WHO Regions Research Articles

Global overview of government-endorsed nutrition labeling policies of packaged foods: a document review

IntroductionNutrition labeling provides nutritional information about nutrients present in a food product. It is commonly applied to packaged foods and beverages, where the information can be presented on the back or front of the pack as the nutrient declaration, nutrition and health claims, and supplementary nutrition information. Nutrition labeling is an important policy instrument for improving the nutritional quality of foods and promoting healthy diets, as it allows consumers to make informed purchasing decisions. This document review aims to provide a comprehensive overview of government-endorsed nutrition labeling policies related to nutrient declaration, nutrition claims, and supplementary nutrition information enforced worldwide.MethodsWe searched two nutrition policy databases, the Global database on the Implementation of Food and Nutrition Action (GIFNA) and the NOURISHING database, and government websites of some selected countries for the government-endorsed nutrition labeling policies published up to June 2023. We narrated the policy adopting countries' distribution by WHO regions, mode of implementation (voluntary or mandatory), and types of front-of-pack labels implemented.ResultsGlobally, we found that 95 countries have mandatory policies for nutrient declarations on packages of processed products. These include 41 countries in Europe, 19 in America, 14 in the Western Pacific, nine in Africa, seven in the Eastern Mediterranean region, and five countries from South-East Asia. Additionally, 71 countries have policies on the use of nutrient claims like “fat-free,” “excellent source,” and “fortified.” European region has the highest number of countries (37) that have rules on nutrient claims. Front-of-pack labeling (FOPL) policies have been introduced in 44 countries as supplementary nutrition information. Of these, 16 countries have adopted FOPL as mandatory, while others have implemented it voluntarily. The FOPL systems include warning labels, keyhole logo, health star rating, traffic light labeling, nutri-score, and healthy choice logos.ConclusionOver recent years, the number of countries adopting mandatory nutrition labeling policies, especially FOPLs, has increased globally. Labeling policies should be evidence-based and follow the best practices to protect consumers from unhealthy nutrients and promote healthy eating. FOPL designs need to be selected based on country-specific evidence of effectiveness and appropriateness, avoiding industry influence.

The prevalence of hydatid cyst in raw meat products: a global systematic review, meta-analysis, and meta-regression

Hydatid cyst contamination in food presents a persistent and pervasive threat to public health. Hence, several studies have been published on hydatid cysts in raw meat products. The current study aimed to meta-analyze the prevalence of hydatid cysts in meat. The search was performed in international databases, including PubMed, Web of Science, Scopus, and Google Scholar, from January 1, 2000, to February 10, 2024. A meta-analysis of prevalence was conducted using the metaprop command in the subgroups of countries, animals, and WHO regions. Meta-regression of the prevalence of hydatid cysts in meat over time and sanitation services ranking was conducted using a random effects model (restricted maximum–-likelihood). Fifty-seven published references with 130 data reports were included in the study. The lowest and highest prevalence of hydatid cysts in raw meat was observed in Sudan at 0.01%, 95%CI (0.01–0.02) and Italy at 69.86%, 95%CI (68.14–71.55), respectively. The highest prevalence of hydatid cysts was observed in Sheep (12.32%), Cattle (11.85%), and Buffalo (10.65%). The lowest and highest prevalence of hydatid cysts was South-East Asian Reg (2.77%) and European Region (33.21%), respectively. Meta-regression showed that the prevalence of hydatid cysts has significantly decreased over time (p-value = 0.021) and insignificantly decreased with sanitation services ranking (p-value = 0.679). Therefore, in order to maintain the existing conditions and even reduce the burden of hydatidosis, public health education, promotion of hygienic practices, and investment need to be carried out continuously.

5.E. Round table: Crafting Policies for Health Promotion: evidence from local settings

Abstract As communities vary in their needs, challenges, and resources, tailoring health promotion policies to specific contexts becomes imperative for effectiveness. Drawing upon the expertise of seasoned practitioners, policymakers, and researchers, this workshop offers a multifaceted perspective on navigating the complexities inherent in designing, implementing, and evaluating locally tailored health promotion policies, with a specific focus on environmental and social factors. The workshop will make it possible to compare different experiences from various European countries, with high-level speakers who have different backgrounds and roles in their countries and regions, thus providing an interesting and interactive way of comparing and examining real-world examples and best practices. The examples provided delve into: participatory techniques to design healthier environments, to identifying, collecting and elaborating evidence upon which to build policies and actions that are effective in addressing specific health challenges. Through the examples presented, we will seek to make the case for multi-actor and multisectoral collaboration. In addition, we will try to understand How do subnational authorities and partners identify priorities for action. A common question asked to the speakers will therefore: how can a variety of actors (local and regional authorities, university and research centres...) come together to support cross-sectoral action? How can policymakers be supported towards creating environments that prioritize the well-being of all, ensuring a healthier and more prosperous future for everyone? The end goal will be to enable attendees to be equipped with actionable strategies and tools to foster meaningful change within their own communities, by understanding the intricate interplay between community dynamics, stakeholder engagement, evidence-based practices, and policy implementation strategies. The workshop is being organized by the WHO Regions for Health Network (RHN). Key messages • Tailoring health promotion policies to specific contexts is imperative for effectiveness, considering the diverse needs, challenges, and resources of different communities. • Subnational authorities and partners must identify priorities for action and collaborate across sectors to address specific health challenges effectively. Speakers/Panelists Klara Dokova Medical University of Varna, Varna, Bulgaria Camilla Ihlebaek Norwegian University of Life Sciences, Aas, Norway Jo Peden Public Health Wales, Cardiff, UK Odile Mekel NRW Centre for Health, Bochum, Germany Liesbeth van Holten Province of Utrecht, Utrecht, Netherlands

Impacts of long-term climate change on human health: a global scoping review

Abstract Introduction Research output on climate change and human health is growing rapidly. This can make it difficult to find and use relevant information to develop public health action. Methods We present a global scoping review of the rapidly growing quantitative research output on long-term climate change and human health. We searched Scopus, Embase, and PubMed for quantitative, English language literature published between January 2000 and June 2021 that referenced climate change and human health in titles, abstracts, or keywords. Results From 36,956 publications we identified 754 relevant studies. Europe, the Americas, and the Western Pacific were studied much more often than other WHO regions. Research on temperature and vectors accounted for 70% of all included publications. Malaria, diarrheal diseases, and cardiovascular diseases were the most studied specific health outcomes. We found very few studies on non-communicable diseases in low- and middle-income countries. Retrospective publications (153) showed effects of climate change are already occurring worldwide. Most studies on tick-borne encephalitis, malaria, and lower respiratory infections associated with air pollution found impacts caused by climate change have increased. The strongest attribution of climate change was found for heat-related impacts. In prospective publications (626) diarrheal diseases, and impacts associated with heat and chemical air pollution were most consistently projected to increase. Future vector-borne disease impacts were projected to be highly location specific. Some studies demonstrated adaptation can effectively reduce impacts, while noting that capacity to adapt differs greatly between population groups. Conclusions Our findings underline climate change impacts are diverse and complex. Future research should prioritize the relatively understudied regions most vulnerable to climate change, such as Africa, and impacts beyond those related to temperature and vector-borne diseases.

New evidence on household financial protection against out-of-pocket payments for health in Poland

Abstract Background Protecting households against financial hardship when using health care is an integral element of universal health coverage. Previous analysis showed that in Poland, catastrophic spending on health is more common than in many European countries. Over the last decade, several measures were undertaken to reduce the burden of out-of-pocket payments for households in Poland. Methods The study aimed to assess financial protection in Poland using the indicators of catastrophic and impoverishing health spending. It relies on the methodology developed by the WHO Region Office for Europe. Catastrophic expenditure is defined as out-of-pocket payments that are greater than 40% of household capacity to pay. The study uses data from the Polish household budget surveys in 2013-2021. Results The incidence of catastrophic health spending remained relatively constant over the years analyzed, with 9% of households affected. Only in the first year of the COVID-19 pandemic (2020) it reached nearly 10%, although overall household out-of-pocket expenditure declined that year. The share of households impoverished or further impoverished due to out-of-pocket payments decreased from 4% in 2013 to 3% in 2021. Payments on medicines are the main driver of catastrophic spending, particularly among poorer households, although their role has diminished over time. Household’s available resources, gender, age, education, disability status, residence place, number of children, and household’s main source of income are significantly associated with catastrophic health payments. Conclusions Despite the implemented policies, household financial protection against out-of-pocket payments in Poland did not improve significantly between 2013 and 2021. Available evidence should be used to design well-tailored measures to reduce the burden of out-of-pocket payments, targeting the most vulnerable population groups and specific healthcare areas. Key messages • Household financial protection against out-of-pocket payments in Poland did not improve significantly between 2013 and 2021. • Out-of-pocket payments for medicines are the main cause of financial hardship for Polish households.

Prevalence of Chronic Obstructive Pulmonary Disease Exacerbation with Heart Failure Comorbid: A Systematic Review and Meta-Analysis

Heart Failure (HF) is one of the comorbidities in Chronic Obstructive Pulmonary Disease (COPD), associated with the incidence of respiratory tract infections which is a risk factor for COPD exacerbations. Eleven studies conducted in the meta-analysis. Pooled prevalence of COPD exacerbations with HF comorbidity was 29,43 % (95%CI:17,68%- 42,92%) and statistical heterogenity among the eleven studies was significant (I2 = 99,95%. Q = 191,96 p=<0,001). Eight studies were based in Europe, two studies in Americas and one study in Asia. Prevalence of COPD exacerbations with HF comorbidity based on WHO region subgroup analysis found European region 31,44% (95%CI: 17,87%-46,58%), America’s region 32,92% (95%CI: 12,61%-55,73%) and the Western Pacific region 10,86% (95%CI:10,03%- 13,21%) with significant statistical heterogeneity (I2 = 99,94%, Q = 191,96, p= <0,001). The age of exacerbating COPD patients with comorbid heart failure was above 70 years and there were differences in gender characteristics based on the two studies that reported. Statins reduce the incidence of COPD exacerbations. Differences in the risk of COPD exacerbation receiving Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker (ACEi/ARB) therapy. The most common comorbid cardiovascular disease apart from heart failure are atrial fibrillation and ischemic heart disease. As a conclusion, the pooled prevalence of COPD exacerbations with heart failure comorbid in this systematic review and meta-analysis was 29.43% (95% CI:17.68%-42.92%). Keywords: COPD exacerbation, Heart Failure, prevalence

Exploring global perspectives on the use of computer-based simulation in pharmacy education: a survey of students and educators.

: Increasing student numbers and logistical challenges in pharmacy education limit patient counselling and clinical placement opportunities. Computer-based simulation (CBS) offers scalable, interactive learning but faces integration barriers. : To explore global perceptions of CBS implementation in pharmacy education among educators and students. Methods: An online cross-sectional survey was developed based on literature review and expert feedback. The survey was distributed globally through academic pharmacy organisations, social media, and the authors' networks. It included 20 questions targeting pharmacy educators and students. : Responses from 152 educators across 38 countries and 392 students from 46 countries, spanning six WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, and WPRO) were analysed using descriptive and inferential statistics. The majority of educators (90.1%, n = 137) and students (84.2%, n = 330) expressed comfort with using CBS and implementing it in their curriculum. Despite this, CBS was perceived as underutilised by 53.5% (n = 81) of educators and 63.7% (n = 250) of students. Students valued CBS for enhancing communication and problem-solving skills, while educators highlighted its relevance to community pharmacy practice. Both groups supported CBS use in assessments. All educators (100%) identified workload reduction as a key priority, hoped CBS could assist in this area. Educators also reported barriers such as financial constraints (56.6%, n = 86) and insufficient technical support (53.3%, n = 81). On the other hand, students were less optimistic about institutional support, with only a few (7.4%, n = 29) believed institutional leaders would actively support CBS adoption. Regional differences emerged, with SEARO (Southeast Asia) and AFRO (Africa) showing the lowest CBS usage rates. Educators in SEARO, AFRO, and EMRO (Eastern Mediterranean) raised concerns about technical support, while those in SEARO, AFRO, and WPRO (Western Pacific, including Australia, New Zealand, and Singapore) expressed financial concerns. Educators in AFRO and WPRO, however, reported being 100% comfortable with using CBS. : Both students and educators recognised the potential of CBS in pharmacy education, with strong support for its integration. Addressing barriers such as educator workload, financial constraints, and technical support is crucial for broader adoption. Improved resource allocation and targeted training for educators are essential to effectively incorporate CBS into the pharmacy curriculum.

A Worldwide Systematic Review and Meta-Analysis of the Prevalence and Subtype Distribution of Blastocystis Sp. in Water Sources: A Public Health Concern.

Contaminated water sources can result in outbreaks of parasitic infections such as Blastocystis sp. in communities, creating a substantial strain on healthcare systems and affecting the general health of the population. To ascertain the prevalence and subtype distribution of Blastocystis sp. in water sources globally, a systematic review and meta-analysis of published papers up to May 19, 2024 were carried out. A thorough search of multiple electronic databases (PubMed, Scopus, Google Scholar, and Web of Science) identified 24 studies/28 datasets meeting the inclusion criteria, encompassing 2,451 water samples from 15 countries worldwide. Water samples comprised wastewater (six datasets, 285 samples), tap/drinking water (10 datasets, 253 samples), surface water (eight datasets, 1013 samples), and uncategorized water (four datasets, 900 samples). Total estimates and 95% confidence intervals (CIs) were computed using a random-effects model. This review found that 18.8% (95% CI: 12.8-26.9%) of examined water samples contained Blastocystis sp. Wastewater showed the highest Blastocystis sp. infection rate at 35.5% (95% CI: 13.5-66.1%), followed by tap/drinking water at 19.1% (95% CI: 9.5-34.5%), surface water at 17.6% (95% CI: 7.2-36.8%), and uncategorized water at 9.9% (95% CI: 4.1-21.8%). Sensitivity analysis assessed weighted prevalence variations following the exclusion of individual studies. Subgroup analysis of Blastocystis sp. prevalence was performed based on publication years, countries, continents, WHO regions, sample sizes, and diagnostic methods. Water samples can be the source of infection for nine Blastocystis sp. subtypes (STs) (ST1-ST4, ST6, ST8, ST10, ST21, and ST24), with seven STs (ST1-ST4, ST6, ST8, and ST10) capable of infecting humans. It is important to take preventative and control measures, improve the cleanliness and quality of water sources, and promote public health awareness due to the presence of different parasites such as Blastocystis sp. in water sources.

8558 Prevalence of Polycystic Ovary Syndrome in Adolescent Girls by World Health Organization Region

Abstract Disclosure: S. Hatoum: None. M. Amiri: None. R.P. Buyalos: None. A. Sheidaei: None. R. Azziz: Consulting Fee; Self; Spruce Bioscience, May Health, Core Access Surgical Technologies, Acacia Bio, Fortress Biotech, Rani Therapeutics. Stock Owner; Self; Martin Imaging. Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The use of several diagnostic criteria imposes a challenge for healthcare providers, especially in adolescents, whose PCOS symptoms may mimic normal pubertal changes. Objectives: This systematic review and meta-analysis aims to estimate the pooled prevalence of PCOS in adolescents using various diagnostic criteria in total and by WHO region. Methods: We systematically reviewed Pubmed and Embase through July 2023 to capture all studies performed in medically unbiased adolescent populations (age <18 years) reporting PCOS prevalence. Studies were categorized according to: a) PCOS criteria (NIH 1990 [PCOS phenotypes A&B], AE-PCOS 2006 [PCOS phenotypes A-C], Rotterdam 2003 [PCOS phenotypes A-D], and ‘other/self-reported’ criteria); b) subject assessment type (direct assessment, survey/indirect assessment, or mixed assessment); and c) study quality, assessed using the PCOS Epidemiology and Phenotype (PEP) quality assessment tool. We performed a meta-analysis using fixed-effects or random-effects models depending on the heterogeneity among the studies. We conducted subgroup analyses based on PCOS criteria, assessment type, study quality, and WHO region. Results: 6,644 studies were initially retrieved, of which 11 were eligible for inclusion including a total of 10,516 adolescents, yielding 15 study groups according to the diagnostic criteria. Considering all studies, PCOS prevalence was 4.98% according to the NIH 1990, 8.80% according to Rotterdam 2003, 4.74% according to the AE-PCOS 2006, and 1.69% according to other criteria/self-report, with an overall pooled PCOS prevalence of 4.57%. All studies using NIH 1990, Rotterdam 2003, and AE-PCOS 2006 were of high quality, and those using other criteria/self-report were of low quality, thus subgroup analysis based on quality resulted in the same prevalences as above. When including only high-quality studies that used direct or mixed assessment, PCOS prevalence was highest in the Western Pacific Region (WPR) at 20.69% and lowest in the Eastern Mediterranean Region at 3.43% under Rotterdam 2003, while it was highest in the South-East Asia Region at 6.20% and lowest in the WPR at 3.94% under NIH 1990. Only one high-quality study using direct or mixed assessment was available under AE-PCOS 2006. Conclusion: This meta-analysis revealed that PCOS prevalence varies according to the PCOS criteria, assessment type, and WHO region. This variability should be addressed, ideally through unifying the diagnostic criteria and using meticulous methods in PCOS epidemiologic studies. The effect of study quality alone on PCOS prevalence could not be detected because of insufficient data, further reinforcing the need for undertaking PCOS prevalence studies in all populations and regions. Presentation: 6/2/2024

Psychometric validation of the Cardiac Rehabilitation Barriers Scale Revised (CRBS-R) for hybrid delivery

ObjectiveTo test the measurement properties of the revised version of the English Cardiac Rehabilitation Barriers Scale (CRBS-R), suitable for hybrid delivery, structural validity, internal reliability, as well as face, cross-cultural,...

Prevalence and accurate diagnosis of polycystic ovary syndrome in adolescents across world regions: a systematic review and meta-analysis.

To examine the global prevalence of polycystic ovary syndrome (PCOS) among adolescents across world regions, comparing the 2003 Rotterdam consensus criteria with the current International Evidence-based PCOS Guideline criteria which omits polycystic ovarian morphology (PCOM). Systematic review and meta-analysis, Prospero CRD42022372029. OVID MEDLINE, All EBM, PsycInfo, EMBASE, and CINAHL were searched from 1990 to November 2023 for studies assessing the prevalence of PCOS in unselected adolescent populations. Overall, 15 708 articles were identified. After removal of duplicates, 11 868 titles and abstracts and 445 full texts were assessed. Of these, 24 articles reporting on 23 studies from five world regions were included. In meta-analysis of 20 studies (n = 14 010 adolescents), global prevalence was 9.8% (95% CI 7.2, 12.3) according to original Rotterdam criteria, and 6.3% (95% CI 3.9, 8.8) according to International Evidence-based Guideline criteria. Global PCOS prevalence based on self-report was 9.8% (95% CI 5.5, 14.1). Grouped by WHO region, prevalence ranged from 2.9% (95% CI 2.0, 3.9) in the Western Pacific region to 11.4% (95% CI 7.1, 15.7) in the South-East Asia region according to guideline criteria. This paramount global meta-analysis on adolescent PCOS diagnosis directly informed the 2023 International PCOS Guideline. Guideline criteria generated a global PCOS prevalence of 6.3%, compared with 9.8% on Rotterdam criteria (including PCOM). Excluding PCOM, which overlaps with normal pubertal transition, is expected to deter over-diagnosis. To avoid under-diagnosis, the Guideline recommends identifying those with either irregular cycles or hyperandrogenism as being "at risk"; this group should undergo longitudinal serial evaluations until adulthood.

The pathway to delivering injectable CAB for HIV prevention: strategies from global PrEP leaders leveraging an adapted version of the Intervention Scalability Assessment Tool (ISAT)

BackgroundLonger-acting cabotegravir (CAB) is a novel, safe, and efficacious pre-exposure prophylaxis (PrEP) for HIV prevention. As we near a time for CAB scale-up, the experience of global leaders in PrEP research and implementation can be leveraged to identify optimal strategies for scaling and integrating CAB into existing PrEP infrastructure worldwide.MethodsWe recruited leaders of HIV prevention clinical trials and large PrEP programs through a combination of purposive and snowball sampling for participation in individual interviews. We conducted interviews using a semi-structured guide that compared CAB to oral PrEP and sought perspectives on barriers and strategies for CAB scale-up. Interviews were conducted virtually, audio recorded, and transcribed. We used thematic analysis, grounded in an adapted version of the Intervention Scalability Assessment Tool (ISAT), to identify critical elements for optimizing delivery of CAB.ResultsFrom October 2021 to April 2022, we interviewed 30 participants with extensive experience in PrEP research, care, and programming. Participants worked in all seven WHO regions and reported a median of 20 years working in HIV and 10 years in PrEP. Participants agreed that CAB was efficacious and discrete, therefore having the potential to address current concerns about oral PrEP adherence and stigma. Participants indicated direct and indirect costs for provider training, expansion of existing medical infrastructure, and the current medication cost of CAB as major concerns for roll out. The true cost to the end-user and health system were unknown. There were some conflicting strategies on how to best address product targeting, presentation of efficacy, and timing of product availability with scale-up. Some thought that targeting CAB for the general population could normalize PrEP and decrease stigma, while others thought that prioritizing key populations could optimize impact by targeting those with highest risk. Overall, participants emphasized that to ensure successful CAB scale-up, communities and stakeholders must be involved at every stage of planning and implementation.ConclusionsOur evaluation found that although there is a clear and urgent need for additional HIV PrEP options beyond daily oral PrEP, CAB scale-up must be thoughtful, flexible, and based in lessons learned from oral PrEP rollout.

Global emergency medicine research priorities: a mapping review.

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world.

Associations of tobacco and alcohol use with sexual behaviors among adolescents in 59 countries: a population-based study

BackgroundSexual behaviors, particularly risky sexual behavior, has become a serious public health concern among adolescents worldwide, presenting a substantial obstacle to the prevention of sexually transmitted infections, including human immunodeficiency virus (HIV). However, there is limited research using consistent and standardized methodology to examine associations between tobacco and alcohol use frequency and both total and risky sexual behaviors among adolescents. We aimed to examine the association between tobacco and/or alcohol use with both total and risky sexual behaviors among adolescents worldwide.MethodsData were collected from the Global School-based Student Health Survey, which comprised 211,847 adolescents aged 12–17 years from 59 countries. The frequency of tobacco or alcohol use during the past 30 days was categorized as 0, 1–2, 3–5, 6–9, or ≥ 10 days. Tobacco and alcohol use were also categorized as non-use, tobacco use alone, alcohol use alone, and combined use. Multi-variable logistic regression analysis was used to examine both the independent and combined associations of tobacco and alcohol use with total and risky sexual behaviors.ResultsCompared with no tobacco use, the odds ratio of engaging in sexual intercourse increased with the frequency of tobacco use from 1 to 2 days to ≥ 10 days (total: 2.03 [95% confidence interval 1.47–2.81] to 3.98[2.63–6.03]; risky: 2.43[1.75–3.38] to 4.21[3.26–5.42]), as well as with the frequency of alcohol use. Overall, combined users had greater likelihood of both total and risky sexual behaviors than tobacco users alone, alcohol users alone, and non-users. Similarly, the association between risky sexual behaviors and tobacco use alone was more pronounced among adolescent girls (vs. adolescent boys), as were those of risky sexual behaviors with alcohol use alone among younger adolescents aged 12–14 years (vs. aged 15–17 years) and with tobacco and/or alcohol use among adolescents in the Western Pacific region (vs. Regions of Africa and Americas).ConclusionsOur findings suggest independent and combined associations between tobacco and/or alcohol use with sexual behaviors among adolescents, with variations across age, sex, and WHO region.

WP4.14 - Association of Socioeconomical Status and Disparity In Paediatric Burn: Results From The Global Burden Of Disease Study 2019

Abstract Background Burn represents a significant contributor to both morbidity and mortality in the paediatric population and is closely related to socioeconomic and geographic factors but is often overlooked. This study aims to estimate the unbalanced distributions, temporal trends and quality of care in paediatric burn. Methods Data focusing on paediatric population (<20 years old) was sourced from the Global Burden of Disease (GBD) Study 2019 stratified by Socio-demographic Index (SDI) and WHO region, including incidence, mortality and disability-adjusted life-years (DALYs). Joinpoint regression analysis and principal component analysis were conducted to compute the temporal trend and quality of care (QCI) index respectively. Result In 2019, 3,719,806 paediatric burn cases were reported, resulting in 23,986 deaths and 2,240,311 DALYs globally. Over 40% of deaths and DALYs attributable to burn occur in the African region, despite the region accounting for around 20% of the total incidence. The age-standardised incidence rate (ASIR) from 2010-2019 was 0.419 per 100,000 but death (ASDR) and DALYs (ASDALYs) were reduced at the rate of 3.04 per 100,000 and 2.92 per 100,000 respectively. The global QCI for paediatric burn was 88 with a proportional trend observed across SDI quintiles Significant association in between SDI scores and gender disparity and quality of care was observed. Conclusion This study highlights the significant burden of paediatric burn and its disproportionate global distribution. Preventive measures, enhancing access to quality healthcare, and addressing the social and economic determinants of burn should be addressed in future studies.

Monkeypox- need for Vigilant Health system and Regulations towards a Global Health Threat

A viral illness caused by the monkey pox virus, monkeypox is now known as Mpox. It is a zoonotic infectious disease causing painful rash, enlarged lymph nodes, fever, headache, muscle ache, backpain and low energy. According to WHO, most cases in 2022 were in Africa but later m-pox was reported from USA, Europe Australia & Canada. Mpox continues to be a threat today, with upsurge of cases in Democratic Republic of Congo and other countries in Africa. Since 2022, there has also been an upsurge in mpox cases and deaths in the Democratic Republic of the Congo. Over 120 countries have reported mpox between Jan 2022-Aug 2024, with over 1,00,000 laboratory-confirmed cases reported and over 220 deaths among confirmed cases. In India, MoHFW reported 30 cases in the last 2022 outbreak, with last case occurring in March 2024. The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research. The first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (1970). Mpox steadily emerged in central, east and west Africa following the eradication of smallpox in 1980 and the end of smallpox vaccination worldwide. In 2003, there was an outbreak in the United States of America, linked to imported wild animals. Since 2005, thousands of cases are reported in the Democratic Republic of the Congo every year. In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions including refugee camps in the Republic of the Sudan.

Extensively Drug-resistant Tuberculosis in the World: From 1990 to 2019, by WHO Regions

Extensively Drug-resistant Tuberculosis in the World: From 1990 to 2019, by WHO Regions

Methodological considerations in cross-sectional studies validating the International Classification of Functioning, Disability and Health (ICF) Core-Sets: a systematic review.

To describe and analyze the methodological characteristics and quality of cross-sectional studies that have validated an ICF-CS. A systematic review was conducted to identify empirical studies published in English that validated any ICF-CS using a cross-sectional design. Databases searched included Web of Science, Scopus, CINAHL, PubMed, Embase, and PsycINFO. The search was conducted in November 2022 with an update in October 2023. Two independent reviewers coded studies that met the inclusion criteria and assessed their methodological quality and risk of bias using the AXIS tool. Synthesis was performed by calculating frequencies and percentages. 87 articles validating 24 ICF-CSs were analyzed. Most articles showed strengths in consistency between study objectives and the outcome variables measured. However, a large majority did not report sample size calculation (up to 94.2% in Delphi studies), and few validation studies were conducted in the WHO regions of Africa and the Eastern Mediterranean. The quality of cross-sectional studies validating ICF-CSs was satisfactory, although several articles did not describe aspects such as sample size calculation. Validity evidence for ICF-CS studies could be improved by conducting more multicenter studies, replicating ICF-CS validation studies in different WHO regions, and through synthesis of existing research.

Association between heavy metals exposure and risk of attention deficit hyperactivity disorder (ADHD) in children: a systematic review and meta-analysis.

Heavy metals can negatively affect children's neurodevelopment, yet the relationship between heavy metals exposure and attention deficit hyperactivity disorder (ADHD) in children remains unclear. We aimed to examine associations between exposure to five common heavy metals (lead, arsenic, mercury, cadmium, and manganese) with neurodevelopmental toxicity and the risk of ADHD in children. Online databases of PubMed, Web of Science, and Embase were searched before February 29, 2024. A total of 31 studies involving 25,258 children were included in the final analysis. Our findings revealed that lead exposure was positively associated with ADHD risk in children (OR = 1.95, 95% CI: 1.57-2.41) overall, while the associations varied among different WHO regions, with the strongest in the Americas. Sensitivity analyses revealed significant associations between arsenic (OR = 1.53, 95% CI: 1.01-2.32) and manganese (OR = 1.79, 95% CI: 1.28-2.49) exposure and ADHD risk after omitting one study. Arsenic exposure was positively associated with ADHD risk in studies conducted in the Americas and adjusted for environmental smoke exposure. Positive associations between manganese exposure and ADHD risk were also found in several subgroup analyses. No significant associations were found for mercury and cadmium exposure. Dose-response meta-analysis suggested that children with higher blood lead levels exhibited a higher probability of ADHD diagnosis. Lead exposure consistently increases the risk of ADHD in children, while arsenic and manganese exposure may be associated with ADHD under different occasions. More research is required to understand heavy metals' impact on ADHD across varying exposure levels, particularly in less contaminated regions.

Premature mortality trends in 183 countries by cancer type, sex, WHO region, and World Bank income level in 2000-19: a retrospective, cross-sectional, population-based study.

Cancer is a leading cause of mortality worldwide. By 2040, over 30 million new cancers are predicted, with the greatest cancer burden in low-income countries. In 2015, the UN passed the Sustainable Development Goal 3.4 (SDG 3.4) to tackle the rising burden of non-communicable diseases, which calls for a reduction by a third in premature mortality from non-communicable diseases, including cancer, by 2030. However, there is a paucity of data on premature mortality rates by cancer type. In this study, we examine annual rates of change for cancer-specific premature mortality and classify whether countries are on track to reach SDG 3.4 targets. This is a retrospective, cross-sectional, population-based study investigating premature mortality trends from 2000-19 using the WHO Global Health Estimates data. All cancers combined and thirteen individual cancers in 183 countries were examined by WHO region, World Bank income level, and sex. The risk of premature mortality was calculated for ages 30-69 years, independent of other competing causes of death, using standard life table methods. The primary objective was to compute average annual rate of change in premature mortality from 2000 to 2019. Secondary objectives assessed whether this annual rate of change would be sufficient to reach SDG 3.4. targets for premature mortality by 2030. This study was conducted using data retrieved for the years 2000-19. Premature mortality rates decreased in 138 (75%) of 183 countries across all World Bank income levels and WHO regions, however only eight (4%) countries are likely to meet the SDG 3.4 targets for all cancers combined. Cancers where early detection strategies exist, such as breast and colorectal cancer, have higher declining premature mortality rates in high-income countries (breast cancer 48 [89%] of 54 and colorectal cancer 45 [83%]) than in low-income countries (seven [24%] of 29 and four [14%]). Cancers with primary prevention programmes, such as cervical cancer, have more countries with declining premature mortality rates (high-income countries 50 [93%] of 54 and low-income countries 26 [90%] of 29). Sex-related disparities in premature mortality rates vary across WHO regions, World Bank income groups, and by cancer type. There is a greater reduction in premature mortality for all cancers combined and for individual cancer types in high-income countries compared with lower-middle-income and low-income countries. However, most countries will not reach the SDG 3.4 target. Cancers with early detection strategies in place, such as breast and colorectal cancers, are performing poorly in premature mortality compared with cancers with primary prevention measures, such as cervical cancer. Investments toward prevention, early detection, and treatment can potentially accelerate declines in premature mortality. WHO.