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532
450
421
386
306
298
284
282
216
213
190
184
143
125
125
111
105
99
73
63
49
47
15
2
Despite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes a
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mong key populations is suboptimal. Client-centered differentiated service delivery approaches may facilitate addressing HIV prevention and treatment needs of key populations in Malawi.
Methods
De-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation.
Results
Of the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation.
Conclusions
These data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings.
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Snakebite envenoming constitutes a serious medical condition that primarily affects residents of rural communities in Africa, Asia, Latin America, and New Guinea. It is an occupational, environmental, and domestic health hazard that exacerbates the
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already impoverished state of these communities. Conservative estimates indicate that, worldwide, more than 5 million people suffer snakebite every year, leading to 25,000–125,000 deaths, while an estimated 400,000 people are left with permanent disabilities.
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This infographic provides important information on what to do and what not to do in regard to alcohol during the COVID-19 pandemic, including: avoiding alcohol altogether, reaching out for help, avoiding alcohol as a social cue for smoking, discussi
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ng with children and young people the problems associated with drinking and COVID-19, not using alcohol as a way of dealing with your emotions and stress, never mixing alcohol with medications, and making sure that children and young people do not have access to alcohol.
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Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasingnumber of people live with CHD and may need support to manage
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their symptoms and improve prognosis. Cardiac rehabilitation is acomplex multifaceted intervention which aims to improve the health outcomes of people with CHD. Cardiac rehabilitation consists of threecore modalities: education, exercise training and psychological support. This is an update of a Cochrane systematic review previouslypublished in 2011, which aims to investigate the specific impact of the educational component of cardiac rehabilitation.
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People living with disabilities (PLWDs) have poor access to health services compared to people without disabilities. As a result, PLWDs do not benefit from some of the services provided at health fa
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cilities; therefore, new methods need to be developed to deliver these services where PLWDs reside. This case study reports a household-based screening programme targeting PLWDs in a rural district in Malawi. Between March and November 2016, a household-based and integrated screening programme was conducted by community health workers, HIV testing counsellors and a clinic clerk. The programme provided integrated home-based screening for HIV, tuberculosis, hypertension and malnutrition for PLWDs. The programme was designed and implemented for a population of 37 000 people. A total of 449 PLWDs, with a median age of 26 years and about half of them women, were screened. Among the 404 PLWDs eligible for HIV testing, 399 (99%) agreed for HIV testing. Sixty-nine per cent of PLWDs tested for HIV had never previously been tested for HIV. Additionally, 14 patients self-reported to be HIV-positive and all but one were verified to be active in HIV care. A total of 192 of all eligible PLWDs above 18 years old were screened for hypertension, with 9% (n = 17) referred for further follow-up at the nearest facility. In addition, 274 and 371 PLWDs were screened for malnutrition and tuberculosis, respectively, with 6% (n = 18) of PLWDs referred for malnutrition, and 2% (n = 10) of PLWDs referred for tuberculosis testing. We successfully implemented an integrated home-based screening programme in rural Malawi.
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Right now, we are facing an unpredictable and highly dynamic situation as a global community. However, as we have seen from the solidarity, support and power of communities in the HIV epidemic and already
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in communities responding to the COVID-19 pandemic, the response must not be fear and stigma. We need to build a culture of solidarity, trust and kindness. Our response to COVID-19 must be grounded in the realities of people’s lives and focused on eliminating the barriers people face in being able to protect themselves and their communities. Empowerment and guidance, rather than restrictions, can ensure that people can act without fear of losing their livelihood, sufficient food being on the table and the respect of their community. Ultimately it will give us a more effective, humane and sustainable response to the epidemic.
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The Lancet. 1 December 2020. doi: 10.1016/S0140-6736(20)32340-0.
To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one
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in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.
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Best practices” are exemplary public health practices that have achieved results, and which need to be scaled up so as to benefit more people. The expansion and institutionalization of successfull
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y tested best practices requires strategic planning. There are several creative and constructive actions by people and organizations in the health sector to improve the health outcomes of people.
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The Community Action Research on Disability (CARD) programme in Uganda embraced and modified the EDR approach, recognising the need for including people
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with disability in the research process from concept to outcome, and nurturing participation and collaboration between all the stakeholders in achieving action-based research. T
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In most contexts, the social stigma surrounding mental health issues exists because of cultural norms and a lack of understanding of mental health’s complexities and realities, resulting in isolat
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ion, increased vulnerability, and lack of support for people with mental health problems.
This stigma has been exacerbated during COVID-19, as more people may need mental health or psycho-social support but cannot access it due to the cessation of in-person services and limited remote care option
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he Western Pacific is the world’s most disaster-prone region. When a disaster occurs, people may need to seek accommodation in a disaster evacuat
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ion shelter. However, it may be difficult for people in a disaster evacuation shelter to avoid confined and enclosed spaces with poor ventilation; crowded places with many people nearby; and close-contact settings, such as close-range conversations. This document outlines key considerations and strategies that should be considered for the establishment of a disaster evacuation shelter in the context of COVID-19. In particular, considerations and strategies as outlined for the preparedness, response and recovery phases of disasters.
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8 March 2022
A very large number of people from Ukraine are fleeing the country and entering the European Union (EU) countries bordering Ukraine (Hungary, Poland, Romania, Slovakia) and the EU-neighbourhood country of the Republic of Moldova. Those
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fleeing Ukraine - mainly women and children - are currently dispersing into communities, but as more people congregate at border crossings it is likely that they will also need to be housed in reception centres.
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This sourcebook aims to detail why health needs to be part of urban and territorial planning and how to make this happen. It brings together two vital elements we need to build habitable cities on a habitable planet: 1) Processes to guide the develo
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pment of human settlements – in this document referred to as “urban and territorial planning (UTP)”; and 2) concern for human health, well-being and health equity at all levels – from local to global, and from human to planetary health.
This sourcebook identifies a comprehensive selection of existing resources and tools to support the incorporation of health into UTP, including advocacy frameworks, entry points and guidance, as well as tools and illustrative case studies. It does not provide prescriptions for specific scenarios – these should be determined by context, people and available resources.
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Africa is experiencing an increasing burden of cardiac arrhythmias. Unfortunately, the expanding need for appropriate care remains largely unmet because of inadequate funding, shortage of essential medical expertise, and the high cost of diagnostic
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equipment and treatment modalities. Thus, patients receive suboptimal care. A total of 5 of 34 countries (15%) in Sub-Saharan Africa (SSA) lack a single trained cardiologist to provide basic cardiac care. One-third of the SSA countries do not have a single pacemaker center, and more than one-half do not have a coronary catheterization laboratory. Only South Africa and several North African countries provide complete services for cardiac arrhythmias, leaving more than hundreds of millions of people in SSA without access to arrhythmia care considered standard in other parts of the world. Key strategies to improve arrhythmia care in Africa include greater government health care funding, increased emphasis on personnel training through fellowship programs, and greater focus on preventive care.
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The WHO Framework Convention on Tobacco Control (WHO FCTC) is an evidence-based treaty that reaffirms the right of all people to the highest standard of health and was developed in response to
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the globalization of the tobacco epidemic. Member States of the WHO South-East Asia Region have made attempts to implement the demand and supply reduction strategies for tobacco control as recommended by the treaty. While recognizing the need to accelerate implementation of the WHO FCTC in the Region, this document has been developed to support the Member States in implementing the treaty using a ‘PRACTICAL’ Approach which pertains to identified demand and supply reduction strategies under the treaty.
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Policy Note #2: Myanmar Health Systems in Transition Policy Notes Series
Myanmar is a country in which people’s access to health services is ... determined more by where they live than their need for care – a situation that is fundamentally inequitable. The challenge is to reduce levels of inequity between different groups in the population and different geographical areas, and most particularly to ensure that health services reach poor and disadvantaged groups, including minorities and those living in conflict-affected areas. more
Myanmar is a country in which people’s access to health services is ... determined more by where they live than their need for care – a situation that is fundamentally inequitable. The challenge is to reduce levels of inequity between different groups in the population and different geographical areas, and most particularly to ensure that health services reach poor and disadvantaged groups, including minorities and those living in conflict-affected areas. more
Spirituality involves a sense of connectedness, meaning making and transcendence. There is abundant published research that focuses on the importance of spirituality to patients and their families during times of illness and distress. However over the last decade there has also been a growing awaren
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ess about the importance of considering the need to address peoples’ spiritual needs in the workplace. Engaging in ones own personal spirituality involves connecting with the inner self, becoming more self aware of ones humanity and limitations. Engaging with ones personal spirituality can also mean that people begin to greater find meaning and purpose in life and at work. This may be demonstrated in the workplace by collegial relationships and teamwork. Those who engage with their own spirituality also engage more easily with others through a connectedness with other staff and by aligning their values with the respective organization if they fit well with ones personal values.
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On 6 February 2023, south-eastern Turkey and northern Syrian were hit by the most powerful earthquake in the region for over 80 years. This was quickly followed by a further earthquake and hundreds of aftershocks.
While the situation is still devel
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oping, widespread destruction has been reported. At the time of writing, more than 36,000 people have died and this figure is likely to increase. The natural disaster has exacerbated the high level
of humanitarian need in the region, with many Syrian refugees concentrated in the 10 affected provinces of southern Turkey, and Syria suffering from over a decade of civil war.
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Corruption is embedded in health systems. Throughout my life—as a researcher, public health worker, and a Minister of Health—I have been able to see entrenched dishonesty and fraud. But despite being one of the most important barriers to impleme
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nting universal health coverage around the world, corruption is rarely openly discussed. In this Lecture, I outline the magnitude of the problem of corruption, how it started, and what is happening now. I also outline people's fears around the topic, what is needed to address corruption, and the responsibilities of the academic and research communities in all countries, irrespective of their level of economic development. Policy makers, researchers, and funders need to think about corruption as an important area of research in the same way we think about diseases. If we are really aiming to achieve the Sustainable Development Goals and ensure healthy lives for all, corruption in global health must no longer be an open secret.
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The National Strategic Plan is based on the following guiding principles:
1) Life-course approach: adolescence is a key decade in the course of life that influences the health outcomes later in ... life.
2) Comprehensive approach: It recognizes the cross cutting health and development needs of young people such as intentional and unintentional injuries and violence, SRH, HIV/AIDS, mental health, substance use, violence, substance use and substance use disorders, infectious diseases and common conditions.
3) Equity and rights-based approach: focusing on equitable access to services to all adolescents including vulnerable groups and the recognizing the need to move from aspirations to obligations in fulflling young people rights for the highest attainable standard of health.
4) Multisectoral approach: recognizing cognizant of the fact that holistic development of young people requires multisectoral approach involving education, social welfare. more
1) Life-course approach: adolescence is a key decade in the course of life that influences the health outcomes later in ... life.
2) Comprehensive approach: It recognizes the cross cutting health and development needs of young people such as intentional and unintentional injuries and violence, SRH, HIV/AIDS, mental health, substance use, violence, substance use and substance use disorders, infectious diseases and common conditions.
3) Equity and rights-based approach: focusing on equitable access to services to all adolescents including vulnerable groups and the recognizing the need to move from aspirations to obligations in fulflling young people rights for the highest attainable standard of health.
4) Multisectoral approach: recognizing cognizant of the fact that holistic development of young people requires multisectoral approach involving education, social welfare. more
