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Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach.
International Journal of Adolescent Medicine and Health. 2016 Nov 10; 30(2)The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-a-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.
Lancet. HIV. 2016 Jul; 3(7):e286-8.Add to my documents.
Lancet. HIV. 2016 Sep; 3(9):e409.Add to my documents.
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Trainees' handbook.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 199 p.The Trainees’ handbook is designed to train gynaecologists and non-specialist clinicians in performing colposcopy and treatment of cervical precancerous conditions so they can provide the necessary diagnostic and therapeutic services in a cervical cancer screening programme. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training programme on cervical cancer screening and treatment. The Trainees’ handbook contains different modules intended to assist trainees to develop their knowledge and learn the correct steps to perform colposcopy and treatment procedures. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. The structure and methodology of the training have been designed to impart knowledge in the most effective manner and have taken into consideration the overall training objectives, profiles of trainees and the expected learning outcomes. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Facilitators' guide.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 118 p.This manual is an instruction guide for facilitators to provide competence based training to providers of colposcopy and treatment services in a cervical cancer screening programme. The training is intended to assist gynaecologists and non-specialist clinicians to learn and improve upon their skills to perform colposcopy and to treat cervical pre-cancers by excision methods. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training participants through interactive presentations, group discussions, role plays, clinical practice sessions, etc. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions and guidelines for assessment of trainees. The Trainees’ handbook contains different modules to assist trainees with step-by-step learning of colposcopy and treatment procedures. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Trainees' handbook.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 171 p.The Trainees’ handbook is designed for paramedical workers, midwives, nurses and clinicians involved in cervical cancer screening to help them acquire the necessary skills to perform VIA, collect samples for HPV test and treat cervical pre-cancers by ablative methods. The publication of the World Health Organization guidance document Comprehensive cervical cancer control: A guide to essential practice, 2nd edition, 2014 has necessitated modifications in the existing training resources for cervical cancer screening and treatment. The new screening recommendations and management algorithms have been incorporated in the present Trainees’ handbook. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training on cervical cancer screening and treatment. The handbook contains different modules to assist trainees to learn various screening and treatment procedures step- by-step and to comprehend their underlying principles. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Facilitators' guide.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 123 p.This manual is an instruction guide for facilitators to provide competence based training to providers for screening (with VIA or HPV test) and ablative treatment services in a cervical cancer screening programme. The training is intended to assist midwives, paramedical workers, nurses and clinicians to learn and improve upon their skills to perform counselling, screening tests and treatment. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training through interactive presentations, group discussions, role plays, simulated learning sessions, and clinical practice sessions. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions, simulated learning sessions and guidelines for assessment of trainees. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of community health workers.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 92 p.The training manual is designed to assist in building capacity of community health workers (CHWs) in educating women and community members on relevant aspects of cervical cancer prevention. The manual aims to facilitate improvement in communication skills of CHWs for promoting uptake of cervical cancer screening services in the community. The primary intention of this manual is to assist CHWs in spreading community awareness on cervical cancer prevention and establishing linkage between the community and available screening services. The information and instructions included in the manual can be used by both the facilitators and CHWs while participating in the training. The manual contains nine different sessions to assist CHWs to be acquainted with different aspects of cervical cancer prevention at the community level with focus on improving their communication skills. Each session contains key information in ‘question and answer’ format written in simple language so that CHWs can comprehend the contents better. At the end of each session, there are group activities like role plays, group discussion and games for active learning. These are intended to give opportunity to CHWs to learn by interacting with each other and also relate themselves with their roles and responsibilities at the community level. The manual includes ‘notes to the facilitator’ on how to conduct various sessions as per the given session plan. A set of ‘Frequently Asked Questions’ has been included to help the CHWs provide appropriate information to women and community members.
Cervical cancer screening and management of cervical pre-cancers. Trainees' handbook and facilitators' guide - Programme managers' manual.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 145 p.The training manual for programme managers is designed to build the capacity of professionals in managerial positions to develop cervical cancer screening programmes, plan implementation strategies and effectively manage the programme at the national or sub national levels. The guidelines and information included in the manual are intended to be used both by trainees and facilitators while participating in the structured training programme for programme managers. The manual contains different modules to assist trainees to be acquainted with different aspects of planning, implementing and monitoring of cervical cancer screening services. Considering the fact that programme managers need to understand cervical cancer screening in the broader perspective of the national cancer control programme (NCCP), modules describing the planning and implementation of NCCP are also included in the manual. The modules include relevant case studies from real screening programmes in different countries. The manual includes notes to facilitators on how to conduct the various training sessions as per the session plan. The detailed methodology of conducting trainee evaluation is also part of this manual.
Vaccine. 2016 Oct 10; 34(43):5144-5149.BACKGROUND: The African Region is set to achieving polio eradication. During the years of operations, the Polio Eradication Initiative [PEI] in the Region mobilized and trained tremendous amount of manpower with specializations in surveillance, social mobilization, supplementary immunization activities [SIAs], data management and laboratory staff. Systems were put in place to accelerate the eradication of polio in the Region. Standardized, real-time surveillance and response capacity were established. Many innovations were developed and applied to reaching people in difficult and security challenged terrains. All of these resulted in accumulation of lessons and best practices, which can be used in other priority public health intervention if documented. METHODS: The World Health Organization Regional Office for Africa [WHO/AFRO] developed a process for the documentation of these best practices, which was pretested in Uganda. The process entailed assessment of three critical elements [effectiveness, efficiency and relevance] five aspects [ethical soundness, sustainability, involvement of partners, community involvement, and political commitment] of best practices. A scored card which graded the elements and aspects on a scale of 0-10 was developed and a true best practice should score >50 points. Independent public health experts documented polio best practices in eight countries in the Region, using this process. The documentation adopted the cross-sectional design in the generation of data, which combined three analytical designs, namely surveys, qualitative inquiry and case studies. For the selection of countries, country responses to earlier questionnaire on best practices were screened for potential best practices. Another criterion used was the level of PEI investment in the countries. RESULTS: A total of 82 best practices grouped into ten thematic areas were documented. There was a correlation between the health system performances with DPT3 as proxy, level of PEI investment in countries with number of best practice. The application of the process for the documentation of polio best practices in the African Region brought out a number of advantages. The triangulation of data collected using multiple methods and the collection of data from all levels of the programme proved useful as it provided opportunity for data verification and corroboration. It also helped to overcome some of the data challenge. Copyright (c) 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
MMWR. Morbidity and Mortality Weekly Report. 2017 Nov 10; 66(44):1226-1229.The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.
Casting light on old shadows: Ending sexually transmitted infection epidemics as public health concerns by 2030.
Geneva Switzerland, World Health Organization [WHO], 2017. 8 p. (Advocacy Brief; WHO/RHR/17.17)Countries can boost the response to STIs and improve the health of millions of women, men and adolescents by adopting WHO’s Global STI Strategy. Some viral STIs, like human papillomavirus (HPV) and HIV, are still incurable and can be deadly, while some bacterial STIs – like chlamydia, gonorrhoea, syphilis and trichomoniasis – are curable if detected and treated. This brief provide milestones and targets and five strategic directions for countries to develop their own national plans.
Tracing Africa's progress towards implementing the Non-Communicable Diseases Global action plan 2013-2020: a synthesis of WHO country profile reports.
BMC Public Health. 2017 Apr 05; 17(1):297.BACKGROUND: Half of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013-2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa's progress towards WHO policy recommendations for reducing the NCD burden. METHODS: Data from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports. RESULTS: More than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive. CONCLUSION: Our findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa.
Guideline: use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women.
Geneva, Switzerland, WHO, 2016. 32 p.The guideline is intended for a wide audience, including governments, nongovernmental organizations, healthcare workers, scientists and donors involved in the design and implementation of micronutrient programmes and antenatal care services and their integration into national and subnational public health strategies and programmes. This WHO guideline states that routine use of multiple micronutrient powders during pregnancy is not recommended as an alternative to standard iron and folic supplementation during pregnancy for improving maternal and infant health outcomes.
Washington, D.C., Center for Global Development, 2015. 68 p.Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3-$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses -- and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death. Many researchers and policymakers have hypothesized that models tying grant payments to achieved and verified results -- referred to in this report as next generation financing models -- offer an opportunity for the Global Fund to push forward its strategic interests and accelerate the impact of its investments. Free from year-to-year disbursement pressure (like government agencies) and rigid allocation policies (like the World Bank’s International Development Association), the Global Fund is also uniquely equipped to push forward innovative financing models. But despite interest, the how of new grant designs remains a challenge. Realizing their potential requires technical know-how and careful, strategic decisionmaking that responds to specific country and epidemiological contexts -- all with little evidence or experience to guide the way. This report thus addresses the how of next generation financing models -- that is, the concrete steps needed to change the basis of payment from expenses to something else: outputs, outcomes, or impact. (Excerpts)
Washington, D.C., Center for Global Development, 2016 Feb. 38 p. (Center for Global Development Working Paper 425)This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. The rest of the paper then discusses how one can build a real-world contract from these theoretical foundations, and how these contracts should be adapted to different contexts when the basic assumptions do not hold. Finally, we provide a synthesis of these various results with the aim of guiding policy makers as to when and how ‘results-based’ incentive contracts can be used in practice.
Advocacy, communication, and partnerships: Mobilizing for effective, widespread cervical cancer prevention.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:57-62.Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. Failure to launch or expand cervical cancer prevention programs is by and large due to the absence of dedicated funding, along with a lack of recognition of the urgent need to update policies that can hinder access to services. Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Validation of maternal and neonatal tetanus elimination in Equatorial Guinea, 2016. alidation de l'elimination du tetanos maternel et neonatal en Guinee equatoriale, 2016.
Releve Epidemiologique Hebdomadaire. 2017 Jun 16; 92(24):333-44.Add to my documents.
Progress towards measles elimination - African Region, 2013-2016. Progres realises en vue d'eliminer la rougeole - Region africaine, 2013-2016.
Releve Epidemiologique Hebdomadaire. 2017 May 05; 92(18):229-39.Add to my documents.
An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding, and Wasting.
Washington, D.C., International Bank for Reconstruction and Development / The World Bank, 2017 Apr. 258 p.The report estimates the costs, impacts and financing scenarios to achieve the World Health Assembly global nutrition targets for stunting, anemia in women, exclusive breastfeeding and the scaling up of the treatment of severe wasting among young children. To reach these four targets, the world needs $70 billion over 10 years to invest in high-impact nutrition-specific interventions. This investment would have enormous benefits: 65 million cases of stunting and 265 million cases of anemia in women would be prevented in 2025 as compared with the 2015 baseline. In addition, at least 91 million more children would be treated for severe wasting and 105 million additional babies would be exclusively breastfed during the first six months of life over 10 years. Altogether, achieving these targets would avert at least 3.7 million child deaths. Every dollar invested in this package of interventions would yield between $4 and $35 in economic returns, making investing in early nutrition one of the best value-for-money development actions. Although some of the targets -- especially those for reducing stunting in children and anemia in women -- are ambitious and will require concerted efforts in financing, scale-up, and sustained commitment, recent experience from several countries suggests that meeting these targets is feasible. These investments in the critical 1000 day window of early childhood are inalienable and portable and will pay lifelong dividends -- not only for children directly affected but also for us all in the form of more robust societies -- that will drive future economies.
Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor.
Global Public Health. 2017 Apr; 12(4):396-415.The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behavior, risk and disease, which implicitly locates ‘risk’ within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with ‘alternative’ environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralize health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralizing health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualizing strategies that may address both behavioral and structural determinants of health.
[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.
Geneva, Switzerland, WHO, 2016. 64 p.This report is a companion to the World Health Organization’s 2016 guide for “Introducing HPV Vaccine Into National Immunization Programmes.” It summarizes experiences introducing HPV vaccine and provides guidance for introduction.
Geneva, Switzerland, WHO, EPI, 2016. 104 p.This document is intended for use by national immunization programme managers and immunization partners to inform the policy discussions and operational aspects for the introduction of HPV vaccine into national immunization programmes and to provide up-to-date references on the global policy, as well as the technical and strategic issues related to the introduction of HPV vaccine.
The Cervical Cancer Prevention Initiative: Investing in Cervical Cancer Prevention 2015–2020. Year One update, November 2016.
[Seattle, Washington], PATH, 2016 Nov. 7 p.It has been a year since the groundbreaking meeting in London where the Cervical Cancer Prevention Initiative was launched. This short report documents progress building the Initiative over the past 12 months, and lists key global milestones in cervical cancer during that time.