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 multisectoral 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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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 c...ountries, 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.
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In 2014, the World Heart Federation (WHF) launched
an initiative to develop a series of Roadmaps [1e6]. Their
aim is to identify potential roadblocks on the pathway to
effective prevention, detection, and management of cardiovascular ..."attribute-to-highlight medbox">disease (CVD), along with evidence-based
solutions to overcome them. The resulting documents
provide a framework to translate strategic intent into action
on integrating epidemiology, population, and cardiovascular outcome trial data into national plans for optimal
CVD management.
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In one of his final essays, statesman and former United Nations secretary general Kofi Annan said, ‘Snakebite is the most important tropical disease you’ve never heard of’. Mr. Annan firmly believed that victims of snakebite envenoming should ...be recognised and afforded greater efforts at improved prevention, treatment, and rehabilitation. During the last years of his life, he advocated strongly for the World Health Organisation (WHO) and the global community to give greater priority to this disease of poverty and its victims.
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This guidance note developed by UNICEF helps WASH staff in their preparedness and response to the current COVID-19 pandemic. It provides an overview of Infection Prevention and Control (IPC) and its... intersection with water, sanitation and hygiene (WASH). It also provides key actions that staff can implement to help prevent infection and its spread in health-care facilities: from human to human, among health care workers and patients, through droplets, and by touching surfaces contaminated with the virus. WASH, including waste management and environmental cleaning, is essential for IPC
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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<.../span> blood pressure, blood sugar and blood cholesterol.
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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Many low-resource settings have a shortage of physicians and health workers. (1) In order to provide patient-centred continuous care more effectively, primary care systems can include team-based care strategies in their clinic workflows and protocols. Team-based care uses multidisciplinary teams (wh...ich may involve new staff, or the shifting of tasks among existing staff). Teams can include patients themselves, primary care physicians, and other allied health professionals, such as nurses, pharmacists, counsellors, social workers, nutritionists, community health workers, or others. Teams reduce the burden on physicians by utilizing the skills of trained health workers. Strong evidence shows that team-based care is effective in improving hypertension control among patients in a cost-effective way. (2) Some amount of task shifting/team-based care is already taking place in many settings; this module provides further guidance on how to maximize this approach for greater impact.
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Palliative care has been shown to provide significant and diverse benefits for patients with serious, complex,or life-limiting health problem.
Jamison DT, Gelband H, Horton S, Jha P, Laxminarayan R, Mock CN, Nugent R., editors. ...te-to-highlight medbox">Disease Control Priorities, 3rd Edition,
Volume 9: Improving Health and Reducing Poverty. Washington DC: World Bank 2018. doi:10.1596/978-1-4648-0527-1
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Updated guidance. The guidance provides useful information to staff working in prisons, as well as to health and prison authorities, explaining how to prevent and address a potential outbreak of COVID-19. In addition, it aims to protect the health and well-being of all those who live and work in, an...d visit, these settings and the general population at large. People deprived of their liberty, and living or working in enclosed environments in close proximity, are likely to be more vulnerable to the COVID-19 disease than the general population. Moreover, correctional facilities may amplify and enhance COVID-19 transmission beyond their walls.
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Those who clean are the first line of defense against health care-associated infections (HAIs), and support efforts to reduce antimicrobial resistance (AMR).
Strengthening the training of this important group can contribute to resolving many of today’s public health challenges. This is importan...t given that cleaning both surfaces and hands is vital to control the transmission of a number of HAIs.
This two-part training package targets those who clean heath care facilities.
The Trainer’s Guide takes the user through how to prepare, deliver and sustain an effective training for those who clean. The Modules and Resources provides instructions, definitions, photographs, posters and specific illustrations of recommended practices
The package can be used by those who deliver environmental cleaning training programmes and/or those with a background in IPC including ministries of health, nongovernmental organizations, academic institutions, experts working in Quality of care, IPC and environmental cleaning/ Water, sanitation and Hygiene (WASH) and Health facility IPC focal points and onsite cleaning supervisors
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According to WHO, infection prevention and control (IPC) is a scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers. It is grounded i...n infectious diseases, epidemiology, social science and health system strengthening. IPC occupies a unique position in the field of patient safety and quality universal health coverage since it is relevant to health workers and patients at every single health-care encounter. Poor WASH and IPC lead to health acquired infections, transmission of diseases from health facilities to communities and increased use of antibiotics and exacerbate outbreak and spread of infections- in this case- COVID- 19. On the contrary, effective IPC reduces hospital-acquired infections by at least 30% (WHO 2016).
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The road map sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups as well as cross-cutting... targets aligned with the Sustainable Development Goals. Three foundational pillars will support global efforts to achieve the targets: accelerate programmatic action (pillar 1), intensify cross-cutting approaches (pillar 2) and change operating models and culture to facilitate country ownership (pillar 3).
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This manual provides guidance on best practices to be followed in Ebola Care Units (ECUs)/Community Care Centres (CCCs). It is intended for health aid workers (including junior nurses and community ...health-care workers) and others providing care for patients in ECUs/CCCs. While the focus is on the care and management of patients with Ebola Virus Disease (EVD), the care of patients with other causes of fever is also described.
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To save the lives of mothers and their babies, mitigate complications, and limit the spread of disease, it is critical that recommendations are made on the prevention, treatment, and surveillance of... women who are exposed to EVD, acquire EVD during pregnancy or breastfeeding, or survive EVD with ongoing pregnancies. These guidelines are the first to provide such recommendations.
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West Africa is experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. On 11 August 2014, WHO convened a consultation where the participants concluded that in the particular context of the current Ebola outbre...ak in West Africa, it is ethically acceptable to offer unproven interventions that have shown promising results in the laboratory and in animal models but have not yet been evaluat-
ed for safety and efficacy in humans as potential treatment or prevention
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The Zambia Population Based HIV impact assessment of 2016, reported the prevalence of viral hepatitis in Zambia as ranging between 5.6% among adults aged 15 to 59% in the general population, and 7.1% among HIV infected individuals. It is estimated that the majority of persons with chronic hepatitis ...B and/ or hepatitis C are unware of their infection and do not benefit from promotive, preventive and curative services designed to reduce onward transmission. Zambia introduced hepatitis B virus vaccine to the routine Under 5 vaccination schedule in 2005. Preliminary results from the ZAMPHIA indicate that hundreds of infections have been abated in children since then. However, its also clear that we continue to miss key opportunities to prevent transmission, diagnose and treat infections, prevent serious disease, and in many cases cure people. In addition, high risk groups inter alia health care workers still have limited access to the vaccine.
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BMJ Open 2021;11:e042279. doi:10.1136/bmjopen-2020-042279. Neglected tropical diseases tend to cluster in the same poor populations, and to make progress with their control, they will have to be dea...lt with in an integrated manner. Peptide microarrays may be a solution to tese problems, where diagnosis for co-infection can be detected simultaneously using the one tool.
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. Interim Guidelines. This interim guideline lays out some basic principles of optimal nutritional care for adults and paediatric patients during treatment and convalescence in Ebola treatment units, community care ...t medbox">centres or to other centres where Ebola patients are receiving care and support. It highlights the key clinical problems in patients affected by Ebola virus disease (EVD) that may interfere with their nutritional status and overall clinical support in the context of the current Ebola crisis, and summarizes their nutritional needs. It does not provide specific advice on fluid management in cases of vomiting, diarrhoea and dehydration or parenteral nutrition
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Mental, Neurological, and Substance Use Disorders: Disease Control Priorities, Third Edition (Volume 4).
Patel V, Chisholm D, Dua T, et al., editors.
Washington (DC): The International Bank ...n class="attribute-to-highlight medbox">for Reconstruction and Development / The World Bank; 2016 Mar 14.
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The sixteenth meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD) was held as a hybrid meeting, 27–28 September 2022.
Dr Ren Minghui, Assistant Dire...ctor-General, Universal Health Coverage/Communicable and Noncommunicable Diseases, welcomed participants to the meeting. He said the World Health Organization’s Department of Control of Neglected Tropical Diseases (WHO/NTD) was in a state of transition. Following the death of the late esteemed Director Dr Mwelecele Ntuli Malecela earlier in the year, Dr Gautam Biswas had taken over as Acting Director but would soon retire; the appointment of a new Director was under way. Owing to rotation of STAG-NTD members, this would be the last meeting for some and the first meeting for several new participants. The work however would continue with the same commitment. Discussions over the next two days would focus on critical issues regarding recovery of NTD services following the disruptions caused by coronavirus disease (COVID-19), which had impacted many health services worldwide. He looked forward to receiving the advice and guidance of STAG-N
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