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2
Guidelines for Management of ST-Elevated Myocardial Infarction
Directorate General of Health Services
Ministry of Health & Family Welfare Government of India
(2022)
CC
Myocardial infarctions are generally clinically classified into ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI), based on changes in ECG. When blood flow to a part of the heart stops or the heart is injured and fails to receive enough oxygen required for its adequate functioning the conditi
...
on is termed as STEMI or the ‘heart-attack’ in laymen language. Patients with elevated cardiac troponin levels but negative CK-MB who were formerly diagnosed with unstable angina or minor myocardial injury are now reclassified as non-ST-segment elevation Myocardial Infarction (non-STEMI) even in the absence of diagnostic changes.
more
WHO has published the first-ever guidance on the clinical management of diphtheria. The only previously available guidance was an operational protocol. The new guidance followed the rigorous process for developing guidance at WHO.
It addresses the use of Diphtheria Antitoxin (DAT) in the treatmen
...
t of diphtheria. There is a worldwide shortage of DAT and evidence based recommendations on the use of DAT were requested by many Member States.
The guidance also includes new recommendations on antibiotics. In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) rather than penicillin antibiotics.
This clinical practice guideline has been rapidly developed recognizing the global increase in diphtheria outbreaks. Outbreaks of diphtheria in Nigeria, Guinea and neighbouring countries in 2023 have highlighted the urgent need for evidence-based clinical practice guidelines for the treatment of diphtheria. Given the sporadic nature of outbreaks, many clinicians in the affected regions have never managed acute diphtheria and its related complications. Diphtheria remains a neglected disease and vaccination is the top priority. At the same time, for patients with diphtheria, access to antibiotics, DAT and supportive care can be lifesaving.
more
The ERF provides WHO staff with essential guidance on how the Organization manages the assessment, grading and response to public health events and emergencies with health consequences, in support of Member States and affected communities. The ERF adopts an all-hazards approach and it is therefore a
...
pplicable in all acute public health events and emergencies.
This version (2024) of the WHO ERF has been developed following extensive consultation across the three levels of the Organization and response experiences over the last five years of emergency response. Key areas have been updated to improve the accountability, predictability, timeliness and effectiveness of WHO’s response to emergencies.
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 physical activity occurs may promote physical activity a
...
t 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
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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The Guidelines for drinking-water quality: small water supplies have been developed to address the needs and opportunities associated with small supplies to facilitate progressive improvement towards safe and sustainable drinking-water services for all. These Guidelines are based on the principal re
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commendation in the World Health Organization’s Guidelines for drinking-water quality, and they provide guidance on applying that recommendation to small water supplies in particular. These Guidelines aim to help governments and practitioners improve the safety of drinking-water delivered through small supplies.
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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
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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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Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status—wealth and education—differ among
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high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.
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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
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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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Objective: To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training in three underserved communities in Brazil.
Metho
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ds: A cross-sectional, population-based survey of non-institutionalised adults age 30 or greater was conducted in three municipalities in Eastern Brazil. Data were analysed as survey-weighted percentages of the sampled populations.
Results: 3035 surveys were completed. Overall, one-third of respondents was unable to identify at least one cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction symptom. A minority of respondents had received training in CPR or were able to identify an AED. Low levels of education and low socioeconomic status were consistent predictors of lower knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR and AED use.
Conclusions: In three municipalities in Eastern Brazil, overall public knowledge of cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate CPR and AED use was low. Our findings indicate the need for interventions to improve public knowledge and response to acute cardiovascular events in Brazil as a first step towards improving health outcomes in this population. Significant heterogeneity in knowledge seen across sites and socioeconomic strata indicates a need to appropriately target such interventions.
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As the Americas undergo profound demographic change and there are more persons aged 65 years or older than children younger than 5 years, it is crucial to recognize that national immunization programs must be redesigned to ensure comprehensive protection for individuals across the lifespan. By adopt
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ing a life course approach (LCA) to immunization, vaccination programs can be tailored to close immunity gaps at different stages of life. The life course approach foresees the establishment of multiple strategies to reduce missed opportunities for vaccination according to age group. This technical document explains the key concepts of the LCA with a focus on immunization by vaccination, as well as the underlying biological mechanisms that require the application different vaccines at different life stages according to changes to the immune system and in the epidemiological situation of a community.
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Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns
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of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment.
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The World Food Programme (WFP) has taken important steps to progress disability inclusion across its programming and operations. In late 2022, WFP commissioned the Nossal Institute, University of Melbourne in partnership with the Faculty of Psychology, Universitas Gadjah Mada, Indonesia to identify
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pathways for increasing disability inclusion in WFP’s emergency preparedness and response (EPR) programming.
The study explored WFP’s programming in Indonesia and the Philippines, including WFP’s advisory, technical assistance and service provision roles to government and partners and informed the development of this guide (see appendix 2). As general guidance on disability inclusion is increasingly available, the purpose of this guide is to contextualize disability inclusion in WFP’s emergency preparedness and response programming. The guide builds on core reference materials, such as the Inter-Agency Standing Committee (IASC) Guidelines on Inclusion of Persons with Disabilities in Humanitarian Action, 2019. While of wider relevance, this guide is directed at WFP’s EPR programming in Asia and the Pacific.
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To survive and thrive, children and adolescents need good health, adequate nutrition, security, safety and a supportive clean environment, opportunities for early learning and education, responsive relationships and connectedness, and opportunities for personal autonomy and self-realization. To prom
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ote their health and wellbeing, children and adolescents need support from parents, families, communities, surrounding institutions, and an enabling environment. Scheduled well care visits provide a critical opportunity for support of individual children, adolescents, parents, caregivers and families promote health and wellbeing. This guidance on scheduled child and adolescent well-care visits is the first in a series of publications to support the operationalization of the comprehensive agenda for child and adolescent health and wellbeing. It provides guidance on what is required to strengthen health systems and services to ensure healthy growth and development of all children and adolescents, and to support their parents and caregivers.
The guidance focuses on scheduled routine contacts with providers to support children and adolescents in their growth and developmental trajectory, as well as their primary caregivers and families. It outlines the rationale and objectives of well care visits and proposes a minimum 17 scheduled visits; describes the expected tasks during a contact; provides age-specific content to be address during each contact; and proposes actions to build on and maximize existing opportunities and resources.
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Developed as part of the UN Women–WHO Global Joint Programme on Violence Against Women Data, this briefing note focuses on the measurement of violence against women with disability and is one in a series of methodological briefing notes for strengthening the measurement and data collection of viol
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ence against particular groups of women or specific aspects of violence against women.
The briefing note is meant for researchers, national statistics offices, and others involved in data collection on violence against women. It provides an overview of the challenges in the availability, measurement, and collection of data on violence against women with disability and outlines recommendations for good practice in measurement, with the aim of strengthening ongoing and future data collection efforts and increasing the availability of such data.
The inclusion of women with disability and the issue of disability within population-based surveys and research on violence against women is necessary for an improved understanding of populations of women at specific risk of violence. This knowledge would also allow more tailored prevention strategies and response/services and programmes to be designed in a way that addresses the specific needs of women with disability.
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At the global, national, and regional levels, there are several guidelines and guides regarding the preparedness, prevention, surveillance, and control of diseases caused by respiratory viruses; most initiatives focus on specific virus events or cases. During the coronavirus disease 2019 (COVID-19)
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pandemic, it has been found that even when there are strategies designed and planned for pandemics, it is necessary to strengthen and improve them. Planning for imminent threats, including those posed by respiratory viruses, contributes to strengthening the core capacities of the International Health Regulations (IHR [2005])
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Terminology used to describe the transmission of pathogens through the air varies across scientific disciplines, organizations and the general public. While this has been the case for decades, during the coronavirus disease (COVID-19) pandemic, the terms ‘airborne’, ‘airborne transmission’ a
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nd ‘aerosol transmission’ were used in different ways by stakeholders in different scientific disciplines, which may have contributed to misleading information and confusion about how pathogens are transmitted in human populations.
This global technical consultation report brings together viewpoints from experts spanning a range of disciplines with the key objective of seeking consensus regarding the terminology used to describe the transmission of pathogens through the air that can potentially cause infection in humans.
This consultation aimed to identify terminology that could be understood and accepted by different technical disciplines. The agreed process was to develop a consensus document that could be endorsed by global agencies and entities. Despite the complex discussions and challenges, significant progress was made during the consultation process, particularly the consensus on a set of descriptors to describe how pathogens are transmitted through the air and the related modes of transmission. WHO recognizes the important areas where consensus was not achieved and will continue to address these areas in follow-up consultations.
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Heart and circulatory diseases is an umbrella term for all diseases of the heart and circulation. It includes everything from conditions that are inherited or that a person is born with, to those that develop later, such as coronary heart disease, atrial fibrillation, heart failure, stroke and vascu
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lar dementia.
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This is an update (third edition) of the BACPR Standards & Core Components and represents current evidence-based best practice and a pragmatic overview of the structure and function of Cardiovascular Prevention and Rehabilitation Programmes (CPRPs) in the UK. The previously described seven standards
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have now been reduced to six but without sacrificing any of the key elements and with a greater emphasis placed on measurable clinical outcomes, audit and certification. Similarly, the second edition provided an overview of seven core components felt to be essential for the delivery of quality prevention and rehabilitation, and this too has been reduced to six. The interplay between cardio-protective therapies and medical risk factors is almost impossible to disentangle for the vast majority of patients and even if specific drug therapies are deployed exclusively for risk factor modulation, the indirect effect will also be cardio-protective. Thus, these have been combined into a single core component – medical risk management.
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Comprehensive Primary Health Care has an important role in the primary and secondary prevention of several disease conditions, including non-communicable diseases which today contribute to over 60% of the mortality in India. The provision of Comprehensive primary health care reduces morbidity, disab
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ility and mortality at much lower costs and significantly reduces the need for secondary and tertiary care. Estimates suggest that almost 52% of all conditions can be managed at the
primary care level.
In order to ensure comprehensive primary health care, close to where people live, Sub- Centres should be strengthened as Health and Wellness Centres (H&WC), staffed by appropriately trained primary health care team. The Medical officer of the Primary Health Centre would oversee the functioning of the SC/HWC that falls in that area.
Services include those that (i) can be delivered at the level of the household and outreach sites in the community by suitably trained frontline workers, (ii) those that are delivered by a team headed by a mid-level health provider, at the level of the Sub-Centre/Health and Wellness Centre and (iii) the referral support and continuity of care within the district health system in rural and urban areas. The package of services is in Box. States would need to either phase in these services or add on additional services based on state specific and local context.
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