World Health Organization Global Health Research Articles

Global, Regional, and Country-Level Economic Impacts of Oral Conditions in 2019.

The recent World Health Organization (WHO) Oral Health Resolution and the subsequent WHO Global Oral Health Action Plan highlight the key relevance of providing information on the economic impacts of oral conditions. The purpose of this study was to provide updated estimates for the global, regional, and country-level economic impacts of oral conditions in 2019. Extending previously established methods, dental expenditures (costs for treatments) and productivity losses for 5 oral conditions (caries in deciduous and permanent teeth, periodontitis, edentulism, other oral diseases) were estimated for the year 2019. The estimated total worldwide economic impacts of oral conditions in 2019 were US $710B, of which US $387B (US $327B to US $404B) was due to direct costs and US $323B (US $186 to US $460) was due to productivity losses for the 5 main oral conditions. Low-income countries spent an average of US $0.52 (US $0.22 to US $0.96) per capita on dental care, while high-income countries spent an average of US $260 (US $257 to US $268) per capita-a 500-fold difference. These findings suggest that oral conditions continue to substantiate an enormous economic burden to individuals and society. The comprehensiveness of estimates supersedes that of previous work as the primary information on direct costs was identified for a larger number of countries. The need for more and better routine reporting and monitoring of the economic impact of oral conditions is emphasized. The relevance of such information is also highlighted by its inclusion in the first-ever WHO Global Oral Health Status Report and Global Strategy on Oral health 2023 to 2030. Given the persistently high economic burden of oral conditions, there is a key role for better prioritization of cost-efficient oral health programs as well as needs-responsive capacity planning.

Rethinking the World Health Organization's leadership of global health governance and the global health surveillance systems.

Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO's ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts' perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO's global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO's governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS.

ASSESSMENT OF THE PREVALENCE OF DEPRESSION AND THE USE OF ANTIDEPRESSANTS IN A STUDY POPULATION

The World Health Organization (WHO) has reported that there is an increasing burden of depression and other mental health conditions globally. WHO global health estimate for depression reports a prevalence of 5.4% in Sub-Saharan Africa. Pharmacological therapy still remains the most popular treatment for diagnosed depression. The aim of this study was to determine the prevalence of clinically diagnosed depression and outcomes of antidepressants among final year undergraduate students in a Federal University. A descriptive cross- sectional study was carried out at University of Benin, Benin City. A validated questionnaire was distributed to the 319 final year clinical students of the College of Medicine, School of Dentistry and Faculty of Pharmacy. Data obtained were organized and analysed with Microsoft Excel and SPSS version 25. Descriptive statistics was done; frequencies and percentages were used to summarize variables of interest. Ethical considerations were observed. All the questionnaires used were valid for analysis. About 90.0% of the respondents were knowledgeable about depression. Symptoms of depression were reported in 20.0% of the respondents with 16.6% having moderate symptoms of depression and 3.4% having moderately severe symptoms of depression. The same 20.0% used antidepressants and 14.7% did not adhere to their regimen. Side effects were experienced by majority of respondents (16.3%) on antidepressants. There was a low prevalence of depression in the study population. Adherence to drug therapy was poor. Side effects to treatment were reported by majority of students receiving antidepressants. Majority of patients claim to be better now that they are using antidepressant treatment as the symptoms of the disease are resolving.

Health Inequality Data Repository

The Health Inequality Data Repository from the World Health Organization (WHO) is a free, open-access selection of publicly available disaggregated data about health and indicators of health. It includes regional and continental data sets from 1950 to 2022, covering all world regions, from 16 sources on more than 2,000 indicators. As of November 2023, the available data set categories are Sustainable Development Goals; WHO Global Health Observatory; COVID-19; Reproductive, Maternal, and Child Health; Immunization; HIV, Tuberculosis, and Malaria; Adult Health; Health Care; Burden of Disease; Disability; Migration; Environmental Health; WHO General Programme of Work; and Beyond the Health Sector (Health Inequality Monitor 2023). The sources of the data sets include publicly available data from the WHO and numerous United Nations (UN) agencies, the Organisation for Economic Co-operation and Development (OECD), the European Union, the US Agency for International Development (USAID), and more. In addition to the data sets, two software options are available. The Health Equity Assessment Toolkit (HEAT) allows users to view the data in various chart and graph formats, and HEAT Plus allows users to upload their own disaggregated data in addition to the available data sets. The Health Inequality Data Repository and its supporting software tools are housed within the Health Inequality Monitor section of the WHO website, and it has numerous educational options related to its resources and goals.

Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019.

Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking. This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years. Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034. Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of -0.37 (95% CI -0.44 to -0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease. While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.

The determinants of longevity: The perspectives from East Asian economies.

The determinants of longevity: The perspectives from East Asian economies.

Global prevalence of 4 neglected foodborne trematodes targeted for control by WHO: A scoping review to highlight the gaps.

Foodborne trematodiases (FBTs) are a group of trematodes targeted for control as part of the World Health Organization (WHO) road map for neglected tropical diseases from 2021 to 2030. Disease mapping; surveillance; and capacity, awareness, and advocacy building are critical to reach the 2030 targets. This review aims to synthesise available data on FBT prevalence, risk factors, prevention, testing, and treatment. We searched the scientific literature and extracted prevalence data as well as qualitative data on the geographical and sociocultural risk factors associated with infection, preventive/protective factors, and methods and challenges of diagnostics and treatment. We also extracted WHO Global Health Observatory data representing the countries that reported FBTs during 2010 to 2019. One hundred and fifteen studies reporting data on any of the 4 FBTs of focus (Fasciola spp., Paragonimus spp., Clonorchis sp., and Opisthorchis spp.) were included in the final selection. Opisthorchiasis was the most commonly reported and researched FBT, with recorded study prevalence ranging from 0.66% to 88.7% in Asia, and this was the highest FBT prevalence overall. The highest recorded study prevalence for clonorchiasis was 59.6%, reported in Asia. Fascioliasis was reported in all regions, with the highest prevalence of 24.77% reported in the Americas. The least data was available on paragonimiasis, with the highest reported study prevalence of 14.9% in Africa. WHO Global Health Observatory data indicated 93/224 (42%) countries reported at least 1 FBT and 26 countries are likely co-endemic to 2 or more FBTs. However, only 3 countries had conducted prevalence estimates for multiple FBTs in the published literature between 2010 to 2020. Despite differing epidemiology, there were overlapping risk factors for all FBTs in all geographical areas, including proximity to rural and agricultural environments; consumption of raw contaminated food; and limited water, hygiene, and sanitation. Mass drug administration and increased awareness and health education were commonly reported preventive factors for all FBTs. FBTs were primarily diagnosed using faecal parasitological testing. Triclabendazole was the most reported treatment for fascioliasis, while praziquantel was the primary treatment for paragonimiasis, clonorchiasis, and opisthorchiasis. Low sensitivity of diagnostic tests as well as reinfection due to continued high-risk food consumption habits were common factors. This review presents an up-to-date synthesis on the quantitative and qualitative evidence available for the 4 FBTs. The data show a large gap between what is being estimated and what is being reported. Although progress has been made with control programmes in several endemic areas, sustained effort is needed to improve surveillance data on FBTs and identify endemic and high-risk areas for environmental exposures, through a One Health approach, to achieve the 2030 goals of FBT prevention.

Health and economic benefits of meeting WHO air quality guidelines, Western Pacific Region.

To quantify the number of avoidable annual deaths and associated economic benefits from meeting the World Health Organization (WHO) air quality guidelines for ambient concentrations for fine particulate matter (PM2.5) for Member States of the WHO Western Pacific Region. Using the AirQ+ software, we performed a quantitative health impact assessment comparing country-level PM2.5 concentrations with the 2005 and 2021 air quality guidelines recommended maximum concentrations of 10 and 5μg/m3, respectively. We obtained PM2.5 data from the WHO Global Health Observatory (latest available year 2016), and population and mortality estimates from the United Nations World Population Prospects database for the latest 5-year period available (2015-2019), which we averaged to 1-year estimates. A risk estimate for all-cause mortality, based on a meta-analysis, was embedded within AirQ+ software. Our economic assessment used World Bank value of a statistical life adjusted to country-specific gross domestic product (latest available year 2014). Data were complete for 21 of 27 Member States. If these countries achieved the 2021 guidelines for PM2.5, an estimated 3.1 million deaths would be avoided annually, which are 0.4 million more deaths avoided than meeting the 2005 guidelines. China would avoid the most deaths per 100 000 population (303 deaths) and Brunei Darussalam the least (5 deaths). The annual economic benefit per capita ranged from 5781 United States dollars (US$) in Singapore to US$143 in Solomon Islands. Implementing effective measures to reduce PM2.5 emissions would save a substantial number of lives and money across the Region.

A Review and Analysis of the Impact of Homicide Measurement on Cross-National Research

The number of cross-national homicide studies is increasing rapidly. Many scholars, however, do not consider the details of how individual nations and the four main centralized homicide data sources—raw estimates from the World Health Organization (WHO) Mortality Database, adjusted estimates from the WHO Global Health Observatory, United Nations Office on Drugs and Crime, and World Bank World Development Indicators—generate national homicide rates and the impact this may have on results and the scientific record. We tested whether homicide trends, levels, and structural covariates are dependent on data source. We used 1990–2018 data in 5-year groupings and pooled them over time and nation. We utilized exploratory data analysis techniques to look for differences in homicide rates and trends. Then we employed seemingly unrelated regression (SUR) to determine whether associations with homicide of typical structural covariates were dependent on homicide data source. Finally, we examined Wald Tests to determine whether differences in the sizes of the SUR coefficients from each data source were significantly different from zero. We found differences in homicide trends and rates by data source and that associations with homicide rates of structural covariates varied in significance, magnitude, and even direction depending on homicide data source. Cross-national homicideresearch has a promising future for understanding short- and long-term global and regional trends and population-level covariates and constructing theoretical explanations for geographical and temporal variation. However, researchers must better understand how national homicide data are generated by nations and these four data sources. All four systems possess limitations, but homicide data from the WHO Mortality Database present the most attractive option.

Distribution, Risk Factors, and Temporal Trends for Lung Cancer Incidence and Mortality: A Global Analysis

Lung cancer ranks second for cancer incidence and first for cancer mortality. Investigation into its risk factors and epidemiologic trends could help describe geographical distribution and identify high-risk population groups. What is the global incidence, mortality, associated risk factors, and temporal trends of lung cancer by sex, age, and country? Data on incidence and mortality were retrieved from the Global Cancer Observatory (GLOBOCAN), Cancer Incidence in Five Continents series I-X, World Health Organization (WHO) mortality database, the Nordic Cancer Registries (NORDCAN), and the Surveillance, Epidemiology, and End Results Program (SEER). We searched the WHO Global Health Observatory data repository for age-adjusted prevalence of current smoking. The Average Annual Percentage Change (AAPC) of the trends were obtained by Joinpoint Regression. The age-standardized rate of incidence and mortality were 22.4 and 18.0 per 100,000 globally. The lung cancer incidence and mortality were associated with Human Development Index (HDI), Gross Domestic Products (GDP), and prevalence of smoking. For incidence, more countries had increasing trends in females but decreasing trends in males (AAPC, 1.06 to 6.43 for female;-3.53 to-0.64 for male). A similar pattern was found in those 50 years or older, whereas those aged younger than 50 years had declining incidence trends in both sexes in most countries. For mortality, similar to incidence, 17 of 48 countries showed decreasing trends in males and increasing trends in females (AAPC,-3.28 to-1.32 for male, 0.63 to 3.96 for female). Most countries had increasing trends in females but decreasing trends in males and in lung cancer incidence and mortality. Tobacco related measures and early cancer detection should be implemented to control the increasing trends of lung cancer in females, and in regions identified as having these trends. Future studies may explore the reasons behind these epidemiological transitions.

A Temporal and Multinational Assessment of Acute Myeloid Leukemia (AML) Cancer Incidence, Survival, and Disease Burden

Introduction: As US and global populations continue to age, a corresponding rise in incidence of age-associated cancers including acute myeloid leukemia (AML) remains persistent (Kraywinkel & Spix, 2017; Reedijk et al., 2019; Siegel, Miller, & Jemal, 2020; Yi et al., 2020). Characterizing the current and future epidemiologic impact of AML is critical for assessing therapeutic demand and informing allocation of health care resources. However, very few recent publications have reported international estimates of AML diagnoses and none have projected future cases. In this study, we estimate current and future incidence of AML (2021-2040) in 29 countries from 4 continents. Next, we describe survival trends in the US over the last 4 decades and by age at diagnosis. Finally, we assess the societal burden of AML in 29 countries by calculating average years of life lost (AYLL) due to AML-related death in 2021.Methods: Incidence rates were age-standardized to the World Health Organization (WHO) New World Population. For these calculations, age-specific rates were estimated using data from the International Agency for Research on Cancer's (IARC's) Cancer Incidence in Five Continents Volume XI (CI5-XI) database for 28 countries outside of the US (11 in Asia, 9 in Europe, 6 in the Americas, and 2 in Oceania). For US rates, data from National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) 21 were assessed. To project crude (unstandardized) incidence rates and the number of incident cases forward to 2040, age- and sex-specific incidence rates were applied to each country's age- and sex-specific population projections using data from the United Nation's World Population Prospects. Five-year Kaplan-Meier survival curves reflecting observed survival by year of diagnosis and age at diagnosis were derived using SEER 9 and SEER 18 databases, respectively. AYLL calculations utilized US age- and sex-specific mortality rates from the National Center for Healthcare Statistics (NCHS); non-US mortality rates were estimated by applying the incidence to mortality ratio from the US. The WHO's Global Health Observatory provided life expectancy data to estimate AYLL for each of the 29 countries.Results: Age-standardized incidence rates ranged from 0.70 cases per 100,000 persons (Costa Rica) to 3.23 cases per 100,000 persons (United States) with a median of 2.28 cases per 100,000 persons (interquartile range (IQR): 1.61-2.71). Projected growth in incident AML cases varied from +3% (Russia) to +51% (Colombia) over the next 20 years; median growth in incident AML cases was +32% (IQR: 27%-43%). AML survival after diagnosis more than doubled in the US over the last 40 years with the following median survival times observed: 4 months (1978-1987) vs. 11 months (2008-2017). Five-year survival in the US was likewise extended during this period: 8% (1978-1987) to 28% (2008-2017). Disparate survival was observed when patients were stratified by age. During the period 2008 to 2017, US cases diagnosed 60 years and older (which represented 67% of all new AML cases) had a median survival of 3 months with a five-year observed survival (OS) of 10%; this was far lower than their younger counterparts (< 60 years) who experienced a median survival of 60 months and a 5-year OS of 51%. The multinational assessment of societal disease burden due to premature AML death estimated a median AYLL of 19.6 years (IQR: 17.3-23.3 years).Conclusion: This epidemiologic assessment of AML disease burden projected significant growth in new AML diagnoses over the next 20 years. In fact, we estimated the growth of AML cases to outpace population growth in most countries - a phenomenon that can be attributed in part to the disproportionate increase in the elderly population where AML is most persistent. Our analysis additionally confirmed differences in survival by age with younger patients exhibiting more favorable survival compared to older adults. This stark contrast in prognosis may be partly explained by the current treatment approach using stem cell transplant for younger, fit patients and the limited therapeutic options among older patients. Despite the noted improvements in survival over the last 4 decades, median survival among all AML patients remains poor highlighting the unmet medical need for novel therapeutic approaches. [Display omitted] DisclosuresAnderson: Amgen: Current Employment, Current equity holder in publicly-traded company. Girguis: Amgen: Current Employment, Current equity holder in publicly-traded company. Kim: Amgen: Current Employment, Current equity holder in publicly-traded company. Shewale: Amgen: Current Employment, Current equity holder in publicly-traded company. Braunlin: Amgen: Current Employment, Current equity holder in publicly-traded company. Werther: Amgen: Current Employment, Current equity holder in publicly-traded company. Hidalgo-Lopez: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Zaman: Amgen: Current Employment, Current equity holder in publicly-traded company. Kim: Amgen: Current Employment, Current equity holder in publicly-traded company.

Occupational Health, Productivity and Evidence-Based Workplace Health Intervention

Occupational Health, Productivity and Evidence-Based Workplace Health Intervention

Disease Burden, Risk Factors, and Recent Trends of Liver Cancer: A Global Country-Level Analysis

Background: This study aimed to evaluate the updated disease burden, risk factors, and temporal trends of liver cancer based on age, sex, and country. Methods: We estimated the incidence of liver cancer and its attribution to hepatitis B virus (HBV) and hepatitis C virus (HCV) in 2018 based on the Global Cancer Observatory and World Health Organization (WHO) Cancer Causes database. We extracted the prevalence of risk factors from the WHO Global Health Observatory to examine the associations by weighted linear regression. The trend analysis used data from the Cancer Incidence in Five Continents and the WHO mortality database from 48 countries. Temporal patterns of incidence and mortality were calculated using average annual percent change (AAPC) by joinpoint regression analysis. Results: The global incidence of liver cancer was (age-standardized rate [ASR]) 9.3 per 100,000 population in 2018, and there was an evident disparity in the incidence related to HBV (ASR 0.2–41.2) and HCV (ASR 0.4–43.5). A higher HCV/HBV-related incidence ratio was associated with a higher level of alcohol consumption (β 0.49), overweight (β 0.51), obesity (β 0.64), elevated cholesterol (β 0.70), gross domestic product (β 0.20), and Human Development Index (HDI; β 0.45). An increasing trend in incidence was identified in many countries, especially for male individuals, population aged ≥50 years, and countries with a higher HCV/HBV-related liver cancer incidence ratio. Countries with the most drastic increase in male incidence were reported in India (AAPC 7.70), Ireland (AAPC 5.60), Sweden (AAPC 5.72), the UK (AAPC 5.59), and Norway (AAPC 4.87). Conclusion: We observed an overall increasing trend of liver cancer, especially among male subjects, older individuals, and countries with a higher prevalence of HCV-related liver cancer. More efforts are needed in enhancing lifestyle modifications and accessibility of antiviral treatment for these populations. Future studies should investigate the reasons behind these epidemiological changes.

Coronavirus disease 2019 (COVID-19) pandemic: how countries should build more resilient health systems for preparedness and response

ObjectiveA resilient health system plays a crucial role in pandemic preparedness and response. Although the World Health Organization (WHO) has required all states parties to strengthen core capacities to respond to public health emergencies under the International Health Regulations (2005), the actions of most countries to combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This cross-sectional study aimed to examine the health system resilience of selected countries and analyze their strategies and measures in response to the COVID-19 pandemic. MethodsThis study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K., and the U.S., based on the severity of the national epidemic, the geographical location, and the development level. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure the severity of the impact of the pandemic in each country; WHO State Parties Self-Assessment Annual Reporting (SPAR) Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience; and research articles and press materials were summarized to identify the strategies and measures adopted by countries during response to COVID-19. This study applied the resilient health systems framework to analyze health system resilience in the selected countries from five dimensions, including awareness, diversity, self-regulation, integration and adaptation. ResultsThe SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and the U.S. were above the global and regional averages; the SPAR Scores of Iran were above the global average while the GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. invested more health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategy of extensive testing and identification of suspected patients. In terms of specific measures, all the five countries adopted measures such as restrictions on entry and international travel, closure of schools and industries, lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied across countries, based on the response strategies. ConclusionAlthough SPAR Scores and GHS Index have evaluated the national core capacities for preparedness and response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries still do not build resilient health systems in response to public health emergencies. Health system strengthening and health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach to developing resilient health systems.

Analysis of out-of-pocket health expenditure using the WHO Global Health Expenditure Database (GHED): A systematic review

Introduction: Tracking out-of-pocket (OOP) health expenditure is a very useful reference for knowing the progress of countries in the goal of universal health coverage (UHC) in 2030. The World Health Organization (WHO) has developed the Global Health Expenditure Database (GHED) to facilitate analysis of health financing in countries or regions. The paper explores the use of GHED in the analysis of OOP health expenditure in the specialized literature. Objective: To perform a systematic review of the studies in which GHED is used to analyze OOP health expenditure in countries or groups of countries. Methods: The systematic review followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). The database used was PubMed. All publications that were available on PubMed by July 30, 2020, were identified. Results: Twenty-five papers were identified. The use of the GHED to analyze OOP health expenditure was reported in five studies, one country study, and four studies with regional comparisons. The included studies cover the period 1995-2016. Discussion: The use of the GHED for the analysis of the evolution of OOP health expenditure in countries or regions is not very widespread in the specialized literature. The GHED has proven to be a very useful instrument for international comparison, although the fact that there are differences with national reports (public expenditure reviews) makes it advisable to combine both sources of information in the analysis of country- specific health policies. Conclusion: The systematic use of the GHED can be useful to improve the quality of information and estimates, such as country-specific expenditure analyses. To this end, it is particularly important to characterize the levels of OOP health expenditure and to incorporate policy monitoring into the analyses.

Do South Asian women with menopausal symptoms have access to optimal therapy?

Background Menopausal symptoms can have a significant impact on a woman's quality of life. Information on availability of menopausal hormone therapy (MHT) in National Essential Medicines Lists (NEMLs) of South Asian (SA) countries has not been widely studied. Objective To review the availability of non-injectable MHT included in NEMLs of SA countries and to assess differences in availability compared to the recommended MHT preparations in the World Health Organization (WHO) model essential medicines list and the list of MHT available to women of a developed country in the Asia Pacific Region, while comparing with the healthcare expenditure and country's economic status. Methods Most recent NEMLs were obtained from all eight SA counties by visiting the Ministry of health/regulatory website of the respective country. Latest WHO model essential medicines list and Pharmaceuticals Benefits Scheme (PBS) schedule from Australia were obtained from the WHO and PBS websites respectively. Per capita health expenditure was obtained from The WHO Global Health Expenditure Database. Two investigators extracted the non-injectable MHT preparations independently from NEMLs and conducted the comparison. Results Except in two countries, in all other SA coun­tries NEMLs were updated within the preceding five years. According to available data, seven SA countries had at least one separate preparation of oestrogen suitable for MHT while all countries had a separate progesterone preparation suitable for MHT. The oestrogen preparations available in the SA NEMLs were limited to either ethinyl estradiol or conjugated oestrogen tablets whilst in the WHO model, oestrogen preparations were not specified. In Australia, estradiol tablets were the only available oral oestrogen while there were four more different dosage forms of oestrogens available through the PBS Scheme. Progesterone preparations found in SA countries, WHO list and PBS schedule were similar, but oestrogen progesterone combination MHT preparations were only available in the PBS schedule. Per capita health expenditure was much higher in Australia compared to SA countries where a wide variation was observed. Conclusions The available evidence suggests that a larger population of SA women have access only to a very limited number of options if in need of MHT. In contrast, importance of MHT is highlighted in PBS Schedule. Although per capita health expenditure was low in SA countries, given that MHT products are relatively low cost and that there is a large proportion of women in menopausal age in this region, it would be imperative to update the WHO model list and NEMLs of SA countries to address the growing need of safe MHT and to improve the quality of life of postlnenopausal women in our region.

Progress Toward Hepatitis B Control - South-East Asia Region, 2016-2019.

In 2015, the World Health Organization (WHO) South-East Asia Region (SEAR)* reported an estimated 40 million persons living with chronic hepatitis B virus (HBV) infection and 285,000 deaths from complications of chronic infection, cirrhosis, and hepatocellular carcinoma (1). Most chronic HBV infections, indicated by the presence of hepatitis B surface antigen (HBsAg) on serologic testing, are acquired in infancy through perinatal or early childhood transmission (2). To prevent perinatal and childhood infections, WHO recommends that all infants receive at least 3 doses of hepatitis B vaccine (HepB), including a timely birth dose (HepB-BD)† (1). In 2016, the SEAR Immunization Technical Advisory Group endorsed a regional hepatitis B control goal with a target of achieving hepatitis B surface antigen (HBsAg) seroprevalence of ≤1% among children aged ≥5 years by 2020, which is in line with the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 (2,3). The South-East Asia Regional Vaccine Action Plan 2016-2020 (SEARVAP) (4) identified the acceleration of hepatitis B control as one of the eight regional goals for immunization. The plan outlined four main strategies for achieving hepatitis B control: 1) achieving ≥90% coverage with 3 doses of HepB (HepB3), 2) providing timely vaccination with a HepB birth dose (HepB-BD), 3) providing catch-up vaccination of older children, and 4) vaccinating adult populations at high risk and health care workers (1,4). In 2019, SEAR established a regional expert panel on hepatitis B to assess countries' HBV control status. This report describes the progress made toward hepatitis B control in SEAR during 2016-2019. By 2016, all 11 countries in the region had introduced HepB in their national immunization programs, and eight countries had introduced HepB-BD. During 2016-2019, regional HepB3 coverage increased from 89% to 91%, and HepB-BD coverage increased from 34% to 54%. In 2019, nine countries in the region achieved ≥90% HepB3 coverage, and three of the eight countries that provide HepB-BD achieved ≥90% HepB-BD coverage. By December 2019, four countries had been verified to have achieved the hepatitis B control goal. Countries in the region can make further progress toward hepatitis B control by using proven strategies to improve HepB-BD and HepB3 coverage rates. Conducting nationally representative hepatitis B serosurveys among children will be key to tracking and verifying the regional control targets.

The potential for active commuting by bicycle and its possible effects on public health

IntroductionThe World Health Organization (WHO) has concluded that physical inactivity and overweight/obesity are the world's fourth and fifth leading risk factors for non-communicable diseases, respectively. This article investigates the potential for active commuting by bicycle in Scania county, southern Sweden, and its possible impact on public health. Physical inactivity is a growing problem on both an individual and a societal level. Method, setting and populationA complete statistical survey and geographic analysis has been carried out based on data concerning the home and work addresses of the entire working population in the county of Scania, Sweden as of the end of 2014. This data set includes a total of 575,959 individuals. ResultsApproximately 27.9% of the population can reach their workplace by a 15-min bicycle commute, while 47.2% can reach their workplace in 30 min. It is possible to achieve a 47.2% modal share for active transport in Scania if all individuals within cycling distance of work choose to commute by bicycle. If that were to happen, 19.2% of the working population would meet the WHO's global health recommendations just through their commutes. ConclusionThe results demonstrate that the spatial distribution of homes and workplaces in Scania is conducive to increasing the mode share for active transport through well-designed physical environments and transport systems that prioritise physical activity.

Disease burden of hepatitis C in the Austrian state of Tyrol - Epidemiological data and model analysis to achieve elimination by 2030.

BackgroundIn 2016, the World Health Organization (WHO) and 69th World Health Assembly approved the first global health sector strategy (GHSS) on viral hepatitis with the goal to eliminate hepatitis C virus (HCV) infections worldwide. The aim is a 90% reduction of new infections and 65% reduction of HCV-related deaths by 2030.AimThis study reports on the epidemiology of HCV infections in the Austrian state of Tyrol (total population 750,000) and uses a predictive model to identify how the WHO strategy for elimination of HCV can be achieved.MethodsWe developed a regional disease burden model based on observed local diagnosis data from 2001 to 2016. Scenarios were developed to evaluate the impact of diagnosis and treatment on HCV-related outcomes (viremic prevalence, decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths) from 2015 through 2030.ResultsIn the last 15 years, 1,721 patients living in Tyrol have been diagnosed with chronic HCV infection. When ageing, mortality and treatment were factored in, there were an estimated 2,043 viremic HCV infections in 2016, of which 1,136 cases had been diagnosed. A baseline model predicts a decrease of 588 HCV cases from 2015 to 2030, which would not translate into the significant reduction of infections needed to achieve WHO global health recommendations. A total of 1,843 infected individuals need to be identified and treated to achieve the WHO goals by 2030 (1,254 averted cases as compared to baseline model). Implementation of this strategy would avoid 523 new HCV infections and decreases HCV-related mortality by 73%.ConclusionHCV elimination and >65% reduction of associated mortality are possible for Tyrol, but requires a significant increase in new diagnoses and treatment rate. The model presented in this study could serve as an example for other regions to reliably predict regional disease burden and estimate how WHO goals can be met in the future.

PROTOCOL: Effects of interventions for infant and young child feeding (IYCF) promotion on optimal IYCF practices, nutrition, growth and health in low- and middle-income countries: a systematic review.

PROTOCOL: Effects of interventions for infant and young child feeding (IYCF) promotion on optimal IYCF practices, nutrition, growth and health in low- and middle-income countries: a systematic review.