BMC Medicine201210:107
https://doi.org/10.1186/1741-7015-10-107© Katchanov and Birbeck; licensee BioMed Central Ltd. 2012
Received: 10 July 2012Accepted: 24 September 2012Published: 24 September 2012
In 2011, the World Health Organization’s (WHO) mental health Gap Action Programme (mhGAP) r...eleased evidence-based epilepsy-care guidelines for use in low and middle income countries (LAMICs). From a
geographical, sociocultural, and political perspective, LAMICs represent a heterogenous group with significant differences in the epidemiology, etiology, and perceptions of epilepsy. Successful implementation of
the guidelines requires local adaptation for use within individual countries. For effective implementation and sustainability, the sense of ownership and empowerment must be transferred from the global health authorities to the local people. Sociocultural and financial barriers that impede the implementation of the guidelines should be
identified and ameliorated. Impact assessment and program revisions should be planned and a budget allocated to them. If effectively implemented, as intended, at the primary-care level, the mhGAP
guidelines have the potential to facilitate a substantial reduction in the epilepsy treatment gap and improve the quality of epilepsy care in resource-limited settings.
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Journal of the International AIDS Society Vol. 21 (2018) e25133
Many prevention of mother-to-child HIV transmission programmes across Africa initiate HIV-infected (HIV positive) pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care (“same-day” initiation...). However, there are concerns that same-day initiation may limit patient preparation before starting ART and contribute to subsequent non-adherence, disengagement from care and raised viral load. We examined if same-day initiation was associated with viral suppression and engagement in care during pregnancy.
The data suggest that same-day ART initiation during pregnancy is not associated with lower levels of engagement in care or viral suppression through 12 months post-delivery in this setting, providing reassurance to ART programmes implementing Option B+.
https://doi.org/10.1002/jia2.25133
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World Psychiatry. 2010 Jun;9(2):67-77.
The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels ...of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates
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The revised guidelines present two major changes to existing guidelines: (A) there are now just 2 categories of pneumonia instead of 3 (“pneumonia” which is treated at home with oral amoxicillin and “severe pneumonia” which requires injectable antibiotics) and (B) oral amoxicillin replaces o...ral cotrimoxazole as first line treatment, preferably in 250mg dispersible tablet form, twice daily for five days which can be reduced to three days in low HIV settings.
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This technical report describes the results of a cross-sectional survey conducted in Dushanbe, Tajikistan, between April and May 2016, as part of the FEEDcities Project – Eastern Europe and Central Asia. The aim was to describe the local street food environment: the characteristics of the vending ...sites, the food offered and the nutritional composition of the industrial and homemade foods usually consumed in these settings.
The study was part of a bilateral partnership between WHO and the Institute of Public Health of the University of Porto, Portugal, in collaboration with the Faculty of Medicine, the Faculty of Nutrition and Food Sciences and the Faculty of Pharmacy of the University of Porto (WHO registration numbers 2015/591370 and 2017/698514).
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Climate change and health vulnerability and adaptation assessment
In 2013 the World Health Organization (WHO) published the report Protecting health from climate change:
vulnerability and adaptation assessment. The aim was to provide basic and flexible guidance on conducting national or subnati...onal assessments of current and future vulnerability (the susceptibility of a population or region to harm) to the health risks of climate change, and of policies and programmes that could increase resilience, taking into account the multiple determinants of climate-sensitive health outcomes.
That guidance has been a very useful tool, applied to more than 50 countries and settings, and has helped countries to prepare their health contributions to United Nations Framework Convention on Climate Change national adaptation plans.
Since the launch of the guidance, WHO, technical partners such as Health Canada, and countries have learned much in terms of its applicability in different countries, at national and local levels.
At the same time, knowledge on climate change and health has increased.
WHO, the Pan American Health Organization and Health Canada have produced this updated version, which aims to better support countries in their assessments by proposing a simpler tool that incorporates all lessons learned.
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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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This study provides information about vulnerabilities within the targeted population and contributes to reflection within UNHCR on how to interpret their multisectorial Home Visit assessments. By exploring relationships between vulnerability indicators and other data collected, the report outlines k...ey trends and relationships. The report details predefined VAF indicators and then provides an in-depth descriptive analysis for each sector
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Event-based surveillance (EBS) is defined as the organized collection, monitoring, assessment and interpretation of mainly unstructured ad hoc information regarding health events or risks, which may represent an acute risk to health. Both indicator-based and event-based surveillance components serve... the early warning and response (EWAR) function of the public health surveillance system. The Framework for Event-based Surveillance offers guidance to public health practitioners seeking to implement EBS at each administrative level in healthier countries.
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Event-based surveillance (EBS) is defined as the organized collection, monitoring, assessment and interpretation of mainly unstructured ad hoc information regarding health events or risks, which may represent an acute risk to health. Both indicator-based and event-based surveillance components serve... the early warning and response (EWAR) function of the public health surveillance system. The Framework for Event-based Surveillance offers guidance to public health practitioners seeking to implement EBS at each administrative level in their countries.
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Census Report Volume 4-K
The results of the 2014 Census collected only relates to four of the six types of disability domains recommended by the Washington Group on Disability Statistics, namely: seeing, hearing, walking, and remembering or concentrating.
Out of a total of 50.3 million pe...rsons enumerated in the 2014 Census, there were 2.3 million persons (4.6 per cent of the total population) who reported some degree of difficulty with either one or more of the four functional domains. Of this number, over half a million (representing over 1 per cent of the population as a whole) reported having a lot of difficulty or could not do one or more of the four activities at all (referred to as severe disability). Among those with the severest degree of disability, 55 thousand were blind, 43 thousand were deaf, 99 thousand could not walk at all and 90 thousand did not have the capability to remember or concentrate.
The Census shows that disability is predominantly an old age phenomenon with its prevalence remaining low up to a certain age, after which rates increase substantially.
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The right to adequate housing, despite having been recognized by multiple international instruments, continues to be a human right that is consistently violated. Around 2O% of the world's population do not have adequate housing . In Latin America, informal settlements generally lack the conditions r...equired to live a decent life, and local and national public policies fail to radically transform this situation.
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The main purpose of the meeting was to review tsetse control tools, activities and their contribution to the elimination of gHAT and the monitoring thereof. Seven endemic countries provided reports on recent and ongoing vector control interventions at the national level (Angola, Cameroon, Côte d’...Ivoire, Chad, Democratic Republic of the Congo, Guinea and Uganda). Country reports focused on the in situations implementing and supporting vector control activities, the tools and the approaches in use, the coverage of the activities in space and time and their impacts on tsetse populations. Future perspectives for vector control in the respective countries were also discussed, including opportunities and challenges to sustainability.
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The strategic plan reflects shared commitments to enhance collaboration between environmental, animal (wildlife and domestic) and human health, and building new One Health workforce capacity through higher institutions of learning. The strategy also outlines interventions to be undertaken by governm...ent institutions and other partners to enhance existing structures and pool together additional resources to prevent and control zoonotic diseases and other events of public health importance. Successful implementation of the strategy will contribute to the realization of vision 2020 by improving public health, food safety and security, and hence significantly improve the socioeconomic status of the people of Rwanda. It is in this regard that we call upon implementing institutions, bilateral and multilateral partners, civil society and the private sector to join us in implementing the One Health strategy in Rwanda.
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Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primar...y health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
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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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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.
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The NDMS&IP focuses on mainstreaming disability to promote equitable access to services in the six thematic areas of health, education, livelihoods, empowerment, and social inclusion and cross-cutting issues.
The first part of the NDMS&IP outlines incongruences between national and sectoral policie...s and pieces of legislation on one hand, and practice on the other and identifies key priority areas/themes of the strategy,
medium-term outcomes and strategies for each identified priority area/ theme. This process is largely informed by key findings and recommendations from a study on the Situation of Persons with Disabilities
in Malawi (CBMM/NAD, 2011). The study provides background descriptive information on existing national and sectoral policy and legal framework, level of access by children, adult women and males with disabilities to services in the areas of education, health, livelihoods and other social services as well as of participation by persons with disabilities through self-representation in development activities at various levels. A review of relevant documents at the international level further describes the disability situation in Malawi in the global context.
The second part of the NDMS&IP consists of the operational matrix, (Annex 1), a monitoring and evaluation framework (Annex 2) and budget estimates (Annex 3). This part outlines specific actions by various actors both in the public, private and civil society sectors to prioritise disability in their routine policy, programming, resource mobilisation and allocation, monitoring, evaluation and reporting routines. The action plan lays out priority sectors and concrete actions by setting out implementation schedules, defining targets, assigning responsibility to key duty bearers and rights holders for coordination, decision-making, monitoring and reporting, mobilisation and allocation and control of resources.
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Background
Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and ris...k factors for asthma in adolescents in an LMIC.
Methods
A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.
Results
A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.
Conclusion
Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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This paper aims to provide aid agencies with initial analysis and guidance to inform the design, implementation and adaptation of conflict-sensitive humanitarian and development responses to the COVID-19 pandemic. It presents a series of overarching considerations to take into account when determini...ng how to build a conflict-sensitive approach into COVID-19 response activities, before outlining some initial, sector-specific considerations. Recommendations are presented throughout.
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