The WHO Pharmaceuticals Newsletter provides you with the latest information on the safety of medicinal products and regulatory actions taken by authorities around the world.
In addition, this edition includes summary and recommendations from the virtual meeting of the members of the WHO Programme f...or International Drug Monitoring (PIDM) and other partners, which was held on 20 October 2022.
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Tuberculosis (TB) is, and should be, a curable disease; however, each year significant numbers of patients acquire or develop drug-resistant TB, which has a much lower cure rate. Patients with drug-resistant TB have a high prevalence of symptoms; hence, staff caring for these patients should h...ave some familiarity with palliative care, so that general palliative care principles are available to all patients. The timely identification, and addressing, of adverse events occurring during the treatment course is considered as general palliative care for those receiving curative treatment. This publication summarizes the general palliative care approach, which is recommended for use in settings and services that occasionally treat palliative care patients, but do not provide palliative care as the main focus of their work. The review focuses on 18 high TB priority countries of the WHO European Region.
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The main objective of these guidelines is to provide guidance on up-to-date, uniform, evidence-informed practices for suspecting, diagnosing and managing various forms of extra-pulmonary tuberculosis (EPTB) at all levels of healthcare delivery. They can then contribute to the National Programme to i...mprove detection, care and outcomes in EPTB; to help the programme with initiation of treatment, adherence and completion whilst minimizing drug toxicity and overtreatment; and contribute to practices that minimize the development of drug resistance.
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Leprosy/Hansen disease is a chronic infectious disease primarily impacting the skin and peripheral nerves. If left untreated, leprosy can have long-term consequences, including deformities and disabilities, which are associated with stigma. Leprosy is one of the 21 neglected tropical diseases (NTDs)..., a group of conditions prevalent in tropical regions. In the “WHO Roadmap for Neglected Tropical Diseases 2021–2030”, leprosy, human African trypanosomiasis (HAT) and onchocerciasis are targeted for interruption of transmission. Acknowledging the growing necessity for establishing a process to verify the absence of new autochthonous leprosy cases, a technical guidance has been developed outlining a clear pathway, demarcating phases with
indicators and milestones leading towards the elimination of leprosy disease.
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Nat Commun 9, 5370 (2018). https://doi.org/10.1038/s41467-018-07804-8. Mycobacterium ulcerans is the causative agent of Buruli ulcer, a neglected tropical skin disease that is most commonly found in children from West and Central Africa. Despite the severity of the infection, therapeutic options are... limited to antibiotics with severe side effects. Here, we show that M. ulcerans is susceptible to the anti-tubercular drug Q203 and related compounds targeting the respiratory cytochrome bc1:aa3. While the cytochrome bc1:aa3 is the primary terminal oxidase in Mycobacterium tuberculosis, the presence of an alternate bd-type terminal oxidase limits the bactericidal and sterilizing potency of Q203 against this bacterium. M. ulcerans strains found in Buruli ulcer patients from Africa and Australia lost all alternate terminal electron acceptors and rely exclusively on the cytochrome bc1:aa3 to respire. As a result, Q203 is bactericidal at low dose against M. ulcerans replicating in vitro and in mice, making the drug a promising candidate for Buruli ulcer treatment.
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Acta Trop. 2020 Mar:203:105289. doi: 10.1016/j.actatropica.2019.105289
The role of malacological surveys to identify potential transmission sites for schistosomiasis control in this era of
mass drug administration have received little attention. In that context, the present study was conducted to
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determine the abundance, identity and disease transmission potential of intermediate host snails for intestinal
schistosomiasis on Ijinga Island, north-western Tanzania.
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hese are two parallel guidelines, one for small hospitals and another one for large hospitals. In view of heavy burden of malaria and prevalence of drug resistant falciparum malaria in the South-East Asia Region, the guidelines were developed for use by medical personnel who treat severe malaria pat...ients, referred from lower-level health facilities. The guidelines were developed by the WHO Regional Office for South-East Asia and the WHO Collaborating Centre for the Clinical Management of Malaria, Faculty of Tropical Medicine, Mahidol University, Thailand. The guidelines are based on a review of current evidence, existing WHO guidelines and experience in the management of malaria in the Region
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Antibiotic Stewardship (AS) is a coordinated program that promotes the appropriate use of antimicrobials to improve patient outcomes, reduce microbial resistance, and decrease the spread of multi-drug resistant organisms. In clinical settings, stewardship activities focus on measuring and improving ...how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management.
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The goal of this addendum is to help management and staff
minimize the risk of TB transmission at facilities in resource limited settings in which a.) HIV-infected persons receive diagnosis, care, treatment,
and/or support, and b.) there is a high prevalence of HIV infection, both known
and... undiagnosed, in settings such as prisons, jails, other
detention centers, and drug rehabilitation centers.
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The WHO standard: Universal access to rapid tuberculosis diagnostics sets benchmarks to achieve universal access to WHO-recommended rapid diagnostics (WRDs), increase bacteriologically confirmed tuberculosis and drug resistance detection, and reduce the time to diagnosis. WHO-recommended rapid diagn...ostics are highly accurate, cost-effective, reduce the time to treatment initiation, and impact patient-important outcomes.
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The Updated guidelines on Management of tuberculosis in children and adolescents include new recommendations that cover diagnostic approaches for TB, shorter treatment for children with non-severe drug-susceptible TB, a new option for the treatment of TB meningitis, the use of bedaquiline and delama...nid in young children with multidrug- and rifampicin-resistant TB and decentralized and family-centred, integrated models of care for TB case detection and prevention in children and adolescents.
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The current guidelines on Integrated Management of Acute Malnutrition (IMAM), addresses the issue of improved management of severe acute malnutrition (SAM), particularly in children under 5 years of age. In the absence of standard protocols, mortality in children admitted to hospital with SAM can ra...nge between 20 -30% with the highest levels of 50-60% among those with oedematous malnutrition. With modern treatment regimens and improved access to treatment, case-fatality rates can be reduced to less than 5%. These provincial guidelines on IMAM in KZN, includes inpatient care protocols on the management of SAM, and outpatient and community outreach components to manage moderate acute malnutrition (MAM) and prevent deterioration to SAM.
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Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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Malaria is a prevalent cause of febrile illnesses in areas with high transmission, and its clinical presentation overlaps with initial signs of Ebola disease. For this reason, the effectiveness of the Ebola response in Guinea, Liberia and Sierra Leone can be optimized through the deployment of targe...ted measures to reduce the number of fever cases due to malaria
WHO recommends specific adaptations in the diagnosis of malaria and in LLIN distribution in countries heavily affected by the Ebola outbreak and mass drug administration using artemisinin-based combination therapies (ACTs) in areas where transmission of both Ebola and malaria is high and access to malaria treatment is very low.
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Of the 50 antibiotics in the pipeline, 32 target WHO priority pathogens but the majority have only limited benefits when compared to existing antibiotics. Two of these are active against the multi-drug resistant Gram-negative bacteria, which are spreading rapidly and require urgent solutions.
Gr...am-negative bacteria, such as Klebsiella pneumoniae and Escherichia coli, can cause severe and often deadly infections that pose a particular threat for people with weak or not yet fully developed immune systems, including newborns, ageing populations, people undergoing surgery and cancer treatment.
The report highlights a worrying gap in activity against the highly resistant NDM-1 (New Delhi metallo-beta-lactamase 1), with only three antibiotics in the pipeline. NDM-1 makes bacteria resistant to a broad range of antibiotics, including those from the carbapenem family, which today are the last line of defence against antibiotic-resistant bacterial infections.
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Tuberculosis (TB) is an infectious disease that usually affects the lungs, though it can affect any organ in the body. It can develop when bacteria spread through droplets in the air. TB can be fatal, but in many cases, TB is preventable and treatable. This report examines the human rights impact of... the prevalence of Tuberculosis (TB) and Multi-drug-resistant tuberculosis (MDR-TB) among the Indigenous San peoples of Namibia. Combining political economy and root-cause methodology, the report explores the socioeconomic factors that make the San vulnerable to TB and limit their access to adequate health services.
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Mental health problem is one of the growing major public health issues in the Asia Pacific region. It contributes to the high number of Disability Adjusted Life Years (DALYs), morbidity and mortality in the region. It is expected that leading mental health problems will occur in the low-and middle-i...ncome countries (LMICs) and majority of the countries which comes under this category are in the Asia Pacific region. In addition, mental health problem hamper the achievement of Millennium Development Goals (MDGs), particularly MDG 1, MDG 4 and MDG 5. The most common mental health problems in the region are depression, anxiety, posttraumatic stress disorder, suicidal behaviour and substance abuse disorder. Several modifiable and non-modifiable risk factors were identified for the cause of these major mental health issues. Interventions, programmes and policies need to be designed in order to curb mental health problems at all levels.
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In recent years Terre des Hommes Netherlands observed the steady rise of a new form of child sexual exploitation. One that is enabled and fuelled by rapid technological advances, increasing global connectivity, persisting poverty rates, and growing disparity in the global distribution of resources. ...Terre des Hommes Netherlands received alarming signals from collaborating project partners from the Philippines that new commercial child exploitation trades are evolving and spreading parallel to rising global Internet access rates and developments in communications technology.
Webcam child sex tourism is evidently growing, closely related to child prostitution, child trafficking and child abuse. What is not clear however, are the psychological and social consequences of this new phenomenon. To date, no research has been done on the psychosocial consequences of webcam sex for children. The aim of this research is therefore to gain more knowledge on the psychosocial consequences of webcam child sex tourism for children and to give insight into the antecedent factors that play a role.
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Despite the increasing population of refugees stuck in protracted situations and our awareness of the vulnerability of children and adolescents growing in up these contexts, relatively little is known about community based child protection mechanisms (CBCPMs) in refugee communities. CBCPMs, defined ...broadly, include all groups or networks that respond to and prevent problems of child protection and vulnerable children. These mechanisms may include family supports, peer group supports, and community groups such as primary and secondary schools, non-formal education and vocational training structures, women’s groups, religious groups, and youth groups, as well as traditional community processes, government mechanisms, and mechanisms initiated by international or domestic non-governmental organisations (NGOs). In diverse contexts, CBCPMs represent front-line, day-to-day efforts to protect children from exploitation, abuse, violence, and neglect and to promote children’s well being. This study, together with a parallel study conducted among the urban refugee population in Uganda, is the first study of CBCPMs undertaken in refugee settings.
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The guidelines begin with an overview of the determinants of mental health among children and adolescents before reviewing related South African policies and legislation. The document then discusses strategies to build skills among caregivers, teachers and other frontline providers of mental health ...interventions as well as those for counselling professionals. The guidelines conclude by identifying priority areas for mental health services among children and adolescents, including the prevention of child and substance abuse as well as services for those living with intellectual disabilities
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