THE WORLD IS RUNNING OUT OF ANTIBIOTICS

News release

20 SEPTEMBER 2017 | GENEVA - A report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, launched today by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

"Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine," says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. "There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery."

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae(such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

"Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence," says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

"Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years," says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme. "If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines".

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

For more information, download the following reports:

Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosisPrioritization of pathogens to guide discovery, research and development of new antibiotics for drug-resistant bacterial infections, including tuberculosis

The clinical pipeline analysis data can be explored in an interactive way through:

WHO Global Observatory on Health Research and Development

Sarah Cumberland
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The Safe Motherhood Initiative and beyond

In 2007, the Safe Motherhood Initiative is celebrating its 20th anniversary. Many countries have been able to improve the health and well-being of mothers and newborns over the last 20 years. However, countries with the highest burdens of mortality and illness have made the least progress, and inequalities between countries are increasing. In many places, inequalities within countries are increasing too, between those who live in better conditions and have access to care, and those who for a variety of reasons are excluded.

Globally, the numbers remain staggering: each year there are at least 3.2 million stillborn babies, 4 million neonatal deaths and more than half a million maternal deaths. The majority of these deaths are avoidable. HIV/AIDS and malaria in pregnancy are having an impact on maternal mortality and could reverse the progress that has been made.

A total of 11–17% of maternal deaths occur during childbirth itself; 50–71% occur in the post-partum period. The time spent in labour and giving birth, the critical moments when a joyful event can suddenly turn into an unforeseen crisis, needs more attention, as does the often-neglected post-partum period. These periods account not only for the high burden of post-partum maternal deaths, but also for the associated large number of stillbirths and early newborn deaths.

A total of 98% of stillbirths and newborn deaths occur in low- and middle-income countries: obstetric complications, particularly in labour, are responsible for perhaps 58% of them. The care that can reduce maternal deaths and improve women’s health is also crucial for newborns’ survival and health.

During the early years of the 20th century, standard maternity care in Europe, North America and Japan consisted of a home delivery with regular, frequent visits by an obstetric specialist. The advent of modern obstetric care in the late 1930s did not alter this practice, but gradually moved the process to institutional settings, with post-partum follow-up and care by a skilled health-care provider. Antenatal care is a relatively new concept, and pregnant women in most developed countries now receive an integrated package of antenatal, childbirth and post-partum care.

This contrasts with the situation in developing countries, where antenatal care tends to be the first service to receive resources and is commonly widely implemented within maternal health programmes. Most pregnant women in developing countries visit antenatal care services at least once. Far less available and accessible is provision of professional childbirth care, either institutional or at home, and of emergency obstetric and newborn care services. In many settings, systematic and regular post-partum follow-up care is rarely available. Even women who deliver in a health facility are often discharged within hours post-partum and are not seen again until some considerable time afterwards.

Very few developing countries have accurate data on maternal and newborn deaths and morbidities, and less than one developing country in three reports national data on post-partum care. Unlike the situation for disease-specific programmes, for maternal and child health very little attention has been paid to monitoring progress and evaluating programmes, even for the analysis and use of existing data. Policy decisions and programme planning are therefore often carried out without evidence-based information and programme evaluation.

This issue of the Bulletin contains several papers that focus on important technical areas, particularly the management of post-partum complications and saving pregnant women’s and newborns’ lives by providing evidence and recommendations for policy changes and programme implementation. Other papers provide evidence that simple but effective monitoring of programmes in developing countries is possible.

However, the challenges to be met are not new technologies nor new knowledge about effective interventions, because we mostly know what needs to done to save the lives of mothers and newborns. The real challenges are how to deliver services and scale up interventions, particularly to those who are vulnerable, hard to reach, marginalized and excluded. Effective health interventions exist for mothers and babies such as those described in this issue of the Bulletin, and several proven means of distribution can be used to put these in place. However, none will work if political will is absent where it matters most: at national and district levels.

A key constraint limiting progress is the gap between what is needed and what exists in terms of skills and geographical availability of human resources at local, national and international levels. Other challenges are how to address deteriorating infrastructures; how to maintain stocks of drugs, supplies and equipment in the face of increased demand; lack of transport; ineffective referral to and inadequate availability of 24-hour quality services – particularly emergency obstetric care services – and weak management systems. We need to challenge our policy-makers and programme managers to refocus programme content and to shift focus from development of new technologies towards development of viable organizational strategies that ensure a continuum of care and account for every birth and death.

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Source: who.int

STRATEGIES TO IMPROVE MATERNAL HEALTH

61 maternal deaths out of 31,380 deliveries was recorded for the period of January to June in the Eastern Region of Ghana as compared to 58 deaths out of 30,945 deliveries and 52 deaths with 30,220 deliveries for the same period in 2016 and 2015 respectively.

The situation is described as unacceptable by the Health Services and therefore put in place several strategies to improve maternal health outcome in the region and even beyond.

PICCAM (professionals working with Passion, Innovation, Commitment, Compassion, and being Accountable to Maternal and Child Health), zoning the region into five zones, with obstetrician/gynaecologists' assigned to each zone who will provide service in diverse forms as and when necessary.

Also, setting up of maternal and neonatal deaths audit committee and tracking the committees to follow up and ensure that recommendations made during maternal mortality audits are implemented, and building the capacity of health professionals. 

Dr Mrs Charity Sarpong, Eastern Regional Director of the GHS, made these known during her speech at the recent mid-year review meeting of the directorate in Koforidua.

She said to further enhance efforts in addressing the challenges of high maternal deaths, all midwives in charge of labour units and specialists were invited to attend the review meeting to plan the way forward.

She mentioned some other challenges that hindered work to include the shortage of critical staff, especially in the rural and hard-to-reach areas, dilapidated and poor infrastructure, lack of ambulances for prompt referrals and inadequate funds.

Success story
Dr Mrs Sarpong said despite the challenges, the region had chalked up some successes, including an improvement in data management at all levels and surveillance activities, which had gone a long way to enable the directorate to achieve its targets.

She noted that to improve logistics and the availability of medicines in health facilities, the region, with support from the GHS and the United States Agency for International Development (USAID), had successfully implemented the Last Mile Distribution Project which involves service delivery points making requests based on their needs.

Success Story
She said to improve upon the care of newborns, including pre-term babies, the region, as part of an ongoing project, had trained 845 staff in newborn care and had also put in place a first-class Kangaroo Mother Care Centre at the Koforidua Regional Hospital and the Nsawam Government Hospital.

Aknowledgement
Dr Mrs Sarpong thanked all stakeholders, including health workers who continued to work hard despite the challenges, and hoped they would continue to work harder to support better care delivery in the region.

The Deputy Director-General of the GHS, Dr Mrs Gloria Quansah-Asare, urged the participants to come out with ideas on how to improve health delivery in the region.

In a speech read on his behalf, the Eastern Regional Minister, Mr Eric Kwakye Darfour, said although there had been an improvement in the health sector over the years, the sector still had to work hard to meet the Sustainable Development Goal (SGD) Three, which seeks to provide good health and well-being for all people.

ockos.blogspot.com

Source: graphic.com.gh

CALL FOR ACTION

PRESS RELEASE, SEPTEMBER 8, 2017

Maternal mortality still inflict pain on motherhood.
The magnitude of maternal mortality in the eastern region and its disparity with similar statistics across the country has touched the responsive cord of a Primary Health Nurse, the Programmes Manager for DMAC foundation and representative of eastern regional secretariat of the Ghana Coalition of NGOs in Health (GCNH) after witnessing the recent mid-year performance review of the Ghana Health, Eastern Regional Health Directorate in Koforidua.
Speaking to the media,  Mr Charles Oduro Owurani called on primary health nurses in the region and beyond for action.
"We have a wide range of roles to intensify to address the needs of clients in the community across their lifespan to improve Maternal and Child Health despite the increasing caseloads".
According to Mr Owurani, employing community education, home visitations and other community-based interventions including through community mobilization efforts as strategies is a key way to increase the demand for maternal and child health services at the community level.
In addition to this he  said "communities have responsibilities in improving their own health outcomes: Our women should report/visit the nearest health post during the first month of pregnancy for care, husbands, family's and the community should support the women before, during and after birth to improve health at the community level".
He ended his speech by quoting the PICCAM slogan "No woman should die while giving life".

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