementing HEARTS, and PAHO has developed many technical resources to support them. Most of these resources are clinical tools for primary healthcare teams and focus on quality improvement. This compendium aims to group all these clinical tools in a single document under a simple format that facilitates their practical implementation in daily clinical practice. The reader will notice that each tool is summarized on a single page and presented in a modular format. Therefore, each tool can be used together or separately as needed. In addition, at the bottom of each tool, the reader will find the references and hyperlinks to access full texts in case deeper knowledge is required.
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Int. J. Environ. Res. Public Health 2018, 15(12), 2626; https://doi.org/10.3390/ijerph15122626
Climate change is increasing risks to human health and to the health systems that seek to protect the safety and well-being of populations. Health authorities require information about current associatio...ns between health outcomes and weather or climate, vulnerable populations, projections of future risks and adaptation opportunities in order to reduce exposures, empower individuals to take needed protective actions and build climate-resilient health systems. An increasing number of health authorities from local to national levels seek this information by conducting climate change and health vulnerability and adaptation assessments. While assessments can provide valuable information to plan for climate change impacts, the results of many studies are not helping to build the global evidence-base of knowledge in this area. They are also often not integrated into adaptation decision making, sometimes because the health sector is not involved in climate change policy making processes at the national level. Significant barriers related to data accessibility, a limited number of climate and health models, uncertainty in climate projections, and a lack of funding and expertise, particularly in developing countries, challenge health authority efforts to conduct rigorous assessments and apply the findings. This paper examines the evolution of climate change and health vulnerability and adaptation assessments, including guidance developed for such projects, the number of assessments that have been conducted globally and implementation of the findings to support health adaptation action. Greater capacity building that facilitates assessments from local to national scales will support collaborative efforts to protect health from current climate hazards and future climate change. Health sector officials will benefit from additional resources and partnership opportunities to ensure that evidence about climate change impacts on health is effectively translated into needed actions to build health resilience.
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Background: East African trypanosomiasis is an uncommon, potentially lethal disease if not diagnosed and treated in a timely manner. South Africa, as a centre for emergency medical evacuations from much of sub-Saharan Africa, receives a high proportion of these patients, mostly tourists and expatria...te residents.
Methods: The cases of East African trypanosomiasis patients evacuated to South Africa, for whom diagnostic and clinical management advice was provided over the years 2004–2018, were reviewed, using the authors’ own records and those of collaborating clinicians.
Results: Twenty-one cases were identified. These originated in Zambia, Malawi, Zimbabwe, Tanzania, and Uganda. Nineteen cases (90%) had stage 1 (haemolymphatic) disease; one of these patients had fatal myocarditis. Of the two patients with stage 2 (meningoencephalitic) disease, one died of melarsoprol encephalopathy. Common problems were delayed diagnosis, erroneous assessment of severity, and limited access to treatment.
Conclusions: The key to early diagnosis is recognition of the triad of geographic exposure, tsetse fly bites, and trypanosomal chancre, plus good microscopy. Elements for successful management are rapid access to specific drug treatment, skilled intensive care, and good laboratory facilities. Clinical experience and the local stock of antitrypanosomal drugs from the World Health Organization have improved the chance of a successful outcome in the management of East African trypanosomiasis in South Africa; the survival rate over the period was 90.5%.
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The chapter Closing the Gap: The Health Disparities of Older LGBTI People in the Americas, is part of the publication series titled ‘Decade of Healthy Aging: situation and challenges’. In order to outline the current knowledge available on the situation of health and well-being of older persons ...in the Americas at the beginning of the United Nations Decade of Healthy Aging (2021-2030), this document presents data and existing evidence different forms of discrimination and mistreatment older people face due to their sexual orientation and gender identities that ultimately increase health disparities. Previous studies on LGBTI older people offer valuable information on the lived experiences of these communities and demonstrate that they face unique challenges with aging, emphasizing the difficulties related to access to care. Very few studies on older people and aging include a focus on sexual orientation or gender identity; however, it is possible to point out that HIV/AIDS is one of the most significant health disparities confronting LGBTI older persons, followed by physical and mental health problems, substance use, social isolation, poverty, and the lack of access to quality healthcare, including long-term care facilities or other institutions. Closing the gap in access and quality of health and care services is an imperative to increase longevity, health status and quality of life of LGBTI older people.
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The chapter Closing the Gap: The Health Disparities of Older LGBTI People in the Americas, is part of the publication series titled ‘Decade of Healthy Aging: situation and challenges’. In order to outline the current knowledge available on the situation of health and well-being of older persons ...in the Americas at the beginning of the United Nations Decade of Healthy Aging (2021-2030), this document presents data and existing evidence different forms of discrimination and mistreatment older people face due to their sexual orientation and gender identities that ultimately increase health disparities. Previous studies on LGBTI older people offer valuable information on the lived experiences of these communities and demonstrate that they face unique challenges with aging, emphasizing the difficulties related to access to care. Very few studies on older people and aging include a focus on sexual orientation or gender identity; however, it is possible to point out that HIV/AIDS is one of the most significant health disparities confronting LGBTI older persons, followed by physical and mental health problems, substance use, social isolation, poverty, and the lack of access to quality healthcare, including long-term care facilities or other institutions. Closing the gap in access and quality of health and care services is an imperative to increase longevity, health status and quality of life of LGBTI older people.
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The Africa Centres for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative was launched by the Africa CDC in April 2019 with the aim of strengthening the African Union (AU) Member States’ biosafety and biosecurity systems and enabling them to comply with national and i...nternational requirements for biosafety and biosecurity including the International Health Regulations (IHR) (2005), the Biological Weapons Convention (BWC), and United Nations Security Council Resolution (UNSCR) 1540 and the multi-country Global Health Security Agenda (GHSA). The World Health Organization (WHO) Joint External Evaluation (JEE) and the Global Health Security Index report confirmed the known capacity gaps in biosafety and biosecurity among Africa Union Member (AU).
The regional consultations by Africa CDC conducted between 2019-2021 highlighted the deficiency or limited availability of standardized and regionally recognized training programs in the continent, limiting biosafety and biosecurity capacity building efforts in the region. In response, Africa CDC working with AU Member States developed a home grown, implementable and accessible professional training and certification program that is both recognized and endorsed by AU Member States. The Regional Training and Certification Program for Biosafety and Biosecurity Professionals, for African Biosafety and Biosecurity Professionals (RTCP-BBP) has four (4) areas of specialization, namely
Selection, Installation, Maintenance and Certification of Biological Safety Cabinets
Biorisk Management
Design and Maintenance of Facilities Handling High Risk Pathogens (Biocontainment Engineering)
Biological Waste management
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The Africa Centres for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative was launched by the Africa CDC in April 2019 with the aim of strengthening the African Union (AU) Member States’ biosafety and biosecurity systems and enabling them to comply with national and i...nternational requirements for biosafety and biosecurity including the International Health Regulations (IHR) (2005), the Biological Weapons Convention (BWC), and United Nations Security Council Resolution (UNSCR) 1540 and the multi-country Global Health Security Agenda (GHSA). The World Health Organization (WHO) Joint External Evaluation (JEE) and the Global Health Security Index report confirmed the known capacity gaps in biosafety and biosecurity among Africa Union Member (AU).
The regional consultations by Africa CDC conducted between 2019-2021 highlighted the deficiency or limited availability of standardized and regionally recognized training programs in the continent, limiting biosafety and biosecurity capacity building efforts in the region. In response, Africa CDC working with AU Member States developed a home grown, implementable and accessible professional training and certification program that is both recognized and endorsed by AU Member States. The Regional Training and Certification Program for Biosafety and Biosecurity Professionals, for African Biosafety and Biosecurity Professionals (RTCP-BBP) has four (4) areas of specialization, namely
- Selection, Installation, Maintenance and Certification of Biological Safety Cabinets
- Biorisk Management
- Design and Maintenance of Facilities Handling High Risk Pathogens (Biocontainment Engineering)
- Biological Waste management
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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...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.”
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