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Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-income countries (LMICs), which have disproportionately high asthma-related mortality relati
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ve to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma.
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The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the
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disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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At the end of 2023, WHO convened our first-ever annual WHO Stakeholder Review Conference for Prevention and Response to Sexual Misconduct. Aimed at joint learning and frank discussion on challenges faced in the achieving zero tolerance for all forms of sexual misconduct by aid workers, the Conferenc
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e brought together Member States, Civil Society Organizations, United Nations Agencies and Programmes, academia and media joined by WHO personnel. A set of recommendations to support all agencies are documented in the Conference Report. In addition, WHO’s Director-General hosted a social engagement segment on the evening of Day 1 to further underscore the centrality of a victim and survivor-centred approach, to celebrate progress however small, and to reaffirm commitment and renew energy for the journey ahead. The Conference took place on 30 November and 1 December 2023 in Geneva, Switzerland
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Aerosol pollutants are known to raise the risk of development of non-communicable respiratory diseases (NCRDs) such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and allergic rhinitis. Sub-Saharan Africa’s rapid pace of urbanization, economic expansion, and population growt
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h raise concerns of increasing incidence of NCRDs. This research characterizes the state of research on pollution and NCRDs in the 46 countries of Sub-Saharan Africa (SSA). This research systematically reviewed the literature on studies of asthma; chronic bronchitis; allergic rhinitis; and air pollutants such as particulate matter, ozone, NOx, and sulfuric oxide.
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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
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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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Bonchial asthma is the most common chronic respiratory disease in the world. In Kenya, it has been estimated that about 7.5% of the Kenyan population, nearly 4 million people, are currently living with asthma. Many cases tend to be underdiagnosed and undertreated which leads to high levels of morbid
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ity and avoidable deaths. The consequences of poorly controlled asthma, including physical, mental, social, and economic impacts, are magnified in the poor on account of poor access to asthma services and sub-optimal quality of those services. With these guidelines, Kenya's Ministry of Health aims to work towards embedding asthma care in Universal Health Care (UHC) to ensure that quality asthma services are available in primary care settings with
referral networks strengthened for those who may require secondary and tertiary care. These national asthma guidelines will also ensure that treatment for asthma is standardized in both the public and the non-state health care sector.
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The guidance document provides a set of indicators for assessing the status of development, implementation and monitoring of key policy interventions for prevention and control of NCDs and injuries. It promotes city-level evidence based decision-making processes to identify gaps and take appropriate
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s actions to strengthen responses. Additionally, using the standardized indicators can facilitate cross-city learning, sharing best practices and lessons learnt in implementing various policy interventions.
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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
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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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On 14 August 2024, the Director-General of the World Health Organization determined that the upsurge of mpox in a growing number of countries in Africa constitutes a new public health emergency of international concern (PHEIC) under the International Health Regulations (IHR) (2005)
The Global Action Plan on Antimicrobial Resistance (AMR) calls for making AMR a core component of professional education and training. In 2018, the World Health Organization (WHO) published Competency framework for health workers’ education and training on AMR to ensure that academic institutions
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and regulatory agencies provided pre-service and in-service training to equip health workers with the adequate competencies to address AMR. This was followed by Health workers’ training and education on AMR: curricula guide, which outlines the learning objectives and expected outcomes of pre-service training of health workers to improve curricula. These tools were designed to strengthen the capacity of health workers in various settings to address the growing challenge of AMR.
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The WHO Global research agenda on health, migration and displacement identified the health of displaced and migrant populations in the context of climate change as one of the most pressing, yet under-researched, topics.
Most of the global burden of sepsis occurs in low- and middle-income countries (LMICs), but the prevalence and etiology of sepsis in LMICs are not well understood. In particular, the lack of laboratory infrastructure in many LMICs has historically precluded an assessment of the pathogens leading to
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sepsis. A recent systematic review found that data describing antimicrobial resistance were absent for 43% of countries in Africa, and only two countries have national antimicrobial resistance plans. In addition, small studies have identified indiscriminate antibiotic use both in and out of hospital settings in sub-Saharan Africa. The absence of microbiological data and lack of antibiotic stewardship complicate sepsis management and almost certainly worsens outcomes, particularly in low-resource systems. The purpose of this study was to examine the prevalence, etiology, and outcomes of sepsis among a cohort of critically ill patients in a referral hospital of Malawi, with a focus on the prevalence of culture-confirmed bacteremia and urinary tract infections.
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Healthy Settings, a key component of Malawi’s Health Sector Strategic Plan (HSSP) 2011–2016, is the World Health Organization’s (WHO) holistic community-led approach to achieving health improvement by addressing social determinants of health, an approach which is central to the current WHO fra
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mework on integrated people-centred health services. Healthy Settings projects by their construct have many different components which vary from one group and community to another depending on their priorities: from housing, hospital improvements and waste management to “softer” interventions like leadership skills training and health promotion. It can be challenging to find relevant indicators to monitor and assess the impact of such a complex holistic project, this paper explores if social capital data can provide useful impact assessment indicators at the start of such a project.
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The Guidance on global monitoring for diabetes prevention and control by WHO provides a comprehensive framework to support countries in tracking and managing diabetes prevention, care, and outcomes. This document outlines indicators across 4 domains: health system determinants, service delivery, ris
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k factors, and outcomes/impacts. The guidance helps countries align their monitoring efforts with WHO’s global diabetes targets, Global Diabetes Compact, and relevant global NCD targets.
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This document provides a list of key WHO-recommended maternal and newborn health commodities and aims to accelerate progress towards the SDGs. It consolidates the key and enabling commodities from existing WHO guidelines on maternal and newborn health.
Monitoring Framework
Caring for burns patients from the incident scene to definitive treatment can be a complex, resource-consuming process with the potential to overwhelm health system capacity.This document provides practical guidance for building capacity and capability for burns care from clinical, human resources a
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nd operational perspectives. It is therefore recommended that guidance in this document be applied to any contexts in which the local health system might struggle to cope and require surge support.
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interim guidance, 25 November 2024
Effective malaria case management requires quick access to diagnostics and antimalarial treatments to reduce illness and death. Artemisinin-based combination therapy (ACT) has been essential to malaria treatment since 2001, as it combines artemisinin for rapid parasite reduction with a partner drug
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to ensure complete cure. However, resistance to antimalarial drugs, where parasites survive standard doses, threatens malaria control.
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Some testing done
