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Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversible factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (rarely) true severe,
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therapy-resistant asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
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Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income countries (LMICs) due to well documented factors including decreased access to screening, trained health professionals, and therapies for disease manageme
...
nt. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
more
Open Forum Infect Dis . 2022 Apr 5;9(5):ofac148.doi: 10.1093/ofid/ofac148. eCollection 2022 May. Dolutegravir HIV drug resistance (HIVDR) data from Africa remain sparse. We reviewed HIVDR results of Malawians on dolutegravir-based antiretroviral therapy
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(November 2020– September 2021). Of 6462 eligible clients, 33 samples were submitted to South Africa, 27 were sequenced successfully, and 8 (30%) had dolutegravir HIVDR. Malawi urgently requires adequate HIVDR testing capacity.
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Time has seen management for Cystic Fibrosis (CF) advance drastically, most recently in the development of the disease-modifying triple combination therapy ivacaftor/tezacaftor/elexacaftor. There is currently limited evidence regarding both the glob
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al epidemiology of CF and access to this transformative therapy - and therefore where needs are not being met. Therefore, this study aims to define gaps in access to CF treatment. The results show that a significant CF patient burden exists in countries where disease-modifying drugs are unavailable, and final figures are likely underestimates. This analysis shows the potential to improve rates of diagnosis and treatment for CF, so a higher percentage of patients receive the most effective triple combination treatment.
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Effective malaria case management requires quick access to diagnostics and antimalarial treatments to reduce illness and death. Artemisinin-based combination therapy (ACT) has been essential to malaria treatment since 2001, as it combines artemisini
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n for rapid parasite reduction with a partner drug to ensure complete cure. However, resistance to antimalarial drugs, where parasites survive standard doses, threatens malaria control.
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Accessed June 2025. This document outlines the Ministry of Health's management guidelines for malaria in pregnancy in Uganda. Pregnant women without malaria symptoms receive intermittent preventive treatment in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) as directly observed
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therapy (DOT), starting from the second trimester with monthly doses until delivery, except for HIV-positive mothers on cotrimoxazole.
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With the advent and ongoing development of novel antiretroviral agents, people living with HIV (PLWHIV) are living longer and experiencing the effects of HIV infection on aging. The success of antiretroviral therapy (ART) has transformed HIV from a
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fatal disease into a manageable chronic condition, with PLWHIV on effective ART having life expectancies approaching those of the general population. As a result, a growing proportion of PLWHIV are 50 and older. The interplay between chronic HIV infection, the adverse effects of ART, and the natural aging process gives rise to unique challenges. These include an increased risk for conditions such as cardiovascular disease, metabolic syndrome, renal dysfunction, neurocognitive disorders, immunosenescence, and more
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BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022 (2025 interim update)
The purpose of the 2025 interim update of the guidelines was to update our recommendations based on new evidence since the last update, including: (i) incorporating new evidence related to injectable therapy including frequency of viral load monitor
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ing and use of long-acting cabotegravir/rilpivirine in non-virally suppressed people; (ii) removal of abacavir from first-line recommendations for most and a recommendation to switch away from abacavir where clinically appropriate; (iii) removal of the CD4 caveat for first-line dolutegravir/lamivudine use; (iv) updated recommendations for people with NRTI resistance. These changes, with the supporting evidence, are highlighted in green.
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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 Transmis
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sion (PMTCT) guidelines.This document is written for 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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Prevention of mother-to-child HIV transmission (PMTCT) has been a success in many respects
but there is still much to do to eliminate mother-to child transmission (MTCT), particularly in low
antiretroviral therapy (ART) coverage areas and in the p
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ostnatal phase. The success of PMTCT is
highly dependent on the availability and accessibility of patient-centred care, which enables women
and their families to take informed decisions about their health and the health of their infant. For
this reason, it is recommended to have a patient-centred approach when implementing PMTCT.
PMTCT success is also linked to the partners’ involvement, as well as to community acceptance
of HIV.
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In the context of the Support to National Malaria Control Programme (SuNMaP), demand creation is the strategic combination of advocacy, communication and mobilisation approaches that seek to achieve increased community awareness of, and demand for, effective malaria prevention and treatment services
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. For malaria treatment, demand creation focuses on promoting improved testing, prompt and proper use of artemisinin combination therapy (ACT) treatment for individual cases of malaria, and effective home management of fever, together with referrals of severe cases to a higher-level health facility.
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Clinical guideline, Methods, Evidence and Recommendations
In this guideline the following is covered: information needs of people with chronic hep
titis B and their carers; where children, young people and adults with chronic hepatitis B a-
should be assessed; assessment of liver disease, includi
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ng the use of non-invasive tests and genotype testing; criteria for offering antiviral treatment; the efficacy, safety and cost effectiveness of currently available treatments; selection of first-line therapy; management of treatment failure or drug resistance; prophylactic treatment during im-
munosuppressive therapy; and monitoring for treatment response
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Medikamente sicher einnehmen (Arabic)
Ärztliches Zentrum für Qualität in der Medizin (ÄZQ)
(2011)
C1
Patienteninformation „Sichere Arzneimitteltherapie“ – Arabische Übersetzung. Broschüre auch erhältlich in: Deutsch, Englisch, Französisch, Russisch, Türkisch, Spanisch.
Patient information "Safe Medical Therapy " - Arabic translation. B
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rochure also available in: German, English, French, Russian, Turkish, Spanish.
Für andere Sprachversionen, siehe auch / For other language versions go to: http://www.patienten-information.de/kurzinformationen/arzneimittel-und-impfungen/sichere-arzneimitteltherapie
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Disabled village children. 2nd edition
recommended
A guide for community health workers, rehabilitation workers, and families.
This manual covers identifying primary and secondary disabilities, developing skills for daily living, and working through behavior problems. The new 2018 edition features new topics, including mental and developmental di
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sabilities, microcephaly and Zika, causes of birth defects and childhood disability, epilepsy and seizures, hearing loss and vision problems, HIV, leprosy, and more, and has updated information on polio, cerebral palsy, juvenile arthritis, muscular dystrophy, and medications.
Readers will find instructions on how to build six different wheelchairs using local resources; useful therapy techniques, such as making fun and educational toys; ideas for improving playground accessibility for all children; and low-cost rehabilitation aids and adaptations for home and community.
You can download chapter 4 for free. The complete book is available at Hesperian Book STore
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The mandate of the National Tuberculosis Control Programme is to provide leadership and stewardship to accelerate intense and coordinated efforts to reduce the adult TB burden of 290 per 100,000 population recently established in the 2013 National TB Prevalence Survey. Other key challenges are low T
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B case notification, unacceptably high TB death rates, low antiretroviral therapy (ART) coverage among TB/HIV patients and low drug-resistant notification and treatment.
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Wheelchair Service Training Package - Basic level | The main purpose of the training package is to develop the minimum skills and knowledge required by personnel involved in wheelchair service delivery. An important aim of the training package is to get it integrated into the regular paramedical/reh
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abilitation training programs such as physiotherapy, occupational therapy, prosthetics and orthotics, rehabilitation nursing. Towards this, WHO is posting the whole training package in the Website for the training institutes and wheelchair service providers. The easiest way to make use of the training package is to download the complete package (requires 3 GB space).
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Wheelchair Service Training Package - Basic level | The main purpose of the training package is to develop the minimum skills and knowledge required by personnel involved in wheelchair service delivery. An important aim of the training package is to get it integrated into the regular paramedical/reh
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abilitation training programs such as physiotherapy, occupational therapy, prosthetics and orthotics, rehabilitation nursing. Towards this, WHO is posting the whole training package in the Website for the training institutes and wheelchair service providers. The easiest way to make use of the training package is to download the complete package (requires 3 GB space).
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CADEIRA DE RODAS PACOTE DE TREINAMENTO EM SERVIÇOS - Manual do Instrutor (NÍVEL BÁSICO)
Organização Mundial da Saúde; Secretaria de Estado dos Direitos da Pessoa com Deficiência de São Paulo
World Health Organisation (WHO)
(2012)
C_WHO
Wheelchair Service Training Package - Basic level | The main purpose of the training package is to develop the minimum skills and knowledge required by personnel involved in wheelchair service delivery. An important aim of the training package is to get it integrated into the regular paramedical/reh
...
abilitation training programs such as physiotherapy, occupational therapy, prosthetics and orthotics, rehabilitation nursing. Towards this, WHO is posting the whole training package in the Website for the training institutes and wheelchair service providers. The easiest way to make use of the training package is to download the complete package (requires 3 GB space).
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Q3: Can febrile seizures (simple or complex) be managed at first or second level care by non-specialist health care providers in low and middle income country settings? What is the role of diagnostic tests in the management of febrile seizures by non-specialists in low and middle income settings? Fo
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r prophylaxis to prevent recurrence of simple or complex febrile seizures, which of the pharmacological interventions when compared with placebo/comparator produce benefit/harm in specified outcomes?
- continuous anticonvulsant therapy - intermittent anticonvulsant therapy - intermittent antipyretic treatment
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The present Consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these WHO guidelines documents. The consolidated guidelines include policy recommendations on treatment regimens for isoniazid-resistant TB (Hr-TB) and MDR/RR-TB,
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including longer and shorter regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.
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