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.
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ABSTRACT
More than 500 million people worldwide live with cardiovascular disease (CVD). Health systems today face fundamental challenges in delivering optimal care due to ageing populations, healthcare workforce constraints, financing, availability and affordability of CVD medicine, and service del...ivery.
Digital health technologies can help address these challenges. They may be a tool
to reach Sustainable Development Goal 3.4 and reduce premature mortality from
non-communicable diseases (NCDs) by a third by 2030. Yet, a range of fundamental barriers prevents implementation and access to such technologies. Health system governance, health provider, patient and technological factors can prevent or distort their implementation.
World Heart Federation (WHF) roadmaps aim to identify essential roadblocks on the pathway to effective prevention, detection, and treatment of CVD. Further, they aim to provide actionable solutions and implementation frameworks for local adaptation. This WHF Roadmap for digital health in cardiology identifies barriers to implementing digital health technologies for CVD and provides recommendations for overcoming them.
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The World Heart Federation (WHF) Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection and management of cardiovascular diseases and provide a generic global framework available for loca...l adaptation. A first Roadmap on raised blood pressure was published in 2015. Since then, advances in hypertension have included the publication of new clinical guidelines (AHA/ACC; ESC; ESH/ISH); the launch of the WHO Global HEARTS Initiative in 2016 and the associated Resolve to Save Lives (RTSL) initiative in 2017; the inclusion of single-pill combinations on the WHO Essential
Medicines’ list as well as various advances in technology, in particular telemedicine and mobile health. Given the substantial benefit accrued from effective interventions in the management of hypertension and their potential for scalability in low and middle-income countries (LMICs), the WHF has now revisited and updated the ‘Roadmap for raised BP’ as ‘Roadmap for hypertension’
by incorporating new developments in science and policy. Even though cost-effective lifestyle and medical interventions to prevent and manage hypertension exist, uptake is still low, particularly in resource-poor areas. This Roadmap examined the roadblocks pertaining to both the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and
traditions) and the supply side (health systems resources and processes) along the patient pathway to propose a range of possible solutions to overcoming them. Those include the development of population-wide prevention and control programmes; the implementation of opportunistic screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidencebased, inexpensive BP-lowering agents.
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Humanitarian crises exacerbate nutritional risks and often lead to an increase in acute malnutrition. Emergencies include both manmade (conflict) and natural disasters (floods, drought, cyclones, typhoons, earthquakes, volcanic eruptions, etc.). Complex emergencies are combinations of both manmade a...nd natural disasters, often of a protracted nature. Millions of people are affected by humanitarian crises every year. The increasing frequency and scale of emergencies requires nutrition to be addressed in all phases of a response.
Crisis situations, whether acute or protracted, impact on a range of factors that can increase the risk of undernutrition, morbidity, and mortality. They may involve: the large-scale destruction of property and infrastructure; the erosion of livelihood strategies and purchasing power; a breakdown of and reduced access to essential services, including health services, water supply, and sanitation; and the displacement of large numbers of people. Emergencies can also disrupt social systems and the quality of care/feeding practices. Household access to food may be negatively affected and people may find themselves in overcrowded settlements with their families divided. As a result, at the individual level, there is often an increased risk of deteriorating health and nutritional status, resulting in a greater likelihood of death.
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After introducing Ethiopia's WASH sector challenges and trends, the plan describes IRC Ethiopia's vision and strategy which draws from IRC and Water For People's joint framework - Destination 2030. It then details the organisational changes and business development needed to implement the strategic ...plan. Detailed targets are provided in the annexes.
At IRC, we believe that turning on a working tap should not be a surprise or cause for celebration. We believe in a world where water, sanitation and hygiene services are fundamental utilities that everyone is able to take for granted. For good.
We face a complex challenge. Every year, thousands of projects within and beyond the WASH sector fail – the result of short-term targets and interventions, at the cost of longterm service solutions.
This leaves around a third of the world’s poorest people without access to the most basic of human rights, and leads directly to economic, social and health problems on a global scale. IRC exists to continually challenge and shape the established practices of the WASH sector.
Through collaboration and the active application of our expertise, we work with governments, service providers and international organisations to deliver systems and services that are truly built to last.
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Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and
middle-income countries.
Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations.
Co...untry-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed
each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation).
We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of
guidelines and plans for dissemination to target audiences.
Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries.
Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending
surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development;
breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and
middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines
encompassed detailed implementation plans and socioeconomic considerations.
Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of
health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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This report includes analysis from informal regional consultations in the African Region, the Caribbean and North America, Latin America, South-East Asia Region, European Region, Eastern Mediterranean Region, alongside three forums in the Western Pacific Region. It analyses the overarching similarit...ies, regional nuances and priorities raised across the six WHO regions for the meaningful engagement of individuals with lived experience.
It is the second publication in the WHO Intention to action series, which aims to enhance the limited evidence base on the impact of meaningful engagement and address the lack of standardized approaches on how to operationalise meaningful engagement. The Intention to action series aims to do this by providing a platform from which individuals with lived experience, and organizational and institutional champions, can share solutions, challenges and promising practices related to this cross-cutting agenda. The Intention to action series also aims to provide powerful narratives, inspiration and evidence towards the Fourth United Nations High Level Meeting on NCDs in 2025 and achieving the 2030 United Nations Sustainable Development Goals (SDGs).
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Non-Communicable Diseases (NCDs), including mental disorders, currently pose one of the biggest threats to health and development globally, particularly in low and middle income countries2. It is predicted that unless proven interventions are rapidly implemented in countries, in the short to medium ...term, health care costs will increase exponentially and severe negative consequences will ensue not only to individuals and families but to whole societies and economies. NCDs are already a major burden in South Africa, but without added rigorous and timely action the health and development consequences may well become catastrophic. Immediate and additional, high quality, evidence based and focussed interventions are needed to promote health, prevent disease and provide more effective and equitable care and treatment for people living with NCDs at all levels of the health system. The problem is further compounded by the rising global prevalence of multi-morbidity (defined as the coexistence of two or more chronic diseases in one individual).
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Language influences the way we think, how we perceive reality, and how we behave. With respect to HIV, language can embody stigma and discrimination, which impacts access to testing, acquisition of HIV, and engagement with treatment. Language plays a role in supporting respect and empowerment of ind...ividuals, as communities shape how they are referred to and the labels they wish to use. Consideration and use of appropriate language can strengthen the global response to the HIV pandemic by diminishing stigma and discrimination and increasing support and understanding for individuals and communities living with HIV. Comments and suggestions for modifications should be sent to
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Women, girls and marginalized groups who are largely dependent on natural resources for livelihoods are among the hardest hit by extreme weather patterns. These weather patterns limit their access to food, water, shelter, education and access to essential health services, including those that addres...s sexual and reproductive health and rights (SRHR), gender-based violence (GBV) and preventing harmful practices such as child marriage and female genital mutilation.
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To give you a better idea of when and how psychotherapy can help you, we have written this brochure titled Paths to Psychotherapy. While it is therefore primarily intended for people who have never been treated by a psychotherapist, the brochure can also enable those who have previously had psychoth...erapy to find out about the range of psychotherapeutic care and assistance that is currently available. Regardless of your previous experience with psychotherapy, this brochure offers you clear information about what a mental illness is, whether scheduling an initial appointment is advisable, and the circumstances in which psychotherapeutic treatment is necessary.
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Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the tee...nage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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Bonchial asthma is the most common chronic respiratory disease in the world. In Kenya, it has been estimated that about 7.5% of the Kenyan population, nearly 4 million people, are currently living with asthma. Many cases tend to be underdiagnosed and undertreated which leads to high levels of morbid...ity and avoidable deaths. The consequences of poorly controlled asthma, including physical, mental, social, and economic impacts, are magnified in the poor on account of poor access to asthma services and sub-optimal quality of those services. With these guidelines, Kenya's Ministry of Health aims to work towards embedding asthma care in Universal Health Care (UHC) to ensure that quality asthma services are available in primary care settings with
referral networks strengthened for those who may require secondary and tertiary care. These national asthma guidelines will also ensure that treatment for asthma is standardized in both the public and the non-state health care sector.
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The guidance document provides a set of indicators for assessing the status of development, implementation and monitoring of key policy interventions for prevention and control of NCDs and injuries. It promotes city-level evidence based decision-making processes to identify gaps and take appropriate...s actions to strengthen responses. Additionally, using the standardized indicators can facilitate cross-city learning, sharing best practices and lessons learnt in implementing various policy interventions.
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This threat assessment addresses the implications of the ongoing Marburg virus disease (MVD) outbreak in
Rwanda for the European Union/European Economic Area (EU/EEA). MVD is a severe disease in humans and,
although uncommon, it has the potential to cause epidemics with significant case fatality. ...All recorded MVD
outbreaks to date have originated in Africa. MVD is not an airborne disease and is considered not to be
contagious before symptoms appear. Direct contact with the blood and other body fluids of infected people
and animals or indirect contact with contaminated surfaces and materials like clothing, bedding and medical
equipment is required for transmission. The risk of infection is minimised when proper infection prevention and
control precautions are strictly followed. There is no approved treatment or vaccine for MVD; however, several
pharmaceuticals and candidate MVD vaccines are under investigation.
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PEPFAR Malawi’s Country Operational Plan 2022 (COP22) embodies joint priorities from national and subnational dialogues building on the 2020-2025 National Strategic Plan for HIV/AIDS. The interagency team has developed a person-centered, district-tailored and Malawi Population-Based HIV Impact Ass...essment (MPHIA)-informed strategy through extensive engagement with Government of Malawi (GoM) and Civil Society Organizations (CSOs) to sustain HIV epidemic control. At the end of COP21, PEPFAR Malawi was commended for contributing to reaching epidemic control in strong collaboration with GoM and stakeholders including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This includes enrollment of 88% of recipients of care on three or more months of antiretroviral treatment (ART), better outcomes for Malawian children through remarkable efforts in Orphans and Vulnerable Children (OVC) programming and progress made towards reaching men with more intentional and focused programming.
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PEPFAR Malawi’s Country Operational Plan (COP) 2021 reflects a culmination of strong interagency collaboration between the PEPFAR Malawi team, Government of Malawi (GoM), and civil society organizations (CSOs) to mitigate the devastating impacts of COVID-19 and sustain progress achieved over the l...ast two decades towards HIV epidemic control.
At the conclusion of the March 2020 Johannesburg Regional Planning Meeting, the PEPFAR Malawi team presented a COP20 surge strategy to improve client-centered care, mitigate treatment disruption, scale prevention programs to key and vulnerable populations, and strengthen national health systems.
Following this meeting, the first three COVID-19 cases were reported in Malawi and immediately thereafter, adaptations to the COP20 strategy became imperative to deliver safe, client-centered care.
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The new guidelines provide public health guidance on pharmacological agents for managing hyperglycaemia in type 1 and type 2 diabetes for use in primary health-care in low-resource settings. These guidelines update the recommendations for managing hyperglycaemia in the WHO Package of Essential NCD I...nterventions (WHO PEN) for primary care in low-resources settings, reviewing several newer oral agents as second- and third-line treatment: dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter 2 inhibitors and thiazolidinediones. The guidelines also present recommendations on the selection of type of insulin (analogue versus human insulin) for adults with type 1 and type 2 diabetes.
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Oxfam Water Supply Scheme for Emergencies. This manual is part of a series of guides devised by the Oxfam Public Health Engineering Team to help provide a reliable water supply for populations affected by conflict or natural disaster. Wherever possible, water supplies in emergency conditions should ...be obtained from underground sources by exploitation of springs, tubewells, or dug wells. No filtration will then be needed. However, if sources are not available or cannot be developed, the use of surface water from streams, rivers, lakes or ponds becomes necessary. Usually these surface sources are polluted. The level of faecal contamination can be measured by use of the Oxfam/Delagua Water Test Kit (see Section C). Where a serious level of faecal pollution exists, it is essential firstly to try to reduce the cause of contamination, and secondly to treat the water to make it suitable for human consumption. The Filtration equipment provides a simple, long-term physical and biological treatment system that requires no chemicals (except small amounts of chlorine required during filter cleaning) and needs only simple regular maintenance
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This book is a practical manual of mental health care for community health workers, primary care nurses, social workers and primary care doctors, particularly in developing countries.Helpful features include: over 50 illustrations and case studies, jargon-free explanations and descriptions, flow-cha...rts on common clinical problems, and a practical guide to the use of psychiatric medicines and simple psychological treatments.
Chapters 1, 9 and 10 can be found on the e-TALC CD-ROM number 2 (April 2003). See www.talcuk.org for details Links to Chapters 2 and 3 above. Printed copies of this book can also be obtained from the Royal College of Psychiatrists www.rcpsych.ac.uk/wnitp
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