The occurrence of a case of wild polio in a previously polio free area as presently in Syria, whether through importation, laboratory accident, or mutation of vaccine virus (VDPV), should be considered a public health emergency, that requires a rapid and high quality response as utmost priority
This is only the cover of the book. Download the whole Toolkit at: www.cdc.gov/reproductivehealth/Refugee/
Understanding the reproductive health needs of conflict-affected women will enable organizations to implement and enhance programs and services to improve the health of women and their fam...ilies. The Reproductive Health Assessment Toolkit (RHA) for Conflict-Affected Women provides user-friendly tools to quantitatively assess the reproductive health needs of conflict-affected women aged 15–49 years. The RHA Toolkit enables field staff to collect data to inform program planning, monitoring, evaluation, and advocacy. It promotes using the collected data to enhance services and improve the reproductive health of women and their families.
more
This is the third guidance note in a four-part series of notes related to impact evaluation developed by InterAction with financial support from the Rockefeller Foundation.This third guidance note, Introduction to Mixed Methods in Impact Evaluation, starts by explaining what a mixed methods (MM) imp...act evaluation design is and what distinguishes this approach from quantitative or qualitative impact evaluation designs. It notes that a mixed methods approach seeks to integrate social science disciplines with predominantly quantitative (QUANT) and predominantly qualitative (QUAL) approaches to theory, data collection, data analysis and interpretation. The guidance note is also available in French and Spanish on https://www.interaction.org/impact-evaluation-notes. ATTENTION: ANNEXES 1 TO 11 TO THIS DOCUMENT CAN BE FOUND IN ENGLISH VERSION ON: https://www.interaction.org/introduction-mixed-methods-impact-evaluation-annexes
more
Despite improvements in recent years, the prevalence of undernutrition among women and children in Myanmar remains unacceptably high. One in three children are stunted and about 8% are acutely malnourished. Micronutrient deficiencies are common among infants, young children and pregnant women. In fa...ct, more than 80% of children 6 to 23 months of age and 70% of pregnant women are anemic. To better understand the determinants of undernutrition and the linkages between food security, livelihoods and nutrition in Myanmar as a whole as well as in specific geographic areas where programs supported by the Livelihoods, Food Security Trust Fund (LIFT) are being implemented, the LEARN project has reviewed food and nutrition security data from the past five years and synthesized relevant findings into this report.
Following the Introduction, Section 2 presents national level data on the food and nutrition security situation in Myanmar in the past five years. Sections 3, 4 and 5 present data on food and nutrition security from the various agro-ecological zones that are of interest to LIFT, namely the Coastal/Delta, Dry, and Uplands.
more
Lesotho’s predominantly rural population faces significant health challenges within a setting of inadequate human resources for health. It is essential that nurses and nurse-midwives, who together make up the largest health workforce in the country, be adequately prepared to address Lesotho’s He...alth Priorities according to the Poverty Reduction Strategy Paper (PRSP) in the settings where they work. Under the HRAA project, Jhpiego conducted a task analysis study to obtain data on job duties or tasks performed by these cadres, as well as information about how often the tasks are performed, if and where tasks were learned, and the self-perceived level of competence in performing the tasks.
more
The intended purpose of this compendium is to provide program managers, organizations, and policy makers with a menu of indicators to better “know their HIV epidemic/know their response” from a gender perspective. The indicators in the compendium are all either part of existing indicators used i...n studies or by countries or have been adapted from existing indicators to address the intersection of gender and HIV. The indicators can be measured through existing data collection and information systems (e.g. routine program monitoring, surveys) in most country contexts, though some may require special studies or research.
more
Slum population in India is growing fast (25.1% decadal growth – Census 2011). Its health and nutrition indicators are worse than that of the non slum urban areas and comparable to that of rural India.
The National Urban Health Mission (HUHM), launched in 2013, focuses on improving the health of ...urban slum population through a needs based, city-specific urban health care system that includes a revamped primary care system, targeted outreach, equitable access, and involvement of the community and urban local bodies (ULBs).
The HUHM recognizes that lack of disaggregated data collected at local and/or city level impedes efficient planning with focus on the urban poor, and that data availability is a critical need.
more
Vitamin A supplementation (VAS) programs targeted at children aged 6–59 months are implemented in many countries. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. There is currently a debate regarding the relevance of VAS, but a...midst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data.
Article published in: Nutrients, 2017, 9, 190
https://doi.org/10.3390/nu9030190
more
This handbook was designed primarily as a tool for district clinical specialist teams (DCSTs), and for the provincial specialists who will guide and support their work. This handbook will also be useful to managers of health facilities, heads of clinical units and nurses, doctors and allied health w...orkers at the coalface of clinical care. This handbook will be of interest to district managers and other members of the district management team who are dedicated to developing the capacity of the district health system to respond
effectively to the health needs of the population they serve. It will help them understand the role of the DCSTs and the type of
activities they need to engage in to improve the quality of care
more
INTRODUCTION: Health service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kin...shasa, including strict lock-down measures in the Gombe health zone.
METHODS: Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (i.e, Gombe vs other health zones).
RESULTS: Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lock-down was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.
CONCLUSION: The COVID-19 pandemic resulted in important reductions in health service utilizsation in Kinshasa, particularly Gombe. Lifting of lock-down led to a rebound in the level of health service use but it remained lower than pre-pandemic levels.
more
There has been no systematic comparison of how the policy response to past infectious disease outbreaks and epidemics was funded. This study aims to collate and analyse funding for the Ebola epidemic and Zika outbreak between 2014 and 2019 in order to understand the shortcomings in funding reporting... and suggest improvements. Methods: Data were collected via a literature review and analysis of financial reporting databases, including both amounts donated and received. Funding information from three financial databases was analysed: Institute of Health Metrics and Evaluation’s Development Assistance for Health database, the Georgetown Infectious Disease Atlas and the United Nations Financial Tracking Service. A systematic literature search strategy was devised and applied to seven databases: MEDLINE, EMBASE, HMIC, Global Health, Scopus, Web of Science and EconLit. Funding information was extracted from articles meeting the eligibility criteria and measures were taken to avoid double counting. Funding was collated, then amounts and purposes were compared within, and between, data sources.
more
Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (...SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
more
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
Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests t...hat SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
more
Background
Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity a...t a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.
Methods
We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.
Results
We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).
Conclusions
Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.
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
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...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.
more
Produced by UNICEF and IRC, with the support of the German Corporation for International Cooperation GmbH (GIZ) and the generous funding from the German Federal Ministry of Economic Cooperation and Development (BMZ), the Caring for Child Survivors of Sexual Abuse (CCS) Resource Package (Second Editi...on, 2023) is a revision of the original CCS Guidelines and associated Training (First Edition, 2012). The Second Edition offers an up-to-date global technical guidance on providing a model of quality care for children and families affected by sexual abuse in humanitarian settings. The new resources include both revised and content additions based on practitioner feedback, the most recent evidence and learning. In particular, the Guidelines aim to bring a stronger focus on gender inequality, intersectionality, as well as the connections between the best interests of the child and a survivor-centered approach.
more
Asthma is the most common chronic disease in children, imposing a consistent burden on health system. In recent years, prevalence of asthma symptoms became globally increased in children and adolescents, particularly in Low-Middle Income Countries (LMICs). Host (genetics, atopy) and environmental fa...ctors (microbial exposure, exposure to passive smoking and air pollution), seemed to contribute to this trend. The increased prevalence observed in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception. Asthma accounts for 1.1% of the overall global estimate of “Disability-adjusted life years” (DALYs)/100,000 for all causes. Mortality in children is low and it decreased across Europe over recent years. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality. Global asthma-related costs are high and are usually are classified into direct, indirect and intangible costs. Direct costs account for 50–80% of the total costs. Asthma is one of the main causes of hospitalization which are particularly common in children aged < 5 years with a prevalence that has been increased during the last two decades, mostly in LMICs. Indirect costs are usually higher than in older patients, including both school and work-related losses. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities and study performance. The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease.
more
The global prevalence, morbidity and mortality related to childhood asthma among children has increased significantly over the last 40 years. Although asthma is recognized as the most common chronic disease in children, issues of underdiagnosis and undertreatment persist. There are substantial globa...l variations in the prevalence of asthma symptoms in children, with up to 13-fold differences between countries. The rising number of hospital admissions for asthma may reflect an increase in asthma severity, poor disease management and/or the effect of poverty. The financial burden of asthma is relatively high within developed countries (those for which data is available) spending 1 to 2% of their healthcare budget on this condition. Established in 1989, the Global Initiative for Asthma (GINA) attempts to raise awareness about the increasing prevalence of asthma, improve management and reduce the burden of asthma worldwide. Despite global efforts, GINA has not achieved its goal, even among developed nations. There are multiple barriers to reducing the global burden of asthma, including limited access to care and/or medications, and lack of prioritization as a public healthcare priority. In addition, the diversity of healthcare systems worldwide and large differences in access to care require that asthma management guidelines be tailored to local needs.
more