ESCAPE FROM HEPATITIS

World Hepatitis Day is commemorated each year on 28 July to enhance awareness of viral hepatitis, an inflammation of the liver that causes a range of health problems, including liver cancer.

There are five main strains of the hepatitis virus – A, B, C, D and E. Together, Hepatitis B and C are the most common cause of deaths, with 1.4 million lives lost each year. Amid the COVID-19 pandemic, viral hepatitis continues to claim thousands of lives every day.

This year’s theme is “Hepatitis-free future,” with a strong focus on preventing Hepatitis B (HBV) among mothers and newborns. On 28 July, WHO will publish new recommendations on the prevention of mother-to-child transmission of the virus. HBV can be prevented among newborns through the use of a safe and effective vaccine.

In 2016, at the 69th World Health Assembly, your government made a commitment to eliminate viral hepatitis by 2030, as set out in the WHO Global Health Sector Strategy on Viral Hepatitis. With less than 10 years to go, only a handful of countries are on track to eliminate hepatitis C, and progress towards eliminating hepatitis B is lagging as well.

Undersigned, people living with viral hepatitis and the wider community, call on you to honour your commitment to eliminate viral hepatitis by 2030.

Viral hepatitis affects 325 million people worldwide and claims 4,000 lives every day, more than malaria and HIV combined. Yet, all the tools to reach elimination exist; we have effective treatments and a vaccine to protect children from hepatitis B infection and an easily administered cure for hepatitis C. Elimination can be  reached with concerted - and properly resourced - action.

Viral hepatitis elimination by 2030 will prevent seven million deaths from hepatitis B and hepatitis C. In all countries, viral hepatitis elimination is a cost-effective  investment with long-term savings to health systems. The global financial outlook should only increase your willingness to invest in hepatitis elimination and benefit from cost saving health outcomes that strengthen health systems and aid preparation for the next health crises.

During the COVID-19 pandemic, we have seen the importance of decisive political leadership to co-ordinate effective responses from healthcare systems for the community and to provide adequate resources to save lives. Viral hepatitis is no different. Strong political leadership, which works hand-in-hand with the healthcare systems, civil society and the affected community, can drive forward efforts to eliminate hepatitis and save millions of lives.

Numerous countries are scaling-up services to achieve viral hepatitis elimination by 2030, implementing WHO’s regional and global action plans. Yet, despite the available scale-up and killing 1.4 million people every year, the response to viral hepatitis is critically under-funded and widely overlooked by international funders and development partners.




Source: www.nohep.org
               www.who.int

WHO receives first-ever donation of insulin

Fifty low- and middle-income countries are soon to receive insulin for people with diabetes, thanks to a donation by global health-care company, Novo Nordisk. The donation, of insulin and glucagon^[1], to the value of US$ 1.3 million, comes at a time when many people with noncommunicable diseases such as diabetes are facing challenges with access to life-saving treatment as a result of the COVID-19 pandemic. 

“For many people living with diabetes these are difficult times,” said Professor Andrew Boulton, President of the International Diabetes Federation. “They are both vulnerable to the severe effects of COVID-19 and struggling with day-to-day problems managing their diabetes, such as disrupted access to medication, equipment and health care. Initiatives to secure the supply of essential diabetes medicines, and of insulin in particular, are very welcome.” 

“We are very grateful for this timely donation of insulin,” said Dr Bente Mikkelsen, Director of the Department of Noncommunicable Diseases at WHO. “It is the first donation of a medicine for a noncommunicable disease to WHO and it comes at a critical point.“ 

The selection of countries to receive this donation was based on their income group and information provided to WHO by ministries of health on the capacity of their health systems to manage storage and supply at a time when transport systems have been disrupted and health-care systems are stretched. 

In order to meet the long-term needs of people with diabetes, however, a sustainable supply of insulin, provided at prices that countries can afford, is needed. 

“We must not forget that as we approach the centenary of the discovery of insulin many people globally still face multiple hurdles in accessing insulin on a daily basis in normal circumstances,” said Dr Kaushik Ramaiya, Chair of the International Insulin Foundation. 

The donation comes several months after the inclusion of insulin in WHO’s prequalification programme, which accelerates and increases access to critical medical products that are quality-assured, affordable and adapted for markets in low- and middle-income countries. 

The effort to ensure a regular, affordable supply of insulin is just one of a number of strategies implemented by WHO to improve treatment of diabetes. In April, the Organization launched updated guidance on diagnosis, classification and management of type 2 diabetes intended for all those involved in planning and delivery of diabetes care. WHO also works with countries to promote healthy diets and physical activity to lower people’s risk of developing type 2 diabetes.

Countries are addressing diabetes as part of the Sustainable Development Goals, committing to cut premature death from diabetes and other noncommunicable diseases by one third by 2030.

Source: www.who.int

IVERMECTIN SLASHES CORONAVIRUS VIRAL LOAD IN VITRO

Australian scientists have published research indicating that ivermectin, an approved anti-parasitic drug that is available worldwide, is highly effective against the Covid-19 virus when applied to an infected cell culture. The coronavirus pandemic has infected more than a million people worldwide and caused over 50,000 deaths.
At present there is no vaccine nor treatment for the condition.

The collaborative study led by Monash University's Biomedicine Discovery Institute (BDI) with the Peter Doherty Institute of Infection and Immunity showed that ivermectin reduced Covid-19 viral RNA present in the cell culture by 93% after 24 hours and by 99.8% after 48 hours - around a 5,000-fold reduction in coronavirus RNA, indicating that the ivermectin treatment was leading to the loss of "essentially all viral material".
Dr Kylie Wagstaff from the Monash Biomedicine Discovery Institute, said ""We found that even a single dose could essentially remove all viral RNA by 48 hours and that even at 24 hours there was a really significant reduction in it."
Dr Wagstaff cautioned that the tests were carried out in vitro and trials would need to be carried out in people to see if the drug was truly effective against Covid-19.
Effective anti-viral could be key in the fight against Covid-19

The paper says that development of an effective anti-viral for the coronavirus, if given to patients early on in their infection could limit their viral load, stop the disease progressing and prevent transmission. They believe that ivermectin could be a useful antiviral in the fight against Covid-19.
Ivermectin is also being studied as a potential treatment for a number of other viruses, including dengue fever, HIV and Zika. It is on the World Health Organisation's list of essential medicines for the treatment of parasite infections, including head lice, scabies, river blindness, threadworm and whipworm, among others.

Source: as.com

Coronavirus Anxiety: Worry, Fear, and How Not to Panic

The newest form of coronavirus, COVID-19, is causing a pandemic of fear to spread across the globe. There’s even a name for the fear: coronavirus anxiety. Here’s what you need to know to remain healthy, both mentally and physically.

Why Are People So Anxious about Coronavirus (COVID-19)?

Two types of anxiety are at work around COVID-19: health anxiety and fear of the unknown. These are common forms of anxiety that, when they occur together, can be debilitating and cause panic.
Health anxiety involves excessive fear, worries, and what-ifs about illness that consume time and attention. The more someone thinks about health-related anxieties, the more stuck in these fears they become. In the case of coronavirus, it has become hard to think of other things. Everywhere we turn, we hear reports (some factual and some fear-based rumor) that people are getting sick and dying.
These emotional reports are fueling fear of the unknown. This is a new strain of coronavirus (a coronavirus is simply a type of virus, responsible for strains of the common cold and more serious illnesses such as SARS). Because it’s new, doctors and scientists don’t know everything about it. Anxiety loves to step in with anything unknown and fill in the blanks with assumptions rather than fact. When left unchecked, they consume us.

How to Deal with Coronavirus Anxiety?

Reduce coronavirus anxiety and stay well with these tips:

*Keep your perspective. Rumors that society is shutting down because of coronavirus are just that—fear-based speculation. Remember that this gossip is fueled by health anxiety and fear of the unknown, and let your own knowledge override the rumors you hear.

*Do what you always do to stay healthy. Wash your hands often. Keep surfaces clean. Stay away from crowds when you can. Drink plenty of water and eat nutritious foods to boost your immune system.

*Don’t let empty store shelves fuel your own fear*. People are panicking because of exaggerated news reports,social media posts, and uninformed buzz. Use bleach, vinegar, baking soda, and other basic supplies you likely already have at home to sanitize like you do in any cold and flu season.

The COVID-19 threat is something to be taken seriously, but when you remember that the panic is fueled by fear of the unknown and health anxiety, you can pause, regain your perspective, and do what is in your control to keep yourself and your loved ones healthy.

MENTAL ILLNESS, IT IS WITH US




Source: Unknown

GHANA CONFIRMED 2 COVID-19 CASES

The global number of confirmed cases of COVID-19 has surpassed 100,000. Before 12th March 2020, there was no confirmed case in Ghana, although some countries in the sub region (Nigeria, Togo, Burkina Faso, Cameroon, Senegal) with strong cultural and economic ties to Ghana had confirmed cases. Last week, the World Health Organization (WHO) reminded all countries and communities that the spread of this virus can be significantly slowed or even reversed through the implementation of robust containment and control activities.

Ghana has confirmed two cases of COVID-19 later on Thursday March 12, 2020, being the first cases to be reported in the country.

The Minister for Health disclosed in a press statement that the two confirmed cases were received at the same time from the Noguchi Memorial Institute for Medical Research.

Read full statement from the Health Ministry below:

WHO statement on cases of COVID-19 surpassing 100 000

The global number of confirmed cases of COVID-19 has surpassed 100 000. As we mark this sombre moment, the World Health Organization (WHO) reminds all countries and communities that the spread of this virus can be significantly slowed or even reversed through the implementation of robust containment and control activities.

China and other countries are demonstrating that spread of the virus can be slowed and impact reduced through the use of universally applicable actions, such as working across society to identify people who are sick, bringing them to care, following up on contacts, preparing hospitals and clinics to manage a surge in patients, and training health workers.

WHO calls on all countries to continue efforts that have been effective in limiting the number of cases and slowing the spread of the virus.

Every effort to contain the virus and slow the spread saves lives. These efforts give health systems and all of society much needed time to prepare, and researchers more time to identify effective treatments and develop vaccines.

Allowing uncontrolled spread should not be a choice of any government, as it will harm not only the citizens of that country but affect other countries as well.

We must stop, contain, control, delay and reduce the impact of this virus at every opportunity. Every person has the capacity to contribute, to protect themselves, to protect others, whether in the home, the community, the healthcare system, the workplace or the transport system.

Leaders at all levels and in all walks of life must step forward to bring about this commitment across society.

WHO will continue to work with all countries, our partners and expert networks to coordinate the international response, develop guidance, distribute supplies, share knowledge and provide people with the information they need to protect themselves and others.

Ghana Investivating the Death of a Coronavirus Case

Director of Public Health at the Ghana Health Service (GHS), Dr Badu Sarkodie has revealed that one person who showed symptoms of the deadly coronavirus died in Kumasi over the weekend, though he tested negative for the Covid-19 test.

The deceased according to Dr Badu Sarkodie, arrived in Ghana from Germany and reported of a condition that mimicked the Covid-19; but an emergency test on him proved that he was free of the virus. He, however, died later at the hospital.

The revelation is curious because, at least 129 people have tested positive for Covid-19 in Germany, with the number of cases doubling yesterday.

More than half of the cases are in North Rhine-Westphalia, which counts Düsseldorf, Cologne, and Dortmund as its biggest cities; there are large Ghanaian communities in all these cities.

Dr Badu Sarkodie, however, could not readily tell what killed the person but said the Ghana Health Service is still investigating the matter with the aid of the Kumasi Center for Collaborative Research; this is the first death in the 26 suspected cases of the deadly disease that have proven negative in Ghana since the outbreak.

This comes on the back of pressure group, OccupyGhana’s seven-point recommendation that could help Ghana position itself to counter the outbreak of the virus.

In planning for a possible COVID-19 outbreak, OccupyGhana has suggested that Ghana considers the following variables:1 – Surveillance;2 – Containment; 3 – Prevention; 4 – Testing; 5 – Treatment; 6 – Coordination; and 7 – Finance.

But Dr Badu Sarkodie says the country’s points of entry are under constant surveillance to curb the infiltration of the disease; he spoke with Kwame Sefa Kayi on Peace FM on Monday morning.



Source: www.ghanaweb.com

MY PERIOD: MY VALENTINE

Many cultures have beliefs, myths and taboos relating to menstruation. Almost always, there are social norms or unwritten rules and practices about managing menstruation and interacting with menstruating women. Some of these are helpful but others have potentially harmful implications.
Periods are a natural, healthy part of a girl's life. They shouldn't get in the way of exercising, having fun, and enjoying life.

Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman's monthly cycle. Every month, your body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina. It usually last about 5 days. But a period can be shorter (2 days) or last longer (14 days).

Periods usually start between age 11 and 14 and continue until menopause at about age 51. They usually last from three to five days. Besides bleeding from the vagina, you may have
* Abdominal or pelvic cramping pain
* Lower back pain
* Bloating and sore breasts
* Food cravings
* Mood swings and irritability
* Headache and fatigue

Premenstrual syndrome, or PMS, is a group of symptoms that start before the period. It can include emotional and physical symptoms.

How Often Does a Period Happen?
Periods usually happen about once every 21-40 days,  average 28 days.

Should I Use a Pad, Tampon, or Menstrual Cup?
You have many choices about how to deal with period blood. You may need to experiment a bit to find which works best for you. Some girls use only one method and others switch between different methods.

access to menstrual hygiene products to absorb or collect menstrual blood, privacy to change the materials, and access to facilities to dispose of used menstrual management materials. Menstrual hygiene management can be particularly challenging for girls and women in most local communities, where clean water and toilet facilities are often inadequate.

Should I Watch for Any Problems?
Most girls don't have any problems with their periods. But make an appointment  with your doctor if you:

^ are 15 and haven't started your period
^ have had your period for more than 2 years and it still doesn't come regularly (about every 21–40 days)
^ have bleeding between periodshave severe cramps that don't get better with ibuprofen or paracetamol
^ have very heavy bleeding (bleeding that goes through a pad or tampon faster than every 1 hour)
^ have periods that last more than 14 days
^ have severe PMS that gets in the way of your everyday activities



Reference
HOUSE et al. 2012
kidshealth.org
medlineplus.gov




By Lewis Rosemary

Rosemary is a certified Registered Nurse who is now volunteering her time and clinical knowledge at Tadankro CHPS of the Ghana Health Service in the Akuapem North Municipal to ensuring Universal Health Coverage. She enjoys listening to music and watching movies.
Rosemary is available for health promotion
You can reach her via Email: lewisrosemary93@gmail.com

Coronavirus: Update From Ghana

Two foreign nationals on Wednesday reported at the Korle Bu Teaching Hospital having developed some symptoms suspected to be coronavirus.

The patients, a Chinese and an Argentine who have been living together in the country for some days, have been isolated at the facility while blood samples taken have been sent to the Noguchi Memorial Institute for Medical Research (NMIMR), for further analysis.

Greater Accra Divisional Secretary of the Ghana Medical Association, Dr Winifred Baah revealed on the PM Express on JoyNews Wednesday.

Dr Baah explained that the Chinese left the home country for Ghana sometime in September 2019 while the Argentine, who was in Shanghai, joined the Chinese in Ghana in January.

“They’ve all developed some symptoms that fit the case definition [but] it doesn’t mean they have the disease,” he clarified.

He said another round of testing is expected to be conducted on the two nationals Thursday.

He explained that the patients initially visited an unnamed private facility in the capital and reported the condition and were directed by the medical staff there to report to Korle Bu.

Dr Baah wants the authorities to adequately resource health facilities for them to properly prepare to handle the situation as well as manage communication among health workers.

Suspected Case at KIA
Earlier on the same programme, the National Coordinator for Port Health at the Ghana Health Service, Dr Dennis Laryea disclosed, health officers recently picked one person for testing after he showed symptoms of the virus at the Kotoka International Airport.

He said the individual was kept in isolation for about six hours while the result was being confirmed. Fortunately, he tested negative of the virus, Dr. Laryea added.

“The gentleman wasn’t very happy but he understood that we were doing this in the interest of public safety,” he said.

In a press statement signed by the Minister of Health (Hon. Kwaku Agyeman Manu), he said "As at 6th February,2O2O, there has been 28,28O confirmed cases and 565 deaths globally. Here in Ghana we have recorded 9 suspected cases including the recent 2 from Korle Bu Teaching Hospital.  All of these cases have tested negative.
We wish to provide assurance to the people of Ghana that the Government,
Ministry of Health/Ghana Health Service working in collaboration with partners
are doing everything possible to prevent and protect against the importation of the virus into the country and prevent spread. We continue to advise citizens to remain calm"

Source: Joy News

WHO Declared The Coronavirus As Public Health Emergency of International Concern. Here's What That Means

The World Health Organization (WHO) took the rare step Thursday of declaring a novel coronavirus outbreak that originated in Wuhan, China a public health emergency of international concern (PHEIC). But what does that actually mean?

The WHO defines a PHEIC as an “extraordinary event” that “constitute[s] a public health risk to other States through the international spread of disease” and “potentially require[s] a coordinated international response.” Since that framework was defined in 2005—two years after another coronavirus, severe acute respiratory syndrome (SARS), spread through China—it has been used only six times: for outbreaks of “swine flu” in 2009, polio in 2014, Ebola in 2014, Zika virus in 2016, Ebola in 2019 and, now, coronavirus in 2020.

A PHEIC is meant to mobilize international response to an outbreak. It’s an opportunity for the WHO, with guidance from its International Health Regulations Emergency Committee, to implement “non-binding but practically & politically significant measures that can address travel, trade, quarantine, screening, treatment. WHO can also set global standards of practice,” the organization tweeted.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus emphasized that, at its core, a PHEIC is about prompting countries to work together to contain a threat. It is not about punishing China, nor doubting its ability to contain the outbreak, he said at a press conference Thursday.

“This declaration is not because China is not doing what it can,” Ghebreyesus said. “It’s actually doing more than what China is required to do. [The PHEIC is about] protecting countries with weaker health systems.”

In this case, the WHO advises countries not to unnecessarily restrict travel and trade to China; to support nations with weaker health systems; accelerate the development of vaccines and treatments; stop the spread of rumors and misinformation; work to treat those who are already sick while limiting spread; share knowledge with the WHO and other countries; and work together “in a spirit of solidarity and cooperation.”

In a statement also released Thursday, the Global Preparedness Monitoring Board, an independent body that works toward preparedness for global health crises, encouraged nations to invest in their own public health and outbreak response systems while supporting the WHO’s Contingency Fund for Emergencies. Countries are not compelled to contribute based on the PHEIC designation, but Ghebreyesus tweeted that the WHO “welcome[s] their call for countries to sustainably finance WHO’s preparedness and response activities.”

SOURCE: TIME.COM

"HOW IUD GAVE ME CERVICAL CANCER: STACEY AMOATENG’S SAD STORY.”

REJOINDER BY SOGOG ON "HOW IUD GAVE ME CERVICAL CANCER: STACEY AMOATENG’S SAD   STORY.”

The attention of SOGOG (Society of Obstetricians and Gynaecologists of Ghana) has been drawn to a YouTube video being circulated on social media with the above caption in which Mrs. Stacey Amoateng alleges that she acquired cervical cancer from the use of a copper intrauterine contraceptive device (IUD). 

While our Society empathizes with Mrs. Stacey Amoateng’s predicament and appreciates her apparent drive to help prevent cervical cancer through public education and screening services, the Society will like to correct the misinformation being conveyed by the contents of the said video.

SOGOG hereby informs all persons that at present, there is NO scientific data or evidence to support the assertion that any form of the Intrauterine Device (IUD) causes cervical cancer.

The Society states emphatically that the Copper IUD, which is one of two forms of IUD available in the country, is a SAFE and EFFECTIVE form of long-term reversible contraception, and couples who desire to use them or are currently using them can safely do so without any fear or panic.

The Society also cautions the general public that cervical cancer generally has no symptoms in its early stages. Regular screening with the Pap Smear, Visual Inspection with Acetic Acid 

(VIA) and testing for High-Risk Human Papilloma virus (HPV) is recommended for early detection and prevention advance disease. 

However, any woman diagnosed with cervical cancer is advised to comply with medical treatment which includes surgery and chemo-radiation therapy.

Good nutrition and prayer, whiles good for general health and well-being, are not specific treatment modalities for cervical cancer.

 Signed by 

    Dr Ali Samba

(President of SOGOG)

SCALE UP ANTENATAL CARE AT THE COMMUNITY

Progress to maternal health services to ensuring universal health coverage (health for all) has been slow despite the successes made.

Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however,  access to equipment to check blood level (Heamoglobin) of pregnant women especially during the first antenatal visit, 28 weeks and 36 weeks gestation is limited in rural Ghana. 

Although checking of haemoglobin during pregnancy booking and at least 28 weeks gestation and 36 weeks gestation is routine for all pregnant women across the country the major challenge is the Haemoglobin  Meters not many enough.
The few machines are only found in the hospitals, poly clinics and few health centres, hence pregnant mothers are expected to travel from the indigenous communities to queue for the service.
The stress these women go through has prevented most people in seeking early antenatal care at the community.

 To the improve the situation:
1. Government should equip health centres and CHPS compounds with simple Haemoglobin Meter to check the haemoglobin level of pregnant women during first antenatal visits, 28 weeks gestation and 36 weeks gestation.
2. Civil society organisations and cooperate institutions should support the health sector with Haemoglobin Meters to equip the local facilities.
3. The health should zone satellite laboratory centres to calm the current situation.
4. Private sector laboratory centres should partner district and municipal health directorate to reach out to the had-to-reach areas.

The cheerful face a woman gets when she realizes she has conceived turns into grief when there are complications before, during and after pregnancy as a result of anaemia.

WHO releases first guideline on digital health interventions

WHO today released new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services.

“Harnessing the power of digital technologies is essential for achieving universal health coverage,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”

Over the past two years, WHO systematically reviewed evidence on digital technologies and consulted with experts from around the world to produce recommendations on some key ways such tools may be used for maximum impact on health systems and people’s health.

One digital intervention already having positive effects in some areas is sending reminders to pregnant women to attend antenatal care appointments and having children return for vaccinations. Other digital approaches reviewed include decision-support tools to guide health workers as they provide care; and enabling individuals and health workers to communicate and consult on health issues from across different locations.

“The use of digital technologies offers new opportunities to improve people’s health,” says Dr Soumya Swaminathan, Chief Scientist at WHO. “But the evidence also highlights challenges in the impact of some interventions.”

She adds: “If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate long-term improvements over the traditional ways of delivering health services.”

For example, the guideline points to the potential to improve stock management. Digital technologies enable health workers to communicate more efficiently on the status of commodity stocks and gaps. However, notification alone is not enough to improve commodity management; health systems also must respond and take action in a timely manner for replenishing needed commodities. 

“Digital interventions, depend heavily on the context and ensuring appropriate design,” warns Dr Garrett Mehl, WHO scientist in digital innovations and research. “This includes structural issues in the settings where they are being used, available infrastructure, the health needs they are trying to address, and the ease of use of the technology itself.”

Digital health interventions are not sufficient on their own

The guideline demonstrates that health systems need to respond to the increased visibility and availability of information. People also must be assured that their own data is safe and that they are not being put at risk because they have accessed information on sensitive health topics, such as sexual and reproductive health issues.

Health workers need adequate training to boost their motivation to transition to this new way of working and need to use the technology easily. The guideline stresses the importance of providing supportive environments for training, dealing with unstable infrastructure, as well as policies to protect privacy of individuals, and governance and coordination to ensure these tools are not fragmented across the health system.

The guideline encourages policy-makers and implementers to review and adapt to these conditions if they want digital tools to drive tangible changes and provides guidance on taking privacy considerations on access to patient data.

“Digital health is not a silver bullet,” says Bernardo Mariano, WHO’s Chief Information Officer. “WHO is working to make sure it’s used as effectively as possible. This means ensuring that it adds value to the health workers and individuals using these technologies, takes into account the infrastructural limitations, and that there is proper coordination.”

The guideline also makes recommendations about telemedicine, which allows people living in remote locations to obtain health services by using mobile phones, web portals, or other digital tools. WHO points out that this is a valuable complement to face-to-face-interactions, but it cannot replace them entirely. It is also important that consultations are conducted by qualified health workers and that the privacy of individuals’ health information is maintained.

The guideline emphasizes the importance of reaching vulnerable populations, and ensuring that digital health does not endanger them in any way.

WHO’s work on digital health

This guideline represents the first of many explorations into the use of digital technologies and has only covered a fraction of the many aspects of digital health.

In 2018, governments unanimously adopted a World Health Assembly resolution calling on WHO to develop a global strategy on digital health to support national efforts to achieve universal health coverage. That strategy is scheduled to be considered at the World Health Assembly in 2020.

Although WHO is expanding its focus on digital health, the Organization has been working in this area for years, for example, through the development of the eHealth Strategy Toolkit in 2012, published in collaboration with International Telecommunications Union (ITU).

To support governments in monitoring and coordination of digital investments in their country, WHO has developed the Digital Health Atlas, an online global repository where implementers can register their digital health activities. WHO has also established innovative partnerships with the ITU, such as the BeHe@lthy, BeMobile initiative for the prevention and control of noncommunicable diseases, as well as efforts for building digital health capacity through the WHO Regional Office for Africa. 

Over the years, WHO has released a number of resources to strengthen digital health research and implementation, including the mHealth Assessment and Planning for Scale (MAPS) toolkit, a handbook for Monitoring and Evaluation of Digital Health, and mechanisms to harness digital health to end TB.

On 6 March 2019, Dr Tedros announced the creation of the Department of Digital Health to enhance WHO’s role in assessing digital technologies and support Member States in prioritizing, integrating and regulating them.

Source: who.int

New WHO recommendations to accelerate progress on TB

WHO has issued new guidance to improve treatment of multidrug resistant TB (MDR-TB). WHO is recommending shifting to fully oral regimens to treat people with MDR-TB. This new treatment course is more effective and is less likely to provoke adverse side effects. WHO recommends backing up treatment with active monitoring of drug safety and providing counselling support to help patients complete their course of treatment.

The recommendations are part of a larger package of actions designed to help countries increase the pace of progress to end tuberculosis (TB) and released in advance of World TB Day.

“The theme of this year’s World TB Day is: It’s time to end TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We’re highlighting the urgent need to translate commitments made at the 2018 UN High Level Meeting on TB into actions that ensure everyone who needs TB care can get it.”

Since 2000, 54 million lives have been saved, and TB deaths fell by one-third. But 10 million people still fall ill with TB each year, with too many missing out on vital care.

The WHO package is designed to help countries close gaps in care ensuring no one is left behind. Key elements include:

• An accountability framework to coordinate actions across sectors and to monitor and review progress
• A dashboard to help countries know more about their own epidemics through real-time monitoring – by moving to electronic TB surveillance systems.
• A guide for effective prioritization of planning and implementation of impactful TB interventions based on analyses of patient pathways in accessing care.
• New WHO guidelines on infection control and preventive treatment for latent TB infection
• A civil society task force to ensure effective and meaningful civil society engagement

“This is a set of pragmatic actions that countries can use to accelerate progress and act on the high-level commitments made in the first-ever UN High Level Meeting on TB last September,” said Dr Tereza Kasaeva, Director WHO’s Global TB Programme.

On 22 March, key partners will come together at a World TB Day symposium at WHO in Geneva to develop a collaborative multi-stakeholder and multisectoral platform to accelerate actions to end TB. WHO will present the new package at the meeting.  

TB is the world’s top infectious disease killer, claiming 4 500 lives each day. The heaviest burden is carried by communities facing socio-economic challenges, those working and living in high-risk settings, the poorest and marginalized.

Source : www.who.int

Spending on health is growing faster than the rest of the global economy, accounting for 10% of global gross domestic product (GDP). A new report on global health expenditure from the World Health Organization (WHO) reveals a swift upward trajectory of global health spending, which is particularly noticeable in low- and middle-income countries where health spending is growing on average 6% annually compared with 4% in high-income countries.

Health spending is made up of government expenditure, out-of-pocket payments (people paying for their own care), and sources such as voluntary health insurance, employer-provided health programmes, and activities by non-governmental organizations.

Governments provide an average of 51% of a country’s health spending, while more than 35% of health spending per country comes from out-of-pocket expenses. One consequence of this is 100 million people pushed into extreme poverty each year. 

The report highlights a trend of increasing domestic public funding for health in low- and middle-income countries and declining external funding in middle-income countries. Reliance on out-of-pocket expenses is declining around the world, albeit slowly.

“Increased domestic spending is essential for achieving universal health coverage and the health-related Sustainable Development Goals,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But health spending is not a cost, it’s an investment in poverty reduction, jobs, productivity, inclusive economic growth, and healthier, safer, fairer societies.”

In middle-income countries, government health expenditure per capita has doubled since the year 2000. On average, governments spend US$60 per person on health in lower-middle income countries and close to US$270 per person in upper-middle income countries.

When government spending on health increases, people are less likely to fall into poverty seeking health services. But government spending only reduces inequities in access when allocations are carefully planned to ensure that the entire population can obtain primary health care.

In low- and middle-income countries, new data suggest that more than half of health spending is devoted to primary health care. Yet less than 40% of all spending on primary health care comes from governments.

“All WHO’s 194 Member States recognized the importance of primary health care in their adoption of theDeclaration of Astana last October,” said Dr Agnes Soucat, WHO Director for Health Systems, Governance and Financing. “Now they need to act on that declaration and prioritize spending on quality healthcare in the community.”

The report also examines the role of external funding. As domestic spending increases, the proportion of funding provided by external aid has dropped to less than 1% of global health expenditure. Almost half of these external funds are devoted to three diseases – HIV/AIDS, Tuberculosis (TB) and malaria.

While the report clearly illustrates the transition of middle-income countries to domestic funding of health systems, external aid remains essential to many countries, particularly low-income countries.

The new WHO report points to ways that policy makers, health professionals and citizens alike can continue to strengthen health systems.

“Health is a human right and all countries need to prioritize efficient, cost-effective primary health care as the path to achieving universal health coverage and the Sustainable Development Goals,” concluded Soucat

MALARIA STILL KILLS: NO STANDING STILL

A young mother whose daughter is aged one year plus three months noticed a rise in the child's body temperature, Aunt Adwoa (a mother of four kids) told her that ''your child is warm because she is developing some new tooth's''. The girl fitted the next day and was rushed to a local clinic, her temperature read 41.3°C and she tested positive a Malaria Rapid Diagnostic Test. After diagnosing her of Severe Malaria, the nurse gave some first aid medication and referred her to the hospital for continuity of care. On their way to prepare to the hospital, a community member told them "the child should rather be taken to the community shrine for purification because her fitness might be as a result of demonic attack".

Ogyantanaa the well known fetish gave them a herbal preparation to be applying on the child's body and no false spirit will dare to harm her again.
The child later became more weak and fitted again and died before the parents could reach her to the hospital.

Did you know that a child dies of Malaria every two minutes? Most of this are normally among children under age five.

Key facts

• Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
• In 2017, there were an estimated 219 million cases of malaria in 90 countries.
• Malaria deaths reached 435 000 in 2017.
• The WHO African Region carries a disproportionately high share of the global malaria burden. In 2017, the region was home to 92% of malaria cases and 93% of malaria deaths.
• Total funding for malaria control and elimination reached an estimated US$ 3.1 billion in 2017. Contributions from governments of endemic countries amounted to US$ 900 million, representing 28% of total funding.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat.

• In 2017, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region, as well as in the majority of cases in the WHO regions of South-East Asia (62.8%), the Eastern Mediterranean (69%) and the Western Pacific (71.9%).
• P. vivax is the predominant parasite in the WHO Region of the Americas, representing 74.1% of malaria cases.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

Who is at risk?

In 2017, nearly half of the world's population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk. In 2017, 90 countries and areas had ongoing malaria transmission.

Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.

Disease burden

According to the latest World malaria report, released in November 2018, there were 219 million cases of malaria in 2017, up from 217 million cases in 2016. The estimated number of malaria deaths stood at 435 000 in 2017.

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2017, the region was home to 92% of malaria cases and 93% of malaria deaths.

In 2017, five countries accounted for nearly half of all malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and Uganda (4%).

In areas with high transmission of malaria, children under 5 are particularly susceptible to infection, illness and death; more than two thirds (70%) of all malaria deaths occur in this age group. The number of under-5 malaria deaths has declined from 440 000 in 2010 to 285 000 in 2016. However, malaria remains a major killer of children under five years old, taking the life of a child every two minutes.

Transmission

In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.

Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why nearly 90% of the world's malaria cases are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Prevention

Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.

WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Long-lasting insecticidal nets (LLINs) are the preferred form of insecticide-treated mosquito nets (ITNs) for public health programmes. In most settings, WHO recommends LLIN coverage for all people at risk of malaria. The most cost-effective way to achieve this is by providing LLINs free of charge, to ensure equal access for all. In parallel, effective behaviour change communication strategies are required to ensure that all people at risk of malaria sleep under a LLIN every night, and that the net is properly maintained.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide formulation used and the type of surface on which it is sprayed. In some settings, multiple spray rounds are needed to protect the population for the entire malaria season.

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

In 2012, WHO recommended Seasonal Malaria Chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Much of the success in controlling malaria is due to vector control. Vector control is continues to be highly dependent on the use of pyrethroids, which are the only class of insecticides currently recommended for use in ITNs or LLINs.

In recent years, mosquito resistance to pyrethroids has emerged evolved in Anopheles mosquitoes. Since 2010, 66many malaria-endemic countries have confirmed resistance to this class of insecticide. Resistance to organochlorines, carbamates and organophosphates, used for IRS, is also widespread. So far, 22 countries have confirmed In some areas, resistance to all 4 out of 5 classes of insecticides used for public health and 57 countries have reported resistance to 2 or more classes. No reports has been detected of resistance to neonicotinoids – a fifth class of insecticide – have been received so far. More information on the global status of insecticide resistance can be found in the Global Report on insecticide resistance in malaria vectors http://www.who.int/malaria/publications/atoz/9789241514057/en/

. Fortunately,Despite the emergence and spread of pyrethroid resistance, there is evidence showing that LLINs  this resistance has only rarely been associated with decreased efficacy of LLINs, which continue to provide a substantial level of protection in most settings. This was evidenced in a large multi-country evaluation coordinated by WHO between 2011 and 2016, which found no evidence of association between insecticide resistance and malaria disease burden across study locations in 5 countries.

Nevertheless, the spread of insecticide resistance threatens the effectiveness of vector control interventions. New insecticides and other tools are needed to address the emerging threat.  Rotational use of different existing classes of insecticides for in IRS is recommended as one approach to manage insecticide resistance.

However, malaria-endemic areas of sub-Saharan Africa and India are causing significant concern due to high levels of malaria transmission and widespread reports of insecticide resistance. The use of 2 different insecticides in a mosquito net offers an opportunity to mitigate the risk of the development and spread of insecticide resistance; developing these new nets is a priority. Several promising products for both IRS and nets are in the pipeline.

Detection Monitoring of insecticide resistance should be an essential component of all national malaria control efforts to ensure inform the selection of that the most effective vector control methods are being used. Countries are encouraged to develop national plans for insecticide resistance monitoring and management. A framework to support this process was released by WHO in 2017.  The choice of insecticide for IRS should always be informed by recent, local data on the susceptibility of target vectors.

To ensure a timely and coordinated global response to the threat of insecticide resistance, WHO worked with a wide range of stakeholders to develop the "Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM)", which was released in May 2012.

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).

WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the "WHO Guidelines for the treatment of malaria", third edition, published in April 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

An ACT contains both the drug artemisinin and a partner drug. In recent years, parasite resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam. Studies have confirmed that artemisinin resistance has emerged independently in many areas of this subregion.

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong Subregion (GMS), a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

Consequently, WHO’s Malaria Policy Advisory Committee in September 2014 recommended adopting the goal of eliminating P. falciparum malaria in this subregion by 2030. WHO launched the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015–2030) at the World Health Assembly in May 2015, which was endorsed by all the countries in the subregion. With technical guidance from WHO, all GMS countries have developed national malaria elimination plans. Together with partners, WHO is providing ongoing support for country elimination efforts through the Mekong Malaria Elimination programme, an initiative that evolved from the ERAR.

Surveillance

Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Currently, many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks.

Effective surveillance is required at all points on the path to malaria elimination and the Global Technical Strategy for Malaria 2016-2030 (GTS) recommends that countries transform surveillance into a core intervention. Strong malaria surveillance enables programmes to optimize their operations, by empowering programmes to:

• advocate for investment from domestic and international sources, commensurate with the malaria disease burden in a country or subnational area;
• allocate resources to populations most in need and to interventions that are most effective, in order to achieve the greatest possible public health impact;
• assess regularly whether plans are progressing as expected or whether adjustments in the scale or combination of interventions are required;
• account for the impact of funding received and enable the public, their elected representatives and donors to determine if they are obtaining value for money; and
• evaluate whether programme objectives have been met and learn what works so that more efficient and effective programmes can be designed.

In March 2018, WHO released a reference manual on malaria surveillance, monitoring and evaluation that provides guidance on global surveillance standards and guides countries in their efforts to strengthen surveillance systems and use their own data to make evidence-informed decisions.

Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission.

Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.

Countries that have achieved at least 3 consecutive years of 0 local cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent years, 8 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016) and Paraguay (2018). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.

Vaccines against malaria

RTS,S/AS01 (RTS,S) – also known as Mosquirix – is an injectable vaccine that provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that potentially could be added to (and not replace) the core package of WHO-recommended preventive, diagnostic and treatment measures.

In July 2015, the vaccine received a positive opinion by the European Medicines Agency, a stringent medicines regulatory authority. In October 2015, two WHO advisory groups recommended pilot implementation of RTS, S/AS01 in a limited number of African countries. WHO adopted these recommendations and is strongly supportive of the need to proceed with the pilot programme as the next step for the world’s first malaria vaccine.

In November 2016, WHO announced that the RTS,S vaccine would be rolled out in pilot projects in selected areas in 3 countries in sub-Saharan Africa: Ghana, Kenya and Malawi. Funding has been secured for the initial phase of the programme and vaccinations are due to begin in early 2019. These pilot projects could pave the way for wider deployment of the vaccine if safety and effectiveness are considered acceptable.

WHO response

WHO Global Technical Strategy for Malaria 2016-2030

The WHO Global Technical Strategy for Malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

• Reducing malaria case incidence by at least 90% by 2030.
• Reducing malaria mortality rates by at least 90% by 2030.
• Eliminating malaria in at least 35 countries by 2030.
• Preventing a resurgence of malaria in all countries that are malaria-free.

This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States. It is based on 3 key pillars:

• ensuring universal access to malaria prevention, diagnosis and treatment;
• accelerating efforts towards elimination and attainment of malaria-free status; and
• transforming malaria surveillance into a core intervention.

The WHO Global Malaria Programme (GMP) coordinates WHO's global efforts to control and eliminate malaria by:

• setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
• keeping independent score of global progress;
• developing approaches for capacity building, systems strengthening, and surveillance; and
• identifying threats to malaria control and elimination as well as new areas for action.

GMP is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy-setting process.

High burden high impact approach

At the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response – “High burden to high impact” – was launched in Mozambique in November 2018.

The approach will be driven by the 11 countries that carry the highest burden of the disease (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania). Key elements include:

1. Political will to reduce the toll of malaria;
2. Strategic information to drive impact;
3. Better guidance, policies and strategies; and
4. A coordinated national malaria response.

Catalyzed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be prevented and diagnosed, and that is entirely curable with available treatments. The support and engagement of all partners will be critically important to the success of this country-led approach. For more information, please refer to the “High burden high impact” response brochure .

Source: https://www.who.int/news-room/fact-sheets/detail/malaria