World Health Organization Action Research Articles

The World Health Organization's action plan on the road traffic injury pandemic: is there any action for orthopaedic trauma surgeons?

Road traffic crash-related death, injury, and chronic disability continue to be a major worldwide burden to drivers, pedestrians, and users of mass transit, especially in low- and middle-income countries (LMIC). Projections predict worsening of this burden, and while motorization of LMIC increases exponentially, a corresponding improvement in prehospital and acute in-hospital trauma care has not been seen. The WHO now has 2 programs that address different elements of this challenge, namely, the Violence and Injury Prevention department (prevention) and the Emergency and Essential Surgical Care project (treatment). Activities of Violence and Injury Prevention have included developing guidelines for prehospital and essential trauma care, whereas activities of the Emergency and Essential Surgical Care have included developing the Integrated Management of Emergency and Essential Surgical Care toolkit and a textbook, "Surgical Care at the District Hospital." Organized surgical institutions in high-income countries-trauma associations, university departments, surgical nongovernmental organizations, etc.-can benefit from the infrastructure and tools the WHO has developed to better address the deficits in surgical services to improve the equitable distribution of surgical care services and resources to LMIC.

P3.289 MIC Creep to Ceftriaxone and Low Levels of Resistance to Azithromycin in 7 Countries from South America and the Caribbean

BackgroundThe World Health Organization (WHO) issued an international action plan in 2012 to mitigate the health impact of antimicrobial resistant Neisseria gonorrhoeae isolates. A key strategy is to strengthen international...

Outcome and Monitoring of Cataract Surgical Services at Takeo Province, Cambodia.

To evaluate outcome and monitoring of cataract surgical services at Takeo Eye Hospital, Cambodia A prospective, hospital-based report using a cataract surgical record form from the International Center for Eye Health, London. Data including preoperative and postoperative visual acuity (VA), proportion of ocular pathology, intraoperative and postoperative complications, type of surgery, and causes of poor outcome of all patients with cataract were collected. Exclusion criteria were age of patients being younger than 20 years, combined cataract-glaucoma surgeries, and having traumatic cataract. A total of 8211 cataract surgeries were performed from January 2007 to December 2011. Preoperatively, the presenting VA was less than 6/60 in 65.8%. At discharge, 51.8% had a presenting VA of 6/18 or better.Outcome was poor (VA < 6/60) in 10.6%. Over 5 years, the percentage of patients with poor outcome decreased from 12.6% to 8.5%. Total operative complications decreased from 18.2% in 2007 to 3.3% in 2011, with a reduction of vitreous loss from 6.5% to 1.8%. Of all surgeries, 21.2% were performed by resident physicians. At the first follow-up 1 to 3 weeks postoperatively, 62.6% of the patients presented, whereas 23.9% presented for a second follow-up after 4 to 6 weeks. Monitoring of cataract surgical services indicated an increase in quantity and quality. Hospital-based data collection as recommended by the World Health Organization action plan for the prevention of avoidable blindness is possible, but biased data collection has to be considered in the interpretation of the data.

Chronic Diseases: The Emerging Pandemic

Chronic Diseases: The Emerging Pandemic

Global institutions: the World Health Organization (WHO)

This book is a short and very readable account of the origins and evolution of WHO as the United Nations specialized agency for global health. It will be of interest not only to scholars and practitioners of public health, but also to those interested in development and international relations. Starting with a brief review of the history of international cooperation aimed at prevention and control of the spread of communicable diseases across borders, the book traces the rise of social medicine and public health in response to recognition of social and economic determinants of the health of populations during the Industrial Revolution in Europe and subsequently into the 20th century on both sides of the Atlantic. Biomedical and social concepts of human health have led to tensions with regard to defining the scope and limits of public health and its amenability to scientific and technical or social and political action. The book discusses these tensions in relation to the foundation of WHO in the aftermath of the Second World War, starting with a definition of its mandate and constitution, which came into force on 7 April 1948. While the constitution adopts a broad notion of health, nevertheless the history of WHO in the subsequent 60 years reveals alternating and competing cycles that reflect ongoing debate and opinions on how best to promote the attainment by all peoples of the highest possible level of health. Following a brief review of the events leading up to WHO’s creation, the book analyses the structure, functions and governance of the Organization, all of which are intended to reflect universal membership as well as its role as the United Nations specialized agency for health. This chapter explains WHO’s unique regional and global structure that enables the Organization to carry out its dual normative and technical cooperation functions, the latter implemented through its 147 country offices. Two chapters are dedicated to analysing WHO’s approaches to competing pressures among its Member States on how best to improve and promote health. These pressures arise from two related dichotomies. The first relates to the relative effectiveness of focusing on specific diseases versus strengthening health systems. The second relates to the balance between focus on health and the health sector versus broader determinants of health and the need for health in all policies and intersectoral action. A chapter on global campaigns against specific diseases traces WHO action against malaria, smallpox, HIV/AIDS and poliomyelitis. It notes how disease control and eradication campaigns fire the public imagination and attract donors. For many people they epitomize the work of a world health organization. However, the author notes WHO’s mixed record and concludes that global disease campaigns are not in themselves an adequate fulfilment of WHO’s mandate to improve world health. A chapter on tackling the broad determinants of health examines attempts by the public health community to influence the work of WHO to better reflect its Constitution. It traces early work that focused on single factors such as water, sanitation, nutrition and housing before moving on to the primary health care movement of the 1970s and 1980s that drew international attention to health equity and the fundamental importance of ensuring universal access to services, including essential medicines. The author records the controversies and political tensions that have accompanied WHO’s work in these areas, including recent work on tobacco control, trade and health and prevention of chronic diseases in which strong vested interests have sought to oppose and undermine the work of the Organization. The final chapter describes pressure on WHO to respond to the realities of globalization by engaging with new stakeholders, beyond its member states, and addressing important cross-border health determinants. The author examines the pressures on the secretariat to embrace global health and the ensuing challenges to revisit WHO’s mandate, basic functions and even its underlying value system. In line with the higher-than-ever priority that has been accorded to public health in international affairs, WHO’s functions and governance have been the subject of repeated studies and calls for reform since the early 1990s. The book concludes that politics has been embedded in WHO throughout its history and is an obvious feature of an international organization mandated to promote the attainment of the highest possible level of health for all peoples. In that context, it is remarkably current at this juncture when human health and wellbeing face challenges as great as any since the Organization was established. ■

The Elimination of Congenital Syphilis: A Comparison of the Proposed World Health Organization Action Plan for the Elimination of Congenital Syphilis With Existing National Maternal and Congenital Syphilis Policies

Building upon a critical assessment of national policies, programs, and treatment options, the World Health Organization (WHO) recently developed an action plan for the elimination of congenital syphilis (CS). The objective of the review was to identify areas of commonality or divergence between the national strategies and the WHO plan, thereby helping to target the development of national-level policies in light of the forthcoming recommendations of the proposed WHO action plan to eliminate CS. The 4 strategic pillars of the proposed WHO action plan were used as a comparative framework to examine the policy, programmatic, and monitoring components of a sample of 14 existing national-level congenital or maternal control policies. The countries were chosen to represent a range of resource and prevalence levels. The majority of countries do not meet every element proposed in the WHO action plan. Political commitment (pillar 1) across the 14 countries is varied. CS elimination goals were rare but all had universal screening. Linkages to appropriate case management services were identified in 11 countries, although a national governing body was not generally evident. Efforts to increase and improve access to care (pillar 2) were noted in 8 countries with recommendations to ensure all pregnant women were screened and treated. Low-resource settings have formed international partnerships. Guidelines for the diagnosis and treatment of pregnant women and partners (pillar 3) found in high-resource settings were lacking in low-resource and high CS prevalence countries. Surveillance programs were active in 10 countries while comprehensive details on monitoring and evaluation (pillar 4) components including proxy CS indicators were unavailable for nearly all. The elimination of CS can be achieved through the implementation of a series of proven measures but requires technical support, funding, and a commitment among political forces, health officials, and the public to prevent and treat all CS cases and help countries reach their Millennium Development Goals. Stronger partnerships with clearly defined responsibilities should be developed among agencies responsible for national STI control, HIV/AIDS control, and Making Pregnancy Safer initiatives to ensure the universal coverage of CS control interventions.

Jaundice in malaria

Jaundice is not an unusual accompaniment of malaria. It can occur due to intravascular hemolysis, disseminated intravascular coagulation, and, rarely, 'malarial hepatitis'. Although the primary schizogony of the malarial parasite always leads to the rupture of the infected hepatocyte, alteration of the hepatic functions is uncommonly recorded due to this event. Histologically, the hepatitis or the actual inflammation in the liver has never been demonstrated. Nonetheless, the term 'malarial hepatitis' (MH) has been used in the literature to describe the occurrence of hepatocellular jaundice in patients with Plasmodium falciparum infection. The authors' own data and review of the literature indicate that it is not an uncommon entity. In endemic areas, jaundice is seen in approximately 2.5% of patients with falciparum malaria. It also appears to be a heterogeneous syndrome and one can recognize two clinical subsets. In one group there was an acute, virulent presentation with coma, renal failure and in some cases even hemorrhagic manifestations. It is only in this setting that jaundice signified a 'severe' disease as noted by the World Health Organization action program. This presentation is often confused with acute viral hepatitis and acute hepatic failure in non-endemic areas, but can be clinically differentiated.

Assessing Prescribing Practice in Church-Owned Primary Healthcare (PHC) Institutions Intanzania: A Pilot Study

A retrospective survey of prescribing patterns in 10 church-owned primary healthcare (PHC) institutions in Dar es Salaam region, Tanzania, was carried out by trained research assistants in order to assess the prescribing practices of healthcare providers in these institutions. From a total of 15,000 prescriptions, 600 were recorded randomly from patient registers retrospectively. This work was carried out between April to September 1996. Each prescription was recorded using World Health Organization Action Programme on Essential Drugs (WHO/DAP) forms and analysed manually. The average number of drugs per prescription was 2.9; the percentage encounters for injections and antibiotics was 38 and 71, respectively. Ninety-four per cent of all drugs were prescribed according to the essential drug list of Tanzania.

WHO global campaigns: A way forward in addressing public health importance of common neurological disorders

WHO global campaigns: A way forward in addressing public health importance of common neurological disorders

Antibiotic resistance in the tropics: 3. Medical responsibilities of the pharmaceutical industry with respect to use of antibiotics in the tropics

The pharmaceutical industry has three major medical responsibilities: the efficacy and safety of its products, the accuracy of the statements it makes about them, and the provision to governments and health workers of full and proper information concerning these products. The development of new antibiotics is very costly, and their provision to Third World countries alone can never be financially rewarding; furthermore, only about 20% of world-wide pharmaceutical sales are to Third World countries. The industry's interest in developing drugs for exclusive or major use in such countries is declining. However, support from industry for the World Health Organization's action programme on essential drugs is growing, and this should help to provide drugs more cheaply to the poorer countries of the world.

Glucose intolerance as contributor to noncommunicable disease morbidity and mortality. WHO integrated program for community health in noncommunicable diseases.

The World Health Organization (WHO) has considerable evidence that several interrelated factors (e.g., smoking, hypertension, cholesterol, and obesity) contribute to total mortality. Data are presented documenting that glucose intolerance is also a risk factor for total mortality, as well as for cancer and cardiovascular morality. The Kaunas-Rotterdam Intervention Study, which documented glucose tolerance and mortality in a cohort of men, shows a linear increase in total mortality with increasing blood glucose levels. By use of multiple logistic regressions, glucose was shown to be a significant risk factor (c = .2534, t = 4.0) for total mortality. A paradigm is presented in which diabetes is placed as a disease and glucose intolerance as a risk factor within the total scheme for the development of noncommunicable diseases. The WHO action plan for integrated programs in noncommunicable diseases is discussed. The program expands on the experience gained by WHO investigators in community programs and proposes a cooperative effort globally in community-based programming.