Situation analysis
Description of the disaster
An Ebola epidemic that started in March 2014 in Guinea has relentlessly continued to claim lives and to spread to other countries in West Africa. The current Ebola outbreak is the largest in history and the first to affect multiple countries simu...ltaneously. There have been over 24 000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 10 000 reported deaths (outcomes for many cases are unknown). A total of 58 new confirmed cases were reported in Guinea, 0 in Liberia, and 58 in Sierra Leone in the 7 days to 8 March (4 days to 5 March for Liberia). Many experts believe that the official numbers substantially understate the size of the outbreak because of families' widespread reluctance to report cases. Because of the fluidity of movement of people between West Africa and several countries in the East African countries, especially Kenya and Ethiopia (who in turn have extensive interaction with other countries in the region in terms of human movement), the risk of an outbreak of Ebola in East Africa is as eminent as in any of the countries bordering the affected countries. The IFRC regional office intends to support National Societies to raise their Ebola preparedness and response capacity through training, technical support in planning and implementation of Ebola related activities, and coordination both within and outside the movement.
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Healthcare-associated infections (HAI) are a significant burden globally, with millions of patients affected each year. These infections affect both high- and limited-resource healthcare settings, but in limited-resource settings, rates are approximately twice as high as high-resource settings (15 o...ut of every 100 patients versus 7 out of every 100 patients). Furthermore, rates of infections within certain patient populations are significantly higher in limited-resource settings, including surgical patients, patients in intensive-care units (ICU) and neonatal units. It is well documented that environmental contamination plays a role in the transmission of HAIs in healthcare settings. Therefore, environmental cleaning is a fundamental intervention for infection prevention and control (IPC).It is a multifaceted intervention that involves cleaning and disinfection (when indicated) of the environment alongside other key program elements to support successful implementation (e.g., leadership support, training, monitoring, and feedback mechanisms). To be effective, environmental cleaning activities must be implemented within the framework of the facility IPC program, and not as a standalone intervention. It is also essential that IPC programs advocate for and work with facility administration and government officials to budget, operate and maintain adequate water, sanitation and hygiene (WASH) infrastructure to ensure that environmental cleaning can be performed according to best practices.
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Since the release of the first volume in May 2020, the COVID-19 pandemic has continued to rage around the world. By mid-March, 2021, countries around the globe had reported over 123 million cases—a nearly five-fold increase since this report’s previous volume—and over 2.7 million deaths attrib...uted to the disease. And while new case loads are currently on the rise again, the global health community has already administered almost 400 million doses of vaccines, at last offering some signs of hope and progress.
Economic impacts threaten to undo decades of recent progress in poverty reduction, child nutrition and gender equality, and exacerbate efforts to support refugees, migrants, and other vulnerable communities. National and local governments—together with international and private-sector partners—must deploy vaccines as efficiently, safely and equitably as possible while still monitoring for new outbreaks and continuing policies to protect those who do not yet have immunity.
More than ever, the world needs reliable and trustworthy data and statistics to inform these important decisions. The United Nations and all member organizations of the Committee for the Coordination of Statistical Activities (CCSA) collect and make available a wealth of information for assessing the multifaceted impacts of the pandemic. This report updates some of the global and regional trends presented in Volume I and offers a snapshot of how COVID-19 continues to affect the world today across multiple domains.
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Phil. Trans. R. Soc. B (2010) 365, 2959–2971; doi:10.1098/rstb.2010.0143.
Agricultural ecosystems provide humans with food, forage, bioenergy and pharmaceuticals and are essential to human wellbeing. These systems rely on ecosystem services provided by natural ecosystems, including pollination, b...iological pest control, maintenance of soil structure and fertility, nutrient cycling and hydrological services. Preliminary assessments indicate that the value of these ecosystem services to agriculture is enormous and often underappreciated. Agroecosystems also produce a variety of ecosystem services, such as regulation of soil and water quality, carbon sequestration, support for biodiversity and cultural services. Depending on management practices, agriculture can also be the source of numerous disservices, including loss of wildlife habitat, nutrient runoff, sedimentation of waterways, greenhouse gas emissions, and pesticide poisoning of humans and non-target species. The tradeoffs that may occur between provisioning services and other ecosystem services and disservices should be evaluated in terms of spatial scale, temporal scale and reversibility. As more effective methods for valuing ecosystem services become available, the potential for ‘win–win’ scenarios increases. Under all scenarios, appropriate agricultural management practices are critical to realizing the benefits of ecosystem services and reducing disservices from agricultural activities.
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Food environments are usually defined as the settings with all the different types of
food made available and accessible to people as they go about their daily lives.
That is, the range of food in supermarkets, small retail outlets, wet markets, street
food stalls, coffee shops, tea houses, s...chool canteens, restaurants, and all the other
venues where people buy and eat food. These environments differ enormously depending on the context. They can be extensive and diverse, with a seemingly endless array of options and price ranges, or they can be sparse, with very few options on offer. Because they determine what food consumers can access at a given moment in time, at what price, and with what degree of convenience, food environments both constrain and prompt the consumer’s choice.Food environments are influenced by the food systems which supply them, and vice versa. Food systems encompass the entire range of activities, people and institutions involved in the production, processing,
marketing, consumption and disposal of food (FAO, 2013). They include but are not limited to food supply chains. Making food systems nutrition-sensitive can contribute to addressing all forms of malnutrition, as food systems determine whether the food needed for good nutrition are available, affordable, acceptable and of adequate
quantity and quality. How closely food systems and food environments are interrelated and interdependent, and the degree to which external factors affect nutrition outcomes, varies from setting to setting.Many of today’s food systems
and food environments are challenged in supporting consumer choices that are
consistent with healthy diets and good nutrition. Consumers are not making choices based on nutrition and health, and poor diet is now the number one risk factor for death and disability worldwide (GBD, 2015). Food systems that do not enable healthy diets are increasingly recognized as an underlying cause of malnutrition (GLOPAN, 2016), and malnutrition, irrespective of form, has a huge cost. Economic costs associated with undernutrition are estimated at $1-2 trillion per year, about 2-3% of global GDP (FAO, 2013); the global economic cost of obesity and associated diet-related non-communicable diseases is estimated at $2 trillion per year, about 2.8% of global GDP (McKinsey, 2014). Influencing food environments for promoting healthy diets is an emerging strategy to address today’s nutrition challenges.
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In the face of rapid increases in the number of hospitalizations due to COVID-19 in Latin America and the Caribbean, coupled with shortages of human and material resources, including medical equipment and gases, there is a need to redesign models of care in the Region to optimize available resources... and ensure that more patients receive the quantity and quality of oxygen they need. Oxygen is included in the World Health Organization’s list of essential medicines and is used to care for patients at all levels of integrated health services networks. The efficacy of oxygen use in the treatment of patients with respiratory conditions caused by COVID-19 has been demonstrated, but there is great opportunity to improve the effectiveness of its use if it is used in a rational, sustainable, and safe way. Bearing in mind that the efficacy of a health technology is measured by its benefit under actual conditions of use, practical actions can be taken to improve the use of medical oxygen and avoid oxygen shortages. A drug is considered to be used rationally when patients receive it according to their clinical needs, in doses appropriate to their individual needs, for an appropriate period, and at a low cost to them and their community. By providing instruction on the rational use of oxygen and promoting it, negative repercussions can be avoided, such as loss of efficacy as a result of activities related to oxygen storage, distribution, and administration. Rational use of oxygen also involves controlling waste due to leaks in storage and distribution systems, use of gas at incorrect pressures, use of incorrectly adjusted flowmeters, and disconnections, among other problems. Another aspect to consider is the provision of adequate technical support for all oxygen production systems, in terms of maintenance and calibration, availability of electrical energy, and specific knowledge about these systems. For these reasons, a set of guidelines has been put together for the development of an efficient management system to deal with situations of oxygen scarcity, both now and in the future.
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We developed an integrated vector surveillance (IVS) proposal for cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) in the Americas, based on eco-epidemiological studies conducted by researchers of the Leishmaniasis Research Network of Argentina. For CL, the transmission was explained in ...the framework of the edge effect, the increase of vectors and risk of exposure at ecotones and environmental interfaces, and typified as ephemeral, transient, or permanent edges, supporting a cost-effective IVS strategy for early warning of CL outbreaks through an environmental modification alert network, which includes multiple sources of information and actors. In relation to VL, the earliest colonization sites and spatial distribution were explained by modeling and forecasting the most likely hotspots, persistent in time and space, and modulated by environmental variables. Therefore, for VL, a scalar strategy of critical site selection is proposed from a “city” scale based on secondary sources such as remote sensing for the definition of possible areas to monitor and intervene, a scale of restriction from possible to most likely areas through local knowledge, and a “focal site” scale of trap placement through field observation; in this way, IVS activities are carried out at a few sites of the urban landscape and allow a sustainable program.
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Integrating neglected tropical diseases into global health and development: fourth WHO report on neglected tropical diseases evaluates the changing global public health landscape; assesses progress towards the 2020 targets; and considers the possible core elements of a strategic vision to integratin...g neglected tropical diseases into the 2030 Agenda of the Sustainable Development Goals.
Advances have been made through expanded interventions delivered through five public health approaches: innovative and intensified disease management; preventive chemotherapy; vector ecology and management; veterinary public health services; and the provision of safe water, sanitation and hygiene. In 2015 alone nearly one billion people were treated for at least one disease and significant gains were achieved in relieving the symptoms and consequences of diseases for which effective tools are scarce; important reductions were achieved in the number of new cases of sleeping sickness, of visceral leishmaniasis in South-East Asia and also of Buruli ulcer.
The report also considers vector control strategies and discusses the importance of the draft WHO Global Vector Control Response 2017–2030. It argues that veterinary public health requires a multifaceted approach across the human–animal interface as well as a multisectoral programme of work to protect and improve the physical, mental and social well-being of humans, including veterinary, water, sanitation and hygiene.
Integration of activities and interventions into broader health systems is crucial, and despite challenges, has the potential to accelerate progress towards universal health coverage while advancing the 2030 Agenda.
In short, this report drives the message home that “no one must be left behind”.
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Background
Four methods have previously been used to track aid for reproductive, maternal, newborn, and child health (RMNCH). At a meeting of donors and stakeholders in May, 2018, a single, agreed method was requested to produce accurate, predictable, transparent, and up-to-date estimates that coul...d be used for analyses from both donor and recipient perspectives. Muskoka2 was developed to meet these needs. We describe Muskoka2 and present estimates of levels and trends in aid for RMNCH in 2002–17, with a focus on the latest estimates for 2017.
Methods
Muskoka2 is an automated algorithm that generates disaggregated estimates of aid for reproductive health, maternal and newborn health, and child health at the global, donor, and recipient-country levels. We applied Muskoka2 to the Organisation for Economic Co-operation and Development's Creditor Reporting System (CRS) aid activities database to generate estimates of RMNCH disbursements in 2002–17. The percentage of disbursements that benefit RMNCH was determined using CRS purpose codes for all donors except Gavi, the Vaccine Alliance; the UN Population Fund; and UNICEF; for which fixed percentages of aid were considered to benefit RMNCH. We analysed funding by donor for the 20 largest donors, by recipient-country income group, and by recipient for the 16 countries with the greatest RMNCH need, defined as the countries with the worst levels in 2015 on each of seven health indicators.
Findings
After 3 years of stagnation, reported aid for RMNCH reached $15·9 billion in 2017, the highest amount ever reported. Among donors reporting in both 2016 and 2017, aid increased by 10% ($1·4 billion) to $15·4 billion between 2016 and 2017. Child health received almost half of RMNCH disbursements in 2017 (46%, $7·4 billion), followed by reproductive health (34%, $5·4 billion), and maternal and newborn health (19%, $3·1 billion). The USA ($5·8 billion) and the UK ($1·6 billion) were the largest bilateral donors, disbursing 46% of all RMNCH funding in 2017 (including shares of their core contributions to multilaterals). The Global Fund and Gavi were the largest multilateral donors, disbursing $1·7 billion and $1·5 billion, respectively, for RMNCH from their core budgets. The proportion of aid for RMNCH received by low-income countries increased from 31% in 2002 to 52% in 2017. Nigeria received 7% ($1·1 billion) of all aid for RMNCH in 2017, followed by Ethiopia (6%, $876 million), Kenya (5%, $754 million), and Tanzania (5%, $751 million).
Interpretation
Muskoka2 retains the speed, transparency, and donor buy-in of the G8's previous Muskoka approach and incorporates eight innovations to improve precision. Although aid for RMNCH increased in 2017, low-income and middle-income countries still experience substantial funding gaps and threats to future funding. Maternal and newborn health receives considerably less funding than reproductive health or child health, which is a persistent issue requiring urgent attention.
Funding
Bill & Melinda Gates Foundation; Partnership for Maternal, Newborn & Child Health.
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Asthma is the most common chronic disease in children, imposing a consistent burden on health system. In recent years, prevalence of asthma symptoms became globally increased in children and adolescents, particularly in Low-Middle Income Countries (LMICs). Host (genetics, atopy) and environmental fa...ctors (microbial exposure, exposure to passive smoking and air pollution), seemed to contribute to this trend. The increased prevalence observed in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception. Asthma accounts for 1.1% of the overall global estimate of “Disability-adjusted life years” (DALYs)/100,000 for all causes. Mortality in children is low and it decreased across Europe over recent years. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality. Global asthma-related costs are high and are usually are classified into direct, indirect and intangible costs. Direct costs account for 50–80% of the total costs. Asthma is one of the main causes of hospitalization which are particularly common in children aged < 5 years with a prevalence that has been increased during the last two decades, mostly in LMICs. Indirect costs are usually higher than in older patients, including both school and work-related losses. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities and study performance. The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease.
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Disposer d’une information sanitaire de qualité est une quête
permanente de la DGESS du Ministère de la santé. Le niveau de
qualité des données de routine du système national d’information
sanitaire bien qu’en amélioration ces dernières années demeure une
priorité. Une des cause...s évoquée souvent pour justifier la faible qualité
des données est l’insuffisance de compétence des acteurs chargés de
la collecte et du rapportage des données dans les différentes
structures de soins. L’absence de formation des acteurs sur le SNIS
implique des erreurs de remplissage, de rapportage d’une part et
d’autre part une méconnaissance de l’intérêt des données de qualité
dans la prise de décision. Bien que cette justification soit fondée, on
est à même à se demander si c’est l’unique cause de la faible qualité des données. Certainement
pas. Le sens de la responsabilité et de l’intérêt porté à la qualité des données par les différents
acteurs aux différents niveaux influence la qualité des données. Imaginons un seul instant où chaque
mois, chaque responsable de structure, chaque acteur du SNIS apprécie la complétude, la qualité
d’un certain nombre d’indicateur. Le feedback qui sera fait contribuera à rehausser un tant soit peu la
qualité des données. Nous osons croire que cet exercice sera le quotidien de tout un chacun d’entre
nous. Engageons-nous dès à présent pour la qualité des données. Tout en vous donnant rendezvous au prochain numéro, je réitère mes encouragements à l’ensemble des acteurs du SNIS pour le
travail abattu au quotidien et aux partenaires pour leur soutien inconditionnel à la réalisation de nos
activités. Je souhaite à toutes et à tous, une très bonne lecture.
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"Die folgende Reflexions- und Praxishilfe basiert auf den Seminarerfahrungen von glokal mit Unterstützungsgruppen und aus der Empowerment-Arbeit mit Geflüchteten. Sie ist entstanden in der gemeinsamen Arbeit mit unterschiedlichster Teilnehmer*innen, die wesentliche Aspekte zu der Liste beigetragen... haben. Wir hoffen, dass die Fragen der Liste eine Hilfe sind, um über de eigene Unterstützungsarbeit und die eigene Gruppe nachzudenken. Die Fragen sollen den Blick auf Vorurteile und Diskriminierung schärfen und dabei helfen Rassismus innerhalb der Gruppe zu erkennen und abzubaün." (glokal e.V., Willkommen ohen Paternalismus, 2017)
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Zweiteilige Informationsbroschüre zum Thema Bewegung für Geflüchtete, erhältlich in den Sprachen Albanisch, Arabisch, Bulgarisch, Deutsch, Englisch, Farsi, Russisch zusammen mit jeweils 2. Teil auf:
information on the topic physical activity for refugees, available in german, english, albanic..., arabic, bulgarian, farsi, russian and turkish on:
http://refugium.budrich.de/bewegung/
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A learning resource for facilitators, parents, caregivers, and persons with cerebral palsy | Version 1 - Released March 2008
The new WHODAS 2.0 supersedes WHODAS II and shows the following advantages:
- A generic assessment instrument for health and disability
- Used across all diseases, including mental, neurological and addictive disorders
- Short, simple and easy to administer (5 to 20 minutes)
- Applicable in both... clinical and general population settings
- A tool to produce standardized disability levels and profiles
- Applicable across cultures, in all adult populations
- Directly linked at the level of the concepts to the International
- Classification of Functioning, Disability and Health (ICF)
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National Tuberculosis Control Program; Mycobacterial Disease Control National AIDS/STD Program