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.
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PlosOne December 10, 2014 https://doi.org/10.1371/journal.pone.0111913
Plastic pollution is ubiquitous throughout the marine environment, yet estimates of the global abundance and weight of floating plastics have lacked data, particularly from the Southern Hemisphere and remote regions. Here we re...port an estimate of the total number of plastic particles and their weight floating in the world's oceans from 24 expeditions (2007–2013) across all five sub-tropical gyres, costal Australia, Bay of Bengal and the Mediterranean Sea conducting surface net tows (N = 680) and visual survey transects of large plastic debris (N = 891). Using an oceanographic model of floating debris dispersal calibrated by our data, and correcting for wind-driven vertical mixing, we estimate a minimum of 5.25 trillion particles weighing 268,940 tons. When comparing between four size classes, two microplastic <4.75 mm and meso- and macroplastic >4.75 mm, a tremendous loss of microplastics is observed from the sea surface compared to expected rates of fragmentation, suggesting there are mechanisms at play that remove <4.75 mm plastic particles from the ocean surface.
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The aim of this article is to identify the elements behind the country’s successful COVID-19 rollout as well as lessons and chal lenges derived from this process. The analysis is relevant to many countries today—as they keep searching for strategies to cope with the second year of the COVID-19 p...andemic and the challenge of implementing a large-scale vaccine rollout—and in the coming years—as new variants develop and unceertainty about the vaccination strategy increases.
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En 2016, l’ONUSIDA lançait un appel pour que les pays d’Afrique de l’Ouest et du Centre accélérent la riposte au sida. En effet, si dans des pays d’Afrique de l’Est et du Sud les avancées sont réelles, ceux de l’Afrique de l’Ouest et du Centre sont encore en retard dans l’accès... au dépistage et au traitement antirétroviral. Le 3 juillet 2017, les Présidents de l’Union Africaine avaient adopté un plan de rattrapage pour l’Afrique de l’Ouest et du Centre avec l’appui de ONUSIDA, dans le but d’inverser la tendance de l’épidémie et combler les gaps financiers et programmatiques pour l’atteinte des 90-90-90 en 2020. Le Sénégal, à l’instar des pays de la sous région, s’est engagé à élaborer et mettre en œuvre son plan de rattrapage en 2018 pour accélérer les interventions vers l’atteinte de cet objectif. Le plan de rattrapage du Sénégal est lancé officiellement en janvier 2018 au Novotel en présence des autorités, des acteurs et des partenaires.
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It is widely understood that the food insecurity crisis in the Sahel and the Horn of Africa is one of the world’s fastest growing and most neglected crises. It lacks sufficient global focus, resources and urgency. As in so many crises, women and girls are disproportionately affected and shoulder t...he consequences of protracted neglect, with unconscionable impacts on their safety, life chances and agency.
Gaining a holistic view of the gendered drivers, risks and impacts of food insecurity in the Sahel and the Horn of Africa is difficult. This is due to a lack of data and prioritization, and the large geographical and socioeconomic terrain covered by both regions. However, what we do know about this crisis is more than enough to urgently address the needs of women and girls.
An OCHA discussion paper on this topic (which will be published imminently, and from which this policy brief is drawn) found that there is:
A strong risk of profound regression in gender equality gains made to date in the countries of concern, including on education, sexual and reproductive health, and the economic independence of women and girls (with knock-on effects on broader humanitarian and development outcomes).
An increasing challenge to reverse what must be recognized as a protracted and growing gender-based violence (GBV) emergency in the Sahel and the Horn of Africa.
The food insecurity crisis in the Sahel and the Horn of Africa is protracted, multidimensional and highly gendered, with spiralling impacts on gender equality and food security outcomes. It is driven by interwoven and overlapping factors, including climate change, political instability, conflict, socioeconomic conditions, migration and displacement and, more recently, COVID-19 and the war in Ukraine. Interlinked with these factors are gendered structural drivers of food insecurity, including deeply entrenched gender inequalities and harmful social norms. Gendered risks and impacts of food insecurity include alarming limitations on access to education, sexual and reproductive health rights, women’s agency and participation, and dramatic increases in different existing forms of GBV and the emergence of new ones. Recognition of such gendered dimensions of food insecurity and of the need for a multisectoral approach in the response is key to addressing the crisis, along-side sustained commitment and adequate allocation of resources. This policy brief draws out key findings from the OCHA discussion paper on this topic, which includes a desk review of studies, assessments and reports, and interviews with local women’s organizations on the front lines of the food insecurity crisis in communities across both regions.
Below are the most pressing gendered drivers, risks and impacts of food insecurity (not in order of priority), as well as key gaps in the current humanitarian response to food insecurity, and recommendations to take forward.
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Epidemiology
Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi, and transmitted to humans by infected triatomine bugs, and less commonly by transfusion, organ transplant, from mother to infant, and in rare instances, by ingestion of contaminated food or... drink.1-4 The hematophagous triatomine vectors defecate during or immediately after feeding on a person. The parasite is present in large numbers in the feces of infected bugs, and enters the human body through the bite wound, or through the intact conjunctiva or other mucous membrane.
Vector-borne transmission occurs only in the Americas, where an estimated 8 to 10 million people have Chagas disease.5 Historically, transmission occurred largely in rural areas in Latin America, where houses built of mud brick are vulnerable to colonization by the triatomine vectors.4 In such areas, Chagas disease usually is acquired in childhood. In the last several decades, successful vector control programs have substantially decreased transmission rates in much of Latin America, and large-scale migration has brought infected individuals to cities both within and outside of Latin America.
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Since the last situation report on the multi-country outbreak of cholera was published on 6 July 2023 (covering data reported until 15 of June), and as of 15 July 2023, one new outbreak of cholera was reported from India on 15 May 2023. In total, 25 countries have reported cases since the beginning ...of 2023. The WHO African Region remains the most affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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The WHO End TB Strategy aims to end the global TB epidemic by 2030, in alignment with Goal 3 of the United Nations (UN) Sustainable Development Goals (SDGs). Member States of the World Health Organization (WHO) and the UN committed to ending the TB epidemic through adoption of WHO’s End TB Strateg...y and the UN SDGs in 2014 and 2015, respectivel
Almost half of the deaths worldwide caused by TB in 2019 occurred in the WHO South-East Asia Region, home to around a quarter of the global population. Maintaining robust progress in this Region is therefore essential if the global goal of ending the TB epidemic is to be realized. Despite substantial gains made in the Region, the threat to
health worldwide posed by the COVID-19 pandemic has the potential to reverse these gains and eclipse the focus on the global TB emergency.
While continuing to tackle COVID-19-related challenges, countries will need to rapidly and urgently deploy supplementary measures to address the large numbers of missed cases, poor treatment outcomes and, potentially, a higher TB burden.
The Regional Strategic Plan towards Ending TB in the Region 2021–2025 clearly articulates priority interventions, analyses the challenges, bottlenecks and opportunities, and focuses on implementation considerations in the Region.
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Cholera is an acute gastrointestinal infection caused by the bacterium Vibrio Cholerae serogroup O1 or O139, and is often linked to unsafe drinking water, lack of proper sanitation and personal hygiene. It adversely affects mostly the poor and vulnerable populations in countries, which are already d...eprived of proper health facilities and conducive environmental conditions. The disease spreads through oro-fecal transmission by the ingestion of contaminated food or water or by person-to-person contact. It has a short incubation period of 2 hours to 5 days and the number of affected cases can rapidly increase across large regions. Cholera is a significant threat to global public health leading to an estimated 3-5 million cases per year worldwide, with an annual toll of 100,000 deaths. The disease was first reported in 1817 from the Ganges Delta of India and since then the ongoing 7th pandemic has emerged from Indonesia, reached Africa in 1970 and Somalia happens to be one of the early affected countries. Over the past few decades,
Somalia has witnessed the occurrence of repeated AWD/Cholera disease outbreaks that have caused high morbidity and mortality across the country.
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Slavery on fishing vessels, degradation of ecosystems, overfishing, debt bondage, human trafficking and child labour in peeling sheds – the scandals surrounding the Thai fishery and shrimp industries have garnered international censure. Farmed and processed at the cost of extreme exploitation of b...oth people and the planet, Thai shrimp ends up on plates around the world. The former delicacy can now be bought cheaply everywhere. But how high is the price really? And who has to pay it?
This report by seeks to remind governments in the countries of production that it is their duty to enforce human rights and living wages, rather than to compete for the favour of large companies to the detriment of people and the environment. It also appeals to consumers and their governments – and to importers – to send a clear message to suppliers in Thailand and elsewhere: If you want to survive on the global market, you need to respect human rights and child rights, and uphold social and environmental standards.
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Thousands of HIV-positive Venezuelans have been forced to leave the country, after facing discrimination and zero treatment options, according to UNAIDS.
Patients once received free ARV treatment under Venezuela’s National AIDS Program. In 2017, the country essentially ran out of ARVs—about 9 p...eople a day died from HIV-related illnesses that year.
“Today, HIV patients in Venezuela have three options: go untreated, buy the medication abroad or on the black market for large sums, or leave the country,” writes Gabriela Mesones Rojo.
The exodus of untreated Venezuelans could shift the course of the epidemic throughout the region.
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To implement the set of recommendations on the marketing of foods and non-alcoholic beverages to children
With the growing obesity crisis among children, WHO and other public health advocates and consumer groups have called for restrictions on advertising of ‘unhealthy foods’ high in salt, ...sugar and fat to children. Each day, children in the South East Asia Region are exposed to large volume of marketing of unhealthy foods that may influence children’s food preferences and consumption patterns and is associated with childhood overweight and obesity.
The definition of ‘unhealthy’ is debatable, and therefore, an objective method of describing foods as healthy or unhealthy is needed. A nutrient profile model does just that and therefore, a nutrition profile model for South East Asia was developed. The model is consistent with international guidance for preventing chronic disease and is a simple system with clear cut-offs for defining which foods are not suitable for advertising to children.
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Worldwide, around 2.3 billion people still cook using solid fuels (such as wood, crop waste, charcoal, coal and dung) and kerosene in open fires and inefficient stoves. Most of these people are poor and live in low- and middle-income countries. There is a large discrepancy in access to cleaner cooki...ng alternatives between urban and rural areas: in 2021, only 14% of people in urban areas relied on polluting fuels and technologies, compared with 49% of the global rural population.
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Lancet, Published:February 21, 2019DOI:https://doi.org/10.1016/S0140-6736(19)30424-6.
This article announce the establishment of Countdown Global Mental Health, an independent, multistakeholder monitoring and accountability collaboration for mental health, within an initial timeframe of the UN Sust...ainable Development Goals (SDGs). The scope of the Countdown will be global since mental health is an issue relevant to all countries. The unit of analysis will be countries or states or provinces within large federated countries. Given the huge disparities between and within countries, we expect the Countdown to be a strong instrument for accountability to decrease population-level disparities for mental health.
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This action plan for the Kingdom Saudi Arabia to combat antimicrobial resistance has been formulated in the line of the WHO five objectives. It addresses the need for effective “one health” approach involving coordination among numerous national sectors and actors, including human and veterinary... medicine, agriculture, finance, environment, and well-informed consumers. Therefore, a large committee of all stakeholders was formed with five technical subcommittees were established to addresses every aspect
to contain antimicrobial resistance in the country.
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Bei vielen schwer erkrankten Menschen muss mit einer im Verhältnis zu anderen schweren ARE längeren Behandlung mit Beatmung/zusätzlichem Saürstoffbedarf gerechnet werden. Da weder eine Impfung noch eine spezifische Therapie derzeit zur Verfügung stehen, müssen alle Massnahmen darauf ausgericht...et sein, die Verbreitung der Erkrankung so gut wie möglich zu verlangsamen. Es gibt 3 Komponenten: A) Verhinderung der Ausbreitung durch Fallfindung und Absonderung von engen Kontaktpersonen, B) soziale Distanz schaffen und C) gezielter Schutz von vulnerablen Gruppen, die aktiviert und intensiviert werden müssen ent-sprechend der jeweils aktuellen Lage
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Des efforts considérables ont été menés pour apporter aux
populations rurales du continent africain des soins de base. Mais
la qualité de ces soins reste aujourd’hui peu satisfaisante car le
médecin généraliste est le plus souvent absent en première
ligne. Cette situation est paradoxa...le en regard du nombre de
médecins formés dans les facultés en Afrique francophone et à
Madagascar. Le déficit en médecin généraliste, exerçant dans les
zones rurales, reste particulièrement préoccupant alors que
les jeunes médecins sans emploi se multiplient dans les villes.
L’ONG Santé Sud, depuis plus de vingt ans, propose un concept
– la médecine générale communautaire – qui, associé à un dispositif
d’accompagnement, a permis l’installation de plus de deux
cents médecins généralistes communautaires au Mali et à
Madagascar. Ce concept a pour intérêt d’associer, dans une même
pratique, la médecine de famille et les Soins de Santé Primaires.
S.F.S.P. | « Santé Publique »
2014/HS S1 | pages 59 à 65
Considerable effort has been made to provide rural African
populations with basic health care, but the quality of this care
remains unsatisfactory due to the absence of first-line GPs. This is
a paradoxical situation in view of the large number of physicians
trained in medical schools in French-speaking Africa and
Madagascar. of the lack of GPs working in rural areas is a real
concern, as many young doctors remain unemployed in cities.
For more than 20 years, the NGO Santé Sud has proposed a
Community General Medicine concept, which, combined with
a support system, has allowed the installation of more than
200 community GPs in Mali and Madagascar. The advantage of
this concept is that it provides family medicine and primary health
care in the same practice.
S.F.S.P. | « Santé Publique »
2014/HS S1 | pages 59 à 65
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Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide ho...usehold and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap.
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The article "Under- and over-diagnosis of COPD: a global perspective" reviews the worldwide variation in the prevalence of chronic obstructive pulmonary disease (COPD) and issues related to its misdiagnosis. It highlights that COPD is under-diagnosed due to factors such as limited access to spiromet...ry and variable diagnostic criteria, especially in low- and middle-income countries. Conversely, over-diagnosis often results from reliance on non-standard criteria or inadequate spirometry use. The article discusses key risk factors, including age, gender, exposure to pollutants, and comorbidities, and emphasizes the need for standardized diagnostic practices to better address and manage COPD globally.
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Cystic fibrosis (CF) was earlier thought to be a disease prevalent in the West among Caucasians. However, quite a number of recent studies have uncovered CF cases outside of this region, and reported hundreds of unique and novel variant forms of CFTR. Here, we discuss the evidence of CF in parts of... the world earlier considered to be rare; Africa, and Asia. This review also highlighted the CFTR mutation variations and new mutations discovered in these regions. This discovery implies that the CF data from these regions were earlier underestimated. The inadequate awareness of the disease in these regions might have contributed towards the poor diagnostic facilities, under-diagnosis or/and under-reporting, and the lack of CF associated health policies. Overall, these regions have a high rate of infant, childhood and early adulthood mortality due to CF. Therefore, there is a need for a thorough investigation of CF prevalence and to identify unique and novel variant mutations within these regions in order to formulate intervention plans, create awareness, develop mutation specific screening kits and therapies to keep CF mortality at bay.
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