WHO Policy Research Articles

Resilience in family caregivers of Asian older people with dementia: An integrative review.

To identify factors associated with resilience in family caregivers of Asian older people with dementia based on Luthar and Cicchetti's definition of resilience. Integrative review of resilience in family caregivers of Asian older people with dementia reported by studies with quantitative and qualitative research designs. Databases used for the literature search included CINAHL, PubMed, EMBASE, PsycINFO and Google Scholar. A total of 565 potentially relevant studies published between January 1985 and March 2024 were screened, and 27 articles met the inclusion criteria. Family caregivers were most commonly adult children of care recipients, female and providing care in their home. Two themes emerged from the review: factors associated with adversity (dementia severity, caregiver role strain, stigma, family stress, female gender, low income and low education) and factors associated with positive adaptational outcomes (positive aspect of caregiving, social support and religiosity/spirituality). In our review of Asian research, four new factors-caregiver role strain, stigma, family stress and positive aspects of caregiving-emerged alongside those previously identified in Western studies. A paradigm shift was observed from a focus on factors associated with adversity to factors associated with positive adaptational outcomes, particularly after the issuance of the WHO's 2017 global action plan for dementia. However, a gap remains between WHO policy recommendations and actual research, with studies often neglecting to address gender and socioeconomic factors. The review findings will broaden healthcare providers' understanding of resilience in dementia caregivers and use them to develop comprehensive programmes aimed at reducing factors associated with adversity and enhancing those associated with positive adaptational outcomes. This approach can be customized to incorporate Asian cultural values, empowering caregivers to navigate challenges more effectively. This paper is an integrative review and does not include patient or public contributions.

Safety and efficacy of malaria vaccine candidate R21/Matrix-M in African children: a multicentre, double-blind, randomised, phase 3 trial

Recently, we found that a new malaria vaccine, R21/Matrix-M, had over 75% efficacy against clinical malaria with seasonal administration in a phase 2b trial in Burkina Faso. Here, we report on safety and efficacy of the vaccine in a phase 3 trial enrolling over 4800 children across four countries followed for up to 18 months at seasonal sites and 12 months at standard sites. We did a double-blind, randomised, phase 3 trial of the R21/Matrix-M malaria vaccine across five sites in four African countries with differing malaria transmission intensities and seasonality. Children (aged 5-36 months) were enrolled and randomly assigned (2:1) to receive 5 μg R21 plus 50 μg Matrix-M or a control vaccine (licensed rabies vaccine [Abhayrab]). Participants, their families, investigators, laboratory teams, and the local study team were masked to treatment. Vaccines were administered as three doses, 4 weeks apart, with a booster administered 12 months after the third dose. Half of the children were recruited at two sites with seasonal malaria transmission and the remainder at standard sites with perennial malaria transmission using age-based immunisation. The primary objective was protective efficacy of R21/Matrix-M from 14 days after third vaccination to 12 months after completion of the primary series at seasonal and standard sites separately as co-primary endpoints. Vaccine efficacy against multiple malaria episodes and severe malaria, as well as safety and immunogenicity, were also assessed. This trial is registered on ClinicalTrials.gov, NCT04704830, and is ongoing. From April 26, 2021, to Jan 12, 2022, 5477 children consented to be screened, of whom 1705 were randomly assigned to control vaccine and 3434 to R21/Matrix-M; 4878 participants received the first dose of vaccine. 3103 participants in the R21/Matrix-M group and 1541 participants in the control group were included in the modified per-protocol analysis (2412 [51·9%] male and 2232 [48·1%] female). R21/Matrix-M vaccine was well tolerated, with injection site pain (301 [18·6%] of 1615 participants) and fever (754 [46·7%] of 1615 participants) as the most frequent adverse events. Number of adverse events of special interest and serious adverse events did not significantly differ between the vaccine groups. There were no treatment-related deaths. 12-month vaccine efficacy was 75% (95% CI 71-79; p<0·0001) at the seasonal sites and 68% (61-74; p<0·0001) at the standard sites for time to first clinical malaria episode. Similarly, vaccine efficacy against multiple clinical malaria episodes was 75% (71-78; p<0·0001) at the seasonal sites and 67% (59-73; p<0·0001) at standard sites. A modest reduction in vaccine efficacy was observed over the first 12 months of follow-up, of similar size at seasonal and standard sites. A rate reduction of 868 (95% CI 762-974) cases per 1000 children-years at seasonal sites and 296 (231-362) at standard sites occurred over 12 months. Vaccine-induced antibodies against the conserved central Asn-Ala-Asn-Pro (NANP) repeat sequence of circumsporozoite protein correlated with vaccine efficacy. Higher NANP-specific antibody titres were observed in the 5-17 month age group compared with 18-36 month age group, and the younger age group had the highest 12-month vaccine efficacy on time to first clinical malaria episode at seasonal (79% [95% CI 73-84]; p<0·001) and standard (75% [65-83]; p<0·001) sites. R21/Matrix-M was well tolerated and offered high efficacy against clinical malaria in African children. This low-cost, high-efficacy vaccine is already licensed by several African countries, and recently received a WHO policy recommendation and prequalification, offering large-scale supply to help reduce the great burden of malaria in sub-Saharan Africa. The Serum Institute of India, the Wellcome Trust, the UK National Institute for Health Research Oxford Biomedical Research Centre, and Open Philanthropy.

Assessment of the clinical and analytical performance of three Seegene Allplex SARS-CoV-2 assays within the VALCOR framework.

The coronavirus disease 2019 (COVID-19) pandemic demonstrated the need for accurate diagnostic testing for the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the pandemic has ended, accurate assays are still needed to monitor viral spread at national levels and beyond through population and wastewater surveillance. To enhance early detection, SARS-CoV-2 assays should have high diagnostic accuracy and should be validated to assure accurate results. Three distinct SARS-CoV-2 assays were evaluated with clinical samples using the VALCOR (VALidation of SARS-CORona Virus-2 assays) framework, with the TaqPath COVID-19 assay (ThermoFisher Scientific, USA) as a comparator. We evaluated clinical sensitivity, specificity, limit of detection (LOD), and overall concordance between comparator and three index Allplex SARS-CoV-2 assays (Seegene, South Korea): Allplex-SC2, Allplex-SC2Fast (Fast PCR), and Allplex-SC2FabR (SARS-CoV-2/FluA/FluB/respiratory syncytial virus). Analytical performance and LOD of index assays were assessed using a dilution series of three synthetic SARS-CoV-2 sequence reference materials (RMs). Ninety SARS-CoV-2 positives and 90 SARS-CoV-2 negatives were tested. All Allplex assays had 100.0% sensitivity (95%CI = 95.9%-100.0%). Allplex-SC2 and Allplex-SC2Fast assays had 97.8% specificity (95%CI = 92.3%-99.7%) and 98.9% overall concordance [κ = 0.978 (95%CI = 0.947-1.000)]. Allplex-SC2FabR assay showed 100.0% specificity (95%CI = 95.9%-100.0%) and 100.0% overall concordance [κ = 1.000 (95%CI = 1.000-1.000)]. LOD assessment of index assays revealed detection down to 2.61 × 102 copies/mL in clinical samples, while the analytical LOD was 9.00 × 102 copies/mL. In conclusion, the evaluation of the three Seegene Allplex SARS-CoV-2 assays showed high sensitivity and specificity and an overall good assay concordance with the comparator. The assays showed low analytical LOD using RM and even a slightly lower LOD in clinical samples. Non-overlapping target gene sequences between SARS-CoV-2 assays and RMs emphasize the need for aligning targeted sequences of diagnostic assays and RMs.IMPORTANCEThe coronavirus disease 2019 pandemic has a significant impact on global public health, economies, and societies. As shown through the first phases of the pandemic, accurate and timely diagnosis is crucial for disease control, prevention, and monitoring. Though the pandemic phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has concluded, diagnostic assays remain in demand to monitor SARS-CoV-2 at the individual patient level, regionally, and nationally, as well as to remain an infectious disease preparedness instrument to monitor any new SARS-CoV-2 dissemination across borders using population and wastewater surveillance. The anticipation by WHO and central health care policy entities such as the Center for Disease Control, EMA, and multiple national health authorities is that SARS-CoV-2 will reside as an endemic respiratory disease for years to come. The key strategic consideration is hence shifting from combating a pandemic situation with a high number of patients to instead allowing precise diagnostics of suspected patients with the intention of correct management in a low-prevalence setting.

Mental health plans and policies across the WHO European region

Abstract Evidence is scarce in terms of tracking the progress of implementation of mental healthcare plans and policies (MHPPs) in Europe, we aimed to map and analyze the content of MHPPs across the WHO European region. We collected data from the WHO Mental Health Atlas 2011, 2017 and 2020 to map the development of MHPPs in the region. We contacted 53 key informants from each country in the European region to triangulate the data from WHO Mental Health Atlases and to obtain access to the national mental health plans and policies. We analyzed the content of MHPPs against the four major objectives of the WHO Comprehensive Mental Health Action Plan, and we also focused on the specificity and measurability of their targets. The number and proportion of countries which have their own MHPPs has increased from 30 (52%) to 43 (91%) between 2011 and 2020. MHPPs are generally in line with the WHO policy, aiming to strengthen care in the community, expand mental health promotion and illness prevention activities, improve quality of care, increase intersectoral collaboration, build workforce and system capacity, and improve adherence to human rights. However, specific, and measurable targets as well as a description of concrete steps, responsibilities and funding sources are mostly missing. They often contain very little information systems, evidence and research, and mostly lack information on evaluating the implementation of MHPPs. Progress has been made in terms of the development of MHPPs in the WHO Europe. However, MHPPs are often lacking operationalization and appropriate data collection for evaluation. This is then reflected in missing evaluation plans, which in turn leads to lessons not being learned. To enhance the potential for knowledge generation and demonstration of impact, MHPPs should be more specific and contain measurable targets with allocated responsibilities and funding as well as evaluation plans.

Institutional drivers for integrating palliative care services in a hospital in a sub-Saharan African military hospital context.

The growing burden of life-threatening illnesses and advancements in care interventions call for the intentional integration of palliative care services into existing care systems. The absence of active, functioning palliative care services in most hospitals in Ghana is a major concern. This study explored the factors influencing the integration of palliative care services in one of such institutions. The aim of the study was to explore the institutional drivers of palliative care integration in a military health facility. Exploratory qualitative study. We employed a qualitative exploratory study design situated within a constructivist paradigm. A purposive sampling method was used to select and interview 11 healthcare professionals. A semistructured interview was used to conduct face-to-face, in-depth interviews with participants between April and May 2022. A thematic data analysis was done based on the Braun and Clarke analysis process with the aid of QSR NVivo-12. The six themes that describe the institutional driving factors for integrating palliative care services were cognitive restructuring, supportive logistics and infrastructure, staffing, healthcare professional skills, institutional policies and priorities, and utilization of focal persons. It was observed that a paradigm shift in the mindset of healthcare professionals and administrators was a major driver that would determine the integration of palliative care services. A cognitive restructuring will facilitate a more aggressive integration of palliative care services because logistics, staffing, and medication access will be prioritized. Institutions have the responsibility of aligning with the WHO policy on palliative care service access and must invest in training, staffing, prioritizing palliative care needs and policies, procurement of essential drugs, and the provision of logistics and supportive infrastructure to scale up the implementation of palliative care services.

Breaking Barriers: Telemedicine Triumphs and Health Workforce Transformations in Rural Georgia

This manuscript explores the transformative impact of telemedicine on healthcare accessibility in rural Georgia, as revealed in the MID findings of Giorgi Sinauridze. Focused on overcoming geographic challenges, the narrative emphasizes collaborative efforts involving international organizations, the European Union, United Nations agencies, and the Georgian government. The establishment of 50 telemedicine facilities, detailed in Sinauridze's findings, serves as a landmark achievement, addressing healthcare disparities and reaching over 500 previously underserved patients. The article delves into innovative solutions to internet connectivity challenges, community engagement, and the positive impact on patient care. Additionally, it presents a comprehensive health workforce assessment conducted by the WHO Country Office, highlighting demographic trends, workforce remuneration, and strategies for recruitment and retention. The manuscript concludes with WHO policy recommendations, emphasizing the need for a formal health workforce planning mechanism, substantial investment in primary healthcare, and improved data systems. The collaborative success of the telemedicine initiative and insights from the health workforce assessment position Georgia as a model for resilient and responsive healthcare systems globally.

What's Next and the Quest for 2030 SDG Attainment

Abstract Time is running out to achieve the 2030 SDGs. Data are lacking for many SDG indicators, and data are often outdated or presented with a time lag. The WHO European Region is comprised of 53 countries whose health systems and priorities differ; devising a perfect common indicator framework is difficult. The European Programme of Work Measurement Framework is a set of 26 indicators chosen for data availability. The EPWMF reports on the SDG indicators most relevant to the Region. All indicators can be sourced from existing data collections, presenting no extra burden to Member States (MS). WHO proposes two key processes: 1) develop a European Region Health Information Network with membership from all MS and WHO collaborating centers, research institutions, and international organizations. This will improve the quality of health information through international cooperation and knowledge exchange. As the three country stories have shown, we have much to learn from each other. 2) develop a list of SDG indicator areas for which limited data exist across the Region. Main principles: (1) Organize development work as a long-term, institutionalized activity embedded in regular structures and processes of WHO/Europe; (2) Ensure strong involvement of MS so indicators reflect their priorities and any adaptations to data collections are feasible and agreed upon; (3) Ensure strong involvement of international organizations to prevent duplication of work and increased reporting burden; (4) Align development with policy processes to ensure coherence between WHO policy, monitoring and evaluation frameworks and (5) Create flexible structures bringing together relevant experience through working in topic-specific expert groups, utilizing lessons learned from HIS assessments to create realistic indicators that can measure progress. Thus, we will move towards 2030 with a clear plan for developing concrete indicators to ensure all MS can report on the SDGs. Speakers/Panelists Heidi Lyshol Norwegian Institute of Public Health, Oslo, Norway

Healthy nutrition as a disease prevention factor: WHO Policy and National Experience (to mark the 75th anniversary of WHO in Ukraine)

In the context of the constant increase in the burden of chronic non-communicable diseases, the World Health Organization's (WHO) activities are aimed at developing policies and strategies in the field of non-communicable disease (NCD) prevention, which have been continuously evolving. The work is dedicated to examining the sequential policy of the WHO outlined in documents regarding the link between nutrition and the development of non-communicable diseases. The objective of this study is to identify the main stages of WHO's policy on healthy nutrition as a key prerequisite for preventing the development of non-communicable diseases and outline the corresponding measures in Ukraine. Materials and methods: informational, bibliographic, normative-legal. The study utilized systematic-structural, formal-logical, bibliographic, and non-forma­lized (traditional) analysis methods. An analysis of WHO's policy on healthy nutrition as a factor in preventing the development of chronic non-communicable diseases has been conducted. The key stages of policy development and decision-making at the global level over the past three decades have been identified. It has been determined that the evolution of the role of nutrition within WHO's policy has progressed from urging governments to develop national food policies and create national action plans in the 1990s to global strategies and actions that have taken place in the 21st century. The basic WHO documents regarding the link between nutrition and the development of chronic diseases have been examined, as well as the expansion of understanding the content and necessity of healthy nutrition. The implementation of WHO's policy in Ukraine has been highlighted: the "National Action Plan on Non-communicable Diseases to Achieve the Sustainable Development Goals by 2030" (2018) has been developed and implemented, serving as a roadmap for the development of a series of guiding documents. The most important of these documents pertain to the organization and standards of healthy nutrition for children. However, the formation of a national regulatory and legal framework regarding healthy nutrition has not yet been completed. It has been determined that Ukraine needs to improve its policy on limiting the use of saturated fats, industrially produced trans fatty acids, and marketing unhealthy food and non-alcoholic beverages targeted at children. There is a need for extensive informational and educational activities to promote WHO's recommendations on healthy nutrition.

Mapping the Global Adoption of Mandatory Vaccination against COVID-19: A Scoping Review

The coronavirus (COVID-19) pandemic caused sicknesses ranging from mild to deadly, which disrupted lives and healthcare systems across the globe. Despite the availability of vaccines that are effective in significantly reducing the risks of death and severe disease, misperceptions of COVID-19 vaccine safety, efficacy, risks, and mistrust in institutions responsible for vaccination campaigns have been reported as factors contributing to vaccine hesitancy, leading to an unsatisfactory vaccination rate, which resulted in some countries implementing mandatory COVID-19 vaccination to increase vaccine uptake. This scoping review aimed at mapping global countries that have adopted mandatory COVID-19 vaccination and the reaction of citizens. PRISMA Extension for Scoping Reviews was used. Google Scholar was used to identify papers published in English from December 2019 to February 2022, irrespective of their methodology. A total of 140 studies were identified. After screening for duplication, access, and relevance, 24 were eligible for review. Approximately eleven countries implemented mandatory vaccination, mostly among healthcare workers. Citizens’ reactions towards the policy varied, with some in support of the policy but with a preference for the healthcare workers, and some in support but with the condition that it will only apply to travel, schools, and shopping areas, while others rejected the policy. Studies that may be relevant but were excluded due to eligibility criteria may be a limiting factor to this study. Several ethical considerations should be explicitly addressed when evaluating whether mandatory COVID-19 vaccination is an ethically justifiable policy option as recommended by the WHO policy brief.

Pathways to medical abortion self-use (MASU): results from a cross-sectional survey of women’s experiences in Kenya and Uganda

BackgroundIn Kenya and Uganda, unsafe abortions are a leading cause of maternal mortality. The new WHO policy guidelines on the safe termination of pregnancies up to 9 weeks lack information on women’s experiences with self-administered medical abortion (MA), impeding the development of interventions to increase MA use. This study aimed to comprehend women’s experiences with MA in Kenyan and Ugandan pharmacies.MethodsA cross-sectional mixed-methods survey utilized data from medical registers in 71 purposefully identified pharmacies and clinics dispensing MA drugs between September and October 2021. Forty women who were MA users participated in focus group discussions. The main outcome variables were: sources of MA information, costs of MA services, complications from MA, pain management, follow-up rates, and use of post-MA contraception. Quantitative data were analyzed using Stata 15, while qualitative thematic analysis was conducted using Dedoose qualitative analysis software.Results73.6% of 2,366 women got an MA, both in Kenya (79%) and Uganda (21%). Most (59.1%) were walk-in clients. Kenya had significantly more women referred for MA (49.9%) than Uganda (10.1%) (p 0.05). Friends and family members were the main sources of MA information. The median cost of MA was USD 18 (IQR 10–60.5) in Kenya and USD 4.2 (IQR 2–12) in Uganda. Most MA clients received pain management (89.6%), were followed up (81%), and received post-MA contraception (97.6%). Qualitative results indicated a lack of medicines, high costs of MA, complications, stigma, and inadequate training of providers as barriers to MA use.Conclusions and recommendationsCommunities are a valuable information resource for MA, but only if they have access to the right information. A relatively weak health referral system in Uganda highlights the importance of pharmacies and clinicians collaborating to support clients’ abortion needs and contraceptive use after medical abortion (MA). Low client follow-up rates show how important it is to make sure pharmacy technicians know how to give MA correctly. Finally, it is crucial to strengthen the supply chain for MA products in order to eliminate cost barriers to access.

Vector control for malaria prevention during humanitarian emergencies: a systematic review and meta-analysis

Humanitarian emergencies can lead to population displacement, food insecurity, severe health system disruptions, and malaria epidemics among individuals who are immunologically naive. We aimed to assess the impact of different vector control interventions on malaria disease burden during humanitarian emergencies. In this systematic review and meta-analysis, we searched ten electronic databases and two clinical trial registries from database inception to Oct 19, 2020, with no restrictions on language or study design. We also searched grey literature from 59 stakeholders. Studies were eligible if the population was affected by a humanitarian emergency in a malaria endemic region. We included studies assessing any vector control intervention and in which the primary outcome of interest was malaria infection risk. Reviewers (LAM, JF-A, KC, BP, and LP) independently extracted information from eligible studies, without masking of author or publication, into a database. We did random-effects meta-analyses to calculate pooled risk ratios (RRs) for randomised controlled trials, odds ratios (ORs) for dichotomous outcomes, and incidence rate ratios (IRR) for clinical malaria in non-randomised studies. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO, CRD42020214961. Of 12 475 studies screened, 22 studies were eligible for inclusion in our meta-analysis. All studies were conducted between Sept 1, 1989, and Dec 31, 2018, in chronic emergencies, with 616 611 participants from nine countries, evaluating seven different vector control interventions. Insecticide-treated nets significantly decreased Plasmodium falciparum incidence (RR 0·55 [95% CI 0·37-0·79]; high certainty) and Plasmodium vivax incidence (RR 0·69 [0·51-0·94]; high certainty). Evidence for an effect of indoor residual spraying on P falciparum (IRR 0·57 [95% CI 0·53-0·61]) and P vivax (IRR 0·51 [0·49-0·52]) incidence was of very low certainty. Topical repellents were associated with reductions in malaria infection (RR 0·58 [0·35-0·97]; moderate certainty). Moderate-to-high certainty evidence for an effect of insecticide-treated chaddars (equivalent to shawls or blankets) and insecticide-treated cattle on malaria outcomes was evident in some emergency settings. There was very low certainty evidence for the effect of insecticide-treated clothing. Study findings strengthen and support WHO policy recommendations to deploy insecticide-treated nets during chronic humanitarian emergencies. There is an urgent need to evaluate and adopt novel interventions for malaria control in the acute phase of humanitarian emergencies. WHO Global Malaria Programme.

The use of antibacterial preparations in COVID-19 patients

SARS-CoV-2 which initially causes an acute respiratory infection with primary damage to the lungs, has shown that it later causes multiple lesions, being considered a systemic disease. Pneumonia caused by the coronavirus is characterized by the development of a marked inflammatory process by direct damage to the pulmonary alveolocytes, as well as by an imbalance of the innate and adaptive immune status, pro-inflammatory and anti-inflammatory cytokines and chemokines, coagulation and fibrinolysis processes. The empirical use of antibacterial preparations has shown an evolution depending on the epidemiological situation, the data of experimental and clinical studies and the accumulated experience. The excessive prescription of antibiotics was determined by of subjective reasons, and with the accumulation of data confirming coinfections and/‌or secondary infections, the administration of antibacterial preparations was redirected. Beta-lactams, macrolides and fluoroquinolones were the most prescribed antibacterial drugs, for which possible antiviral effects were also estimated (azithromycin etc.). The use of antibiotics from the surveillance and reserve groups, according to WHO policy, was one of the major problems during the pandemic due to the aspect of dangerous microbial resistance. The elucidation of the microbial agents involved in the etiology of bacterial infections in COVID-19 has allowed for a more targeted selection of antibiotics, including regarding the danger of threatening microbial resistance.

A living mapping review for COVID-19 funded research projects: 21 month update

Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There has however been an ongoing need for greater coordination, with limited resources for research and the shifting global pandemic. Methods: The UK Collaborative on Development Research (UKCDR) and Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), two funder coordination groups have collaborated to develop a live database of funded research projects across the world relating to COVID-19. Drawing data continually from their members and further global funding bodies, as of 15 th April 2022 the database contains 16,353 projects, funded by 319 funders, taking place across 157 countries representing an investment of at least $6.2 billion. To our knowledge it is one of the most comprehensive databases. The database is aligned to the World Health Organisation and GloPID-R Global Research Roadmap: 2019 Novel Coronavirus and the UN Research Roadmap for the COVID-19 Recovery. It is being used by the WHO, governments and further policy makers, research funders and researchers. This living mapping review aims to supplement the database by providing an open accessible and frequently updated resource summarising the characteristics of the COVID-19 funded research portfolio. Both descriptive and thematic analysis are presented and updated frequently to aid interpretation of the global COVID-19 funded research portfolio. Results: In this version eight analysis we provide an updated detailed descriptive analysis of the database (on data from three months after version seven) and focus our thematic analysis on research gaps, research areas in need of coordination, study populations and research locations (with a focus on resource-limited countries). Conclusions: As the global funding response to COVID-19 plateaus, this living mapping review helps both funders and researchers to prioritise resources to areas where there is continued unmet research need.

Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia

BackgroundGlobally oral health care is unequally accessible or utilised within culturally and linguistically diverse (CALD) migrant communities. Yet much remains unknown about CALD mothers and their oral healthcare experiences in Australia. Hence, this paper explores the oral health care attitudes and experiences of CALD mothers within the Australian context with the broader objective to reduce oral health inequalities.MethodsQualitative semi-structured interviews were conducted from a social constructivism paradigm. Participants were foreign country born, spoke language/s other than English and have a child. Purposive snowball sampling and recruitment was conducted through CALD organisations and social media. Participants were interviewed for their attitudes and experiences to dental care and frequency of utilisation in Australia and the home country. Interviews were transcribed verbatim and grounded analysis (Strauss and Corbin) performed. Researcher bias was reduced through reflexivity and triangulation.ResultsThe participants (n = 33) included 20 CALD mothers born in India and 13 from either China, Fiji, Nepal, Macedonia and Israel. The theme, experiences with health workforce personnel revealed positive attitudes toward CALD providers from similar cultural and/or linguistic backgrounds. We coin these CALD providers as the ‘dental diaspora’. The dental diaspora facilitated CALD mothers through culture and/or language factors, alleviating cost barriers and flexibility in appointments. Dental travel to the home country was affirmed, however family visitation was the foremost reason for travel.ConclusionThe findings suggest that the dental diaspora plays a significant role in promoting oral health care utilisation for first generation CALD mothers in Australia. This paper brings to light the phenomenon of the ‘dental diaspora’ as an essential health workforce that contributes to addressing inequities in oral healthcare utilisation within CALD migrant communities. Universal health coverage in oral health is further affirmed, as aligned to the WHO policy context.

Integrated Primary Palliative Care in Nigeria- Perspectives of Patients, Families and Providers.

Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary palliative care among people living with serious illness and their families and the readiness of primary healthcare providers to deliver primary palliative care in Nigeria. Qualitative descriptive interview study with 48 participants: people living with serious illness (n=21) and their family caregivers (n=15), healthcare providers (n=12). Data were analysed using thematic analysis. Three major themes were identified. 1.) Engaging patients and families. 2.) Managing patients and families' expectations and preferences. 3.) Addressing staffing-related issues. Patients and families have existing trust and bonds from using primary healthcare but lack individual agency necessary for person-centered care decisions. They expect an easily accessible service, opportunities for social interaction and adequate communication. Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation. Our findings have identified specific approaches to implement the WHO policy on integrated primary palliative care. Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers' roles to ensure staff work within their competencies and training.

Fear-Responses to Bat-Originating Coronavirus Pandemics with Respect to Quarantines Gauged in Relation to Postmodern Thought—Implications and Recommendations

Fear-responses to bat-originating coronavirus pandemics with respect to quarantine imposition are gathered and interpreted from large datasets, identified and disseminated by media. Responses are effectively gauged using postmodern thought with a continuum ranging from people’s resilience to define their own perspectives to public views being socially conditioned from media persistence in maintaining fear. Public responses to the 2003 SARS pandemic generally presumed and supported resilience of citizens’ perspectives. In contrast, from late 2019 to mid-2022, public responses to the COVID-19 pandemic were media-determined, promoting fear. In this regard, reactions to the COVID-19 quarantines are contrasted to the hospital isolations of SARS. The primary source of the difference was the major polarizing influence by social media of the WHO policy makers’ pronouncements and of healthcare providers’ statements directing media spotlight in their guidance of public response to COVID-19 throughout the pandemic, unlike during SARS. An investigation of cognitive bias regarding the psychological and societal implications related to this migration from resilience to fear regarding public responses to novel bat-originating coronavirus pandemics elicits recommendations concerning future quarantine dictates. These recommendations are dependent on appropriate encouragement of hopeful resilience through evidence based practice with respect to one extreme of the postmodern thought continuum.

TB preventive treatment among pregnant women with HIV.

BACKGROUND: The WHO recommends TB preventive treatment (TPT) for people living with HIV, including pregnant women. Uptake of this policy recommendation in this subpopulation and country alignment with WHO guidance is unclear.METHODS: We conducted a policy review in 38 WHO high TB and TB-HIV burden countries to assess if the uptake of TPT policy among pregnant women living with HIV was in line with the WHO´s 2018 Updated and Consolidated Guidelines for Programmatic Management for LTBI. Data sources included TB national guidelines and HIV/AIDS/ART national guidelines, complemented by results from a previous survey on policy uptake held at the WHO.RESULTS: Uptake of WHO policy to provide TB preventive treatment among women with HIV accessing antenatal care was moderate: 64% (23 of 36 countries) explicitly recommended at least one clinical guideline or policy recommendation on screening, testing or treatment of LTBI among pregnant women living with HIV. There was considerable variation between countries on the stages in pregnancy that TPT should be provided. Two countries (5%) provided clinical monitoring recommendations for pregnant women.CONCLUSIONS: There is moderate uptake of TPT policy for pregnant women with HIV. Failure to provide TPT as part of antenatal or prevention of mother-to-child services is a missed opportunity for TB control.

Drones for Area-Wide Larval Source Management of Malaria Mosquitoes

Given the stagnating progress in the fight against malaria, there is an urgent need for area-wide integrated vector management strategies to complement existing intra-domiciliary tools, i.e., insecticide-treated bednets and indoor residual spraying. In this study, we describe a pilot trial using drones for aerial application of Aquatain Mosquito Formulation (AMF), a monomolecular surface film with larvicidal activity, against the African malaria mosquito Anopheles arabiensis in an irrigated rice agro-ecosystem in Unguja island, Zanzibar, Tanzania. Nine rice paddies were randomly assigned to three treatments: (a) control (drone spraying with water only), (b) drone spraying with 1 mL/m2, or (c) drone spraying with 5 mL/m2 of AMF. Compared to control paddies, AMF treatments resulted in highly significant (p &lt; 0.001) reductions in the number of larvae and pupae and &gt;90% fewer emerging adults. The residual effect of AMF treatment lasted for a minimum of 5 weeks post-treatment, with reductions in larval densities reaching 94.7% in week 5 and 99.4% in week 4 for the 1 and 5 mL/m2 AMF treatments, respectively. These results merit a review of the WHO policy regarding larval source management (LSM), which primarily recommends its use in urban environments with ‘few, fixed, and findable’ breeding sites. Unmanned aerial vehicles (UAVs) can rapidly treat many permanent, temporary, or transient mosquito breeding sites over large areas at low cost, thereby significantly enhancing the role of LSM in contemporary malaria control and elimination efforts.

Physicians’ Antimalarial Utilization Practices in Children below 5 years in a Secondary and Primary Health Facilities in Delta State

Malaria is an epidemic with 1.3% reduction in annual per capital economic growth rate. This study was to assess physicians’ antimalarial utilization in children below five years and conformity to guidelines. This is a retrospective and cross-sectional random sampling of prescriptions of antimalarials in under five between January 2012 and December 2014 in the secondary facility and January 2012 to December 2017 in two health facilities. Data was recorded using WHO indicator forms and analyzed using SPSS. Exactly, 800 prescriptions giving a total of 1,243 and 1313 drugs were prescribed in the Secondary Facility (CH), Warri and Primary Health Care (PHC), Oria respectively with an average of drugs prescribed per encounter (DPPE), CH (3.1 ± 0.01) and PHC, (3.3 ± 0.1). Antimalarials, were the most prescribed. Generic prescription was more in PHC (59%) than in CH (58%). Syrups were most prescribed 70.96% in CH, Warri and 53% in PHC, Oria. However, 27(50.9%) of physicians based prescription on experience, 13(24.5%) and 4(7.5%) followed WHO and National Antimalarial Treatment Policy (NATP) guidelines respectively while (17.1%) on the efficacy of the antimalarial. The antimalarial utilization practices conform to the WHO guidelines although there are lapses. Prescription was predominantly based on experience.

The Correlation in The Anxiety of Pregnant Women Third Trimester With The Coverage of Antenatal Care During The Covid-19 Pandemic in Kertosari Village Banyuwangi

Pregnancy is a natural process. Changes that occur in women during normal pregnancy are physiological, the care provided by minimize intervention. The impact of the Covid-19 pandemic on pregnant women is the emergence of a concern/anxiety related to neonatal growth and development. Therefore, pregnant women need special attention regarding prevention, diagnosis, and management. Anxiety is a state of understanding or worrying that something bad will happen. According to WHO policy, the standard of care for pregnancy is at least 4 visits, one time visit in the 1st trimester, one time visit in the 2nd trimester, two time visit in the 3nd trimester. The study aims to identify the anxiety of pregnant women during the Covid-19 pandemic, to identify the coverage of antenatal care and to analyze the relationship between the anxiety of third trimester pregnant women during the Covid-19 pandemic and the coverage of antenatal care.Cross sectional research design. The population is all third trimester pregnant women in Kertosari Village. The sample taken is 35 respondents, using purposive sampling technique. Collecting data using questions for the anxiety of pregnant women and coverage of antenatal care. Data analysis using Chi Square test with significant results 0.005 where significant 0.005 &gt; 0.05. It was concluded that there was a positive correlation between the anxiety of pregnant women in the third trimester of coverage of antenatal care during the Covid-19 pandemic. So it can be said that the high anxiety of pregnant women in the third trimester will cause low antenatal care visits.