In this entry we are looking at smoking, alcohol consumption and the use of illicit drugs. We are studying who is using these substances, how their use has changed over time, and we are presenting the estimates of their impact on health. Collectively, smoking, alcohol and illicit drug use kills 11.8... million people each year. This is more than the number of deaths from all cancers
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Study Report August 2014
Curatio International Foundation (CIF) and the Association Tanadgoma would like to acknowledge the financial support provided by GFATM under the project “Establishment of evidence base for national HIV/AIDS program by strengthening of HIV/AIDS surveillance system in t...he country” (GEO-H-GPIC), which made this study possible.
The report was prepared by Dr. Ivdity Chikovani, Dr. Natia Shengelia, Lela Sulaberidze (CIF) and Nino Tsereteli (Tanadgoma).
Special thanks are extended to international consultants – Ali Mirzazadeh (MD, MPH, PhD Postdoctoral Scholar, University of California, San Francisco Institute for Health Policy Studies & Global Health Sciences) for his significant contribution in study preparation, protocol and questionnaire design and data analysis and Abu S. Abdul-Quader (PhD, Epidemiologist, Global AIDS Program Centers for Disease Control and Prevention) for his valuable input in refining methodology and overall guidance during the study implementation.
Special thanks are extended to international consultants – Abu S. Abdul-Quader (PhD, Epidemiologist, Global AIDS Program, Centers for Disease Control and Prevention) for his valuable input in refining methodology and overall guidance during the study implementation and Ali Mirzazadeh (MD, MPH, PhD Postdoctoral Scholar, University of California, San Francisco Institute for Health Policy Studies & Global Health Sciences) for his significant contribution in the NSU study preparation, protocol and questionnaire design and data analysis.
Authors appreciate a highly professional work of Tanadgoma staff: the survey coordinator KhatunaKhazhomia; the interviewers: Ketevan Tchelidze, Nino Kipiani, Koba Bitsadze, Kakhaber Akhvlediani, ZazaBabunashvili, Rati Tsintsadze and the social workers: Archil Rekhviashvili, Tea Chakhrakia, Irina Bregvadze, Kakhaber Kepuladze, Ketevan Jibladze and Shota Makharadze for their input in the recruitment process.
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Early damage assessments indicate that at least 800,000 people could be directly exposed to minor to severe damages, including communication, access, security, loss of livelihoods, infrastructure, and health services could be impacted.
Humanitarian Charter and Minimum Standards in Humanitarian Response.
The 2018 Sphere Handbook builds on the latest developments and learning in the humanitarian sector. Among the improvements of the new edition, readers will find a stronger focus on the role of local authorities and communities as ...actors of their own recovery. Guidance on context analysis to apply the standards has also been strengthened. New standards have also been developed, informed by recent practice and learning, such as WASH and healthcare settings in disease outbreaks, security of tenure in shelter and settlement, and palliative care in health. Different ways to deliver or enable assistance, including cash-based assistance, are also integrated into the Handbook.
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Planning and Implementation Training. Myanmar
This training module on resilient development planning in Myanmar consists of a 2.5 hours session, at the end of which, the participants will:
a) Have a common understanding on development and disaster linkages.
b) Be able to identify the ...various factors which contribute towards disaster risk including climate change in Myanmar.
c) Be able to identify measures for risk resilient development process in Myanmar.
The three main learning units include:
1. Disaster and development linkages.
2. Components and drivers of disaster risk including climate change.
3. Mainstreaming disaster and climate risk reduction into development.
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The disaster and Red Cross Red Crescent response to date
9 March 2019: Tropical Cyclone Idai forms over Northern Mozambique Channel. CVM preparedness and early warning actions underway
13 March 2019: IFRC Surge Capacity is deployed to Maputo
14 March 2019: 342,562 Swiss francs allocated from th...e IFRC’s Disaster Relief Emergency Fund (DREF) to meet the immediate shelter, WASH and health needs of 1,500 households
15 March 2019: Tropical Cyclone Idai makes landfall in Beira,
Mozambique.
17 March 2019: IFRC Surge Capacity arrival in Beira with CVM to conduct preliminary assessments.
19 March 2019: IFRC issues an Emergency Appeal for 10 million Swiss francs for 75,000 people for 12 months.
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This evaluation is the first systematic effort by UNICEF to generate evidence on how well its global as well as country level Community Management of Acute Malnutrition (CMAM) strategies have worked, including their acceptance and ownership in various contexts and appropriateness of investments in c...apacity development and supply components. Overall, the evaluation recommends that UNICEF continue to promote and support CMAM as a viable approach to preventing and addressing severe acute malnutrition (SAM), with an emphasis on prevention through strengthening community outreach and integrating CMAM into national health systems and with other intervention
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The use of explosive weapons, such as bombs, rockets, and mortar and
artillery shells, in cities, towns and villages and in other populated areas
has devastating humanitarian consequences. Explosive weapons act mainly
through the projection of blast and fragmentation wi...thin an area. Their use,
in populated areas, causes severe suffering to civilians, both in terms of
death and serious injury resulting directly from the explosion, and in terms
of damage to property and public infrastructure, which can indirectly affect
civilian well-being and survival, sometimes for many years after a conflict
has ended. Explosive weapons also leave behind explosive remnants that
pose a threat to populations until those remnants are removed. [...] The study finds that the regulation of explosive weapons under international
law and policy is fragmentary and incoherent.
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Key questions
What is already known?
Critical illness is common throughout the world and COVID-19 has caused a global surge of critically ill patients.
There are large gaps in the quality of care for critically ill patients, especially in low-staffed and low-resourced settings, and mortal...ity rates are high.
Essential Emergency and Critical Care (EECC) is the effective lifesaving care of low-cost and low-complexity that all critically ill patients should receive in all wards in all hospitals in the world.
What are the new findings?
The clinical processes that comprise EECC and the essential care of critically ill patients with COVID-19 have been specified in a large consensus among clinical experts worldwide.
The resource requirements for hospitals to be ready to provide this care has been described.
What do the new findings imply?
The findings can be used across medical specialties in hospitals worldwide to prioritise and implement essential care for reducing preventable deaths.
Inclusion of the EEEC processes could increase the impact of pandemic preparedness and response programmes and policies for health systems strengthening.
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Young children are especially susceptible to exposure to trauma. Rates of abuse and neglect among this population are staggering. This article presents a review of relevant literature, including research findings specific to early childhood vulnerability to trauma, symptoms associated with traumatic... events, diagnostic validity of early childhood trauma, and treatments for young children. In the past, misconceptions about the mental health of young children have hindered accurate diagnosis and treatment of trauma-related mental illness. Due to the prevalence of trauma exposure in early childhood, counselors are encouraged to become familiar with ways that clients and families are impacted and methods for treatment. Implications for future research also are presented.
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The second ECDC/EFSA/EMA joint report on the integrated analysis of antimicrobial consumption (AMC) and antimicrobial resistance (AMR) in bacteria from humans and food-producing animals addressed data obtained by the Agencies’ EU-wide surveillance networks for 2013–2015. AMC in both sectors, exp...ressed in mg/kg of estimated biomass, were compared at country and European level. Substantial variations between countries were observed in both sectors. Estimated data on AMC for pigs and poultry were used for the first time. Univariate and multivariate analyses were applied to study associations between AMC and AMR. In 2014, the average AMC was higher in animals (152 mg/kg) than in humans (124 mg/kg), but the opposite applied to the median AMC (67 and 118 mg/kg, respectively). In 18 of 28 countries, AMC was lower in animals than in humans. Univariate analysis showed statistically-significant (p < 0.05) associations between AMC and AMR for fluoroquinolones and Escherichia coli in both sectors, for 3rd- and 4th-generation cephalosporins and E. coli in humans, and tetracyclines and polymyxins and E. coli in animals. In humans, there was a statistically-significant association between AMC and AMR for carbapenems and polymyxins in Klebsiella pneumoniae. Consumption of macrolides in animals was significantly associated with macrolide resistance in Campylobacter coli in animals and humans. Multivariate analyses provided a unique approach to assess the contributions of AMC in humans and animals and AMR in bacteria from animals to AMR in bacteria from humans. Multivariate analyses demonstrated that 3rd- and 4th-generation cephalosporin and fluoroquinolone resistance in E. coli from humans was associated with corresponding AMC in humans, whereas resistance to fluoroquinolones in Salmonella spp. and Campylobacter spp. from humans was related to consumption of fluoroquinolones in animals. These results suggest that from a ‘One-health’ perspective, there is potential in both sectors to further develop prudent use of antimicrobials and thereby reduce AMR.
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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide...miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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This diagnostic and treatment manual is designed for use by medical professionals involved in curative care at the dispensary and hospital levels. We have tried to respond in the simplest and most practical way possible to the questions and problems faced by field medical staff, using the accumulate...d field experience of Médecins Sans Frontières, the recommendations of reference organizations such as the World Health Organization (WHO) and specialized works in each field.
Available in English, French, Spanish and Arabic
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Introduction Pharmacovigilance (PV) systems to monitor drug and vaccine safety are often inadequate in sub-Saharan
Africa. In Malawi, a PV enhancement initiative was introduced to address major barriers to PV.
Objective The objective of this initiative was to improve reporting of adverse events (A...Es) by strengthening passive safety
surveillance via PV training and mentoring of local PV stakeholders and healthcare providers (HCPs) at their own healthcare
facilities (HCFs).
Methods An 18-month PV training and mentoring programme was implemented in collaboration with national stakeholders,
and in partnership with the Ministry of Health, GSK and PATH. Two-day training was provided to Expanded Programme on
Immunisation coordinators, identified as responsible for AE reporting, and four National Regulatory Authority representa-
tives. Abridged PV training and mentoring were provided regularly to HCPs. Support was given in upgrading the national
PV system. Key performance indicators included the number of AEs reported, transmission of AE forms, completeness of
reports, serious AEs reported and timeliness of recording into VigiFlow.
Results In 18 months, 443 HCPs at 61 HCFs were trained. The number of reported AEs increased from 22 (January 2000 to
October 2016) to 228 (November 2016 to May 2018), enabling Malawi to become a member of the World Health Organization
Programme for International Drug Monitoring. Most (98%) AE report forms contained mandatory information on reporter,
event, patient and product, but under 1% were transmitted to the national PV office within 48 h.
Conclusion Regular PV training and mentoring of HCPs were effective in enhancing passive safety surveillance in Malawi,
but the transmission of reports to the national PV centre requires further improvement.
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In the present report, the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material, Mama Fatima Singhateh, focuses on the impact of the coronavirus disease (COVID-19) p...andemic on increased risk and various manifestations of sale and sexual exploitation of children. The Special Rapporteur outlines the push and pull factors, protection challenges and good practices, and provides recommendations on measures to address the heightened risks of sale and sexual exploitation of children, both online and offline, during and in the aftermath of the COVID-19 crisis and the ensuing lockdowns.
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The world is not on track to end the AIDS pandemic. New infections are rising and AIDS deaths are continuing in too many communities. This report reveals why: inequalities are holding us back. In frank terms, the report calls the world’s attention to the painful reality that dangerous inequalities... are undermining the AIDS response and jeopardising the health security of everyone. The report highlights three specific areas of inequality for which concrete action is immediately possible—gender
inequalities and harmful masculinities driving HIV; marginalisation and criminalisation of key populations, which our data show is resulting in starkly little progress for those populations and undermining the overall response; and
inequalities for children whose lives must matter more than their market share. But this is not a counsel of despair, it is a call to action. Through bold action to confront these inequalities, we can end AIDS.
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The risks of the use of nuclear, radiological, biological or chemical (NRBC) weapons are heterogeneous. Each risk has its own implications for developing and deploying any capacity to assist victims of an NRBC event and, in parallel, for the health and security of the people bringing this assistance.... At an international level, there are no plans for assisting the victims of an NRBC event which are both adequate and safe. Recognizing
the realities of the contexts associated with each risk throws up numerous challenges; such recognition is also a prerequisite for addressing these challenges. The realities that have to be considered relate to:
1. developing, acquiring, training for and planning an NRBC response capacity;
2. deploying a response capacity in an NRBC event;
3. the mandates and policies of international organizations pertaining to NRBC events. The challenges that will pose the greatest difficulty for a humanitarian organization are those for which the solutions are ‘non-buyable’ and which involve making extremely difficult decisions. Attempting to assist victims of an NRBC event without a reality-based approach might generate ineffective and unacceptably dangerous situations for those involved.
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The Lancet Volume 390, Issue 10110p2397-2409November 25, 2017.
Human African trypanosomiasis (HAT), also called sleeping sickness, is a parasitic infection that almost invariably progresses to death, unless treatment is provided. HAT caused devastating epidemics during the 20th century. Thanks to ...sustained and coordinated efforts during the past 15 years the number of reported cases has fallen to a historic low. Fewer than 3,000 cases were reported in 2015, and the disease is targeted for elimination by the World Health Organization. Despite recent success, HAT still poses a heavy burden on the rural communities where this highly focal disease occurs, most notably in Central Africa. Since patients are also reported from non-endemic countries outside Africa, HAT should be considered in differential diagnosis for all travellers, tourists, migrants and expatriates who have visited or lived in endemic areas. In the absence of a vaccine, disease control relies on case detection and treatment, and vector control. Available drugs are sub-optimal, but ongoing clinical trials give hope for safer and simpler treatments.
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The World Heart Federation (WHF) Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection and management of cardiovascular diseases and provide a generic global framework available for loca...l adaptation. A first Roadmap on raised blood pressure was published in 2015. Since then, advances in hypertension have included the publication of new clinical guidelines (AHA/ACC; ESC; ESH/ISH); the launch of the WHO Global HEARTS Initiative in 2016 and the associated Resolve to Save Lives (RTSL) initiative in 2017; the inclusion of single-pill combinations on the WHO Essential
Medicines’ list as well as various advances in technology, in particular telemedicine and mobile health. Given the substantial benefit accrued from effective interventions in the management of hypertension and their potential for scalability in low and middle-income countries (LMICs), the WHF has now revisited and updated the ‘Roadmap for raised BP’ as ‘Roadmap for hypertension’
by incorporating new developments in science and policy. Even though cost-effective lifestyle and medical interventions to prevent and manage hypertension exist, uptake is still low, particularly in resource-poor areas. This Roadmap examined the roadblocks pertaining to both the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and
traditions) and the supply side (health systems resources and processes) along the patient pathway to propose a range of possible solutions to overcoming them. Those include the development of population-wide prevention and control programmes; the implementation of opportunistic screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidencebased, inexpensive BP-lowering agents.
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Technical Note: Cholera treatment facilities provide inpatient care for cholera patients during outbreaks. Proper case management and isolation of cholera patients is essential to prevent deaths and help control the spread of
the disease. Traditionally, these structures have been referred to as ch...olera treatment centres (CTCs) and
cholera treatment units (CTUs). CTCs are usually large structures set up at central level (e.g. urban areas),
while CTUs are smaller structures set up in the periphery (e.g. peri-urban or rural areas). CTCs/CTUs can
be set up as independent structures in tents or within existing buildings or wards of health structures.
Whatever the structure, the principles described in this document should be respected
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