WHO Regions Research Articles

Estimating the impact of COVID-19 vaccine inequities: a modeling study

Access to COVID-19 vaccines on the global scale has been drastically hindered by structural socio-economic disparities. Here, we develop a data-driven, age-stratified epidemic model to evaluate the effects of COVID-19 vaccine inequities in twenty lower middle and low income countries (LMIC) selected from all WHO regions. We investigate and quantify the potential effects of higher or earlier doses availability. In doing so, we focus on the crucial initial months of vaccine distribution and administration, exploring counterfactual scenarios where we assume the same per capita daily vaccination rate reported in selected high income countries. We estimate that more than 50% of deaths (min-max range: [54−94%]) that occurred in the analyzed countries could have been averted. We further consider scenarios where LMIC had similarly early access to vaccine doses as high income countries. Even without increasing the number of doses, we estimate an important fraction of deaths (min-max range: [6−50%]) could have been averted. In the absence of the availability of high-income countries, the model suggests that additional non-pharmaceutical interventions inducing a considerable relative decrease of transmissibility (min-max range: [15−70%]) would have been required to offset the lack of vaccines. Overall, our results quantify the negative impacts of vaccine inequities and underscore the need for intensified global efforts devoted to provide faster access to vaccine programs in low and lower-middle-income countries.

Estimating global and regional between-country inequality in routine childhood vaccine coverage in 195 countries and territories from 2019 to 2021: a longitudinal study.

Global routine childhood vaccine coverage has plateaued in recent years, and the COVID-19 pandemic further disrupted immunisation services. We estimated global and regional inequality of routine childhood vaccine coverage from 2019 to 2021, particularly assessing the impacts of the COVID-19 pandemic. We used longitudinal data for 11 routine childhood vaccines from the WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), including 195 countries and territories in 2019-2021. The slope index of inequality (SII) and relative index of inequality (RII) of each vaccine were calculated through linear regression to express the difference in coverage between the top and bottom 20% of countries at the global and regional levels. We also explored inequalities of routine childhood vaccine coverage by WHO regions and unvaccinated children by income groups. Globally between January 1, 2019 and December 31, 2021, most childhood vaccines showed a declining trend in coverage, and therefore an increasing number of unvaccinated children, especially in low-income and lower-middle-income countries. Between-country inequalities existed for all 11 routine childhood vaccine coverage indicators. The SII for the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) coverage was 20.1 percentage points (95% confidence interval: 13.7, 26.5) in 2019, and rose to 23.6 (17.5, 30.0) in 2020 and 26.9 (20.0, 33.8) in 2021. Similar patterns were found for RII results and in other routine vaccines. In 2021, the second dose of measles-containing vaccine (MCV2) coverage had the highest global absolute inequality (31.2, [21.5-40.8]), and completed rotavirus vaccine (RotaC) coverage had the lowest (7.8, [-3.9, 19.5]). Among six WHO regions, the European Region consistently had the lowest inequalities, and the Western Pacific Region had the largest inequalities for many indicators, although both increased from 2019 to2021. Global and regional inequalities of routine childhood vaccine coverage persisted and substantially increased from 2019 to 2021. These findings reveal economic-related inequalities by vaccines, regions, and countries, and underscore the importance of reducing such inequalities. These inequalities were widened during the COVID-19 pandemic, resulting in even lower coverage and more unvaccinated children in low-income countries. Bill & Melinda Gates Foundation.

An estimate of the burden of pancreatic cancer globally and its comparison with different WHO regions using Global Burden of Disease Database: A retrospective population-based analysis.

e16321 Background: Pancreatic cancer is a highly aggressive malignancy and is the fourth leading cause of cancer-related deaths in the United States and seventh globally. Most pancreatic cancers are adenocarcinomas that have poor prognoses. The highest incidence is reported between 65-69 in men and 75-79 in women. Worldwide, both incidence and mortality are increasing. We must evaluate the global and regional patterns to understand the impact of risk factors and develop early detection methods and treatments. Methods: We extracted pancreatic cancer mortality data from the Global Burden of Disease database based on the International Classification of Diseases versions 10 and 9. Age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), the age-specific death rate(ASDR), mortality-incidence ratio (MIR) and disability-adjusted life years (DALYs) were extracted for global as well as six WHO regions (Africa, Region of the Americas, South-East Asia, Europe, Eastern Mediterranean, Western Pacific) for both for the years 1990 and 2019. Joinpoint regression analysis was used to describe trends. Results: Between 1990 and 2019, pancreatic cancer ASIRs, ASMRs, and DALYs increased among the six regions in both males and females. Globally, ASIR, ASMR and DALY increased in males (+25.02%, +23.40%, +19.97%) and females (+26.35%, +24.30%, +22.08%). However, MIR decreased globally (males: -1.29%, females: -1.62%). The Eastern Mediterranean region showed the highest percentage change in ASIR, ASMR, and DALY in both males (+110.45%, +106.53%, +103.24%, respectively) and females (+140.20, +135.48%, +127.20% respectively), followed by the South-East Asia region (males: +71.38%, +70.03%, +63.80% respectively; females: +114.20%, +111.78%, +106.91% respectively). MIRs showed decreased trends among all six regions in both sexes. Europe region showed the highest decrease in males (-1.91%) and females (-3.09%). Conclusions: Overall, we reported the increasing disease burden of pancreatic cancer globally between 1990 and 2019. ASIRs, ASMRs and DALYs all increased throughout the six regions in both sexes, with the Eastern Mediterranean region being the highest. MIRs showed a global decreasing trend in both sexes, which may indicate an overall improvement in pancreatic cancer clinical care.

Implementation of Healthcare Financing Based on Diagnosis-related Group in Three WHO Regions; Western Pacific, South East Asia and Eastern Mediterranean: A Systematic Review

Payment methods based on a controlled or adjusted prospective payment system rather than ‘Fee for Services’ or direct payment are considered beneficial to access the healthcare delivery services. The purpose of this review was to identify technical challenges faced by three WHO regions, namely, Western Pacific, South East Asia Eastern and the Mediterranean while establishing or adopting a diagnosis-related group (DRG)/case-mix grouper and report the extent of implementing this system for reimbursement and healthcare financing in three WHO regions, namely, Western Pacific, South East Asia Eastern and the Mediterranean. The study followed PRISMA guidelines, and 33 articles published from 1st January 2009 to 31st December 2019 were selected for critical appraisal after systematic filtration. The objectives of the implementation of the DRG system in most developed and developing countries in these regions were to bring transparency in the payment system and reduce treatment costs by avoiding unnecessary healthcare services. The countries in the study regions were at different levels of economic and social development status, therefore the implementation and adaptation status of DRG/case-mix system/grouper varied in these countries The findings revealed that most of the countries faced challenges related to inequalities and inefficiencies in the healthcare system, shortage of funding, poor documentation related to diagnosis and procedures, incomplete medical record files and lack of primary data required for the case-mix system during the DRG/case-mix adaptation phase. The results also pointed to the importance of initial pilot testing of the DRG/case-mix system/grouper and careful manipulation and adaptation to the local context, especially when the DRG system/grouper imported from other countries.

Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study

Linear growth is an important outcome of child development with implications for economic productivity. Enteric infections, particularly Shigella, have been linked to linear growth faltering (LGF). However, benefits from potential reductions in LGF are rarely included in economic analyses of enteric infections. We aimed to quantify the economic benefits of vaccination related to reduced Shigella-attributable disease and associated LGF compared with the net costs of a vaccine programme. In this benefit-cost analysis, we modelled productivity benefits in 102 low-income and middle-income countries that had recent stunting estimates available, at least one Shigella-attributable death annually, and available economic data, particularly on gross national income and growth rate projections. We modelled benefits strictly related to linear growth improvements and no other benefits associated with reducing diarrhoeal burden. The effect size in each country was calculated as shifts in height-for-age Z score (HAZ), representing population average changes for preventing Shigella-attributable less-severe diarrhoea and moderate-to-severe diarrhoea separately for children younger than 5 years. Benefits data were calculated per country and combined with estimated net costs of the vaccine programme in the form of benefit-cost ratios (BCRs); BCRs above parity, or $1 in benefits per $1 in costs (with a 10% margin representing borderline results: 1·10:1), were considered cost-beneficial. Countries were aggregated for analysis by WHO region, World Bank income category, and eligibility for support from Gavi, the Vaccine Alliance. In the base-case scenario, all regions exhibited cost-beneficial results, with the South-East Asia region and Gavi-eligible countries exhibiting the highest BCRs (21·67 for the South-East Asia region and 14·45 for Gavi-eligible countries), and the Eastern Mediterranean region yielding the lowest BCRs (2·90). All regions exhibited cost-beneficial results from vaccination, except in more conservative scenarios (eg, those assuming early retirement ages and higher discount rates). Our findings were sensitive to assumed returns for increased height, assumptions about vaccine efficacy against linear growth detriments, the anticipated shift in HAZ, and discount rate. Incorporating the productivity benefits of LGF reduction into existing cost-effectiveness estimates resulted in longer-term cost-savings in nearly all regions. LGF is a secondary outcome of Shigella infection and reduction in LGF is not often quantified as a health or economic benefit of vaccination. However, even under conservative assumptions, a Shigella vaccine only moderately effective against LGF could pay for itself from productivity gains alone in some regions. We recommend that LGF be considered in future models assessing the economic and health impacts of interventions preventing enteric infections. Further research is needed on vaccine efficacy against LGF to inform such models. Bill & Melinda Gates Foundation, Wellcome Trust.

A framework for seroepidemiologic investigations in future pandemics: insights from an evaluation of WHO’s Unity Studies initiative

BackgroundThe WHO Unity Studies initiative supports countries, especially low- and middle-income countries (LMICs), in conducting seroepidemiologic studies for rapidly informing responses to the COVID-19 pandemic. Ten generic study protocols were developed which standardized epidemiologic and laboratory methods. WHO provided technical support, serological assays and funding for study implementation. An external evaluation was conducted to assess (1) the usefulness of study findings in guiding response strategies, (2) management and support to conduct studies and (3) capacity built from engagement with the initiative.MethodsThe evaluation focused on the three most frequently used protocols, namely first few cases, household transmission and population-based serosurvey, 66% of 339 studies tracked by WHO. All 158 principal investigators (PIs) with contact information were invited to complete an online survey. A total of 19 PIs (randomly selected within WHO regions), 14 WHO Unity focal points at the country, regional and global levels, 12 WHO global-level stakeholders and eight external partners were invited to be interviewed. Interviews were coded in MAXQDA™, synthesized into findings and cross-verified by a second reviewer.ResultsAmong 69 (44%) survey respondents, 61 (88%) were from LMICs. Ninety-five percent gave positive feedback on technical support, 87% reported that findings contributed to COVID-19 understanding, 65% to guiding public health and social measures, and 58% to guiding vaccination policy. Survey and interview group responses showed that the main technical barriers to using study findings were study quality, variations in study methods (challenge for meta-analysis), completeness of reporting study details and clarity of communicating findings. Untimely study findings were another barrier, caused by delays in ethical clearance, receipt of serological assays and approval to share findings. There was strong agreement that the initiative created equitable research opportunities, connected expertise and facilitated study implementation. Around 90% of respondents agreed the initiative should continue in the future.ConclusionsThe Unity Studies initiative created a highly valued community of practice, contributed to study implementation and research equity, and serves as a valuable framework for future pandemics. To strengthen this platform, WHO should establish emergency-mode procedures to facilitate timeliness and continue to build capacity to rapidly conduct high-quality studies and communicate findings in a format friendly to decision-makers.

Prevalence and factors associated with chronic school absenteeism among 207,107 in-school adolescents: Findings from cross-sectional studies in 71 low-middle and high-income countries.

Despite the negative impact of chronic school absenteeism on the psychological and physical health of adolescents, data on the burden of adolescent chronic school absenteeism (ACSA) and interventions and programs to address it are lacking. We estimated the global, regional and national level prevalence of ACSA and its correlation with violence and unintentional injury, psychosocial, protective, lifestyle, and food security-related factors among in-school adolescents across low and middle-income, and high-income countries (LMICs-HICs). This study aimed to estimate the prevalence of chronic school absenteeism (CSA) as well as to determine its associated factors among in-school adolescents across 71 low-middle and high-income countries. We used data from the most recent Global School-based Student Health Survey of 207,107 in-school adolescents aged 11-17 years in 71 LMICs-HICs countries across six WHO regions. We estimated the weighted prevalence of ACSA from national, regional and global perspectives. Multiple binary logistic regression analyses were used to estimate the adjusted effect of independent factors on ACSA. The overall population-weighted prevalence of CSA was 11·43% (95% confidence interval, CI: 11·29-11·57). Higher likelihood of CSA was associated with severe food insecurity, peer victimisation, loneliness, high level of anxiety, physically attack, physical fighting, serious injury, poor peer support, not having close friends, lack of parental support, being obese, and high levels of sedentary behaviours. Lower likelihood of CSA was associated with being female (odds ratio, OR = 0·76, 95% CI: 0·74-0·78). Our findings indicate that a combination of different socio-economic factors, peer conflict and injury factors, factors exacerbate CSA among adolescents. Interventions should be designed to focus on these risk factors and should consider the diverse cultural and socioeconomic contexts.

Impact and cost-effectiveness of hepatitis B virus prophylaxis in pregnancy: a dynamic simulation modelling study

In 2020, WHO recommended the addition of peripartum antiviral prophylaxis (PAP) to hepatitis B birth dose vaccination (HepB-BD) and hepatitis B infant vaccination (HepB3) to reduce mother-to-child transmission of hepatitis B virus (HBV) infection in pregnant women who have a marker of high infectivity (ie, HBV DNA ≥200 000 international units per mL or HBeAg-positive). We aimed to evaluate the impact and cost-effectiveness of this recommendation and of a theoretical simplified strategy whereby PAP is given to all pregnant women who are HBsAg-positive without risk stratification. This modelling study used a dynamic simulation model of the HBV epidemic in 110 countries in all WHO regions, structured by age, sex, and country. We assessed three strategies of scaling up PAP for pregnant women: PAP for those with high viral load (PAP-VL); PAP for those who are HBeAg-positive (PAP-HBeAg); and PAP for all pregnant women who are HBsAg-positive (PAP-universal), in comparison with neonatal vaccination alone (HepB-BD). We investigated how different diagnostic and antiviral drug costs affected the cost-effectiveness of the strategies evaluated. Using a health-care provider perspective, we calculated incremental cost-effectiveness ratios in cost (US$) per disability-adjusted life-year (DALY) averted in each country's population and compared these with country-specific cost-effectiveness thresholds. We also calculated new neonatal infections averted for each of the strategies. Adding PAP-VL to HepB-BD could avert around 1·1 million (95% uncertainty interval 1·0 million-1·2 million) new neonatal infections by 2030 and around 3·2 million (95% uncertainty interval 3·0 million-3·4 million) new neonatal infections and approximately 8·8 million (7·8 million-9·7 million) DALYs by 2100 across all the countries modelled. This strategy would probably be cost-effective up to 2100 in 28 (26%) of 106 countries analysed (which included some of the countries that have the greatest HBV burden) if costs are as currently expected to be, and in 74 (70%) countries if diagnostic and monitoring costs were lowered (by about 60-75%). The relative cost-effectiveness of PAP-VL and PAP-HBeAg was finely balanced and depended on the respective diagnostic and monitoring costs. The PAP-universal strategy could be more cost-effective than either of these strategies in most countries, but the use of antiviral treatment could be five times as high than with PAP-VL. PAP can provide substantial health benefits, and, although the current approach might already be cost-effective in some high-burden settings, decreased diagnostic costs would probably be needed for PAP to be cost-effective in most countries. Therefore, careful consideration needs to be given about how such a strategy is implemented, and securing reduced costs for diagnostics should be a priority. The theoretical strategy of offering PAP to all women who are HBsAg-positive (eg, if diagnostic tests to identify mothers at risk of transmission are not available) could be a cost-effective alternative, depending on prevailing costs of diagnostics and antiviral therapy. UK Medical Research Council, UK National Institute for Health and Care Research, and the Vaccine Impact Modelling Consortium.

Lowering costs: the golden rule for achieving WHO goals

The WHO Global Health Sector Strategy on Viral Hepatitis 2016–21 has established specific objectives aimed at eliminating viral hepatitis as a major public health concern by 2030. 1 Global health sector strategy on viral hepatitis 2016–2021. https://www.who.int/publications/i/item/978-92-4-155058-1Date: 2016 Date accessed: April 4, 2023 Google Scholar To achieve this goal, all WHO regions are striving for a 90% reduction in new cases of chronic hepatitis B virus (HBV) infection by 2030, which is equivalent to a prevalence of HBsAg of less than 0·1% among children aged 5 years. As most HBV-related illnesses stem from infections contracted during infancy through perinatal or early childhood exposure to the virus, the global targets for 2030 aim to ensure that 90% of infants receive a timely birth dose of HBV vaccine and that 90% of the neonate population receive two to three additional doses of the HBV vaccine. 1 Global health sector strategy on viral hepatitis 2016–2021. https://www.who.int/publications/i/item/978-92-4-155058-1Date: 2016 Date accessed: April 4, 2023 Google Scholar Impact and cost-effectiveness of hepatitis B virus prophylaxis in pregnancy: a dynamic simulation modelling studyPAP can provide substantial health benefits, and, although the current approach might already be cost-effective in some high-burden settings, decreased diagnostic costs would probably be needed for PAP to be cost-effective in most countries. Therefore, careful consideration needs to be given about how such a strategy is implemented, and securing reduced costs for diagnostics should be a priority. The theoretical strategy of offering PAP to all women who are HBsAg-positive (eg, if diagnostic tests to identify mothers at risk of transmission are not available) could be a cost-effective alternative, depending on prevailing costs of diagnostics and antiviral therapy. Full-Text PDF Open Access

Weak regulations threaten the safety of consumers from harmful weight-loss supplements globally: results from a pilot global policy scan.

To pilot a global policy scan assessing how governments worldwide regulate weight-loss supplements (WLS). Experts on WLS policies from thirty countries that varied by World Bank income classification, with five from each of the six WHO regions, completed an online survey on WLS regulation in their country. The survey covered six domains: legal frameworks; pre-market requirements; claims, labelling, and advertisements; product availability; adverse events reporting; and monitoring and enforcement. Percentages were calculated for presence or absence of a type of regulation. Experts were recruited through websites of regulatory bodies and professional LinkedIn networks and scientific article searches on Google Scholar. Thirty experts, one from each country (i.e. researchers, regulators, other experts in food and drug regulation). WLS regulations varied widely across countries, and a number of gaps were identified. One country (Nigeria) has a minimum legal age to purchase WLS. Thirteen countries reported independently evaluating the safety of a new WLS product sample. Two countries have limitations on where WLS can be sold. In eleven countries, reports on adverse events related to WLS are publicly available. In eighteen countries, safety of new WLS is to be established through scientific criteria. Penalties for WLS non-compliance with pre-market regulations exist in twelve countries and labelling requirements in sixteen countries. Results of this pilot study document wide variability in national WLS regulations globally, exposing many gaps in important components of consumer protection regulatory frameworks for WLS, which likely put consumer health at risk.

Use of interviewer-administered telephone surveys during infectious disease outbreaks, epidemics and pandemics: a scoping review

IntroductionDuring the COVID-19 crisis, researchers had to collect data remotely. Telephone surveys and interviews can quickly gather data from a distance without heavy expense. Although interviewer-administered telephone surveys (IATS) can...

Immunization requirements in medical school accreditation standards

Healthcare workers (HCW) are at risk of contracting vaccine-preventable diseases and spreading these infections to their patients. Vaccination against preventable diseases prior to clinical training can mitigate this risk. Accreditation guidance can be used as an opportunity to enforce desirable norms and standards. Standards from 144 national accreditation organizations spanning 123 member states listed in the Directory of Organizations that Recognize/Accredit Medical Schools by the Foundation for Advancement of International Medical Education and Research were reviewed and summarized. Findings were further stratified by World Bank income group and WHO region. While higher-income countries were more likely to have accreditation guidelines available than lower- or middle-income countries, few national medical school accreditation bodies specifically request immunization status of trainees as a standard. Further, almost none mention specific antigens for which immunity should be assessed. These findings should be used by medical school and other health professional training accreditation bodies to inform future policy direction to protect trainees as future HCW.

State of general and occupational health of the population in the global burden of disease in Ukraine and the world

STATE OF GENERAL AND OCCUPATIONAL HEALTH OF THE POPULATION IN THE GLOBAL BURDEN OF DISEASE IN UKRAINE AND THE WORLD Antonina M. Nagorna State Institution «Kundiiev Institute of Occupational Health of National Academy of Medical Sciences of Ukraine», Saksaganskoho Str., 75, Kyiv 01033, Ukraine Introduction. Health is an integral indicator of the success of society's development; its assessment is difficult due to the diversity of its characteristics and is most often carried out by indicators of "illness", such as morbidity, disability, mortality, life expectancy, loss of years of healthy life, etc. Occupational health reflects socio-economic changes, quality of life and working conditions of the population. Occupational diseases, accidents and sudden death cases at the workplace remain the main cause of mortality, morbidity, deterioration of the quality of life of workers and are components of the Global burden of disease for society. Aim: to find out for what reasons people of working age all over the world and in Ukraine get sick, lose their ability to work, become disabled and then die. Materials and methods. Data obtained during the implementation of the "Global Burden of Disease" Project, conducted under the auspices of the United Nations together with the World Bank, the Lancet magazine, the American Institute for Health Measurement and Evaluation (IHME) and the University of Washington, were used for the analysis. In addition, an analysis of the occupational health of workers was carried out using the method of continuous sampling in Ukraine according to indicators of occupational morbidity, occupational injuries, and cases of sudden death at the workplace. A comparative assessment of life expectancy and healthy life expectancy was carried out. Materials for the years 1990 to 2019 were analyzed, before the start of the Covid-19 pandemic and the beginning of the full-scale Russian war against Ukraine. The results. A trend towards a decrease in occupational morbidity, industrial injuries, and an increase in cases of sudden death at the workplace among workers engaged in various types of economic activity has been revealed. Lower indicators of life expectancy at birth and healthy life expectancy by WHO regions and at the global level were determined in Ukraine. Conclusion. General and professional health make a significant contribution to the global burden of diseases in Ukraine, although long-term dynamic observation shows that official statistics does not reflect their real level and requires improvement of regulatory and legal regulation, development of modern information technologies for the detection, registration, accounting and analysis of occupational diseases, accidents at workplace and sudden death cases closer to EU criteria. Keywords: Global burden of disease, occupational health, life expectancy.

Schoolchildren's Oral Health Along the Belt and Road

BackgroundThe Belt and Road Initiative (BRI) aims to strengthen China's connectivity with the world and, in doing so, improve health and well-being. There is a dearth of information relating to schoolchildren's oral health to inform oral health–related BRI initiatives. The aim of this research was to report on the oral health status of 12-year-old children across BRI countries and determine variations in oral health regarding geographic regions (BRI routes) and country-income levels. MethodDental caries experience of 12-year-old children was obtained from the World Health Organization's (WHO) database. BRI countries were classified into BRI routes and country income level. Data were assessed for completeness and contemporariness. Variations in dental caries experiences were examined across BRI routes and with respect to country income levels. ResultsDental caries experience data were available in the WHO database for most BRI countries (95.7%, 135/141). Most dental caries data were collected pre-2010 (74.1%, 74/135). The mean number of decayed, missing, and filled teeth (DMFT) was approximately 2 (weighted mean, 1.7; SD, 1.2). Variations in DMFT existed with respect to BRI routes—WHO regions (P < .001) and World Bank regions (P < .001)—and with respect to country income levels (P < .01). ConclusionsDental caries data for 12-year-old schoolchildren are readily available (in the WHO database) for most BRI countries, although the data are not very current. In addition, dental caries experience varies with respect to BRI routes (geographic locations) and country income levels. These findings have implications by way of situation analyses to inform oral health–related BRI initiatives.

Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis

Few studies have examined the temporal trends of Helicobacter pylori prevalence worldwide. We aimed to identify the changes in global prevalence of H pylori infection between 1980 and 2022. In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, Scopus, and Web of Science, with no language restrictions, for observational studies on the prevalence of H pylori infection published between Jan 1, 1980, and Dec 31, 2022. Conference papers, meta-analyses, reviews, and case reports were excluded. We divided the study timeframe into four periods: 1980-90, 1991-2000, 2001-10, and 2011-22. Summary data were extracted from each selected publication. The prevalence of H pylori and its temporal trend were analysed according to WHO region, World Bank income level, WHO universal health coverage service coverage index of the country or region, sex and age of the patient, study type, and diagnostic method. The pooled prevalence was estimated by a random-effect meta-analysis, and the significance of the associated factors was analysed by multivariable meta-regression. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 2022100026. Of the 56 967 records identified, 5236 were included in the quality assessment stage and 224 studies-from 71 countries or regions from all six WHO regions and including 2 979 179 individuals-were included in the final analysis. Significant heterogeneity was found between studies (I2=99·9%). The estimated global prevalence of H pylori infection decreased from 58·2% (95% CI 50·7-65·8) in the 1980-90 period to 43·1% (40·3-45·9) in the 2011-22 period. Prevalence was relatively static between 1991 and 2010 but declined sharply between 2011 and 2022, with the largest decline in the WHO African region. Overall, a lower prevalence of H pylori infection was reported in younger people, high-income countries, or countries with high levels of universal health coverage, and by retrospective studies. Studies based on serological diagnostic methods generally reported higher H pylori prevalence than studies based on non-serological methods (53·2% [49·8-56·6] vs 41·1% [38·1-44·2]) and fluctuated less over time. This meta-analysis shows a declining trend of H pylori prevalence globally, particularly in the 2011-22 period. These results could help to inform future health policy on prevention and management of this important infection. However, a considerable degree of heterogeneity exists between studies and further population-based epidemiological studies are needed. None.

Monkeypox outbreak -Is this another pandemic?

The WHO declares a pandemic when there is a community transmission of a disease that is occurring in at least two countries in two WHO regions. This research evaluated the current (year 2022) outbreak of monkeypox against the criteria of a pandemic and suggests necessary health interventions. Monkeypox is a zoonotic disease, causing diseases in humans similar to smallpox. Since its discovery in humans in 1970, several outbreaks have occurred with the most recent spreading widely to non-endemic areas and fulfilling the WHO criteria for phase 6 of an outbreak as high cases of infections were seen in Europe and America. Although, the pandemic from monkeypox may not be remarkable because the basic reproductive number, attack, and case fatality rates are much lower than some of the previous pandemics. However, it should not be underestimated, as spread to vulnerable groups may be detrimental. It is therefore important for the health systems of countries to develop a pandemic preparedness and response plan for monkeypox and continue to monitor the outbreak with a prompt response when needed.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020.

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Investigating the relationship between cross-national suicide rates and COVID-19 first and second waves spread across the world: An exploratory study

IntroductionCOVID-19 spreads between people in close contact. Social isolation, which is linked with increased suicide risk, prevents COVID-19 from spreading. Suicide and COVID-19 may therefore represent two antagonistic phenomena. Specifically, we tested whether previous cross-national suicide rates inversely correlate with COVID-19 cases and deaths across countries. Material and methodsWe ran unadjusted bivariate correlations between the most updated (2016) cross-national Age-Standardised suicide rates and COVID-19 cumulative cases and deaths (as of: 30/08/2020, 11/10/2020 and 30/05/2021) across countries; and we controlled for WHO Income group, WHO region, suicide data quality, and urbanicity. ResultsSuicide rates negatively correlated with COVID-19 cumulative cases up to 30/08/2020 (r=−0.14, P=.064) and up to 11/10/2020 at an almost significant level (r=−0.149, P=.050) across 174 countries. As of 11/10/2020 this correlation became significant when controlling for WHO region (r=−0.17, P=.028), data quality (r=−0.181, P=.017) and urbanicity (r=−0.172, P=.039); and as of 30/08/2020 when adjusting for WHO region (r=−0.15, P=.047) and data quality a (r=−0.16, P=.036). No significant correlations between suicide rates and COVID-19 deaths were found. ConclusionsThere seems to be an inverse correlation between previous cross-national suicide rates and COVID-19 cumulative cases across countries. Suicide and COVID-19 appear to behave, to some degree, as antagonistic phenomena, which challenges their prevention.

Global prevalence of hepatitis B or hepatitis C infection among patients with tuberculosis disease: systematic review and meta-analysis

There is a substantial overlap in the epidemiology of chronic hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) due to overlapping risk factors. Testing for viral hepatitis is not widely recommended for patients with TB. The aim of this systematic review was to evaluate the global prevalence of chronic viral hepatitis infection among patients with TB. MEDLINE, EMBASE, Web of Science, Cochrane Library, African Journals Online, LILACS, and country TB reports were searched for studies published between January 1st, 2011 and June 17th 2021. Random-effects meta-analyses for proportions were conducted to obtain pooled prevalences. The prevalence of chronic HBV/HCV infection among patients with TB was also compared to that in the general population. The protocol was registered on PROSPERO (CRD42021276468). This analysis included 127 studies (83 for both HBV and HCV, 28 for HBV only, and 25 for HCV only) and data from 94,936 patients. The global pooled seroprevalence was 5.8% (95% CI 5.0-6.8) for HBs-antigen and 10.3% (95% CI 8.4-12.3) for HCV-antibodies. Pooled prevalence was highest in the WHO African Region for HBV at 7.8% (95% CI 5.2-10.9) and in the WHO European Region at 17.5% (95% CI 12.2-23.5) for HCV. In studies among TB patients who inject drugs, HCV prevalence was 92.5% (95% CI 80.8-99.0). Pooled HCV-antibody seroprevalence among patients with TB was higher than in the general population in all six WHO regions while HBs-antigen seroprevalence was higher in 3/6 regions. This review highlights the syndemicity of chronic viral hepatitis and TB and suggests that routine testing for hepatitis upon TB diagnosis may be justified. The prevalence of chronic HBV and HCV infections was higher among patients with TB than in the general population. This study was study was funded by the Global Tuberculosis Programme, World Health Organization.

Inhibitory effect of natural compounds on Dihydropteroate synthase of Mycobacterium leprae: Molecular dynamic study

Leprosy is a chronic infectious disease caused by a bacillus, Mycobacterium leprae. According to official data from 139 countries in the 6 WHO Regions, there were 127558 new leprosy cases worldwide in 2020. Leprosy mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. If this disease is left untreated, can harm the skin, nerves, limbs, eyes, and skin permanently. The disease is curable with multidrug therapy. Over a period of time Mycobacterium leprae has become resistant to these drugs. Therefore, new therapeutic molecules are warranted. This study was aimed to carry out the in-silico analysis to determine the inhibitory effect of natural compounds on Dihydropteroate synthase (DHPS) of Mycobacterium leprae. The DHPS is a key enzyme in the folate biosynthesis pathway in M. leprae and acts as a competitive inhibitor of PABA. The 3D structure of DHPS protein was modeled using homology modeling and was validated. Molecular docking and simulation along with other in-silico methods were employed to determine the inhibitory effect of ligand molecules towards DHPS target protein. Results revealed ZINC03830554 molecule as a potential inhibitor of DHPS. Binding experiments and bioassays utilizing this strong inhibitor molecule against purified DHPS protein are necessary to validate these early findings.Communicated by Ramaswamy H. Sarma