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BMC Pregnancy and Childbirth. 2017 Jun 19; 17(1):194.BACKGROUND: WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. METHODS: Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). RESULTS: A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received >/=1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. CONCLUSIONS: Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.
New York, New York, UN Women, . 7 p. (Policy Brief No. 1)UN Women’s project "Promoting and Protecting Women Migrant Workers’ Labour and Human Rights: Engaging with International, National Human Rights Mechanisms to Enhance Accountability" is a global project funded by the European Union (EU) and anchored nationally in three pilot countries: Mexico, Moldova, and the Philippines. The project promotes women migrant workers’ rights and their protection against exclusion and exploitation at all stages of migration. One of the key results of the project has been the production of high-quality knowledge products. These have provided the foundation of the project’s advocacy and capacity building objectives. This Brief draws from the project’s knowledge products and provides an overview of the key situational and policy concerns for women migrant workers in each of the three pilot countries.
BJOG. 2018 Feb; 125(3):288.Against a background of an increasing demand for surgical intervention for the treatment of FGM/C related complications, Berg et al
Note for typesetter: Please update reference when assigned to an issue.have conducted a systematic review of 62 studies involving 5829 women, to assess the effectiveness of defibulation, excision of cysts and clitoral reconstructive surgery. Berg et al report that defibulation showed a lower risk of Caesarean section and perineal tears; excision of cysts commonly resulted in resolution of symptoms; and clitoral reconstruction resulted in most women self-reporting improvements in their sexual health. However, Berg et al highlight that they had little confidence in the effect estimate for all outcomes as most of the studies were observational and conclude that there is currently poor quality of evidence on the benefits and/or harm of surgical interventions to be able to counsel women appropriately. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Swiss Medical Weekly. 2017 Jun 21; 147:w14432.PURPOSE: Sayana(R) was introduced as the first depot medroxyprogesterone acetate-containing contraceptive that is administered via subcutaneous injection. Within 10 months, the Regional Pharmacovigilance Centre (RPVC) Zurich received several anonymous reports of serious local reactions after Sayana(R) administration. In this retrospective study, individual case safety reports (ICSRs) on local adverse drug reactions (ADRs) related to Sayana(R) were analysed from the WHO pharmacovigilance database. METHODS: International, national and regional ICSRs during Sayana(R) administration up to 1 January 2016 were examined. Data on ADRs were retrieved from the WHO Global Database VigiBase. Demographic data, drug administration information, duration of Sayana(R) treatment, latency time of the ADR, and its course, severity and outcomes were analysed. RESULTS: Worldwide, 398 ICSRs after Sayana(R) use were registered in the database. We identified 20 reported terms that were potentially used to describe a persistent lipodystrophy. When only cases containing one or more of these 20 reported terms were selected, 323 (81.2%) international ICSRs remained for analysis. Of those, 91.6% (n = 296) were categorised as serious. The majority of the reactions (n = 193, 54.4%) did not recover. In the 67 Swiss ICSRs, 77 ADRs were reported using 10 different terms including severe or persistent local reactions like lipodystrophy, atrophy or fat necrosis. Thirty-two patients (47.7%) did not recover. All 11 regional cases reported to the RPVC Zurich were categorised as serious ADRs. For the majority of the patients (n = 7, 63.6%) the interval between the application of Sayana(R) and development of the lipodystrophy was between 2 and 4 months. Most of the reactions were irreversible (n = 9, 81.8%). One patient underwent plastic surgery for artificial infill of the dent. CONCLUSIONS: Persistent local injection site reactions such as lipodystrophy, fat tissue necrosis or atrophy occur frequently after subcutaneous Sayana(R) use. These adverse drug reactions were recently integrated in the Swiss product information. Physicians and patients should be informed and advised about these potentially irreversible effects.
Response to 'WHO classification of FGM omission and failure to recognise some women's vulnerability to cosmetic vaginal surgery'
Journal of Family Planning and Reproductive Health Care. 2017 Feb 24; 1.Add to my documents.
Washington, D.C., World Bank, 2005.  p. (World Bank Working Paper No. 68)In recent years, Europe and Central Asia has experienced the world’s fastest growing HIV/AIDS epidemic. Yet, in the Western Balkan countries the HIV prevalence rate is under 0.1 percent, which ranks among the lowest. This may be due to a low level of infection among the population—or partly due to inadequate surveillance systems. All major contributing factors for the breakout of an HIV/AIDS epidemic are present in the Western Balkans. HIV/AIDS disproportionably affects youth (80 percent of HIV-infected people are 30 years old or younger). Most of the Western Balkan countries have very young populations, which have been affected by the process of social transition, wars, unemployment and other factors. Among youth, there is generalized use of drugs and sexual risk behavior. Therefore, the number of cases of HIV has been increasing, especially in Serbia, and the incidence of Hepatitis C has clearly increased, which suggests that sharing of infected needles is practiced by injecting drug users. Apart from human suffering, an HIV/AIDS epidemic can have a significant impact on costs of care for individuals, households, health services and society as a whole. This study has found weak public health systems and gaps in financing and institutional capacity necessary to implement evidence-based and cost-effective HIV/AIDS Strategies. Political commitment must increase for action to occur promptly. Prevention interventions are cost effective and, in the short term, affordable with own-country resources. Medium- and long-term interventions would require donor assistance. Longer-term interventions would aim at preventing poverty, exclusion and unemployment, for example, by empowering young people to participate in the regional and global labor market.
British Journal of Nursing. 2016 Mar 24-Apr 13; 25(6):344-5.Add to my documents.
Global Health Action. 2015 Sep 18; 8:29034.Background: Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO) has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective: This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design: We outline the scope, content, and intended uses / application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted in WHO Member States and Regions. Conclusions: The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level. Copyright: 2015 World Health Organization. Open Access.
[New York, New York], UNFPA, 2015.  p.The creation of women and girls safe spaces has emerged as a key strategy for the protection and empowerment of women and girls affected by the Syrian crisis. This document provides an overview of what safe spaces are, and what key principles should be followed when establishing such spaces in humanitarian and post-crisis contexts. This guidance is based on the experiences of UNFPA and its partners in Jordan, Lebanon, Iraq, Syria and Turkey. It also refers to experiences documented by the Gender-Based Violence coordination mechanisms in Jordan and Lebanon. Lessons learned from other regions are also referenced. Guidance has also been taken from the child protection and adolescent girls sectors in establishing child-friendly spaces and girls’ safe spaces.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Sep; 121 Suppl 4:11-4.In the World Health Organization (WHO) European region despite official high coverage of essential interventions for maternal and neonatal care, there are still significant gaps in the delivery of effective interventions. Since 2001, WHO designed and implemented the Making Pregnancy Safer programme, which includes hands-on training courses in effective perinatal care for maternity teams, development of clinical guidelines, maternal mortality and morbidity case reviews, and assessments of quality of care. This has contributed to enhancing capacity at country level to improve organisation and provision of care. This paper describes the programme's components, challenges, achievements and results. (c) 2014 Royal College of Obstetricians and Gynaecologists.
Seattle, Washington, PATH, 2013 Apr.  p.To meet the challenge of sustaining reproductive health commodity security in Eastern Europe and Central Asia, the United Nations Population Fund and PATH developed workshops to increase awareness about total market approaches and develop an action plan for the region. This report describes two regional workshops that were held in April 2013.
Road-mapping a total market approach for family planning and reproductive health commodity security. Workshop materials.
Seattle, Washington, PATH, 2013.  p.To meet the challenge of sustaining reproductive health commodity security in Eastern Europe and Central Asia, the United Nations Population Fund and PATH developed workshops to increase awareness about total market approaches and develop an action plan for the region. These workshop materials are from two regional workshops that were held in April 2013.
Journal of Ethnic and Migration Studies. 2014 Jun; 40(6):924-941.This article investigates the complex relationship between the practices of the United Nations High Commissioner for Refugees (UNHCR) in the field of refugee protection and the more recent political rationality of 'migration management' by drawing from governmentality studies. It is argued that the dissemination of UNHCR's own refugee protection discourse creates certain 'figures of migration' allowing for justifying the build-up and perfection of border controls, which in turn enable any attempt to 'manage' migration in the first place. Conversely, the problematisation of population movements as 'mixed migration flows' allows UNHCR to enlarge its field of activitiy despite its narrow mandate by actively participating in the promotion, planning and implementation of migration management systems. Based on ethnographic research in Turkey and Morocco, this article demonstrates, furthermore, that UNHCR's refugee protection discourse and the emerging migration management paradigm are both based on a methodological nationalism, share an authoritarian potential and yield de-politicising effects. What UNHCR's recent embracing of the migration management paradigm together with its active involvement in respective practices then brings to the fore is that UNHCR is part of a global police of populations.
BMJ. 2013; 347:f4172.Add to my documents.
Experiences from the field: HIV prevention among most at risk adolescents in Central and Eastern Europe and the Commonwealth of Independent States.
Geneva, Switzerland, UNICEF, Regional Office for Central and Eastern Europe and the Commonwealth of Independent States, .  p.This document shares experiences in an effort to support programmers, policymakers, and donors to carry out and strengthen further programming among most-at-risk-adolescents (MARA) and other vulnerable adolescents in the Central and Eastern Europe and the Commonwealth of Independent States Region and beyond. It presents programming experiences from Albania, Bosnia and Herzegovina, Moldova, Montenegro, Romania, Serbia, and Ukraine. The overarching goal of these programs has been to promote HIV prevention among MARA and to ensure their integration into national HIV / AIDS program strategies and monitoring and evaluation frameworks.
American Journal of Public Health. 2013 Apr; 103(4):593-6.We discuss the history of the World Health Organization's (WHO's) development of guidelines for governments on providing safe abortion services, which WHO published as Safe Abortion: Technical and Policy Guidance for Health Systems in 2003 and updated in 2012. We show how the recognition of the devastating impact of unsafe abortion on women's health and survival, the impetus of the International Conference on Population and Development and its five-year follow-up, and WHO's progressive leadership at the end of the century enabled the organization to elaborate guidance on providing safe abortion services. Guideline formulation involved extensive review of published evidence, an international technical expert meeting to review the draft document, and a protracted in-house review by senior WHO management.
Paris, France, UNESCO, 2014.  p.This report builds on a program of work on sexuality education for young people initiated in 2008 by UNESCO. It is also informed by several other past and ongoing initiatives related to scaling up sexuality education, as well as drawing on case studies presented at the Bogota international consultation on sexuality education, convened by UNFPA in 2010. The report emphasizes the challenges for scaling-up in terms of integrating comprehensive sexuality education into the formal curricula of schools. It aims to provide conceptual and practical guidance on definitions and strategies of scaling-up; illustrate good practice and pathways for successful scale-up in light of diverse contextual parameters; and provide some principles of scaling up sexuality education that are of relevance internationally.
Environment International. 2012 Oct 15; 47:17-22.There is an assumption that pyrethroid pesticides are converted to non-toxic metabolites by hydrolysis in mammals. However, some recent works have shown their bioaccumulation in human breast milk collected in areas where pyrethroids have been widely used for agriculture or malaria control. In this work, thirteen pyrethroids have been studied in human breast milk samples coming from areas without pyrethroid use for malaria control, such as Brazil, Colombia and Spain. The concentrations of pyrethroids ranged from 1.45 to 24.2 ng g- 1 lw. Cypermethrin, -cyhalothrin, permethrin and esfenvalerate/fenvalerate were present in all the studied samples. The composition of pyrethroid mixture depended on the country of origin of the samples, bifenthrin being the most abundant in Brazilian samples, -cyhalothrin in Colombian and permethrin in Spanish ones. When the pyrethroid concentrations were confronted against the number of gestations, an exponential decay was observed. Moreover, a time trend study was carried out in Brazil, where additional archived pool samples were analyzed, corresponding to years when pyrethroids were applied for dengue epidemic control. In these cases, total pyrethroid levels reached up to 128 ng g- 1 lw, and concentrations decreased when massive use was not allowed. Finally, daily intake estimation of nursing infants was calculated in each country and compared to acceptable WHO levels. The estimated daily intakes for nursing infants were always below the acceptable daily intake levels, nevertheless in certain samples the detected concentrations were very close to the maximum acceptable levels.
Examining Turkey and member states of European union in terms of health perspectives of millennium development goals.
Quality and Quantity. 2012 Apr; 46(3):959-978.Development is related not only to production and increase in per capita income but also to social, cultural and political improvements. The purpose of development is that individuals would live long, healthy and happy lives thanks to economic development of society. From this perspective, it is obvious that the human factor is fundamental to the concept of development. This study examines the most important element in human development-health. As health indicators, it uses the health perspectives in the United Nations millennium development goals that are "reduce child mortality", "improve maternal health" and "combat HIV/AIDS, malaria and other diseases". In the study, European Union (EU) member states and candidate country Turkey are compared in terms of health related goals among millennium development goals by using Multidimensional scaling and Cluster analysis. Initially, countries with similar and dissimilar health indicators are mapped in multidimensional space by multidimensional scaling analysis. Further, the same method is used to reveal similar and dissimilar health indicators among countries. Then, the findings are compared using Cluster analysis and are identified to be similar.
Reproductive Health Matters. 2011 Nov; 19(38):197-207.In March 2009, UN member states met at the 53rd Commission on the Status of Women (CSW) to discuss the priority theme of "the equal sharing of responsibilities between women and men, including caregiving in the context of HIV/AIDS". This meeting focused the international community's attention on care issues and generated Agreed Conclusions that aimed to lay out a roadmap for care policy. I examine how the frame of "care" - a contested concept that has long divided feminist researchers and activists - operated in this site. Research involved a review of documentation related to the meeting and interviews with 18 participants. Using this research I argue that the frame of care united a range of groups, including conservative faith-based actors who have mobilized within the UN to roll back sexual and reproductive rights. This policy alliance led to important advances in the Agreed Conclusions, including strong arguments about the global significance of care, especially in relation to HIV; the need for a strong state role; and the value of caregivers' participation in policy debates. However, the care frame also constrained debate at the CSW, particularly about disability rights and variations in family formation. Those seeking to reassert sexual and reproductive rights are grappling with such limitations in a range of ways, and attention to their efforts and concerns can help us better understand the potentials and dangers for feminist intervention within global policy spaces. Copyright (c) 2010 UNRISD. Published by Elsevier Ltd. All rights reserved.
Gonorrhoea surveillance, laboratory diagnosis and antimicrobial susceptibility testing of Neisseria gonorrhoeae in 11 countries of the eastern part of the WHO European region.
APMIS Acta Pathologica Microbiologica Et Immunologica Scandinavica. 2011 Sep; 119(9):643-649.Quality-assured worldwide surveillance of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is crucial for public health purposes. In the countries of the eastern part of the WHO European region the knowledge regarding gonococcal AMR is limited, and antimicrobials of many different types, sources and quality are used for gonorrhoea treatment. This study surveyed gonorrhoea incidence, laboratory diagnosis and gonococcal AMR testing in 11 independent countries of the former Soviet Union. The national gonorrhoea incidences remain mainly high. In general, gonococcal culture and AMR testing were rarely performed, poorly standardized and rarely quality assured. To establish a gonococcal AMR surveillance programme in Eastern Europe, i.e. the geographical area of the former Soviet Union, several actions have recently been undertaken by the Eastern European Sexual and Reproductive Health (EE SRH) Network and the WHO. The information provided herein will be useful in this respect.
Journal of Human Lactation. 2010 Aug; 26(3):297-303.The objective of this study was to translate and psychometrically assess a Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). The original English version of the BSES-SF was translated to Portuguese and tested among a sample of 89 mothers in southern Brazil from the 2nd to 12th postpartum week followed by face-to-face interviews. The mean total score of the Portuguese version of the BSES-SF was 63.6 +/- 6.22. The reliability analysis of each item in the scale attained significant Cronbach's alphas of 0.63 or superior. The Cronbach's alpha generated by the entire range of 14 questions was 0.71. A factor analysis identified one factor that contributed to 20% of the variance. This study demonstrates that the original English version of the BSES-SF was successfully adapted to Portuguese. The Portuguese version of the BSES-SF constitutes a reliable research instrument for evaluating breastfeeding self-efficacy in Brazil.
Journal of the International AIDS Society. 2010; 13:2.BACKGROUND: Back in 1987, the World Health Organization (WHO) concluded that the screening of international travellers was an ineffective way to prevent the spread of HIV. However, some countries still restrict the entrance and/or residency of foreigners with an HIV infection. HIV-related travel restrictions have serious implications for individual and public health, and violate internationally recognized human rights. In this study, we reviewed the current situation regarding HIV-related travel restrictions in the 53 countries of the WHO European Region. METHODS: We retrieved the country-specific information chiefly from the Global Database on HIV Related Travel Restrictions at hivtravel.org. We simplified and standardized the database information to enable us to create an overview and compare countries. Where data was outdated, unclear or contradictory, we contacted WHO HIV focal points in the countries or appropriate non-governmental organizations. The United States Bureau of Consular Affairs website was also used to confirm and complement these data. RESULTS: Our review revealed that there are no entry restrictions for people living with HIV in 51 countries in the WHO European Region. In 11 countries, foreigners living with HIV applying for long-term stays will not be granted a visa. These countries are: Andorra, Armenia, Cyprus (denies access for non-European Union citizens), Hungary, Kazakhstan, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. In Uzbekistan, an HIV-positive foreigner cannot even enter the country, and in Georgia, we were not able to determine whether there were any HIV-related travel restrictions due to a lack of information. CONCLUSIONS: In 32% of the countries in the European Region, either there are some kind of HIV-related travel restrictions or we were unable to determine if such restrictions are in force. Most of these countries defend restrictions as being justified by public health concerns. However, there is no evidence that denying HIV-positive foreigners access to a country is effective in protecting public health. Governments should revise legislation on HIV-related travel restrictions. In the meantime, a joint effort is needed to draw attention to the continuing discrimination and stigmatization of people living with HIV that takes place in those European Region countries where such laws and policies are still in force.
Bulletin of the World Health Organization. 2011 Jun 1; 89(6):442-50.OBJECTIVE: To appraise the process of development and clinical content of national human immunodeficiency virus (HIV) clinical practice guidelines of countries in the eastern Mediterranean and to formulate recommendations for future guideline development and adaptation. METHODS: Twenty-three countries in the World Health Organization (WHO) Eastern Mediterranean and United Nations Children's Fund Middle East and North Africa regions were invited to submit national HIV clinical practice guidelines for review. The guideline development methodology was assessed using an adaptation of the Appraisal of Guidelines Research and Evaluation (AGREE) instrument and guideline content, using a checklist to evaluate concordance with WHO 2006 generic guidelines. FINDINGS: Twelve countries submitted 20 guidelines developed between 2004 and 2009. Median scores were poor (i.e. < 0.6) for the methodological quality domains of rigour of development, stakeholder involvement and applicability and flexibility. Scores were better for the domains of scope and purpose (median: 0.82, interquartile range, IQR: 0.58-0.89) and clarity and presentation (median: 0.67, IQR: 0.50-0.78). Concerning guideline content, recommended first-line treatment and eligibility criteria for antiretroviral therapy (ART) in adults were in line with WHO recommendations in most guidelines. However, recommendations on antiretroviral prophylaxis for the prevention of vertical HIV transmission, diagnosis and treatment of HIV infection in infants, monitoring patients on ART, treatment failure and co-morbidities were often lacking. CONCLUSION: The large majority of national HIV clinical practice guidelines had methodological weaknesses and content inaccuracies. Countries require assistance with the adaptation process to ensure that guidelines are valid and up to date and accurately reflect WHO global clinical care recommendations for patients with HIV.
Journal of Family Planning and Reproductive Health Care. 2011 Jul; 37(3):128-31.This commentary focuses on guidance around 'missed pill' rules. It discusses the simplification of these rules taken on by the UK's Medicines and Healthcare products Regulatory Agency (MHRA) in 2010 with the aim to produce standardized guidance on the starting of combined hormonal contraceptives and on 'missed pills.'