Global & Disaster Medicine

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WHO: “Today, almost two billion people use a source of drinking-water contaminated with faeces, putting them at risk of contracting cholera, dysentery, typhoid and polio.”

Asian Correspondent

WHO

Radical increase in water and sanitation investment required to meet development targets

News release

Countries are not increasing spending fast enough to meet the water and sanitation targets under the Sustainable Development Goals (SDGs), says a new report published by WHO on behalf of UN-Water – the United Nations inter-agency coordination mechanism for all freshwater-related issues, including sanitation.

“Today, almost two billion people use a source of drinking-water contaminated with faeces, putting them at risk of contracting cholera, dysentery, typhoid and polio,” says Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health.

“Contaminated drinking-water is estimated to cause more than 500 000 diarrhoeal deaths each year and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma,” added Neira.

The report stresses that countries will not meet global aspirations of universal access to safe drinking-water and sanitation unless steps are taken to use financial resources more efficiently and increase efforts to identify new sources of funding.

According to the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2017 report, countries have increased their budgets for water, sanitation and hygiene at an annual average rate of 4.9% over the last three years. Yet, 80% of countries report that water, sanitation and hygiene (WASH) financing is still insufficient to meet nationally-defined targets for WASH services.

In many developing countries, current national coverage targets are based on achieving access to basic infrastructure, which may not always provide continuously safe and reliable services. Planned investments have yet to take into account the much more ambitious SDG targets, which aim for universal access to safely managed water and sanitation services by 2030.

In order to meet the SDG global targets, the World Bank estimates investments in infrastructure need to triple to US $114 billion per year – a figure which does not include operating and maintenance costs.

While the funding gap is vast, 147 countries have previously demonstrated the ability to mobilize the resources required to meet the Millennium Development Goal target of halving the proportion of people without an improved source of water, and 95 met the corresponding target for sanitation. The much more ambitious SDG targets will require collective, coordinated and innovative efforts to mobilize even higher levels of funding from all sources: taxes, tariffs (payments and labour from households), and transfers from donors.

“This is a challenge we have the ability to solve,” says Guy Ryder, Chair of UN-Water and Director-General of the International Labour Organization. “Increased investments in water and sanitation can yield substantial benefits for human health and development, generate employment and make sure that we leave no one behind.”

Additional Findings:

Official development assistance (ODA) disbursements for water and sanitation are increasing, but future investments are uncertain.

Water and sanitation ODA disbursements (spending) increased from US$ 6.3 to US$ 7.4 billion from 2012 to 2015. However, aid commitments for water and sanitation have declined since 2012 from US$ 10.4 billion to US$ 8.2 billion in 2015. Due to the multi-year nature of commitments, if commitments were to continue to decrease, it is likely that future disbursements would also decrease. Considering the greater needs to make progress towards universal access to safely managed WASH services under the SDG targets, the possibility of future reductions in aid disbursements is at odds with global aspirations.

Extending WASH services to vulnerable groups is a policy priority, but implementation is lagging.

Over 70% of countries report having specific measures to reach poor populations in their WASH policies and plans. However, the implementation of such concrete measures is lagging: few countries indicate that they are able to consistently apply financing measures to target resources to poor populations. Increasing and sustaining WASH access for vulnerable groups will not only be critical for achieving SDG 6, but also for SDG 3 on ensuring healthy lives and promoting well-being for all at all ages.

The GLAAS 2017 report presents an analysis of the most reliable and up-to-date data from 75 countries and 25 external support agencies on issues related to financing universal access to water and sanitation under the SDGs. Safe drinking-water and sanitation are crucial to human welfare, by supporting health and livelihoods and helping to create healthy environments. Drinking unsafe water impairs human health through illnesses such as diarrhea, and untreated sewage can contaminate drinking-water supplies and the environment, creating a heavy burden on communities.


WHO Reports ‘Record-breaking’ Progress: About 1.5 billion people in 149 countries, down from 1.9 billion in 2010, are affected by neglected tropical diseases (NTD)

VOA

WHO

Unprecedented progress against neglected tropical diseases, WHO reports

WHO reports remarkable achievements in tackling neglected tropical diseases (NTDs) since 2007. An estimated 1 billion people received treatment in 2015 alone.

“WHO has observed record-breaking progress towards bringing ancient scourges like sleeping sickness and elephantiasis to their knees,” said WHO Director-General, Dr. Margaret Chan. “Over the past 10 years, millions of people have been rescued from disability and poverty, thanks to one of the most effective global partnerships in modern public health”.

The WHO report, Integrating neglected tropical diseases in global health and development, demonstrates how strong political support, generous donations of medicines, and improvements in living conditions have led to sustained expansion of disease control programs in countries where these diseases are most prevalent.

Since 2007, when a group of global partners met to agree to tackle NTDs together, a variety of local and international partners have worked alongside ministries of health in endemic countries to deliver quality-assured medicines, and provide people with care and long-term management.

In 2012, partners endorsed a WHO NTD roadmap, committing additional support and resources to eliminating 10 of the most common NTDs.

Key achievements include:

  • 1 billion people treated for at least one neglected tropical disease in 2015 alone.
  • 556 million people received preventive treatment for lymphatic filariasis (elephantiasis).
  • More than 114 million people received treatment for onchocerciasis (river blindness: 62% of those requiring it.
  • Only 25 human cases of Guinea-worm disease were reported in 2016, putting eradication within reach.
  • Cases of human African trypanosomiasis (sleeping sickness) have been reduced from 37 000 new cases in 1999 to well under 3000 cases in 2015.
  • Trachoma – the world’s leading infectious cause of blindness – has been eliminated as a public health problem in Mexico, Morocco, and Oman. More than 185 000 trachoma patients had surgery for trichiasis worldwide and more than 56 million people received antibiotics in 2015 alone.
  • Visceral leishmaniasis: in 2015 the target for elimination was achieved in 82% of sub-districts in India, 97% of sub-districts in Bangladesh, and in 100% of districts in Nepal.
  • Only 12 reported human deaths were attributable to rabies in the WHO Region of the Americas in 2015, bringing the region close to its target of eliminating rabies in humans by 2015.

However, the report highlights the need to further scale up action in other areas.

“Further gains in the fight against neglected tropical diseases will depend on wider progress towards the Sustainable Development Goals,” said Dr Dirk Engels, Director of the Department of Control of Neglected Tropical Diseases. Meeting global targets for water and sanitation will be key. WHO estimates that 2.4 billion people still lack basic sanitation facilities such as toilets and latrines, while more than 660 million continue to drink water from “unimproved” sources, such as surface water.

Meanwhile, global concern about the recent outbreaks of Zika virus disease, and its associated complications, has re-energized efforts to improve vector control. In May this year, the World Health Assembly will review proposals for a new Global vector control response. There are also brighter prospects to prioritize cross-sectoral collaboration to promote veterinary public health.

Global Partners’ Meeting

Integrating neglected tropical diseases in global health and development is being released at the Global Partners’ Meeting on Neglected Tropical Diseases (NTDs) in Geneva, on 19 April 2017.

The Meeting will celebrate efforts to “Collaborate. Accelerate. Eliminate”, and will be attended by health ministers, industry representatives, partners and a host of well-known personalities, including philanthropists, donors and stakeholders.

Besides celebrating 10 years of multi-stakeholder collaboration, the event will also mark the 5th anniversary of the WHO NTD Roadmap which established targets and milestones for the global control, elimination, and eradication of many of these diseases as well as that of the London Declaration.

Note to editors:

Neglected tropical diseases blind, maim, disfigure and debilitate hundreds of millions of people in urban slums and in the poorest parts of the world.

Once widely prevalent, these diseases are now restricted to tropical and sub-tropical regions with unsafe water, inadequate hygiene and sanitation, and poor housing conditions. Poor people living in remote, rural areas, urban slums, or conflict zones are most at risk.

More than 70% of countries and territories that report the presence of NTDs are low or lower-middle income economies.

 


World Health Day – 7 April 2017

WHO

World Health Day 2017 video

Depression: let’s talk

7 April 2017 – WHO is leading a one-year global campaign on depression. The highlight is World Health Day 2017, celebrated today. The goal of the campaign is that more people with depression, everywhere in the world, both seek and get help. Depression is the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015.

 


Smoking causes one in 10 deaths worldwide and half of them in just 4 countries – China, India, the US and Russia.

BBC

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

www.thelancet.com   Published online April 5, 2017   http://dx.doi.org/10.1016/S0140-6736(17)30819-X

Findings:  Worldwide, the age-standardized prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualized rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualized increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.

 

 


Agony in a Venezuelan Mental Health Hospital: NY TIMES, 12/18/16

http://nyti.ms/2hS9dMc

 

http://nyti.ms/2i2yH5v

 

 


OHIO: Six out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Outbreaks

TFAH

Ready or Not? examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies.  Some key Ohio findings include:

No. Indicator Ohio Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Public Health Funding Commitment: State increased or maintained funding for public health from FY 2014 to FY 2015 and
FY 2015 to FY 2016.
Y 26
2 National Health Security Preparedness Index: State met or exceeded the overall national average score (6.7) of the National Health Security Preparedness IndexTM, as of 2016. 30 + D.C.
3 Public Health Accreditation: State had at least one accredited public health department. Y 43 + D.C.
4 Flu Vaccination Rate: State vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2015 to Spring 2016. 10
5 Climate Change Readiness: State received a grade of C or above in States at Risk: America’s Preparedness Report Card. 32 + D.C.
6 Food Safety: State increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of E. coli. Y 45 + D.C.
7 Reducing Healthcare-Associated Infections (HAIs): State implemented all four recommended activities to build capacity for HAI prevention. Y 35 + D.C.
8 Public Health Laboratories: State public health laboratory provided biosafety training and/or provided information about biosafety training courses for sentinel clinical labs (from July 1, 2015 to June 30, 2016). 44
9 Public Health Laboratories: State public health laboratories reported having a biosafety professional on staff (from July 1, 2015 to June 30, 2016). Y 47 + D.C.
10 Emergency Healthcare Access: State has a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster. Y 10
Total 6

“Starving to death”: UN aid chief urges global action as starvation, famine loom for 20 million across Kenya, Yemen, South Sudan and Somalia

UN

Image result for horn of africa

10 March 2017 – Just back from Kenya, Yemen, South Sudan and Somalia – countries that are facing or are at risk of famine – the top United Nations humanitarian official today urged the international community for comprehensive action to save people from simply “starving to death.”

“We stand at a critical point in history. Already at the beginning of the year we are facing the largest humanitarian crisis since the creation of the UN,” UN Emergency Relief Coordinator Stephen O’Brien told the Security Council today.

Without collective and coordinated global efforts, he warned, people risk starving to death and succumbing to disease, stunted children and lost futures, and mass displacements and reversed development gains.

“The appeal for action by the Secretary-General can thus not be understated. It was right to sound the alarm early, not wait for the pictures of emaciated dying children […] to mobilize a reaction and the funds,” Mr. O’Brien underscored, calling for accelerated global efforts to support UN humanitarian action on the ground.

Turning to the countries he visited, the senior UN official said that, about two-thirds of the population (more than 18 million people) in Yemen needed assistance, including more than seven million severely food insecure, and the fighting continued to worsen the crisis.

“I continue to reiterate the same message to all: only a political solution will ultimately end human suffering and bring stability to the region,” he said, noting that with access and funding, humanitarians will do more, but cautioned that relief-workers were “not the long-term solution to the growing crisis.”

In South Sudan, where a famine was recently declared, more than 7.5 million people are in need of assistance, including some 3.4 million displaced. The figure rose by 1.4 million since last year.

“The famine in the country is man-made. Parties to the conflict are parties to the famine – as are those not intervening to make the violence stop,” stressed Mr. O’Brien, calling on the South Sudanese authorities to translate their assurances of unconditional access into “action on the ground.”

Similarly, more than half the population of Somalia (6.2 million people) is need aid, 2.9 million of whom require immediate assistance. Extremely worrying is that more than one million children under the age of five are at the risk of acute malnourishment.

“The current indicators mirror the tragic picture of 2011, when Somalia last suffered a famine,” recalled the UN official, but expressed hope that a famine can be averted with strong national leadership and immediate and concerted support by the international community.

Concerning Kenya, he mentioned that more than 2.7 million people were food insecure, and that this number could reach four million by April.

“In collaboration with the Government [of Kenya], the UN will soon launch an appeal of $200 million to provide timely life-saving assistance and protection,” he informed.

Further in his briefing, Mr. O’Brien informed the Council of the outcomes of the Oslo Conference on the Lake Chad Basin where 14 donors pledged a total of $672 million, of which $458 million is for humanitarian action in 2017.

“This is very good news, and I commend those who made such generous pledges,” he said but noted that more was needed to fully fund the $1.5 billion required to provide the assistance needed across the region.

On the UN response in these locations, Mr. O’Brien highlighted that strategic, coordinated and prioritized plans are in place and dedicated teams on the ground are closely working with partners to ensure that immediate life-saving support reaches those in need.

“Now we need the international community and this Council to act,” he highlighted, urging prompt action to tackle the factors causing famine; committing sufficient and timely financial support; and ensuring that fighting stops.

In particular, he underscored the need to ensure that humanitarians have safe, full and unimpeded access and that parties to the conflict in the affected countries respect humanitarian law and called on those with influence over the parties to the conflict to “exert that influence now.”

“It is possible to avert this crisis, to avert these famines, to avert these looming human catastrophes,” he concluded. “It is all preventable.”

 


Togo: Since 1 January 2017, 201 suspected cases of meningitis with 17 deaths were reported by 19 health districts.

WHO

Meningococcal disease – Togo

Disease outbreak news
23 February 2017

Since 1 January 2017, 201 suspected cases of meningitis with 17 deaths were reported by 19 health districts. In week 2, the district of Akebou which is part of the Plateau Region issued an alert after four cases of meningitis were reported. In week 4, the epidemic threshold was reached with nine cases and an attack rate of 12.4 per 100 000 inhabitants. From 2 January to 12 February 2017, 48 suspected meningitis cases with three deaths were reported (case fatality rate of 6.3%). Of these, 14 specimens were confirmed as Neisseria meningitidis serogroup W by PCR.

The Plateau Region, together with the other three regions in the country benefited from the mass vaccination campaign with MenAfriVac in December 2014.

Togo is part of the African meningitis belt and documents cases and deaths due to meningitis every year. In 2016, the country recorded an epidemic in the northern part caused by Neisseria meningitidis serogroup W. A total of 1975 cases and 127 deaths were reported in 2016.

Public health response

In response to the outbreak, the following measures are being implemented:

  • 56 000 doses of meningitis vaccines have been requested from the International Coordinating Group (ICG) for the planned vaccination campaign.
  • WHO Field Mission was deployed in the field to strengthen outbreak management.
  • Strengthening of meningitis surveillance at the district level.
  • Training of clinicians at the district level on case management.
  • Conducting cross-border meetings with Ghana and Benin.

WHO risk assessment

The largest burden of meningococcal disease occurs in the African meningitis belt. Although the successful roll-out of MenA conjugate vaccine has resulted in the decreasing trend of meningitis A, other meningococcal serogroups are shown to have caused epidemics. This report of the Neisseria meningitidis W outbreak in Togo calls for a close monitoring of the changing epidemiology of meningococcal disease. There is a need to ensure that global stocks of vaccines are available, laboratory and epidemiologic surveillance systems are strengthened and outbreak response strategies in the countries are on hand.

WHO advice

The epidemic response consists of prompt, appropriate case management involving reactive mass vaccination of populations, and strengthening of meningitis surveillance.

 


China: Increasing rate of MCR-1 carriage in humans

BioRxIV

High rates of human faecal carriage of mcr-1-positive multi-drug resistant isolates emerge in China in association with successful plasmid families

Lan-Lan Zhong, Hang TT Phan, Xi Huang, Karina-Doris Vihta, et al.

Nepal: Almost all isolates of Acinetobacter baumannii were found to be resistant to multiple antibiotics

BioMed Central

Co-existence of bla OXA-23 and bla NDM-1 genes of Acinetobacter baumannii isolated from Nepal: antimicrobial resistance and clinical significance

  • Prabhu Raj Joshi1,
  • Mahesh Acharya1,
  • et al
Antimicrobial Resistance & Infection Control20176:21

DOI: 10.1186/s13756-017-0180-5

“…..Nepalese researchers analyzed 44 isolates of A baumannii, an increasingly important pathogen. The found that 43 (98%) were resistant to carbapenems….. The same number of isolates were multidrug resistant, but all were susceptible to colistin. The bla-OXA-23 gene was detected in all of the isolates, while the New Delhi Metallo-beta-lactamase-1 (NDM-1) gene was identified in 6 (14%)……”


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