For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and... burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
more
his sequel to the Groundswell report includes projections and analysis of internal climate migration for three new regions: East Asia and the Pacific, North Africa, and Eastern Europe and Central Asia. Qualitative analyses of climate-related mobility in countries of the Mashreq and in Small Island D...eveloping States (SIDS) are also provided. This new report builds on the scenario-based modeling approach of the previous Groundswell report from 2018, which covered Sub-Saharan Africa, South Asia, and Latin America. The two reports’ combined findings provide, for the first time, a global picture of the potential scale of internal climate migration across the six regions, allowing for a better understanding of how slow-onset climate change impacts, population dynamics, and development contexts shape mobility trends.
Available in English, French, Arabic, Spanish
more
Development assistance for health (DAH)
plays a vital role in supporting health programmes in lowand middle-income countries. While DAH has historically
focused on infectious diseases and maternal and child
health, there is a lack of comprehensive analysis of DAH
trends, strategic shifts and the...ir impact on health systems
and outcomes. This study aims to provide a comprehensive
review of DAH from 1990 to 2022, examining its evolution
and funding allocation shifts.
more
This assessment is the first of its kind to be conducted in the south-eastern region of Myanmar. It is an important contribution to ensuring the full inclusion of women and children in Myanmar’s political, social, and cultural systems, with a specific focus on the issue of gender-based violence (G...BV) and its impact on these groups in south-eastern Myanmar. The United Nations Population Fund (UNFPA) is grateful for the participation of women, men, boys and girls from Mon, Kayin and Kayah States for sharing their views and experiences during the study.
more
Q4: Can convulsive epilepsy be diagnosed at first level care by a non-specialist health care provider in low and middle income country settings?
A new formulation of a drug to prevent excessive bleeding following childbirth could save thousands of women’s lives in low- and lower-middle-income countries, according to a study led by the World Health Organization (WHO) in collaboration with MSD for Mothers and Ferring Pharmaceuticals.
Curren...tly WHO recommends oxytocin as the first-choice drug for preventing excessive bleeding after childbirth. Oxytocin, however, must be stored and transported at 2–8 degrees Celsius, which is hard to do, in many countries, depriving many women of access to this lifesaving drug. When they can obtain it, the drug may be less effective because of heat exposure.
more
It is estimated that around 2 billion people worldwide do not have access to essential medicines. Access to medicines in the Eastern Mediterranean Region varies among countries, depending on their income level and allocation of domestic resources to medicine and vaccine procurement. Access to safe a...nd effective antibiotics remains a major challenge, especially for low- and middleincome countries. Barriers to access include high prices for new products, weak regulatory systems, substandard and falsified antibiotics, shortages of essential antimicrobials and inefficient procurement and supply management systems.
more
How should humanitarian organisations prepare and respond to COVID-19 in humanitarian settings in low- and middle-income countries?
This Rapid Learning Review outlines 14 actions, insights and ideas for humanitarian actors to consider in their COVID-19 responses. It summarises and synthesises the... best available knowledge and guidance for developing a health response to COVID-19 in low- and middle-income settings as at April 2020
The paper, supported by the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock, will be updated throughout 2020 to reflect emerging knowledge and evidence on the most effective approaches to respond to the COVID-19 Pandemic.
more
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.
more
This year’s MPI results show that more than two-thirds of the multidimensionally poor—886 millionpeople—live in middle-income countries. A further 440 million live in low-income countries. In both groups, data show, simple national averagescan hide enormous inequality inpatterns of povertywith...in countries. For instance, in Uganda 55 percentof the population experience multidimensional poverty—similartotheaverage in Sub-Saharan Africa. But Kampala, the capital city, has an MPI rate of sixpercent, whileinthe Karamojaregion, the MPI soars to 96 percent—meaningthat partsof Ugandaspan the extremes of Sub-Saharan Africa.There is even inequality under the same roof. In South Asia, for example, almost a quarter ofchildren under five live in households where at least one child in the household is malnourished but at least one child is not.
There is also inequality among the poor. Findings of the2019 global MPI paint a detailed picture of the many differences in how-and how deeply -people experience poverty. Deprivationsamong the poor varyenormously: in general, higher MPI valuesgo hand in hand with greater variationin the intensity of poverty. Results also show that children suffer poverty more intensely than adults and are more likely to be deprived in all 10 of the MPI indicators, lackingessentialssuch as clean water, sanitation, adequate nutrition or primary education
more
Chapter · January 2009 DOI: 10.1007/978-0-387-72711-0_25
D.D. Celentano and C. Beyrer (eds.), Public Health Aspects of HIV/AIDS in Low and Middle Income Countries, DOI: 10.1007/978-0-387-72711-0 25, c Springer Science+Business Media, LLC 2008
As of 12June 2020, there are 667confirmed COVID-19 casesin the OPT (565 of which are recovered cases), and 48% of which (320 cases) are in East Jerusalem and its suburbs. Additionally, there have been 5 reported COVID-19 deaths (1 in the West Bank, 1 in Gaza and 3 in East Jerusalem)
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).
more
Population-Based Survey on Perceptions and Attitudes about Peace, Security and Justice in Eastern Democratic Republic of the Congo
Now entering its ninth year, the crisis in north-east Nigeria has created vulnerabilities and humanitarian concerns. An estimated 7.7 million men, women, boys and girls are in acute need of protection and assistance. While the humanitarian community has provided life-saving assistance to over 5.6 mi...llion affected people in 2017 and helped stabilise living conditions for millions of people, reducing mortality and morbidity, significant humanitarian needs still remain.
The Humanitarian Response Plan at a glance:
STRATEGIC OBJECTIVE 1
Provide life-saving emergency assistance to the most vulnerable people in conflict-affected areas ensuring that assistance is timely and appropriate and meets relevant technical standards.
STRATEGIC OBJECTIVE 2
Ensure that all assistance promotes the protection, safety and dignity of affected people, and is provided equitably to women, girls, men and boys.
STRATEGIC OBJECTIVE 3
Foster resilience and early recovery, and strengthen the humanitarian development nexus by working towards collective outcomes.
more
Conflict
In early October, Ukrainian forces continued recapturing areas of southern and eastern oblasts, notably Lyman (Donetsk oblast). The liberation of thousands of square kilometres resulted in the grim discovery of two new mass graves in Lyman and Sviatohirsk (containing of 120 civilian bodi...es). Shelling and missile strikes continue to cause the majority of casualties with 1,043 civilian casualties registered by OHCHR in October. Five waves of missile attacks on urban centres were recorder in October alone, leading to widespread disruption of energy supply with millions of citizens being deprived from electricity and water at times during the month.
more
Produced by Training and Research Support Centre for the Regional Network for Equity in Health in east and southern Africa (EQUINET), March 20, 2020.
This brief summarises and provides links to official, scientific and other resources to support an understanding of and individual to regional level... responses to the epidemic of ‘novel coronavirus’, also known as COVID-19.
more
Climate change is damaging human health now and is projected to have a greater impact in the future. Low- and middle-income countries are seeing the worst effects as they are most vulnerable to climate shifts and least able to adapt given weak health systems and poor infrastructure. Low-carbon appro...ach can provide effective, cheaper care while at the same time being climate smart. Low-carbon healthcare can advance institutional strategies toward low-carbon development and health-strengthening imperatives and inspire other development institutions and investors working in this space. Low-carbon healthcare provides an approach for designing, building, operating, and investing in health systems and facilities that generate minimal amounts of greenhouse gases. It puts health systems on a climate-smart development path, aligning health development and delivery with global climate goals. This approach saves money by reducing energy and resource costs. It can improve the quality of care in a diversity of settings. By prompting ministries of health to tackle climate change mitigation and foster low-carbon healthcare, the development community can help governments strengthen local capacity and support better community health.
more
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).
more
The global burden of disease due to mental disorders continues to rise, especially in low- and middle-income countries (LMIC). In addition to causing a large proportion of morbidity, mental disorders – especially severe mental disorders (SMD) – are linked with poorer health outcomes and increase...d mortality. SMD are defined as a group of conditions that include moderate to severe depression, bipolar disorder, and schizophrenia and other psychotic disorders. People with SMD have a two to three times higher average mortality compared to the general population, which translates to a 10-20 year reduction in life expectancy. While people with SMD do have higher rates of death due to unnatural causes (accidents, homicide, or suicide) than the general population, the
majority of deaths amongst people with SMD are attributable to physical health conditions, both
non-communicable and communicable.
more