The pharmacological treatment of heart failure has evolved over the last three decades since the demonstration of the effect of angiotensinconverting enzyme inhibitors on major cardiovascular events in patients with heart failure with reduced ejection fraction. Composite analysis of heart failure wi...th reduced ejection fraction trials and the recent identification of newer drug treatments show early benefits on the major cardiovascular outcomes, ushering in a change of the treatment strategy; from a ‘sequential’ initiation of the treatments to a ‘simultaneous’ initiation to harness the early benefits. The adoption and implementation of these changes at the bedside have been dismal in many healthcare settings. Papua New Guinea, like many other lower-to-middle-income countries, is facing many barriers that impact on the care of heart failure patients. It needs to adopt and implement these changes to provide evidence-based treatment for its people with heart failure with reduced ejection fraction.
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Cardiovascular disease (CVD) is often thought to be a problem of wealthy, industrialized nations. The term “cardiovascular disease” is used throughout the report to refer to cardiac disease, vascular diseases of the brain and kidney, and peripheral vascular disease. The report’s main focus is ...on the major contributors to global CVD mortality, coronary heart disease and stroke, and on the major modifiable risk factors for cardiovascular diseases. In fact, as the leading cause of death worldwide, CVD now has a major impact not only on developed nations but also on low and middle income countries, where it accounts for nearly 30 percent of all deaths. The terms “developed” and “high income countries” are used interchangeably throughout the report to refer to countries classified by the World Bank as high income economies. The terms “developing” and “low and middle income countries” are used interchangeably throughout the report to refer to countries classified by the World Bank as low, lower middle, and upper middle income economies. The increased prevalence of risk factors for CVD and related chronic diseases in developing countries, including tobacco use, unhealthy dietary changes, reduced physical activity, increasing blood lipids, and hypertension, reflects significant global changes in behavior and lifestyle. The term “chronic diseases” is used throughout the report to refer to CVD and the following related chronic diseases that share many common risk factors: diabetes, cancer, and chronic respiratory disease. These changes now threaten once-low-risk regions, a shift that is accelerated by industrialization, urbanization, and globalization. The potentially devastating effects of these trends are magnified by a deleterious economic impact on nations and households, where poverty can be both a contributing cause and a consequence of chronic diseases. The accelerating rates of unrecognized and inadequately addressed CVD and related chronic diseases in both men and women in low and middle income countries are cause for immediate action.
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In 2012, all Member States of the World Health Organization (WHO) endorsed a historical target to reduce premature mortality from noncommunicable diseases
(NCD). This commitment was echoed in 2015 by the United Nations Sustainable Development Goals, which included a target to reduce premature morta...lity (the
measure of unfulfilled life expectancy and deaths between the ages of 30 and 70 years) from NCD by 30% by the year 2030. The Sustainable Development Goals are especially relevant to cardiovascular disease (CVD), the leading cause of death globally, with increasing prevalence in low- and middle-income countries (LMIC).
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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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Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is created by th...e force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure, the harder the heart has to pump.
Hypertension is a serious medical condition and can increase the risk of heart, brain, kidney and other diseases. It is a major cause of premature death worldwide, with upwards of 1 in 4 men and 1 in 5 women – over a billion people – having the condition. The burden of hypertension is felt disproportionately in low- and middle-income countries, where two thirds of cases are found, largely due to increased risk factors in those populations in recent decades.
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Worldwide, around 2.3 billion people still cook using solid fuels (such as wood, crop waste, charcoal, coal and dung) and kerosene in open fires and inefficient stoves. Most of these people are poor and live in low- and middle-income countries. There is a large discrepancy in access to cleaner cooki...ng alternatives between urban and rural areas: in 2021, only 14% of people in urban areas relied on polluting fuels and technologies, compared with 49% of the global rural population.
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The document is a handbook on implementing the mBreatheFreely program, an mHealth initiative by the World Health Organization (WHO) and the International Telecommunication Union (ITU) aimed at improving the management of asthma and COPD through mobile technology. It provides a framework for governme...nts and policymakers to develop, launch, and evaluate national mHealth programs. The guide covers areas such as operations management, content development, promotion strategies, technology infrastructure, and monitoring and evaluation. It emphasizes the importance of mHealth in enhancing self-management, prevention, and treatment of chronic respiratory diseases, particularly in low- and middle-income countries. The handbook also includes examples of successful programs and practical tools for adaptation and implementation.
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The World Health Organization (WHO) fact sheet on ambient (outdoor) air quality and health highlights the significant health risks posed by outdoor air pollution. It reports that in 2019, ambient air pollution was responsible for approximately 4.2 million premature deaths globally, primarily due to ...exposure to fine particulate matter (PM2.5), which leads to cardiovascular and respiratory diseases, as well as cancers. The fact sheet emphasizes that 99% of the global population lived in areas exceeding WHO air quality guidelines in 2019, with low- and middle-income countries bearing the highest burden. To mitigate these health impacts, WHO advocates for policies and investments that promote cleaner transportation, energy-efficient housing, improved waste management, and access to clean household energy.
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The World Health Organization (WHO) fact sheet on ambient (outdoor) air quality and health highlights the significant health risks posed by outdoor air pollution. It reports that in 2019, ambient air pollution was responsible for approximately 4.2 million premature deaths globally, primarily due to ...exposure to fine particulate matter (PM2.5), which leads to cardiovascular and respiratory diseases, as well as cancers. The fact sheet emphasizes that 99% of the global population lived in areas exceeding WHO air quality guidelines in 2019, with low- and middle-income countries bearing the highest burden. To mitigate these health impacts, WHO advocates for policies and investments that promote cleaner transportation, energy-efficient housing, improved waste management, and access to clean household energy.
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The World Health Organization (WHO) fact sheet on ambient (outdoor) air quality and health highlights the significant health risks posed by outdoor air pollution. It reports that in 2019, ambient air pollution was responsible for approximately 4.2 million premature deaths globally, primarily due to ...exposure to fine particulate matter (PM2.5), which leads to cardiovascular and respiratory diseases, as well as cancers. The fact sheet emphasizes that 99% of the global population lived in areas exceeding WHO air quality guidelines in 2019, with low- and middle-income countries bearing the highest burden. To mitigate these health impacts, WHO advocates for policies and investments that promote cleaner transportation, energy-efficient housing, improved waste management, and access to clean household energy.
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The World Health Organization (WHO) fact sheet on ambient (outdoor) air quality and health highlights the significant health risks posed by outdoor air pollution. It reports that in 2019, ambient air pollution was responsible for approximately 4.2 million premature deaths globally, primarily due to ...exposure to fine particulate matter (PM2.5), which leads to cardiovascular and respiratory diseases, as well as cancers. The fact sheet emphasizes that 99% of the global population lived in areas exceeding WHO air quality guidelines in 2019, with low- and middle-income countries bearing the highest burden. To mitigate these health impacts, WHO advocates for policies and investments that promote cleaner transportation, energy-efficient housing, improved waste management, and access to clean household energy.
more
The World Health Organization (WHO) fact sheet on ambient (outdoor) air quality and health highlights the significant health risks posed by outdoor air pollution. It reports that in 2019, ambient air pollution was responsible for approximately 4.2 million premature deaths globally, primarily due to ...exposure to fine particulate matter (PM2.5), which leads to cardiovascular and respiratory diseases, as well as cancers. The fact sheet emphasizes that 99% of the global population lived in areas exceeding WHO air quality guidelines in 2019, with low- and middle-income countries bearing the highest burden. To mitigate these health impacts, WHO advocates for policies and investments that promote cleaner transportation, energy-efficient housing, improved waste management, and access to clean household energy.
more
The World Health Organization (WHO) fact sheet on ambient (outdoor) air quality and health highlights the significant health risks posed by outdoor air pollution. It reports that in 2019, ambient air pollution was responsible for approximately 4.2 million premature deaths globally, primarily due to ...exposure to fine particulate matter (PM2.5), which leads to cardiovascular and respiratory diseases, as well as cancers. The fact sheet emphasizes that 99% of the global population lived in areas exceeding WHO air quality guidelines in 2019, with low- and middle-income countries bearing the highest burden. To mitigate these health impacts, WHO advocates for policies and investments that promote cleaner transportation, energy-efficient housing, improved waste management, and access to clean household energy.
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The Global Asthma Report (GAR) 2022, prepared by the Global Asthma Network (GAN), is the fourth such report (others 2011, 2014, 2018). GAN builds upon the work of the International Study of Asthma and Allergies in Childhood (ISAAC) and The International Union Against Tuberculosis and Lung Disease (T...he Union) to monitor asthma and improve asthma care, particularly in low- and middle-income countries (LMICs).
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As we approach World Asthma Day on the May 2, 2023, we reflect on the theme “ Asthma Care for All”. Prevalence of Asthma is increasing amongst children, adolescents and adults. Under-diagnosis, underutilization of inhaled corticosteroids, inaccessibility of treatment, and unaffordability of medi...cines are amongst the challenges that low-middle income countries are faced with. This commentary seeks to highlight the challenges, the resources available and to suggest recommendations that can be implemented to improve asthma care for all and reduce burden of asthma in Africa.
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Asthma is the commonest chronic childhood disease and encompasses a spectrum of airway diseases with similar symptoms. Inaccurate diagnosis remains common, especially in younger children, with failure to characterize the different “asthmas.” Children worldwide repeatedly suffer symptoms which se...verely affect their everyday lives. Children die from asthma, especially in low and middle-income countries (LMICs). In many countries, asthma prevalence is rising. Access to effective care and changing environments are hugely variable and may explain the higher morbidity in inner-city children, in LMICs, and in deprived populations in high-income countries. Despite the disease being eminently controllable, morbidity and mortality persist.
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Chronic respiratory diseases, such as asthma and
chronic obstructive pulmonary disease, kill more than
four million people every year and affect hundreds
of millions more. These diseases erode the health
and well-being of the patients and have a negative
impact on families and societies. Women ...and
children are particularly vulnerable, especially those
in low and middle income countries, where they are
exposed on a daily basis to indoor air pollution from
solid fuels for cooking and heating. In high income
countries, tobacco is the most important risk factor
for chronic respiratory diseases, and in some of
these countries, tobacco use among women and
young people is still increasing.
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Chronic respiratory diseases, such as asthma and
chronic obstructive pulmonary disease, kill more than
four million people every year and affect hundreds
of millions more. These diseases erode the health
and well-being of the patients and have a negative
impact on families and societies. Women ...and
children are particularly vulnerable, especially those
in low and middle income countries, where they are
exposed on a daily basis to indoor air pollution from
solid fuels for cooking and heating. In high income
countries, tobacco is the most important risk factor
for chronic respiratory diseases, and in some of
these countries, tobacco use among women and
young people is still increasing.
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Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the tee...nage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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