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[Washington, D.C.], MCSP, 2018 Mar. 6 p.In 2016, the World Health Organization (WHO) published Recommendations on Antenatal Care for a Positive Pregnancy Experience (WHO 2016), which outlines a new set of evidence-based global guidelines on recommended content and scheduling for antenatal care (ANC). These recommendations are the first set of ANC guidelines created under WHO’s current approved process for development of clinical guidelines. This FAQ addresses commonly asked questions about the implementation of IPTp programs in the context of the 2016 ANC recommendations, as well as reminders about technical considerations for intermittent preventive treatment of malaria in pregnancy programs.
Implementing malaria in pregnancy programs in the context of World Health Organization recommendations on antenatal care for a positive pregnancy experience.
[Washington, D.C.], MCSP, 2017 Apr. 6 p.This technical brief highlights recommendations for the prevention and treatment of malaria in pregnancy (MiP) in the context of the World Health Organization (WHO) Recommendations on Antenatal Care for a Positive Pregnancy Experience, published in 2016. Also available in French and Portuguese.
Updated WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage. Highlights and key messages from the World Health Organization's 2017 Global Recommendation.
Geneva, Switzerland, WHO, 2017 Oct. 5 p. (WHO/RHR/17.21)This summary brief highlights key messages from the updated World Health Organization’s recommendation on Tranexamic acid (TXA) for the treatment of postpartum haemorrhage (PPH), including policy and program implications for translating the TXA recommendation into action at the country level. In 2012, WHO published recommendations for the prevention and treatment of postpartum haemorrhage, including a recommendation on the use of tranexamic acid (TXA) for treatment of PPH. The 2017 updated WHO Recommendation on TXA is based on new evidence on use of TXA for treatment of PPH. Key messages include: 1) The World Health Organization (WHO) recommends early use of intravenous tranexamic acid (TXA) within 3 hours of birth in addition to standard care for women with clinically diagnosed postpartum haemorrhage (PPH) following vaginal birth or caesarean section; 2) Administration of TXA should be considered as part of the standard PPH treatment package and be administered as soon as possible after onset of bleeding and within 3 hours of birth. TXA for PPH treatment should not be initiated more than 3 hours after birth; 3) TXA should be used in all cases of PPH, regardless of whether the bleeding is due to genital tract trauma or other causes; 4) TXA should be administered at a fixed dose of 1 g in 10 mL (100 mg/mL) IV at 1 mL per minute (i.e., administered over 10 minutes), with a second dose of 1 g IV if bleeding continues after 30 minutes; and 5) TXA should be administered via an IV route only for treatment of PPH. Research on other routes of TXA administration is a priority.This summary brief is intended for policy-makers, programme managers, educators and providers.
Geneva, Switzerland, World Health Organization [WHO], 2017. 56 p.Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and advancements in prevention, diagnosis and treatment necessitate changes in STI management. This guideline provides updated recommendations for syphilis screening and treatment for pregnant women based on the most recent evidence and available serologic tests for syphilis. The objectives of this guideline are: 1) to provide evidence-based guidance on syphilis screening and treatment for pregnant women; and 2) to support countries to update their national guidelines for syphilis screening and treatment for pregnant women.
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.
Projected Uptake of New Antiretroviral (ARV) Medicines in Adults in Low- and Middle-Income Countries: A Forecast Analysis 2015-2025.
PloS One. 2016; 11(10):e0164619.With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
[Poliomyelitis--Challenges for the Last Mile of the Eradication Programme] Poliomyelitis--Herausforderungen in der Endphase des globalen Eradikationsprogramms.
Gesundheitswesen). 2016 Apr; 78(4):227-9.The World Health Organisation initiated the Global Polio Eradication Initiative in the year 1988. With the large-scale application of routine and mass vaccinations in children under the age of 5 years, polio disease has become restricted to only 3 endemic countries (Afghanistan, Pakistan and Nigeria) by today. However, since the beginning of the 21st century, increasing numbers of secondary polio epidemics have been observed which were triggered through migration, political turmoil and weak health systems. In addition, there emerged serious technical (e. g., back-mutations of oral vaccine virus to wild virus) and socio-political (refusal of vaccinations in Muslim populations of Nigeria and Pakistan) problems with the vaccination in the remaining endemic countries. It thus appears questionable if the current eradiation initiative will reach its goal in the foreseeable future. (c) Georg Thieme Verlag KG Stuttgart . New York.
Seminars In Perinatology. 2015 Oct; 39(6):430-6.Induction of labor in resource-limited settings has the potential to significantly improve health outcomes for both mothers and infants. However, there are relatively little context-specific data to guide practice, and few specific guidelines. Also, there may be considerable issues regarding the facilities and organizational capacities necessary to support safe practices in many aspects of obstetrical practice, and for induction of labor in particular. Herein we describe the various opportunities as well as challenges presented by induction of labor in these settings. Copyright (c) 2015 Elsevier Inc. All rights reserved.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed.
Geneva, Switzerland, WHO, 2016.  p.These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
[Geneva, Switzerland], WHO, 2016 Feb.  p.Emergency contraception can prevent most pregnancies when taken after intercourse. Emergency contraception can be used in the following situations: unprotected intercourse, contraceptive failure, incorrect use of contraceptives, or in cases of sexual assault. There are 3 methods of emergency contraception: emergency contraceptive pills (ECPs), combined oral contraceptive pills or the Yuzpe method, and copper-bearing intrauterine devices (IUDs). A copper-bearing IUD is the most effective form of emergency contraception available when inserted within 5 days of unprotected intercourse. The emergency contraceptive pill regimen recommended by WHO is either: a. 1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse; or b. 2 doses of combined oral contraceptive pills (also known as the Yuzpe regimen).
Guideline: Managing possible serious bacterial infection in young infants when referral is not feasible.
Geneva, Switzerland, WHO, 2015.  p.This guideline, developed by a panel of international experts and informed by a thorough review of existing evidence, contains a number of recommendations on the use of antibiotics for neonates (0–28 days old) and young infants (0–59 days old) with PSBI in order to reduce young infant mortality rates. The guideline is intended for use in resource-limited settings in situations when families do not accept or cannot access referral care. The goal of the guideline is to provide clinical guidance on the simplest antibiotic regimens that are both safe and effective for outpatient treatment of clinical severe infections and fast breathing (pneumonia) in children 0–59 days old. In addition, the guideline seeks to provide programmatic guidance on the role of CHWs and home visits in identifying signs of serious infections in neonates and young infants.
Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.
Antiviral therapy. 2014; 19 Suppl 3:31-7.The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.
Controlling maternal anemia and malaria. Ensuring pregnant women receive effective interventions to prevent malaria and anemia: What program managers and policymakers should know.
[Washington, D.C.], Maternal and Child Survival Program, 2015 Apr.  p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief describes WHO recommendations for IPTp (intermittent preventive treatment of malaria in pregnancy) to prevent MIP (malaria in pregnancy) and iron-folic acid (IFA) supplementation to prevent iron deficiency anemia in sub-Saharan Africa (SSA) countries, with an emphasis on giving the correct dose of folic acid to maximize the effectiveness of interventions to prevent malaria. The brief is for program managers of health programs and policymakers to guide them in designing programs and developing policies. (Excerpts)
WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP).
[Geneva, Switzerland], WHO, 2013 Apr 11.  p.Malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her fetus and the newborn. In areas with moderate to high transmission of Plasmodium falciparum, the World Health Organization (WHO) recommends a package of interventions for controlling malaria and its effects during pregnancy, which includes the promotion and use of insecticide-treated nets (ITNs), the administration during pregnancy of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), and appropriate case management through prompt and effective treatment of malaria in pregnant women . During the last few years, WHO has observed a slowing of efforts to scale-up IPTp-SP in a number of countries in Africa. Although there may be several reasons for this, an important factor is confusion among health workers about sulfadoxine-pyrimethamine administration for intermittent preventive treatment in pregnancy. At a recent WHO evidence review, a meta-analysis of 7 trials evaluating IPTp-SP was undertaken. It showed that 3 or more doses of IPTp-SP were associated with higher mean birth weight and fewer low birth weight (LBW) births than 2 doses of IPTp-SP. The estimated relative risk reduction for LBW was 20% (95% CI 6-31). This effect was consistent across a wide range of SP resistance levels. The 3+ dose group also was found to have less placental malaria. There were no differences in serious adverse events between the two groups . Based on this evidence review, in October 2012, WHO updated the recommendations on IPTp-SP as outlined in this document, and urges national health authorities to disseminate this update widely and ensure its correct application. IPTp-SP is an integral part of WHO’s three-pronged approach to the prevention and treatment of malaria in pregnancy, which also includes the use of insecticide-treated nets and prompt and effective case management. (Excerpts)
Updated WHO policy recommendation (October 2012): Intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP).
[Geneva, Switzerland], WHO, Global Malaria Programme, 2012 Oct.  p.Each year, 655,000 people die from malaria -- of these, 200,000 are newborns and 10,000 are mothers. Yet, recent evidence brings to light that use of bednets and intermittent preventive treatment by pregnant women, both powerful and cost-effective tools to prevent contracting malaria in areas of stable transmission, is associated with reductions in neonatal mortality and low-birth weight. The World Health Organization has updated its recommendations on the use of intermittent preventive treatment, urging countries to adapt their policies and practices to quickly scale-up this life-saving measure.
Lancet. 2012 Jun 23; 379(9834):2328.Thiomersal, a mercury-based chemical, has been used in low doses as a preservative in multi-dose vaccines since the 1930s. But since the publicâ€™s growing concern about a possible link between thiomersal and autism, and the Center for Disease Controlâ€™s 1999 recommendation to manufacturers to remove thiomersal-containing vaccines, American companies have been removing the chemical from their vaccines and have been making single-dose vial for years. So far, these changes in vaccine production have only been reported in the US, but there is growing concern that if a global ban of thiomersal is recommended by the UN Environment Program (UNEP), it will have a deeply negative effect on the developing world. Multi-dose vials used in the developing world can hold up to ten doses of vaccines, increasing their ease of storage and transport in developing countries, and thiomersal-containing vaccines are an essential medicine. This article summarizes some concerns of a possible ban and its implications for global health.
MMWR. Morbidity and Mortality Weekly Report. 2011 Dec 2; 60:1611-4.Rotavirus disease is the leading cause of childhood morbidity and mortality related to diarrhea in Latin America and the Caribbean (LAC), where an estimated 8,000 deaths related to rotavirus diarrhea occur annually among children aged <5 years. After two safe and effective rotavirus vaccines became available, the World Health Organization (WHO) in 2007 recommended inclusion of rotavirus vaccine in the immunization programs of Europe and the Americas, and in 2009 expanded the recommendation to all infants aged <32 weeks worldwide. This report describes progress in the introduction of rotavirus vaccine in LAC, where it was first introduced in 2006 in Brazil, El Salvador, Mexico, Nicaragua, Panama, and Venezuela; by January 2011, it was included in the national immunization schedules of 14 countries in LAC. Estimated national rotavirus vaccine coverage (2 doses of the monovalent vaccine or 3 doses of the pentavalent vaccine) among children aged <1 year in 2010 ranged from 49% to 98% (median: 89%) in the 11 LAC countries with vaccine introduction before 2010. Of the 14 countries that had introduced rotavirus vaccine into their national immunization programs, 13 participate in a hospital-based rotavirus surveillance network. Data from some countries in this network and from other monitoring efforts in LAC countries have shown declines in hospitalizations and deaths related to severe diarrhea after rotavirus vaccine introduction. The rapid introduction of rotavirus vaccine in LAC demonstrates the benefits of the early commitment of national decision makers to introduce these vaccines in low-income and middle-income countries at the same time as in high-income countries.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2011.  p. (WHO/RHR/11.10)The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders. This evidence base includes chapters on indications, methods, treatment of uterine hyperstimulation and setting.
Geneva, Switzerland, WHO, 2011.  p.The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders.
Journal of Child Health Care. 2010 Jun; 14(2):142-50.The aims of the study were to find out the routine immunization coverage in under-five children; and to impart correct health education regarding the importance of complete immunization. This hospital- and outreach-session-based cross-sectional study was carried out by the interview method in two underserved areas of Aligarh city. Two thousand five hundred and thirty-one under-five children and their mothers or family members were included in the population sample. Statistical analysis was done by proportions and chi-square test. In Shahjamal area, a maximum 86.5 percent of children were immunized with DPT, OPV (86.5%) first doses followed by BCG (84.9%). DPT and OPV second and third doses were given in 64.5 percent and 54.8 percent respectively. Measles and DPT booster coverage was low at 39.0 percent and 11.4 percent respectively. Similarly, in Bhojpura, 99 percent of children received DPT and OPV first doses followed by BCG (94.1%). DPT and OPV second and third doses were given in 67.7 percent and 47.4 percent of children respectively. Measles and DPT booster coverage was low as 31.9 percent and 6.7 percent respectively. The results reveal high coverage of DPT1, OPV1, BCG, DPT2 and OPV2 in both areas. Immunization services need to be strengthened beyond infancy.
From paper to practice. Implementing the World Health Organization’s 2010 Antiretroviral Therapy Recommendations for Adults and Adolescents in Zambia.
Arlington, Virginia, John Snow [JSI], AIDS Support and Technical Assistance Resources [AIDSTAR-One], 2011 May.  p. (USAID Contract No. GHH-I-00-07-00059-00; AIDSTAR-One Case Study Series)After the 2009 release of WHO’s Rapid Advice for HIV treatment in adults and adolescents, Zambia launched a broad-based effort to update its national treatment protocols. The Ministry of Health succeeded in creating an efficient and inclusive review and revision process for the guidelines, which they began implementing in 2011.
Monitoring antiretroviral therapy in resource-limited settings: balancing clinical care, technology, and human resources.
Current HIV / AIDS Reports. 2010 Aug; 7(3):168-74.Due to the rapid expansion of first-line antiretroviral therapy in resource-limited settings (RLS), increasing numbers of people are living with HIV for prolonged periods of time. Treatment programs must now decide how to balance monitoring costs necessary to maximize health benefits for those already on treatment with the continued demand to initiate more patients on first-line treatment. We review currently available evidence related to monitoring strategies in RLS and discuss their implications on timing of switching to second-line treatment, development of HIV resistance, and clinical outcome.
Washington, D.C., Advocates for Youth, .  p. (From Research to Practice)This article defines and describes emergency contraception, its effectiveness, available forms, conditions of its availability in the United States, regimen specifics, efficacy, modes of action, safety and screening issues, side effects, and barriers and ways to dismantle them, especially for young women. Statements on emergency contraception from prominent health organizations are also provided.
Geneva, Switzerland, WHO, 2009 Nov. 25 p.Based on the latest scientific evidence, the World Health Organization (WHO) has released new recommendations on HIV treatment and prevention and infant feeding in the context of HIV. WHO now recommends earlier initiation of antiretroviral therapy for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization Guidelines for the treatment of malaria provides evidence-based and up-to-date recommendations for countries on malaria diagnosis and treatment which help countries formulate their policies and strategies. In scope, the Guidelines cover the diagnosis and treatment of uncomplicated and severe malaria caused by all types of malaria, including in special groups (young children, pregnant women, HIV / AIDS), in travellers (from non-malaria endemic regions) and in epidemics and complex emergency situations. The first edition of the Guidelines for the treatment of malaria were published in 2006. The second edition introduces a new 5th ACT to the four already recommended for the treatment of uncomplicated malaria. Furthermore, the Guidelines recommend a parasitological confirmation of diagnosis in all patients suspected of having malaria before treating. The move towards universal diagnostic testing of malaria is a critical step forward in the fight against malaria as it will allow for the targeted use of ACTs for those who actually have malaria. This will help to reduce the emergence and spread of drug resistance. It will also help identify patients who do not have malaria, so that alternative diagnoses can be made and appropriate treatment provided. The new Guidelines will therefore help improve the management of not only malaria, but other childhood febrile illnesses.