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The response to a cholera outbreak must focus on limiting mortality and reducing the spread of the disease. It should be comprehensive and multisectoral, including epidemiology, case management, water, sanitation and hygiene, logistics, community en
...
gagement and risk communication. All efforts must be well coordinated to ensure a rapid and effective response across sectors.
This document provides a framework for detecting and monitoring cholera outbreaks and organizing the response. It also includes a short section linking outbreak response to both preparedness and long-term prevention activities.
more
Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. There are significant differences in the burden of cardiovascular disease and associated risk factors, across high-income countries and low- and middle-income cou
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ntries. Cardiac imaging by echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, single-photon emission computed tomography, and positron emission tomography myocardial perfusion imaging are well-established non-invasive tests that aid in the diagnosis, risk stratification, and management of various cardiac diseases. However, there are significant inequalities in availability and access to imaging modalities in low- and middle-income countries attributed to financial constraints, disparities in healthcare and technical infrastructure. In the post-COVID-19 pandemic era, these disparities are exaggerated by the continued technological advancements driving innovations in the field of cardiovascular (CV) imaging in high-income countries, while there is an urgent need to provide sustainable access to diagnostic imaging for patients in economically strained healthcare systems in regions like Africa. This review aims to highlight the inequalities in the burden of cardiac disease, associated risk factors, and access to diagnostic CV imaging tests, while also exploring the need for sustainable solutions to implementing CV imaging all over the world.
more
Background
Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physi
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cal activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.
Methods
We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.
Results
We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).
Conclusions
Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.
more
Background
Low- and middle-income countries now experience the highest prevalence and mortality rates of cardiovascular disease.
Main text
While improving the availability and delivery of proven, effective therapies will no doubt mitigate this
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burden, we posit that studies evaluating cardiovascular disease risk factors, management strategies and service delivery, in diverse settings and diverse populations, are equally critical to improving outcomes in low- and middle-income countries. Focusing on examples drawn from four cardiovascular diseases — coronary artery disease, stroke, diabetes and kidney disease — we argue that ethnicity, culture and context matter in determining the risk factors for disease as well as the comparative effectiveness of medications and other interventions, particularly diet and lifestyle interventions.
Conclusion
We believe that a host of cohort studies and randomized control trials currently being conducted or planned in low- and middle-income countries, focusing on previously understudied race/ethnic groups, have the potential to increase knowledge about the cause(s) and management of cardiovascular diseases across the world.
more
Many vaccines and drugs hold the promise of reducing mortality and morbidity among pregnant women and infants living in low- and middle-income countries (LMICs). However, sufficient information on the safety of drugs and vaccines in pregnant women i
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s rarely available at the time of product licensure or approval. To account for this, active safety surveillance efforts are needed during the post-licensure and post-approval
phase to assess the safety of drugs and vaccines in pregnant women and their offspring. Pregnancy exposure registries (PER) are used to monitor the safety of vaccines and drugs. PERs are observational studies that systematically collect health information on exposure to medical products such as drugs and vaccines during pregnancy. This review demonstrates that a number of resources presently exist in LMICs that perform active safety surveillance in pregnant populations. These results indicate such systems employ a wide variety of approaches, each with their own set of strengths and challenges, as summarized in the final section of the report.
more
Type 1 diabetes is reported to have significant mortality in Africa. However, there is a paucity of data on pooled estimates of its incidence and prevalence in Africa. This first systematic review and meta-analysis will be conducted to determine the
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incidence and prevalence of this condition in Africa.
more
Diabetes mellitus is a major cause of morbidity and mortality in Scotland and worldwide, with an increasing prevalence. In 2009 there were around 228,000 people registered as having diabetes in Scotland, an increase of 3.6% from the preceding year.
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This increase relates, in part, to the increasing age of the population, an increase in obesity and also perhaps to increasing survival of those with diabetes.
more
Air pollution is one of the leading causes of health complications and mortality worldwide, especially affecting lower-income groups, who tend to be more exposed and vulnerable. This study documents the relationship between ambient air pollution exp
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osure and poverty in 211 countries and territories. Using the World Health Organization’s (WHO) 2021 revised fine particulate matter (PM2.5) thresholds, we show that globally, 7.3 billion people are directly exposed to unsafe average annual PM2.5 concentrations, 80 percent of whom live in low- and middle-income countries. Moreover, 716 million of the world’s lowest income people (living on less than $1.90 per day) live in areas with unsafe levels of air pollution, especially in Sub-Saharan Africa. Air pollution levels are particularly high in lower-middle-income countries, where economies tend to rely more heavily on polluting industries and technologies. These findings are based on high-resolution air pollution and population maps with global coverage, as well as subnational poverty estimates based on harmonized household surveys.
more
The report provides an overview of alcohol consumption, related health harm, and policy responses in 30 European countries (EU Member States, Norway, and Switzerland). It highlights the high levels of alcohol consumption in the WHO European Region, which contribute to a significant disease burden co
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mpared to other regions. The report covers trends in alcohol consumption and harm between 2010 and 2016, noting some progress in reducing alcohol-attributable mortality but stagnation in consumption reduction and heavy episodic drinking.
The assessment of alcohol policies shows variability in implementation across countries, particularly in areas like pricing and reducing the negative consequences of drinking. It emphasizes the need for stronger evidence-based policies, such as better regulation, taxation, and accessibility restrictions, to further reduce alcohol-related harm and achieve health-related Sustainable Development Goals.
more
Background: Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity
and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and
affordable essential medi
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cines is variable. We aimed to review the existing literature relating to the availability, cost,
and affordability of WHO’s essential medicines for asthma and COPD in LMICs.
more
Chronic kidney disease (CKD) is an important contributor to mortality from noncommunicable diseases. No decrease has been seen for CKD mortality contrary to many other important non-communicable dis
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eases (e.g., cardiovascular disease). The prevalence of CKD and kidney failure are increasing all over the world – and thereby also the need for dialysis. Unfortunately, the prevalence increases most rapidly in lowand middle-income countries. Globally, there are great inequities in access and quality of management of kidney failure. Many low- and middle-income countries cannot meet the increased need for dialysis. If the patients receive dialysis, it might only be for a limited period due to the out-of-pocket expenses. There are global disparities in CKD mortality reflecting the disparities in access to care. Lack of access to dialysis is an important cause of the increased CKD mortality in low- and middle-income countries.
more
Pneumonia and diarrhoea account for 23% of under-five mortality and were responsible for an estimated 1.17 million deaths in children under five globally. Furthermore, pneumonia and diarrhoea were responsible for 18% of
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mortality in children 5–9 years of age, resulting in an estimated 86 000 preventable deaths globally in 2021. Existing World Health Organization (WHO) guidance on the clinical management of pneumonia and diarrhoea has mainly focused on children less than 5 years of age.
more
The main objective of the malaria prevention and control programme in Somalia is to prevent mortality and reduce morbidity due to malaria. The groups most vulnerable to the disease, children aged under 5 years and pregnant women, are especially targ
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eted. Effective case management - early diagnosis and treatment - is a critical component of malaria prevention and control. To achieve the main objective of reducing malaria morbidity and prevention of malaria mortality, the availability of safe, effective, affordable and accessible anti-malarial drugs is a prerequisite.
more
ETHIOPIA RISK OF PREMATURE DEATH DUE TO NCDS (%)*SELECTED ADULT RISK FACTOR TRENDS PROPORTIONAL MORTALITY
Kenya in undergoing an epidemiological transition marked by a decline in morbidity and mortality due to communicable conditions, and an increase in the burden of non-communicable diseases (NCDs), which include diseases such as diabetes, cancers, car
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diovascular diseases and chronic respiratory infections. The second strategic objective of KHSSP 2014-2018 targets to halt and reverse the rising burden of non-communicable conditions, while the fifth strategic objective is focused on putting into place health promotion interventions that will address risk factors to health.
more
Over a period of two decades, under-5 mortality rate in Bangladesh has declined by 66% from 133 per 1000 live births in 1993-94 to 45 per 1000 live births in 2017-18. The country reached the MDG-4 goal in the reduction of child
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mortality on time. However, the comparison of neonatal and under-5 mortality rates in Bangladesh over the same years reveals that the reduction in the neonatal mortality rate was much slower than the child mortality rate. This led to a rise in the proportion of neonatal deaths in overall under-five deaths from 40% in 1993-1994 to 67% percent in 2017-2018. More than 75% of neonatal deaths occur within the first 7 days. To achieve SDG target 3.2, Bangladesh has to further reduce under-5 mortality rate by 44% and newborn deaths by 60%. Infection is the leading cause of preventable deaths among the neonates and the young infants and the standard recommendations for treating severe bacterial infections in infants under 2 months of age include hospitalization and 7-10 days of parenteral therapy.
more
Background: Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality among women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical can
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cer prevention (CECAP) services in Burkina Faso were limited to temporary screening campaigns.
Program Description: Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity.
Methods: Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy.
Results: Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions.
Conclusions: Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.
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This document focus on the direct consequences of the virus (morbidity and mortality) in specific populations and on the results of measures aimed at mitigating the spread of the virus, with indirect impacts on socio-economic conditions. In this com
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plex scenario, the gender approach has not received due attention during the pandemic. Gender is one of the structural determinants of health, but it does not appear in analyses of the direct and indirect effects of the pandemic, despite being essential in the recognition and analysis of the differential impacts on men and women and their interaction with the different determinants of health.
more
Contains data from World Health Organization's data portal covering the following categories:
Mortality and global health estimates, Sustainable development goals, Millennium Development Goals (MDGs), Health systems, Malaria, Tuberculosis, Child he
...
alth, Infectious diseases, Neglected Tropical Diseases, World Health Statistics, Health financing, Tobacco, Substance use and mental health, Injuries and violence, HIV/AIDS and other STIs, Public health and environment, Nutrition, Urban health, Noncommunicable diseases, Noncommunicable diseases CCS, Negelected tropical diseases, Infrastructure, Essential health technologies, Medical equipment, Demographic and socioeconomic statistics, Health inequality monitor, Health Equity Monitor, Child malnutrition, TOBACCO, Neglected tropical diseases, International Health Regulations (2005) monitoring framework, 0, Insecticide resistance, Oral health, Universal Health Coverage, Global Observatory for eHealth (GOe)
more
This document focus on the direct consequences of the virus (morbidity and mortality) in specific populations and on the results of measures aimed at mitigating the spread of the virus, with indirect impacts on socio-economic conditions. In this com
...
plex scenario, the gender approach has not received due attention during the pandemic. Gender is one of the structural determinants of health, but it does not appear in analyses of the direct and indirect effects of the pandemic, despite being essential in the recognition and analysis of the differential impacts on men and women and their interaction with the different determinants of health.
more
