Health Organization Regional Office Research Articles

Assessment of Clinical Toxicological Resources in Countries Belonging to the World Health Organization's Regional Office of the Eastern Mediterranean.

Poison Centers are vital to prevent and manage exposures to chemicals, toxins, and ionizing radiation. However, many countries still lack sufficient poison information center services. Within the World Health Organization's Eastern Mediterranean Regional Office (EMRO) region, we were not able to identify a formal assessment of its toxicological resources. We sought to assess the clinical toxicological resources in the EMRO region and the attitudes, needs, andperspective of the workforce in thatregion. METHODS: This was a two part survey study. First, wedeveloped a poison center questionnaire and scoring system based on the World Health Organization's Guidelines for Establishing a Poison Center; thisinstrument wasadministeredby phone to poison center directors and faculty in the EMROregion. Questions assessed for the presence or absence of important poison center capabilities listed in the WHO guidelines, and points were assigned based on response. Secondly, we administered an electronicworkforce survey to clinical toxicology professionals in the region; participanteligibility for the workforce survey was based on themembership roster ofMENATOX. Out of 22 EMRO countries, 16 countries have an established poison center, and 14 of 16 participated in the poison center survey. The results reflected a wide variability in capabilities amongcountries. Areas such as call centers, clinical toxicology units, laboratory services, and data management were relatively lacking while some other areas including toxicovigilance, chemical incidents and emergencies, antidotes/antivenoms, poisoning information sources, and the availability of free services were relatively stronger.Twenty-seven out of 32 workforce respondents were physicians. Results from that survey highlighted a desire for more support from government and better compensation. Our studyidentified areas of need for the EMRO region.The poison center survey results reflect large disparities amongcountries with some areas being stronger than others. The workforce survey highlighted issues such as compensation and government recognition. Overall, a formal assessment of individual poison centers can provide benchmarks to drive improvement of services, but further research is needed to identify and characterize country-specific needs.

Sicilians' knowledge, perceptions, prevention and practices during the pandemic in relation to vaccination: A questionnaire-based survey.

COVID-19 has influenced Sicily, Italy as any other part of the world, and people had various types of reactions to this global epidemic. This study aimed to assess the behavior, perception, and willingness of the Sicilian population to accept vaccination, as well as their attitudes toward conspiracy theories, which have been a concern for governments around the globe. Study design: cross sectional-descriptive study. The data were collected through a survey developed based on a protocol from the World Health Organization's regional office in Europe, which was distributed in two waves. The first wave took place in April and May 2020, and a modified survey was distributed during June and July. Sicilians showed a very good knowledge of the virus, while their positive attitude has changed toward vaccination in the second wave. Furthermore, Sicilians showed an average trust in the governmental institutions, which allow the doubts of conspiracy to exist in the population. Although the results indicate a good level of knowledge and positive attitude toward vaccination, we believe that further studies should be conducted in the Mediterranean to better understand how to face future epidemics with limited resources in the healthcare system, as compared with other countries.

Applying WHO COVID-19 workforce estimate tools remotely in an African context: a case report from Mali and Kenya

BackgroundThe COVID-19 pandemic has increased the burden on health systems, particularly in low- and middle-income countries, where health systems already struggle. To meet health workforce planning needs during the pandemic, IntraHealth International used two tools created by the World Health Organization (WHO) Regional Office for Europe. The Health Workforce Estimator (HWFE) allows the estimation of the quantity of health workers needed to treat patients during a surge, and the Adaptt Surge Planning Support Tool helps to predict the timing of a surge in cases and the number of health workers and beds needed for predicted caseload. These tools were adapted to fit the African context in a rapid implementation over 5 weeks in one region in Mali and one region in Kenya with the objective to test the feasibility of adapting these tools, which use a Workload Indicators of Staffing Need (WISN)-inspired human resources management methodology, to obtain daily and surge projections of COVID-19 human resources for health needs.Case presentationUsing a remote team in the US and in-country teams in Mali and Kenya, IntraHealth enacted a phased plan to gather stakeholder support, collect data related to health systems and COVID-19 cases, populate data into the tools, verify modeled results with results on the ground, enact policy measures to meet projected needs, and conduct national training workshops for the ministries of health.ConclusionsThis phased implementation in Mali and Kenya demonstrated that the WISN approach applied to the Health Workforce Estimator and Adaptt tools can be readily adapted to the local context for African countries to rapidly estimate the number of health workers and beds needed to respond to the predicted COVID-19 pandemic caseload. The results may also be used to give a proxy estimate for needed health supplies—e.g., oxygen, medications, and ventilators. Challenges included accurate and timely data collection and updating data. The success of the pilot can be attributed to the adapted WHO tools, the team composition in both countries, access to human resources data, and early support of the ministries of health, with the expectation that this methodology can be applied to other country contexts.

The ineligibility of food products from across the EU for marketing to children according to two EU-level nutrient profile models.

BackgroundA variety of nutrient profiling models have been developed to restrict food marketing to children. Previous assessments have shown substantial differences in terms of model strictness and agreement, but EU-wide data on how leading products in the various national markets perform against these health-minded nutrition criteria are unavailable.ObjectiveTo evaluate the nutritional composition of the pre-packaged food offer in selected categories sold at scale in the EU using criteria of two nutrient profile models intended to restrict food marketing to children.MethodsThe nutrient profile models of the private-sector EU Pledge and of the World Health Organization's Regional Office for Europe were applied to a commercial database with sales and nutritional information of 2691 pre-packaged products from five product categories (breakfast cereals, ready meals, processed meat, processed seafood, and yoghurts) and 20 EU countries. This study describes the criteria not met, the product ineligibility rates, and the distances to the various criteria thresholds.FindingsBetween 48% (EU Pledge) and 68% (WHO Europe) of the 2691 products analysed were found to be ineligible for marketing to children. The criteria thresholds most often not met were those for total sugars (in breakfast cereals, yoghurts), salt (in processed meat, processed seafood, ready meals), and fibre (in breakfast cereals). Total and saturated fat criteria also played a substantial role in rendering yoghurt products ineligible, and the energy criterion did so for ready meals.InterpretationA large number of food products selling at scale in the EU do not meet the criteria of two EU-level nutrient profile models intended to restrict food marketing to children. Given the considerable market share of many such products, they are likely to be consumed widely and in some cases regularly, including by children, even without being marketed to them. Nutrient profile models could serve as benchmarking tools for monitoring and evaluating food product reformulation efforts.

Reaching every child with rotavirus vaccine: Report from the 10th African rotavirus symposium held in Bamako, Mali.

The Center for Vaccine Development - Mali (CVD - Mali), the World Health Organization's regional office in Africa (WHO/AFRO), and the CVD at the University of Maryland School of Medicine hosted the 10th African Rotavirus Symposium in Bamako, Mali on 1-2 June 2016. The symposium is coordinated by WHO/AFRO, the Regional Rotavirus Reference Laboratories, and the African Rotavirus Network (ARN), with support from the Bill & Melinda Gates Foundation. The event brings together leading rotavirus researchers, scientists, and policy-makers from across Africa and the world. Over 150 participants, from 31 countries, including 27 in Africa, joined forces to address the theme "Reaching Every Child in Africa with Rotavirus Vaccines." This symposium, the first in francophone Africa, occurred at an unprecedented time when 33 African countries had introduced rotavirus vaccines into their national immunization programs. The symposium concluded with a Call to Action to introduce rotavirus vaccines in the 21 remaining African countries, to increase access in countries with existing vaccination programs, and to continue surveillance and research on rotavirus and other diarrheal diseases.

The challenge of making health services people-centred: how are policy-makers in Asia approaching it?

As early as 2005, the World Health Organization's Regional Office for the Western Pacific (WPRO) had worked closely with countries in its region to promote people-centred health care and provide practical guidance on health policies and interventions that can lead to better quality of health care, better health outcomes and improved well-being. The people-centred approach to health makes the perspectives of individuals, families and communities central to the organization of health services and systems, and is critical in improving service quality and contributing to progress towards Universal Health Coverage (UHC). WHO convened a policy roundtable to in Asia on the topic of People-Centred Integrated Health Services, and brought together 36 policy-makers and experts from 12 countries in the WHO Western Pacific Region. Challenges of implementing people-centred, integrated health services were shared and good practices for developing health services that were people-centred and integrated were discussed. The sessions discussed good practices on engagement with patients and families, ideas to strengthening governance and accountability, and coordination of services around the needs of people. Participants shared on the challenges of the current health systems, which were historically developed to provider-centric and hospital-centric, built on the bio-medical model of health. Recent changes in population demographics, healthcare needs and community expectations require health systems to evolve and adapt, to be more needs- and value-based. However in many settings, health services and social services are not well-integrated, and have contributed to poor outcomes and resource optimization. These can be worsened by technological or system barriers to timely communication and information sharing between healthcare providers. In several areas, lack of regulatory oversight has led to over-commercialization and commoditization of healthcare services. To advance people-centred, integrated health services and move towards universal health coverage, patients, families and communities need to be recognized as key partners and stakeholders in health, and be engaged accordingly. Links between health and social sectors need to be strengthened at all levels to better address the co-dependency between social and health for the population. Health systems need to promote communications and teamwork between providers and create platforms to facilitate information sharing. Alignment of policy directions and incentives is critical to generate the desired behaviors in healthcare providers and users. Health systems should collect data on what is meaningful to patients, families and communities, and shift our health systems’ KPIs to become more value-based.

Communicating about the Middle East respiratory syndrome outbreak to the international community and in-country foreigners, Republic of Korea, 2015.

WPSAR Vol 7, No 1, 2016 | doi: 10.5365/wpsar.2015.6.4.002 www.wpro.who.int/wpsar 28 a Division of International Cooperation, Ministry of Health and Welfare, Sejong, Republic of Korea. b Country Support Unit, World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. Submitted: 13 October 2015; Published: 24 February 2016 doi: 10.5365/wpsar.2015.6.4.002 Under the International Health Regulations (2005), risk communication is one of the eight core capacities that are critical to effectively detect and respond to public health threats.1 During outbreaks, international visitors and foreign residents may be poorly informed about the risk of infection and response measures due to language barriers. Specific strategies targeting these groups are needed for effective outbreak communications.

Engaging the international community during the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea.

WPSAR Vol 7, No 1, 2016 | doi: 10.5365/wpsar.2015.6.4.003 www.wpro.who.int/wpsar 21 a Division of International Cooperation, Ministry of Health and Welfare, Sejong, Republic of Korea. b International Cooperation Task Force on MERS outbreak response, Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea. c Country Support Unit, World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. Submitted: 13 October 2015; Published: 1 February 2016 doi: 10.5365/wpsar.2015.6.4.003 The 2015 Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, which started with an imported case1 and spread throughout the country with a total of 186 cases,2 revealed the vulnerabilities of the health-care system of the country. The situation was compounded by the unique health-care settings in the Republic of Korea, including crowded emergency departments and large numbers of hospital visitors seeking care at multiple hospitals.3 To assist with the outbreak response, the Ministry of Health and Welfare of the Republic of Korea hosted several international joint missions that provided valuable information and recommendations for MERS control and prevention of future outbreaks. This report briefly summarizes the missions’ outcomes and discusses their positive impacts.

Is registration of foreign medical teams needed for disaster response? Findings from the response to Typhoon Haiyan.

WPSAR Vol 6, Suppl 1, 2015 | doi: 10.5365/wpsar.2015.6.2.HYN_014 www.wpro.who.int/wpsar 29 a Offi ce of the WHO Representative in the Philippines, Sta Cruz, Manila, Philippines. b Bureau of International Health Cooperation, Department of Health, Sta Cruz, Manila, Philippines. c Disaster Response and Management, Division of Health Security and Emergencies, World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. Submitted: 16 June 2015; Published: 6 November 2015 doi: 10.5365/wpsar.2015.6.2.HYN_014 In the last three decades there has been an increase in the number of sudden onset disasters causing more than 800 000 deaths and affecting approximately 1 billion people.1,2 The Islamic Republic of Iran earthquake in 2003, South-East Asia tsunami in 2004, Pakistan earthquake in 2005, Pakistan floods and Haiti earthquake in 2010 all required an immediate health response, surpassing national capacities. A large number of foreign medical teams (FMTs) were deployed in these responses, for example more than 300 after the Haiti earthquake.3

ISO 15189:2012: What changes for African laboratories?

No abstract available.

Avian influenza A(H7N9) and the closure of live bird markets

WPSAR Vol 4, No 2, 2013 | doi: 10.5365/wpsar.2013.4.2.008 www.wpro.who.int/wpsar 1 a Division of Health Securities and Emergencies, World Health Organization Regional Offi ce for Western Pacifi c, Manila, Philippines. b World Health Organization, Geneva, Switzerland. c Emerging Diseases Surveillance and Response, World Health Organization, China Offi ce, Beijing, China. d Chinese Center for Disease Control and Prevention, Beijing, China. * Members of the World Health Organization Regional Offi ce for the Western Pacifi c Event Management Team: Nyka Alexander, Steve Bice, Joy Rivaca Caminade, Xavier Dufrenot, Emily Jane Fearnley, Alice Ruth Foxwell, Nori Isoda, Michelle McPherson, Zu Rongqiang, Tomoe Shimada. Submitted: 8 May 2013; Published: 21 May 2013 doi: 10.5365/wpsar.2013.4.2.008 On 31 March 2013, the National Health and Family Planning Commission, China notified the World Health Organization of three cases of human infection with avian influenza A(H7N9) from Shanghai and Anhui.1 By 8 May, 131 cases, including 26 deaths, had been notified from 11 provinces/ municipalities.1,2 The majority (81%) of reported cases were from Shanghai municipality and Zhejiang and Jiangsu provinces. Available data indicate that more than three quarters of cases (59/77, 76%) had recent exposure to animals. Among these, 58% (34/59) had direct contact with chickens and 64% (38/59) visited a live bird market (LBM).3 Provincial and national authorities in China have collected more than 80 000 samples from LBMs, poultry slaughter houses, poultry farms, wild bird habitats, pig slaughter houses and their environments. As of 7 May, 50 samples were positive for avian influenza A(H7N9): 39 samples from poultry from LBMs in Anhui, Jiangsu, Jiangxi, Guangdong, Shanghai and Zhejiang provinces (26 chickens, three ducks, four pigeons, six unknown) and 11 environmental samples from LBMs in Shanghai, Henan and Shandong provinces.4 None of the samples from poultry farms or pigs were positive.5

Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution

WPSAR Vol 4, No 2, 2013 | doi: 10.5365/wpsar.2013.4.2.005 www.wpro.who.int/wpsar 1 a Emerging Disease Surveillance and Response, Division of Health Security and Emergencies, World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. b Emerging Disease Surveillance and Response, World Health Organization China Offi ce, Beijing, China. * Members of the World Health Organization Regional Offi ce for the Western Pacifi c Event Management Team: Nyka Alexander, Jang Hwan Bae, Joy Rivaca Caminade, Erica Dueger, Xavier Dufrenot, Norikazu Isoda, Frank Konings, Chin-Kei Lee, Ailan Li, Michelle McPherson, Satoko Otsu, Karl Schenkel and Huu Thuan Vo. Submitted: 13 April 2013; Published: 20 April 2013 doi: 10.5365/wpsar.2013.4.2.005 Since 31 March 2013, the Government of China has been notifying the World Health Organization (WHO) of human infections with the avian influenza A(H7N9) virus,1 as mandated by the International Health Regulations (2005).2 While human infections with other subgroups of H7 influenza viruses (e.g. H7N2, H7N3 and H7N7) have previously been reported,3 the current event in China is of historical significance as it is the first time that A(H7N9) viruses have been detected among humans and the first time that a low pathogenic avian influenza virus is being associated with human fatalities.4 In this rapidly evolving situation, detailed epidemiologic and clinical data from reported cases are limited—making assessments challenging— however, some key questions have arisen from the available data. Age and sex data, as one of the first and Human infections with avian infl uenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution

Using tuberculosis surveillance data for informed programmatic decision-making

WPSAR Vol 4, No1, 2013 | doi: 10.5365/wpsar.2013.4.1.007 www.wpro.who.int/wpsar 1 a World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines doi: 10.5365/wpsar.2013.4.1.007 Public health surveillance, through the ongoing and systematic collection, analysis, interpretation and dissemination of health information, plays a critical role in informed decision-making and appropriate public health action.1 Different surveillance systems are required to meet disease-specific public health objectives, and some systems have been expanded through the collection of risk factor, behaviour and health practice information.

Rapid Assessment Survey of The Prevalence of Buruli Ulcer in The Health District of South Maniema, Maniema Province, The Democratic Republic of The Congo

Background: Buruli ulcer (BU) is endemic in more than 30 countries worldwide. Africa is the most affected continent with 16 confirmed endemic countries and 7 suspected or potential endemic countries. In the Democratic Republic of the Congo, a survey in 2004 showed the presence of suspected cases of BU in five of the country’s 11 provinces. The current survey was carried out in 2010 to confirm the endemicity of BU is the southern part of the Maniema Province and to provide support for case management and control measures if necessary. Method: The method of the survey was based on the protocol of rapid prevalence assessment survey (RPAS), proposed by the Buruli ulcer control Program of the World Health Organization (WHO) Regional Office for Africa to confirm BU endemic in countries. It included: awareness campaign and sensitization of health workers and communities in suspected endemic areas, followed by clinical screening of patients with suspected BU lesions and sampling of suspicious lesions by swab or fine needle aspiration (FNA) for laboratory confirmation of diagnosis, mainly by PCR. WHO-recommended treatment is proposed for cases which clinical features were in favor of the diagnosis of Buruli ulcer. Results: The survey in the Southern part of Maniema province targeted six of the nine health zones of Kasongo district. The three other health zones in the district were not be visited for accessibility and security reasons. A total of 66 suspected cases of Buruli ulcer were found at the Hospital of Kindu and in the six visited health zones. The lab tests with Ziehl-Nielsen (ZN) technique have confirmed 9 cases of BU. PCR tests confirmed eight cases of BU, including three who were not positive to the ZN tests. This makes a total of 12 BU patients confirmed by ZN and/or PCR and gives a proportion of laboratory confirmation of 18%. Discussions: Based on the results of this survey all health zones in South Maniema were classified as Buruli ulcer endemic areas, because of the same geo-climatic features that characterize all of them. These findings are similar to those of previous studies in the same province. The low confirmation rate of BU suspected cases by laboratory tests (18%) could be explained by the fact that many of the suspicious lesions which were sampled were very old wounds and had been evolving for several years. The WHO Regional Office for Africa has developed a plan of surveys, using the same rapid assessment protocol to confirm the endemicity of Buruli ulcer in other suspected endemic provinces of the DRC and in other member states of WHO African Region.

Laboratory capability for molecular detection and confirmation of novel coronavirus in Europe, November 2012

A rapid survey by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe ascertained the availability of national reference laboratory testing for a recently detected novel coronavirus as of 28 November 2012. Screening by internal quality controlled upE-RT-PCR assay was available in 23/46 of responding countries in the WHO European Region, of which 19/30 in European Union (EU) and European Economic Area (EEA) countries. Confirmation of positive screened samples by either ORF1b - RT-PCR, or other target RT-PCR assays with sequence analysis or whole-genome sequence analysis was available in 22/46 responding countries of which 18/30 in EU/EEA countries.

Mental health and the World Health Organization: translating strategy into practice

We asked the programme managers for mental health at the World Health Organization's Regional Offices for Europe, the Eastern Mediterranean and South-East Asia to provide an account of developments in the provision of mental health services within their regions. We are very fortunate that these busy and influential individuals were able to set aside the time to prepare articles that shed a fascinating light on strategic thinking within the World Health Organization.

Strengthening the surveillance of and response to HIV in the Western Pacific

WPSAR Vol 3, No 3, 2012 | doi: 10.5365/wpsar.2012.3.3.010 www.wpro.who.int/wpsar 1 a World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. doi: 10.5365/wpsar.2012.3.3.010 Countries in the Western Pacific Region have lowlevel epidemics – HIV may have been present for many years but never spread to substantial levels in any subpopulation; i.e. prevalence has not been consistently >5% in any subpopulation or concentrated HIV epidemics – the spread of HIV has occurred in a defined subpopulation; i.e. prevalence is consistently >5% in a defined subpopulation but is <1% in pregnant women in urban areas.1 Predominantly affected subpopulations, usually referred to as key populations, in the Region are sex workers (SW), people who inject drugs (PWID), men who have sex with men (MSM) and transgender people (TG).2 These populations also show high rates of sexually transmitted infections (STI), which play an important role in enhancing the HIV transmission.3 Understanding levels of STI (other than HIV) could help to identify populations for which HIV prevention interventions are needed, especially in areas where HIV prevalence is currently low.2 Over the past decades, tremendous efforts and resources have been invested to establish functional HIV surveillance systems in many countries in the Region.4,5 However, the same cannot be reported for strengthening STI surveillance.2

Improving health research governance and management in the Western Pacific: A WHO Expert Consultation

Repeated calls have been made in recent decades to increase investments in health research, especially in low- and middle-income countries (LMIC). However, the perceived low relevance and quality of health research, poor visibility of outputs, and difficulties in tracking current levels of and returns on investments have undermined efforts to advocate for additional investments in these countries. Some of these issues emanate from inadequate governance and management systems for health research at the national level, which are ineffective in tracking and steering the research portfolio and investments, ensuring quality, and facilitating access to research outputs. In spite of this, the value, necessity, and cost of performing health research management and governance functions are not well appreciated, especially in LMIC. To address this, the World Health Organization (WHO) Regional Office for the Western Pacific organized an expert consultation in August 2011, involving experts from 14 of its developed and developing member states and from leading research organizations such as the Wellcome Trust. The consultation identified essential health research governance and management functions that must be performed by appropriate organizational entities to maximize returns on health research investments. In addition, three specific areas for intervention were considered: (1) prospective research registration in publicly accessible national health research registries; (2) systematic health research data archiving and wider access; and (3) national research ethics systems. A consensus was reached on the need to invest more in essential health research and management functions, including establishing publicly accessible web-based national health research registries for prospective registration of health research, setting up systems to archive and share health research data, and improving the governance of research ethics committees. The consultation also concluded that the costs of performing these functions are legitimate and necessary research costs that must be shouldered by research funding organizations.

Commentary: Interpreting Data on "Institutionalization": Not Simply Counting Beds

Commentary: Interpreting Data on "Institutionalization": Not Simply Counting Beds

The Spanish toxic oil syndrome 20 years after its onset: a multidisciplinary review of scientific knowledge.

In 1981, in Spain, the ingestion of an oil fraudulently sold as olive oil caused an outbreak of a previously unrecorded condition, later known as toxic oil syndrome (TOS), clinically characterized by intense incapacitating myalgias, marked peripheral eosinophilia, and pulmonary infiltrates. Of the 20,000 persons affected, approximately 300 died shortly after the onset of the disease and a larger number developed chronic disease. For more than 15 years, a scientific committee supported by the World Health Organization's Regional Office for Europe and by the Institute of Health Carlos III in Madrid has guided investigation intended to identify the causal agent(s), to assess toxicity and mode of action, to establish the pathogenesis of the disease, and to detect late consequences. This report summarizes advances in research on this front. No late mortality excess has been detected. Among survivors, the prevalence of some chronic conditions (e.g., sclerodermia, neurologic changes) is high. Attempts to reproduce the condition in laboratory animals have been unsuccessful, and no condition similar to TOS has been reported in the scientific literature. Laboratory findings suggest an autoimmune mechanism for TOS, such as high levels of seric soluble interleukin-2 receptor. Epidemiologic studies integrated with chemical analyses of case-related oils have shown that the disease is strongly associated with the consumption of oils containing fatty acid esters of 3-(N-phenylamino)-1,2-propanediol (PAP). These chemicals have also been found in oils synthesized under conditions simulating those hypothesized to have occurred when the toxic oil was produced in 1981. Whether PAP esters are simply markers of toxicity of oils or have the capability to induce the disease remains to be elucidated.