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The Democratic Republic of Timor-Leste has the highest TB incidence rate in the South East Asian Region - 498 per 100,000, which is the seventh highest in the world. In Timor-Leste TB is the eighth most common cause of death.
The salient observations are as follows:
In 2018, 487 (12.5%) of the
...
3906 notified TB patients were tested for RR-TB and only 12 lab confirmed RR-TB patients were initiated on standard MDR-TB treatment of 20-months duration, (a 3-fold increase in RR-TB detection compared with 2017). This amounts to treatment coverage of only 17% of 72 estimated MDR/RR-TB among notified TB patients (3906) and 5% of 240 estimated incident MDR-TB patients as compared to 62% treatment coverage of 6300 incident drug sensitive TB patients estimated in TLS. The treatment success in the 2016 annual cohort of 6 MDR-TB patients has been reported at 83%. 80% of TB patients know their HIV Status with around 1% TB-HIV co-infection, 37/ 77 (48%) TB-HIV Co-infection Detected. Of the 387 PLHIV currently alive on ART, exact status on TB screening and testing is unknown. % of PLHIV newly enrolled in HIV care who received IPT is not known.
In 2018, the mortality rate for TB was 94 deaths per 100,000 people (1200 per annum) in TL with an increasing mortality trend (Figure 1), despite TB services being available for nearly two decades.
A survey of catastrophic costs due to TB (2016) highlights that 83% of TB patients are reported to be facing catastrophic costs due to the disease. This is the highest rate in the world.
more
The Disaster Recovery Framework (DRF) Guide for the Health Sector provides guidance on how to implement a comprehensive, integrated, and structured approach to disaster recovery. Its overarching goal is to minimize the impact of the disaster on communities and help countries to recover quickly and e
...
ffectively from disasters, in coordination with key stakeholders.
The DRF Guide for the Health Sector is adapted from the generic DRF Guide, and draws on the Implementation Guide For Health Systems Recovery in Emergencies, the Health Emergency and Disaster Risk Management Framework as well as the Disaster Recovery Guidance Series. The guide also makes links with multi-sectoral, government-led recovery planning processes such as the Post-Disaster Needs Assessment (PDNA), and it supports the implementation of the HDPN.
more
Ukraine: Russian invasion has forced older people with disabilities to endure isolation and neglect – new report
Many temporary shelters inaccessible to people with physical disabilities
Overburdened care system often provides few alternatives to institutions for older people
Authorities
...
and humanitarian actors must ensure an inclusive response
Displaced older people with disabilities in Ukraine are physically and financially unable to access adequate housing and care amid Russia’s ongoing invasion, sometimes leaving few alternatives to being placed in residential institutions, Amnesty International said in a new report.
more
Pregnancy and childbirth during adolescence profoundly affects the lives of millions of girls worldwide, and is a leading cause of maternal mortality and morbidity, and infant and child mortality. Every year, an estimated 21 million girls aged 15–19 years old in low- and middle-income countries be
...
come pregnant, and approximately 12 million give birth.
For many adolescent girls, the ability to control their sexual lives remains limited. Long-standing gender inequalities and discrimination, marginalization, harmful social and gender norms, and denial of rights, compounded by poverty and violence, render them vulnerable to early pregnancy, HIV and other health threats. Lack of age-appropriate sexual and reproductive health and rights (SRHR) information and services create additional barriers to care and support; as a result, adolescent girls who become pregnant are much more likely to go on to have rapid repeated births.
more
A Guide to Inclusive Education 2023
recommended
Refugee children with disabilities experience a reality of exclusion and marginalisation that makes them among the most vulnerable displaced persons in the world. Excluded from participation in social activities and access to school, not only because of their disability, but especially because of so
...
cial, cultural, and political barriers that prevent them from enjoying the same opportunities as their peers.
Daniela Bruni, a specialist in education in emergency contexts, who has overseen JRS’s related projects for the past two years, has developed a guide on inclusive education.
more
This checklist is an operational tool to help national authorities develop or revise national respiratory pathogen (inclusive of influenza and coronaviruses) pandemic preparedness plans.
Unpreparedness of health professionals to address non-communicable diseases (NCD) at peripheral health facilities is a critical health system challenge in Mozambique. To address this weakness and decentralize NCD care, training of the primary care workforce is needed. We describe our experience in t
...
he design and implementation of a cascade training of trainers (ToT) intervention to strengthen the prevention and control of cardiovascular disease.
more
Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the
...
patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
more
The World Heart Federation (WHF) has been advocating globally for stronger
legislation and policy regarding cardiovascular disease (CVD) for many years. Now, as focus shifts from global to national progress, we call on members and colleagues to advocate for greater action on CVD in your local setti
...
ngs. This ‘Road to 2018 Toolkit’ provides World Heart Federation members with information
and specific, practical tools to support national CVD advocacy, especially around the United Nations High-Level Meeting on NCDs in 2018.
more
This report shows that increased domestic revenues can and will cover only part of the necessary SDG budget spending of the LIDCs. Achieving the SDGs in the LIDCs will also require increases of both Official Development Assistance (ODA) and Private Development Assistance (PDA) to reach aggregate lev
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els of SDG-directed development aid on the order of US$300-400 billion USD per year
more
Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease
Abola, M. T. B.; Golledge, J.; Miyata, T. et al.
Journal of Atherosclerosis and Thrombosis
(2020)
CC
Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic mod
...
alities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD.
more
After the earthquake in Türkiye-Syria in February 2023 an emergency response was provided to the affected population. Young persons with disabilities were one of the social groups most affected by the crisis. These were either young persons who acquired a disability due to the earthquake, or young
...
persons with disabilities who were further isolated after the crisis due to compounded and structural barriers.
In response to this situation the Compact for Young People in Humanitarian Action reached out to the Youth2030 Disability Task Team with the aim of supporting humanitarian teams in the field. The current version of this checklist has been developed for a broader context not only for the Türkiye-Syria case, but also for other humanitarian crises. This checklist aims to provide guidance on how to ensure meaningful participation of young persons with disabilities in local humanitarian response. The expected users are humanitarian actors, especially those working in the field.
more
As a central component of the UNHCR Strategic Directions 2022-2026, UNHCR has identified eight focus areas for renewed attention and accelerated action, including Climate Action. This Focus Area Strategic Plan for Climate Action sets out a global roadmap for prioritized action, providing further cla
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rity on UNHCR’s role and direct contribution, its asks of others, and the immediate actions the organization will take to be optimally calibrated to advance this agenda.
more
Global progress against cardiovascular disease (CVD) is flatlining.
Though rates of CVD deaths globally have fallen in the last three
decades, this trend has begun to stall and, without concerted
efforts, is at risk of reversing.
The World Heart Federation (WHF) is a leading global advocate for stronger legislation and policies regarding cardiovascular disease (CVD) and its risk factors, including raised cholesterol. The present Cholesterol Advocacy Toolkit 2022 provides WHF member organizations with information as well as p
...
ractical tools to
support cholesterol advocacy at the local and regional levels.
more
Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (
...
SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
more
Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the t
...
reatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resourcelimited environment. Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes.
more
Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisector
...
al population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
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Background
Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death.
Methods
This review is based on articles retrieved by a selective search in PubMed, as well as on r
...
elevant guidelines.
Results
Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharmacotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients.
Conclusion
The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
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In April 2020, Gavi and COVAX joined the Access to COVID-19 Tools Accelerator (ACT-A) to provide equitable global access to COVID-19 vaccines to tackle the pandemic. In June 2020, the Gavi COVAX Advance Market Commitment (AMC) was launched to finance equitable access in 92 lower-income countries. Si
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nce then, US$ 10 billion has been raised for the AMC to procure vaccines and support delivery. Despite a challenging supply situation, COVAX has now shipped one billion doses to 144 countries, including over 870 million to AMC economies.
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