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Effectiveness of a diabetes program based on digital health on capacity building and quality of care in type 2 diabetes: a pragmatic quasi-experimental study
Moreas Morelli, D.; Rubinstein, F.; Santero, M.; et al.
BMC Health Services Research, part of Springer Nature
(2023)
CC2
Health systems in Latin America face many challenges in controlling the increasing burden of diabetes. Digital health interventions are a promise for the provision of care, especially in developing countries where mobile technology has a high penetration. This study evaluated the effectiveness of th
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e implementation of a Diabetes Program (DP) that included digital health interventions to improve the quality of care of persons with type 2 Diabetes (T2DM) in a vulnerable population attending the public primary care network.
more
This global status report on prevention and control of NCDs (2014), is framed around the nine voluntary global targets. The report provides data on the current situation, identifying bottlenecks as well as opportunities and priority actions for attaining the targets. The 2010 baseline estimates on N
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CD mortality and risk factors are provided so that countries can report on progress, starting in 2015. In addition, the report also provides the latest available estimates on NCD mortality (2012) and risk factors, 2010-2012.All ministries of health need to set national NCD targets and lead the development and implementation of policies and interventions to attain them. There is no single pathway to attain NCD targets that fits all countries, as they are at different points in their progress in the prevention and control of NCDs and at different levels of socioeconomic development. However all countries can benefit from the comprehensive response to attaining the voluntary global targets presented in this report.
more
The "WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care" provides a set of cost-effective, evidence-based interventions to address noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers. Designed
...
for implementation in primary healthcare settings, especially in low-resource environments, the package includes protocols for screening, diagnosis, treatment, and management of these diseases. The document emphasizes an integrated approach, supporting universal health coverage by empowering healthcare workers with practical tools to improve NCD care. It aims to reduce premature mortality from NCDs and enhance global health equity.
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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a
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sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-income countries (LMICs), which have disproportionately high asthma-related mortality relati
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ve to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma.
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This template dossier complements and should be used after fulfilling the criteria and preconditions specified in the Process of validation of elimination of kala-azar as a public health problem in South-East Asia. The national kala-azar programme should be in the consolidation phase of elimination;
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that is, the annual incidence of kala-azar in the implementation unit is maintained below 1 case (new plus relapse) per 10 000 population for a minimum of 3 consecutive years.
The template is designed to help national kala-azar elimination programmes prepare a dossier documenting the essential evidence supporting the request to the World Health Organization (WHO) to validate the status of kala-azar elimination as a public health problem in their country. The information presented in this document will help independent assessors understand the national programme’s specific context, achievements and relevant epidemiological data.
The dossier should be organized according to the following sections:
- Description of the country context and health system capabilities
- Historical data and delineation of endemic areas
- Surveillance and elimination activities
- Epidemiological data
- Vector control strategy and activities
- Post-validation surveillance plan
Once the dossier is prepared, it should be examined and duly endorsed by the National Task Force on kala-azar elimination and/or neglected tropical diseases, or a similar body, before submission to WHO.
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The document “Malaria Elimination Programme Review, India 2022”, published by the WHO Country Office for India, provides an in-depth assessment of India’s progress toward malaria elimination. It evaluates the structure, implementation, and eff
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ectiveness of national and subnational malaria programs, focusing on surveillance, diagnosis, treatment, vector control, and community engagement. The review identifies strengths, challenges, and areas for improvement, offering evidence-based recommendations to accelerate India's efforts to eliminate malaria by 2030.
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This paper examines the implications of the IMF’s April 2024 macro-fiscal forecast updates on government health expenditure (GHE) across 170 economies through 2029, covering nearly all years remaining to achieve the Sustainable Development Goals (SDGs). The findings reveal wide disparities in gove
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rnments' capacities to increase health spending, with differences not only observed across income groups but also within them. Primary concerns focus to two groups of low- and lower middleincome
countries: the first group is projected to experience a contraction in real per capita GHE from 2019 and 2029, threatening to reverse progress toward the health SDG targets, while the other group faces stagnation in real per capita GHE, greatly limiting advancement. The insights presented are crucial for health policymakers and their external partners to respond to evolving macro-fiscal circumstances and stabilize investment growth in health. While increasing the priority of health in spending is a key policy option, it will not be sufficient on its own. Effective responses also
require improving spending efficiency and addressing broader fiscal challenges. Without decisive action, many countries have little chance of achieving the health SDGs.
more
The world is facing a sustainable development crisis. The 2024 Financing for Sustainable Development Report: Financing for Development at a Crossroads finds that financing challenges are at the heart of the crisis and imperil the SDGs and climate action. The window to rescue the SDGs and prevent a c
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limate catastrophe is still open but closing rapidly. Financing gaps for sustainable development are large and growing – the estimates by international organizations and others are coalescing around $4 trillion additional investment needed annually for developing countries. This represents a more than 50% increase over the pre-pandemic estimates. Meanwhile, the finance divide has not been bridged, with developing countries paying around twice as much on average in interest on their total sovereign debt stock as developed countries. Many countries lack access to affordable finance or are in debt distress. Weak enabling environments are preventing progress. Average global growth has declined, while policy and regulatory frameworks still do not set appropriate incentives. Public budgets and spending is not fully aligned with SDGs. Private investors are not incentivised to invest enough in SDGs and climate action. The world is at a crossroads. This is the last chance to correct course if we want to achieve the SDGs by the 2030 deadline. Only an urgent, large-scale and sustainable investment push can help us achieve our global goals. Next year’s Fourth International Conference on Financing for Development in 2025 will be a once in 80-year opportunity to support coherent transformation of financing.
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The objectives of this guideline are the same as those of the 2011 edition, namely to provide evidence-based normative guidance on interventions to improve adolescent morbidity and mortality by reducing the chances of early pregnancy and its resulting poor health outcomes. The specific objectives of
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the guideline were to: 1. identify effective interventions to prevent early pregnancy by influencing factors such as early marriage, coerced sex, unsafe abortion, access to contraceptives and access to maternal health services by adolescents; and 2. provide an analytical framework for policy-makers and programme managers to use when selecting evidence-based interventions to prevent early pregnancy and negative health outcomes when they occur that are most appropriate for the needs of their countries and context. The recommendations and best practice statements described in this document aim to enable evidence-based decision-making with respect to preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income country contexts.
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This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers and partners to plan and implement readiness and response activities for Ebola disease outbreaks. The toolkit conta
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ins: information about Ebola disease; RCCE considerations on how to approach key issues during Ebola disease outbreaks; tools for understanding the context in which Ebola disease outbreaks occur; methods for collecting data to inform strategy development and bring evidence into the planning and implementation of activities; guidance to support prevention and response interventions; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
more
This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers, and partners to plan and implement readiness and response activities for yellow fever outbreaks. The toolkit conta
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ins: information about yellow fever; RCCE considerations for how to approach key issues during yellow fever outbreaks; tools for understanding the context in which yellow fever outbreaks occur; methods for collecting data to inform strategy development and bring evidence into planning and implementation of activities; guidance to support vector control and immunization campaigns; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
more
This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers, and partners to plan and implement readiness and response activities for yellow fever outbreaks. The toolkit conta
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ins: information about yellow fever; RCCE considerations for how to approach key issues during yellow fever outbreaks; tools for understanding the context in which yellow fever outbreaks occur; methods for collecting data to inform strategy development and bring evidence into planning and implementation of activities; guidance to support vector control and immunization campaigns; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
more
This guidance covers different options for banning or phasing out a pesticide and suggests related risk reduction measures to be taken during the phase-out period. A key focus of this guidance is how to take action to manage, prevent, minimize, and communicate about identified risks during the
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implementation of a phase-out strategy. It contains a description of legal aspects to consider when phasing out a product and illustrates how a risk communication plan can be structured and implemented. How different stakeholders may be involved when a pesticide is going to be phased out is also described.
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Drawing on the World Health Organization’s package of NCD best buys, the report demonstrates how these evidence-based measures can help countries reduce premature deaths, strengthen health systems, and advance progress towards the Sustainable Development Goals. It provides policymakers, donors, ad
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vocates, and partners with a clear economic and social rationale for scaling up implementation of proven solutions. By framing NCD prevention and control as both a health and development priority, the report offers a roadmap for action that delivers benefits across populations, economies, and generations. The evidence is clear: investing in WHO’s best buys is not only possible—it is imperative. The time to act is now.
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WHO consolidated guidelines on tuberculosis: Module 6: tuberculosis and comorbidities, 2nd ed
recommended
Addressing TB comorbidities and risk factors is central to the World Health Organization (WHO) End TB Strategy. These guidelines consolidate the latest WHO recommendations on TB and key comorbidities. The guidelines are a living document and will include dedicated sections for each key TB comorbidit
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y or health-related risk factor. The first edition focused on HIV-associated TB, updating the WHO policy on collaborative TB/HIV activities. This second edition expands on the previous edition and consolidates new and existing recommendations on interventions to address undernutrition in people with TB, to provide food assistance to households of people with TB in food-insecure settings, and to screen for TB among those who are undernourished or food insecure.
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The document provides a standardized protocol for evaluating the Early Warning Alert and Response Network (EWARN), a surveillance system used during humanitarian emergencies when regular national health surveillance may be disrupted. The purpose of EWARN is to detect outbreaks of communicable diseas
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es early and enable rapid public health response. The guidance explains how the system should be assessed in terms of its structure, implementation, effectiveness, and usefulness. It outlines the key steps of evaluation: preparation, system description, data collection, and post-evaluation reporting. The protocol highlights common challenges observed in previous EWARN implementations, such as delays in establishing the system, limited data quality, weak outbreak response, and lack of clear transition plans back to routine surveillance systems. It emphasizes the need to evaluate both weekly disease reporting and alert verification processes, and to review attributes such as simplicity, data quality, timeliness, sensitivity, and stability. The document also provides templates for interviews, data review forms, and laboratory assessment, as well as guidance on conducting remote evaluations when access is limited. The overall goal of the protocol is to ensure that EWARN functions effectively to detect and respond to outbreaks and that practical recommendations are developed to improve the system’s performance and sustainability in emergency settings.
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This report was developed by the WHO TB Vaccine Accelerator Finance and Access working group, co-led by WHO, Gavi and the Government of South Africa. It sets out the working group’s shared vision for equitable access to novel TB vaccines and will advance a shared understanding of the current lands
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cape and its possible evolution in the future. It identifies six urgently needed solutions to accelerate access and financing and highlights the roles of different stakeholders to support the implementation of these solutions.
more
he United Nations Development Programme’s (UNDP) Gender Equality Strategy 2022-2025 has
been created during turbulent times. Multiple crises and risks are threatening the world and
we are witnessing an alarming backlash against women’s rights and gender equality. Since the
COVID-19 pandemic h
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it, women have been nearly twice as likely to lose their jobs compared to
men. Yet less than 20 percent of policy measures implemented by countries across the world have
addressed women’s economic insecurity. Gender inequality also takes a toll on men and other
affected groups. For men, rigid gender norms can fuel risky behaviours resulting in violence, poor
health, and lower life expectancy.
more
This 5th Edition of the Malawi Guidelines for Clinical Management of HIV in Children and Adults is implemented from January 2022. It replaces all previous editions of the Malawi Antiretroviral therapy (ART) and Prevention of Mother to Child Transmission (PMTCT) guidelines.This document is written fo
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r medical doctors, clinical officers, medical assistants, nurses, midwives, laboratorians, health surveillance assistants (HSAs) and medical records clerks who are working in public and private sector health facilities in Malawi. It is designed to be a practical guide for implementation of integrated HIV Services
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