La pandémie actuelle de COVID-19 entraîne des difficultés exceptionnelles et sans précédent pour les autorités compétentesa responsables des systèmes nationaux decontrôle de la sécurité sanitaire des alimentsb, qui sont tenues de continuer à assurer des fonct...ions et des activités de routine en se conformant aux règlements nationaux et aux recommandations internationales. Dans de nombreux pays, le personnel employé par les autorités compétentes travaille généralement à domicile car le télétravail est devenu la norme et toutes les réunions en présentiel sont annulées ou sont réorganisées sous forme de téléconférence. Il est difficile de maintenir, sans interruption, les activités de routine telles que l’inspection des entreprises du secteur alimentaire, la certification des exportations, le contrôle des denrées alimentaires importées, le suivi et la surveillance de la sécurité de la chaîne d’approvisionnement alimentaire, l’échantillonnage et l’analyse des aliments, la gestion des incidents alimentaires, les conseils sur la sécurité sanitaire des aliments et la réglementation relative aux denrées alimentaires à l’intention de l’industrie et la communication au grand public sur les questions relatives à la sécurité sanitaire des aliments.
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INTRODUCTION: The COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimat...e the number of visits lost through December 2020.
METHODS: We used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico's population-65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale.
RESULTS: The study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change.
CONCLUSION: Significant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.
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The sub-Saharan African region, carries 90% of the over 250 million cases of schistosomiasis occurring worldwide. In this region, after Nigeria, Tanzania is second country having the highest cases of schistosomiasis and approximately 51.5%0 of the Tanzanian population is either exposed or live in ar...eas with high risk of exposure. The country is endemic to both Schistosoma mansoni and Schistosoma haematobium, these infections are common in communities characterised with limited access to water, sanitation, hygienic practices and health services. Schistosoma mansoni infection is associated with hepatosplenic disease characterised with hepatomegaly, splenomegaly, progressive periportal fibrosis (PPF) which can lead to portal hypertension and its related sequelae, mainly ascites, liver surface irregularities, oesophageal varices and haematemesis. The main consequences of S. haematobium infection are haematuria, dysuria, nutritional deficiencies, urinary bladder lesions, hydronephrosis, urinary bladder squamous cell carcinoma and in children, growth retardation. Preventive chemotherapy using mass drug administration (MDA) of praziquantel targeting primary school aged children is the main strategy for controlling schistosomiasis in Tanzania.
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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.
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Many features of the environment have been found to exert an important influence on cardiovascular disease (CVD) risk, progression, and severity. Changes in the environment due to migration to different geographic locations, modifications in lifestyle choices, and shifts in social policies and cultu...ral practices alter CVD risk, even in the absence of genetic changes. Nevertheless, the cumulative impact of the environment on CVD risk has been difficult to assess
and the mechanisms by which some environment factors influence CVD remain obscure. Human environments are complex; and their natural, social and personal domains are highly variable due to diversity in human ecosystems, evolutionary histories, social structures, and individual choices. Accumulating evidence supports the notion that ecological features such as the diurnal cycles of
light and day, sunlight exposure, seasons, and geographic characteristics of the natural environment such altitude, latitude and greenspaces are important determinants of cardiovascular health and CVD risk. In highly developed societies, the influence of the natural environment is moderated by the physical characteristics of the social environments such as the built environment
and pollution, as well as by socioeconomic status and social networks. These attributes of the
social environment shape lifestyle choices that significantly modify CVD risk. An understanding
of how different domains of the environment, individually and collectively, affect CVD risk could
lead to a better appraisal of CVD, and aid in the development of new preventive and therapeutic
strategies to limit the increasingly high global burden of heart disease and stroke.
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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide...miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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Small drinking-water supplies commonly experience operational, managerial, technical and resourcing challenges that impact their ability to deliver safe and reliable services. The needs and opportunities associated with these supplies therefore warrant explicit consideration in policies and regulati...ons.
These Guidelines, specifically tailored to small water supplies, build on over 60 years of guidance by the World Health Organization (WHO) on drinking-water quality and safety. They focus on establishing drinking-water quality regulations and standards that are health based and context appropriate; on proactively managing risks through water safety planning and sanitary inspections; and on carrying out independent surveillance. The guidance is intended primarily for decision-makers at national and subnational levels with responsibility for developing regulatory frameworks and support programmes related to these activities. Other stakeholders involved in water service provision will also benefit from the guidance in this document.
Designed to be practical and accessible, these Guidelines offer clear guidance that is rooted in the principle of progressive improvement. State-of-the-art recommendations and implementation guidance are provided, drawn from a comprehensive evidence review and established good practices. Additionally, case examples are provided from countries and areas around the world to demonstrate how the guidance in this publication has been implemented in practice in a wide variety of contexts.
Together with WHO’s 2024 Sanitary inspection packages – a supporting tool for the Guidelines for drinking-water quality: small water supplies, these Guidelines update and supersede WHO’s 1997 Guidelines for drinking-water quality. Volume 3: surveillance and control of community supplies. Key changes to this updated publication include a greater focus on preventive risk management and a broader range of small water supplies covered, including those managed by households, communities and professional entities.
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In Latin America and the Caribbean (LAC), one maternal death was registered every hour in 2020. That same year, the trend in the maternal mortality ratio (MMR) for the Region of the Americas regressed alarmingly and unprecedentedly to the levels seen two decades ago. In addition to indicating a wors...ening of health outcomes, these figures also signal a deepening of inequalities, representing thousands of individual, unacceptable tragedies that in most cases could have been preventable. Maternal death is the result of a multifactorial process in which structural elements such as the economic system, environmental conditions, and culture interact. Other factors related to social inequality are also present, such as racism, poverty, gender inequality, and lack of access to the education system. The current situation calls for urgent mobilization of the health systems of LAC countries in order to strengthen efforts to combat maternal mortality, especially in countries that are still far from achieving the SHAA2030 regional target. For this reason, a preventive, health-promoting, life-course-based approach is needed, with models of care centered on women, families, and the community Scientific evidence shows that health systems with a solid foundation in primary health care (PHC) achieve better outcomes, greater equity, and reduced health expenditures. To address this, PAHO proposes a strategy, aimed primarily at women who are in the most vulnerable situation, who are the ones who represent the greatest burden of maternal mortality, to accelerate the reduction of maternal mortality in the Region of the Americas, based on the expansion and strengthening of PHC.
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Las geohelmintiasis son una de las parasitosis más comunes en el mundo, y se estima que 1500 millones de personas, el 24 % de la población mundial, están infestadas. Estas infestaciones afectan a las comunidades más pobres y desfavorecidas de zonas tropicales y subtropicales con un acceso defici...ente a servicios de agua limpia, saneamiento e higiene, y la prevalencia más alta se ha notificado en el África subsahariana, China, América del Sur y Asia. Las geohelmintiasis transmiten a través de los huevos de los parásitos eliminados con las heces fecales de las personas infestadas, que, a su vez, contaminan el suelo en zonas donde el saneamiento es deficiente. Más de 260 millones de niños en edad preescolar, 654 millones de niños en edad escolar, 108 millones de niñas adolescentes y 138,8 millones de embarazadas y madres lactantes viven en zonas donde la transmisión de esos parásitos es intensa y, por esa razón, necesitan tratamientos e intervenciones preventivas.
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Climate change also affects human health by increasing the frequency and intensity of extreme heat events. Increases in
the overall temperature of the atmosphere and oceans associated with climate change cause changes in wind, moisture, and heat circulation patterns. These changes contribute to shi...fts in extreme weather events, including extreme heat events.
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DHS Working Papers No. 112 | Zimbabwe Working Papers No. 13
This clinical job aid addresses the importance of maternal health and antiretroviral therapy adherence, as well as care and testing for the HIV-exposed infant until the infant’s final HIV diagnosis after the end of breastfeeding.
Anxiety disorders
Chapter F.1
2018 edition
On 15–16 December 2020, WHO and the Medicines for Malaria Venture co-convened a technical consultation to consider the preferred product characteristics (PPCs) for drugs used in malaria chemoprevention. The main goal of the technical consultation was to agree on the most important PPCs for drugs t...o protect populations from malaria (chemoprevention), while considering relevant measures of efficacy and the safety data needed to support WHO policy recommendations.
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La schistosomiase est une parasitose aiguë et chronique provoquée par des vers (trématodes) du genre Schistosoma. Selon les estimations, au moins 251,4 millions de personnes avaient besoin d’un traitement préventif en 2021. Le traitement préventif, qui devrait être renouvelé pendant un cert...ain nombre d’années, permettra de réduire et de prévenir la morbidité. La transmission de la schistosomiase est avérée dans 78 pays. Cependant, la chimioprophylaxie de la maladie, dont le but est de traiter à grande échelle les populations et les communautés, n’est nécessaire que dans 51 pays d’endémie où la transmission est de modérée à forte.
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La esquistosomiasis es una enfermedad parasitaria aguda y crónica causada por duelas sanguíneas (trematodos) del género Schistosoma. Se calcula que al menos 251,4 millones de personas necesitaron tratamiento profiláctico en 2021. El tratamiento profiláctico, que se debería repetir durante algu...nos años, permite reducir y prevenir la morbilidad. Hay constancia de la transmisión de la enfermedad en 78 países. Sin embargo, la quimioprofilaxis para la esquistosomiasis, en la que se aplica un tratamiento a gran escala a personas y comunidades, solamente se requiere en 51 países en los que la enfermedad es endémica y tienen una transmisión de moderada a alta.
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داء البلهارسيات هو مرض طفيلي حاد ومزمن تسبّبه الديدان المثقوبة الدموية (المثقوبات) من جنس البلهارسية. وتشير التقديرات إلى أن 251.4 مليون شخص على الأقل كانوا بحاجة إلى ...لعلاج الوقائي من داء البلهارسيات في عام 2021. ومن شأن العلاج الوقائي، الذي ينبغي تكراره على مدى عدة سنوات، أن يحد من المراضة ويمنعها. وقد أُبلغ عن سريان المرض في 78 بلداً. ومع ذلك، فإن العلاج الكيميائي الوقائي لداء البلهارسيات الذي يُستهدف فيه الأشخاص والمجتمعات المحلية بالعلاج على نطاق واسع، لا يلزم إلا في 51 بلداً موطوناً يشهد مستويات سريان المرض المتوسطة أو العالية.
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Шистосомоз является острой и хронической паразитарной болезнью, вызываемой кровяными сосальщиками (трематодными червями) из рода Schistosoma. В 2021 г. количество нуждаю...ихся в профилактическом лечении шистосомоза оценивалось на уровне не менее 251,4 млн человек. Профилактическое лечение, которое необходимо повторять через несколько лет, снижает и предотвращает заболеваемость шистосомозом. Передача шистосомоза регистрируется в 78 странах. Однако профилактическая химиотерапия в рамках широкомасштабного лечения шистосомоза среди людей и общин требуется только в 51 эндемичной стране с умеренными и высокими показателями передачи инвазии.
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