Health Organization Global Initiative Research Articles

Towards attainment of the 2030 goal for childhood cancer survival for the World Health Organization Global Initiative for Childhood Cancer: An ecological, cross-sectional study.

The World Health Organization (WHO) recently launched the Global Initiative for Childhood Cancer (GICC), with the goal of attaining at least 60% cancer survival for children worldwide by the year 2030. This study aims to describe the global patterns of childhood cancer survival in 2019 to help guide progress in attaining the GICC target goal. In this ecological, cross-sectional study, we used 5-year net childhood cancer survival (2015-2019) data from a prior micro-modeling study from 197 countries and territories. Descriptive statistics were used to analyze the patterns of overall childhood cancer survival and survival for each of the six cancer tracer diagnoses as proposed by the GICC. We used hot spot analysis to identify geographic clusters of high and low cancer survival. Most high-income countries reached at least 60% (92%, n = 59/64), net childhood cancer survival at baseline. No lower-middle-income or low-income country reached at least 60% overall cancer survival at baseline. The South-East Asia region had the highest proportion of countries that did not achieve at least 60% survival at baseline (100%, n = 10/10), followed by the African region (98%, n = 49/50). For each cancer tracer diagnosis, we found the highest number of countries that have achieved at least 60% survival was for Burkitt lymphoma (44%, n = 87/197) followed by acute lymphocytic leukemia (41%, n = 80/197).Hot spot analysis showed the highest overall survival was concentrated in North America and Europe, while the lowest survival was concentrated in Sub-Saharan Africa and South-East Asia.A majority of LMICs had not reached the WHO target goal of at least 60% survival from childhood cancer at baseline in 2019, with variable success for the six childhood cancer tracer diagnoses of the GICC. These findings provide baseline assessment of individual country performance to help achieve the GICC goal of 60% overall cancer survival globally by 2030.

CRISPR-Based Multiplex Detection of Human Papillomaviruses for One-Pot Point-of-Care Diagnostics.

The World Health Organization's global initiative toward eliminating high-risk Human Papillomavirus (hrHPV)-related cancers recommends DNA testing over visual inspection in all settings for primary cancer screening and HPV eradication by 2100. However, multiple hrHPV types cause different types of cancers, and there is a pressing need for an easy-to-use, multiplex point-of-care diagnostic platform for detecting different hrHPV types. Recently, CRISPR-Cas systems have been repurposed for point-of-care detection. Here, we established a CRISPR-Cas multiplexed diagnostic assay (CRISPRD) to detect cervical cancer-causing hrHPVs in one reaction (one-pot assay). We harnessed the compatibility of thermostable AapCas12b, TccCas13a, and HheCas13a nucleases with isothermal amplification and successfully detected HPV16 and HPV18, along with an internal control in a single-pot assay with a limit of detection of 10 copies and 100% specificity. This platform offers a rapid and practical solution for the multiplex detection of hrHPVs, which may facilitate large-scale hrHPV point-of-care screening. Furthermore, the CRISPRD platform programmability enables it to be adapted for the multiplex detection of any two nucleic acid biomarkers as well as internal control.

Strengthening public health policies for childhood cancer: Peru's achievements through the WHO Global Initiative for Childhood Cancer.

To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.

Surgically Amenable Childhood Cancers: An Overview of the Burden and Challenges of Management in Low- and Middle-Income Countries.

The World Health Organization's Global Initiative for Childhood Cancer was launched to decrease the disparities in childhood cancer outcomes and improve treatments for childhood cancer in resource-limited settings. Low-grade glioma, retinoblastoma, and Wilms tumors are among the index cancers included in this global initiative, as these cancers represent a large percentage of childhood tumors and are curable with cost-effective, evidence-based interventions. Herein, we discuss the global childhood tumor burden, the status of pediatric cancer surgery capacity and services around the world, and the strategic considerations for building pediatric surgical oncology capacity.

Pediatric Neurosurgical Capacity for the Care of Children With CNS Tumors Worldwide: A Cross-Sectional Assessment.

Efforts to address inequities in the treatment of pediatric CNS tumors and the burden of childhood cancer globally have prompted the designation of low-grade glioma as one of six index cancers for the World Health Organization Global Initiative for Childhood Cancer. Understanding the importance of neurosurgical interventions and evaluating pediatric neurosurgical capacity may identify critical interventions to improve outcomes for children with low-grade glioma and other CNS tumors. An online, cross-sectional survey assessing pediatric neurosurgical practice and capacity was distributed to members of the International Society of Pediatric Neurosurgery. The survey included 36 items covering domains including patient volume, available infrastructure, scope of practice, case distribution, and multidisciplinary care. Responses from 196 individuals from 61 countries, spanning all WHO regions, were included. Ninety-six (49.0%) were from high-income countries, 57 (29.1%) were from upper-middle-income countries, 42 (21.4%) were from lower-middle-income countries (LMICs), and 1 was (0.5%) from a low-income country. Most respondents had a catchment population of ≥ 1 million and indicated the availability of basic neurosurgical resources such as a dedicated neurosurgical operating theater and surgical microscope. The presence of a neurosurgical intensive care unit, inpatient rehabilitation services, and infection monitoring showed similar availability across country groups. Quantitative scoring of 13 infrastructure and service items established that fewer resources were available in low-income countries/LMICs and upper-middle-income countries compared with high-income countries. The volume of pediatric CNS tumor cases and case distribution did not vary according to World Bank country groups. This study provides a comprehensive evaluation of pediatric neurosurgical capacity across the globe, establishing variability of resources on the basis of the country income level. Our findings suggest that pediatric neurosurgeons in LMICs may benefit from key neurosurgical instrumentation and increased support for multidisciplinary brain tumor programs and childhood cancer research efforts.

Abstract 1999: The impact of the COVID-19 pandemic on 30-day survival in pediatric cancer patients in low, middle, and high-income countries: an international, observational cohort study

Abstract Objectives: To conduct the first international cohort study to ascertain the short-term outcome for pediatric oncology patients who underwent treatment across 16 high-income countries (HICs) and 23 low- and- middle-income countries (LMICs) during the COVID-19 pandemic. The hypotheses being tested was that the COVID-19 pandemic had affected paediatric cancer care, and that the outcomes of children were worse in LMICs. Design: A multicenter, international, collaborative cohort study. Setting: 91 hospitals and cancer centers in 39 countries providing cancer treatment to pediatric patients between March and December 2020. Participants: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukemia, Non-Hodgkin lymphoma, Hodgkin lymphoma, Wilms Tumor, Sarcoma, Retinoblastoma, Gliomas, Medulloblastomas or Neuroblastomas, in keeping with the World Health Organization Global Initiative for Childhood Cancer. Main outcome measure: All-cause mortality at 30 days and 90 days. Results: 1660 patients were recruited. Over 30 days, 45 LMIC patients (4.3%; 95% CI: 3.1 to 5.5) and 2 HIC patients (0.4%; 95% CI: -0.1 to 0.9) died. 219 children had their treatments delayed, interrupted, or modified. LMIC patients had 11.7 (95% CI: 10.3 to 13.1) and 7.4 (95% CI: 6.5 to 8.3) times the risk of death at 30 days and 90 days respectively (p < 0.001). After adjusting for confounders, pediatric cancer patients in LMICs had 35.7 times the odds of death at 30 days (p < 0.001). Conclusions: The COVID-19 pandemic has affected pediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, most pediatric cancer patients continued to receive their normal standard of care. This speaks to the adaptability and resilience of health-care systems and healthcare workers globally. Citation Format: Muhammed Elhadi, Soham Bandyopadhyay, Noel Peter, Kokila Lakhoo, Global Children's NCDs Collaborative. The impact of the COVID-19 pandemic on 30-day survival in pediatric cancer patients in low, middle, and high-income countries: an international, observational cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1999.

Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia

ImportanceSurgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making.ObjectiveTo analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities.Design, Setting, and ParticipantsIn this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health. On-site data collection was conducted from February 1 through August 30, 2011, with an adapted World Health Organization Global Initiative for Emergency and Essential Surgical Care survey. Data collection at each facility included interviews with hospital personnel and assessment of material resources. Data were geocoded and analyzed in a data visualization platform from March 1 to December 1, 2015. We analyzed time and distance to surgical services, as well as the proportion of the population living within 2 hours from a facility providing surgical care.Main Outcomes and MeasuresSurgical capacity, supplies, human resources, and infrastructure at each surgical facility, as well as the population living within 2 hours from a hospital providing surgical care.ResultsData were collected from all 103 surgical facilities identified as providing surgical care. When including all surgical facilities (regardless of human resources and supplies), 14.9% of the population (2 166 460 of 14 500 000 people) lived more than 2 hours from surgical care. However, only 17 hospitals (16.5%) met the World Health Organization minimum standards of surgical safety; when limiting the analysis to these hospitals, 65.9% of the population (9 552 780 people) lived in an area that was more than 2 hours from a surgical facility. Geographic analysis of emergency and essential surgical care, defined as access to trauma care, obstetric care, and care of common abdominal emergencies, found that 80.7% of the population (11 704 700 people) lived in an area that was more than 2 hours from these surgical facilities.Conclusions and RelevanceA large proportion of the population in Zambia does not have access to safe and timely surgical care; this percentage would change substantially if all surgical hospitals were adequately resourced. Geospatial visualization tools assist in the evaluation of surgical infrastructure in Zambia and can identify key areas for improvement.

Proceedings of the 4th Annual Meeting of the Alliance for Surgery and Anesthesia Presence (ASAP): Building Sustainable Surgical Systems

Proceedings of the 4th Annual Meeting of the Alliance for Surgery and Anesthesia Presence (ASAP): Building Sustainable Surgical Systems

World Health Organization Global Initiative for Emergency and Essential Surgical Care: 2011 and Beyond

The world's burden of surgical diseases is large and increasing. Unfortunately, <5 % of all surgical procedures are performed in countries ranked within the lowest one-third in terms of per-capita health expenditures [1]. The unmet need for surgical care results in unacceptable morbidity/mortality rates associated with a host of conditions (trauma, pregnancy-related complications, other emergencies). This is especially true for rural and marginalized populations in low- and middle-income countries (LMICs). Recognizing that variations in the spectrum of surgical diseases are observed among and within countries, “essential” surgery and anesthesia may be viewed as a core group of services that can be delivered within the context of universal access. These high-priority interventions are those for which: (1) there is a large public health burden; (2) the treatment is highly successful; (3) the treatment is cost-effective [2]. To date, essential surgery and anesthesia have received minimal financial and political support as public health strategies because of the perception that the services are costly, are resource-intensive, require highly specialized training, and benefit only a fraction of the population relative to competing health interests. Evidence is amassing to refute these claims. The World Health Organization (WHO) Global Initiative for Emergency and Essential Surgical Care (GIEESC) was launched in 2005. It is a global forum whose goal is to promote collaboration among a diverse group of stake-holders (individuals, institutions, societies, universities, ministries of health, other nongovernmental organizations) to strengthen the delivery of surgical services at the primary referral level in LMICs (http://www.who.int.surgery) [3–6]. The inaugural meeting was at WHO headquarters in Geneva, Switzerland in November 2005 [7], and subsequent biennial meetings were hosted by ministries of health in Dar es Salaam, Tanzania in September 2007) [8] and Ulaanbaatar, Mongolia in June 2009) [9]. There are currently more than 624 GIEESC members from 93 countries representing all six WHO regions. In all, 45 % of members are from LMICs. The LMICs with ≥10 GIEESC members are India, Nigeria, Ethiopia, Ghana, and Uganda. The WHO GIEESC members have contributed to a number of activities aimed at strengthening the delivery of essential surgical services in LMICs. One component involved the implementation, local adaptation, and translation of training tools that were developed by the WHO's Emergency and Essential Surgical Care (EESC) project, which was initiated in the Clinical Procedures Unit of the Department of Essential Health Technologies in 2004 [3–6]. These training tools include the WHO Integrated Management of Emergency and Essential Surgical Care (IMSCStoolkit [10] and the Manual of Surgical Care at the District Hospital [11]. These materials have been introduced in 39 countries through collaborations with the respective Ministry of Health (MoH) and WHO country offices. The materials have been translated into Mongolian, Spanish, Chinese, Vietnamese, Korean, Dari, and Farsi. A WHO situational analysis tool to assess the availability of EESC at the level of individual health facilities was developed in 2007. It was based on infrastructure, human resources, procedures, equipment, and supplies [12]. This questionnaire has now been utilized in more than 35 countries, and the data collected and entered in the WHO EESC Global Database has been published to highlight gross deficiencies in the availability of EESC [13–22]. The WHO EESC Global Database was created to facilitate data entry from different countries. The situational analysis tool has been integrated into the WHO's Service Availability Mapping (SAM) technology [23] with the goal of facilitating monitoring the availability of surgical services at the facilities level. This technology was introduced in Mongolia in 2009. Plans have been made to continue with a surgical module in the WHO's recent adaptation of facilities-based monitoring, Service Availability and Readiness Assessment (SARA). A planning tool was developed to assist policymakers integrate EESC into their national health plans.An online Global MedNet serves as a platform for online discussions and for posting announcements and materials related to GIEESC (http://www.who.int/ surgery/globalinitiative/en/).

Surgical Care in the Solomon Islands: A Road Map for Universal Surgical Care Delivery

Access to surgical care and emergency obstetrical care is limited in low-income countries. The Solomon Islands is one of the poorest countries in the Pacific region. Access to surgical care in Solomon Islands is limited and severely affected by a country made up of islands. Surgical care is centralized to the National Referral Hospital (NRH) on Guadalcanal, leaving a void of care in the provinces where more than 80% of the people live. To assess the ability to provide surgical care to the people living on outer islands in the Solomon Islands, the provincial hospitals were evaluated using the World Health Organization's Global Initiative for Emergency and Essential Surgical Care Needs Assessment Tool questionnaire. Data on infrastructure, workforce, and equipment available for treating surgical disease was collected at each provincial hospital visited. Surgical services are centralized to the NRH on Guadalcanal in Solomon Islands. Two provincial hospitals provide surgical care when a surgeon is available. Six of the hospitals evaluated provide only very basic surgical procedures. Infrastructure problems exist at every hospital including lack of running water, electricity, adequate diagnostic equipment, and surgical supplies. The number of surgeons and obstetricians employed by the Ministry of Health is currently inadequate for delivering care at the outer island hospitals. Shortages in the surgical workforce can be resolved in Solomon Islands with focused training of new graduates. Training surgeons locally, in the Pacific region, can minimize the "brain drain." Redistribution of surgeons and obstetricians to the provincial hospitals can be accomplished by creating supportive connections between these hospitals, the NRH, and international medical institutions.

Smoking-Related Attitudes, Characteristics, and Opinions in a Group of Young Men with Asthma

The objective of this study was to examine the attitudes, characteristics, and opinions about smoking of a group of young asthmatic men. An anonymous, personal questionnaire was administered to 611 young male volunteers who had been diagnosed with asthma (according to the National Heart, Lung, and Blood Institute/World Health Organization Global Initiative for Asthma, 1995) in the respiratory disease and allergy clinics of the Burgos Military Hospital (Spain). This questionnaire contained items related to personal information, asthma characteristics, opinions about smoking, and information related to smoking habits. Six hundred patients with asthma completed the questionnaire. All were men, mean age 20.16 +/- 3.03 years; 189 (31.5%) were smokers and 16 (2.5%) were ex-smokers. Mean age at onset of regular smoking was 16.46 +/- 2 years. Sixty-five percent (65.07%) smoked fewer than 10 cigarettes per day. Most of the smoking asthmatics had mild asthma (58.9%). Eighty-eight percent (88.3%) had moderate dependence. Many of the smoking asthmatics were contemplating stopping smoking (54%), and 59% had tried before to stop. Concern about health was the main reason given for stopping smoking. Asthmatics who smoked had a higher percentage of smokers among family members, friends, and colleagues than nonsmoking asthmatics. Attitudes toward smoking were more permissive among smoking asthmatics. Only 36.64% of the total had received information about tobacco previously. In the sample group, 7% claimed that they did not smoke but their carbon monoxide concentration in exhaled air was 10 ppm or higher. There were no differences in the onset of the smoking habit between asthmatic and nonasthmatic young people. A large percentage of the smoking asthmatics were considering smoking cessation, motivated mainly by their asthma condition. The group as a whole had little previous information about tobacco.

Guidelines for Asthma

International guidelines for the management of asthma are now available. These include the US National Heart, Lung, and Blood Institute (NHLBI) International Consensus for the Diagnosis and Treatment of Asthma and the NHLBI/World Health Organization Global Initiative for Asthma (GINA).

National and international guidelines for the diagnosis and treatment of asthma.

Excellent guidelines on the management of asthma are now available. The most comprehensive guidelines developed recently are the National Heart, Lung, and Blood Institute (NHLBI) Guidelines for the Diagnosis and Management of Asthma, the NHLBI/World Health Organization Global Initiative for Asthma, and the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology Practice Parameters for the Diagnosis and Treatment of Asthma. The main purpose of such guidelines is to improve the quality of care for patients with asthma. This can only be accomplished, however, if these documents are used effectively.