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The waves of yellow fever transmission in the Region of the Americas in 2016–2018 involved the largest number of human and epizootic cases to be reported in several decades. Yellow fever is a serious viral hemorrhagic disease that poses a challenge for health professionals. It requires early recog
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nition of signs and symptoms, which are often nonspecific, and it can mimic other acute febrile syndromes. Early detection of suspected or confirmed cases, monitoring of vital signs, life support measures, and treatment of acute kidney failure continue to be the recommended strategies for case management. This report is the result of discussions among experienced specialists in the Americas on the clinical management of yellow fever patients, especially during outbreaks and epidemics, in the context of current medical and scientific evidence and taking into account the technical guidelines already available in the countries of the Region. It includes flowcharts for initially addressing patients with clinical suspicion of yellow fever and proposes a minimum package of laboratory tests that may be useful in contexts where resources are limited. In addition, it considers aspects of health system organization for dealing with yellow fever outbreaks and epidemics.
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The burden of diabetes is enormous, positioning it as one of the main challenges facing public health today. Currently, it is estimated that 62 million people are living with diabetes in the Region of the Americas and projections show its prevalence will continue rising over the following years. The
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Region shows the highest number of years of healthy life lost (through either disability or premature death) due to diabetes worldwide. The high costs associated with its treatment produce a heavy economic burden. Its complications can seriously affect the quality of life of people living with diabetes, their families, and society and overload health systems. This report shows the latest internationally comparable data on diabetes and its main risk factors by year, country, and sex.
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La carga de la diabetes es enorme, posicionándola como uno de los principales desafíos que enfrenta la salud pública en la actualidad. Actualmente, se estima que 62 millones de personas viven con diabetes en la Región de las Américas y las proyecciones muestran que su prevalencia seguirá aumen
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tando en los próximos años. La Región muestra el mayor número de años de vida saludable perdidos (ya sea por discapacidad o muerte prematura) debido a la diabetes en todo el mundo. Los altos costes asociados a su tratamiento producen una pesada carga económica. Sus complicaciones pueden afectar seriamente la calidad de vida de las personas que viven con diabetes, sus familias y la sociedad y sobrecargar los sistemas de salud. Este informe muestra los últimos datos comparables internacionalmente sobre la diabetes y sus principales factores de riesgo por año, país y sexo. También incluye un resumen de la respuesta de los sistemas de salud de los países a la diabetes, incluidos planes nacionales, objetivos, vigilancia, directrices y acceso a medicamentos y tecnologías esenciales, y sintetiza información sobre las complicaciones relacionadas con la diabetes y la estrecha relación entre la diabetes y otras patologías, como enfermedades cardiovasculares, tuberculosis y COVID-19.
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In 2015 around 15 million people living with HIV were receiving antiretroviral treatment (ART) in sub–Saharan Africa. Sustained provision of ART, though both prudent and necessary, creates substantial long–term fiscal obligations for countries affected by HIV/ AIDS. As donor assistance for healt
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h remains constrained, novel financing mechanisms are needed to augment funding domestic sources. We explore how Innovative Financing has been used to co–finance domestic HIV/AIDS responses. Based on analysis of non–health sectors, we identify innovative financing instruments that could be used in the HIV response.
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The environment in which young people live, learn and play significantly affects their decisions about whether to consume alcohol. Environmental factors are the main risk factors driving alcohol consumption and related harm among young people. Environments that normalize alcohol consumption – term
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ed alcogenic environments – include contexts with unregulated advertising and marketing of alcoholic beverages, higher alcohol outlet density, products designed to facilitate affordability and low prices of alcoholic beverages. A recent body of research evidence has emerged related to the measurement, functional significance and consequences of living in alcogenic environments. This includes findings on the complex and bidirectional interactions among alcohol acceptability, availability and affordability and how they create and perpetuate alcogenic environments. Comprehensive and enforced alcohol control policies are effective at delaying the age of onset and lowering alcohol prevalence and frequency among young people. Evidence consistently confirms the effectiveness of designing and implementing alcohol control policies that regulate upstream the drivers of alcogenic environment, including alcohol availability, acceptability and affordability. These policies need to be multipronged and address the complex interactions between these drivers and the local alcohol culture
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Developmental disabilities are common. Yet, children with developmental disabilities have been neglected in health systems planning and policy provisions for health and continue to experience stigmatization, institutionalization, barriers to access health care and inequalities in health and educatio
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n outcomes.
Using findings from research and practice and guided by the tenets of international human rights conventions, this WHO-UNICEF Global Report on children with developmental disabilities provides principles and approaches to intentionally include the needs and aspirations of children and young people with developmental disabilities in policy, programming and public health monitoring. It makes the case for greater accountability and proposes 10 priority actions to accelerate changes towards inclusive environments and responsive multisectoral care systems for children with developmental disabilities.
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Los avances en el tratamiento del cáncer pediátrico han permitido ampliar las iniciativas más allá de la curación y abarcar aspectos como la detección precoz, la continuidad del tratamiento y la reducción de su toxicidad. Todo ello ha abierto paso a una visión más integral del cuidado de lo
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s pacientes, lo que supone mejores oportunidades de curación y una vida más plena, objetivos de la Iniciativa Mundial contra el Cáncer Infantil. Dentro de ese cuidado integral, la atención psicosocial incluye las dimensiones social, psicológica, espiritual y funcional del proceso de enfermedad de los pacientes. Esta serie recoge una serie de orientaciones y normas basadas en la evidencia que garantizan la calidad de dicha atención. Las normas son el resultado de la discusión y la revisión de distintos profesionales de América Latina y el Caribe. El módulo 1 se centra en la evaluación psicosocial como estrategia de apoyo a los objetivos de la Iniciativa Mundial contra el Cáncer Infantil y como herramienta para que los profesionales de la salud recaben la información necesaria para ofrecer a estos pacientes un abordaje integral enfocado en el bienestar, la adaptación al proceso de enfermedad y la adherencia al tratamiento.
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This report compiles data for the first time on the far-reaching consequences of uncontrolled hypertension, including heart attacks, strokes and premature death, along with substantial economic losses for communities and countries. It also contains information on the global, regional and country-lev
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el burden of hypertension and progress of control efforts.
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Trustworthy, evidence-based health guidelines form the basis of national policies affecting both patients and health-care workers. Emphasizing the link between robust evidence and people’s trust in their health systems, Dr Hans Henri P. Kluge, WHO Regional Director for Europe said at the launch ev
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ent, “Trust and transformation are key words for us, especially when we talk about improving and strengthening our health systems. Transformation should first and foremost serve the interests of patients and health-care workers”.
While it is not always easy to demonstrate the immediate effect of guidelines on people’s health, there is no viable alternative to utilizing guidelines based on the best available evidence.
Yet, developing robust guidelines remains a challenge for most countries. “Guidelines need to be both simple to use and timely, they need to address people’s real needs, especially at the local level, and should ultimately reflect the resources available,” said Dr Natasha Azzopardi-Muscat, Director, Country Health Policies and Systems, WHO/Europe. “This means that any successful guideline needs to be adjusted and adapted to local contexts and realities.”
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Little is known about the patterns of development assistance (DA) for each component of reproductive, maternal, newborn, child and adolescent health (RMNCAH) in conflict-affected countries nor about the DA allocation in relation to the burden of disease
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
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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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The World Health Organization (WHO) is releasing the second edition of its Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance. The document aims to equip governments to respond to the health and well-being challenges, opportunities and needs of adolescents.
The guidance pro
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vides the latest available data on adolescent health and well-being. It also outlines an updated list of core indicators that data should be collected on. Globally, road injury was the top cause of death for adolescent males in 2019. Among female adolescents, the leading causes of death were diarrhoeal diseases among the younger group (10-14 years) and tuberculosis (TB) in the older group (15-19 years).
Over the last 20 years, mortality rates have declined among adolescents globally, with the largest decline in older (15–19 years) adolescent girls. For non-fatal diseases, the burden has not improved over the past two decades, with the main causes of ill health in this category being: mental health conditions (depressive and anxiety disorders, childhood behavioural disorders), iron deficiency anaemia, skin diseases and migraine.
Adolescent well-being depends on a range of factors, including healthy food, education, life skills and employability, connectedness, feeling valued by society, safe and supportive environments, resilience, and the freedom to make choices. To take an appropriately holistic approach, the guidance outlines how to take crosscutting action to support adolescent health and well-being, with mutually reinforcing interventions across sectors, such as health, education, social protection, and telecommunications. Targeted efforts are also required to engage adolescents, as they trust health systems less than adults do and are especially vulnerable to modern-day trends, like online bullying and gaming.
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The Infection prevention and control in the context of coronavirus disease 2019 (COVID-19): a living guideline consolidates technical guidance developed and published during the COVID-19 pandemic into evidence-informed recommendations for infection prevention and control (IPC). This living guideline
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is available both online and PDF.
This version of the living guideline (version 6.0) includes fifteen statements on IPC measures in health-care settings (screening and patient placement, ventilation, physical barriers, environmental cleaning, waste management, amongst others) as well as one statement on mask fit in the community context.
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Significant progress has been made in the eradication of three priority diseases in the African Region, as a result of extensive collaboration between the Regional Office, WHO country offices and countries. For example, in August 2020, the region was certified free of wild poliovirus. In the area of
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neglected tropical diseases, Guinea worm disease is on the verge of eradication, and 12 member states are within reach of being certified as having eradicated yaws by the end of this year.
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Building on the 2021 Interim guidance, this second version and update, incorporates the lessons and feedback from the hepatitis pilots that successfully demonstrated the feasibility of measuring hepatitis B and C impact targets to demonstrate elimination, whilst highlighting challenges caused by hig
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h disease burden in some countries, as well as delays in reaching mortality targets due to the long natural history of disease progression to liver cirrhosis and hepatocellular carcinoma.
The path to elimination provides a framework with 3 levels of achievements for which WHO certification is available. Each stepwise progression from bronze to silver to gold tiers will promote an iterative expansion of prevention, diagnosis and treatment services for viral hepatitis services and strengthen measurement systems to support attainment of the 2030 elimination goals.
This updated version also includes changes, clarifications and new guidance on alternative measurement approaches for country validation of elimination. Through the validation process, WHO and partners continue to provide country support for strengthening health system capacity and patient-centred services that respect and protect the human rights of people living with viral hepatitis and ensures meaningful engagement of communities in the national, regional and global viral hepatitis response.
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Development assistance for health (DAH) is an important part of financing healthcare in low- and middle-income countries. We estimated the gross disbursement of DAH of the 29 Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD)
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for 2011–2019; and clarified its flows, including aid type,
channel, target region, and target health focus area. Data from the OECD iLibrary were used. The DAH definition was based on the OECD sector classification. For core funding to non-healthspecific multilateral agencies, we estimated DAH and its flows based on the OECD methodology for
calculating imputed multilateral official development assistance (ODA).
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Reproductive health needs are particularly acute in countries affected by armed conflict. Reliable information
on aid investment for reproductive health in these countries is essential for improving the efficiency and effectiveness of
aid. The purpose of this study was to analyse official developm
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ent assistance (ODA) for reproductive health activities in
conflict-affected countries from 2003 to 2006.
Methods and Findings: The Creditor Reporting Syst
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People affected by impairments and disabilities associated with TB are even more likely to belong to marginalized segments of society and are more likely to have their human rights unprotected. The challenges faced by people affected by TB include the consequences of impairment and disability associ
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ated with the disease, its treatment as well as with the stigma and discrimination applied to people affected by TB. There is now compelling evidence that the disease and its treatment affect quality of life and life expectancy even after successful treatment.
The WHO Global Tuberculosis Programme has produced the first policy brief on TB-associated disability, building on the increasing evidence in recent years on the unaddressed needs of people with TB who experience impairment and disability while on TB treatment and after completing TB treatment.
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This document presents the World Health Organization Operational framework for building climate resilient and low carbon health systems*. ***The framework's goal is to increase the climate resilience of health systems to protect and improve the health of communities in an unstable and changing clima
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te, while optimizing the use of resources and implementing strategies to reduce GHG emissions. It aims to contribute to the design of transformative health systems that can provide safe and quality care in a changing climate.
Implementation of the framework's ten components would help health organizations, authorities, and programmes to be better able to anticipate, prevent, prepare for, and manage climate-related health risks and therefore decrease the burden of associated climate-sensitive health outcomes. Implementing low carbon health practices would contribute to climate change mitigation while also improving health outcomes. Achieving these aims is an important contribution to universal health coverage (UHC), global health security, and specific targets within the Sustainable Development Goals (SDGs). The document is a useful resource for decision-makers in health systems, including public health agencies, and other specialized institutions, and for decision-makers in health-determining sectors.
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Prompt, effective antimalarial treatment, and supportive care can substantially reduce the rate of mortality from severe malaria. However, many children in malaria-endemic countries do not have access to health facilities or a qualified health care provider and do not receive the necessary care in a
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timely fashion. Without rapid detection of danger signs and access to effective treatment, including pre-referral treatment that can be administered in the community level, many of these children with severe malaria die.
In situations where there is no immediate access to a health care facility, WHO recommends the administration of a standard dose of an effective antimalarial medicine as pre-referral treatment before referral to a facility at which complete treatment can be administered.
Rectal artesunate is the WHO-recommended pre-referral intervention in situations where artesunate injection are not feasible for children under the age of 6 years with suspected severe malaria. The intervention reduces the risk of death or permanent disability by up to 50% provided the child is referred to a health facility at which complete treatment can be administered.
This field guide is aimed at supporting the effective deployment of RAS as pre-referral treatment of suspected severe malaria in line with the WHO malaria guidelines.
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