World Health Organization's Vision Research Articles

ULTRASOUND AS A SCREENING TOOL FOR FETAL GLAUCOMA: A CLINICAL APPROACH

The World Health Organization's VISION 2020 initiative has recognised paediatric glaucoma as the third leading cause of significant visual impairment and blindness in children in low- and middle-income countries, accounting for 5% of global childhood blindness. Childhood glaucoma is a critical condition in paediatric ophthalmology, causing damage to the optic nerve and ganglion cells. The objective of the study was to assess the feasibility of ultrasonography screening in pregnant women for the early identification of probable congenital glaucoma in the fetus. Material and methods of the study. To achieve this, we conducted a comprehensive ultrasound examination of 500 pregnant women at the Republican Centre for Mother and Child Screening in 2022-2024. The article was prepared on the basis of the results of the planned dissertation research (Registration code B2023.3.DSc/Tib902; due dates: 2022 -2025). Results: Ultrasound scans of pregnant women provide important information for ophthalmologists. Ultrasound screening of pregnant women, monitoring the orbits and eyeballs of the fetuses, was performed from 20 to 40 weeks of gestation. Of the total, data were analysed for 2 (0.4%) cases of fetal eye pathology in which echographic indicators of glaucoma, known as buphthalmos, were identified. After birth, the suspected diagnosis of congenital glaucoma was confirmed in the children, requiring emergency hospitalisation and surgical intervention. This is particularly important in children with congenital glaucoma to prevent blindness and visual impairment in the future. Conclusions: This imaging could serve as a cost-effective and safe screening technique that provides important information to ophthalmologists. Comprehensive ultrasound assessment of embryonic ocular structures may provide significant information and identify congenital glaucoma in infants. Accurate diagnosis and verification of congenital glaucoma typically requires more specialised ophthalmological assessment postnatally.

Kenya must wake up to the threat of cryptic Anopheles species and their impact on residual malaria transmission.

Malaria remains a major health problem in Kenya despite the huge efforts put in place to control it. The non-relenting malaria threat has partly been attributed to residual malaria transmission driven by vectors that cannot effectively be controlled by the two popularly applied control methods: long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). Reports indicate that residual transmission is widely spread in areas where malaria is endemic. This could mean that the World Health Organization's vision of a world free of malaria remains a mirage as elimination and prevention of re-establishment of malaria are rendered unachievable. Amongst the major contributors to residual malaria transmission are cryptic rare species, species of mosquitoes that are morphologically indistinguishable, but isolated genetically, that have not been the focus of malaria control programs. Recent studies have reported extensive new Anopheles cryptic species believed to be involved in malaria transmission in Kenya. This underscores the need to understand these malaria vector species, their distribution and bionomics and their impact on malaria transmission. This article discusses reports of these cryptic species, their importance to malaria transmission, especially in the arid and semi-arid areas, and what can be done to mitigate the situation.

Ameliorating Gonorrhea: Recent Therapeutic Adaptations and Scope to Improve its Prevailing Condition.

Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. According to recent research, the prevalence of gonorrhea has been increasing in many parts of the world, with some areas reporting high rates of antibiotic resistance. In the United States, the Centers for Disease Control and Prevention (CDC) reported that the number of reported gonorrhea cases increased by 56% between 2015 and 2019. Globally, the World Health Organization (WHO) estimated that there were 87 million new cases of gonorrhea in 2016, with the highest burden of infection in low- and middle-income countries. Research has also shown that gonorrhea is becoming increasingly resistant to conventional antibiotics, increasing the prevalence of gonorrhea. This raises concerns and challenges in disease management. The present review gives updated insight on the current state of the disease, challenges, and shortcomings of existing approaches along with the modern and alternative direction like vaccine development, its challenges, and scope to confront the existing state of drug resistance and increased rate of incidence. Alternative strategies like immunotherapy and phage therapy along with recent antibiotics researched for the treatment of gonorrhea. The review provides a thorough insight into the current state of the disease and various available methods used currently and recommended by WHO. To overcome disease prevalence, various alternate therapies are coming into the limelight. However, scientists and researchers show a lack of interest in the drug development and research of gonorrhea, due to less commercial scope, lack of funding, and limited scope in the scientific scenario. These hurdles need to be overcome to meet the WHO vision of reducing gonorrhea by 90% by 2030. So, there is a need to optimize the drug therapy (optimizing dosing schedule, and precision monitoring) to reduce the chance of drug resistance. Also, there is a wide scope for drug and therapeutic system development.

Improving visual outcomes in patients with rare paediatric eye diseases.

Rare paediatric eye diseases (RPEDs) threaten both vision and life. Recently, rare diseases were recognised as a global public health agenda, with children specified as a priority in the World Health Organization's VISION 2020 against avoidable visual loss. We conducted a review through a query of online databases (PubMed, Embase and Cochrane Library). Articles related to RPEDs were selected based on relevance by 2 authors, with any disagreements adjudicated by the third author. We synthesise the current state of knowledge regarding RPEDs, barriers to their care, and recommendations for the future. RPEDs often result in significant visual loss, profoundly impacting the way children comprehend and participate in the world. These diseases may also reduce life expectancy and even be life-threatening. Barriers to the care of RPEDs include an unclear definition of "rare diseases", missed or delayed diagnosis, inadequate knowledge and expertise in management, and challenging research environments. Our findings provide an update on the diagnosis and management of RPEDs, which is of relevance to ophthalmologists, paediatricians, healthcare policymakers and social workers. We propose supportive policies and adequate resource allocation to these diseases, comprehensive and patient-centred care, alongside improved education and training, enhanced research capabilities and continued collaboration across institutions.

Mycobacterium tuberculosis mixed infections and drug resistance in sub-Saharan Africa: a systematic review.

Sub-Saharan Africa, is a region that records high rates of TB infection. Mycobacterium tuberculosis mixed strain infection, especially when the strains involved are of different susceptibilities, is an area of great interest because it is linked with an increased risk of treatment failure and transmission of resistant strains within the population. This paper reviewed original studies that reported MTB mixed infection and heteroresistance in the region between 2010 and 2020 to understand the extent of mixed strain infection and heteroresistance in the region. This information is very critical in the control of TB and ending the TB epidemic by 2035 as per the World Health Organization's vision. pubmed, Scopus, JSTOR, AJOL, and Google Scholar databases were searched through both key terms and subject headings. The literature was screened, assessed for the quality and evidence synthesized. Eighteen original articles were included in this review after having met the inclusion criteria. The frequency of mixed strain infection reported in these studies varied between 2.8% and 21.1% while drug resistance range between 0.06% to 19% depending on the study design and the drug susceptibility screening technique utilized. The majority of the studies (50%) utilized Spoligotyping in conjunction with MIRU-VNTR typing in the detection of mixed infections. Despite the scarcity of data on mixed infections and heteroresistance in sub-Saharan Africa, various studies have revealed that these conditions are frequent in the region than previously thought. Given the evidence of the effect of mixed infections on drug resistance and treatment outcome, we conclude that mixed infection is an unavoidable topic for future studies.

Transitioning to Digital Systems: The Role of World Health Organization's Digital Adaptation Kits in Operationalizing Recommendations and Interoperability Standards.

The transition from paper to digital systems requires quality assurance of the underlying content and application of data standards for interoperability. The World Health Organization (WHO) developed digital adaptation kits (DAKs) as an operational and software-neutral mechanism to translate WHO guidelines into a standardized format that can be more easily incorporated into digital systems. WHO convened health program area and digital leads, reviewed existing approaches for requirements gathering, mapped to established standards, and incorporated research findings to define DAK components. For each health domain area, the DAKs distill WHO guidelines to specify the health interventions, personas, user scenarios, business process workflows, core data elements mapped to terminology codes, decision-support logic, program indicators, and functional and nonfunctional requirements. DAKs aim to catalyze quality of care and facilitate data use and interoperability as part of WHO's vision of SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines. Efforts will be needed to strengthen a collaborative approach for the uptake of DAKs within the local digital ecosystem and national health policies.

COVID-19 and international primary care systems: Rebuilding a stronger primary care.

In this BJGP Open collection, we examine how international primary care systems have performed in response to COVID-19. The past few months have seen rapid change and adaption of primary care systems to meet unprecedented new challenges. The pandemic has also exposed critical weaknesses in systems all over the world.1 The World Health Organization (WHO) and the World Organization of Family Doctors (WONCA) contend that an ideal primary care system should fulfil the core characteristics laid out by Barbara Starfield:2 primary care should be accessible, affordable, available at the time of need, and represent the ‘front-door’ to the health system. It should provide ongoing care and coordination with other specialists and focus on individuals and their families beyond their biological disease.3,4 The Astana Declaration5 and the WHO Vision for Primary Health Care in the 21st Century 6 also make a case for empanelment (working for a listed or geographically defined population) and a model of primary care that is engaged with …

The United Nations Sustainable Development Goals, the WHO General Program of Work 2019-2023 and International Safe Communities

Background: A number of international safe communities are displaying increasing interest in the United Nations Sustainable Development Goals (UNSDG). The International Safe Communities Certifying Centre is seeking to establish formal relations with the World Health Organization (WHO). Purpose: A formal review of the UNSDG and WHO General Program of Work 13 – 2019 to 2023 (WHO GPW13) alignment with the international Safe Communities indicators. Methods: UNSDGs were formally reviewed by 4 senior ISCCC certifiers and ranked in terms alignment with International Safe Communities Indicators. Results: While injury imposes a considerable cost burden on communities, safety is a critical precondition necessary for the attainment of the productive physical, physical and social environments that communities require to achieve their full potential. Safety provides a dynamic leverage point for communities to achieve their aspiration for sustainable development. There is very strong alignment between the UNSDGs and the International Safe Community Indicators The holistic understanding of injury prevention and safety promotion adopted by the safe communities movement supports the WHO vision to “Promote health, keep the world safe and serve the vulnerable” articulated in its 13th General Program of Work (GPW): 2019 to 2023. Based on the analysis the ISCCC board has identified 7 domains of injury prevention and safety promotion practice that are of high strategic importance8: • Disaster preparedness • Prevention of Road Traffic Injuries • Prevention of Violence against Women • Prevention Violence against Children • Suicide prevention • Falls prevention • Prevention of workplace injury. All new designation applications submitted after the 1st of July 2019 must provide statistical information regarding the incidence of these issues and to describe how they are addressed in their community. Conclusion: The International Safe Community movement embraces a whole of system (ecological) definition of injury prevention and safety promotion that aligns easily with the United Nations Sustainable Development Goals (UNSDG) and the WHO General Program of Work 13, 2019 to 2023 (WHO GPW13).

An Internet for Some threatens health for All: What effects could the repeal of net neutrality in the USA have on individual and population health?

In the United States of America, the Federal Communications Commission's repeal of the popular Open Internet Order (a.k.a 'net neutrality') has yielded pointed criticism from many different sectors, but it has yet to be examined for its potential effect on the public's health. In this commentary, we focus on the health implications of this policy change, considering expert opinion on the subject, past history, and global perspectives. We argue that the repeal of net neutrality has the potential to compromise health education and promotion efforts by widening the 'digital divide', thereby impairing health literacy and exacerbating health inequities. By negatively affecting people's ability to access, understand, and use unbiased, evidence-based health information to improve and maintain their health, the repeal of net neutrality may hinder the World Health Organization's vision of 'Health for All' by dismantling public protections in the name of corporate profit.

Achieving the World Health Organization's vision for clinical pharmacology.

Clinical pharmacology is a medical specialty whose practitioners teach, undertake research, frame policy, give information and advice about the actions and proper uses of medicines in humans and implement that knowledge in clinical practice. It involves a combination of several activities: drug discovery and development, training safe prescribers, providing objective and evidence-based therapeutic information to ethics, regulatory and pricing bodies, supporting patient care in an increasingly subspecialized arena where co-morbidities, polypharmacy, altered pharmacokinetics and drug interactions are common and developing and contributing to medicines policies for Governments. Clinical pharmacologists must advocate drug quality and they must also advocate for sustainability of the Discipline. However for this they need appropriate clinical service and training support. This Commentary discusses strategies to ensure the Discipline is supported by teaching, training and policy organizations, to communicate the full benefits of clinical pharmacology services, put a monetary value on clinical pharmacology services and to grow the clinical pharmacology workforce to support a growing clinical, academic and regulatory need.

Intermediate-Term Cataract Surgery Outcomes from Rural Provinces in Lao People’s Democratic Republic

Purpose: Limited data are available about cataract surgery outcomes from developing regions in South-East Asia, but are necessary to monitor the impact of ongoing program delivery as outlined in the World Health Organization Vision 2020 directives.Methods: We conducted a retrospective cohort study of 488 eyes of 449 patients who had undergone cataract surgery in 2011 in Luang Prabang and Xayaboury provinces of northwestern Lao People’s Democratic Republic (Lao PDR). The study included 400 eyes of 361 subjects (80.4% of the target population). The main outcomes were presenting and pinhole visual acuity (VA).Results: Subjects’ mean age was 68 years (standard deviation 12.1 years); 52.6% were women. Preoperative presenting VA in the operated eye was <6/60 in all patients where presenting VA data was available (76.4%). Presenting VA in the operated eye was >6/18 in 185/400 eyes (46.3%, 95% confidence interval, CI, 41.4–51.2%), <6/18–6/60 in 177/400 (44.3%, 95% CI 39.4–49.2%) and <6/60 in 38/400 (9.5%, 95% CI 6.6–12.4%). VA improved two or more lines in 61/400 eyes (15.3%, 95% CI 11.7–18.8%) with pinhole. Relative afferent pupillary defect was present in 13/400 eyes (3.3%, 95% CI 1.5–5.0%).Conclusion: Presenting postoperative VA did not meet the World Health Organization criteria for good outcomes. Further study is required to determine specific factors contributing to adverse outcomes in this population.

The international contribution to occupational health research.

The importance of international occupational health research is established in achieving the World Health Organization's vision of "occupational health for all". The aim of this short communication is to describe the geographical distribution of research published in leading occupational health journals. Seven leading occupational health journals were identified, based on citation rates and impact factors. All research papers published in these journals in 2011 and 2012 were identified and attributed to a country, based on the affiliation of the first author. The crude rate and rates adjusted by GDP and population were calculated for each country. A total of 1466 papers were identified, with first authors based in 56 different countries. Over half of the papers were published by first authors based in 4 countries (USA, UK, the Netherlands and Japan). The leading 10 countries contributed 76% of the total number of papers and the leading 20 countries 94%. Of the 1466 papers, 89% were published by authors based in high-income countries. An analysis of the adjusted rates of publications by population and GDP revealed dominance by the Scandinavian countries. The data are consistent with results of previous studies showing that a large proportion of papers are produced by researchers in the USA, but that the highest rates adjusted by GDP are from Scandinavian countries and the Netherlands. This indicates that a small number of countries continue to dominate research published in leading occupational health journals. As a result, the areas of research risk being biased to the needs of those countries rather than the wider international community.

Scaling up in Europe: learning from diversity

Over the past decade, attention has increasingly focused on the need to increase the capacity of mental health services. The World Health Report 2001 - Mental Health: New Understanding, New Hope (World Health Organization, 2001) set the agenda, advocating the development of community-based mental health services. The case for scaling up, inspired by the World Health Organization's vision of 'no health without mental health', was powerfully argued first in the Lancet series in 2007 (Prince et al, 2007) and again in the Lancet in 2011 (Eaton et al, 2011). The forthcoming Global Mental Health Action Plan, requested in a resolution by member states of the World Health Organization at the 2012 World Health Assembly, is a great opportunity to formulate objectives and targets for countries, and to analyse experiences from around the world. The forthcoming European Action Plan builds on this, customising actions for European countries.

WHO's Assessment Instrument for Mental Health Systems: Collecting Essential Information for Policy and Service Delivery

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Pattern of presentation and outcome of surgical management of primary open angle glaucoma in Kano, Northern Nigeria

Primary open angle glaucoma (POAG) is one of the leading causes of avoidable blindness. Unlike blindness from cataracts, glaucomatous optic nerve damage is irreversible, and prevention of glaucoma is one of the priorities of World Health Organization (WHO) Vision 2020 program. POAG is the commonest type of glaucoma and affects about 33.1 million people worldwide. This study is a five year review of 71 eyes of 63 patients who had trabeculectomy. The study evaluates the pattern of presentation and modality of surgical treatment in our environment. Records of all patients with primary open angle glaucoma operated over a five year period was retrieved. Information extracted included patients bio data, visual acuity, gonioscopic findings, intra ocular pressure as measured with applanation tonometer before and after surgery, and recorded in mmHg. Perimetry was done with 2 m tangent screen and recorded in a perimetry chart. All the patients had trabeculectomy with application of antimetabolite (5-fluorouracil). Extra capsular cataract extraction with or, without posterior chamber intra ocular lens implantation was done on 13 patients. Biometry was not done on patients with cataract. Surgery was done on better eye first in all patients. There were 71 eyes of 63 patients. The male to female ratio was 3:1. The age ranged between 18 to 75 years. 8 patients were below the age of 30 years. One third of the patients were between the ages of 50 to 59 years. At presentation 12 patients (19%) had normal vision (WHO vision category O), 26 patients (41%) were visually impaired, 12 patients (19%) were severely visually impaired and 13 patients (21%) were blind (from co existing cataracts). The cup disc(c: d) ratio assessed before surgery was 0.5 in 9 eyes (13%), 31 eyes (53%) had c: d ratio 0.6 to 0.8 and 18 eyes had c: d ratio of 0.9. All the patients had open anterior chamber angles (Schafer grade 3 and 4). Perimetric changes were; mild peripheral constriction in 5 eyes (8%), peripheral constriction with arcuate scotoma in 19 eyes (26%), constricted fields of 300 or less in 34 eyes (48%), and in 13 eyes there was inability to fixate on target. IOP before surgery was 21 to 30 mm Hg in 12 eyes (17%), and above 31 mm Hg in 69 eyes (83%). Post operative IOP of 10 to 15 mm Hg was obtained in 58 eyes (82%) and 11 eyes (15%) had IOP of 16 to 20 mm Hg. Only 2 eyes (3%) had IOP in the lower twenties. Primary open angle glaucoma is characterized by late presentation. Trabeculectomy with application of 5FU is the surgical treatment of choice in our environment and give good intra ocular pressure control. There is need to increase public awareness on glaucoma to limit this type of avoidable blindness.

A new approach to prison public health? Challenging and advancing the agenda for prison health

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization's vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.

Retinopathy of prematurity in South Africans at a tertiary hospital: a prospective study

World Health Organization's vision 20/20 programme has recognized retinopathy of prematurity (ROP) as an important cause of childhood blindness in industrialized and middle-income countries. While ROP is virtually nonexistent in many African countries, ROP is seen in urban areas where facilities for neonatal care exist. The aim of this study is to establish the frequency of ROP in a cohort of patients screened for ROP and to establish if current screening criteria apply to our patients. Infants with birth weight (BW) of 1500 g or less and/or gestational age of 32 weeks or less were screened for ROP over a 2(1/2)-year period by a single examiner. ROP was observed in 84 of 514 (16.3%) of infants included for analysis. Threshold disease (tROP) was noted in 1.6% of the total cohort although 41/84 babies with ROP were lost prior to regression or progression to tROP. Of the 43/84 adequately followed up, eight (18.6%) developed tROP. An estimated frequency of tROP was more likely to be 2.9%. There was no tROP noted in babies of BW greater than 1250 g. Gestational age was an unreliable risk parameter in our population. The projected occurrence rate of tROP is similar to that found in black population in the Multicentre Cryotherapy for ROP Trial. Our data suggest that the screening criterion based on BW can safely be lowered to 1250 g in our population.

Correction of refractive error in the adult population of Bangladesh: meeting the unmet need.

To assess the extent of uncorrected refractive error and associated factors in Bangladesh and to suggest ways in which this need can be met. A nationally representative sample of 12,782 adults (>/= 30 years of age) was selected. Of them, 11,624 subjects underwent a demographic interview, visual acuity (logarithm of the minimum angle of resolution [logMAR]) measurement, automated refraction, and optic disc examination. Subjects with visual acuity less than 6/12 in either eye also had a corrected refraction measurement, cataract grading, and dilated retinal examination. Of the 11,624 subjects examined, 2,469 (22.1%) were myopes (less than -0.5 D) and 2,308 (20.6%) hyperopes (more than +0.5 D). The spectacle coverage percentage, calculated as [met need/(met need + unmet need) x 100%] was 25.2% and 40.5%, using 6/12 and 6/18 visual acuity cutoffs, respectively, and was higher in men and urban inhabitants. Older subjects and the literate and more highly educated were more likely to wear spectacles; however, most spectacle wearers (81%) had inadequate correction. Of the 1142 subjects who would benefit from spectacles, 827 (72.4%) would be suitable for off-the-shelf spectacles. Subjects without spectacles with less than 6/12 in the better eye (n = 835), would achieve 6/12 or better with correction (unmet need). Extrapolation to the national population yields an estimate that 1.5 million (6.7%) adult men and 1.8 million (9.2%) women have an unmet need for refractive correction. In Bangladesh, there is low spectacle coverage with a large unmet need. This survey identified risk groups, in particular women and those living in rural areas. This description of the availability of refractive services suggests areas for improvement (e.g., off-the-shelf spectacles) that may enable Bangladesh to achieve the goals of the World Health Organization's Vision 2020 initiative.

Childhood blindness in the context of VISION 2020--the right to sight.

The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic development, and the availability of primary health care and eye care services. In high-income countries, lesions of the optic nerve and higher visual pathways predominate as the cause of blindness, while corneal scarring from measles, vitamin A deficiency, the use of harmful traditional eye remedies, and ophthalmia neonatorum are the major causes in low-income countries. Retinopathy of prematurity is an important cause in middle-income countries. Other significant causes in all countries are cataract, congenital abnormalities, and hereditary retinal dystrophies. It is estimated that, in almost half of the children who are blind today, the underlying cause could have been prevented, or the eye condition treated to preserve vision or restore sight. The control of blindness in children is a priority within the World Health Organization's VISION 2020 programme. Strategies need to be region specific, based on activities to prevent blindness in the community--through measles immunization, health education, and control of vitamin A deficiency--and the provision of tertiary-level eye care facilities for conditions that require specialist management.