Recognition, Assessment and Treatment
National Clinical Guideline Number 159
DEM supporting material
• Person stories
• Role plays
• Case scenarios
• Treatment planning handouts
• Treatment planning suggestions
• Multiple choice questions
• Video link
Activity 3: mhGAP DEM module – assessment
Barriers to the prompt and effective diagnosis and treatment of malaria exist at both the community and health facility level. Household surveys measure malaria case management at the population level with standard indicators that assess treatment-seeking behavior, access to diagnostic testing, and ...access to appropriate treatment. Performance on these indicators varies widely from country to country. Among countries with Demographic and Health Surveys (DHS) or Malaria Indicator Surveys (MIS) completed between 2014 and 2016, advice and treatment was sought for a median of 47% of children under age 5 with fever.
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Advice on physical activity should be encouraged as part of treatment for adults with depressive episode/disorder with inactive lifestyles. In moderate and severe depression, this intervention should be considered as adjunct to antidepressants or brief structured psychological treatments.
The present booklet is about gender-responsive substance abuse treatment services for women. It is part of the United Nations Office on Drugs and Crime (UNODC) project to develop tools to support the development and improvement of substance abuse treatment services, based on evidence from the litera...ture and case studies that illustrate practical experiences and lessons learned in providing substance abuse treatment services in various regions of the world.
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The HIV drug resistance report 2021 summarizes findings from 38 countries that had finalized the surveys by the time of this report and shared data with WHO.
Pretreatment HIVDR to non-nucleoside reverse-transcriptase inhibitors (NNRTI) can affect more than 10% of adults starting therapy and is fo...und up to 3 times more often in people who had previous exposure to antiretroviral drugs. In addition, nearly half of infants newly diagnosed with HIV has HIVDR to NNRTI before initiating treatment.The high levels of observed NNRTI pretreatment HIVDR among emphasize the need to fast-track the transition to WHO-recommended dolutegravir-based ART.
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The outbreak of the coronavirus is leading to increased challenges in clinical management and uncertainty among the general population. To support the advice and treatment of patients, we have updated our Knowledge Library to include an informative Learning Card about COVID-19.
This update contai...ns essential details, as well as references to reputable sources and the newest treatment recommendations from the institutes and authorities who are evaluating these developments on a daily basis. The Learning Card has been written, curated and extensively checked by our qualified team of international physicians.
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Africa Centers for Disease Control and Prevention (Africa CDC) is aware of the media releases of the preliminary results of a large randomized clinical trial conducted in the United Kingdom, which included dexamethasone, a corticosteroid, as one of the drugs used for the treatment of COVID-19 patien...ts. The investigators reported that administration of oral or injectable dexamethasone resulted in about one-third reduction in mortality among COVID-19 patientsi that required mechanical ventilation and about one-fifth for patients requiring oxygen.
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WHO published guidance for clinicians and health care decision-makers on the use of corticosteroids in patients with COVID-19.
We recommend systemic corticosteroids for the treatment of patients with severe and critical COVID-19. We suggest not to use corticosteroids in the treatment of patients ...with non-severe COVID-19 as the treatment brought no benefits, and could even prove harmful. Treatment should be under supervision of a clinician.
Corticosteroids are listed in the WHO model list of essential medicines, readily available globally at a low cost. WHO encourages countries to maintain sufficient stocks of corticosteroids to treat COVID-19 and the other disease for which they are effective, while not maintaining excessive stocks which could deny other countries access.
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Ivermectin is an antiparasitic drug approved for the treatment of parasitic infections, including strongyloidiasis and onchocerciasis in humans. There is a reported increase in the use of ivermectin for the prevention and treatment of COVID-19 by the public in African Union Member States.
Currently..., there is:
1. No scientific evidence from pre-clinical studies on the therapeutic effect of ivermectin for the management of COVID-19;
2. No evidence of its clinical efficacy for the management of patients with asymptomatic, mild, moderate or severe COVID-19; and
3. No safety data regarding the use of ivermectin for COVID-19 in the majority of the published studies.
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Medical oxygen is an essential medicine in the treatment of COVID-19. How is it used? Why is there a shortage in some countries and what are WHO, partners and Governments doing about it? WHO’s Dr Janet Diaz explains in Science in 5.
Global and Regional Data 1 December 2021; The 90–90–90 targets were missed, but not by much. At the end of 2020, 84% of people living with HIV knew their HIV status, 87% of people living with HIV who knew their HIV status were accessing antiretroviral therapy, and 90% of people on treatment were... virally suppressed.
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Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections ha...rder to treat and increasing the risk of disease spread, severe illness and death. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.
Antimicrobials - including antibiotics, antivirals, antifungals and antiparasitics - are medicines used to prevent and treat infections in humans, animals and plants. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
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Clinical Guidelines. Diagnosis and Treatment Manual.
The Lancet olume 395, ISSUE 10232, P1259-1267, April 18, 2020. Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifa...mpicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions.
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Phillips and colleagues have shown that rifampicin combined with clarithromycin is non-inferior to RS8, and is safer. This much anticipated trial provides us with a high degree of confidence that an 8-week course of oral rifampicin and clarithromycin should now be the cornerstone of the treatment of... Buruli ulcer everywhere. However, this finding does not mean that
Buruli ulcer is cured at 8 weeks.
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A systematic review of clinical and observational antiparasitic treatment studies to assess the potential for establishing an individual participant-level data platform.
Chagas disease (CD), caused by the parasite Trypanosoma cruzi, affects ~6–7 million people worldwide. Significant limitations s...till exist in our understanding of CD. Harnessing individual participant data (IPD) from studies could support more in-depth analyses to address the many outstanding research questions. This systematic review aims to describe the characteristics and treatment practices of clinical studies in CD and assess the breadth and availability of research data for the potential establishment of a data-sharing platform.
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At the forefront of DNDi’s efforts to develop new treatments is the need to understand the realities and treatment needs of patients and health care staff in the field. The ultimate goal for human African trypanosomiasis (HAT) is a truly simplified
treatment which can be orally administered, impl...emented at the primary health care level, and effective against both stages of the disease.
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After 100 years of chemotherapy with impractical and toxic drugs, an oral cure for human African trypanosomiasis (HAT) is available: Fexinidazole. In this case, we review the history of drug discovery for HAT with special emphasis on the discovery, pre-clinical development, and operational challenge...s of the clinical trials of fexinidazole. The screening of the Drugs for Neglected Diseases initiative (DNDi) HAT-library by the Swiss TPH had singled out fexinidazole, originally developed by Hoechst (now Sanofi), as the most promising of a series of over 800 nitroimidazoles and related molecules. In cell culture, fexinidazole has an IC50 of around 1 µM against Trypanosoma brucei and is more than 100-fold less toxic to mammalian cells. In the mouse model, fexinidazole cures both the first, haemolymphatic, and the second, meningoencephalitic stage of the infection, the latter at 100 mg/kg twice daily for 5 days. In patients, the clinical trials managed by DNDi and supported by Swiss TPH mainly conducted in the Democratic Republic of the Congo demonstrated that oral fexinidazole is safe and effective for use against first- and early second-stage sleeping sickness. Based on the positive opinion issued by the European Medicines Agency in 2018, the WHO has released new interim guidelines for the treatment of HAT including fexinidazole as the new therapy for first-stage and non-severe second-stage sleeping sickness caused by Trypanosoma brucei gambiense (gHAT). This greatly facilitates the diagnosis and treatment algorithm for gHAT, increasing the attainable coverage and paving the way towards the envisaged goal of zero transmission by 2030.
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Sleeping sickness is controlled by case detection and treatment but this often only reaches less than 75% of the population. Vector control is capable of completely interrupting HAT transmission but is not used because of expense. We conducted a full scale field trial of a refined vector control tec...hnology. From preliminary trials we determined the number of insecticidal tiny targets required to control tsetse populations by more than 90%. We then carried out a full scale, 500 km2 field trial covering two HAT foci in Northern Uganda (overall target density 5.7/km2). In 12 months tsetse populations declined by more than 90%. A mathematical model suggested that a 72% reduction in tsetse population is required to stop transmission in those settings. The Ugandan census suggests population density in the HAT foci is approximately 500 per km2. The estimated cost for a single round of active case detection (excluding treatment), covering 80% of the population, is US$433,333 (WHO figures). One year of vector control organised within country, which can completely stop HAT transmission, would cost US$42,700. The case for adding this new method of vector control to case detection and treatment is strong. We outline how such a component could be organised.
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