Module 1
Clinical
July 2017
Module 1: Clinical. This module is for clinicians, including physicians, nurses and clinical officers. It gives an overview of how to provide PrEP safely and effectively, including: screening for substantial risk of HIV; performing appropriate testing before initi...ating someone on PrEP and while the person is taking PrEP; and how to follow up PrEP users and offer counselling on issues such as adherence.
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Phil. Trans. R. Soc. B (2010) 365, 2959–2971; doi:10.1098/rstb.2010.0143.
Agricultural ecosystems provide humans with food, forage, bioenergy and pharmaceuticals and are essential to human wellbeing. These systems rely on ecosystem services provided by natural ecosystems, including pollination, b...iological pest control, maintenance of soil structure and fertility, nutrient cycling and hydrological services. Preliminary assessments indicate that the value of these ecosystem services to agriculture is enormous and often underappreciated. Agroecosystems also produce a variety of ecosystem services, such as regulation of soil and water quality, carbon sequestration, support for biodiversity and cultural services. Depending on management practices, agriculture can also be the source of numerous disservices, including loss of wildlife habitat, nutrient runoff, sedimentation of waterways, greenhouse gas emissions, and pesticide poisoning of humans and non-target species. The tradeoffs that may occur between provisioning services and other ecosystem services and disservices should be evaluated in terms of spatial scale, temporal scale and reversibility. As more effective methods for valuing ecosystem services become available, the potential for ‘win–win’ scenarios increases. Under all scenarios, appropriate agricultural management practices are critical to realizing the benefits of ecosystem services and reducing disservices from agricultural activities.
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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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Policy Note #1: Myanmar Health Systems in Transition Policy Notes Series
The Government of the Republic of the Union of Myanmar is committed to achieving universal health coverage (UHC) by 2030. In practice, this means that over the next 15 years the aim is to progressively ensure that all peop...le in all parts of the country have access to the health-care services they need – both preventive and curative – without suffering financial hardship when paying for them.
This policy note is the first in a set of four. It provides an overview of the challenges to be overcome in making progress toward UHC and sets out recommendations for how they can be tackled. The other notes look in more detail at three specific issues: how UHC can improve equity, and how strengthening the township health system and expanding financial risk protection contribute to UHC.
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Aligned to the Lancet Migration Global Statement to include migrants and refugees incountries’response to COVID-19, this update focuses on Mexico’s challenges and opportunities to build an inclusive response that is based on a contextualized adaptation of there commendations published by th...e Lancet Migration. A critical component for this analysis is the recognition of migration as a social determinant of health, which acts as a major risk factor for populations subjected to violence, trauma and forced exile while in the face of a global pandemic.
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The UNICEF-GAIN Partnership Project
The report notes that iodine deficiency is a leading cause of preventable brain damage worldwide. Insufficient iodine during pregnancy and infancy results in neurological and psychological deficits, reducing a child’s IQ by 8 to 10 points. This translates ...into major losses in the cognitive capital of entire nations and thus their socio-economic development.
The report outlines urgent steps to reduce the risk of mental impairment to babies’ growing brains:
• Integrate salt iodization into national plans to support children’s nutrition and brain development in early childhood;
• Align salt iodization and salt reduction agendas;
• Establish surveillance systems to identify unreached populations;
• Strengthen regulatory systems to enforce existing legislation on salt iodization;
• Recognize the growing importance of fortified foods as potential sources of iodized salt.
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Most of the global burden of sepsis occurs in low- and middle-income countries (LMICs), but the prevalence and etiology of sepsis in LMICs are not well understood. In particular, the lack of laboratory infrastructure in many LMICs has historically precluded an assessment of the pathogens leading to ...sepsis. A recent systematic review found that data describing antimicrobial resistance were absent for 43% of countries in Africa, and only two countries have national antimicrobial resistance plans. In addition, small studies have identified indiscriminate antibiotic use both in and out of hospital settings in sub-Saharan Africa. The absence of microbiological data and lack of antibiotic stewardship complicate sepsis management and almost certainly worsens outcomes, particularly in low-resource systems. The purpose of this study was to examine the prevalence, etiology, and outcomes of sepsis among a cohort of critically ill patients in a referral hospital of Malawi, with a focus on the prevalence of culture-confirmed bacteremia and urinary tract infections.
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Women and girls have specific needs that are often ignored during crisis. While on the run or while living in shelters, women and girls continue to become pregnant, but they often lack access to basic sexual and reproduc-tive health care. Without assistance by midwifes or access to contraceptives, w...omen and girls are at increased risk of unsafe sex, unwanted pregnancy and unsafe delivery, and are at a higher risk of infection by HIV and other sexually transmitted infections. In addition, displaced women have virtually no access to protection, security, justice, and other services related to gender-based violence (GBV). For these reasons, the delivery of sexual and reproduc-tive health and rights (SRHR) as well as GBV services to conflict-affected communities – most of whom are living in protracted displacement – is a key part of UNFPA’s Women and Girls First Programme (WGF). The initia-tive is a commitment to prevent and respond to violence perpetrated against women and girls in Myanmar, and to realize their sexual and reproductive health and rights.
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In an effort to improve the capabilities and accountability of humanitarian and economic practitioners, the SEEP (Small Enterprise Education and Promotion) Network's Minimum Economic Recovery Standards focus on minimum industry standards for facilitating economic recovery in crisis situations.
Th...e handbook sets out strategies and interventions designed to improve income, cash flow, asset management, and growth among crisis-affected households and enterprises. These include financial services, productive assets, employment, and enterprise development. It emphasizes encouraging the re-start of enterprises and livelihoods strategies, and improving market productivity and governance
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In most malaria-endemic countries, temperatures frequently exceed the recommended storage temperatures for malaria RDTs. Correct storage of the RDTs may be difficult, especially during transport and in locations where air-conditioning is unavailable.
This publication is intended to support health p...ersonnel who use RDTs. It describes the basic principles for management and storage of RDT stock; outlines practical solutions for protecting RDTs against high temperatures during storage and transport; and describes how to manage waste generated from RDT use in health clinics and central and peripheral storage facilities.
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The Zambia Population Based HIV impact assessment of 2016, reported the prevalence of viral hepatitis in Zambia as ranging between 5.6% among adults aged 15 to 59% in the general population, and 7.1% among HIV infected individuals. It is estimated that the majority of persons with chronic hepatitis ...B and/ or hepatitis C are unware of their infection and do not benefit from promotive, preventive and curative services designed to reduce onward transmission. Zambia introduced hepatitis B virus vaccine to the routine Under 5 vaccination schedule in 2005. Preliminary results from the ZAMPHIA indicate that hundreds of infections have been abated in children since then. However, its also clear that we continue to miss key opportunities to prevent transmission, diagnose and treat infections, prevent serious disease, and in many cases cure people. In addition, high risk groups inter alia health care workers still have limited access to the vaccine.
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In Deutschland leben ca. 200.000 Geflüchtete in Aufnahmeeinrichtungen und Gemeinschaftsunterkünften (Stand:31.12.2018). Massnahmen der physischen Distanzierung sind in der Sammelunterbringung für Geflüchtete meist nicht oder nur bedingt umsetzbar: Beengte Verhältnisse, Mehrbettzimmer und gemein...schaftliche Nutzung von Küchen und Sanitäranlagen stellen Kontexte dar, die eine Ausbreitung von Infektionserkrankungen begünstigen. Zunehmend werden in diesen Settings Infektionen mit dem neuartigen Coronavirus (SARS‐CoV‐2) bekannt. Die Ansätze zu Prävention und Management von SARS‐CoV‐2 sind regional unterschiedlich, Vorgaben fehlen bisher auf nationaler und internationaler Ebene. So werden vielerorts Aufnahmeeinrichtungen und Gemeinschaftsunterkünfte beim Auftreten einer SARS‐CoV‐2‐Infektion unter Geflüchteten kollektiv unter Quarantäne gestellt.
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The household transmission investigation is a case-ascertained prospective study of all identified household contacts of a laboratory confirmed 2019-nCoV infection (see 2.2 Study population). It is intended to provide rapid and early information on the clinical, epidemiological and virological chara...cteristics of 2019-nCoV.
There are three primary objectives of this household transmission study:
To better understand the extent of transmission within a household by estimating the secondary infection rate for household contacts at an individual level, and factors associated with any variation in the secondary infection risk.
To characterize secondary cases including the range of clinical presentation, risk factors for infection, and the extent and fraction of asymptomatic infections.
To characterize serologic response following confirmed 2019-nCoV infection (highly encouraged, but optional depending on laboratory capacity and resources)
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This report is part of the gender and noncommunicable diseases (NCDs) initiative launched by the WHO Regional Office for Europe, which aims to strengthen the response to NCDs through a gender approach. It is part of a series of country profiles and a synthesis report. The country profile of Ukraine ...presents a gender analysis of the WHO STEPwise survey (STEPS) data to support international commitments to reducing the burden of NCDs with evidence and knowledge exchange. A gender analysis of STEPS NCD risk-factor survey data describes how risk factors for chronic diseases differ between and among men and women by exploring and tracking the direction and magnitude of trends in risk factors and accessing services by sociodemographic variables. Important differences hide even in sex-disaggregated data that need to be unpacked through sociodemographic characteristics, because men and women are not homogenous groups. The report also recognizes gaps in evidence and calls for further analysis of the impact of gender-based inequalities.
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The Bolivarian Republic of Venezuela has been facing a prolonged socio-political and economic situation that has profoundly and negatively impacted social and health indicators. The COVID-19 pandemic further aggravated the humanitarian context in the
country, which stretched the limits of an alread...y weakened national health system. Violence and social conflicts, hyperinflation, constant political tensions, the persistence of migratory movements, and intensification of climate threats and natural hazards
have worsened the living conditions and health status of populations in vulnerable situations, including women, children, and indigenous people. A large influx of returnees back to Venezuela (Bolivarian Republic of) marked the first
two years of the pandemic. However, the country’s continued deteriorating political, socio-economic, and human rights situation resulted in renewed increased migration of Venezuelans in 2022. The profile of Venezuelan migrants has progressively changed
over the years, from single men in search of better economic opportunities to families with women and children in situations of extreme vulnerability. The increasingly irregular and unsafe journeys of those migrants are constantly putting their lives at high risk
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This Rapid Gender Analysis provides preliminary information and observations on the different needs, capacities and coping strategies of Venezuelan migrant and refugee women, men, boys, and girls in Colombia. It seeks to understand how gender roles and relations have changed as a result of the crisi...s and share recommendations for how the humanitarian community can more effectively consider these changing dynamics to better meet the different needs of women, men, boys and girls of different ages, abilities and other contextually relevant forms of diversity. The refugee and migrant crisis in Colombia is characterized by gendered dynamics and has taken a significant toll on the health and welfare on all those affected, but particularly on women and girls. Refugee and migrant women and girls face profound vulnerabilities as they leave Venezuela and either cross Colombia or stay in various locations across the country; this is even more the case for those at increased risk, such as indigenous populations, adolescent girls, etc.
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The National Guidelines for HIV-1 Viral Load Laboratory Testing support plans to scale up viral load (VL) testing to reach the 90-90-90 targets in India. This phased scale-up includes the setup of 70 additional VL testing laboratories nationally. These guidelines include laboratory design considerat...ions, a summary of VL technologies, and specimen collection and handling as well as transportation and storage guidance. Quality control and quality assurance requirements are described as well as laboratory safety issues. The guidelines also describe the VL laboratory network to be developed with supply chain management issues and commodities described. Annexes include laboratory registers and reporting forms.
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The resources provide both the older as well as the updated Operational Guidelines for antiretroviral therapy centres, including administrative issues, functions and establishment of centres, reporting and recording tools, measures to improve retention in HIV care, supply chain management of drugs a...nd various other aspects that are essential to ensure quality treatment for people living with HIV/AIDS.
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The WHO Cholera Vaccine Position Paper (August 2017) highlights the importance of oral cholera vaccines (OCVs) as a key tool in outbreak response and prevention, alongside water, sanitation, and hygiene (WASH) measures. It recommends OCVs for high-risk populations, endemic areas, and humanitarian cr...ises, emphasizing their effectiveness in reducing cases and mortality. The paper discusses two types of OCVs (Dukoral®, Shanchol™, Euvichol®) and supports the WHO-managed vaccine stockpile for rapid deployment in cholera-prone regions.
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Primary care represents the first level of personal health care services in the community, which ensures accessible, continual,
whole-person care for health needs throughout an individual’s lifespan. Primary care professionals work with patients and
their families to address their immediate and ...long-term health needs and not just for a set of specific diseases with an
approach that addresses the broader determinants of health and the interrelated aspects that influence people’s physical,
mental, and social well-being.
Nurses have a key role to play in primary care in expanding, connecting and coordinating care. Through their training and
work, they are well placed and have been shown to provide safe and effective care in disease prevention, diagnosis,
treatment, management and rehabilitation. The purpose of this document is to provide guidance and inspiration for
policymakers, instructors, managers and clinicians
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