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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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...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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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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This paper has been prepared to inform discussion at the conference “Beating the DRUM - Domestic Resource Use and Mobilization for accelerating progress towards SDG3,”. Many countries face critical shortfalls in domestic resource use and mobilization (DRUM) for health, threatening to push health... goals out of reach. DRUM failures weaken human capital formation, a vital input to economic growth. Countries need more and better health spending. The first step is to apply already-proven DRUM solutions, adapting them to new contexts. However, in many countries, even the best achievable DRUM performance will not be enough. New solutions are needed, including private-sector engagement and a next generation of DAH. The “Beating the DRUM” conference offers a platform for countries and partners to dialogue and build joint strategy. While each country’s situation is unique, shared lines of action are emerging.
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In 2017, $37.4 billion of development assistance was provided to low- and middleincome countries to maintain or improve health. This amount is down slightly compared to 2016, and since 2010, development assistance for health (DAH) has grown at an annualized rate of 1.0%. While global development ass...istance for health has seemingly leveled off, global health spending continues to climb, outpacing economic growth in many countries. Total health spending for 2015, the most recent year for which data are available, was estimated to be $9.7 trillion (95% uncertainty interval: 9.7–9.8)*, up 4.7% (3.9–5.6) from the prior year, and accounted for 10% of the world’s total economy. With some sources of health spending growing and other types remaining steady, and with major variations in spending from country to country, it is more important than ever to understand where resources for health come from, where they go, and how they align with health needs. This information is critical for planning and is a necessary catalyst for change as we aim to close the gap on the unfinished agenda of the Millennium Development Goals (MDGs) and move forward toward universal health coverage (UHC) in the Sustainable Development Goals (SDGs) era.
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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.
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Background:Neonatal mortality accounts for 43% of global under-five deaths and is decreasing more slowly than maternal or child mortality. Donor funding has increased for maternal, newborn, and child health (MNCH), but no analysis to date has disaggregated aid for newborns. We evaluated if and how a...id flows for newborn care can be tracked, examined changes in the last decade, and considered methodological implications for tracking funding for specific population groups or diseases. MethodsandFindings:We critically reviewed and categorised previous analyses of aid to specific populations, diseases, or types of activities. We then developed and refined key terms related to newborn survival in seven languages and searched titles and descriptions of donor disbursement records in the Organisation for Economic Co-operation and Development’s Creditor Reporting System database, 2002–2010. We compared results with the Countdown to 2015 database of aid for MNCH (2003–2008) and the search strategy used by the Institute for Health Metrics and Evaluation. Prior to 2005, key terms related to newborns were rare in disbursement records but their frequency increased markedly thereafter. Only two mentions were found of ‘‘stillbirth’’ and only nine references were found to ‘‘fetus’’ in any spelling variant or language
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A major problem facing the world is how to build peace following the ravages of increasingly protracted armed conflict. Armed conflicts leave behind shattered, divided societies that are at risk of repeating cycles of violence, and therefore need concerted peacebuilding efforts. Conflicts also take ...a heavy toll on people’s mental health and psychosocial well-being. One in five people who live in a war zone will likely develop a mental disorder, and many others suffer from painful everyday stresses associated with multiple losses, family separation, gender-based violence (GBV), disability, climate change and ongoing insecurity, among other issues.
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The burden of diabetes is enormous, positioning it as one of the main challenges facing public health today. Currently, it is estimated that 62 million people are living with diabetes in the Region of the Americas and projections show its prevalence will continue rising over the following years. The... Region shows the highest number of years of healthy life lost (through either disability or premature death) due to diabetes worldwide. The high costs associated with its treatment produce a heavy economic burden. Its complications can seriously affect the quality of life of people living with diabetes, their families, and society and overload health systems. This report shows the latest internationally comparable data on diabetes and its main risk factors by year, country, and sex.
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The present book deals not only with emergency response, but also with measures designed to reduce the impact of disasters on environmental health infrastructure, such as water supply and sanitation facilities. It also aims to strengthen the ability of people to withstand the disruption of their acc...ustomed infrastructure and systems for environmental health (e.g. shelter, water supply, sanitation, vector control etc.) and to recover rapidly.
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Panorama de la Salud: Latinoamérica y el Caribe 2020 presenta indicadores clave sobre la salud y los sistemas de salud en 33 países de Latinoamérica y el Caribe. Esta primera edición del Panorama de la Salud sobre Latinoamérica y el Caribe fue preparada en conjunto por la OCDE y el Banco Mundia...l. Los análisis se basan en los datos comparables más recientes de alrededor de 100 indicadores sobre equidad, situación de salud, determinantes de la salud, recursos y actividades, gasto y financiación, y calidad en la atención de salud. El editorial discute los principales desafíos para la región en el contexto de la pandemia de COVID-19, incluyendo tanto el manejo de la epidemia como la movilización y el uso eficiente de recursos para asegurar una respuesta efectiva
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La carga de la diabetes es enorme, posicionándola como uno de los principales desafíos que enfrenta la salud pública en la actualidad. Actualmente, se estima que 62 millones de personas viven con diabetes en la Región de las Américas y las proyecciones muestran que su prevalencia seguirá aumen...tando en los próximos años. La Región muestra el mayor número de años de vida saludable perdidos (ya sea por discapacidad o muerte prematura) debido a la diabetes en todo el mundo. Los altos costes asociados a su tratamiento producen una pesada carga económica. Sus complicaciones pueden afectar seriamente la calidad de vida de las personas que viven con diabetes, sus familias y la sociedad y sobrecargar los sistemas de salud. Este informe muestra los últimos datos comparables internacionalmente sobre la diabetes y sus principales factores de riesgo por año, país y sexo. También incluye un resumen de la respuesta de los sistemas de salud de los países a la diabetes, incluidos planes nacionales, objetivos, vigilancia, directrices y acceso a medicamentos y tecnologías esenciales, y sintetiza información sobre las complicaciones relacionadas con la diabetes y la estrecha relación entre la diabetes y otras patologías, como enfermedades cardiovasculares, tuberculosis y COVID-19.
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Promoting and protecting health is essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted that Health for All would contribute
both to a better quality of life and also to global peace a...nd security
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La serovigilancia es una herramienta que complementa los métodos tradicionales de salud pública para la vigilancia de las enfermedades transmisibles y proporciona información valiosa sobre la transmisión de enfermedades en los grupos de la población; por ejemplo, para detectar brechas en la inm...unidad frente a las enfermedades prevenibles mediante vacunación. Esta información es útil para hacer un seguimiento de la exposición de la población a enfermedades como la malaria, las enfermedades infecciosas desatendidas, las enfermedades transmitidas por alimentos, agua y vectores, así como las enfermedades infecciosas emergentes. Como muchas enfermedades infecciosas están o han estado presentes en grupos que viven en entornos donde se superponen diversos factores de riesgo, la serovigilancia integrada facilita las sinergias y optimiza la utilización de los recursos de salud pública. Este conjunto de herramientas se elaboró para facilitar el diseño, la puesta en marcha, el análisis, la interpretación y el uso de los resultados de las encuestas serológicas integradas para reforzar las capacidades de los países con vistas a la eliminación de las enfermedades transmisibles. En la primera parte se describen los conceptos básicos sobre encuestas y vigilancia serológicas, sus usos, ventajas y desafíos, formas de mejorar su eficiencia, así como su potencial para contribuir a la toma de decisiones de salud pública. Posteriormente, se presenta un proceso gradual para la puesta en marcha de la vigilancia serológica integrada basada en encuestas serológicas. Incluye recomendaciones sobre cómo determinar la necesidad y el propósito de recopilar información serológica; el diseño y la metodología de la encuesta; los métodos del laboratorio; las consideraciones prácticas para la realización de encuestas; el análisis e interpretación de los datos y el uso de los resultados para respaldar la toma de decisiones. Su objetivo principal es apoyar a los directores de programas y equipos que participan en el control y eliminación de las enfermedades transmisibles. Se elaboró para ser usado, entre otros, por los coordinadores de enfermedades transmisibles, enfermedades infecciosas desatendidas y programas de vacunación; directores de vigilancia epidemiológica; personal de laboratorios de salud pública; y otros profesionales de los ministerios de salud y autoridades nacionales y subnacionales de salud que puedan estar interesados en incorporar la vigilancia serológica integrada como parte de las herramientas de sus sistemas de vigilancia, para obtener información adicional sobre la transmisión de enfermedades infecciosas en la población.
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The Global Report on Food Crises (GRFC) 2023 highlights that the number of people experiencing high levels of acute food insecurity and requiring urgent food and livelihood assistance increased for the fourth consecutive year in 2022. Over a quarter of a billion people were estimated to face acute h...unger, with economic shocks and the Ukraine war contributing to the increase. In 2022, around 258 million people across 58 countries and territories faced acute food insecurity at crisis or worse levels (IPC/CH Phase 3-5), up from 193 million people in 53 countries and territories in 2021.
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Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported ...cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected.
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En el presente documento se comunica el progreso logrado en la Región hacia la eliminación de la transmisión maternoinfantil del VIH y la sífilis entre los años 2010 y 2017. Se trata también del primer informe regional sobre la eliminación de la transmisión maternoinfantil y durante la prime...ra infancia de la hepatitis B y la enfermedad de Chagas congénita. Los resultados principales son los siguientes: El acceso de las embarazadas a la atención prenatal y del parto es alto en la Región de las Américas.
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Countries are making progress toward the global goal of 95% of people living with HIV knowing their status by 2025. However, considerable gaps remain in achieving these goals globally. Men in high HIV burden settings and men from key populations in all settings are consistently less likely to know t...heir HIV status than women. Globally, 78% of men ages 15 years and older who are living with HIV are aware of their HIV status, compared with 86% of women with HIV of these ages.
Offering HIV testing services, including HIV self-testing, at formal and informal workplaces has emerged as an effective, acceptable and feasible approach for reaching men. A 2018 World Health Organization (WHO) and International Labour Organization (ILO) policy brief provides key guiding principles for HIVST implementation at workplaces. Building on the 2018 policy brief, this brief captures early experience with HIVST implementation at workplaces and discusses emerging approaches of sustainable financing that can be adapted for HIV self-testing at workplaces.
The primary audiences for this policy brief are ministries of health and labour, national HIV programmes, employers’ organizations, workers’ organizations (labour unions), enterprises, implementing partners, including civil society organizations, and health insurance agencies.
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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...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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