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In 2014, the World Heart Federation (WHF) launched
an initiative to develop a series of Roadmaps [1e6]. Their
aim is to identify potential roadblocks on the pathway to
effective prevention, detection, and management of cardiovascular disease (CVD), along with evidence-based
solutions to overcome
...
them. The resulting documents
provide a framework to translate strategic intent into action
on integrating epidemiology, population, and cardiovascular outcome trial data into national plans for optimal
CVD management.
more
Hypertension is referred to as a “silent killer”. Most people with hypertension are unaware of their condition as in most cases, they experience no warning signs or symptoms hence they are not identified or treated. Hypertention is associated with a number of conditions, disability, and causes o
...
f death. These include: strokes; myocardial infarction; end-stage renal disease; congestive heart failure; peripheral vascular disease and blindness. According to Stats SA, in 2017, hypertensive disorders resulted in 19 900 deaths with a further 44 357 deaths associated with cerebrovascular diseases and other heart diseases. This means around 30% of all deaths in 2017 were associated with increased blood pressure.
more
This paper explores the angles and opportunities of digital health, with a look
at digital innovation and its potential to support patients with circulatory diseases.
In reviewing developments in the field, current applications as well as gaps, the paper aims to support policymakers in leveraging
...
technology for better circulatory health and to capture the roles that various sectors have in making
digital health a tool for everyone.
more
In 2012, all Member States of the World Health Organization (WHO) endorsed a historical target to reduce premature mortality from noncommunicable diseases
(NCD). This commitment was echoed in 2015 by the United Nations Sustainable Development Goals, which included a target to reduce premature morta
...
lity (the
measure of unfulfilled life expectancy and deaths between the ages of 30 and 70 years) from NCD by 30% by the year 2030. The Sustainable Development Goals are especially relevant to cardiovascular disease (CVD), the leading cause of death globally, with increasing prevalence in low- and middle-income countries (LMIC).
more
The World Heart Federation (WHF) Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection and management of cardiovascular diseases and provide a generic global framework available for loca
...
l adaptation. A first Roadmap on raised blood pressure was published in 2015. Since then, advances in hypertension have included the publication of new clinical guidelines (AHA/ACC; ESC; ESH/ISH); the launch of the WHO Global HEARTS Initiative in 2016 and the associated Resolve to Save Lives (RTSL) initiative in 2017; the inclusion of single-pill combinations on the WHO Essential
Medicines’ list as well as various advances in technology, in particular telemedicine and mobile health. Given the substantial benefit accrued from effective interventions in the management of hypertension and their potential for scalability in low and middle-income countries (LMICs), the WHF has now revisited and updated the ‘Roadmap for raised BP’ as ‘Roadmap for hypertension’
by incorporating new developments in science and policy. Even though cost-effective lifestyle and medical interventions to prevent and manage hypertension exist, uptake is still low, particularly in resource-poor areas. This Roadmap examined the roadblocks pertaining to both the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and
traditions) and the supply side (health systems resources and processes) along the patient pathway to propose a range of possible solutions to overcoming them. Those include the development of population-wide prevention and control programmes; the implementation of opportunistic screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidencebased, inexpensive BP-lowering agents.
more
Background
Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-
...
incidence ratio (MIR) across the world over 28 years.
Methods
The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.
Results
The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.
Conclusions
Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.
more
This publication aims to provide updated guidance on the specific use of yellow fever laboratory assays in the context of surveillance to be used across the Global Yellow Fever Laboratory Network for disease surveillance. In the recent years, new commercial assays became available and are now recomm
...
ended for use by WHO and this publication will support national program on the use of compound laboratory assays as per the most recent recommended testing algorithms. This piece is aligned with the elimination effort set in the comprehensive global strategy to eliminate yellow fever epidemics (EYE) strategy 2017-2026 and where its advisory laboratory technical working group actively contributed to its development. The target audiences are policy-makers and health workers.
more
The document is a comprehensive practical guide for managing cholera epidemics. It includes detailed instructions on outbreak investigation, control measures, case management, and the organization of treatment facilities. It emphasizes strategies such as rehydration therapy, water sanitation, hygien
...
e promotion, and vaccination to prevent the spread of cholera. The guide serves as a resource for healthcare professionals, logisticians, and public health officials to respond effectively to cholera outbreaks.
more
This document contains guidance for strengthening the disability inclusiveness of MHPSS responses and programmes in emergency settings. It is intended to supplement the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007).
Overall Objective
To consider and add
...
ress the mental health and psychosocial support (MHPSS) requirements of persons living in emergency settings with all types of disabilities on an equal basis to the MHPSS requirements of all persons, using a human rights-based approach and implementing social-ecological frameworks.
more
Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to
...
accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
more
Laboratory manual for yellow fever
recommended
This WHO laboratory manual provides the most up to date methods and procedures for the laboratory identification of yellow fever virus infection in humans. It provides guidance on the establishment and maintenance of an effective laboratory providing routine surveillance testing for yellow fever, wh
...
ich operates within the WHO coordinated Global Yellow Fever Laboratory Network (GYFLaN) capable of providing confirmation of yellow fever infection reliably and timely. This second edition supersedes the first edition of the 2004 WHO manual for the monitoring of yellow fever virus infection.
more
The ERF provides WHO staff with essential guidance on how the Organization manages the assessment, grading and response to public health events and emergencies with health consequences, in support of Member States and affected communities. The ERF adopts an all-hazards approach and it is therefore a
...
pplicable in all acute public health events and emergencies.
This version (2024) of the WHO ERF has been developed following extensive consultation across the three levels of the Organization and response experiences over the last five years of emergency response. Key areas have been updated to improve the accountability, predictability, timeliness and effectiveness of WHO’s response to emergencies.
more
Small drinking-water supplies commonly experience operational, managerial, technical and resourcing challenges that impact their ability to deliver safe and reliable services. The needs and opportunities associated with these supplies therefore warrant explicit consideration in policies and regulati
...
ons.
These Guidelines, specifically tailored to small water supplies, build on over 60 years of guidance by the World Health Organization (WHO) on drinking-water quality and safety. They focus on establishing drinking-water quality regulations and standards that are health based and context appropriate; on proactively managing risks through water safety planning and sanitary inspections; and on carrying out independent surveillance. The guidance is intended primarily for decision-makers at national and subnational levels with responsibility for developing regulatory frameworks and support programmes related to these activities. Other stakeholders involved in water service provision will also benefit from the guidance in this document.
Designed to be practical and accessible, these Guidelines offer clear guidance that is rooted in the principle of progressive improvement. State-of-the-art recommendations and implementation guidance are provided, drawn from a comprehensive evidence review and established good practices. Additionally, case examples are provided from countries and areas around the world to demonstrate how the guidance in this publication has been implemented in practice in a wide variety of contexts.
Together with WHO’s 2024 Sanitary inspection packages – a supporting tool for the Guidelines for drinking-water quality: small water supplies, these Guidelines update and supersede WHO’s 1997 Guidelines for drinking-water quality. Volume 3: surveillance and control of community supplies. Key changes to this updated publication include a greater focus on preventive risk management and a broader range of small water supplies covered, including those managed by households, communities and professional entities.
more
The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for diseases
...
, injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders.
more
Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status—wealth and education—differ among
...
high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.
more
Objective: To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training in three underserved communities in Brazil.
Metho
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ds: A cross-sectional, population-based survey of non-institutionalised adults age 30 or greater was conducted in three municipalities in Eastern Brazil. Data were analysed as survey-weighted percentages of the sampled populations.
Results: 3035 surveys were completed. Overall, one-third of respondents was unable to identify at least one cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction symptom. A minority of respondents had received training in CPR or were able to identify an AED. Low levels of education and low socioeconomic status were consistent predictors of lower knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR and AED use.
Conclusions: In three municipalities in Eastern Brazil, overall public knowledge of cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate CPR and AED use was low. Our findings indicate the need for interventions to improve public knowledge and response to acute cardiovascular events in Brazil as a first step towards improving health outcomes in this population. Significant heterogeneity in knowledge seen across sites and socioeconomic strata indicates a need to appropriately target such interventions.
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Background
Low- and middle-income countries now experience the highest prevalence and mortality rates of cardiovascular disease.
Main text
While improving the availability and delivery of proven, effective therapies will no doubt mitigate this burden, we posit that studies evaluating cardiovasc
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ular disease risk factors, management strategies and service delivery, in diverse settings and diverse populations, are equally critical to improving outcomes in low- and middle-income countries. Focusing on examples drawn from four cardiovascular diseases — coronary artery disease, stroke, diabetes and kidney disease — we argue that ethnicity, culture and context matter in determining the risk factors for disease as well as the comparative effectiveness of medications and other interventions, particularly diet and lifestyle interventions.
Conclusion
We believe that a host of cohort studies and randomized control trials currently being conducted or planned in low- and middle-income countries, focusing on previously understudied race/ethnic groups, have the potential to increase knowledge about the cause(s) and management of cardiovascular diseases across the world.
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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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Strategic communication is at the heart of public health and more important than ever in the digital age. Using communication strategically requires expertise, skills and resources to plan, implement and evaluate interventions that encourage governments to implement policies that improve people’s
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lives and well-being, that empower health workers to deliver the best care possible, and that encourage people to take actions that protect and improve their health and that of their family and community. This Regional Action Framework on Communication for Health (C4H) aims to support Member States in implementing the C4H approach. It outlines steps to be taken by WHO and Member States to use C4H to achieve shared public health goals in the Western Pacific.
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