This Topic Guide has been compiled to provide an overview of undernutrition in the context of development. The focus of the Guide is on undernutrition, defined as the outcome of insufficient (quantity and quality) of food intake (hunger) and repeated infectious diseases. Undernutrition includes bein...g underweight for one’s age, too short for one’s age (stunted), underweight for one’s height (wasted), and deficient in vitamins and minerals (micronutrient malnutrition). This review does not focus on the other component of malnutrition, which is overnutrition
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The agenda focuses on six critical changes necessary for more children suffering from SAM to access effective treatment. Building on lessons from the last decade, and the experiences of other successful health initiatives, the agenda addresses issues ranging from the creation of a more enabling envi...ronment to stronger mechanisms for tracking progress. It provides a diagnosis of the key challenges in each of these areas to-date and the specific solutions needed to turn things around over the next five years. These solutions require a collective effort at global, regional and national levels. The Agenda lays out Action Against Hunger’s commitments and contributions to these joint efforts
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Medical devices are used for the prevention, diagnosis and treatment of illness and diseases and for rehabilitation. WHO developed guidance on medical device donation in 2011, which has been now reviewed, with new evidence, new references on considerations for medical device solicitation and provisi...on, risks associated with inappropriate donations, the responsibilities of donors and recipient, and the steps they should follow before, during and after a donation. It includes three sections: description of major problems that may be faced during the donation process, listing of best practices for donors and recipients and addressing situations requiring special attention. It also has three annexes for further reading: the criteria for the acceptability of a donation, literature review on donations of medical devices between 2010 and 2023 and a flyer. This document is intended to improve the quality of medical devices donations, including medical equipment, single-use medical devices and in-vitro diagnostics, to provide maximum benefit to all stakeholders. The considerations can be used to develop institutional or national policies and regulations for medical devices donations. This document is intended for use by any organization, expert or practitioner involved in the donation, procurement, management of medical devices, including health workers, biomedical engineers, health managers, policymakers, donors, nongovernmental organizations and academic institutions.
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The global burden of disease due to mental disorders continues to rise, especially in low- and middle-income countries (LMIC). In addition to causing a large proportion of morbidity, mental disorders – especially severe mental disorders (SMD) – are linked with poorer health outcomes and increase...d mortality. SMD are defined as a group of conditions that include moderate to severe depression, bipolar disorder, and schizophrenia and other psychotic disorders. People with SMD have a two to three times higher average mortality compared to the general population, which translates to a 10-20 year reduction in life expectancy. While people with SMD do have higher rates of death due to unnatural causes (accidents, homicide, or suicide) than the general population, the
majority of deaths amongst people with SMD are attributable to physical health conditions, both
non-communicable and communicable.
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The recommendation in this document thus supersedes the previous WHO recommendation for the prevention of PPH as published in the 2012 guideline, WHO recommendations for the prevention and treatment of postpartum haemorrhage.
Little is known about asthma control in the rising number of African children who suffer from this condition. The Achieving Control of Asthma in Children in Africa (ACACIA) study is an observational study collecting evidence about paediatric asthma in urban areas of Ghana, Malawi, Nigeria, South Afr...ica, Uganda and Zimbabwe. The primary objectives are: (1) to identify 3000 children aged between 12 years and 14 years with asthma symptoms; and (2) to assess their asthma control, current treatment, knowledge of and attitudes to asthma and barriers to achieving good control. Secondary objective is to develop interventions addressing identified barriers to good symptom control.
Each centre will undertake screening to identify 500 school children with asthma symptoms using questions from the Global Asthma Network’s questionnaire. Children identified to have asthma symptoms will fill in a digital survey, including: Asthma Control Test, questions on medication usage and adherence, medical care, the Brief-Illness Perception questionnaire and environmental factors. Exhaled nitric oxide testing and prebronchodilator and postbronchodilator spirometry will be performed. A subgroup of children will participate in focus group discussions. Results will be analysed using descriptive statistics and comparative analysis. Informed by these results, we will assess the feasibility of potential interventions, including the adaption of a UK-based theatre performance about asthma attitudes and digital solutions to improve asthma management.
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BUKO Pharma-Kampagne has investigated the causes and consequences of antibiotic resistance in India, South Africa, Tanzania and Germany. Together with our partners we collected data and did interviews with numerous stakeholders. The outcome is presented in a brochure that is now available in English...
Resistant bacteria are spreading worldwide. In collaboration with partners in India, Tanzania, South Africa and Germany, we have investigated the causes and consequences of this spread.2 This Pharma-Brief Special presents the results. It examines the risks for humans, animals and the environment. It focuses on local problems and approaches, international interactions and the re-sponsibility of doctors, farmers and consumers.
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Adolescence, defined as the period between 10 and 19 years of age, is a developmental stage during which many psychosocial and mental health challenges emerge. There is a well-established link between mental health and HIV outcomes. Adolescents and young adults living with HIV typically have additio...nal mental health needs linked to their experiences of living with and managing a chronic illness, along with prevailing stigma and discrimination. Mental health promotion and prevention is thus a critical priority for this group.
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This volume presents the complex patterns of cancer incidence and death around the world and evidence on effective and cost-effective ways to control cancers. The Disease Control Priorities Volume 3 evaluation of cancer will indicate where cancer treatment is ineffective and wasteful, and offer alte...rnative cancer care packages that are cost-effective and suited to low-resource settings.
Disease Control Priorities, Third Edition: Volume 3
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Supplement to the 2016 consolidated Guidelines on the use of antiretroviral drugs for Treating and Preventing HIV infection
HIV Treatment
Cryptococcal disease is one of the most common opportunistic infections among people living with advanced HIV disease and is a major contributor to severe illness, morbidity, and mortality, particularly in sub-Saharan Africa.
These guidelines update the recommendations that were first released i...n 2018 on diagnosing, preventing, and managing cryptococcal disease. In response to important new evidence that became available in 2021, these new guidelines strongly recommend a single high dose of liposomal amphotericin B as part of the preferred induction regimen for the treatment of cryptococcal meningitis in people living with HIV. This simplified regimen - a single high dose of liposomal amphotericin B paired with other standard medicines (flucytosine and fluconazole) - is as effective as the previous WHO standard of care, with the benefits of lower toxicity and fewer monitoring demands.
The objective of these guidelines is to provide updated, evidence-informed recommendations for treating adults, adolescents and children living with HIV who have cryptococcal disease. These guidelines are aimed at HIV programme managers, policymakers, national treatment advisory boards, implementing partners and health-care professionals providing care for people living with HIV in resource-limited settings with a high burden of cryptococcal disease.
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Background
Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and ris...k factors for asthma in adolescents in an LMIC.
Methods
A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.
Results
A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.
Conclusion
Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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Cardiovascular disease is a major cause of disability and premature death throughout the world, and contributes substantially to the escalating costs of health care. The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, genera...lly in middle age. Acute coronary and cerebrovascular events frequently occur suddenly, and are often fatal before medical care can be given. Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease.
This publication provides guidance on reducing disability and premature deaths from coronary heart disease, cerebrovascular disease and peripheral vascular disease in people at high risk, who have not yet experienced a cardiovascular event. People with established cardiovascular disease are at very high risk of recurrent events and are not the subject of these guidelines. They have been addressed in previous WHO guidelines.
Several forms of therapy can prevent coronary, cerebral and peripheral vascular events. Decisions about whether to initiate specific preventive action, and with what degree of intensity, should be guided by estimation of the risk of any such vascular event. The risk prediction charts that accompany these guidelinesb allow treatment to be targeted accord-
ing to simple predictions of absolute cardiovascular risk.
Recommendations are made for management of major cardiovascular risk factors through changes in lifestyle and prophylactic drug therapies. The guidelines provide a framework for the development of national guidance on prevention of cardiovascular disease that takes into account the particular political, economic, social and medical circumstances.
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The main aim of this assessment was to evaluate the PSS response of URCS to these VHF, against the needs of beneficiaries and communities focused on the areas of most ‘added value’ of the URCS; community engagement mobilisation and support, documenting any unintended outcomes and best practice r...elated to the operation.
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One important application of digital health in TB patient care is the support that it can lend to medication adherence. TB programmes have already been using short message service (SMS), video-supported treatment (VOT) and event monitoring device for medication support ...(EMM)1 to help patients complete treatment and health-care workers to monitor both daily dosing and treatment continuity
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SARS-CoV-2 infections among children and adolescents cause less severe illness and fewer deaths compared to adults. While a less severe course of infection is a positive outcome, there are concerns that mild symptoms may have led to less testing, resulting in fewer identified cases of COVID-19 in ch...ildren. If children with mild or no symptoms transmit the disease, they may act as drivers of transmission within their communities. Understanding symptoms, infectivity and patterns of SARS-CoV-2 transmission in children and adolescents is essential for developing, adapting and improving control measures for COVID-19 across all ages. This is a summary of the current knowledge around SARS-CoV-2 infection acquisition and transmission and COVID-19 disease symptoms in children and adolescents. It aims to inform decisions, based on local contexts, on how to best keep schools, kindergarten and day-care facilities open and what advice to apply to intergenerational mixing.
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Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the... patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
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The full range and scale of all forms of violence against children are only now becoming visible, as is the evidence of the harm it does. This book documents the outcomes and recommendations of the process of the United Nations Secretary-General’s Study on Violence against Children. ‘The Study... is the first comprehensive, global study on all forms of violence against children.
It builds on the model of the study on the impact of armed conflict on children, prepared by Graça Machel and presented to the General Assembly in 1996, and follows the World Health Organization’s 2002 World Report on Violence and Health.1
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This report reviews and analyses the Affordable Medicines Programme, which was introduced in Ukraine in April 2017 to provide patients with improved access to 23 outpatient medicines for the treatment of chronic noncommunicable diseases. The evaluation combines both quantitative and qualitative anal...ysis. The findings confirm that the Programme has contributed to a significant increase in access to needed outpatient medicines in Ukraine. Further, while implementation was successful overall, uptake across regions was uneven. The report concludes by listing a number of policy options to support the sustainability and expansion of the Affordable Medicines Programme.
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Namibia is estimated to be at 94-97-93 as defined by the UNAIDS 95-95-95 treatment cascade, one of the first high burden countries to approach epidemic control. COP22 is about sustaining the impact of years of investment and partnership with the Namibian government and other stakeholders by employin...g targeted and innovative approaches to prevent new infections, reduce mortality rates, and strengthen the health system to endure the impact of unexpected external shocks, while still providing person-centered health services.
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