This publication, the third module of a resource manual to support the training of planners and practitioners in managing flash flood risk, deals with structural measures. It presents bioengineering techniques, physical measures for slope stabilisation and erosion control, and physical measures for ...river training. It also presents the concept of integrated flood management as a component of integrated water resource management. It emphasizes that structural measures are most effective and sustainable when implemented together with appropriate non-structural measures. The manual is aimed at junior to mid-level professionals with a civil engineering background working on flash flood risk management at the district level.
Flash floods are among the most destructive natural disasters in the Hindu Kush Himalayan region. Flash flood mitigation is generally addressed by community-based organisations, local non-governmental organisations, or district and local-level staff in government organisations. But these groups often lack adequate understanding of the processes causing flash floods and knowledge of flash flood risk management measures.
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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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Men lag behind women regarding use of HIV services and represent the majority of individuals living with uncontrolled HIV, advanced HIV, and who experience HIV-related mortality. Men (15+) globally are less likely than women (15+) to know their HIV status (83% for men vs 91% for women), be on antire...troviral treatment (ART) (72% for men vs 83% for women) and reach viral suppression (67% for men vs 78% for women).
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Vector-borne diseases are responsible for 17% of the global burden of communicable diseases and more than 500 000 deaths annually. The ambitious global targets for the control of vector-borne diseases come in the context of the (re-)emergence of diseases, increasing resistances to insecticides and u...ncertainty related to the financing of global vector control efforts. The United Nations 2030 Agenda with its related Sustainable Development Goals (SDGs), the New Urban Agenda adopted at the United Nations Conference on Housing and Sustainable Urban Development (Habitat III)
in Quito in 2016 and WHO’s Global vector control response 2017–2030 (WHO, 2017a) emphasize the value of elevating multisectoral actions and strategies that extend beyond the health sector to the core of integrated vector control.
This policy brief underlines the important role housing conditions have in the transmission of vector-borne diseases and showcases interventions and policies the housing sector can contribute to effective, integrated and intersectoral vector-borne diseases management.
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A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund
Advising principles. The purpose of this document is to support competent authorities in charge of IHR implementation to improve national capacities for the prevention, detection and control of events, by strengthening communications and coordination between points of entry and the national health s...urveillance system
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Male circumcision reduces a man’s risk of heterosexual acquisition of HIV by about 60%. This guideline provides an evidence-based recommendation on the use of adult male circumcision devices for HIV prevention in public health programmes in high HIV prevalence, resource-limited settings. It also p...resents key programmatic considerations for the introduction and use of these devices in public health HIV prevention programmes. The primary audiences are policy- and decision-makers, programme managers, health-care providers, donors and implementing agencies.
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Thirty-three years after its discovery, the Human Immunodeficiency Virus (HIV), responsible for the AIDS pandemic, remains a major public health problem despite advanced researches providing better diagnostic and therapeutic tools. The virus targets especially CD4+ T cells, leading to deficiency of ...the immune system and altering therefore defense against infections and cancer cells. Antiretroviral
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Infectious diseases are constantly in transition. New diseases develop, known dis-eases become widespread or reemerge, and occasionally a disease is eradicated.Infectious diseases such as HIV, tuberculosis, and cholera are significant causes ofillness and death in many parts of the world. Health car...e personnel are on thefront lines, helping to protect their clients from infectious diseases and treatingthem when infections occur. During the course of their work, health care person-nel perform clinical procedures or other activities that can expose both them andtheir clients to potentially infectious microorganisms. Many of their clients aresick and thus may be more susceptible to infections or may have infections thatcan be transmitted to others. Fortunately, all staff working at health care facilities can perform simple proce-dures to minimize risk—to themselves and clients—and reduce the spread ofinfections. These practices can be integrated at minimal cost into the routineworkday at clinics and hospitals around the world. This reference booklet isspecifically designed for use at all levels of the health care system, from thelargest hospitals to the smallest dispensaries or health posts, in settings whereresources are scarce. This booklet, which was first published in 1999, has now been updated. Whilemost practices remain the same, there have been a few important changes—forexample, in recommendations related to hand hygiene and standard precautions.Nonetheless, this booklet continues to present practical recommendations forsimple and relatively low-cost procedures that can be implemented anywhere,with basic supplies and little to no high-technology equipment.
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Women and girls are paying the price of the war in Yemen – Humanitarian actors must increase the priority given to women and girls’ needs, with specific attention to GBV prevention and response, and reproductive health services
The evolving epidemic of type 2 diabetes mellitus has challenged health-care professionals. It stands among the leading causes of mortality in the present world. It warrants new and versatile approaches to improve mortality and the associated huge quality-adjusted life years lost to it once diagnose...d. A possible venue to lower the incidence is to assess the safety and efficacy of various diabetes prevention strategies. Diet and exercise have a well-developed role in the prevention of weight gain and, ultimately, diabetes mellitus type II in high-risk individuals. However, high-risk individuals can also benefit from adjunct pharmacotherapy. In light of this information, we decided to conduct a systematic review of randomized controlled trials. This article summarizes the evidence in the literature on the pharmacological prevention of diabetes in high-risk individuals.
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Background
Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death.
Methods
This review is based on articles retrieved by a selective search in PubMed, as well as on r...elevant guidelines.
Results
Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharmacotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients.
Conclusion
The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
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These WHO guidelines which were updated in 2018, are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.
The 2018 edition of the guidelines includes the re...vision of the recommendation regarding the use of 80% fraction of inspired oxygen (high FiO2) in surgical patients under general anaesthesia with tracheal intubation and the update of the section on implementation. Between 2017 and 2018, WHO re-assessed the evidence on the use of high FiO2 by updating the systematic review related to the effectiveness of this intervention to reduce SSI and commissioning an independent systematic review on adverse events potentially associated with it. Based on the updated evidence, the GDG decided to revise the strength of the recommendation from strong to conditional.
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The World Health Organization Regional Office for Africa (WHO AFRO), in accordance with recommendations from various WHO committees, has developed three flagship programmes to support Member States in the African region to prepare for, detect and respond to public health emergencies. They are the re...sult of extensive consultations with more than 30 African government ministers, technical actors, partners across the continent as well as regional institutions such as the Africa Centres for Disease Control and Prevention (Africa CDC), whose contributions have shaped the priority activities. This report provides the second quarterly summary of progress in implementing the flagship programmes.
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Nat Commun 9, 5370 (2018). https://doi.org/10.1038/s41467-018-07804-8. Mycobacterium ulcerans is the causative agent of Buruli ulcer, a neglected tropical skin disease that is most commonly found in children from West and Central Africa. Despite the severity of the infection, therapeutic options are... limited to antibiotics with severe side effects. Here, we show that M. ulcerans is susceptible to the anti-tubercular drug Q203 and related compounds targeting the respiratory cytochrome bc1:aa3. While the cytochrome bc1:aa3 is the primary terminal oxidase in Mycobacterium tuberculosis, the presence of an alternate bd-type terminal oxidase limits the bactericidal and sterilizing potency of Q203 against this bacterium. M. ulcerans strains found in Buruli ulcer patients from Africa and Australia lost all alternate terminal electron acceptors and rely exclusively on the cytochrome bc1:aa3 to respire. As a result, Q203 is bactericidal at low dose against M. ulcerans replicating in vitro and in mice, making the drug a promising candidate for Buruli ulcer treatment.
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Facilitator's Guide. This guide is designed to assist facilitators in training community health workers (CHWs) and community volunteers (CVs) in integrating community-based TB services into their work. The training will help community workers who already provide numerous services to understand TB an...d contribute to prevention, care and support services in their communities
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Masangane Case Study
The Vesper Society commissioned ARHAP to do research on the integrated Masangane HIV/AIDS programme affiliated with the Moravian Church in Eastern Cape, South Africa. Completed in 2006, this study aimed to understand the role of the religious health assets of the Masangane ART ...programme for public health, as a model for a replicable response to HIV/AIDS. A crucial aspect of this research involved teasing out what value is added to this programme by its faith-based nature. Field work for this case study consisted of more than 20 key informant interviews of various stakeholders: Masangane staff and management; church leaders; health seekers; donors and health providers. Health seekers also answered 77 questionnaires and were involved in two focus groups.
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Undernutrition increases the risk of tuberculosis (TB) and in turn TB can lead to malnutrition. Undernutrition is therefore highly prevalent among people with TB. It has been demonstrated that undernutrition is a risk factor for progression from TB infection to active TB disease and that undernutrit...ion at the time of diagnosis of active TB is a predictor of increased risk of death and TB relapse. However, the evidence concerning the effect of nutritional supplementation on TB prevention and health outcomes among people with TB had not previously been systematically reviewed. This guideline provides guidance on the principles and recommendations for nutritional care and support of patients with TB as part of their regular TB care
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This guide was prepared to enable advocates to use data
when advocating for universal access to SRHR at the national,
regional and global levels. It is a direct outcome of the Strategic
SRHR Indicators workshop held in Kuala Lumpur, Malaysia on
21-22 August for the project “Strengthening the N...etworking,
Knowledge Management and Advocacy Capacities of an AsiaPacific
Network for SRHR” supported by the EU.
One of the major objectives of the project is to develop
a comprehensive monitoring framework of indicators for
measuring government performance to fulfil their international
commitments, particularly to the ICPD and the MDGs, both in
the Asia-Pacific region and globally.
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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...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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