World Health Organization Regions Research Articles

An Epidemic of Acute Hepatitis of Unknown Etiology in Children

An Epidemic of Acute Hepatitis of Unknown Etiology in Children

Improved sub-seasonal forecasts to support preparedness action for meningitis outbreak in Africa

West African countries are hit annually by meningitis outbreaks which occur during the dry season and are linked to atmospheric variability. This paper describes an innovative co-production process between the African Centre of Meteorological Applications for Development (ACMAD; forecast producer) and the World Health Organisation Regional Office for Africa (WHO AFRO; forecast user) to support awareness, preparedness and response actions for meningitis outbreaks. Using sub-seasonal to seasonal (S2S) forecasts, this co-production enables ACMAD and WHO AFRO to build initiative that increases the production of useful climate services in the health sector. Temperature and relative humidity forecasts are combined with dust forecasts to operationalize a meningitis early warning system (MEWS) across the African meningitis belt with a two-week lead time. To prevent and control meningitis, the MEWS is produced from week 1 to 26 of the year. This study demonstrates that S2S forecasts have good skill at predicting dry and warm atmospheric conditions precede meningitis outbreaks. Vigilance levels objectively defined within the MEWS are consistent with reported cases of meningitis. Alongside developing a MEWS, the co-production process provided a framework for analysis of climate and environmental risks based on reanalysis data, meningitis burden, and health service assessment, to support the development of a qualitative roadmap of country prioritization for defeating meningitis by 2030 across the WHO African region. The roadmap has enabled the identification of countries most vulnerable to meningitis epidemics, and in the context of climate change, supports plans for preventing, preparing, and responding to meningitis outbreaks.

The effect of occupational exposure to welding fumes on trachea, bronchus and lung cancer: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BackgroundThe World Health Organization (WHO) and the International Labour Organization (ILO) are the producers of the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). Welding fumes have been classified as carcinogenic to humans (Group 1) by the WHO International Agency for Research on Cancer (IARC) in IARC Monograph 118; this assessment found sufficient evidence from studies in humans that welding fumes are a cause of lung cancer. In this article, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from trachea, bronchus, and lung cancer attributable to occupational exposure to welding fumes, to inform the development of WHO/ILO Joint Estimates on this burden of disease (if considered feasible). ObjectivesWe aimed to systematically review and meta-analyse estimates of the effect of any (or high) occupational exposure to welding fumes, compared with no (or low) occupational exposure to welding fumes, on trachea, bronchus, and lung cancer (three outcomes: prevalence, incidence, and mortality). Data sourcesWe developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CENTRAL and CISDOC. We also searched grey literature databases, Internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. Study eligibility and criteriaWe included working-age (≥15 years) workers in the formal and informal economy in any Member State of WHO and/or ILO but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies, and other non-randomized intervention studies with an estimate of the effect of any (or high) occupational exposure to welding fumes, compared with occupational exposure to no (or low) welding fumes, on trachea, bronchus, and lung cancer (prevalence, incidence, and mortality). Study appraisal and synthesis methodsAt least two review authors independently screened titles and abstracts against the eligibility criteria at a first review stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. If studies reported odds ratios, these were converted to risk ratios (RRs). We combined all RRs using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence, and strength of evidence, using the Navigation Guide tools and approaches adapted to this project. Subgroup (e.g., by WHO region and sex) and sensitivity analyses (e.g., studies judged to be of “high”/“probably high” risk of bias compared with “low”/“probably low” risk of bias) were conducted. ResultsForty-one records from 40 studies (29 case control studies and 11 cohort studies) met the inclusion criteria, comprising over 1,265,512 participants (≥22,761 females) in 21 countries in three WHO regions (Region of the Americas, European Region, and Western Pacific Region). The exposure and outcome were generally assessed by job title or self-report, and medical or administrative records, respectively. Across included studies, risk of bias was overall generally probably low/low, with risk judged high or probably high for several studies in the domains for misclassification bias and confounding.Our search identified no evidence on the outcome of having trachea, bronchus, and lung cancer (prevalence). Compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk of acquiring trachea, bronchus, and lung cancer (incidence) by an estimated 48 % (RR 1.48, 95 % confidence interval [CI] 1.29–1.70, 23 studies, 57,931 participants, I2 24 %; moderate quality of evidence). Compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk dying from trachea, bronchus, and lung cancer (mortality) by an estimated 27 % (RR 1.27, 95 % CI 1.04–1.56, 3 studies, 8,686 participants, I2 0 %; low quality of evidence). Our subgroup analyses found no evidence for difference by WHO region and sex. Sensitivity analyses supported the main analyses. ConclusionsOverall, for incidence and mortality of trachea, bronchus, and lung cancer, we judged the existing body of evidence for human data as “sufficient evidence of harmfulness” and “limited evidence of harmfulness”, respectively. Occupational exposure to welding fumes increased the risk of acquiring and dying from trachea, bronchus, and lung cancer. Producing estimates for the burden of trachea, bronchus, and lung cancer attributable to any (or high) occupational exposure to welding fumes appears evidence-based, and the pooled effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates. Protocol identifierhttps://doi.org/10.1016/j.envint.2020.106089.

COVID-19 Vaccine Booster Dose Acceptance: Systematic Review and Meta-Analysis.

The World Health Organization (WHO) recommended coronavirus disease 2019 (COVID-19) booster dose vaccination after completing the primary vaccination series for individuals ≥18 years and most-at-risk populations. This study aimed to estimate the pooled proportion of COVID-19 vaccine booster dose uptake and intention to get the booster dose among general populations and healthcare workers (HCWs). We searched PsycINFO, Scopus, EBSCO, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, Web of Science, Google Scholar, and ScienceDirect according to PRISMA guidelines. From a total of 1079 screened records, 50 studies were extracted. Meta-analysis was conducted using 48 high-quality studies according to the Newcastle-Ottawa Scale quality assessment tool. Using the 48 included studies, the pooled proportion of COVID-19 vaccine booster dose acceptance among 198,831 subjects was 81% (95% confidence interval (CI): 75–85%, I2 = 100%). The actual uptake of the booster dose in eight studies involving 12,995 subjects was 31% (95% CI: 19–46%, I2 = 100%), while the intention to have the booster dose of the vaccine was 79% (95% CI: 72–85%, I2 = 100%). The acceptance of the booster dose of COVID-19 vaccines among HCWs was 66% (95% CI: 58–74%), I2 = 99%). Meta-regression revealed that previous COVID-19 infection was associated with a lower intention to have the booster dose. Conversely, previous COVID-19 infection was associated with a significantly higher level of booster dose actual uptake. The pooled booster dose acceptance in the WHO region of the Americas, which did not include any actual vaccination, was 77% (95% CI: 66–85%, I2 = 100%). The pooled acceptance of the booster dose in the Western Pacific was 89% (95% CI: 84–92%, I2 = 100), followed by the European region: 86% (95% CI: 81–90%, I2 = 99%), the Eastern Mediterranean region: 59% (95% CI: 46–71%, I2 = 99%), and the Southeast Asian region: 52% (95% CI: 43–61%, I2 = 95). Having chronic disease and trust in the vaccine effectiveness were the significant predictors of booster dose COVID-19 vaccine acceptance. The global acceptance rate of COVID-19 booster vaccine is high, but the rates vary by region. To achieve herd immunity for the disease, a high level of vaccination acceptance is required. Intensive vaccination campaigns and programs are still needed around the world to raise public awareness regarding the importance of accepting COVID-19 vaccines needed for proper control of the pandemic.

Participatory Monitoring and Evaluation of the COVID-19 Response in the Africa Region.

As the COVID-19 pandemic swept throughout the world, it created a demand for information to help understand the public health response and its effects. Limited capacity to see and interpret data-"sensemaking" with measures of progress-affects the use of data for quality improvement. The World Health Organization Regional Office for Africa (WHO AFRO) supported partners from the Member States in using a participatory monitoring and evaluation system to document and systematically reflect on the COVID-19 response at the country level. The WHO AFRO's COVID-19 Response Monitoring and Evaluation (M&E) team captured and communicated response activities based on available reports from 35 of the 47 member countries. By reviewing reports and communications, the M&E team documented nearly 8,000 COVID-19 response activities during the study period (January 2020 through July 2021). A "sensemaking" protocol was used to support country partners in identifying factors associated with increases or decreases in both new cases and response activities. This report describes this participatory M&E approach and process of shared sensemaking. We illustrate with a country-level case study of the COVID-19 response in the Africa Region.

The notable global heterogeneity in the distribution of COVID-19 cases and the association with pre-existing parasitic diseases.

The coronavirus Disease 2019 (COVID-19) is a respiratory disease that has caused extensive ravages worldwide since being declared a pandemic by the World Health Organization (WHO). Unlike initially predicted by WHO, the incidence and severity of COVID-19 appeared milder in many Low-to-Middle-Income Countries (LMIC). To explain this noticeable disparity between countries, many hypotheses, including socio-demographic and geographic factors, have been put forward. This study aimed to estimate the possible association of parasitic diseases with COVID-19 as either protective agents or potential risk factors. A country-level ecological study using publicly available data of countries was conducted. We conceptualized the true number of COVID-19 infections based on a function of test positivity rate (TPR) and employed linear regression analysis to assess the association between the outcome and parasitic diseases. We considered demographic, socioeconomic, and geographic confounders previously suggested. A notable heterogeneity was observed across WHO regions. The countries in Africa (AFRO) showed the lowest rates of COVID-19 incidence, and the countries in the Americas (AMRO) presented the highest. The multivariable model results were computed using 165 countries, excluding missing values. In the models analyzed, lower COVID-19 incidence rates were consistently observed in malaria-endemic countries, even accounting for potential confounding variables, Gross Domestic Product (GDP) per capita, the population aged 65 and above, and differences in the duration of COVID-19. However, the other parasitic diseases were not significantly associated with the spread of the pandemic. This study suggests that malaria prevalence is an essential factor that explains variability in the observed incidence of COVID-19 cases at the national level. Potential associations of COVID-19 with schistosomiasis and soil-transmitted helminthiases (STHs) are worthy of further investigation but appeared unlikely, based on this analysis, to be critical factors of the variability in COVID-19 epidemic trends. The quality of publicly accessible data and its ecological design constrained our research, with fundamental disparities in monitoring and testing capabilities between countries. Research at the subnational or individual level should be conducted to explore hypotheses further.

Review of national nutrition standards with salt-related criteria for publicly funded institutions around the world.

Creating healthy food environments through nutrition standards for publicly funded institutions (eg, schools, workplaces, and hospitals) provides an important opportunity to improve population diets. This study aimed to identify countries with national nutrition standards for publicly funded institutions that included salt-related criteria and to describe and summarize these initiatives. Peer-reviewed and grey literature was searched to December 2019, including MEDLINE, CENTRAL, Embase, TRoPHI, LILACS, Web of Science, Cochrane Public Health Group Specialised Register, and Effective Public Health Practice Project Database. In addition, a questionnaire was sent to country contacts and salt-reduction experts, and a targeted search on relevant government websites was conducted. Key characteristics of the national nutrition standards for publicly funded institutions were extracted, including name, governance, institution type, implementation status, and details of food and nutrient criteria. Nutrition standards were analyzed by World Health Organization region, World Bank income level, institution type, type of criteria, regulatory approach, and method of application. Sixty-six countries were identified as having national nutrition standards that included salt-related criteria for at least one publicly funded institution. Standards were more prevalent in the European Region, high-income countries, and schools compared to other regions, income levels, and institution types, respectively. Most standards were mandatory and contained nutrition criteria pertaining to both foods and nutrients. Nutrition standards have the potential to significantly improve diets, but there is considerable scope to develop and implement nutrition standards more effectively using the new World Health Organization Action Framework.

Early essential newborn care in national tertiary hospitals in Cambodia and Lao People’s Democratic Republic: a cross-sectional study

BackgroundMinistries of health in collaboration with the World Health Organization Regional Office for the Western Pacific (WPRO) have been scaling up early essential newborn care (EENC). This study was carried out to understand current EENC practices at hospitals in two priority countries: the Kingdom of Cambodia (Cambodia) and Lao People’s Democratic Republic (Lao PDR).MethodsEENC is subdivided into 79 checkpoints, referencing the self-monitoring checklist developed by the WPRO. Each checkpoint is rated using a 0 to 2-point scale, and a percentage was calculated for the rate of practice of each checkpoint by dividing the total scores by the maximum possible scores.ResultsIn total, 55 and 56 deliveries were observed in Cambodia and Lao PDR, respectively, and 35 and 34 normal deliveries were included in the analysis. The overall rates of the practices within the first 15 minutes after birth were high in both countries. The rates of the practices before birth and 15 minutes after birth were lower than the rates of the practices performed within the first 15 minutes after birth, especially “hand wash before preparation”, “preparation for newborn resuscitation”, and “monitoring of postpartum mothers and babies”. A detailed analysis revealed that the quality of the practices differed between the two countries regarding skin-to-skin contact and breastfeeding support.ConclusionsThe high rates of the practices within the first 15 minutes after birth suggest that the EENC coaching sessions supported by ministries of health and the WPRO have been effective. Differences in the quality of practices performed at a high rate between the two countries appeared to be related to factors such as the timing of the study, the perception of the staff, and the situation at the health facilities. These differences and identified practices with lower rates should be improved according to the situation in each country or health facility. Therefore, determining the quality of the practices in a country or a health facility is important. To further improve the quality of EENC, interventions tailored to the specific situation are necessary.

Determining Gaps in Publicly Shared SARS-CoV-2 Genomic Surveillance Data by Analysis of Global Submissions.

Viral genomic surveillance has been a critical source of information during the COVID-19 pandemic, but publicly available data can be sparse, concentrated in wealthy countries, and often made public weeks or months after collection. We used publicly available viral genomic surveillance data submitted to GISAID and GenBank to examine sequencing coverage and lag time to submission during 2020-2021. We compared publicly submitted sequences by country with reported infection rates and population and also examined data based on country-level World Bank income status and World Health Organization region. We found that as global capacity for viral genomic surveillance increased, international disparities in sequencing capacity and timeliness persisted along economic lines. Our analysis suggests that increasing viral genomic surveillance coverage worldwide and decreasing turnaround times could improve timely availability of sequencing data to inform public health action.

A longitudinal analysis of MPOWER implementation, 2008-2018

Background In 2008, the World Health Organization (WHO) introduced MPOWER-a package of evidence-based, high-impact policy measures to help countries reduce tobacco use. These measures align with selected articles within the World Health Organization’s Framework Convention on Tobacco Control (FCTC), a global public health treaty to prevent and reduce tobacco use. Methods Observational longitudinal study involving 195 countries that submitted biannual national reports between 2008 and 2018. To report changes in MPOWER scores, countries were assessed using a validated checklist of the seven MPOWER indicators and a maximum possible unweighted composite score of 34 points. Covariate analysis was conducted among selected health, sociopolitical, and economic indicators. Results 176 out of 195 countries improved their MPOWER scores between 2008 and 2018, with two achieving full implementation (Brazil and Turkey). Twenty-three (23) countries representing 11.2% of the global population recorded an MPOWER scoring increase of at least 10 points between 2008 and 2018. The overall mean 10-year scoring increase was 5.1 points or a relative improvement of 27.1%. In 2018, 20 countries representing 10.4% of the global population excelled in MPOWER implementation by receiving a total composite score of at least 30 of 34 possible points. The MPOWER elements with the highest degree of implementation in 2018 include Warn (package), Protect (smoking ban) and Enforce (ad ban). Several covariates were positively associated with higher levels of MPOWER implementation, including cigarette affordability, the existence of national tobacco control objectives, the human development index score, the national corruption index score, national literacy rates and the political regime index score. Conclusions MPOWER implementation increased markedly between 2008 and 2018 in all seven WHO regions and countries representing all four World Bank income classifications. However, only two countries achieved full implementation by 2018. More work is needed to improve MPOWER implementation. Countries with low-income levels, compromised human development, reduced literacy rates, higher rates of corruption, and autocratic political regimes appear to struggle more with MPOWER implementation.

Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature.

Monkeypox is an emerging zoonotic disease caused by the monkeypox virus, which is an infectious agent belonging to the genus Orthopoxvirus. Currently, commencing from the end of April 2022, an outbreak of monkeypox is ongoing, with more than 43,000 cases reported as of 23 August 2022, involving 99 countries and territories across all the six World Health Organization (WHO) regions. On 23 July 2022, the Director-General of the WHO declared monkeypox a global public health emergency of international concern (PHEIC), since the outbreak represents an extraordinary, unusual, and unexpected event that poses a significant risk for international spread, requiring an immediate, coordinated international response. However, the real magnitude of the burden of disease could be masked by failures in ascertainment and under-detection. As such, underestimation affects the efficiency and reliability of surveillance and notification systems and compromises the possibility of making informed and evidence-based policy decisions in terms of the adoption and implementation of ad hoc adequate preventive measures. In this review, synthesizing 53 papers, we summarize the determinants of the underestimation of sexually transmitted diseases, in general, and, in particular, monkeypox, in terms of all their various components and dimensions (under-ascertainment, underreporting, under-detection, under-diagnosis, misdiagnosis/misclassification, and under-notification).

Is monkeypox a new, emerging sexually transmitted disease? A rapid review of the literature.

Monkeypox, a milder disease compared to smallpox, is caused by a virus initially discovered and described in 1958 by the prominent Danish virologist von Magnus, who was investigating an infectious outbreak affecting monkey colonies. Currently, officially starting from May 2022, an outbreak of monkeypox is ongoing, with 51 000 cases being notified as of September 1, 2022-51 408 confirmed, 28 suspected, and 12 fatalities, for a grand total of 51 448 cases. More than 100 countries and territories are affected, from all the six World Health Organizationregions. There are some striking features, that make this outbreak rather unusual when compared with previous outbreaks, including a shift on average age and the most affected age group, affected sex/gender, risk factors, clinical course, presentation, and the transmission route. Initially predominantly zoonotic, with an animal-to-human transmission, throughout the last decades, human-to-human transmission has become more and more sustained and effective. In particular, clusters of monkeypox have been described among men having sex with men, some of which have been epidemiologically linked to international travel to nonendemic countries and participation in mass gathering events/festivals, like the "Maspalomas (Gran Canaria) 2022 pride."This review will specifically focus on the "emerging" transmission route of the monkeypox virus, that is to say, the sexual transmission route, which, although not confirmed yet, seems highly likely in the diffusion of the infectious agent.

Global, regional, and national COVID-19 vaccination rate in 237 countries and territories, March 2022: a systematic analysis for World Health Organization COVID-19 Dashboard, Release 2

Objective: We aimed to better understand the impact of the COVID-19 pandemic through analysis of disruptions in a global, regional, and national status of COVID-19 vaccination coverage compared by a global scale, World Health Organization regions, World Bank income groups, and each country. Methods: Global datasets of 237 countries and territories from the World Health Organization Dashboard until March 5, 2022 were used and paired with estimates of COVID-19 vaccination coverage of individual levels which were derived from country level models form World Health Organization Dashboard, Release 1. The numbers of persons vaccinated with at least one dose, persons vaccinated with at least one dose per 100 population, and persons fully vaccinated per 100 population were then calculated and estimated. The data were described by a global scale and stratified by World Health Organization regions (Eastern Mediterranean, Americas, Europe, Southeast Asia, the Western Pacific, and Africa), World Bank income groups (high, upper-middle, lower-middle, and low income), and each country. Results: A total of 4,964,626,775 persons worldwide were vaccinated with at least one dose, which is 63.69 per 100 population administered of COVID-19 vaccines at least one dose, and 56.16 per 100 population were fully vaccinated. The number of persons vaccinated with at least one dose was highest in the Eastern Mediterranean (84.18 per 100 population), followed by the Americas (75.82 per 100 population), South-East Asia (68.97 per 100 population), Europe (66.28 per 100 population), Western Pacific (47.18 per 100 population), and Africa (15.87 per 100 population). Persons fully vaccinated had similar patterns of those vaccinated with at least one dose; Eastern Mediterranean (84.25 per 100 population), the Americas (65.08 per 100 population), Europe (61.59 per 100 population), South-East Asia (55.67 per 100 population), Western Pacific (39.04 per 100 population), and Africa (11.62 per 100 population). The proportion of persons who were vaccinated at least one dose or fully vaccinated was greatest in the high income countries, followed by upper-middle, lower-middle, and low income. Conclusion: The rate of COVID-19 vaccination with at least one dose and those who were fully vaccinated was estimated to be 63.69 per 100 population and 56.16 per 100 population, respectively. Although the COVID-19 vaccine coverage trajectories points towards global increasement in vaccination, persistent inequality in preventing the COVID-19 pandemic occurred in vulnerable groups such as under-developed and low income countries.

Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression.

ABSTRACTObjectiveThe association between human immunodeficiency virus (HIV)/AIDS and suicidality is not well understood, partly because of variability in results. This meta-analysis aimed to investigate the predictive value of HIV/acquired immune deficiency syndrome for incident suicidality.MethodsA literature review was conducted of articles published between January 1, 2010, and October 31, 2021. The following databases were searched: Embase, MEDLINE, CINAHL, Web of Science, and Scopus. The search terms included human immunodeficiency virus (HIV), suicidal behavior, auto mutilation, and self-injurious behavior. Observational studies were screened following a registered protocol, and eligible ones were meta-analyzed and followed by meta-regression.ResultsA total of 43 studies were included in this systematic review, and a meta-regression included 170,234 participants. The pooled prevalence estimates of suicidal ideation, attempted suicide, and deaths by suicide were 22.3%, 9.6%, and 1.7%, respectively. The following significant risk factors for suicide ideation were found: substance use, depression, low quality of life, low social support, without HIV status disclosure, living alone, low level of memory problems, family history of suicide, and stage III of HIV. Risk factors for suicide attempts were depression and family history of suicide. An elevated risk for suicide-related death was found for people living with HIV (PLHIV) who had a psychiatric disorder and in studies conducted in hospital-based settings (versus national database studies or HIV clinic settings).ConclusionsThe risk of suicidality is high among PLHIV within all six World Health Organization regions during the modern antiretroviral therapy era. Assessment of socioeconomic and psychological factors is recommended for further management to prevent suicide among PLHIV. The present findings are useful for design of intervention protocols and development of clinical practice guidelines intended to manage the well-being of PLHIV worldwide.

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies.

Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was "flesh removed" (Type I or II) in 19 countries. Among girls, "not sewn closed" (Type I, II, or IV) and "flesh removed" (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C. In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3. Registration: CRD42020186937.

S02 Physical activity surveillance across the life-course: from data to policy

As a major risk factor for non-communicable diseases (NCDs), physical inactivity is a prominent challenge for public health. The purpose of this symposium is to present an overview of physical inactivity prevalence in Europe using data collected through international surveillance initiatives, while highlighting successes and discussing future challenges for utilising data to promote physical activity across the life course.The World Health Organization (WHO) is involved in several physical activity surveillance systems on which discussions during this symposium will be based: 1. The WHO European Childhood Obesity Surveillance Initiative (COSI) is the largest survey of its kind in the world. An overview of results from the most recent round of COSI will be presented focusing on prevalence estimates for physical activity, screen time and sleep. Variations between countries of the socioeconomic determinants of physical inactivity, as well as the impact of the COVID-19 pandemic, will demonstrate the ongoing need for quality data to guide targeted policy actions in support of vulnerable groups throughout the life course.2. The WHO’s STEPwise approach to surveillance (STEPS) survey provides important national level prevalence data on the behavioural and metabolic risk factors for NCDs. For many countries, the STEPS survey has provided the first estimates of physical inactivity and sedentary behaviour in the population and has been essential in raising awareness of the need for national policy actions to increase population levels of physical activity.3. The European Commission, with the support of the WHO Regional Office for Europe, has established the European Union Physical Activity Focal Points Network to monitor implementation of the 23 indicators of the Health-Enhancing Physical Activity (HEPA) monitoring framework on physical activity policy development and implementation.4. Within the European Union Physical Activity Focal Points Network, and during the COVID-19 pandemic, some countries established a survey on physical activity and screen time in children and adolescents.

The effect of COVID-19 on public confidence in the World Health Organization: a natural experiment among 40 countries

BackgroundAt a time when a highly contagious pandemic and global political and economic turmoil are intertwined, worldwide cooperation under the leadership of an international organization has become increasingly important. This study aimed to estimate the effect of COVID-19 on public confidence in the World Health Organization (WHO), which will serve as a reference for other international organizations regarding the maintenance of their credibility in crisis management and ability to play a greater role in global health governance.MethodsWe obtained individual data from the World Values Survey (WVS). A total of 44,775 participants aged 16 and older from 40 countries in six WHO regions were included in this study. The COVID-19 pandemic was used as a natural experiment. We obtained difference-in-differences (DID) estimates of the pandemic’s effects by exploiting temporal variation in the timing of COVID-19 exposure across participants interviewed from 2017 to 2020 together with the geographical variation in COVID-19 severity at the country level. Public confidence in the WHO was self-reported by the respondents.ResultsAmong the participants, 28,087 (62.73%) reported having confidence in the WHO. The DID estimates showed that the COVID-19 pandemic could significantly decrease the likelihood of people reporting confidence in the WHO after controlling for multiple covariates (adjusted OR 0.54, 95% CI: 0.49–0.61), especially during the global outbreak (0.35, 0.24–0.50). The effect was found in both younger individuals (0.58, 0.51–0.66) and older adults (0.49, 0.38–0.63) and in both males (0.47, 0.40–0.55) and females (0.62, 0.53–0.72), with a vulnerability in males (adjusted P for interaction = 0.008).ConclusionOur findings are relevant regarding the impact of COVID-19 on people’s beliefs about social institutions of global standing, highlighting the need for the WHO and other international organizations to shoulder the responsibility of global development for the establishment and maintenance of public credibility in the face of emergencies, as well as the prevention of confidence crises.

Monkeypox in pregnancy: virology, clinical presentation, and obstetric management

The 2022 monkeypox outbreak, caused by the zoonotic monkeypox virus, has spread across 6 World Health Organization regions (the Americas, Africa, Europe, Eastern Mediterranean, Western Pacific, and South-East Asia) and was declared a public health emergency of international concern on July 23, 2022. The global situation is especially concerning given the atypically high rate of person-to-person transmission, which suggests viral evolution to an established human pathogen. Pregnant women are at heightened risk of vertical transmission of the monkeypox virus because of immune vulnerability and natural depletion of population immunity to smallpox among reproductive-age women, and because orthopoxviral cell entry mechanisms can overcome the typically viral-resistant syncytiotrophoblast barrier within the placenta. Data on pregnancy outcomes following monkeypox infection are scarce but include reports of miscarriage, intrauterine demise, preterm birth, and congenital infection. This article forecasts the issues that maternity units might face and proposes guidelines to protect the health of pregnant women and fetuses exposed to the monkeypox virus. We review the pathophysiology and clinical features of monkeypox infection and discuss the obstetrical implications of the unusually high prevalence of anogenital lesions. We describe the use of real-time polymerase chain reaction tests from mucocutaneous and oropharyngeal sites to confirm infection, and share an algorithm for the antenatal management of pregnant women with monkeypox virus exposure. On the basis of the best available knowledge from prenatal orthopoxvirus infections, we discuss the sonographic features of congenital monkeypox and the role of invasive testing in establishing fetal infection. We suggest a protocol for cesarean delivery to avoid the horizontal transmission of the monkeypox virus at birth and address the controversy of mother–infant separation in the postpartum period. Obstetrical concerns related to antiviral therapy with tecovirimat and vaccinia immune globulin are highlighted, including the risks of heart rate–corrected QT-interval prolongation, inaccuracies in blood glucose monitoring, and the predisposition to iatrogenic venous thromboembolism. The possibility of monkeypox vaccine hesitancy during pregnancy is discussed, and strategies are offered to mitigate these risks. Finally, we conclude with a research proposal to address knowledge gaps related to the impact of monkeypox infection on maternal, fetal, and neonatal health.

Global, regional, and national disruptions to COVID-19 vaccine coverage in 237 countries and territories, March 2022: a systematic analysis for World Health Organization COVID-19 Dashboard, Release 1

Objective: Measuring coronavirus disease 2019 (COVID-19) vaccination is crucial in improving global public health system during the pandemic. However, there is limited supporting data needed in order to identify the global, regional, and national status of the COVID-19 vaccination coverage. Given to such limitations, this study aimed at investigating the status of COVID-19 vaccination coverage in a global, regional, and national perspective. Methods: For this study, we analyzed the COVID-19 vaccination data by the World Health Organization Dashboard of 237 countries and territories up to March 5, 2022. We then calculated the total vaccine doses administered and total vaccine doses administered per 100 population. There were some cases when the total doses administered per 100 population exceeded 100 while some populations received heterologous vaccine regime. The COVID-19 vaccination data were categorized according to World Health Organization regions, the World Bank income groups, and each country. Results: A total of 10,704,043,684 doses of COVID-19 vaccines and 137.33 doses per 100 population were administered globally. The COVID-19 vaccine coverage was highest in the Eastern Mediterranean (204 per 100 population), followed by the Americas (163.43 per 100 population), Europe (161.52 per 100 population), South-East Asia (127.82 per 100 population), Western Pacific (90.58 per 100 population), and Africa (24.17 per 100 population). High COVID-19 vaccine coverage was associated with the World Bank according to income groups (per 100 population; high income, 187.50; upper-middle income, 176.95; lower-middle income, 104.81; and low income, 19.65). Conclusion: After the introduction of worldwide COVID-19 vaccine coverage, a total of 10,704,043,684 doses of COVID-19 vaccines were administered globally. However, international attention is needed on vaccination strategies for underdeveloped countries, which have low COVID-19 vaccine coverage.

COVID-19 and the gendered impacts on adolescent wellbeing: Evidence from a cross-sectional study of locally adapted measures in Ethiopia, Jordan, and Palestine.

SummaryBackgroundThe COVID-19 pandemic and associated policy responses have interrupted services, increased financial stress, and driven social isolation, with acute impacts for adolescents. This study explores relationships between gender, COVID-19 vulnerability, social protection, and adolescent wellbeing in three diverse contexts: Ethiopia, Jordan, and Palestine.MethodsThis study presents findings from a quantitative phone survey with adolescents in Ethiopia, Jordan, and Palestine (n = 5752) on household-level vulnerability to COVID-19-related shocks, household-level social protection (cash transfers or food aid), and locally adapted outcome measures designed to capture the gendered impacts of COVID-19 (collected between November 22, 2020 and February 25, 2021). We examine the relationship between each outcome and household-level COVID-19 vulnerability and social protection (and their interaction) using multivariate regressions, adjusting for adolescent and household characteristics.FindingsFor all adolescents, increased vulnerability to COVID-19-related shocks is associated with worse outcomes for resilient coping and time spent on domestic tasks and care work. Across samples, girls spent over two additional hours on domestic and care work compared to boys. Girls in more vulnerable households experienced greater gendered constraints on behaviour. We find no association between receipt of social protection and adolescent wellbeing, and find that it only moderates the effect of COVID-19 vulnerability for less vulnerable households. Disability status, being out of school, and experiencing child marriage are also associated with adverse outcomes.InterpretationOur study highlights that the pandemic has exacerbated underlying gender inequalities across adolescents in three very different settings, and that existing social safety nets are not adequate to fully address these impacts, particularly for the most vulnerable.FundingThis work was supported by UK aid through a grant from the Foreign, Commonwealth & Development Office to the Gender and Adolescence: Global Evidence (GAGE) longitudinal research study; the EMERGE project (Bill & Melinda Gates Foundation grants: OPP1163682 and INV018007; PI Anita Raj) and the World Health Organization (WHO) Regional Office for the Eastern Mediterranean.