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April 2022 Volume 35 Issue 2 e00152-21
Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cr
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uzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field.
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The protozoan parasite Trypanosoma cruzi causes Chagas disease, an important public health problem throughout Latin America. Current therapeutic options are characterised by limited efficacy, long treatment regimens and frequent toxic side-effects.
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Advances in this area have been compromised by gaps in our knowledge of disease pathogenesis, parasite biology and drug activity. Nevertheless, several factors have come together to create a more optimistic scenario. Drug-based research has become more systematic, with increased collaborations between the academic and commercial sectors, often within the framework of not-for-profit consortia. High-throughput screening of compound libraries is being widely applied, and new technical advances are helping to streamline the drug development pipeline. In addition, drug repurposing and optimisation of current treatment regimens, informed by laboratory research, are providing a basis for new clinical trials. Here, we will provide an overview of the current status of Chagas disease drug development, highlight those areas where progress can be expected, and describe how fundamental research is helping to underpin the process.
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Schistosomiasis is a neglected tropical disease of global medical and veterinary importance. As efforts to eliminate schistosomiasis as a public health problem and interrupt transmission gather momentum, the potential zoonotic risk posed by livestoc
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k Schistosoma species via viable hybridisation in sub-Saharan Africa have been largely overlooked. We aimed to investigate the prevalence, distribution, and multi-host, multiparasite transmission cycle of Haematobium group schistosomiasis in Senegal, West Africa.
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Since 2000, concerted efforts by national programmes, supported by public–private partnerships, nongovernmental organizations, donors and academia under the auspices and coordination of the World Health Organization (WHO), have produced important
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achievements in the control of human African trypanosomiasis (HAT). As a consequence, the disease was targeted for elimination as a public health problem by 2020. The Sixty-sixth World Health Assembly endorsed this goal in resolution WHA66.12 on neglected tropical diseases, adopted in 2013.
National sleeping sickness control programmes (NSSCPs) are core to progressing control of the disease and in adapting to the different epidemiological situations. The involvement of different partners, as well as the support and trust of long-term donors, has been crucial for the achievements.
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The Onchocerciasis Control Programme in West Africa (OCP) undertook regional and large scale frght against onchocerciasis in West Africa in 1974 using a vector control strategy. By 2002 OCP had succeeded in eliminating the disease as a public health
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, socio-economic and development problem in 10 out of I I countries. This campaign was highly technical and expensive. ln 1987, Merck & Co.,lnc. committed themselves to provide ivermectin free of charge for as long as needed to onchocerciasis endemic countries. This made it possible to envrsage the extension of onchocerciasis control activities to the remaining endemic countries in Africa.
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Snakebite is an acute life threatening time limiting medical emergency. It is a preventable public
health hazard often faced by rural population in tropical and subtropical countries with heavy
rainfall and humid climate.
Classical rabies caused by RABV occurs worldwide besides some isolated countries and Western Europe that are regarded rabies free. Carnivores, especially of the canidae family represent the principal reservoir species and are responsible for the maintenance of the infectious cycle and hence for the
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presence of the disease (see Epidemiology of rabies). While wildlife rabies maintained by different reservoirs hosts predominantly occurs in the Northern hemisphere, canine rabies is by far more important for public health in the developing world.
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Rabies has an enormous impact on both agriculture and conservation biology, but its greatest burden is undeniably on public health. As such, routine methods for rapid risk assessment after human exposures to rabies as well as applications for labora
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tory-based surveillance, production of biologicals and management of this infectious disease are critical. Given its mandate to improve human health and control disease among its Member States, WHO has led the production of this fifth edition of Laboratory techniques in rabies.
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In the Indian state of Bihar, visceral leishmaniasis (VL) is a major public health issue that has been aggravated by the rising incidence of new Human immunodeficiency virus (HIV) infections. In endemic areas, the risk of VL infections in patients l
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iving with HIV (PLHIV) is higher. It is important to investigate the disease-related knowledge, attitude, and practices (KAP) of PLHIV in Bihar in order to monitor HIV/VL co-infection. Adequate knowledge, a positive attitude, and good practices for VL control are essential to stamp out the disease. This study investigated the KAP towards VL in HIV patients attending antiretroviral therapy (ART) clinic at ICMR-RMRIMS, Patna.
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Today, patient harm due to unsafe care is a large and growing global public health challenge and is one of the
leading causes of death and disability worldwide. Most of this patient harm is avoidable. As countries strive to
achieve universal healt
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h coverage and the Sustainable Development Goals, the beneficial effects of improved
access to health services can be undermined by unsafe care. Patient safety incidents can cause death and
disability, and suffering for victims and their families. The financial and economic costs of safety lapses are high.
There is often reduced public confidence and trust in local health systems when such incidents are publicized.
Health workers involved in serious incidents involving death or serious harm to a patient can also suffer lasting
psychological harm and deep-seated feelings of guilt and self-criticism.
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A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in
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non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.
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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 possibl
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e core elements of a strategic vision to integrating 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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Safe drinking-water management must consider drinking-water quality, acceptability and quantity in the context of public health protection. In this manual, the term “safety” encompasses these three elements. Although the principles in this manua
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l can be broadly applied to all types of drinking-water supplies, the guidance is primarily intended for piped water supplies that are professionally managed (by a water supplier or equivalent management entity).The guidance may be applied to existing drinking-water supplies, or adapted for water supplies that are in the planning stage before construction.
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The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed,
especially during public health emergencies. Development assistance is an important source of health financing in
many low-income countries, yet li
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ttle is known about how much of this funding was disbursed for COVID-19. We
aimed to put development assistance for health for COVID-19 in the context of broader trends in global health
financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.
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UNAIDS is calling on governments to ensure that the right to health is realized by all by prioritizing public investments in health. At least half of the world’s population cannot access essential health services. Every two minutes a woman dies wh
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ile giving birth. Among the people being left behind are women, adolescents, people living with HIV, gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people, migrants, refugees and poor people.
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This report analyses the intersection of HIV, COVID-19 and public debt in developing countries. The collision between COVID-19 and a crippling debt crisis have reversed decades of progress - putting present and future investments in health and HIV a
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t risk. Pragmatic options to address the pandemic triad are proposed.
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Mental disorders are a leading cause of the global burden of disease, and the provision of mental health services in developing countries remains very limited and far from equitable. Using the Creditor Reporting System, we estimate the amounts and patterns of development assistance for global mental
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health (DAMH) between 2007 and 2013. This allows us to examine how well international donors have responded to calls by global mental health advocates to scale up evidence-based services. Although DAMH did increase between 2007 and 2013, it remains low both in absolute terms and as a proportion of total development assistance for health (DAH). The average annual DAMH between 2007 and 2013 was US$133.57 million, and the proportion of DAH attributed to mental health is less than 1%. Approximately 48% of total DAMH was for humanitarian assistance, education, and civil services. More annual DAMH was channelled into the nonpublic sector than the public sector. Despite an expanding body of evidence suggesting that sustainable mental health care can be effectively integrated into existing health systems at relatively low cost, mental health has not received significant development assistance.
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The development of this draft Proposed programme budget 2022–2023 comes at a unique moment for WHO. The world is in the grip of the coronavirus disease (COVID-19) pandemic and faces health, social and economic consequences on an unprecedented scale. Although it is not known when the COVID-19 pande
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mic will end, recent encouraging vaccine results, in addition to the examples of countries that have achieved good results through public health measures, hold out the prospect of better days ahead. The full impact of the pandemic cannot yet be determined. But whatever its implications, the Secretariat will rise to the challenge and is ready to adapt so that it is fully equipped to support Member States for any eventuality in the future – to make sure that the world will never again have to face this kind of crisis.
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Japan has been implementing projects of global extension of medical technologies under an official development assistance policy to improve public health and medicine by promoting Japanese medical technologies worldwide. The current work examines th
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e impact and goals of implementing this new scheme. The scheme has involved dozens of projects that sent Japanese experts to partner countries and that invited their counterparts to Japan to showcase Japanese medical technologies. Approximately 50 projects have been implemented in 24 countries over 5 years, and 19,638 individuals have been trained. As a result, the introduced technology was adopted in national guidelines in 4 projects and the introduced equipment was procured in the partner country in 17 projects. In total, 912,334 individuals have benefitted from the introduction of these medical technologies. The concept of "creating shared value" (CSV) could help promote project success by both creating economic value and encouraging social progress. However, the sustainability of that business model remains in question in terms of the internationalization of CSV. Several successful projects improved medical care and led to new business opportunities.
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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
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will continue rising over the following years. The 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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