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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
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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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Time has seen management for Cystic Fibrosis (CF) advance drastically, most recently in the development of the disease-modifying triple combination therapy ivacaftor/tezacaftor/elexacaftor. There is currently limited evidence regarding both the global epidemiology of CF and
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access to this transformative therapy - and therefore where needs are not being met. Therefore, this study aims to define gaps in access to CF treatment. The results show that a significant CF patient burden exists in countries where disease-modifying drugs are unavailable, and final figures are likely underestimates. This analysis shows the potential to improve rates of diagnosis and treatment for CF, so a higher percentage of patients receive the most effective triple combination treatment.
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While epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by cha
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llenges in diagnosis and management. These challenges, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in subSaharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region. Methods We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and selfmanagement, and barriers and facilitators for accessing T1D care.
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The article "Cardiovascular Diseases" on Our World in Data provides an in-depth analysis of cardiovascular diseases (CVD), the leading cause of death globally. It examines CVD trends, such as the decline in mortality rates in high-income countries due to
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improved healthcare and lifestyle changes, while low- and middle-income countries experience rising CVD burdens. The article highlights major risk factors, including high blood pressure, obesity, smoking, and poor diet. It emphasizes the importance of preventive measures and access to treatment to reduce global disparities in CVD outcomes. The data-driven approach uses visualizations to illustrate the global impact and distribution of CVD.
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This global progress report attempts to lay the groundwork for the kind of accelerated action needed. Section 1 presents key data, trends and developments in women’s, children’s and adolescents’ heal
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th and well-being. That is followed in Section 2 by a deeper dive into the impact of the COVID-19 pandemic, which has created and contributed to many threats and challenges to progress for women, children and adolescents. In Section 3, the report concludes with recommendations for accelerating progress towards the achievement of the 2030 Agenda even in such challenging times, with an emphasis on partnership
and clear-eyed recognition of the consequences of failing to do better.
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14 August 2020
Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013
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. However, increased spending by donors might not improve outcomes, if funds are delivered in ways that undermine countries’ public financial management systems and incur high transaction costs for project implementation
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The power relations around global decisions which shape population health can be changed through new alliances and information flows. The Democratising Global Health Governance Initiative, of which
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WHO Watch is a project, is designed to contribute to improved population health (and health equity) through new alliances and information flows.
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Rehabilitation in health systems provides recommendations for Member States and other relevant stakeholders to strengthen and expand the availability of quality rehabilitation services. Currently, t
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here is a significant unmet need for rehabilitation services and it is frequently undervalued in the health system. As populations age and the prevalence of noncommunicable diseases and injuries increases, and the demand for rehabilitation grows, strengthening rehabilitation in health systems becomes ever more paramount.
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This toolkit will help you to plan and run an event that helps to change the way that people in your community think about, and behave towards, people with mental
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health problems
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According to WHO, around 22% of adults in conflict settings have mental health conditions.
This is almost triple to non-conflict settings. There i
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s no generally accepted estimate for children but it is clear that children who are refugees, IDPs or who live in conflict settings have high levels of mental health issues.
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Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review
Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee
Reproductive Health Matters
(2012)
CC
From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public heal
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th system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the literature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda’s progress in expanding the coverage of four key women’s health services. Progress took place in 2000–2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000–2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
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A guide to promote health systems strengthening to achieve universal health coverage.
For IST to be effective there is need for utilization of multiple techniques that will lead to transfer of competences (Bluestone et al. 2013). Learning settings should be selected
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to support relevant and realistic practice so as to increase the efficiency of IST. Alternatives to hotels such as training institutions and hospitals are viable options for reducing costs of IST as well as being appropriate venues (MOH 2012). There is documented evidence of involvement of academic institutions in providing health leadership capacity building through IST in other countries; for example, in Uganda, IST in leadership for doctors and nurses was done through a blended approach that included didactic and online sessions (Nakanjako et al. 2015). Adapting these concepts, FUNZOKenya piloted eight regional hubs, each serving a cluster of counties, which would train health workers for five years (2012-2016) on priority service delivery topics
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According to the latest available estimates, more than 1 in 7 adolescents aged 10–19 is estimated to live with a diagnosed mental disorder globally. Almost 46,000 adolescents die from suicide each
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year, among the top five causes of death for their age group. Meanwhile, wide gaps persist between mental health needs and mental health funding. The report finds that about 2 per cent of government health budgets are allocated to mental health spending globally.
The full report , excecutive summary, brief reports are available in English, French, Spanish and Arabic athttps://www.unicef.org/reports/state-worlds-children-2021?utm_source=referral&utm_medium=media&utm_campaign=sowc-web
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Health systems strengthening, including for sexual and reproductive health and rights services
This Course for Service Providers on how to give Vitamin A Supplementation and Deworming (VAS+D) uses both a Learner’sGuide and a Facilitator’s Guide. The Learner’s Guide is designed for participants in the course who are healthcare workers or
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trainers learning to deliver vitamin A and Albendazole(for deworming) as part of regular activities associated with community or facility-based health care services, while the Facilitator’s Guide is designed for course facilitators who are planning and conducting courses .
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The Countdown country profile presents in one place the best and latest evidence to enable an assessment of a country’s progress in improving reproductive, maternal, newborn, and child health (RMN
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CH)
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The Countdown country profile presents in one place the best and latest evidence to enable an assessment of a country’s progress in improving reproductive, maternal, newborn, and child health (RMN
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CH)
more
