World Health Organization Indications Research Articles

Calculation of the alcohol per capita consumption in Brazil: using national dataCálculo del indicador del consumo de alcohol per cápita en Brasil: uso de datos nacionales

To calculate the alcohol per capita consumption (APC) in Brazil (Brazil APC) using national data and to establish the Brazil APC as gold standard for the country, replacing the indicator previously calculated by the World Health Organization (WHO) based on international data. The Brazilian public data sources necessary for calculating the recorded APC were selected, and the alcohol concentration was defined by beverage category. For the variables of tourist APC and unrecorded APC, which are unavailable in Brazil, estimates from the United Nations (UN) and the WHO were used. The Brazil APC indicator was calculated and compared to the indicator produced by the WHO through analysis of the medians obtained for the period from 2005 to 2020. The national alcohol consumption indicator was 9.2 liters per capita in 2005, reaching 9.8 in 2020. The WHO indicator showed a consumption of 8.4 liters per capita in 2005, decreasing until 2016 and slightly increasing to 7.8 in 2020. The Brazil APC was calculated based on national sources and showed a distinct trend compared to the WHO indicator, which showed a decrease. The regular and transparent provision of this indicator through government channels will support the development of policies to address alcohol consumption in the country.

Prevalence of Differentiated High-Grade Thyroid Carcinoma Among Well-Differentiated Tumors: A Systematic Review and Meta-Analysis.

Background: The current edition of the World Health Organization (WHO) classification of endocrine tumors introduced grading for follicular cell-derived thyroid cancer. Tumors with necrosis and/or high mitotic count but not fulfilling the Turin criteria for poorly differentiated carcinoma will be reclassified as differentiated high-grade thyroid carcinoma (DHGTC). However, the impact of this reclassification has not been evaluated. In this study, we performed a systematic review and meta-analysis to estimate the prevalence of this new entry across thyroid tumor subtypes. Methods: In this systematic review and meta-analysis, studies reporting data on necrosis and/or mitoses in well-differentiated thyroid carcinoma (WDTC) were used to estimate the prevalence of DHGTC. Heterogeneity and potential publication bias were also evaluated. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and quality assessment was performed using a modification of the Newcastle-Ottawa scale. The study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, ID: CRD42022378716). Results: In clinically unselected patients, the prevalence of DHGTC in WDTC was 0.072 [95% confidence interval, CI, = 0.045-0.113]. The proportion of high-grade tumors greatly varied across growth patterns and subtypes. Overall, the prevalence of DHGTC was higher in follicular thyroid carcinoma (FTC; 0.146 [CI = 0.101-0.205]) than in papillary thyroid carcinoma (PTC; 0.059 [CI = 0.036-0.097]). Diffuse sclerosing, follicular, and classic subtype PTC had the lowest rates of high-grade features (i.e., 0.018 [CI = 0.004-0.084]; 0.036 [CI = 0.010-0.124]; and 0.042 [CI = 0.027-0.066], respectively), while a greater proportion of solid trabecular and histologically aggressive PTC could be reclassified as DHGTC (i.e., 0.154 [CI = 0.067-0.314] and 0.168 [CI = 0.108-0.252], respectively). Similar proportions were obtained for minimally and widely invasive FTC (i.e., 0.136 [CI = 0.058-0.287] and 0.152 [CI = 0.086-0.254], respectively). Finally, in a cohort of patients with poor prognosis (i.e., fatal cases, metastatic and radioiodine resistant tumors, cases with biochemical recurrence), the proportion of DHGTC was 0.287 [CI = 0.155-0.469]. Conclusions: Following the current WHO indications, some tumors will be reclassified as DHGTC. The proportion of tumors with high-grade features is relevant in FTC, solid trabecular, and histologically aggressive PTC subtypes. A remarkable enrichment in DHGTC among patients with poor prognosis confirms the negative impact of high-grade features on outcome.

International harm reduction indicators are still not reached: results from a repeated cross-sectional study on drug paraphernalia distribution in Germany, 2021

BackgroundTo prevent the transmission of blood-borne infections and reach the elimination of viral hepatitis by 2030, the World Health Organization (WHO) has set the goal to distribute 300 sterile needles and syringes each year per person who injects drugs (PWID). We aimed to assess drug paraphernalia distribution in Germany in 2021, including the WHO indicator, and to analyse changes to the distribution measured in 2018.MethodsWe conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 using an online and paper-based questionnaire. We conducted a descriptive statistical analysis of data from 2021, assessed fulfillment of the WHO indicator and changes in services that participated 2021 and in the previous study 2018.ResultsFive hundred and eighty-nine of 1760 distributed questionnaires were returned in 2021. 204 drug services from 15 out of 16 federal states confirmed drug paraphernalia distribution, covering 20% of Germany’s rural and 51% of urban counties. 108 services had also participated in 2018. The most frequently distributed paraphernalia for injecting drug use in 2021 were syringes (97% of services), needles (96%) and vitamin C (90%). Pre-cut aluminium foil (79% of services) and pipes (28%) for inhaling, and sniff tubes (43%) for nasal use were distributed less frequently. We found a median reduction in distributed syringes by 18% and by 12% for needles compared to 2018. Of 15 states, two reached the 2030 WHO-target for needles and one for syringes.ConclusionsThe current national estimates and changes from 2018 to 2021 for drug paraphernalia distribution seem far from meeting the WHO target. Reasons could include a change in drug consumption behaviour towards less injecting use and more inhaling, and effects of the COVID-19 pandemic (supply difficulties, social distancing, lockdown, reduced opening hours of services). We observed pronounced regional differences in drug paraphernalia distribution. To close existing gaps, Germany should expand its drug paraphernalia distribution programmes and other harm reduction services, such as drug consumption rooms. Further investigation of determinants for adequate distribution is essential to reduce blood-borne infections in this key population.

Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data.

Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization's indicator "Availability of EmONC facilities" was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate "Availability of EmONC" by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator's value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator's validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.

Indoor Air Quality: A Focus on the European Legislation and State-of-the-Art Research in Italy

The World Health Organization (WHO) has always stressed the importance of indoor air quality (IAQ) and the potential danger of pollutants emitted from indoor sources; thus, it has become one of the main determinants for health. In recent years, reference documents and guidelines have been produced on many pollutants in order to: i) decrease their impact on human health (as well as the number of pollutants present in indoor environments), and ii) regulate the relevant levels of chemicals that can be emitted from the various materials. The aim of this paper is to discuss and compare the different legislations present in the European Union (EU). Furthermore, a focus of this paper will be dedicated at Italian legislation, where there is currently no specific reference to IAQ. Although initiatives in the pre-regulatory sector have multiplied, a comprehensive and integrated policy on the issue is lacking. Pending framework law for indoor air quality, which takes into account WHO indications, the National Study Group (GdS) on Indoor Air Pollution by the Italian Institute of Health (IIS) is committed to providing shared technical-scientific documents in order to allow actions harmonized at a national level. An outlook of the main Italian papers published during these last five years will be reported and discussed.

The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis.

BackgroundAcute flaccid paralysis (AFP) surveillance is an essential strategy for poliovirus eradication.ObjectiveThis study aimed to evaluate the performance of the AFP surveillance system in Yemen from 2010 to 2015, identify components that require strengthening, and compare the indicators by year and governorates.MethodsThis descriptive study was based on secondary analysis of AFP surveillance data reported during 2010-2015 from all Yemeni governorates. The World Health Organization (WHO) minimum performance standards were used to evaluate the performance of the AFP surveillance system.ResultsA total of 3019 AFP cases were reported between January 2010 and December 2015. At the national level, AFP surveillance achieved WHO targets throughout the evaluating period for the nonpolio AFP rate of cases per 100,000 members of the population younger than 15 years of age, proportion of AFP cases reported within 7 days, proportion of AFP cases investigated within 48 hours of notification, proportion of AFP cases with two adequate stool specimens, and proportion of stool specimens from which nonpolio enterovirus was isolated. However, the proportion of specimens that arrived at the central level within 3 days of the first sample collection and the proportion of stool specimens with results sent from the reference laboratory within 28 days of receipt did not reach targets in 2011 and 2015, respectively.ConclusionsThe AFP surveillance system in Yemen has met most of the WHO indicator levels. Nevertheless, the evaluation showed areas of weakness regarding the arrival of specimens at the central level within 3 days of the first sample collection and delays in processing of the results and submitting feedback by the laboratory. Therefore, there is a need to strengthen the follow-up of specimens submitted to the laboratory.

Morbidity surveillance and treatment of MDR-TB with the support of NGOs in Ukraine

ObjectiveDescribe the common work of Donetsk State Phthisiological Service and non-governmental organizations that has been conducted since 2014 in order to achieve the global goal for tuberculosis elimination.IntroductionThe global strategy for eliminating tuberculosis (TB) epidemic "End TB" has been implemented in the world since 2016. Its main goal is to reduce the 2015 TB incidence rate by 90% and 2015 TB mortality rate by 95% by 2035. In Ukraine, in 2016, the incidence rate of new cases of tuberculosis among the general population was 54.7 per 100 thousand of population (2015 - 55.9), the rate of decrease was 2.1 ± 0.1%. In Donetsk Oblast (that is under control of Ukrainian authorities), the incidence rate increased by 2.4% and was 56.4 per 100 thousand of population. The mortality rates were 19 ± 0.6% in the country and 29 ± 2.5% in Donetsk Oblast. However, according to the World Health Organization (WHO) estimates, we need to enhance the annual incidence rate reduction by 10% by 2025, and TB mortality rate should be reduced to 6.5% in order to achieve the strategy-targeted values.In Ukraine, as well as globally, there is a crisis of multidrug-resistant tuberculosis (MDR-TB). According to WHO estimates, Ukraine belongs to five European countries where 2/3 of MDR-TB cases were registered; the proportion of MDR-TB cases among newly diagnosed TB cases was 16%, and 48% of repeated cases. In Ukraine, this rate is equal to 24.3% and 58.2% in Donetsk Oblast, respectively.Such results in the Donetsk region may be related to the beginning of hostilities in eastern Ukraine in 2014, which lead to the active migration of population and breakdown of the supply of anti-TB drugs. According to monitoring data, 20% of with MDR-TB on the territory of the Donetsk region controlled by Ukraine were lost and did not seek medical assistance.MethodsThis work describes a retrospective cohort study of MDR-TB patients' treatment efficacy. The MDR-TB diagnosis was confirmed by the BSL3 laboratory by molecular genetic testing of sputum using Gene Expert and bacteriological methods to determine resistance to rifampicin and isoniazid.All MDR-TB patients were divided into 3 cohorts. The first cohort of 86 patients received outpatient treatment within the project “Outpatient Home Treatment Model Using Mobile Response Team" supported by the Foundation for Development of Ukraine in Kramatorsk, Donetsk Oblast, during one year (2014-2015). The response team consisting of a nurse, a driver and a doctor (if necessary) delivered drugs to patients with TB six times a week. The second cohort of 477 MDR-TB patients has received outpatient treatment via the Red Cross Society since 2015. A nurse visited patients every day and controlled drugs administration. In addition to the treatment, patients were given food kits twice a month. The third cohort of 391 MDR-TB patients received outpatient treatment in healthcare institutions without any support of non-governmental organizations. Before the beginning of the controlled treatment, psychologists worked with patients from risk groups.ResultsSurveillance data in Donetsk Oblast showed the increase of the MDR-TB morbidity rate from 15.0 to 20.1 per 100 thousand of population. According to the analysis results, MDR-TB is found in 31% of cases among all newly diagnosed TB cases.The successful treatment rate of all TB cases in Donetsk Oblast in 2015 was 61.9 ± 5.4%, which is lower than the average rate in Ukraine, which is 11.1 ± 1.0% (WHO indicator is 75%). The number of MDR-TB cases with "treatment failure" (treatment was completed, but bacterial secretion continued) - 9.3 ± 2.6% and "interrupted treatment" - 13.3 ± 2, 6% is very high in Donetsk Oblast.Results analysis of the controlled treatment showed that the treatment efficacy for MDR-TB patients in the first cohort was 75%. In the second cohort, 205 out of 477 patients completed their treatment. The treatment efficacy was 78.5%. In the third cohort 45.0% of patients were cured, which corresponds to general rates in this oblast. However, the treatment efficacy for MDR-TB patients, who received the support of non-governmental organizations, was 30,0-33.5% higher than among patients who did not receive such support (Table 1).ConclusionsThe cooperation of the State Phthisiatrician Service with non-governmental organizations concerning patients at the outpatient stage of treatment and development of treatment adherence increased the treatment efficacy for MDR-TB patients by almost 30%, which is important to control the spread of dangerous sources of tuberculosis agents in order to improve the epidemic situation.Cohort analysis of treatment results and clinical MDR-TB monitoring reflects the peculiarities of the epidemic situation and reveals errors in the work of the State Phthisiatrician Service in Donetsk Oblast. Nevertheless, the results show that common work of healthcare institutions, non-governmental organizations and volunteers can bring significant results in strengthening TB patients care.

Monitoring the World Health Organization Global Target 2025 for Exclusive Breastfeeding: Experience From the United States.

Exclusive breastfeeding under 6 months, calculated from a single 24-hour recall among mothers of children 0 to 5 months of age, is a World Health Organization (WHO) indicator used to monitor progress on the 2025 global breastfeeding target. Many upper-middle-income and high-income countries, including the United States, do not have estimates for this indicator. Research aim: To describe the prevalence of exclusive breastfeeding under 6 months in the United States. We used a single 24-hour dietary recall from the National Health and Nutrition Examination Survey 2009-2012 to calculate the prevalence of exclusive breastfeeding under 6 months. We discuss our results in the context of routine breastfeeding surveillance, which is reported from a national survey with different methodology. Among children younger than 6 months, 24.4%, 95% confidence interval [17.6, 31.1], were exclusively breastfed the previous day. To our knowledge, this is the first estimate of the WHO indicator of exclusive breastfeeding under 6 months for the United States. This study supports the global surveillance and data strategy for reporting to the WHO on the 2025 target for exclusive breastfeeding.

Teaching the World Health Organization’s How to Handrub and Five Moments for Hand Hygiene in a health care delivery course at a new school of pharmacy

ObjectiveTo implement and evaluate instruction of hand rubbing with alcohol-based products using the World Health Organization (WHO) guidelines and indications. DesignNewly matriculated P1 students were required to attend a 75-minute class during which an instructor presented hand hygiene in the context of professionalism and the incidence of health care-associated infections and community-acquired antimicrobial-resistant infections in pharmacy practice settings. Students then practiced the eight-step World Health Organization (WHO) method using a WHO infographic and alcohol-based hand sanitizer and watched a New England Journal of Medicine video to reinforce skill instruction and to introduce the WHO indications for hand hygiene. AssessmentIndividual hand rubbing skill was assessed by individual observation using a ten-point rubric. Knowledge was tested by exam. Change in student attitudes and motivation to perform hand hygiene were measured by survey. All students (n = 77) demonstrated mastery of WHO hand rubbing. Correct answers to exam questions ranged from 83% to 100% per question. Student attitudes and motivation to perform hand hygiene increased significantly. ConclusionsMastery of WHO hand rubbing can be achieved with limited class time. This skill may protect both students and patients from health care-associated infections and community-acquired infections while providing a strong visual demonstration of professionalism to patients and other providers.