World Health Organization Benchmark Research Articles

A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned

Uganda has been implementing the Global Health Security Agenda (GHSA) since 2015 to build its capacity according to World Health Organization (WHO) Benchmarks on International Health Regulations Capacities. The country remains prone to outbreaks, with more than 20 disease outbreaks reported in the past five years, including Ebola virus disease, Crimean-Congo haemorrhagic fever, Marburg haemorrhagic fever, measles, yellow fever, coronavirus disease 2019 (COVID-19), and cholera. Antimicrobial resistance (AMR) is an ongoing challenge. Uganda scored capacity level 3 on infection prevention and control (IPC) and antimicrobial stewardship (AMS) in the 2017 Joint External Evaluation (JEE) assessment. Identified gaps were being addressed after a self-assessment in 2021. This paper describes the technical assistance approaches provided to Uganda by the Medicines, Technologies, and Pharmaceutical Services Program, funded by the United States (U.S.) Agency for International Development, and implemented by Management Sciences for Health. The program, through a One Health approach, supported systematic capacity strengthening based on the JEE’s capacity advancement framework for global health security, specifically relating to AMR. The program’s interventions impacted 32 WHO benchmark actions (7 for AMR multisectoral coordination, 16 for IPC, and 9 for AMS), contributing to Uganda’s strengthened GHSA capacity. Leveraging success built on the AMR platform, the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams. The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions, covering 45 districts and reaching 5,452 health workers at 858 health facilities.

Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity

BackgroundAntimicrobial resistance (AMR) poses a global threat to human, animal, and environmental health. AMR is a technical area in the Global Health Security Agenda initiative which uses the Joint External Evaluation tool to evaluate national AMR containment capacity. This paper describes four promising practices for strengthening national antimicrobial resistance containment capacity based on the experiences of the US Agency for International Development’s Medicines, Technologies, and Pharmaceutical Services Program work with 13 countries to implement their national action plans on AMR in the areas of multisectoral coordination, infection prevention and control, and antimicrobial stewardship.MethodsWe use the World Health Organization (WHO) Benchmarks on International Health Regulations Capacities (2019) to guide national, subnational, and facility actions that advance Joint External Evaluation capacity levels from 1 (no capacity) to 5 (sustainable capacity). Our technical approach is based on scoping visits, baseline Joint External Evaluation scores, benchmarks tool guidance, and country resources and priorities.ResultsWe gleaned four promising practices to achieve AMR containment objectives: (1) implement appropriate actions using the WHO benchmarks tool, which prioritizes actions, making it easier for countries to incrementally increase their Joint External Evaluation capacity from level 1 to 5; (2) integrate AMR into national and global agendas. Ongoing agendas and programs at international, regional, and national levels provide opportunities to mainstream and interlink AMR containment efforts; (3) improve governance through multisectoral coordination on AMR. Strengthening multisectoral bodies’ and their technical working groups’ governance improved functioning, which led to better engagement with animal/agricultural sectors and a more coordinated COVID-19 pandemic response; and (4) mobilize and diversify funding for AMR containment. Long-term funding from diversified funding streams is vital for advancing and sustaining countries’ Joint External Evaluation capacities.ConclusionsThe Global Health Security Agenda work has provided practical support to countries to frame and conduct AMR containment actions in terms of pandemic preparedness and health security. The WHO benchmarks tool that Global Health Security Agenda uses serves as a standardized organizing framework to prioritize capacity-appropriate AMR containment actions and transfer skills to help operationalize national action plans on AMR.

Estimated Dietary and Health Impact of the World Health Organization's Global Sodium Benchmarks on Packaged Foods in Australia: a Modeling Study.

In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO's sodium benchmarks in Australia and compared it to the potential impact of Australia's 2020 sodium reformulation targets. We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia's sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. Compliance with the WHO's sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168-2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603-9513) new cases, and 25 700 (17 655-35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO's more stringent and comprehensive sodium benchmarks.

Sodium Content in Cereal-Based Products Sold in Italy: How Far Are We from the Global Benchmarks?

Reformulation of food products is one of the measures needed for reducing salt consumption. Accordingly, the World Health Organization (WHO) recently proposed global sodium benchmarks for different food categories to be used for setting national policies. Therefore, the sodium content of cereal-based products currently sold in Italy was compared with the WHO benchmarks, highlighting those categories primarily needing a reformulation. To this aim, the sodium content and several declarations (i.e., nutrition and health claims, organic or gluten free declaration) were retrieved from 2917 cereal-based products sold on the Italian market. All “minimally processed breakfast cereals” had a sodium content below the benchmark, while “flatbreads” and “leavened bread” had the highest percentage of items above the respective sodium benchmarks. Flatbreads and “crackers/savory biscuits” showed the highest median delta values from the respective benchmarks of 360 and 278 mg/100 g, respectively. Large variability in terms of percentage of products with sodium content above the benchmark was observed within the same categories, as well as among products with different declarations. A large number of food products currently sold on the Italian market have a sodium content above the benchmark. This result suggests the need to reformulate many food products currently on the market to achieve the WHO/United Nations (UN) objective of 30% global reduction in sodium intake by 2025.

Reviewing Health Security Capacities in Nigeria Using the Updated WHO Joint External Evaluation and WHO Benchmarks Tool: Experience from a Country-Led Self-Assessment Exercise.

Across the world, the level of pandemic preparedness varies and no country is fully prepared to respond to all public health events. The International Health Regulations 2005 require state parties to develop core capacities to prevent, detect, and respond to public health events of international concern. In addition to annual self-assessment, these capacities are peer reviewed once every 5 years through the voluntary Joint External Evaluation (JEE). In this article, we share Nigeria's experience of conducting a country-led midterm self-assessment using a slightly modified application of the second edition of the World Health Organization (WHO) JEE and the new WHO benchmarks tool. Despite more stringent scoring criteria in the revised JEE tool, average scoring showed modest capacity improvements in 2019 compared with 2017. Of the 19 technical areas assessed, 11 improved, 5 did not change, and 3 had lower scores. No technical area attained the highest-level scoring of 5. Understanding the level of, and gaps in, pandemic preparedness enables state parties to develop plans to improve health security; the outcome of the assessment included the development of a 12-month operational plan. Countries need to intentionally invest in preparedness by using existing frameworks (eg, JEE) to better understand the status of their preparedness. This will ensure ownership of developed plans with shared responsibilities by all key stakeholders across all levels of government.

Assessment of Sodium Content of Processed Food Available in Indonesia

This study was conducted to identify the sodium content in processed food and determine the proportion of products that meet the World Health Organization (WHO) global sodium benchmark criteria. Spesific concern was placed for sodium content in instant noodles. A comparative analysis was conducted to determine the relevance between the WHO and Indonesian Food and Drug Authority (Indonesian FDA) benchmarks in limiting sodium in instant noodles. Data on sodium levels (mg/100 g) of processed food was obtained from the register in the Indonesian FDA, Directorate of Processed Food Registration for 2019 to 2020. There were 3,850 products, consisting of 3,036 Local Products (LP) and 814 Imported Products (IP). These products were grouped into seven food categories and 18 types of food. The highest sodium content was found in chili sauce at 2,254,06 mg/100 g, and the lowest was in wafers at 218.64 mg/100 g. Overall, 2,538 of all products (66.56%) did not meet the sodium criteria based on the WHO benchmark. While for instant noodles, only 14.2% of the products met the sodium criteria based on the Indonesian FDA regulations and only 7.4% comply to the WHO sodium benchmark. The Cohen’s Kappa test showed a strong agreement (K=0.650; 95% CI; p=0.00, strong) between the two regulations in limiting sodium levels in instant noodles. This study provides an overview of sodium levels in processed food in Indonesia. The sodium content in most products including instant noodles, as one of the most frequently consumed products, are still above the recommended value. Therefore, it is necessary to develop sodium benchmarkof wider range of food categories in national level that might contribute to sodium intake, as well as for instant noodles. In order to achieve this goal, involvement of multi stakeholder among government, food industry and expert are also needed to deliver effective policies regarding sodium intake concerns.

Emission characteristics and quantitative health risk assessment of bioaerosols in an indoor toilet after flushing under various ventilation scenarios

In the indoor environment, toilet is one of the primary sources of bioaerosol because flushing events can disturb stool materials. Bioaerosol exposure has a significant impact on human health. Therefore, this research focused on systematical investigation of Staphylococcus aureus bioaerosol emission characteristics in an indoor toilet after flushing with time. Then, annual probability of infection and disease burden with time under various ventilation scenarios were determined using a Monte Carlo simulation-based quantitative microbial risk assessment. The results showed that at the initial phase, the highest and lowest bioaerosol concentrations were found in poor and combined ventilation scenarios, respectively. The bioaerosol concentration in natural ventilation scenario was 1.1 times higher than that in mechanical ventilation scenario. However, a decreasing trend was observed after flushing. The adult male's health risks were consistently higher than those of all other exposed persons. However, the maximum and minimum health risks were observed in the poor and combined ventilation scenario, respectively. The health risks in the mechanical ventilation scenario were lower than those in the natural ventilation scenario. However, the health infection risk varied with time: it was unbearable to the U.S. Environmental Protection Agency benchmark at 0 min–15 min after flushing, but it was tolerable after flushing 35 min. Moreover, the disease health burdens were below the World Health Organization benchmark after flushing 20 min to 35 min. This research delivered novel data and provide a guideline for controlling the essential health threats from bioaerosol emissions in various toilet usage scenarios.

Tracking immunization coverage, dropout and equity gaps among children ages 12-23months in Malawi - bottleneck analysis of the Malawi Demographic and Health Survey.

BackgroundBetween 2010 and 2016, the proportion of children 12–23 months of age who received full immunization in Malawi decreased from 81% to 76%. Most studies on immunization have mainly focused on the risk factors of vaccination coverage while data on dropouts and equity gaps is very scanty. Thus the aim of the present study was to describe the trend in immunization coverage, dropout rates and effective immunization coverage (EIC) among children ages 12–23 months in Malawi.MethodsSecondary analyses of the cross-sectional data obtained from the three waves of the Demographic and Health Surveys (2004, 2010 and 2015–16) were conducted. Using bottleneck analysis, outputs were generated based on service coverage, demand/equity (service utilization) and quality (full immunization). The World Health Organization benchmarks were used to assess gaps in the immunization coverage indicators.ResultsThe coverage was >90.0% in most of the antigens while full immunization status was estimated at 65%, 84% and 73% in 2004, 2010 and 2015, respectively. The highest coverage was observed in Bacillus Calmette–Guérin (BCG) and lowest in oral polio vaccine 1 (OPV1). OPV1 coverage was <90% in the 2004 cohort year, while pentavalent 3 (Penta3) and measles-containing vaccine 1 (MCV1) coverages were <90% in 2004. Dropout rates of Penta3 and MCV1 were significantly >10% in 2004. The logistic regression analyses showed that children were significantly less likely to be immunized with Penta3 and MCV1 in all cohort years compared with Penta1.ConclusionsAlthough immunization coverage was in line with the national and district targets for various antigens, full vaccination coverage (FVC) is still lagging behind. Furthermore, the dropout rates for Penta3 and MCV1 showed upside U-shaped patterns. Thus health education, supervision and orientation of service providers are urgently needed to address disparities that are existing in FVC.

ASSURED Point-of-Need Food Safety Screening: A Critical Assessment of Portable Food Analyzers.

Standard methods for chemical food safety testing in official laboratories rely largely on liquid or gas chromatography coupled with mass spectrometry. Although these methods are considered the gold standard for quantitative confirmatory analysis, they require sampling, transferring the samples to a central laboratory to be tested by highly trained personnel, and the use of expensive equipment. Therefore, there is an increasing demand for portable and handheld devices to provide rapid, efficient, and on-site screening of food contaminants. Recent technological advancements in the field include smartphone-based, microfluidic chip-based, and paper-based devices integrated with electrochemical and optical biosensing platforms. Furthermore, the potential application of portable mass spectrometers in food testing might bring the confirmatory analysis from the laboratory to the field in the future. Although such systems open new promising possibilities for portable food testing, few of these devices are commercially available. To understand why barriers remain, portable food analyzers reported in the literature over the last ten years were reviewed. To this end, the analytical performance of these devices and the extent they match the World Health Organization benchmark for diagnostic tests, i.e., the Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end-users (ASSURED) criteria, was evaluated critically. A five-star scoring system was used to assess their potential to be implemented as food safety testing systems. The main findings highlight the need for concentrated efforts towards combining the best features of different technologies, to bridge technological gaps and meet commercialization requirements.

Implementing an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative.

At many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth. Chart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks. The bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%. Implementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines. Implementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.

Assessment of Microbial Load in Water and Sediments of Rivers Otamiri and Nworie in Owerri, South Eastern Nigeria

Water pollution is a global problem. The study was carried out to assess the microbial constituents in water and sediment of Rivers Otamiri and Nworie during dry and rainy seasons (March and September, 2020) with comparison to WHO benchmark for drinking water .Samples were randomly collected at six (6) sampling points and analyzed using routine microbiological protocols. The results revealed detectable amount of microbial activates in surface water of both rivers during the dry and rainy season. During the rainy season, a THB bioload average of 2.02x104 and 5.1x104CFU/mL for Nworie and Otamiri river respectively were measured. For the TCC, the average was 9.8x103 and 2.5x104 CFU/mL, while in the dry period there was corresponding reduction in the bioload value for both rivers. THB average value for Nworie river was 1.34x104 CFU/mL, with corresponding 3.5x104 values for Otamiri river, while in same inclination, TCC measured 6.1x103 and 1.8x104 CFU/mL. There were noteworthy variations in the values for the two rivers as well as in the two seasons. TBC value for Otamiri measured about 1.5 folds than the value for Nworie. In same trend, TCC value for Nworie measured about 39%. All values measured were above WHO permissible limit for drinking water. The biochemical and cultural features of the isolated microorganism in water showed the presence of E. coli identified in the entire stations (100%), Salmonella and faecal coliform occurred 83.3% each, while Vibrio and Shigella were detected in 4 of the 6 stations. The mean total bacterial count, total coliform count and total E. coli, were not in conformity with World Health Organization (WHO) Standard for drinking water and thus constitute a threat to the River; these were attributed to indiscriminate waste dumps around the rivers. The study underscores the need for adequate waste management system to forestall outbreak of pathogenic diseases in the area.

Coping with COVID-19 pandemic in blood transfusion services in West Africa: the need to restrategize.

IntroductionThe West African region has been lagging in terms of the availability of, and accessibility to, safe blood. According to the 2016 World Health Organization (WHO) Global Status Report on Blood Safety and Availability, none of the West African countries met the WHO benchmark of 10 blood units per 1000 inhabitants. This study is aimed at discussing the blood transfusion status of West African countries in the pre-COVID-19 period and analyze the capacity to respond to the COVID-19 blood crisis, as well as to outline the panacea.MethodsSecondary data were extracted from published reports, journal articles and web pages, reviewed and analyzed.ResultAll the West African countries have recorded confirmed COVID-19 cases and deaths. The confirmed cases have reached 55,697, with 1069 deaths and a fatality rate of 1.9%, as of June 17, 2020. The assessed countries lagged in most of the WHO benchmarks for effective blood transfusion services.ConclusionBlood transfusion services in the West African region lacked the basic benchmark practice and policy, are not coordinated and may find it hard to tackle the blood transfusion crisis created by the COVID-19 pandemic.

Strengthening multisectoral coordination on antimicrobial resistance: a landscape analysis of efforts in 11 countries

BackgroundIncreasingly, there has been recognition that siloed approaches focusing mainly on human health are ineffective for global antimicrobial resistance (AMR) containment efforts. The inherent complexities of AMR containment warrant a coordinated multisectoral approach. However, how to institutionalize a country’s multisectoral coordination across sectors and between departments used to working in silos is an ongoing challenge. This paper describes the technical approach used by a donor-funded program to strengthen multisectoral coordination on AMR in 11 countries as part of their efforts to advance the objectives of the Global Health Security Agenda and discusses some of the challenges and lessons learned.MethodsThe program conducted a rapid situational analysis of the Global Health Security Agenda and AMR landscape in each country and worked with the governments to identify the gaps, priorities, and potential activities in multisectoral coordination on AMR. Using the World Health Organization (WHO) Joint External Evaluation tool and the WHO Benchmarks for International Health Regulations (2005) Capacities as principal guidance, we worked with countries to achieve key milestones in enhancing effective multisectoral coordination on AMR.ResultsThe program’s interventions led to the achievement of key benchmarks recommended actions, including the finalization of national action plans on AMR and tools to guide their implementation; strengthening the leadership, governance, and oversight capabilities of multisectoral governance structures; establishing and improving the functions of technical working groups on infection prevention and control and antimicrobial stewardship; and coordinating AMR activities within and across sectors.ConclusionA lot of learning still needs to be done to identify best practices for building mutual trust and adequately balancing the priorities of individual ministries with cross-cutting issues. Nevertheless, this paper provides some practical ideas for countries and implementing partners seeking to improve multisectoral coordination on AMR. It also demonstrates that the WHO benchmark actions, although not intended as an exhaustive list of recommendations, provide adequate guidance for increasing countries’ capacity for effective multisectoral coordination on AMR in a standardized manner.

Moderate to Substantial Inter-Rater Reliability in the Assessment of Cranial Bone Mobility Restrictions.

Background: The World Health Organization benchmarks for osteopathic training consider cranial osteopathy as an important manual skill. Studies of cranial manual therapy have exhibited poor reliability. The aim of this study was to investigate the inter-rater reliability of the manual mobility tests of the spheno-occipital synchondrosis (SOS), and the temporal, parietal, and frontal bones, as assessed in osteopathic manual therapy. Methods: Twenty-one adults were assessed on a single day by three experienced osteopaths using a standard assessment protocol. Before data collection, the osteopaths participated in a consensus training, which included establishing the criteria for identifying a cranial bone mobility restriction; the application of the seven-step palpation method; a pretesting practice; a fine-tuning palpation training; and a calibration period before the assessment of the subjects. Three subjects were assessed simultaneously with the evaluators rotating to assess each subject. The evaluators were blinded to the subject by a curtain, and each other's assessments. Each bone was rated as restricted or not restricted. The authors applied the Landis and Koch classification to describe the magnitude of inter-rater reliability. Results: Moderate reliability was established for a lateral strain of the SOS (Fleiss' generalized kappa 0.48), substantial reliability was established for the other SOS strain patterns (Fleiss' generalized kappa 0.62-0.75), and almost perfect reliability for temporal, parietal, and frontal bone (Fleiss' generalized kappa 0.81-0.96). Conclusion: The results demonstrate consistency when three experienced osteopaths evaluate cranial bone mobility restrictions. The results highlight the importance of consensus training and rigorous methodology in manual therapy reliability studies.

An Evaluation of the Health Safety Concerns in Zimbabwean Public Schools Operating under the Covid-19 Pandemic

This paper sought to evaluate the health safety concerns in public schools’ operations under the Covid-19 pandemic and focused on schools in Masvingo Urban. The study was necessitated by an increasing number of public schools in Zimbabwe reporting significant cases of Covid-19 infections since reopening in September 2020 raising public fear that the Standard Operations Procedures (SOPs) prescribed for schools to prevent, combat and manage the spread of the coronavirus were not being enforced hence schools were not safe for the learners and teachers. The study used a descriptive design narrative and a qualitative discourse. The descriptive survey design was preferred for its suitability and simplicity as well as its focus on analyzing data gathered for purpose of describing attitudes and behaviours that influence and shape how the population under study feel and understand things around them. The data for the study, particularly the obvert breaches of SOPs were gathered through observation. Interviews and questionnaires were used to ensure triangulation of techniques so as to better understand whether the shortcomings in implementation of SOPs were due to personal omissions or challenging circumstances that school communities found themselves in. While observation was for all and sundry at the fifteen (15) school selected for the study, targeted sampling was used to come up with seventy-five (75) respondents for interviews and questionnaires. The study revealed that the implementation of SOPs in public schools is far below stakeholders’ expectations and World Health Organization benchmarks. Regrettably, the school environment meant to be improved by the SOPs was still congested and characterized by risk behaviours which expose learners and teachers to the Covid-19 scourge. Chief among the undesirable behaviours include doing without personal protective equipment (gowns, gloves, face masks) or improper use of the same, failure to keep social distance, loopholes in screening of learners and visitors for Covid-19 symptoms and poor hand hygiene. The study further revealed a plethora of underlying challenges to the implementation of the SOPs. Central to the challenges is understaffing of all the school covered by the study. The shortage of teachers has made it difficult to split the mega classes (doubling normal teacher-pupils’ ratio) to desirable and manageable numbers. The neck breaking workload shouldered on the teachers in post that now included close monitoring of learners to enforce Covid-19 prevention and management protocols weighed down on their morale and commitment to duty. Financial constrain was also detrimental as all school did not have adequate supplies of personal protective equipment and sanitizers. The study primarily recommends that the highlighted challenges faced in the implementation of the SOPs be addressed as a matter of urgency. The Ministry of Primary and Secondary Education (MoPSE) should engage the Public Service Commission with the view of employing additional teachers to easy the staff shortage and spread the workload. MoPSE should also explore possibilities of introducing a separate school calendar for various levels to meaningfully decongest classrooms and hostels. The Ministry of Finance must step up its appropriation allocation to public schools through grants to ensure adequate supply of personal protective equipment and sanitizers. In order to empower learners through life skills positive behaviour change for the ‘new normal’ school environment, psycho–educational in form of intensified guidance and counselling programmes must be offered to all learners at all levels in the schools. Keywords: COVID-19, Standard Operating Procedures (SOPs), Coronavirus Management Protocols. DOI: 10.7176/JAAS/70-05 Publication date: January 31 st 2021

Least-Square Models with Structural Breaks for Price-Demand Relationship of Prevention-Commodities to Covid-19 Disease: Evidence from Pooled Weekly Data of Hand Sanitizers, Face-Masks and Vitamin-C Supplements

The present study employs log-log models and comparatively estimates the price-demand relationship of hand sanitizers, face-masks and vitamin-c supplements as COVID-19 prevention-commodities both before and after the exponential spread of the current pandemic. A novel weekly data is collected and generated by a two-stage stratified sampling technique in a field survey from five capital and most populous cities of Pakistan. The least-square methods with structural breaks are employed for city-wise assessment, while fully modified ordinary least square methods are employed for the pooled panel of Pakistan. The structural breaks are assessed using a priori information via graphical analysis as well as employing the global information criterion of structural breaks. The findings suggest demands and prices structurally surged exponentially after the spread of COVID-19 disease in Pakistan. Thus, implying; i) immediate policy check to stabilize the prices of COVID- 19 prevention-commodities for the poor and lower-income groups of people and ii) importing the commodities to fill the existing demand-supply gap to mitigate the spread of the current pandemic as per the World Health Organization benchmark for public prepared-ness to combat COVID-19 disease.

Treatment outcomes and associated factors of tuberculosis patients on directly observed treatment (short course) in a tertiary hospital in Port Harcourt, Nigeria

Introduction: Although concerted efforts have been implemented to achieve tuberculosis (TB) prevention and control, varying outcomes have been reported in several quarters, despite the implementation of the directly observed treatment short-course (DOTS) strategy in virtually all parts of the world. It was considered necessary to assess the treatment outcomes of TB patients on DOTS strategy and the associated factors against the World Health Organization (WHO) target at the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, to stimulate improvements in efforts toward patients care in the hospital and elsewhere. Methods: A health facility-based review of patients' records (January 1, 2014–December 31, 2018) at the TB Clinic of UPTH was carried out using a validated data record sheet. Patients undergoing treatment were excluded. Data were analyzed with the SPSS software version 20. Outcome frequencies were summarized, and the Pearson's Chi-square test was used to determine the association between the outcome and independent variables at P ≤ 0.05 statistical significance level. Results: Overall, 174 (25.7%) had completed treatment, 181 (26.7%) were cured, 95 (14.0%) died, 70 (10.3%) transferred out, 45 (6.6%) defaulted, 49 (7.2%) were not evaluated, 44 (6.5%) were lost to follow-up, and 8 (1.2%) failed treatment. There was a 17.6% decline in the proportion of patients that completed treatment from 35.9% in 2014 to 18.3% in 2018. On the contrary, there was an increase in the proportion of patients that were cured, from 14.1% in 2014% to 26.1% in 2018. Conclusions: The treatment success rate for TB in the hospital was below the WHO benchmark of 85% cure rate throughout the period under review. Basic reforms in the service delivery processes that specifically targets groups at risk (male patients, sputum smear-negative TB patients, and patients with human immunodeficiency virus/TB co-infection) with drug adherence counselling, defaulter tracing arrangements, and emphasis on drug-susceptibility testing are recommended to improve treatment outcomes.

Assessment of readiness to transition from antenatal HIV surveillance surveys to PMTCT programme data-based HIV surveillance in South Africa: The 2017 Antenatal Sentinel HIV Survey

ObjectiveSouth Africa has used antenatal HIV surveys for HIV surveillance in pregnant women since 1990. We assessed South Africa’s readiness to transition to programme data based antenatal HIV surveillance with respect to PMTCT uptake, accuracy of point-of-care rapid testing (RT) and selection bias with using programme data in the context of the 2017 antenatal HIV survey. MethodsBetween 1 October and 15 November 2017, the national survey was conducted in 1,595 public antenatal facilities selected using stratified multistage cluster sampling method. Results of point-of-care RT were obtained from medical records. Blood samples were taken from eligible pregnant women and tested for HIV using immunoassays (IA) in the laboratory. Descriptive statistics were used to report on: PMTCT uptake; agreement between HIV point-of-care RT and laboratory-based HIV-1 IA; and selection bias associated with using programme data for surveillance. ResultsPMTCT HIV testing uptake was high (99.8%). The positive percent agreement (PPA) between RT and IA was lower than the World Health Organization (WHO) benchmark (97.6%) at 96.3% (95% confidence interval (CI): 95.9%–96.6%). The negative percent agreement was above the WHO benchmark (99.5%), at 99.7% (95% CI: 99.6%–99.7%) nationally. PPA markedly varied by province (92.9%–98.3%). Selection bias due to exclusion of participants with no RT results was within the recommended threshold at 0.3%. ConclusionFor the three components assessed, South Africa was close to meeting the WHO standard for transitioning to routine RT data for antenatal HIV surveillance. The wide variations in PPA across provinces should be addressed.

Effective Vaccine Management: The Case of a Rural District in Ghana.

Background The Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels to enhance the development of improvement plan to strengthen the system. This valuation was carried out in the Tolon District of the Northern Region, Ghana. Methods A descriptive valuation of vaccine management was carried out in six vaccine stores in the Tolon District of Northern Ghana. We employed World Health Organization (WHO) assessment tools and procedures which consisted of desk reviews and interviews of cold chain managers to assess vaccine management practices in the district. Five out of the nine global assessment criteria were assessed and a minimum target level required for all criteria to meet the WHO standard was 80%. Results None of the facilities assessed met the WHO benchmark of 80% for all but one criteria assessed. With regards to temperature control, the scores ranged from 42% at Kasuliyili CHPS Centre to 77% at the district store with an average district score of 60%. Stock management ranged between 11% at Wantugu Health Centre and 75% at Nyankpala Health Centre with district average score of 32%. Effective vaccine distribution scores ranged between 13% at Kasuliyili CHPS and 46% at Nyankpala Health Centre with an average district score of 27%. Only Nyankpala Health Centre had an acceptable score of 84% for vaccine management, whereas the lowest score for this indicator was 5% at Tolon Health Centre store with district average score of 53%. Information management and supportive functions scores ranged from 0% at Tolon Health Centre to 26% at the district store with the district average score of 16%. Nineteen (90.5%) of vaccine users had poor knowledge regarding temperature control and vaccine distribution. Conclusion Effective vaccine management knowledge and practices are poor at Tonlon district and calls for urgent and pragmatic approaches such as training and re-training of vaccine users at all levels.

Improving exclusive breastfeeding in low and middle‐income countries: A systematic review

Exclusive breastfeeding (EBF) rates until 6months in most low and middle income countries (LMICs) are well below the 90% World Health Organization benchmark. This systematic review sought to provide evidence on effectiveness of various interventions on EBF until 6months in LMICs, compared with standard care. Experimental and observational studies with concurrent comparator promoting EBF, conducted in LMICs with high country rates of breastfeeding initiation, were included. Studies were identified from a systematic review and PUBMED, Cochrane, and CABI databases. Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for individual studies and pooled. High heterogeneity was explored through prespecified subgroup analyses for the primary outcome (EBF until 6months) by context and by intervention for the randomized controlled trials. Prediction intervals were calculated for each effect estimate. Sixty-seven studies with 79 comparisons from 30 LMICs were included. At 6months, intervention group infants were more likely to be exclusively breastfed than controls (RR=2.19, 95% CI [1.73, 2.77]; I2 78.4%; 25 randomized controlled trials). Larger effects were obtained from interventions delivered by a combination of professional and laypersons (RR 3.90, 95% CI [1.25, 12.21]; I2 46.7%), in interventions spanning antenatal and post-natal periods (RR 2.40, 95% CI [1.70, 3.38]; I2 83.6%), and when intensity was between four to eight contacts/sessions (RR 3.20, 95% CI [2.30, 4.45]; I2 53.8%). Almost every intervention conducted in LMICs increased EBF rates; choice of intervention should therefore be driven by feasibility of delivery in the local context to reduce infant mortality.