A manual for physicians and other senior health workers. This fourth revision of the manual reflects recent clinical experience and research findings in diarrhoea case management. Compared to earlier versions, it includes revised guidelines on the management of children with acute diarrhoea using th...e new reduced (low) osmolarity ORS formulation and using zinc supplements, which have been shown to reduce duration and severity of diarrhoeal episodes, and revised guidelines for the management of bloody diarrhoea. Guidelines in the manual are based on the revised WHO chart that are included at the end of this document.
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Patients with diabetes are at increased risk of developing cardiovascular disease (CVD) with its manifestations of coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), and stroke, as well as aortic and peripheral artery diseases. In addition, diabetes is a major risk factor f...or developing chronic kidney disease (CKD), which in itself is associated with developing CVD. The combination of diabetes with these cardio-renal comorbidities enhances the risk not only for cardiovascular (CV) events but also for CV and all-cause mortality. The current European Society of Cardiology (ESC) Guidelines on the management of cardiovascular disease in patients with diabetes are designed to guide prevention and management of the manifestations of CVD in patients with diabetes based on data published until end of January 2023. Over the last decade, the results of various large cardiovascular outcome trials (CVOTs) in patients with diabetes at high CV risk with novel glucose- lowering agents, such as sodium–glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), but also novel non-steroidal mineralocorticoid receptor antagonists (MRAs), such as finerenone have substantially expanded available therapeutic op-
tions, leading to numerous evidence-based recommendations for the management of this patient population.
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The seventh WHO Report on the global tobacco epidemic analyses national efforts to implement the most effective measures from the WHO Framework Convention on Tobacco Control (WHO FCTC) that are proven to reduce demand for tobacco.
The report showed that while only 23 countries have implemented ce...ssation support policies at the highest level, 116 more provide fully or partially cost-covered services in some or most health facilities, and another 32 offer services but do not cost-cover them, demonstrating a high level of public demand for support to quit.
Tobacco use has also declined proportionately in most countries, but population growth means the total number of people using tobacco has remained stubbornly high. Currently, there are an estimated 1.1 billion smokers, around 80% of whom live in low- and middle-income countries (LMICs).
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The full-scale invasion of Ukraine has caused a deterioration in the level of access to health-care services and medicines in the country, particularly for people living in regions close to the front line and areas that are not partially or fully controlled by the Government of Ukraine, and for peop...le who have been internally displaced. Cost and time constraints involved in getting to and from health facilities, as well as limited transportation options were the main barriers to accessing essential health-care services. At the same time, the findings show that the country’s health system remains resilient and that overall access to health services is fairly high.This report is based on data collected through a quantitative cross-sectional survey of self-reported health needs of the general population in Ukraine. It presents results of the first round survey conducted in September 2022 and could help to address the specific health-care needs of the population groups concerned.
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Policy Brief, Updated in March 2017
Key messages
• The criminalisation of male-to-male sex heightens HIV and other sexually transmissible infection (STI) risks and vulnerabilities, and hinders access to HIV and STI services including HCT.
• Men who have sex with men (MSM) and tran...sgender persons (TG) are not a homogeneous group. As such, a variety of HCT service models are needed to reach the various segments of these populations.
• Stigma and discrimination remain ongoing issues at a number of service points. Targeted training of service providers is therefore needed so that MSM and TG are not discouraged from seeking HCT and high-quality prevention, treatment and care services.
• Specific guidelines on HIV prevention, treatment and care services for MSM or TG help improve the delivery of services.
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The United Nations Population Fund (UNFPA) is the lead UN agency working to further gender equality and women’s empowerment in Sri Lanka. We are pleased to be a part of the joint effort with the Ministry of Health to develop the first ‘Standard Operating Procedures on sexual and gender-based vio...lence for first-contact-point healthcare providers’.
These operating procedures were developed alongside the ‘National guidelines on sexual and gender-based violence’, which aims to strengthen Sri Lanka’s health systems response to survivors of violence. We are grateful to the British High Commission in Colombo for their support in developing these guidelines and procedures as they mark an important milestone in creating a safer Sri Lanka for all women and girls. UNFPA is proud to be a part of this journey, and we stand ready to provide continued assistance to the Government of Sri Lanka and all key stakeholders to ensure women and girls receive essential services that support their safety, well-being and access to justice and to create a violence-free Sri Lanka.
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Heart failure (HF) is a global public health concern with disproportionate socioeconomic, morbidity and mortality burden on low- and middle-income countries (LMICs). This review summarises contemporary data on the demographic and clinical characteristics, aetiologies, treatment, economic burden and ...outcomes of HF in LMICs. Patients with HF in LMICs are younger than those from high-income countries (HICs) and present at advanced stages of the disease. Hypertension, ischaemic heart disease (IHD), cardiomyopathy (CMO), and rheumatic heart disease (RHD) are the leading causes of HF in LMICs. The contribution of infectious diseases to HF remains prominent in many LMICs. Most health facilities in LMICs lack adequate diagnostic tools for HF, and the use of evidence-based medical and device therapies is suboptimal. Further, HF in LMICs is associated with prolonged hospital stay and high in-hospital and one-year mortality. Finally, HF has profound economic impact on individual patients who, mostly, have no health insurance, and on societies where patients are young, comprising those who have the greatest potential to contribute to economic productivity.
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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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The development of the Country Cooperation Strategy (CCS) was based on a consultative and participatory process with strong commitment and support from the Ministry of Health of Ghana. The CCS draws on lessons from the implementation of the first, and second generation CCSs, the country focus strate...gy, and the United Nations Sustainable Development Cooperation Framework (2023–2025).
The strategic agenda of the CCS outlines three strategic priorities, which are:
1. improving universal access to essential health services through the primary health care approach.
2. health emergency preparedness and response: addressing gaps in IHR core capacities and strengthening national capacities to prevent, detect and respond appropriately to public health emergencies through a resilient health system.
3. addressing social, economic, and environmental determinants of health; promoting high-impact interventions to address public health risks using multisectoral approaches.
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The manual is written for clinicians working at the district hospital (first-level referral care) who diagnose and manage sick adolescents and adults in resource constrained settings. It aims to support clinical reasoning, and to provide an effective clinical approach and protocols for the managemen...t of common and serious or potentially life-threatening conditions at district hospitals. The target audience thus includes doctors, clinical officers, health officers, and senior nurse practitioners. It has been designed to be applicable in both high and low HIV prevalence settings.
Volume 2 provides a symptom-based approach to clinical care for acute and subacute conditions (including mental health). It provides short summaries of the management of diseases that affect multiple systems of the body, focusing on communicable diseases. It also includes the chronic or long-term management of HIV, TB, alcohol, and substance use disorders.
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Countries around the world are facing the challenge of increased demand for care of people with COVID-19, compounded by fear, misinformation and limitations on movement that disrupt the delivery of health care for all conditions. Maintaining essential health services: operational guidance for the CO...VID-19 context recommends practical actions that countries can take at national, subregional and local levels to reorganize and safely maintain access to high-quality, essential health services in the pandemic context. It also outlines sample indicators for monitoring essential health services, and describes considerations on when to stop and restart services as COVID-19 transmission recedes and surges.
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Global food insecurity has markedly increased over the last two-years due to conflict, economic and political instability, displacement, environmental degradation and disasters, and major disruptions to global food systems because of the Covid-19 pandemic. In 2021, levels of hunger surpassed all pre...vious records with close to 193 million people acutely food insecure and in need of urgent assistance across 53 countries and territories. This represents an increase of nearly 40 million people compared to what was previously considered a record level high in 2020.
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The WHO Ebola Virus Disease (EVD) Clinical management: living guidance contains the Organization’s most up-to-date recommendations for the clinical management of people with EVD. Providing guidance that is comprehensive and holistic for the optimal care of patients with EVD throughout their il...lness is important.
The living guidance is available in both pdf format (via the ‘Download’ button) and via an online platform in both French and English, and is updated regularly as new evidence emerges.
This first version of the Clinical management for EVD living guidance contains four new recommendations regarding use of therapeutics for EVD, this includes two strong recommendations for the use of monoclonal antibody therapies. This new living guideline is written to accompany the optimized supportive care (oSoC) for EVD standard operating procedures (5, 6). The living guideline aims to summarize high quality evidence for EVD therapeutics and make recommendations for their use.
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People younger than 20 years comprise 35% of the global population and 40% of the global population of least-developed nations. The number of children - neonates, infants, children, and adolescents up to 19 years of age - who need pediatric palliative care (PPC) each year may be as high as 21 millio...n. Another study found that almost 2.5 million children die each year with serious health related suffering and that more than 98% of these children are in low- and middle-income countries (LMICs) (3). While estimates differ, there is no doubt that there is an enormous need for prevention and relief of suffering among children - for PPC.
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Maternal and child malnutrition is a significant public health problem in South Sudan. Among children aged 6-59 months, 31% are stunted, 28% are underweight, and nearly 23% are acutely malnourished of which 13% are estimated to suffer from moderate acute malnutrition and 10% from severe acute malnut...rition.
Overall, South Sudan’s nutrition situation is worrisome, with GAM persistently above the emergency threshold in the Greater Upper Nile, Northern Bahr el Ghazal and Warrap states. Though data on micronutrient deficiencies is scanty, Vitamin A Supplementation (VAS) among children 6-59 months stood at only 2.6% in 2010, showing low uptake (SHHS, 2010). This is against a backdrop of high morbidity levels and a negligible proportion of children 6 to 23 months receiving at least the recommended minimum acceptable diet. In order to ensure optimal child growth, it is essential to ensure good nutrition and basic health care from pregnancy through two years of age (the first 1000 days).
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As a public good, antimicrobial medicines require rational use if their effectiveness is to be preserved. However, up to 50% of antibiotic use is inappropriate, adding considerable costs to patient care, and increasing morbidity and mortality. In addition, there is compelling evidence that antimicro...bial resistance is driven by the volume of antimicrobial agents used. High rates of antimicrobial resistance to common treatments are currently reported all over the world, both in health care settings and in the community. For over two decades, the Region of the Americas has been a pioneer in confronting antimicrobial resistance from a public health perspective. However, those efforts need to be stepped up if we are to have an impact on antimicrobial resistance and want to quantify said impact.
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By almost any measure, human health is better now than at any time in history. Life expectancy has soared from 47 years in 1950–1955, to 69 years in 2005–2010, and death rates in children younger than 5 years of age have decreased substantially, from 214 per thousand live births in 1950–1955, ...to 59 in 2005–2010. But these gains in human health have come at a high price: the degradation of nature’s ecological systems on a scale never seen in human history. A growing body of evidence shows that the health of humanity is intrinsically linked to the health of the environment, but by its actions humanity now threatens to destabilise the Earth’s key life-support systems.
As a Commission, we conclude that the continuing degradation of natural systems threatens to reverse the health gains seen over the last century. In short, we have mortgaged the health of future generations to realise economic and development gains in the present.
Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance.
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There is increasing interest in understanding the role of air pollution as one of the greatest threats to human health worldwide. Nine of 10 individuals breathe air with polluted compounds that have a great impact on lung tissue. The nature of the relationship is complex, and new or updated data are... constantly being reported in the literature. The goal of our review was to summarize the most important air pollutants and their impact on the main respiratory diseases (chronic obstructive pulmonary disease, asthma, lung cancer, idiopathic pulmonary fibrosis, respiratory infections, bronchiectasis, tuberculosis) to reduce both short- and the long-term exposure consequences. We considered the most important air pollutants, including sulfur dioxide, nitrogen dioxide, carbon monoxide, volatile organic compounds, ozone, particulate matter and biomass smoke, and observed their impact on pulmonary pathologies. We focused on respiratory pathologies, because air pollution potentiates the increase in respiratory diseases, and the evidence that air pollutants have a detrimental effect is growing. It is imperative to constantly improve policy initiatives on air quality in both high- and low-income countries.
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Maternal mortality has fallen significantly in recent years, especially in countries that have emphasized the prevention of its main causes, such as hemorrhagic and infectious complications and hypertension , including in the Region of the Americas. In its final report on the Plan of Action to Accel...erate the Reduction of Maternal Mortality and Severe Maternal Morbidity, the Pan American Health Organization (PAHO) reported a continuing downward trend in maternal mortality, with an 18.1% reduction in the maternal morbidity ratio during the period 2010-2015 . From a pathophysiological perspective, death events are a common end result of a wide spectrum of complications leading to multi-organ dysfunction. However, there is a group of women in this situation who survive, despite the seriousness of their condition. This high number of patients––who were in serious condition
but did not die––reflects the actual health conditions in an institution or a country. For this reason, there is a need to create indicators to estimate morbidity in women due to diseases and incidents that occur during pregnancy, childbirth, and the puerperium. To this end, we propose conducting epidemiological surveillance of an indicator that includes women who survived after presenting a potentially fatal complication during pregnancy, childbirth, or the puerperium, reflecting quality medical attention and care (5, 6). This indicator
is maternal near-miss (MNM), which refers to extremely severe maternal morbidity––cases of a severity that
brings women very close to the death event. After adjusting the definition to a specific population and time,
MNM is defined as a case in which a woman nearly died, but survived a complication that occurred during
pregnancy, childbirth, or within 42 days of termination of pregnancy
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1 June 2020
Countries around the world are facing the challenge of increased demand for care of people with COVID-19, compounded by fear, misinformation and limitations on movement that disrupt the delivery of health care for all conditions. Maintaining essential health services: operational guidan...ce for the COVID-19 context recommends practical actions that countries can take at national, subregional and local levels to reorganize and safely maintain access to high-quality, essential health services in the pandemic context. It also outlines sample indicators for monitoring essential health services, and describes considerations on when to stop and restart services as COVID-19 transmission recedes and surges. This document expands on the content of pillar 9 of the COVID-19 strategic preparedness and response plan, supersedes the earlier Operational guidance for maintaining essential health services during an outbreak, and complements the recently-released Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic. It is intended for decision-makers and managers at the national and subnational levels.
This is an update to COVID-19: Operational guidance for maintaining essential health services during an outbreak: Interim guidance, 25 March 2020
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