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This manual provides a framework for morbidity management and disability prevention of patients affected by NIDs and gives specific guidance for the proper care of patients suffering from chronic conditions caused by lymphatic filariasis, leprosy, trachoma, and Chagas disease. It is intended to be u
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sed mainly by health care workers at the primary health care level, but health workers at more complex and specialized levels may also find it useful.
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Rev. Panam Salud Publica. 2017;41:e153. doi: 10.26633/RPSP.2017.153
Worldwide, over 6 million people are infected with Trypanosoma cruzi, the pathogen that causes Chagas disease (CD). In the Americas, CD creates the greatest burden in disability-adjusted life years of any parasitic infection. In Co
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lombia, 437 000 people are infected with T. cruzi, of whom 131 000 suffer from cardiomyopathy. Colombia’s annual costs for treating patients with advanced CD reach US$ 175 016 000. Although timely etiological treatment can significantly delay or prevent development of cardiomyopathy—and costs just US$ 30 per patient—fewer than 1% of people with CD in Colombia and elsewhere receive it.
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Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and
middle-income countries.
Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations.
Co
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untry-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed
each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation).
We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of
guidelines and plans for dissemination to target audiences.
Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries.
Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending
surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development;
breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and
middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines
encompassed detailed implementation plans and socioeconomic considerations.
Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of
health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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As the Americas undergo profound demographic change and there are more persons aged 65 years or older than children younger than 5 years, it is crucial to recognize that national immunization programs must be redesigned to ensure comprehensive protection for individuals across the lifespan. By adopt
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ing a life course approach (LCA) to immunization, vaccination programs can be tailored to close immunity gaps at different stages of life. The life course approach foresees the establishment of multiple strategies to reduce missed opportunities for vaccination according to age group. This technical document explains the key concepts of the LCA with a focus on immunization by vaccination, as well as the underlying biological mechanisms that require the application different vaccines at different life stages according to changes to the immune system and in the epidemiological situation of a community.
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The Kenya Health Policy 2014-2030 aims at attaining the highest possible standard of health in a manner responsive to the health needs of our popul
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ation. One of the major policy directions towards realizing the intentions of this policy is to halt and reverse the
rising burden of non-communicable diseases.
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Diabetes mellitus, also called diabetes, is a chronic metabolic condition in which the hormone insulin is not produced by the
pancreas in sufficient quantities or is not utilized effectively by the body to control blood glucose levels. As a result, blood
glucose levels are abnormally high (hypergl
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ycaemia). Chronic uncontrolled hyperglycemia leads to long-term target organ damage, such as: retinopathy, nephropathy and neuropathy (microvascular complications); stroke, coronary heart disease
and peripheral arterial disease (macrovascular complications).
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Exploring equity and inclusion in Malawi’s National Disability Mainstreaming Strategy and Implementation Plan
Ebuenyi, I.D.; Smith, E.M.; Munthali, A. et al.
International Journal for Equity in Health
(2021)
CC
Background
Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi’s National Disability Mainstreaming Strategy and Implementation Plan.
Met
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hods
We applied an analytical methodology to review the Malawi’s National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion.
Results
The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process.
Conclusions
The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production – co-implementation – co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.
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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a
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sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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Technical Brief Workforce Development
recommended
The World Health Organization (WHO) projects a global shortfall of 18 million health workers by 2030, mostly in low- and lower-middle-income countries. Contributing to the global deficit are chronic
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under-investment in education and training of health workers; workforce migration; an aging health workforce; rapid increases in chronic diseases; and inability to track existing human resources using health information systems. Health care worker shortages are compounded by the increased portability and virulence of infections. Rapid population growth, climate change, deforestation, international travel, migration, poverty, and social inequality have dramatically increased the risk of pandemics and highlighted the need for skilled health workforce to effectively respond to emerging health threats. This is evident now more than ever as COVID-19 exacerbates health inequity and barriers to access, and further strains the already fragile health systems in many countries.
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he National Department of Health (NDOH) presents this Malaria Elimination Strategic
Plan 2019-2023 for the Republic of South Africa. The strategy comes at an important time
as the Southern African Development Community (SADC) heads of state have r
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ecently
renewed the commitment to eliminate malaria in Botswana, Eswatini, Namibia and South
Africa by 2020 and in the whole SADC region by 2030, with the target of zero local malaria
cases and deaths. South Africa has made steady progress towards this elimination goal
through the implementation of evidence-based malaria policies aligned to the World Health
Organization’s (WHO) Global Technical Strategy.
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Rwanda Malaria Strategic Plan 2020–2024
Ministry of Health, Rwanda; Rwanda Biomedical Centre (RBC)
Ministry of Health, Republic of Rwanda
(2020)
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The Rwanda Malaria Strategic Plan 2020–2024 outlines Rwanda’s national strategy to reduce malaria morbidity and mortality by at least 50% compared to 2019 levels. The vision is a malaria-free Rwanda contributing to socioeconomic development.
The plan includes strengthening prevention through lo
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ng-lasting insecticide-treated nets, indoor residual spraying, and larval source management; ensuring universal access to testing and treatment; improving surveillance and data use; and enhancing program management, coordination, and financing. It also emphasizes community engagement and behavior change to ensure at least 85% of the at-risk population adopts protective practices.
The strategy builds on past lessons, involves multi-sectoral collaboration, and aligns with global malaria goals. It highlights equity, quality services, and evidence-based interventions as guiding principles, aiming to mobilize national and international resources for sustained impact.
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On Global Handwashing Day, WHO and UNICEF have released the first-ever global Guidelines on Hand Hygiene in Community Settings to support governments and practitioners in promoting effective hand hygiene outside health care – across households, pu
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blic spaces and institutions. Framing hand hygiene as a public good and a government responsibility, the Guidelines translate evidence into ready-to-adopt actions that enable sustainable access to effective hygiene services. This will reduce diarrhoeal disease, acute respiratory infections and other preventable illnesses, strengthening routine public health where people live, work, visit and study, and emergency preparedness, including outbreaks like cholera.
Despite clear benefits, 1.7 billion people still lacked basic hand hygiene services at home in 2024, including 611 million with no facility at all. Meeting the 2030 target will require accelerated progress – about a doubling in the global rate, and much faster in specific settings (up to 11-fold in least-developed countries and 8-fold in fragile contexts). Hand hygiene remains one of the most cost-effective health investments, reducing diarrhoea by 30% and acute respiratory infections by 17%, with large, measurable gains for population health.
“Clean hands save lives, but results at scale require policy, financing and accountability,” said Dr Ruediger Krech, Director a.i, Department of Environment, Climate Change, One Health & Migration at the World Health Organization. “These Guidelines help countries move beyond fragmented projects to government-led systems that make soap, water, and conditions conducive to everyday hand hygiene the norm.”
“Children and young people pay the highest price when basic hygiene is out of reach,” said Cecilia Scharp, Director, Water Sanitation and Hygiene (WASH) Team, Programme Group, UNICEF. “These Guidelines provide practical steps to ensure facilities are accessible when they need to be – in homes, schools, markets, and transport hubs – so every child can learn, play and thrive with dignity.”
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A Clinical Guideline for the Diagnosis and Treatment of Drug-susceptible TB in Children and Adolescents
in South Africa. This new guidance is aligned with the updated WHO guidelines but has been adapted specifically for the South African context.
The intention of this publication is to provide g
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uidance on the Diagnosis and treatment of TB in children and adolescents and they may be downloaded and distributed as required. Distribution for remuneration is not permitted. No changes to the content or format of this publication is permitted.
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Final Policy
