WHO Global Research Articles

Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary.

Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. Protocol Registry: PROSPERO CRD42017055549.

Operational lessons learned in conducting an international study on pharmacovigilance in pregnancy in resource-constrained settings: The WHO Global Vaccine safety Multi-Country collaboration project

The WHO Global Vaccine Safety Multi-Country Collaboration study on safety in pregnancy aims to estimate the minimum detectable risk for selected perinatal and neonatal outcomes and assess the applicability of standardized case definitions for study outcomes and maternal immunization in low- and middle-income countries (LMICs). This paper documents the operational lessons learned from the study.A prospective observational study was conducted across 21 hospitals in seven countries. All births occurring at sites were screened to identify select perinatal and neonatal outcomes from May 2019 to August 2020. Up to 100 cases per outcome were recruited to assess the applicability of standardized case definitions. A multi-pronged study quality assurance plan was implemented. The impact of the COVID-19 pandemic on site functioning and project implementation was also assessed.Multi-layered ethics and administrative approvals, limited clinical documentation, difficulty in identifying outcomes requiring in-hospital follow-up, and poor quality internet connectivity emerged as important barriers to study implementation. Use of electronic platforms, application of a rigorous quality assurance plan with frequent interaction between the central and site teams helped improve data quality. The COVID-19 pandemic disrupted data collection for up to 6 weeks in some sites.Our study succeeded in establishing an international hospital-based surveillance network for evaluating perinatal and neonatal outcomes using common study protocol and procedures in geographically diverse sites with differing levels of infrastructure, clinical and health-utilization practices. The enhanced surveillance capacity of participating sites shall help support future pharmacovigilance efforts for pregnancy interventions.

The Analysis of Trends of Preschool Child Stunting, Wasting and Overweight in the Eastern Mediterranean Region: Still More Effort Needed to Reach Global Targets 2025.

This study was undertaken to analyze and compare Eastern Mediterranean (EM) countries in achievement of WHO nutrition global targets for children growth indicators by 2025. A total of 108 national surveys from 20 countries in EM region were analyzed to estimate the prevalence of stunting and wasting and 93 surveys to estimate the prevalence of overweight/obesity in children. These data were obtained from national surveys included in the WHO Global Database on Child Growth and Malnutrition. In EM region, the prevalence of childhood stunting was estimated to have a 38% decline from 2000 (34.7%) to 2025 (21.2%). Only three countries in EM region (Iran and Jordan, Saudi Arabia) were anticipated to achieve the expected WHO target by 2025. From 2000 to 2020, the prevalence of wasting decreased from 6.9 to 5.3. Six countries were presumed to achieve the expected WHO target by 2025. Nine countries will presumably have overweight rates >5% (Djibouti, Egypt, Iraq, Kuwait, Lebanon, Libya, Morocco, Syrian Arab Republic and Tunisia) in 2025 whereas five countries will have overweight rates above 10% (Egypt, Libya, Morocco, Syrian Arab Republic and Tunisia). Despite descending trends of child stunting and wasting and a secular trend of child obesity in EM region, it is expected that WHO targets will not be achieved by 2025. A diverse socio-economic condition in EM countries necessitates different action plans. International determination, political commitment and, above all, involvement of the families are needed to achieve 2025 targets for child stunting, wasting and overweight/obesity.

Prevalence of childhood exposure to intimate partner violence in low-income and lower-middle-income countries: a systematic review

ObjectiveTo determine the proportion of children in low-income and lower-middle-income countries exposed to intimate partner violence (IPV).DesignSystematic review.Data sourcesPubMed, CINAHL, ERIC, PsycINFO, Web of Science, WHO Global Index Medicus, and...

A national initiative to promote public involvement in medicine safety in Scotland: the use of a population survey to identify candidate behaviours for intervention development

Abstract Introduction Medicines are the most commonly used healthcare intervention (1). Every medicine has benefits and harms. One of the five objectives of the WHO Global Patient Safety campaign, Medication Without Harm, is to “empower patients, families and their carers to become actively involved and engaged in treatment or care decisions, ask questions, spot errors and effectively manage their medications” (2). Effective strategies are needed to promote greater public involvement in the safe and effective use of medicines. Aim The aim of this study was to explore the prevalence of public behaviour in terms of information-/advice-seeking about medicines in general, newly prescribed medicines, and pain management including their use of oral, over-the-counter (OTC) analgesics. The survey also included exploration of self-reported behaviour regarding their use of pharmacies and OTC analgesics. Methods A cross-sectional online survey of 1000 adults (aged >16years) in Scotland was undertaken in collaboration with Ipsos MORI. The content was informed by a multi-stakeholder prioritisation event (held in November 2019) and supplemented with information from earlier studies, including national surveys using Citizen Panels. The following themes were included in the questionnaire: The data were input online by respondents then cleaned and weighted by Ipsos Mori using random iterative method (RIM) weighting to the known offline population proportions for age, gender, region and working status. All data were analysed and presented using descriptive statistics. Results Most respondents (78%, n=777) had used a pharmacy in the previous 12 months to obtain a prescription medicine and slightly fewer (61%, n=610) to obtain an OTC medicine. Low levels of information- and advice-seeking were reported especially on receipt of new prescription medicines. Few (5%) respondents ‘always’ discussed their new prescription medicine with pharmacy staff and 29% reported ‘never’ engaging in this behaviour. Older people (> 35 years) were less likely to engage in this behaviour. Up to 65% of respondents reported ‘always’ engaging with specific aspects of the appropriate use of OTC analgesics e.g. appropriate dose. Potentially unsafe behaviours were identified with medicine disposal. Nearly one third (29%) of respondents considered waste bin disposal to be of low or no harm, and 19% considered disposal of medicines via the toilet/sink to be of low/no harm. Conclusion Despite the extensive use of pharmacies, low levels of information-/advice-seeking were reported especially on receipt of new prescription medicines. Potentially unsafe behaviours were also identified with medicine use and disposal. The key determinants of these behaviours will be explored in more detail and theory-based interventions will be developed and tested to evaluate their effect. Respondent opinion (positively or negatively) regarding their perceptions regarding community pharmacies and/or pharmacy personnel could have been influenced by the increased use and/or awareness of community pharmacy services due to the pandemic. References (1) National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE Guidelines [NG5]. 2015. https://www.nice.org.uk/guidance/ng5 (accessed 13/10/2021). (2) Medication without harm - Global patient safety challenge on medication safety. Geneva: World Health Organization, 2017. Licence: CCBY-NC-SA3.0IGO.

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs)....

New global WHO postnatal guidance is welcome but misses the long-term perspective

Despite high rates of maternal mortality, widespread and persistently severe maternal morbidity, and suboptimum breastfeeding rates,1–3 postnatal care attracts little attention from policy makers. The WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience,4 issued on March 30, 2022, are therefore important. Recommendations intended for healthy women and newborn babies reflect a human rights-based approach to support a positive postnatal experience that accords with the WHO vision for better-quality maternity care5 and complements existing WHO pregnancy and birth guidance.

Sodium in the New Zealand diet: proposed voluntary food reformulation targets will not meet the WHO goal of a 30% reduction in total sodium intake

PurposeTo simulate the potential impact of the HeartSAFE 2020 programme, a food reformulation initiative by the New Zealand (NZ) Heart Foundation, on sodium intake in the NZ adult population.MethodsA representative sample of NZ adults aged 15 years and older completed a 24-h diet recall survey, with 25% of participants completing a second diet recall, in the 2008/09 New Zealand Adult Nutrition Survey (n = 4721). These data were used to estimate sodium intakes of participants. The effect of altering the sodium content of 840 foods in 17 categories and 35 sub-categories included in the NZ HeartSAFE 2020 programme was simulated. The simulated sodium intake reductions in each food sub-category for the entire sample were calculated. Using sampling weights, simulated reductions in population sodium intake and by sociodemographic subgroups were also analysed.ResultsSodium intake from foods included in the HeartSAFE 2020 programme was 1307 mg/day (95% CI 1279, 1336) at baseline. After applying the HeartSAFE 2020 targets, potential sodium intake was 1048 mg/day (95% CI 1024, 1027). The absolute sodium reduction was 260 mg/day (95% CI 252, 268), corresponding to 20% sodium reduction for the foods included in the NZ HeartSAFE programme.ConclusionCurrent sodium targets featured in the NZ HeartSAFE programme will not meet the 30% sodium intake reduction set out by the WHO Global Action Plan. A more comprehensive strategy consistent with the WHO SHAKE Technical Package is needed to advance the goal of sodium intake reduction.

PECULIARITIES OF TREATMENT AND PREVENTION OF INFECTION CAUSED BY HEPATITIS C VIRUS. Review

Relevance. The goal of the WHO Global Strategy on Hepatitis Agents, in particular hepatitis C virus, is to identify infected people early for treatment and prevention of chronic infection. Early detection and treatment of this infection with direct antiviral drugs significantly reduces the incidence of liver cirrhosis and subsequent deaths. Development of an effective hepatitis C vaccine that can primarily protect at-risk individuals is ongoing.
 Objective: to determine the main approaches for the treatment and prevention of hepatitis C, proposed by WHO, which can lead to the prevention of the formation of chronic forms of the disease and the development of hepatocarcinoma.
 Methods. Analysis of publications from scientometric databases PubMed, Google Scolar, Cohrane Database by keywords. Search depth is 10 years (2011–2021).
 Results. Analysis of literature sources about the peculiarities of the treatment of C viral hepatitis showed the feasibility of using drugs with direct antiviral action. Selection of such drugs in order the structural features of the pathogen and specificity of inhibition of the stages of viral reproduction process is discussed and justified. The specificity of the action of these drugs and the main targets of their application are considered. Today, WHO recommends the using of thirteen antiviral drugs with direct action. Two preparations are inhibitors of viral polymerase and the other eleven drugs inhibit of the viral proteases activity. Two direct-acting drugs with a different mechanism of activity are used in the therapeutic schemes. The genotype of the virus, the age and state of health of the patients, especially liver state, have to be considered during the treatment process. This treatment allows to get a positive result without using of interferon, which can cause some complication. Prospects with using new technologies for the creation of effective drugs for the specific prevention of hepatitis C, such as recombinant vaccines, nanovaccines, mRNA containing modified vaccines are considered. Such vaccines will allow to provide specific prophylaxis, especially among people from risk groups, including those with immunodeficiency states.
 Conclusions. The application of the global strategy proposed by WHO such as early detection and treatment of acute hepatitis C for prevention of the development of chronic forms will lead to a decrease in the incidence of hepatitis in the world.

Progressive disseminated histoplasmosis in HIV-positive patients.

Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection. Describe general aspects and challenges of this disease and its association with HIV. Review of literature. Articles found using different combinations of terms including "disseminated histoplasmosis" and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database. We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients. Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus encountered throughout the world, mainly in soil enriched with bat and bird excreta. Progressive disseminated histoplasmosis is the main presentation of this mycosis in people living with advanced HIV and is fatal if left untreated. Symptoms include a systemic disease characterized by fever, weight loss, night sweats, skin manifestations, hepatomegaly, splenomegaly, and septic shock. Diagnostic tests include culture, visualization of H. capsulatum by direct and histopathological examination, serology, antigen, molecular, and skin testing. Patients with disseminated disease require aggressive and prolonged treatment to eradicate the pathogen and include amphotericin B and itraconazole. In many low income countries of endemic regions, histoplasmosis in HIV-positive patients is often undiagnosed or misdiagnosed as another opportunistic infection, due to the similarity in clinical manifestations and to the paucity of better diagnostic tests. Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.

Ultrasensitive molecular tests for Plasmodium detection: applicability in control and elimination programs and reference laboratories.

ABSTRACTObjective.To evaluate molecular tools to detect low-level parasitemia and the five species of Plasmodium that infect humans for use in control and elimination programs, and in reference laboratories.Methods.We evaluated 145 blood samples from patients who tested positive by nested polymerase chain reaction (nPCR), from asymptomatic individuals and from the WHO Global Malaria Programme/United Kingdom National External Quality Assessment Service. Samples were assayed using the genus-specific RealStar® Malaria PCR Kit 1.0 (alt-Gen; altona Diagnostics) and the RealStar® Malaria Screen & Type PCR Kit (alt-S&T; altona Diagnostics). The results from the molecular tests were compared with those from quantitative PCR (qPCR), nPCR and thick blood smear.Results.The levels of parasitemia ranged from 1 to 518 000 parasites/µL, depending on the species. Compared with nPCR, alt-S&T had a sensitivity of 100%, except for identifying P. falciparum, for which the sensitivity was 93.94%. All samples positive by alt-Gen were also positive by nPCR. When comparing alt-Gen to qPCR, the sensitivity was 100% for P. vivax, P. malariae and P. falciparum. For all Plasmodium species, the correlation between cycle threshold values of alt-S&T and alt-Gen compared with qPCR was significant (P < 0.0001, Spearman’s test), with r = 0.8621 for alt-S&T and r = 0.9371 for alt-Gen. When all Plasmodium species were considered, there was a negative correlation between the level of parasitemia and real-time PCR cycle threshold values (P < 0.0001). In this study, only 2 of 28 samples from asymptomatic individuals were positive by thick blood smear; however, all 28 of these samples were positive by alt-S&T.Conclusions.The alt-Gen and alt-S&T assays are suitable for detecting submicroscopic infections for distinct epidemiological purposes, such as for use in surveys and reference laboratories, and screening in blood banks, which will contribute to global efforts to eliminate malaria.

A new generation of long-lasting insecticidal nets

The scale-up of malaria interventions over the past two decades has resulted in substantial reductions in malaria burden, especially in sub-Saharan Africa, which accounts for 95% of the global malaria burden. 1 Bhatt S Weiss DJ Cameron E et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature. 2015; 526: 207-211 Crossref PubMed Scopus (1439) Google Scholar , 2 WHOWorld malaria report 2020: 20 years of global progress and challenges. https://www.who.int/publications/i/item/9789240015791Date: Nov 30, 2020 Date accessed: December 5, 2021 Google Scholar Between 2000 and 2019, an estimated 1·5 billion malaria cases and 7·6 million malaria deaths were averted, with many of the early gains attributed to widescale deployment of insecticide-treated nets and availability of effective drugs. 1 Bhatt S Weiss DJ Cameron E et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature. 2015; 526: 207-211 Crossref PubMed Scopus (1439) Google Scholar However, progress in global malaria control and elimination efforts have stagnated in recent years, the reasons for which are multifactorial and include the development and spread of insecticide resistance in malaria vectors. The massive scale-up of insecticide-treated nets and, later, long-lasting insecticidal nets (LLINs), which have an insecticide incorporated into the net fibre and can last longer under typical use, was accompanied by the emergence of vector resistance to pyrethroids. 3 Hancock PA Hendriks CJM Tangena JA et al. Mapping trends in insecticide resistance phenotypes in African malaria vectors. PLoS Biol. 2020; 18e3000633 Crossref PubMed Scopus (37) Google Scholar This resistance is now present in all primary vectors throughout much of sub-Saharan Africa. 3 Hancock PA Hendriks CJM Tangena JA et al. Mapping trends in insecticide resistance phenotypes in African malaria vectors. PLoS Biol. 2020; 18e3000633 Crossref PubMed Scopus (37) Google Scholar , 4 Knox TB Juma EO Ochomo EO et al. An online tool for mapping insecticide resistance in major Anopheles vectors of human malaria parasites and review of resistance status for the Afrotropical region. Parasit Vectors. 2014; 7: 76 Crossref PubMed Scopus (86) Google Scholar , 5 Moyes CL Athinya DK Seethaler T et al. Evaluating insecticide resistance across African districts to aid malaria control decisions. Proc Natl Acad Sci USA. 2020; 117: 22042-22050 Crossref PubMed Scopus (17) Google Scholar Studies have shown that a new generation of LLINs that include the synergist piperonyl butoxide have improved efficacy compared with pyrethroid-only nets. 6 WHOGlobal plan for insecticide resistance management in malaria vectors. https://apps.who.int/iris/handle/10665/44846Date: 2012 Date accessed: December 5, 2021 Google Scholar , 7 Mosha JF Kulkarni MA Lukole E et al. Effectiveness and cost-effectiveness against malaria of three types of dual-active-ingredient long-lasting insecticidal nets compared with pyrethroid-only long-lasting insecticidal nets in an area with pyrethroid-resistant mosquitoes in Tanzania: a four-arm, cluster-randomised trial. Lancet. 2022; 399: 1227-1241 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar However, although piperonyl butoxide can restore susceptibility in pyrethroid-resistant mosquito populations wherein the primary resistance mechanism is metabolic detoxification by oxidase enzymes, it has minimal impact on other mechanisms of pyrethroid resistance. Insecticide-treated nets with novel active ingredients and different modes of action are needed. The WHO Global Plan for Insecticide Resistance Management recommends the use of two or more compounds of different insecticide classes to make a single product or formulation as an approach to combating resistance. 6 WHOGlobal plan for insecticide resistance management in malaria vectors. https://apps.who.int/iris/handle/10665/44846Date: 2012 Date accessed: December 5, 2021 Google Scholar The challenge is developing products that are not only effective against pyrethroid-resistant mosquitoes but are also safe to humans and are amenable to incorporation into the net fibres. Effectiveness and cost-effectiveness against malaria of three types of dual-active-ingredient long-lasting insecticidal nets (LLINs) compared with pyrethroid-only LLINs in Tanzania: a four-arm, cluster-randomised trialAfter 2 years, chlorfenapyr LLINs provided significantly better protection than pyrethroid-only LLINs against malaria in an area with pyrethroid-resistant mosquitoes, and the additional cost of these nets would be considerably below plausible cost-effectiveness thresholds ($292–393 per DALY averted). Before scale-up of chlorfenapyr LLINs, resistance management strategies are needed to preserve their effectiveness. Poor textile and active ingredient durability in the piperonyl butoxide and pyriproxyfen LLINs might have contributed to their relative lack of effectiveness compared with standard LLINs. Full-Text PDF Open Access

Complementary feeding practices and the associated risk of childhood obesity among ethnic minority groups living in high-income countries: protocol for a systematic review and meta-analysis

IntroductionComplementary feeding (CF) is defined as the period from when exclusive breast milk and formula are no longer sufficient for meeting the infant’s nutritional needs. The CF period occurs from...

A study to evaluate and compare the effectiveness of quality of life in patient with COPD by upper limb exercise training program: An experimental study

Background: COPD is one of the world's leading causes of morbidity and mortality. In Early 2020 COPD was the fourth leading cause of death worldwide, it has now become the third leading cause of death after 2020. In fact, COPD already has surpassed cerebro vascular disease to become the third leading cause of death in the United States. In addition, COPD is now recognized as a life-limiting illness that imposes significant symptom burden on those with the disease [1]. India also contributes a significant and growing percentage of COPD mortality which is estimated to be amongst the highest in the world; i.e. more than 64.7 estimated age standardized death rate per 100,000 amongst both sexes as mentioned in the WHO Global InfoBase Updated on 20th January 2011 (India 102.3 and China 131.5). This would translate into approximately 5,56,000 in case of India (>20%) and 1,354,000 cases in China (about 50%) out of a world total of 2,748,000 annually [2]. Aims and Objectives: To measure and compare the association between QoL and upper limb muscle strength and endurance.Material and Methods: The present study was carried out in the department of Pulmonary Medicine, and its allied specialties in Gauhati Medical College and Hospital as well as Rahman Hospital, Pvt Ltd. It was a prospective observational study carried out for a period of about three year from March 2016 to July 2019. After getting the approval from Institutional Human Ethical Committee. All patients diagnosed with COPD above 40 years of age irrespective of gender and giving proper written informed consent were included in this study. Results: In the study, a total of 100 patients diagnosed with COPD were included. Initially at first visit, the average hand grip muscle strength was found to be 33.52±5.57 kg but it significantly increased after 8 weeks of continuous upper limb exercise training with hand held dynamometer and elastic band exercises to 39.23±5.39 kg. On first visit the mean MMRC grading of Dyspnea was 2.28±0.45.On doing regular exercise with the hand held dynamometer and elastic band for duration of eight weeks, the main MMRC grading significantly improved to 1.45±0.5.Conclusion: In the present study it was observed that upper limb exercise training with hand held dynamometer and elastic band for the patients with COPD improves upper limb exercise capacity, decreases dyspnea grading in a significant manner. So upper limb exercise training programme should be included for treatment regimen in COPD patients along with the pharmacotherapy in order to improve quality of life.

Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019

SummaryBackgroundHand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.MethodsFrom Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation.Findings3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248–430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55–100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35–75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated.InterpretationMost health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all.FundingWHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19).

Little is known about the effect of the COVID-19 pandemic on antimicrobial consumption worldwide. To describe the impact of the WHO Global Action Plan on Antimicrobial Resistance (GAP-AMR) on antimicrobial consumption pre-pandemic and to evaluate the impact of the COVID-19 pandemic on antimicrobial consumption worldwide. A cross-sectional time-series analysis using a dataset of monthly purchases of antimicrobials (antibiotics, antivirals and antifungals) from August 2014 to August 2020. Antimicrobial consumption per 1000 population was assessed pre-pandemic by economic development status using linear regression models. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes with pandemic declaration (March 2020) and during its first stage from April to August 2020, worldwide and by country development status. Prior to the pandemic, antimicrobial consumption decreased worldwide, with a greater apparent decrease in developed versus developing countries (-8.4%, P = 0.020 versus -1.2%, P = 0.660). Relative to 2019, antimicrobial consumption increased by 11.2%, P < 0.001 in March 2020. The greatest increase was for antivirals in both developed and developing countries (48.2%, P < 0.001; 110.0%, P < 0.001) followed by antibiotics (6.9%, P < 0.001; 5.9%, P = 0.003). From April to August 2020, antimicrobial consumption decreased worldwide by 18.7% (P < 0.001) compared with the previous year. Specifically, antibiotic consumption significantly decreased in both developed and developing countries (-28.0%, P < 0.001; -16.8%, P < 0.001). The global decrease in antimicrobial consumption pre-pandemic suggests a positive impact of the WHO GAP-AMR. During the pandemic, an initial increase in antimicrobial consumption was followed by a decrease worldwide. AMR plans should specify measures to ensure full implementation of AMR efforts during health crises such as the COVID-19 pandemic.

P04 An evaluation of antimicrobial stewardship education in the School of Pharmacy of an Irish university—a mixed methods study

BackgroundAntimicrobial stewardship (AMS) is essential to control the emergence of antimicrobial resistance (AMR) which has become an international health priority. Education of undergraduate students on AMS and AMR is a strategic objective in the WHO Global Action Plan on AMR and Ireland's National Action Plan.1,2 Research on AMS/AMR education has focused primarily on medical students with less emphasis on those from other healthcare profession including pharmacy students.ObjectivesTo investigate AMS and AMR education in the Pharmacy undergraduate programme in the School of Pharmacy of an Irish University.MethodsA mixed methods study was conducted. Ten semi-structured interviews were conducted in October 2019 with academic staff to capture their views on AMS education. Participants included staff members from different disciplines, those identified as involved in teaching elements of infectious disease, antibiotics, AMS and related topics, and those involved in curriculum design and approval within the School of Pharmacy. Interview transcripts were analysed by thematic analysis. An electronic survey of 17 questions was emailed to all second to fifth year UCC Pharmacy students in October 2019 to gather students’ views and experiences of AMS education. The survey contained four sections which addressed demographics, AMS, resources and education using open-ended, closed-ended or Likert-scale questions. Ethical approval was obtained.ResultsSix key themes were identified from the ten interviews: (i) curriculum priorities and capacity; (ii) housing of the subject, fragmentation and cohesion; (iii) integration; (iv) communication; (v) teaching methods; and (vi) assessment methods. 113 students participated in the survey (32.3% response rate). 96% agree that a strong knowledge of antimicrobials for their future careers is important, and over 89% of students desire more education on AMR and AMS. Only 43% of students found their AMS education provided sufficient preparation for practice. Students felt most prepared to recognize clinical signs of infection and least prepared for IV to oral switching, interpreting biological marker and de-escalation of antimicrobials. Over 50% of students never used or were not familiar with the national primary care antimicrobial guidelines: www.antibioticprescribing.ie.ConclusionsPharmacy students and staff agree that AMS and AMR are important and need enhanced educational focus. Students feel there are gaps in their AMS education and expressed a desire for more education in this area. Improved communication and identification of curriculum priorities by staff could help to establish a more cohesive and comprehensive educational approach to this area.

Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage.

PURPOSEThe global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer.METHODSA narrative literature review of collaborative groups performing pediatric cancer clinical research in each continent was conducted. An inventory of research groups was assembled and reviewed by current pediatric cancer regional and continental leaders. Each group was narratively described with identification of common structural and research themes among consortia.RESULTSThere is wide variability in the structure, history, and goals of pediatric cancer clinical trial collaborative groups internationally. Several continental regions have longstanding endogenously-formed clinical trial groups that have developed and published numerous adapted treatment regimens to improve outcomes, whereas other regions have consortia focused on developing foundational database registry infrastructure supported by large multinational organizations or twinning relationships.CONCLUSIONThere cannot be a one-size-fits-all approach to increasing collaboration between international pediatric cancer clinical trial groups, as this requires a nuanced understanding of local stakeholders and resources necessary to form partnerships. Needs assessments, performed either by local consortia or in conjunction with international partners, have generated productive clinical trial infrastructure. To achieve the goals of the Global Initiative for Childhood Cancer, global partnerships must be sufficiently granular to account for the distinct needs of each collaborating group and should incorporate grassroots approaches, robust twinning relationships, and implementation science.

Paediatric chronic pain prevalence in low- and middle-income countries: A systematic review and meta-analysis.

SummaryBackgroundChronic pain is a leading cause of morbidity in children and adolescents globally, with a significant impact on quality of life. This is the first systematic review and meta-analysis on paediatric chronic pain in low- and middle-income countries (LMICs).MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE (via PubMed), Embase, CINAHL, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, and the WHO Global Index Medicus for all studies published prior to January 7, 2022. Articles published in all languages that included populations age 19 years and under living in LMICs were considered. Chronic pain was defined as persistent or recurrent pain that is present for ≥3 months, per the International Classification of Diseases (ICD-11) definition. Summary data were extracted from published reports and evaluated with mixed-effects regression analysis. PROSPERO Record ID: CRD42021227967.FindingsOf the 2875 studies identified, 70 articles were reviewed, with 27 studies representing 20 LMICs eligible for analysis. The average prevalence for each pain type reported with 95% confidence interval is as follows: general/multi-site/any 20% (16–25), musculoskeletal (MSK) pain 9% (7–13), abdominal pain 7% (5–10), headache 4% (2–10), and fibromyalgia per American College of Rheumatology or Yunus and Masi criteria 3% (1–10). Overall, a pooled mean of 8% chronic pain was estimated across all studies. A significantly high level of heterogeneity was found across all studies (I2 >90%). Chronic headache (OR=1·65, 95% CI 1·39–1·96), abdominal pain (OR=1·36, 95% CI 1·22–1·51), and generalized/multi-site pain (OR=1·54, 95% CI 1·31–1·81) were significantly more prevalent in females than males.InterpretationThe characterization of paediatric chronic pain in low- and middle-income countries suffers from a paucity of data and significant heterogeneity in the assessment methods. Understanding the global burden of chronic pain in this group should be prioritized.FundingNone.

How older people experience the age-friendliness of The Hague: A quantitative study

The municipality of The Hague has been a member of the WHO's Global Network for Age-Friendly Cities and Communities since 2015. The municipality commissioned a survey to investigate how older citizens view the age-friendliness of their city. A cross-sectional survey was conducted among a diverse sample of 393 community-dwelling older citizens. The survey made use of the Age Friendly Cities and Communities Questionnaire (AFCCQ), and multilevel regression techniques to investigate how social groups differ on the domains of the AFCCQ. The Hague scored a satisfied as an overall score (16.9 ± 8.87), and a satisfied on social participation (2.6 ± 2.46), civic participation and employment (1.4 ± 1.34), communication and information (1.4 ± 1.32), respect and social inclusion (1.6 ± 1.59), community support and health services (2.7 ± 2.79), transportation (1.7 ± 1.26) and financial situation (1.9 ± 1.26). The Hague has an above-average score in the field of housing (2.4 ± 1.06). For Outdoor spaces and buildings, the municipality scores a moderate positive score (0.9 ± 1.41). Significant differences were found for sex, age, socio-economic position, receiving care support, and use of mobility aids. The findings show that older people have different perceptions regarding their city's age-friendliness. Policy makers must acknowledge this heterogeneity among their older citizens and adapt city policies accordingly.