WHO Recommendations Research Articles

Tobacco taxes can save the next generation in the Eastern Mediterranean Region

Background: Tobacco use remains a significant challenge to public health in the Eastern Mediterranean Region (EMR), particularly among adolescents, despite various control measures implemented by countries. Aim: To evaluate the effectiveness of tobacco taxation policies in reducing consumption among adolescents in the EMR and identify optimal tax structures and enforcement strategies. Methods: We analysed data from the Global Youth Tobacco Survey and the Global Tobacco Control Report up to 2023 to assess prevalence of tobacco use among adolescents, access to tobacco products, and types of taxes imposed by EMR countries. Literature reviews were conducted to examine global evidence on tobacco taxation effectiveness. Results: The analysis revealed high accessibility of tobacco products by adolescents in the EMR, with over 50% having easy access to cigarettes. Enforcement of age-related regulations was lacking. Effective tobacco taxation, with high and uniform excise taxes, emerged as a crucial measure for reducing tobacco use among adolescents. Conclusion: Implementation and enforcement of tobacco taxation policies are vital to curb tobacco use among adolescents in the EMR. Comprehensive taxation strategies that limit affordability and accessibility, in line with WHO recommendations, can help mitigate the health burdens due to tobacco use among adolescents.

Occurrence and diversity of Shiga toxin-producing Escherichia coli (STEC) in Italian Alpine raw milk cheeses and their development in the earlier stages of different cheese-making processes

Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens implicated in diseases including hemorrhagic colitis and hemolytic uremic syndrome. In the last years, an increasing number of STEC infections associated with the consumption of raw milk cheeses have been reported, contributing to raise the public awareness. The aim of this study was to assess the occurrence of STEC biotypes in raw milk cheeses from Italian Alpine region and evaluate the influence of different scalding temperatures on their development. Six out 82 (7.3%) cheeses led to the isolation of E. coli biotypes with different virulence traits (stx1, stx2 and eae genes). To evaluate the impact of scalding temperatures on STEC growth, three E. coli biotypes were spiked into milk (< 50 CFU/mL) according to the FAO and WHO recommendation. An increase in STEC counts of 3 log occurred in uncooked and semi-cooked cheeses (scalding temperature of 38 and 45 °C) while in the cooked-cheeses (54 and 56 °C) E. coli content does not exceed the 2.5 log10 CFU/g. These findings showed that raw milk cheese safety is strictly related to their production technology, highlighting the importance of the control measures at farm and dairy level to preserve the safety of these products.

Mobile Heatlh Berbasis Smartphone untuk Kemampuan Ibu Menyusui secara Eksklusif

Educational media in the implementation of exclusive breastfeeding plays a very big role in increasing mothers' knowledge and attitudes in order to give birth to breastfeeding actions and skills. Mobile health or mobile-based health or mhealth is one of WHO's recommendations, namely a form of care in the field of education which is expected to be able to overcome health problems by reducing costs, energy and care time. The aim of this research is to determine the effectiveness of smartphone-based mobile health in improving the ability of breastfeeding mothers. exclusively Method: This research is a literature review. Article searches were carried out using several databases with publications in 2014-2024 with the keywords mobile application for exclusive breastfeeding" or "smartphone to improve knowledge and exclusive breastfeeding" or "telehealth for exclusive breastfeeding". Results: The results of studies that have been carried out show that MHealth can be used as an educational medium to increase coverage of exclusive breastfeeding through increasing knowledge, attitudes and changes in behavior of postpartum mothers. Mhealth can be considered an effective educational medium due to the increasing development of technology and its use, which is cheap, easy and can be taken anywhere. The abstract does not contain citations, formulas, tables and figures. Conclusion: Mhealth can be used as an educational medium to increase coverage of exclusive breastfeeding through increasing knowledge, attitudes and changes in behavior of postpartum mothers

Efficiency of Artificial Intelligence for Interpretation of Chest Radiograms in the Republic of Tajikistan

The article presents data from recent publications and own data on screening studies with interpretation of chest radiographs using artificial intelligence CAD (Computer-Assisted Diagnosis), which, according to WHO recommendations, provides more accurate clinical thresholds for deciding who needs to take a sputum test. Another aspect of the WHO recommendations is the cost-effectiveness of CAD as a tool for triaging patients with tuberculosis symptoms in low-income countries with a high incidence of tuberculosis. Compared with smear microscopy and GeneXpert, without preliminary sorting, the use of mobile digital X-ray machines equipped with a CAD tool reduces costs, allowing sorting of individuals suspected of having tuberculosis for testing on GeneXpert, while reducing the time to start tuberculosis treatment. Thus, conducting a study using portable X-ray machines using a CAD program is a low-cost and easy-to-implement method, does not require large funds, does not require separate rooms, is highly effective, has good image quality, allows you to quickly clarify individuals suspected of having tuberculosis, differentiating it from other pathological changes in the lungs. Our experience shows that machine analysis of chest computed tomography data, due to the higher resolution capabilities of the method and the absence of fundamental disadvantages of radiography, including the effect of shadow summation, the presence of “blind” zones, etc., is finding increasing application in both diagnostics and screening of respiratory diseases. Our use of this tool allowed us to identify additional new cases of phthisio-onco-pulmonary diseases in field conditions.

Relationship between Gestational Age and Examination Results Triple Elimination of Pregnant Women at UPTD Jayakerta Community Health Center

Human Immunodeficiency Virus (HIV), Syphilis, and Hepatitis B are sexually transmitted infections that pregnant women can pass to their babies. To address this, the Ministry of Health of the Republic of Indonesia has implemented the Triple Elimination program based on WHO recommendations. This study aims to evaluate the effectiveness of the Triple Elimination screening compared to gestational age. Using the Chi-Square method, the research involved 47 pregnant women examined in the first, second, and third trimesters. Data was collected from reports of initial screenings in the first trimester, followed by re-examinations in the subsequent trimesters. A questionnaire with six questions was used. Statistical analysis with a p-value of 0.06 indicated a significant correlation between sexual intercourse habits and an increase in syphilis cases in the third trimester. Additionally, habits related to genital cleaning post-intercourse also significantly impacted syphilis rates. The study highlights the need for ongoing education for pregnant women on preventing sexually transmitted infections and the importance of early detection through Triple Elimination screenings.

Assessment of Infection Prevention and Control Program in Misurata Medical Center Using the WHO Infection Prevention and Control Assessment Framework (IPCAF), 2023.

Globally, about 5–15% of patients admitted to hospitals get HAIs and the primary cause for this is poor infection prevention and control (IPC) practices in the hospitals. HAIs continue to be one of the most common adverse events in health care, Despite the developments in infection control measures, HAIs play crucial role in occurrence of antimicrobial resistance. This study aims to evaluate the IPC compliance at Misurata Medical Center (MMC), using the WHO IPCAF tool. A hospital based cross sectional study conducted in The Central Misurata Center in August 2023, data was collected using IPCAF tool form WHO by interviewing the IPC specialist in the center. Responses were scored and interpreted according to WHO guidelines. The total score was calculated to be 607.5 which according to the IPCAF Scoring and Interpretation is an advanced level (601-800), meaning full implementation of the IPC core components according to the WHO recommendations and appropriate to the facility`s needs. Structures and processes of Infection prevention and control (IPC) are in general well established in Misurata Central center. Regular assessment of IPC activities is needed and better action plans to improve the IPC activities in the MMC should be adopted.

Pretreatment and acquired HIV drug resistance in Belize—results of nationally representative surveys, 2021–22

Abstract Background The rising prevalence of pretreatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitors threatens the effectiveness of ART. In response, the WHO recommends dolutegravir-based ART regimens due to their high genetic barrier to resistance and better treatment outcomes. This is expected to contribute to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 95% viral suppression in people on ART. Objectives To estimate the prevalence of PDR among adults initiating ART and assess viral suppression and acquired HIV drug resistance (ADR) among individuals receiving ART in Belize. Patients and methods Nationally representative cross-sectional PDR and ADR surveys were conducted between 2021 and 2022. Sixty-seven adults were included in the PDR survey, and 43 children and adolescents and 331 adults were included in the ADR survey. Demographic and clinic data and blood specimens were collected. HIV drug resistance (HIVDR) was predicted using the Stanford HIVdb tool. Results The prevalence of PDR to efavirenz or nevirapine in adults was 49.3% (95% CI 42.2%–56.4%) and was significantly higher in those with previous antiretroviral exposure (OR: 7.16; 95% CI 2.71–18.95; P = 0.002). Among children and adolescents receiving ART, 50.0% had viral suppression, with better rates for those receiving dolutegravir-based ART (OR: 5.31; 95% CI 3.02–9.34; P &amp;lt; 0.001). In adults, 79.6% achieved viral suppression. No resistance to integrase inhibitors was observed in those on dolutegravir-based ART. Conclusions Prioritizing dolutegravir-based ART is critical for achieving HIV epidemic control in Belize. Efforts should focus on retention in care and adherence support to prevent HIVDR.

Affordability of healthy and water-saving dietary patterns in The Gambia

Abstract Background: Dietary modification has the potential to improve nutritional status and reduce environmental impacts of the food system. However, for many countries, the optimal composition of locally contextualised healthy and sustainable diets is unknown. The Gambia is vulnerable to climate-change-induced future water scarcity which may affect crop yields and the ability to supply healthy diets. This study identifies potential shifts in Gambian diets that could make diets healthier and reduce the associated agricultural water footprint, and assesses the cost and affordability implications of such dietary changes. &amp;#xD;Methods: Gambian Integrated Household Survey (IHS) food consumption data was combined with market prices, food expenditure and agricultural water footprint data. Current dietary patterns were compared with WHO dietary guidelines and optimised using linear programming to identify least-cost diets that met nutrition recommendations and reduced agricultural water use. Optimisation scenarios explored the maximum reduction in green water use that could be achieved with “culturally-acceptable” dietary shifts, and the magnitude of shifts required to maintain green water use at current levels. &amp;#xD;Results: On average, current diets provide adequate energy and have appropriate macronutrient composition. However, only 14% of households consume enough fruit and vegetables, and consumption of added sugars exceeds recommendations. With ‘culturally-acceptable’ changes in consumption, agricultural water use could decrease by 10–13% or increase by 9%, depending on baseline dietary pattern. Extreme dietary shifts will be required to maintain water use at 2015 levels with projected population growth. To meet WHO recommendations dietary costs would increase by 43% compared to the current baseline. Healthy and green water-saving diets would require 48–63% of average household expenditure to purchase, which is unaffordable for almost half of the population. Fruit and vegetables alone account for 31–40% of the cost of optimised diets compared to 12% of current diets.&amp;#xD;Conclusion: Dietary modification has the potential to improve the nutritional quality of Gambian diets while reducing agricultural water use, but the required changes are likely to be unaffordable for a large proportion of the population. Improving availability and affordability of nutritious foods—particularly fruit and vegetables—will be crucial for accessibility of healthy and sustainable diets in the Gambian population.&amp;#xD;

Spatial patterns and predictors of missing key contents of care during prenatal visits in Ethiopia: Spatial and multilevel analyses.

Quality Antenatal Care (ANC) is considered if pregnant women have access to essential services that align with the best evidence-based practice. Although several studies have been conducted on ANC uptake in Ethiopia, they have focused on the timing and number of visits and the level of complete uptake of care contents according to the WHO recommendation remains scarce. Hence, this study aimed to assess the magnitude of missing care content during ANC visits, its spatial variations, and individual- and community-level determinants in Ethiopia. The study was conducted using the 2016 Ethiopian Demographic and Health Survey and included a total weighted sample of 4,771 women who gave birth within five years before the survey. Spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran's I) was checked to determine the non-randomness of the spatial variation in the missing contents of care. Multilevel multivariable logistic regression analysis was performed using STATA version 16. The adjusted odds ratio (aOR) with its corresponding 95% CI was used as a measure of association. The prevalence of missing full contents of ANC in Ethiopia was 88.2% (95% CI: 87.2, 89.0), with significant spatial variations observed across regions. Missing essential contents of care was higher among women who live in rural areas (aOR = 1.68, 95% CI: 1.47, 2.71), not completed formal education (aOR = 1.94, 95% CI:1.24, 3.02), late initiation of ANC (aOR = 3.05, 95% CI:1.59, 6.54), attended only one ANC (aOR = 4.13, 95% CI: 1.95, 8.74), and not having a mobile phone (aOR = 1.44, 95% CI: 1.07, 1.95). The level of missing care content during prenatal visits was high in Ethiopia, with significant spatial variation across regions. Health systems and policymakers should promote early initiation and encourage multiple visits to provide optimal care to pregnant women. In addition, it is vital to focus on enhancing education and healthcare infrastructure in rural parts of the country.

Developing and validating the Sierra Leone perinatal psychological distress scale through an emic-etic approach

BackgroundAddressing perinatal psychological distress in Sierra Leone faces challenges due to the lack of culturally appropriate assessment tools, despite recent WHO recommendations for screening during the pre- and postpartum periods. While high-income countries use tools like the Edinburgh Postnatal Depression Scale or Patient Health Questionnaire-9 (PHQ-9), their cross-cultural validity and efficacy in developing countries are uncertain. The aim of this study was to address this gap by developing a functional assessment tool, culturally appropriate screening tool for perinatal psychological distress, and validate it with the PHQ-9. MethodFollowing scale development guidelines, the study encompassed three phases: Item Development, Scale Development, and Scale Evaluation. Data from free listing interviews (n = 96), FGDs (n = 24), and cognitive interviews (n = 8) informed the development of the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS) and a Function scale. Item reduction via exploratory factor analysis (n = 120) and validation (n = 140) were conducted in subsequent phases. ResultTwo screening instruments were developed: the 10-item SLPPDS and a 5-item Function scale assessing perinatal women's ability to perform daily tasks. Sensitivity/specificity values for the SLPPDS and PHQ-9 were 80.0/85.7 and 73.8/76.2 respectively. Internal consistency reliability was 0.88 for the SLPPDS and 0.81 for the PHQ-9. Confirmatory factor analysis supported a one-factor model with 54.9 % variance explained. ROC/cut-off points for SLPPDS and PHQ-9 were 0.90/0.81 and 8.0/7.0 respectively. ConclusionThe PHQ-9 shows validity and reliability as a screening instrument, but the SLPPDS emerges as a potentially more salient alternative for assessing perinatal psychological distress in Sierra Leone. This implies the SLPDDS is particularly relevant, meaningful, and applicable to the specific cultural or community context it was designed for. It suggests that the tool effectively addresses the unique needs, perspectives, and experiences of the perinatal women, making it more likely to resonate with users and stakeholders. This relevance may enhance the tool's acceptance, usability, and overall impact in identifying and addressing perinatal mental health issues in Sierra Leone. These instruments could enable effective evaluation of perinatal mental health initiatives by government agencies, locals, and international NGOs.

Administration patterns of magnesium sulphate for women with preeclampsia and immediate newborn outcomes in Kawempe National Referral Hospital-Uganda: a cohort study

BackgroundPreeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates.MethodsThis was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe MgSO4 administration patterns and immediate newborn outcomes using Apgar and Thompson scores. SPSS version 23 was used to analyse data, and both bivariate and multivariate logistic regressions were used to determine factors associated with the low Apgar score at five minutes.ResultsOverall, majority of the patients received more than one dose with 33.3% received a sixth dose of MgSO4. The majority, 84.8%, of the mothers delivered live babies, 31.0% babies had complications, and were admitted to the neonatal intensive care unit (NICU). NICU admissions were mostly due to respiratory distress21.4%, preterm delivery21.0%, and 5.5% died within seven days. Majority 93.3% of the newborns had an Apgar score of seven and above at five minutes, of the newborns who were Thompson scored, 70.4% scored between 1 to 10 which is mild HIE. Initiation of MgSO4 treatment within one hour from prescription (AOR = 0.49, CI: 0.01–1.94), 4-hourly timing of the first maintenance dose (AOR = 0.22, CI: 0.06–0.79) and having complete doses of MgSO4 treatment (AOR = 0.89, CI: 0.03–3.05) decreased the likelihood of having low Apgar scores at five minutes.ConclusionsTimely administration of the first maintenance dose of MgSO4 decreases the likelihood of low Apgar score at 5 min and NICU admission in newborns, and most NICU admissions were due to respiratory distress and preterm delivery.

Human Papillomavirus (HPV) Genotypes in Mixed Squamous Cell Carcinoma of the Penis: A Study of 101 Tumors.

Squamous cell carcinomas with two or more coexisting clearly different histological subtypes of penile carcinomas are designated as mixed carcinomas in current classification models. They represent about 10% of all penile carcinomas. The aim of this study was to detect HPV genotypes in these unusual tumors. Tumors were selected from an international series of 1010 patients with penile carcinomas. Mixed carcinomas were grouped, according to WHO recommendations, as follows: 1. Carcinomas with warty/basaloid features mixed with HPV-independent carcinomas and 2. HPV-independent subtypes mixed with each other. HPV detection and p16INK4a immunostaining were performed. For HPV detection, whole tissue section-PCR analyses were performed by SPF10-DEIA-LiPA25 (version 1). As expected, HPV was detected more frequently in HPV-associated mixed carcinomas than in HPV-independent mixed carcinomas. Carcinomas with basaloid or warty features mixed with other SCC subtypes showed an HPV positivity rate of 46% (33 of 72 tumors) compared with 7% found in tumors with nonwarty/basaloid morphology (2 of 29 tumors). Eleven high-risk HPV genotypes were identified and the most common was HPV16 (65%) usually associated with basaloid morphology. p16INK4a immunostaining was positive in 76% of HPV-positive tumors. As in nonmixed carcinomas, although in lower proportion, a variable array of HPV genotypes was detected in mixed carcinomas. Apparently, the presence of a non-HPV component in an otherwise typical HPV-associated type tumor does adversely affect the prevalence of HPV positivity. Any amount of HPV-associated morphology superior to 20% in a mixed tumor is sufficient to classify them as HPV-associated, a WHO requirement.

Dropout from Maternity Continuum of Care and Associated Factors Among Mothers Who Gave Birth After War in Adigrat Town, Tigray, Northern Ethiopia 2024

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Maternity continuum of care is the continuity of maternal health care services given to mothers during antenatal period, child birth and post natal period. It is one of the strategic programs meant to lower the death rates of mothers, newborns, and children. In spite of this, a large number of moms discontinue their participation in maternal continuum care. Dropout from the maternity continuum of care is prevalent public health issue in underdeveloped nations, such as Ethiopia. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;Community based quantitative cross-sectional study was carried out among 357 mothers who gave birth in the 12 months in Adigrat town. Systematic sampling method was used to obtain study participants. Data was collected using pretested, semi- structured and face to face interviewer administered questioner. Bivariable and multivariable logistic regression model was fitted. Variables having p-value less than 0.2 in bivariable analysis was entered to multivariable logistic regression model. In multivariable logistic regression adjusted odds ratio with 95% confidence interval was used to determine strength and direction of the association between dependent and independent variables. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; The overall magnitude of drop out from the maternity continuum of care was 237 (66.4%) [95%CI (61.3-70.9)], 60.6% drop out from ANC visit, 5.6% drop out from skill birth attendant and 58.9% drop out from PNC. Mothers never heard on maternal health care service (AOR=4.179 (1.107, 15.783), service out of health facility (AOR =5.136 (1.988, 13.267) noabortionhistory (AOR=1.424 (1.113, 12.133), unplannedpregnancy (AOR=5.478 (1.902, 15.777), less than 4 ANC visit (AOR= 5.583 (2.598, 11. 997) and mothers attitude (AOR=15.049 (2.489, 32.997) were statically significant factors associated with drop out from maternity continuum of care. &amp;lt;i&amp;gt;Conclusion and discussion: &amp;lt;/i&amp;gt;This study showed that magnitude of drop out from maternity continuum of care was high as compared to WHO recommendations. As a result concerned stakeholders and policy makers should initiate more than four ANC visit, create awareness on harmful traditional practice, bad pregnancy history, support mothers to use family planning to prevent unplanned pregnancy, and work on attitude change of the community.

CARBOHYDRATE METABOLISM IN BLOOD DONORS

Objective: This study investigates the effects of blood donation on carbohydrate metabolism and examines dietary strategies to support donor health. Blood donation is vital for healthcare but can temporarily disrupt glucose levels, potentially causing symptoms like fatigue and dizziness, particularly in donors susceptible to blood sugar fluctuations. Method: The research integrates a review of WHO guidelines, an analysis of recent studies on carbohydrate metabolism in blood donors, and the development of specific nutritional recommendations to support recovery. The WHO guidelines offer foundational insights into safe donation practices, while scientific research provides data on glucose regulation and recovery needs. Results: Findings reveal that complex carbohydrates before donation stabilize glucose levels, while fast-absorbing carbohydrates after donation rapidly restore energy, reducing symptoms associated with blood sugar dips. Regular donation may also benefit individuals with high carbohydrate intake by regulating glucose levels and reducing disease risks. Novelty: This study uniquely combines WHO recommendations with recent scientific insights to provide a practical, evidence-based dietary framework specifically tailored for blood donors, addressing both donor safety and physiological recovery. This approach emphasizes the importance of carbohydrate type and timing, offering a nuanced perspective for dietary management in donation contexts, and underscores the need for future research on personalized nutrition strategies for optimal donor health.

Antibiotic Prescribing Practices in a Tertiary Care Teaching Hospital: A Retrospective Cross-Sectional Analysis.

Background Antibiotics are among the most frequently prescribed medications in hospitals, yet a significant portion of their use is inappropriate, contributing to the growing global threat of antimicrobial resistance (AMR). In Pakistan, AMR has reached alarming levels with the rise of multi- and extensively drug-resistant bacteria. This study evaluates antibiotic prescribing practices and the use of culture sensitivity (CS) testing to assess the appropriateness of antibiotic therapy. Methods This cross-sectional retrospective study was conducted in a 500-bed tertiary care teaching hospital in Islamabad, Pakistan, analyzing inpatient records from 2020 to 2022. From over 5000 patient files, 1012 met the inclusion criteria and were reviewed. The study assessed the rationality of antibiotic prescriptions based on the evidence of infection (EoI), clinical parameters, and the presence or absence of CS testing. Statistical analyses, including Chi-square tests, logistic regression, and Cox proportional hazards regression, were applied to determine the association between antibiotic use and patient outcomes. Results Among the 1,012 patients analyzed, 91.8% (n = 929) received one or more antibiotics. However, 30% (n = 274) of these prescriptions were issued without any documented EoI.Only 17.5% of patients underwent CS testing. Patients exposed to five or more antibiotics had a 2.5-fold increased risk of ICU mortality (HR = 2.50, p < 0.001). A positive correlation (r = 0.42, p < 0.001) was found between the number of antibiotics prescribed and the length of hospitalization. Conclusion The findings of this study reveal a high rate of inappropriate antibiotics prescribed without EoI and CS testing. The results emphasize the urgent need for comprehensive Antibiotic Stewardship Programs (ASPs) in hospital settings, particularly focusing on mandatory CStesting protocols. By reducing irrational antibiotic use, these initiatives can significantly mitigate the rise of AMRglobally, especially in resource-limited settings. Implementing ASPs not only optimizes antibiotic use but also aligns with the WHO recommendations, demonstrating the effectiveness of multifaceted interventions in minimizing resistance and improving patient outcomes.

Combining OpenStreetMap mapping and route optimization algorithms to inform the delivery of community health interventions at the last mile.

Community health programs are gaining relevance within national health systems and becoming inherently more complex. To ensure that community health programs lead to equitable geographic access to care, the WHO recommends adapting the target population and workload of community health workers (CHWs) according to the local geographic context and population size of the communities they serve. Geographic optimization could be particularly beneficial for those activities that require CHWs to visit households door-to-door for last mile delivery of care. The goal of this study was to demonstrate how geographic optimization can be applied to inform community health programs in rural areas of the developing world. We developed a decision-making tool based on OpenStreetMap mapping and route optimization algorithms in order to inform the micro-planning and implementation of two kinds of community health interventions requiring door-to-door delivery: mass distribution campaigns and proactive community case management (proCCM) programs. We applied the Vehicle Routing Problem with Time Windows (VRPTW) algorithm to optimize the on-foot routes that CHWs take to visit households in their catchment, using a geographic dataset obtained from mapping on OpenStreetMap comprising over 100,000 buildings and 20,000 km of footpaths in the rural district of Ifanadiana, Madagascar. We found that personnel-day requirements ranged from less than 15 to over 60 per CHW catchment for mass distribution campaigns, and from less than 5 to over 20 for proCCM programs, assuming 1 visit per month. To illustrate how these VRPTW algorithms can be used by operational teams, we developed an "e-health" platform to visualize resource requirements, CHW optimal schedules and itineraries according to customizable intervention designs and hypotheses. Further development and scale-up of these tools could help optimize community health programs and other last mile delivery activities, in line with WHO recommendations, linking a new era of big data analytics with the most basic forms of frontline care in resource poor areas.

058. A Rare Case: Anterior Wall Rectum Perforation Due to Intrauterine Device Migration

Background: Intrauterine devices (IUDs) are widely used for contraception due to their long-acting, safe, and effective nature in preventing pregnancy. However, common side effects and complications, such as vaginal bleeding, expulsion, displacement, translocation, and perforation necessitate attention, with translocation and perforation being rare but potentially severe, warranting prompt removal according to WHO recommendations. This study aims to document and analyze a rare case of rectal perforation resulting from the migration of an IUD. Case: A report was made from 31-year-old pregnant woman with a history of two cesarean sections presented with 10-day abdominal pain and an IUD inserted 42 days post-surgery, which MRI revealed had translocated into the left anterolateral rectal wall, prompting retroscopy for extraction. Uterine perforation and IUD migration into adjacent organs can result in various complications, including uterine, bladder, and intestinal perforation, with initial symptoms potentially being asymptomatic, emphasizing the need for routine check-ups. Retrieval of migrated IUDs can be achieved through methods such as endoscopy, laparoscopy, or laparotomy, as illustrated in a case involving a patient with abdominal pain and imaging evidence of IUD translocation to the rectum's anterior wall, managed through less invasive rectoscopy. Conclusion: Translocated IUDs may exhibit varying symptoms or none at all, necessitating removal regardless of type or location, with management guided by radiological and endoscopic findings alongside understanding abdominal organ anatomy

Postoperative continuation of antibiotic prophylaxis beyond 24 h is unnecessary for abdominal surgeries in children and neonates

PurposeDespite recent WHO recommendations, antibiotic prophylaxis is routinely continued for several days after surgery. We conducted a retrospective study to evaluate the safety and efficacy of antibiotic prophylaxis cessation within 24 h after abdominal surgeries MethodsWe retrospectively reviewed the charts of patients who underwent 3 representative gastrointestinal surgeries (1; transumbilical small bowel procedure for intestinal atresia or stenosis, 2; extrahepatic bile duct resection, and hepaticojejunostomy for congenital biliary dilatation, 3; stoma closure for intestinal perforation, anorectal malformation, or inflammatory bowel disease) at our institution between 2011 and 2023. The demographic data collected included age, preoperative hemoglobin level, albumin level, body mass index, and ASA class. Intraoperative and postoperative data were also collected. The patients were divided into 2 groups according to the duration of perioperative antibiotics (‘within 24 h’ and ‘beyond 24 h’), and the incidence of superficial incisional SSI (siSSI) was compared between the 2 groups in each procedure ResultsDuring the study period, 25 cases underwent transumbilical small bowel procedure, 23 cases underwent hepaticojejunostomy, and 45 cases underwent stoma closure. The preoperative care bundle including bowel preparation, cleansing, and operative procedures has not changed during the study period. First- and third-generation cephalosporins were administered to all the patients. All patients received their first single dose of antibiotics within 60 min before the skin incision. In particular, 14 patients who underwent small-bowel procedures received only a single dose. The SSI rates for small bowel procedures, hepaticojejunostomy, and stoma closure were 0%, 4.4%, and 4.4%, respectively. No SSIs were observed in any of the procedures in the 'within 24 h' group ConclusionBased on our study, we conclude that ≤24 h of postoperative continuation of antibiotic prophylaxis is sufficient for siSSI prevention in hepaticojejunostomy and stoma closure. Additionally, single-dose antibiotic prophylaxis is adequate for neonatal small bowel procedures.

MODELOS DE ALEITAMENTO MATERNO E SUAS INDICAÇÕES: UMA REVISÃO LITERÁRIA

Human milk is a food rich in macro and micronutrients, as well as anti-inflammatory agents, immunoglobulins, and antioxidants that promote the infants’s health. Breastfeeding brings significant benefits to both mothers and babies, such as reducing postpartum complications and promoting neuropsychomotor and immunological development in the baby. However, there are situations that may hinder breastfeeding, such as low milk production or the mother’s health conditions, which requires the use of formula. This work conducts an integrative review of the forms of breastfeeding and the circumstances that may influence the choice of the most suitable method for mothers and babies in the first six months of life. The methodology involved analyzing articles published between 2010 and 2024 in various databases. The results highlight that breastfeeding is the ideal form of nutrition, promoting emotional bonds and nutritional benefits. However, the choice between breastfeeding and formula should consider socioeconomic and health variables. The concluding remarks reaffirm that exclusive breastfeeding is the WHO recommendation until six months, but the introduction of formula may be necessary in specific cases. Contraindications to breastfeeding are discussed, emphasizing the importance of individualized decisions to ensure the child’s well-being.

A comprehensive assessment of gold leaching wastewater through pollution and water quality indices. Case study: Small scale extraction facilities in the department of Caldas—Colombia

This study introduced a comprehensive methodology (the Six-Indices method for Water Pollution Assessment) to evaluate the quality of gold leaching effluents. Sampling was conducted for 14 months in small-scale gold mining facilities in the department of Caldas, Colombia. 23 physicochemical parameters were selected based on environmental regulations, standards of use for agricultural purposes and WHO recommendations. They covered general characteristics of effluents and critical inputs of the leaching process. 15 (pH, COD, TSS, CN−, Cl−, SO42−, S2−, Cd, Zn, Cu, Cr, Fe, Ni, Ag, and Pb) of them exceeded permissible limits. Multivariate statistical analysis (Person's correlation and hierarchical clustering analysis) and six Wastewater Quality Indices (WWQIs: Arithmetic Weighted Water Quality Index, WAWQI, Synthetic Pollution Index, SPI, Index of Water Pollution, WPI, Comprehensive Pollution Index, CPI, Heavy Metal Pollution Index, HPI, and Degree of Pollution, Cd) were used to comprehensively assess the effluent contamination. Key pollutant interactions (hydrocarbons & fats and oils, Zn & CN−, Cu & Cl−, as well as CN− & COD & SO42−) were revealed guiding targeted mitigation strategies. CN− and heavy metals were the main pollutants, posing serious environmental risks due to their high levels. The calculated HPI value was above the critical level of 100, indicating that the artisanal gold leaching operations in the studied area could be hazardous to human health. This study provides a starting point for developing effective and sustainable strategies to manage wastewater in mining regions in Colombia and other areas with similar mining practices.