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 Healthy Living Toolkit is developed to educate refugees, immigrants, resettlement agencies, clinics, community based organizations, and other service providers on refugee health issues. The toolkit presents material in a culturally appropriate manner and is intended to help health care-related p...rofessionals more effectively assist refugees and immigrants and reduce health disparities among these populations. The toolkit is available in multiple languages: Amharic; Arabic; Farsi; English; French; Russian, etc.
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Chapter 1 provides new data on the latest developments in the global treatment effort, highlighting positive trends as well as aspects that require improvement. Chapter 2 summarizes the impact of the scale-up in reducing AIDS-related mortality and new HIV infections. Chapter 3 examines the sequence ...of steps in the continuum of care from HIV diagnosis to successful provision of ART services and outlines key supportive innovations. Chapter 4 discusses the implications and anticipated impact of the new "Consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection
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The Asthma Control Questionnaire (ACQ)1 was developed and validated to measure the primary clinical goal of asthma management as identified by international guidelines. They indicate that to achieve good control, treatment should minimise day and night time symptoms, activity limitation, airway narr...owing and rescue bronchodilator use and thus reduce the risk of life-threatening exacerbations and long-term morbidity. The importance of including all aspects of control in the assessment of individual patients was emphasised by a recent factor analysis which showed that clinical asthma is composed of distinct components which are not closely correlated with each other.6 However, in some studies it may not be possible to collect airway calibre or short-acting β2-agonists data. Previous analysis of non-clinical trial data suggested that when ACQ scores are analysed as group data, the heterogeneity of the way in which individual patients present with inadequate control is lost in the estimation of the mean and the need to measure each individual component of asthma control may become unnecessary. In this analysis, ACQ data from a clinical trial was used to evaluate the measurement properties (reliability, responsiveness, validity and interpretability), of three shortened versions of the ACQ. In addition, we have examined whether the precision and accuracy of estimating the effect of the intervention on asthma control was maintained when the two questions concerning airway calibre and short-acting β2-agonists use were omitted from the trial analysis.
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1.1 Why this course is needed
The first few hours and days of a newborn baby’s life are a critical window for establishing breastfeeding and for providing mothers with the support they need to breastfeed successfully. Since 1991, the Baby-friendly Hospital Initiative (BFHI) has helped to motivate... facilities providing maternity and newborn baby services worldwide to better support breastfeeding. It has been adopted by many countries and organizations. The BFHI aims to provide a health-care environment that supports mothers to acquire the skills necessary to exclusively breastfeed for six months, and to continue breastfeeding for two years or beyond.
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Int J Health Policy Manag 2017, 6(10), 587–600
Low-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin ha...ve failed to produce better quality of care for the population and cost-effectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin’s public health sector, as well as the ability of key actors within the sector to address these problems.
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UNHCR’s Public Health Strategy 2021-2025 is based on the lessons learnt, and builds on the achievements, of the Global Strategy for Public Health 2014-2018.
Progress was made on policies favouring inclusion and integration into national systems3 with 92% of 48 operations surveyed reporting refuge...es having access to national primary health care facilities under the same conditions as nationals and 96% reporting refugees having access to all relevant vaccines under the same conditions as nationals. While many refugee hosting countries have policies that allow refugees to access national health services, many face partial access, prohibitive out-of-pocket expenditures and other barriers including distance to facilities, language and provider acceptance. Furthermore, more work is needed on strengthening these systems to be able to meet the needs of both host communities and refugees.
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PEPFAR Malawi’s Country Operational Plan 2022 (COP22) embodies joint priorities from national and subnational dialogues building on the 2020-2025 National Strategic Plan for HIV/AIDS. The interagency team has developed a person-centered, district-tailored and Malawi Population-Based HIV Impact Ass...essment (MPHIA)-informed strategy through extensive engagement with Government of Malawi (GoM) and Civil Society Organizations (CSOs) to sustain HIV epidemic control. At the end of COP21, PEPFAR Malawi was commended for contributing to reaching epidemic control in strong collaboration with GoM and stakeholders including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This includes enrollment of 88% of recipients of care on three or more months of antiretroviral treatment (ART), better outcomes for Malawian children through remarkable efforts in Orphans and Vulnerable Children (OVC) programming and progress made towards reaching men with more intentional and focused programming.
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La méningite est mortelle et débilitante ; elle frappe brutalement ; elle a de graves conséquences sanitaires, économiques et sociales et touche tous les âges de la vie dans tous les pays du monde. La méningite bactérienne peut être à l’origine d’épidémies, entraîner la mort dans les... 24 heures et un patient sur cinq peut rester handicapé à vie à la suite d’une infection. La plupart des cas et des décès dus à la méningite pourraient être évités par la vaccination mais les progrès obtenus pour la vaincre sont bien moins rapides que ceux réalisés contre d’autres maladies à prévention vaccinale.
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HAT diagnosis relies on laboratory techniques because clinical signs and symptoms are unspecific. Serodiagnostic tests exist only for Tbg and are based on the detection of specific antibodies, thus they are not confirmatory of infection. With the current low disease prevalence, the positive predicti...ve value of serological tests is particularly low. Field-applicable tools include the card agglutination test for trypanosomiasis (CATT) used mainly in active screening by specialized mobile teams, and the rapid diagnostic tests that are more suitable for individual testing at point-of-care. Confirmation of Tbg infection requires microscopic examination of body fluids necessitating specific training. The best performing methods are laborious and reach 85–95% diagnostic sensitivity when performed by skilled personnel.
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HAT diagnosis relies on laboratory techniques because clinical signs and symptoms are unspecific. Serodiagnostic tests exist only for Tbg and are based on the detection of specific antibodies, thus they are not confirmatory of infection. With the current low disease prevalence, the positive predicti...ve value of serological tests is particularly low. Field-applicable tools include the card agglutination test for trypanosomiasis (CATT) used mainly in active screening by specialized mobile teams, and the rapid diagnostic tests that are more suitable for individual testing at point-of-care.
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Technical Update
Areas of Africa endemic for Buruli ulcer (BU), caused by Mycobacterium ulcerans, also have a high prevalence of human immunodeficiency virus (HIV), with adult prevalence rates between 1% and 5% (Maps). However, there is limited information on the prevalence of BU–HIV coinfection.... Preliminary
evidence suggests that HIV infection may increase the risk of BU disease (1–3). In the Médecins Sans Frontières project in Akonolinga, Cameroon, HIV prevalence was approximately 3–6 times higher among BU patients than the regional estimated HIV prevalence (2). Similarly in Benin and Ghana, BU
patients were 8 times and 3 times respectively more likely to have HIV infection than those without BU (1, 3). Further study is needed to clarify this association and enhance knowledge about the prevalence ofBU–HIV coinfection in endemic areas.
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Les conflits et les guerres ont des effets catastrophiques sur la santé et le bien-être des nations, et ils ont considérablement évolué au cours des dernières décennies. Avec la forte augmentation des crises humanitaires, y compris de la violence urbaine, de plus en plus de gens sont touchés... pendant des périodes plus longues par des interruptions des services élémentaires, devenues une triste réalité.
Les interventions sanitaires et les approches novatrices face aux défis que posent les
crises humanitaires peuvent sauver des vies et atténuer les conséquences des conflits
pour les civils.
Les équipes médicales qui interviennent lors de conflits armés et dans d’autres
environnements dangereux sont fréquemment confrontées à de graves menaces pour
leur sécurité et leur sûreté. Elles doivent surmonter ces difficultés pour avoir accès
aux patients, d’autant plus qu’elles se heurtent parfois à la réticence des populations
auprès desquelles elles interviennent et qui sont parties au conflit.
Une riposte médicale fondée sur des principes se compose d’interventions cliniques
et opérationnelles inspirées et respectueuses de normes fondamentales, qui mettent
l’accent sur la qualité, la sécurité et la protection dans l’intérêt des patients.
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Journal of Clinical TB and other Mycobacterial Diseases
uberculosis (TB) in the gastrointestinal tract or peritoneum is an uncommon condition in clinical practice. Its rarity, combined with its nonspecific presentations, makes this kind of extrapulmonary tuberculosis difficult to diagnose as it can... mimic other inflammatory or malignant conditions. Delays in treatment and frequent misdiagnosis can lead to hazardous complications. In countries like Ecuador where the disease is endemic, TB should always be considered in the differential diagnosis of a patients who present with nonspecific abdominal symptoms. In these scenarios, laparoscopy can be an invaluable tool when used with sufficiently high clinical awareness and adequate training.
Case presentation
We present the case of a 37-year-old female patient from Ecuador with a 1-year history of abdominal pain, nausea, intermittent vomits, night sweats, and weight loss. After clinical evaluation and a laparoscopic intervention, abdominal TB was detected and promptly treated. Antituberculosis chemotherapy was initiated, and the patient successfully reco
High clinical awareness is imperative when approaching abdominal TB due to its wide spectrum of clinical symptoms and its rarity. Early detection and prompt treatment are critical to minimize the possibility of hazardous complications.
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La guía se basa en las buenas prácticas existentes y se ha elaborado con la colaboración de enfermeras que trabajan en una amplia variedad de ámbitos, pero se enfoca principalmente en las áreas con recursos limitados. Representa el punto de vista del personal técnico ... de La Unión y de la red de Enfermeras y Profesionales Sanitarios entre los miembros de La Unión. Las mejores prácticas se presentan como una serie de pautas que se pueden adaptar a los servicios locales en países de ingresos bajos y medios y que fomentan la evaluación a través del uso de resultados cuantificables. Cada pauta corresponde a un punto importante en el diagnóstico o tratamiento de un paciente con TB, tomando como referencia las estrategias recomendadas por La Unión2, 3 y los regímenes de tratamiento recomendados por la Organización Mundial de la Salud (OMS) para TB susceptible a fármacos y TB resistente a fármacos.4, 5 A lo largo de esta guía, se remitirá a los lectores, a través de notas al pie, a la información relevante publicada en dos guías distintas de La Unión: Manejo de la Tuberculosis: Una guía esencial de buenas prácticas, 6ta edición, 2010 (denominada Guía Naranja)2y Lineamientos para el Manejo Clínico y Operativo de la Tuberculosis Drogorresistente, 2013 (denominada Guía de DR-TB).3 Otros materiales de referencia importantes se indican al final del documento y todos coinciden con las estrategias recomendadas a nivel internacional.
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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide...miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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Humanitarian crises exacerbate nutritional risks and often lead to an increase in acute malnutrition. Emergencies include both manmade (conflict) and natural disasters (floods, drought, cyclones, typhoons, earthquakes, volcanic eruptions, etc.). Complex emergencies are combinations of both manmade a...nd natural disasters, often of a protracted nature. Millions of people are affected by humanitarian crises every year. The increasing frequency and scale of emergencies requires nutrition to be addressed in all phases of a response.
Crisis situations, whether acute or protracted, impact on a range of factors that can increase the risk of undernutrition, morbidity, and mortality. They may involve: the large-scale destruction of property and infrastructure; the erosion of livelihood strategies and purchasing power; a breakdown of and reduced access to essential services, including health services, water supply, and sanitation; and the displacement of large numbers of people. Emergencies can also disrupt social systems and the quality of care/feeding practices. Household access to food may be negatively affected and people may find themselves in overcrowded settlements with their families divided. As a result, at the individual level, there is often an increased risk of deteriorating health and nutritional status, resulting in a greater likelihood of death.
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Las infecciones del sitio quirúrgico (ISQ) constituyen una de las Infecciones Asociadas al Cuidado de la Salud (IACS) más frecuentes que ponen en riesgo a los pacientes llevando muchas veces al fracaso del procedimiento quirúrgico. Con una incidencia mucho mayor en países de medianos y bajos ing...resos, representa un desafío de la práctica médica cotidiana que compromete la salud y la seguridad de los pacientes. La indicación de profilaxis primaria con antibióticos en relación a los procedimientos invasivos, tiene como objetivo disminuir la incidencia de infecciones con la consecuente disminución de la morbimortalidad debiendo utilizarse únicamente en aquellos procedimientos en los que hay evidencia de efectividad. Cabe destacar que la indicación inadecuada, tiene potenciales efectos adversos tales como infecciones por Clostridium difficile, emergencia de resistencia
bacteriana, reacciones adversas a drogas e incremento de los costos en salud.
La profilaxis antibiótica como complemento de una buena técnica quirúrgica, es una medida costo efectiva de prevención de las ISQ representando alrededor del 30% de la indicación de antibióticos entre los pacientes hospitalizados. Dado que en algunos estudios el uso inapropiado de antibióticos se ve reflejado en el 40 al
80% de las indicaciones médicas, desde la Comisión de Infecciones Asociadas al Cuidado de la Salud y Seguridad del Paciente de SADI hemos realizado una actualización de la evidencia disponible. Este documento es una acción complementaria al consenso “Prevención de Infección del Sitio Quirúrgico” realizado entre SADI y el Instituto Nacional de Epidemiología “J. Jara” durante el Congreso de SADI 2015.
La posibilidad de contar con una guía actualizada de profilaxis quirúrgica adaptada a nuestro medio, constituye una herramienta de uso cotidiano por parte de los profesionales del equipo quirúrgico que permite la optimización de la utilización de fármacos restringiendo así la emergencia y diseminación de la resistencia bacteriana. Sin duda esperamos que pueda ser de utilidad para el equipo de salud.
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WHO today released its first roadmap to tackle postpartum haemorrhage (PPH) – defined as excessive bleeding after childbirth - which affects millions of women annually and is the world’s leading cause of maternal deaths.
Despite being preventable and treatable, PPH results in around 70 000 de...aths every year. For those who survive, it can cause disabilities and psychological trauma that last for years.
“Severe bleeding in childbirth is one of the most common causes of maternal mortality, yet it is highly preventable and treatable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This new roadmap charts a path forward to a world in which more women have a safe birth and a healthy future with their families.”
The Roadmap aims to help countries address stark differences in survival outcomes from PPH, which reflect major inequities in access to essential health services. Over 85% of deaths from PPH happen in sub-Saharan Africa and South Asia. Risk factors include anaemia, placental abnormalities, and other complications in pregnancy such as infections and pre-eclampsia.
Many risk factors can be managed if there is quality antenatal care, including access to ultrasound, alongside effective monitoring in the hours after birth. If bleeding starts, it also needs to be detected and treated extremely quickly. Too often, however, health facilities lack necessary healthcare workers or resources, including lifesaving commodities such as oxytocin, tranexamic acid or blood for transfusions.
“Addressing postpartum haemorrhage needs a multipronged approach focusing on both prevention and response - preventing risk factors and providing immediate access to treatments when needed - alongside broader efforts to strengthen women’s rights,” said Dr Pascale Allotey, WHO Director for Sexual and Reproductive Health and HRP, the UN’s special programme on research development and training in human reproduction. “Every woman, no matter where she lives, should have access to timely, high quality maternity care, with trained health workers, essential equipment and shelves stocked with appropriate and effective commodities – this is crucial for treating postpartum bleeding and reducing maternal deaths.”
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KEY MESSAGES
Always talk to a GBV specialist first to understand what GBV services are available in your area. Some services may take the form of hotlines, a mobile app or other remote support.
Be aware of any other available services in your area. Identify services provided by humanitarian pa...rtners such as health, psychosocial support, shelter and non-food items. Consider services provided by communities such as mosques/ churches, women’s groups and Disability Service Organizations.
Remember your role. Provide a listening ear, free of judgment. Provide accurate, up-to-date information on available services. Let the survivor make their own choices. Know what you can and cannot manage. Even without a GBV actor in your area, there may be other partners, such as a child protection or mental health specialist, who can support survivors that require additional attention and support. Ask the survivor for permission before connecting them to anyone else. Do not force the survivor if s/he says no.
Do not proactively identify or seek out GBV survivors. Be available in case someone asks for support.
Remember your mandate. All humanitarian practitioners are mandated to provide non-judgmental and non-discriminatory support to people in need regardless of: gender, sexual orientation, gender identity, marital status, disability status, age, ethnicity/tribe/race/religion, who perpetrated/committed violence, and the situation in which violence was committed. Use a survivor-centered approach by practicing:
Respect: all actions you take are guided by respect for the survivor’s choices, wishes, rights and dignity.
Safety: the safety of the survivor is the number one priority.
Confidentiality: people have the right to choose to whom they will or will not tell their story. Maintaining confidentiality means not sharing any information to anyone.
Non-discrimination: providing equal and fair treatment to anyone in need of support.
If health services exist, always provide information on what is available. Share what you know, and most importantly explain what you do not. Let the survivor decide if s/he wants to access them. Receiving quality medical care within 72 hours can prevent transmission of sexually transmitted infections (STIs), and within 120 hours can prevent unwanted pregnancy.
Provide the opportunity for people with disabilities to communicate to you without the presence of their caregiver, if wished and does not endanger or create tension in that relationship.
If a man or boy is raped it does not mean he is gay or bisexual. Gender-based violence is based on power, not someone’s sexuality.
Sexual and gender minorities are often at increased risk of harm and violence due to their sexual orientation and/or gender identity. Actively listen and seek to support all survivors.
Anyone can commit an act of gender-based violence including a spouse, intimate partner, family member, caregiver, in-law, stranger, parent or someone who is exchanging money or goods for a sexual act.
Anyone can be a survivor of gender-based violence – this includes, but isn’t limited to, people who are married, elderly individuals or people who engage in sex work.
Protect the identity and safety of a survivor. Do not write down, take pictures or verbally share any personal/identifying information about a survivor or their experience, including with your supervisor. Put phones and computers away to avoid concern that a survivor’s voice is being recorded.
Personal/identifying information includes the survivor’s name, perpetrator(s) name, date of birth, registration number, home address, work address, location where their children go to school, the exact time and place the incident took place etc.
Share general, non-identifying information
To your team or sector partners in an effort to make your program safer.
To your support network when seeking self-care and encouragement.
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