PNAS 119 (8) e2113947119 | https://doi.org/10.1073/pnas.2113947119
Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, m...easure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world’s rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.
more
The 2022 Aid Transparency Index reveals that more aid organisations than ever before are publishing good quality information and score “very good” or “good” in the global ranking. However, the whole data set could be under threat as the Aid Transparency Index, the only tool driving tangible ...improvements in data quality, is set to close for lack of funding.
Produced by Publish What You Fund, the Index is the only independent measure of aid transparency among the world’s major aid donors. At a time of climate, hunger, health and debt crises, and some worrying trends in the way official development assistance (ODA) is counted, transparency is more important than ever.
more
INTRODUCTION: Lower extremity peripheral artery disease (PAD) is increasing in prevalence in low- and middle-income countries creating a large health care burden. Clinical management may require substantial resources but little consideration has been given to which treatments are appropriate for les...s advantaged countries.
EVIDENCE ACQUISITION: The aim of this review was to systematically appraise published data on the costs and effectiveness of PAD treatments used commonly in high-income countries, and for an international consensus panel to review that information and propose a hierarchy of treatments relevant to low- and middle-income countries.
EVIDENCE SYNTHESIS: Pharmacotherapy for intermittent claudication was found to be expensive and improve walking distance by a modest amount. Exercise and endovascular therapies were more effective and exercise the most cost-effective. For critical limb ischemia, bypass surgery and endovascular therapy, which are both resource intensive, resulted in similar rates of amputation-free survival. Substantial reductions in cardiovascular events occurred with use of low cost drugs (statins, ACE inhibitors, anti-platelets) and smoking cessation.
CONCLUSIONS: The panel concluded that, in low- and middle-income countries, cardiovascular prevention is a top priority, whereas a lower priority should be given to pharmacotherapy for leg symptoms and revascularisation, except in countries with established vascular units.
more
Testing coverage is a critical component of pandemic response, providing a view on the data available to inform policy and monitor the effectiveness of public health measures. While many countries do not publish official numbers of tests conducted, others are doing this across individual websites, s...tatistical reports and press releases, often in multiple languages and updated with different periodicity. FIND is working to build a global picture of the testing coverage for COVID-19 and facilitate the accurate interpretation and study of case and death numbers.
more
The “Declaration for Accelerated Malaria Mortality Reduction in Africa” is a statement signed by African health ministers reaffirming their commitment to reducing malaria-related mortality. It pledges strengthened leadership, increased domestic financing for malaria control programs, and the imp...lementation of current technical guidelines. The ministers emphasize the need to invest in data technologies, enhance cross-sector collaboration, and build partnerships for financing, research, and innovation in order to intensify malaria control efforts at both national and subnational levels.
more
This situation analysis has gathered information about the current state of AMR, contributing factors and antimicrobial use in Zimbabwe from the human, animal, agricultural and environmental sectors. Data has been gathered from different sectors such as the general public, academia, the Ministry of ...Health and Child Care, the Ministry of Agriculture Mechanization and Irrigation Development and the Ministry of Environment, Water and Climate. It shows that AMR is a real concern in Zimbabwe and a threat to the health outcomes of humans, to the economic productivity of the livestock industry and a risk to the environment.
more
The world is not on track to end the AIDS pandemic. New infections are rising and AIDS deaths are continuing in too many communities. This report reveals why: inequalities are holding us back. In frank terms, the report calls the world’s attention to the painful reality that dangerous inequalities... are undermining the AIDS response and jeopardising the health security of everyone. The report highlights three specific areas of inequality for which concrete action is immediately possible—gender
inequalities and harmful masculinities driving HIV; marginalisation and criminalisation of key populations, which our data show is resulting in starkly little progress for those populations and undermining the overall response; and
inequalities for children whose lives must matter more than their market share. But this is not a counsel of despair, it is a call to action. Through bold action to confront these inequalities, we can end AIDS.
more
Children with disabilities are particularly vulnerable in humanitarian settings, yet they are often not able to access the services and protection they need. While multiple factors create these barriers, a major cause is how data about children with disabilities is collected and mapped. Data collect...ion processes often exclude or underrepresent the views of children with disabilities and thier caretakers. When the experiences of children with disabilities and their caretakers are not defined and collected, they become excluded from mainstreamed protective services, which are meant to serve all children. Children with disabilities also do not get the specialised interventions they need.
This guidance note explores how to use qualitative methods to create more robust assessment processes to ensure more effective programming and services for children with disabilities. This note provides promising practices for engaging with children with disabilities and includes sample tools that can be tailored to fit the needs of a particular assessment process. The note also explores the importance of thoughtful cross-sectoral responses so that children with disabilities, and their families, are carefully considered in areas like water, sanitation, and hygiene (WASH), education, health, and nutrition, and therefore receive the holistic support they need and deserve.
This note is intended for a broad audience of relevant child protection actors, including practitioners, coordination groups, researchers, and donors. The information is not limited to one type of humanitarian setting, geographic region, or culture. As a result, the practices and guidance should be adapted to each specific context, ideally in partnership with well-informed local actors, such as representatives from local organisations for persons with disabilities.
more
Therapy for MDR-TB is extremely long, complex and burdensome to both patients and health care systems. A single diagnosis can require two years of treatment, or longer. When treating children, there are significant additional barriers treating children with MDR-TB. There is limited data on the pharm...acokinetics of second-line TB drugs in children, and almost none are in child-friendly formulations. Nonetheless, there is continued work on second-line drugs to fight MDR-TB. The Sentinel Project has created a complex set of dosing recommendations for administering second-line drugs to children
more
Global HIV control funding falls short of need. To maximize health outcomes, it is critical that national governments sustain reasonable commitments, and that international donor assistance be distributed according to country needs and funding gaps. We develop a country classification framework in t...erms of actual versus expected national domestic funding, considering resource needs and donor financing. With UNAIDS and World Bank data, we examine domestic and donor HIV program funding in relation to need in 84 low- and middle-income countries. We estimate expected domestic contributions per person living with HIV (PLWH) as a function of per capita income, relative size of the health sector, and per capita foreign debt service.
more
This study compared clinical and autopsy findings for three asbestos-related diseases (asbestosis, mesothelioma and lung cancer) in former asbestos mineworkers, and explored factors that influenced agreement between clinical and autopsy findings using data from two compensation systems. In South Afr...ica, statutory compensation for occupational lung diseases in mineworkers makes provisions for autopsy examinations of the cardio-respiratory organs at the National Institute for Occupational Health (NIOH) in Johannesburg. In addition, the Johannesburg-based Asbestos Relief Trust and Kgalagadi Relief Trust (the “Trusts”) compensate individuals with defined asbestos-related diseases who worked in or lived near qualifying asbestos mining or processing operations. The Trusts also compensate dependents of deceased qualifying mineworkers and therefore encourage statutory autopsies for the detection of previously undiagnosed asbestos-related disease or disease that may have progressed to higher compensation grades.
more
This document presents the findings of the National Census of Persons with Disabilities in Rwanda. The preliminary result of this census has been used to produce a summary analysis of tables and figures. It shall be possible to derive basic socio-demographic indicators as well as to obtain the estim...ate of persons with disability in Rwanda, all of which shall serve as a reference to the categorization activity planned to be done in the near future by a medical committee from the Ministry of Health. The data of this report relate to (1) Persons with disability size for various administrative units (Districts and Provinces), (2) Distribution of Persons with disabilities by sex, age, marital status and type of disabilities.
more
The Global Antibiotic Resistance Partnership (GARP)-Mozambique team, in partnership with the Center for Disease Dynamics, Economics & Policy (CDDEP), has produced this report as part of a solid com-mitment to develop actionable policy proposals to tackle antibiotic resistance and improve appropriate... antibiotic access. It is the result of a thorough review of published and unpublished data on antibiotic resistance and a long internal consultation effort that engaged academic scientists, health professionals and other stakeholders within Mozambique.
more
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.
more
The pandemic presents tough choices for governments, local communities, health and school systems, as well as families and businesses: How to re-open safely? How to safeguard people’s lives and protect their livelihoods? Where to allocate scarce resources? How to protect those unable to protect th...emselves? Answers to questions like these will affect our short-term success in battling the spread of the virus and could have impacts for generations to come.
More than ever, the world needs reliable and trustworthy data and statistics to inform these important decisions. The United Nations and all member organizations of the Committee for the Coordination of Statistical Activities (CCSA) collect and make available a wealth of information for assessing the multifaceted impacts of the pandemic. This report updates some of the global and regional trends presented in Volume I and offers a snapshot of how COVID-19 continues to affect the world today across multiple domains.
more
Based on the recently updated 2018 WHO-WFSA International Standards for a Safe Practice of Anaesthesia the WFSA has developed the Anaesthesia Facility Assessment Tool (AFAT) in order to help regional and national anaesthesia and health care leadership to gather data about anaesthesia workforce, equi...pment, medicines and practice at the facility level.
The AFAT is part of a shared effort to improve data collection and knowledge management in support of the implementation of World Health Assembly Resolution 68.15 and to ensure that anaesthesia is represented in national health planning and in National Surgical, Obstetric & Anaesthesia Plans (NSOAPs).
more
Guidelines for Good Clinical Laboratory Practices (GCLP) outlines the principles and procedures to be followed by medical laboratories involved in clinical research and/or patient care so as to provide quality data which can be used for health research and patient treatment. As the use of laboratory... tests (often expensive) are increasingly becoming a part of medical diagnosis and research, generation of quality data would be a cost-effective and ethically sound strategy.
more
Halving snakebite morbidity and mortality by 2030 requires countries to develop both prevention and treatment strategies. The paucity of data on the global incidence and severity of snakebite envenoming causes challenges in prioritizing and mobilising resources for snakebite prevention and treatment.... In line with the World Health Organisation’s 2019 Snakebite Strategy, this study sought to investigate Eswatini’s snakebite epidemiology and outcomes, and identify the socio-geographical factors associated with snakebite risk.
more
A new FMP was opened in Lutaya (Yei County), bringing the total number of EVD-related FMPs within South Sudan to 14. Six additional FMPs are operated in cooperation with DTM Uganda on the Ugandan side of the border due to access issues on the South Sudanese side.
A field mission was carried ou...t in Yambio County to scope potential new FMP locations, provide the enumerators in Gangura with refresher training and improve arrangements for data upload.
Installation of incinerators and waste pits for medical waste management is ongoing at Morobo and Panyume Primary Health Care Centres (PHCC).
Two new POE screening sites established in Lasu and Birigo were officially opened and have started screening activities on the reporting period, making the total active IOM-supported PoE screening sites at 13
more
To eliminate lymphatic filariasis (LF) by 2020, the World Health Organization (WHO) has launched a campaign against the disease. Since the launch in 2000, significant progress has been made to achieve this ambitious goal. In this article we review the progress and status of the LF programme in Afric...a through the WHO neglected
tropical diseases preventive chemotherapy databank, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) portal and other publications. In the African Region there are 35 countries endemic for LF. The Gambia was reclassified as not requiring preventive chemotherapy in 2015, while Togo and Malawi eliminated LF as a public health problem in 2017 and 2020, respectively. Cameroon discontinued mass drug administration (MDA) and transitioned to post-MDA surveillance to validate elimination. The trajectory of coverage continues to accelerate; treatment coverage increased from 0.1% in 2000 to 62.1% in 2018. Geographical coverage has also significantly increased, from 62.7% in 2015 to 78.5% in 2018. In 2019, 23 of 31 countries requiring MDA achieved 100% geographic coverage. Although much remains to be done, morbidity management and disability prevention services have steadily increased in recent years. Vector control interventions conducted by other programmes, particularly malaria vector control, have had a profound effect in stopping transmission in some endemic countries in the region. In conclusion, significant progress has been made in the LF programme
in the region while we identify the key remaining challenges in achieving an Africa free of LF.
more