Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversible factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (rarely) true severe, therapy-resistant ...asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
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Following the encouraging initial results of the pilot project, the Ministry of Health is committed to increasing access to MDR-TB diagnosis, treatment and care. An expansion plan for the programmatic management of drug-resistant TB has been developed and forms part of the Five Year National Strateg...ic Plan for TB Control, 2011-2015. The long-term goals of the MDR-TB expansion plan are threefold:
1. Diagnosis of MDR-TB in all groups of patients at risk for MDR-TB
2. Diagnosis of MDR-TB in all HIV-infected TB patients
3. MDR-TB treatment for all patients diagnosed with MDR-TB under WHO-endorsed treatment protocols
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Policy Brief, Updated in March 2017
Key messages
• The criminalisation of male-to-male sex heightens HIV and other sexually transmissible infection (STI) risks and vulnerabilities, and hinders access to HIV and STI services including HCT.
• Men who have sex with men (MSM) and tran...sgender persons (TG) are not a homogeneous group. As such, a variety of HCT service models are needed to reach the various segments of these populations.
• Stigma and discrimination remain ongoing issues at a number of service points. Targeted training of service providers is therefore needed so that MSM and TG are not discouraged from seeking HCT and high-quality prevention, treatment and care services.
• Specific guidelines on HIV prevention, treatment and care services for MSM or TG help improve the delivery of services.
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The Ghana National Malaria Strategic Plan 2021–2025 aims to reduce malaria mortality by 90% and malaria cases by 50% (using 2019 as baseline) and to achieve pre-elimination in at least six districts by 2025. The plan focuses on scaling up prevention measures like distributing insecticide-treated n...ets, indoor residual spraying, seasonal chemoprevention, and prevention in pregnancy. It also emphasizes universal access to prompt diagnosis and effective treatment, strengthening health system governance, improving supply chains, mobilizing resources, and enhancing surveillance. Special attention is given to vulnerable groups and high-burden areas to ensure equity and sustainability in the fight against malaria.
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The Rwanda Malaria Strategic Plan 2020–2024 outlines Rwanda’s national strategy to reduce malaria morbidity and mortality by at least 50% compared to 2019 levels. The vision is a malaria-free Rwanda contributing to socioeconomic development.
The plan includes strengthening prevention through lo...ng-lasting insecticide-treated nets, indoor residual spraying, and larval source management; ensuring universal access to testing and treatment; improving surveillance and data use; and enhancing program management, coordination, and financing. It also emphasizes community engagement and behavior change to ensure at least 85% of the at-risk population adopts protective practices.
The strategy builds on past lessons, involves multi-sectoral collaboration, and aligns with global malaria goals. It highlights equity, quality services, and evidence-based interventions as guiding principles, aiming to mobilize national and international resources for sustained impact.
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The World Health Organization (WHO) launched the SAFER initiative in 2018 to address the global health and societal challenges posed by alcohol-related harm. The initiative outlines five key strategies aimed at reducing alcohol consumption and its associated consequences. These include strengthening... restrictions on alcohol availability by implementing and enforcing policies to limit its accessibility and advancing drink-driving countermeasures, such as low blood alcohol concentration limits and random breath testing, to reduce alcohol-impaired driving incidents.
Additionally, SAFER emphasizes facilitating access to screening, brief interventions, and treatment for individuals with alcohol use disorders, ensuring that healthcare systems are equipped to provide effective support. Another core strategy is enforcing comprehensive bans or restrictions on alcohol advertising, sponsorship, and promotion to minimize its influence, particularly on vulnerable populations such as youth. Finally, the initiative advocates raising alcohol prices through excise taxes and pricing policies to make it less affordable and thereby reduce consumption.
By implementing these evidence-based, cost-effective measures, the SAFER initiative aims to reduce the global burden of alcohol-related deaths and disabilities, fostering healthier societies worldwide.
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The current outbreak of Ebola in west Africa constitutes the largest and most complex to date. Declared a public health emergency of international concern by WHO, the outbreak of a disease with no known treatment or vaccination is proving difficult to contain given the already fragile and under res...ourced health systems in the affected areas.
The Lancet wishes to assist health workers and researchers working under difficult and dangerous conditions to bring this outbreak to a close. This Ebola hub contains all related resources from The Lancet family of journals offered with free access to support their vital work. Find interesting articles on the website
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The escalating antimicrobial resistance (AMR) pandemic is a global public health threat with extensive health, economic and societal implications. Resistance emerges because of selection pressure from rational and indiscriminate antimicrobial use in human health as well as in the veterinary, agricul...ture and environmental sectors. Infections caused by resistant bacteria result in longer duration of illness, higher mortality rates and increased costs associated with alternative treatment. AMR further constrains procedures that rely on antimicrobial prophylaxis, and AMR is recognized as a threat to theworld economy.
Journal of Public Health | Vol. 39, No. 1, pp. 8–13 | doi:10.1093/pubmed/fdw015 | Advance Access Publication March 3 2016
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Malaria No More is a non-profit organisation dedicated to eradicating malaria, a preventable and treatable disease, in our lifetime. Through innovative partnerships, advocacy and data-driven solutions, Malaria No More works globally to ensure access to prevention tools, diagnostics and treatment, pa...rticularly in vulnerable regions. Malaria No More focuses on high-impact campaigns, technological innovation and policy engagement, collaborating with governments, health organisations and private sector partners to accelerate progress towards malaria eradication and save lives.
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Providing quality, stigma-free services is essential to equitable health care for all and achieving global HIV goals and broader Sustainable Development Goals related to health. Every person has the right to the highest attainable standard of physical and mental health. Countries have a legal obliga...tion to develop and implement legislation and policies that guarantee universal access to quality health services and address the root causes of health disparities, including poverty, stigma and discrimination.
The health sector is uniquely placed to lead in addressing inequity, assuring safe personcentred care for everyone and improving social determinants of health by overcoming taboos and discriminatory or stigmatizing behaviours associated with HIV, viral hepatitis and sexually transmitted infections (STIs). Improving health care quality and reducing stigma work together to enhance health outcomes for people living with HIV. Together, they make health care services more accessible, trustworthy and supportive. This encourages early diagnosis, consistent treatment and improved mental well-being. Thus, people living with HIV are more likely to engage with and benefit from health care services, leading to improved overall health.
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It is essential that all people, including people living with HIV, are able to access health services and ongoing treatment. If people living with HIV who are on ART stop abruptly because they cannot access new supplies they could rapidly become unwell, drug resistance may build and the chances of o...nward transmission of the virus would increase.
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https://doi.org/10.1016/j.vaccine.2019.09.099
The article "Economic burden of cholera in Asia" examines the financial impact of cholera in 14 Asian countries. It analyzes costs related to treatment, out-of-pocket expenses, and lost productivity due to illness and premature deaths. The study estimat...es that cholera caused approximately $41 million in direct costs and $946 million in lost productivity in 2015. It highlights the significant economic burden on public health systems and households, emphasizing the need for investments in cholera prevention, including improved sanitation, clean water access, and vaccination programs.
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In 2017, 3.6 million of the estimated 10 million people with TB worldwide were “missed” by national TB programmes (NTPs). Two thirds of them are thought to access TB treatment of questionable quality from public and private providers who are not engaged by the NTP. The quality of care provided i...n these settings is often not known or substandard. Closing these gaps and ensuring patient-centred care imply that quality-assured and affordable TB services must be made available wherever people choose to seek care.
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Cryptococcal disease, particularly cryptococcal meningitis is a significant cause of morbidity and mortality among people living with HIV with advanced HIV disease. It is estimated that it is responsible for nearly 19% of AIDS-related mortality, second only to tuberculosis. Rapid screening, diagnosi...s and linking to appropriate treatment are critical actions national programs must take to reduce the burden of disease.
WHO in 2022 introduced updated guidelines for diagnosing, preventing, and managing cryptococcal disease among adults, adolescents and children living with HIV. This policy brief provides a summary of the key recommendations, clinical considerations, and also stresses the importance of ensuring access to life-saving antifungals. There is an urgent need for countries to scale-up management for not just cryptococcal meningitis, but address cryptococcal disease in the context of a package of care for advanced HIV disease as recommended by WHO.
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The National Strategic Plan for Malaria Elimination 2021–2025 outlines Bangladesh’s roadmap to achieve zero indigenous malaria cases by 2030, with an interim goal to reduce transmission to near-zero levels by 2025. The strategy builds upon earlier successes in malaria control and shifts focus to...ward elimination in both high- and low-endemic areas.
The plan emphasizes five core objectives: ensuring universal access to quality malaria prevention and treatment services, strengthening surveillance and case detection systems, improving vector control through long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), building community engagement, and enhancing program governance and accountability.
High-priority districts, especially in the Chittagong Hill Tracts, are targeted for intensified interventions, including active case detection and tailored outreach to mobile and vulnerable populations. The strategy also calls for robust health systems support, cross-border collaboration, and integration of malaria services into broader primary health care.
This document serves as Bangladesh’s strategic foundation to transition from malaria control to phased elimination, in line with national and global targets.
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Community health workers (CHWs) serve as a very important direct link between patients, communities and health services. As trusted on-the-ground support to community members, they therefore expand access to essential healthcare information as well as available treatment and prevention programmes.
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This course book provides appropriate, cost-effective, and sustainable targeted learning for the large numbers of emerging community health workers in South Africa.
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Background and aims: Current coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationshi...p between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country's efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country.
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WHO promotes the inclusion of foodborne trematodiases among the targets of preventive chemotherapy interventions. With the aim of providing access to quality medicines, WHO has negotiated with Novartis Pharma AG whereby Novartis donates triclabendazole for the treatment of fascioliasis and paragonim...iasis in endemic countries. WHO collects applications from ministries of health and medicines are shipped free of charge.
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Language influences the way we think, how we perceive reality, and how we behave. With respect to HIV, language can embody stigma and discrimination, which impacts access to testing, acquisition of HIV, and engagement with treatment. Language plays a role in supporting respect and empowerment of ind...ividuals, as communities shape how they are referred to and the labels they wish to use. Consideration and use of appropriate language can strengthen the global response to the HIV pandemic by diminishing stigma and discrimination and increasing support and understanding for individuals and communities living with HIV. Comments and suggestions for modifications should be sent to
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The National AIDS Control Council recognizes the growing, organized and progressive inter-faith religious voice in the spheres of governance and development in Kenya. Across the country, the Faith Sector has been involved in HIV prevention, treatment, care and support to programmes towards... the HIV response.On behalf of the board and the NACC family, I want to thank the Faith Sector Working Group (FSWG) and the Faith Religious Leaders for their contribution in HIV prevention by recognizing their comparative advantage in moulding behaviors among the various populations. We pride in your ability of being able to reach millions of Kenyans at any given time. This is the more reason why NACC wishes to sincerely thank you for working closely with us on the HIV response.We appreciate the Faith Sector support to the provision of HIV and health care services provision which has facilitated access to health services even in the remotest parts our country. The role played by the Religious Leaders in addressing stigma and discrimination as the greatest barrier to access of HIV and Health services by PLHIV and other vulnerable populations is well acknowledged.Finally, our gratitude goes to the theologians who participated in the development of the Faith Sector HIV messages booklet, which provides a tool to facilitate the Religious Leaders with knowledge to address the gaps in the HIV response among the congregants.
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