Cholera is a major health risk in many parts of the world, affecting millions of people every year. Since mid-2021, the world has been facing an acute upsurge of the 7th cholera pandemic, which is characterized by the number, size and concurrence of multiple outbreaks, the spread to areas that had b...een free of cholera for decades and alarmingly high mortality rates. The mortality associated with these outbreaks is of particular concern as many countries have reported higher case fatality ratios (CFR) than in previous years
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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 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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Mpox is an emerging zoonotic disease caused by the mpox virus, a member of the Orthopoxvirus genus closely related to the variola virus that causes smallpox. Mpox was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research. The first human case was recorde...d in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox and since then the infection has been reported in a number of African countries. Mpox can spread in humans through close contact, usually skin-to-skin contact, including sexual contact, with an infected person or animal, as well as with materials contaminated with the virus such as clothing, beddings and towels, and respiratory droplets in prolonged face to face contact. People remain infectious from the onset of symptoms until all the lesions have scabbed and healed. The virus may spread from infected animals through handling infected meat or through bites or scratches. Diagnosis is confirmed by polymerase chain reaction (PCR) testing of material from a lesion for the virus’s DNA. Two separate clades of the mpox virus are currently circulating in Africa: Clade I, which includes subclades Ia and Ib, and Clade II, comprising subclades IIa and IIb. Clade Ia and Clade Ib have been associated with ongoing human-to-human transmission and are presently responsible for outbreaks in the Democratic Republic of the Congo (DRC), while Clade Ib is also contributing to outbreaks in Burundi and other countries.
In 2022‒2023 mpox caused a global outbreak in over 110 countries, most of which had no previous history of the disease, primarily driven by human-to-human transmission of clade II through sexual contact. In just over a year, over 90,000 cases and 150 deaths were reported to the WHO. For the second time since 2022, mpox has been declared a global health emergency as the virus spreads rapidly across the African continent. On 13 Aug 2024, Africa CDC declared the ongoing mpox outbreak a Public Health Emergency of Continental Security (PHECS), marking the first such declaration by the agency since its inception in 2017.7 This declaration empowered the Africa CDC to lead and coordinate responses to the mpox outbreak across affected African countries. On August 14, 2024, the WHO declared the resurgence of mpox a Public Health Emergency of International Concern (PHEIC) emphasizing the need for coordinated international response.
As of August 2024, Mpox has expanded beyond its traditional endemic regions, with new cases reported in countries including Sweden, Thailand, the Philippines, and Pakistan. Sweden has confirmed its first case of Clade 1 variant, which has been rapidly spreading in Africa, particularly in DRC. The emergence of this new variant raises concerns about its potential for higher lethality and transmission rates outside Africa.
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This Clinic Supervisor’s Manual is helpful for focusing managers on the key elements of integrated primary health care as they simultaneously integrate new interventions for HIV/AIDS, tuberculosis, and malaria. This tool contains 12 sections. Section 1 explains how to use the manual. Section 2 hel...ps the clinic supervisors organize their supervisory visit. The remainder of the sections focus on a number of key areas during a clinic supervision visit.
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Lymphatic filariasis is a vector-borne neglected tropical disease that causes damage of the lymphatic system and can lead to lymphoedema (elephantiasis) and hydrocele in infected individuals. The global baseline estimate of persons affected by lymphatic filariasis is 25 million men with hydrocele an...d over 15 million people with lymphoedema. At least 36 million persons remain with these chronic disease manifestations. The disease is endemic in 72 countries. In 2016, an estimated total population of 856 million were living in areas with ongoing transmission of the causative filarial parasites and requiring mass drug administration (MDA). Lymphatic filariasis disfigures and disables, and often leads to stigmatization and poverty. Hundreds of millions of dollars are lost annually due to reduced productivity of affected patients. WHO has ranked the disease as one of the world’s leading causes of permanent and long-term disability.
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While there has been real progress in addressing the burden of disease in the WHO African region, the COVID-19 pandemic has highlighted the link between health, economics and security, as the region saw decades of progress threatened, including positive trends in decreasing inequality. In the Africa...n Region the momentum towards achieving the 2030 SDG disease burden reduction targets (SDG targets 3.3, 3.4 and 3B) has stalled.
The COVID-19 pandemic was also a major threat to gains made, such as the eradication of polio in the region, declared in 2020; reduced numbers of new HIV infections in 2021 compared to 2010; and passing the 2020 milestone of the End TB Strategy, with a 22% reduction in new cases compared with 2015. However, the pandemic also disrupted essential health services in 92% of countries globally, 22.7 million children missed basic immunization, there was an increase in malaria and TB, and global deaths from TB rose for the first time since 2015.
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Ethiopia has been repeatedly affected by conflict, flooding, drought, and disease outbreaks in the past years. As of January 2024, the country is actively responding to the longest recorded cholera outbreak which started in August 2022, recurrent measles outbreaks which started in August 2021, and t...he highest number of malaria cases reported since 2017. The El Niño phenomenon is expected to cause further havoc up to July 2024, by causing drought in some parts of the country, and flooding in others. Food insecurity due to lost harvest and livestock is aggravating already high malnutrition rates, negatively impacting morbidity and mortality.
The Health Cluster is closely collaborating with the Ministry of Health (MOH) to prepare for, prevent, and respond to public health emergencies by mobilizing resources to enable health partners to provide life-saving health services to vulnerable populations.
In an environment with ever-increasing needs and decreased funding, the below priorities for 2024 and 2025 have been identified: 1 Strengthen advocacy for longer-term, development funding to address root causes of recurrent disease outbreaks, including through the Humanitarian-Development-Peace Nexus 2 Advocate for increased access to quality health services, with a strong focus on:
sexual and reproductive health services (including for survivors of sexual and gender-based violence)
inclusion of people with disabilities, older people, and people living with HIV
remote populations through inclusion of Mobile Health Teams (MHT) as part of the health system 3 Standardize health services provided by Health Cluster partners through the implementation of Essential Health Care packages, aligned with existing MOH guidance, aimed at ensuring quality service delivery for affected populations, especially at community level 4 Strengthen quality of, and access to data for needs analysis and informed decision-making 5 Strengthen subnational coordination, with increased focus on zones and local health partners
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People living with HIV who have a low CD4 count are at a much higher risk of falling ill from TB infection than HIV negative people.
It is important to offer both HIV testing to TB patients and TB diagnosis in HIV patients. Early detection and effective treatment are essential to preventing TB...-associated deaths.
WHO and UNAIDS have strongly advised countries to ensure that HIV programmes integrate regular TB screening, preventive therapy and early treatment.
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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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This Strategic Response Plan for the measles emergency in the WHO European Region (SRP) articulates the overall status of measles resurgence in the WHO European Region and the priority actions needed to ensure an effective response to interrupt transmission, save lives and reverse the regional trend... in case numbers.
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Interim Guidance 31 march 2020
WHO has established a shipment mechanism to expedite and cover the costs of the shipment of clinical samples from patients with suspected COVID-19 from the country of collection to one of the WHO reference laboratories providing confirmatory molecular testing for COVI...D-19. This document explains the process and documentation required for shipment of specimens.
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Overview: In this course, you will learn about the causes of unsafe injection practices, how to safely give injections, and how to safely dispose of needles and other sharps. You will also learn what to do when needle-stick injuries occur, how to manage potential exposures, and ways to protect yours...elf, the staff and patients in your facility, and your community.
Course duration: Approximately 2 hours.
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Environmental Research Volume 151, November 2016, Pages 115-123
Dengue is the world’s most important arboviral disease in terms of number of people affected. Over the past 50 years, incidence increased 30-fold: there were approximately 390 million infections in 2010. Globalization, trade, travel,... demographic trends, and warming temperatures are associated with the recent spread of the primary vectors Aedes aegypti and Aedes albopictus and of dengue. Overall, models project that new geographic areas along the fringe of current geographic ranges for Aedes will become environmentally suitable for the mosquito’s lifecycle, and for dengue transmission. Many endemic countries where dengue is likely to spread further have underdeveloped health systems, increasing the substantial challenges of disease prevention and control. Control focuses on management of Aedes, although these efforts have typically had limited effectiveness in preventing outbreaks. New prevention and control efforts are needed to counter the potential consequences of climate change on the geographic range and incidence of dengue, including novel methods of vector control and dengue vaccines.
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The cholera outbreak has affected 14 countries in the WHO African Region. The climate-induced natural disasters such as cyclone and flooding in the southern African region and drought in the Horn of Africa led to increase in cases of cholera in many of the affected countries. With the rainy season c...ommencement in the west African region there is risk of more cholera outbreaks on the horizon. The trend across the region is being closely monitored and this highlights the need for Member States to enhance readiness, heighten surveillance and institute preventive and control measures in communities and around border crossings to prevent and mitigate cross border infection. Since 1 January 2022, a cumulative number of 213 443 cholera cases has been reported to the WHO Regional Office for Africa (AFRO), including 3 951 deaths with a case fatality ratio (CFR) of 1.9% as of 16 July 2023 (Table 1). Malawi accounts for 28% (58 941) of the total cases and 45% (1 766) of all deaths reported, and together with Cameroon, Democratic Republic of the Congo, Mozambique, and Nigeria contribute to 85% (181 300) of the overall caseload and 88% (3 464) of cumulative deaths. In Epidemiologic week 28, six countries Burundi, Cameroon, Ethiopia, Kenya, Malawi and Mozambique reported a total of 667 new cases.
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The Practical Approach to Care Kit (PACK) is a health systems improvement programme designed to support the work of primary care health workers in underserved communities (like doctors, nurses, midwives, health officers, community health practitioners), strengthen the health services in which they w...ork and thereby achieve the best possible patient outcomes
You can register for free and get the PACK Global Adult Guide for free
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Therapy for MDR-TB is extremely long, complex and burdensome to both patients and health care systems. A single diagnosis can require two years of treatment, or longer. When treating children, there are significant additional barriers treating children with MDR-TB. There is limited data on the pharm...acokinetics of second-line TB drugs in children, and almost none are in child-friendly formulations. Nonetheless, there is continued work on second-line drugs to fight MDR-TB. The Sentinel Project has created a complex set of dosing recommendations for administering second-line drugs to children
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Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (G...INA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines.
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Poor quality health services are holding back progress on improving health in countries at all income levels.
Today, inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices, or providers who lack adequate training an...d expertise prevail in all countries.
The situation is worst in low and middle-income countries where 10 percent of hospitalized patients can expect to acquire an infection during their stay, as compared to seven percent in high income countries. This is despite hospital acquired infections being easily avoided through better hygiene, improved infection control practices and appropriate use of antimicrobials.. At the same time, one in ten patients is harmed during medical treatment in high income countries.
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During the past five decades, the incidence of dengue has increased 30-fold. Some 50–100 million new infections are estimated to occur annually in more than 100 endemic countries, with a documented further spread to previously unaffected areas; every year hundreds of thousands of severe cases ari...se, including 20 000 deaths; 264 disability-adjusted life years per million population per year are lost , at an estimated cost for ambulatory and hospitalized cases of US$ 514–1394, often affecting very poor populations. The true numbers are probably far worse, since severe underreporting and misclassification of dengue cases have been documented.
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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