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Safer women, safer world: a fund to increase the number of women UN Peacekeepers and better protect women and girls in conflict situations.
Washington, D.C., Center for Global Development, 2017 Jun. 4 p. (Center for Global Development Brief)Having more women peacekeepers is linked with large reductions in sexual misconduct by peacekeepers and more sustainable peace. The UN could potentially raise the proportion of women peacekeepers to 20 percent for around $75 million. A small multilateral trust fund would offer supplementary payments to troop-contributing countries for each woman peacekeeper provided.
New York, New York, UNFPA, 2015 Nov. 101 p.Gender based violence is a life-threatening, global health and human rights issue that violates international human rights law and principles of gender equality. In emergencies, such as conflict or natural disasters, the risk of violence, exploitation and abuse is heightened, particularly for women and girls. UNFPA’s “Minimum Standards for Prevention and Response to GBV in Emergencies (GBViE)” promote the safety and well being of women and girls in emergencies and provide practical guidance on how to mitigate and prevent gender-based violence in emergencies and facilitate access to multi-sector services for survivors.
Geneva, Switzerland, WHO, 2015 Nov. 2 p. (Pre-Exposure Prophylaxis (PrEP); Policy Brief)This policy brief defines PrEP, presents the World Health Organization's current recommendations for PrEP use and the evidence for it, discusses PrEP's expected cost-effectiveness, and lists considerations for PrEP implementation.
Ethical and safety recommendations for intervention research on violence against women. Building on lessons from the WHO publication, "Putting women first: ethical and safety recommendations for research on domestic violence against women".
Geneva, Switzerland, WHO, 2016. 43 p.As the evidence base on the magnitude, context and consequences of violence against women (VAW) has grown, research efforts and attention have begun to focus on decreasing the knowledge gap on effective responses through intervention research. Demonstrating this focus, in November 2012 the WHO Department of Reproductive Health and Research convened a group of experts to discuss health sector-based research to respond to violence against women. This global network of researchers, scientists and practitioners was brought together to enhance existing research efforts and to advocate for greater funding for research on interventions to address VAW and policies and programmes related to it. With the increased interest in and attention of the global community of researchers, practitioners and policy-makers regarding rigorous intervention research for preventing and responding to VAW, a discussion of the ethical considerations specific to this type of research is warranted. These recommendations have been developed to help answer questions specific to conducting research on health-based interventions to prevent and respond to VAW. Research on strategies that use health or health care as an entry point (regardless of the implementation setting, such as a clinic or community) is the focus. However, the discussion may be relevant to research on other kinds of VAW interventions.
WHO guideline: Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years.
Geneva, Switzerland, WHO, 2016. 60 p.The use of multiple micronutrient powders for point-of-use fortification of foods has been suggested as an alternative to mitigate or overcome the constraints associated with supplementation and mass fortification. They are intended to increase the vitamin and mineral intake of infants and young children aged 6 to 23 months as well as preschool and school-age children aged 2-12 years. This guideline is intended to help Member States and their partners in their efforts to make evidence-informed decisions on the appropriate nutrition actions to improve the nutritional status of infants and children aged 6 months to 12 years. It will also support their efforts to achieve the Sustainable Development Goals, the global targets set by the Comprehensive implementation plan on maternal, infant and young child nutrition, and the Global strategy for women’s, children’s and adolescents’ health 2016-2030. It is intended for a wide audience, including governments, nongovernmental organizations, health-care 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 guideline provides global, evidence-informed recommendations on the use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6-23 months and children aged 2-12 years.
2016; Geneva, Switzerland, WHO, 2016. 38 p.This guideline provides a global, evidence-informed recommendation on iron supplementation in postpartum women, as a public health intervention for the purpose of improving maternal and infant health outcomes. The guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals (SDGs), in particular, Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture.
MMWR. Morbidity and Mortality Weekly Report. 2016 Feb 12; 65(5):115-9.Blood transfusion is a life-saving medical intervention; however, challenges to the recruitment of voluntary, unpaid or otherwise nonremunerated whole blood donors and insufficient funding of national blood services and programs have created obstacles to collecting adequate supplies of safe blood in developing countries (1). Since 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided approximately $437 million in bilateral financial support to strengthen national blood transfusion services in 14 countries in sub-Saharan Africa and the Caribbean* that have high prevalence rates of human immunodeficiency virus (HIV) infections. CDC analyzed routinely collected surveillance data on annual blood collections and HIV prevalence among donated blood units for 2011-2014. This report updates previous CDC reports (2,3) on progress made by these 14 PEPFAR-supported countries in blood safety, summarizes challenges facing countries as they strive to meet World Health Organization (WHO) targets, and documents progress toward achieving the WHO target of 100% voluntary, nonremunerated blood donors by 2020 (4). During 2011-2014, overall blood collections among the 14 countries increased by 19%; countries with 100% voluntary, nonremunerated blood donations remained stable at eight, and, despite high national HIV prevalence rates, 12 of 14 countries reported an overall decrease in donated blood units that tested positive for HIV. Achieving safe and adequate national blood supplies remains a public health priority for WHO and countries worldwide. Continued success in improving blood safety and achieving WHO targets for blood quality and adequacy will depend on national government commitments to national blood transfusion services or blood programs through increased public financing and diversified funding mechanisms for transfusion-related activities.
British Journal of Nursing. 2016 Mar 24-Apr 13; 25(6):344-5.Add to my documents.
Influences on participant reporting in the World Health Organisation drugs exposure pregnancy registry; a qualitative study.
BMC Health Services Research. 2014; 14:525.BACKGROUND: The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome. METHODS: Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically. RESULTS: Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby. CONCLUSIONS: Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics.
Geneva, Switzerland, WHO, 2013.  p.The WHO Traditional Medicine Strategy 2014–2023 was developed and launched in response to the World Health Assembly resolution on traditional medicine (WHA62.13). The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role traditional medicine plays in keeping populations healthy. Addressing the challenges, responding to the needs identified by Member States and building on the work done under the WHO traditional medicine strategy: 2002–2005, the updated strategy for the period 2014–2023 devotes more attention than its predecessor to prioritizing health services and systems, including traditional and complementary medicine products, practices and practitioners.
[Geneva, Switzerland], WHO, 2015 Dec 17.  p.The Global Advisory Committee on Vaccine Safety (GACVS) of the World Health Organization recently reviewed updated data on HPV vaccine. The WHO recommends that HPV vaccines be introduced into national immunization programs provided that: prevention of cervical cancer and/or other HPV-related diseases constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost-effectiveness of vaccination strategies in the country or region is considered. Following a systematic investigation of safety concerns raised about HPV vaccines, to date, the GACVS has not found any safety issues that would alter recommendations for the use of the vaccine.
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.
Bulletin of the World Health Organization. 2014; 92:155.Unsafe abortion is defined by the World Health Organization (WHO) as a procedure for terminating a pregnancy as performed by persons lacking the necessary skills or in an inappropriate environment that fails to meet minimal medical standards, or both. Concepts first outlined in a 1992 WHO Technical Consultation are embodied in this definition. However, although this definition is widely used, it is inconsistently interpreted. In this editorial, we discuss its correct interpretation and operationalization. (excerpt)
A lifesaving strategy. Making the case for scaling up human milk banking to save vulnerable infants in South Africa.
Seattle, Washington, PATH, 2011 Jul.  p. (Strengthening Human Milk Banking)Breastmilk is considered a pillar of child survival. It has unique immunological and nutritional properties that help infants get a healthy start in life. Human milk is even more important for infants in resource-limited settings who are especially vulnerable, such as pre-term babies. These infants are often exposed to potential pathogens through unsafe water or unhygienic conditions and need the additional protection that breastmilk provides. In cases where breastfeeding is not possible because of the baby’s slow development or the mother is unable to breastfeed, the next preferred feed is pasteurized own mother’s milk. Adequate supply can be ensured through early lactation and “room-in” beds. When these are unavailable, pasteurized donor milk should be considered. Human milk banks are one way to provide safe breastmilk to such infants who need it most. In light of the impact human milk can have on infant health outcomes, the World Health Organization (WHO) has recently asked countries to promote the safe use of donor milk through human milk banks for vulnerable infants.
International Journal of Gynaecology and Obstetrics. 2013 Feb; 120(2):200-3.Since its first publication in 2003, the World Health Organization's "Safe abortion: technical and policy guidance for health systems" has had an influence on abortion policy, law, and practice worldwide. To reflect significant developments in the clinical, service delivery, and human rights aspects of abortion care, the Guidance was updated in 2012. This article reviews select recommendations of the updated Guidance, highlighting 3 key themes that run throughout its chapters: evidence-based practice and assessment, human rights standards, and a pragmatic orientation to safe and accessible abortion care. These themes not only connect the chapters into a coherent whole. They reflect the research and advocacy efforts of a growing field in women's health and human rights. Copyright (c) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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.
Meeting of the Strategic Advisory Group of Experts on immunization, April 2013 - conclusions and recommendations.
Releve Epidemiologique Hebdomadaire. 2013 May 17; 88(20):201-6.Add to my documents.
Bulletin of the World Health Organization. 2012 Sep 1; 90(9):712.The World Health Organization’s (WHO) update of its 2003 publication Safe abortion: technical and policy guidance for health systems has responded to a major neglected public health need of women. The substantial revisions in the 2012 update reflect developments in safe abortion methods and clinical care, providing guidance about the range of safe options available to women seeking elective abortion. Women’s participation in the choice of abortion method, pain control and post-abortion contraception is a crucial element, seeing as unsafe induced abortion is not only public health problem but also a human rights issue. The report discusses developments in the application of human rights principles in policy-making and in legislation related to induced abortion. National courts and regional and international human rights bodies, such as the United Nations treaty monitoring bodies, have increasingly applied these principles to facilitate women’s transparent access to safe abortion services.
Indoor residual spraying: an operational manual for indoor residual spraying (IRS) for malaria transmission control and elimination.
Geneva, Switzerland, WHO, 2013.  p.This manual has been created to enhance existing knowledge and skills, and to assist malaria programme managers, entomologists and vector control and public health officers to design, implement and sustain high quality IRS programmes. Though comprehensive, this manual is not intended to replace field expertise in IRS. The manual is divided into three chapters: IRS policy, strategy and standards for national policy makers and programme managers; IRS management, including stewardship and safe use of insecticides, for both national programme managers and district IRS coordinators; IRS spray application guidelines, primarily for district IRS coordinators, supervisors and team leaders. This manual will enable national programmes to: develop or refine national policies and strategies on vector control; develop or update existing national guidelines; develop or update existing national training materials; review access and coverage of IRS programmes; review the quality and impact of IRS programmes.
Landscape for safe injection, phlebotomy, and waste management equipment. Standards, specifications, and products.
Boston, Massachusetts, JSI, MMIS, 2010 Jan.  p.This document provides guidelines for implementing a procurement policy for safe injection and brings together issues that countries should consider when developing and implementing the procurement aspect of a national injection safety policy. The document points out issues to consider in transitioning from policy to implementation, regulatory factors, public-sector considerations, and the need to sensitize private-sector manufacturers. It also includes a landscape of manufacturers of safe injection equipment.
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.
Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics.
Bulletin of the World Health Organization. 2011 Aug 1; 89(8):594-607.OBJECTIVE: To systemically review the evidence in support of World Health Organization guidelines recommending broad-spectrum antibiotics for children with severe acute malnutrition (SAM). METHODS: CENTRAL, MEDLINE, EMBASE, LILACS, POPLINE, CAB Abstracts and ongoing trials registers were searched. Experts were contacted. Conference proceedings and reference lists were manually searched. All study types, except single case reports, were included. FINDINGS: Two randomized controlled trials (RCTs), one before-and-after study and two retrospective reports on clinical efficacy and safety were retrieved, together with 18 pharmacokinetic studies. Trial quality was generally poor and results could not be pooled due to heterogeneity. Oral amoxicillin for 5 days was as effective as intramuscular ceftriaxone for 2 days (1 RCT). For uncomplicated SAM, amoxicillin showed no benefit over placebo (1 retrospective study). The introduction of a standardized regimen using ampicillin and gentamicin significantly reduced mortality in hospitalized children (odds ratio, OR: 4.0; 95% confidence interval, CI: 1.7-9.8; 1 before-and-after study). Oral chloramphenicol was as effective as trimethoprim-sulfamethoxazole in children with pneumonia (1 RCT). Pharmacokinetic data suggest that normal doses of penicillins, cotrimoxazole and gentamicin are safe in malnourished children, while the dose or frequency of chloramphenicol requires adjustment. Existing evidence is not strong enough to further clarify recommendations for antibiotic treatment in children with SAM. CONCLUSION: Large RCTs are needed to define optimal antibiotic treatment in children with SAM with and without complications. Further research into gentamicin and chloramphenicol toxicity and into the pharmacokinetics of ceftriaxone and ciprofloxacin is also required.
Uncovering high rates of unsafe injection equipment reuse in rural Cameroon: Validation of a survey instrument that probes for specific misconceptions.
Harm Reduction Journal. 2011 Feb 7; 8(4):1-9.Background: Unsafe reuse of injection equipment in hospitals is an on-going threat to patient safety in many parts of Africa. The extent of this problem is difficult to measure. Standard WHO injection safety assessment protocols used in the 2003 national injection safety assessment in Cameroon are problematic because health workers often behave differently under the observation of visitors. The main objective of this study is to assess the extent of unsafe injection equipment reuse and potential for blood-borne virus transmission in Cameroon. This can be done by probing for misconceptions about injection safety that explain reuse without sterilization. These misconceptions concern useless precautions against cross-contamination, i.e. "indirect reuse" of injection equipment. To investigate whether a shortage of supply explains unsafe reuse, we compared our survey data against records of purchases. Methods: All health workers at public hospitals in two health districts in the Northwest Province of Cameroon were interviewed about their own injection practices. Injection equipment supply purchase records documented for January to December 2009 were compared with self-reported rates of syringe reuse. The number of HIV, HBV and HCV infections that result from unsafe medical injections in these health districts is estimated from the frequency of unsafe reuse, the number of injections performed, the probability that reused injection equipment had just been used on an infected patient, the size of the susceptible population, and the transmission efficiency of each virus in an injection. Results: Injection equipment reuse occurs commonly in the Northwest Province of Cameroon, practiced by 44% of health workers at public hospitals. Self-reported rates of syringe reuse only partly explained by records on injection equipment supplied to these hospitals, showing a shortage of syringes where syringes are reused. Injection safety interventions could prevent an estimated 14-336 HIV infections, 248-661 HBV infections and 7-114 HCV infections each year in these health districts. Conclusions: Injection safety assessments that probe for indirect reuse may be more effective than observational assessments. The auto-disable syringe may be an appropriate solution to injection safety problems in some hospitals in Cameroon. Advocacy for injection safety interventions should be a public health priority.
Male circumcision: towards a World Health Organisation normative practice in resource limited settings.
Asian Journal of Andrology. 2010; 12(5):628-638.There is now grade 1 evidence that male circumcision (MC) reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with high HIV prevalence. Several African countries are now scaling up public health MC programmes. The most effective immediate public health MC programmes in Africa will need to target 18-20 years old men. In the longer term there is a need for infant circumcision programmes. In order to implement more widespread MC there is a need to make the surgical procedures as simple as possible so that safe operations can be performed by paramedical staff. The WHO Manual of Male Circumcision under local anaesthetic was written with these objectives in mind. Included in the manual are three adult techniques and four paediatric procedures. The adult procedures are the dorsal slit, the forceps guided and the sleeve resection methods. Paediatric methods included are the plastibell technique, the Mogen and Gomco shield method and a standard surgical dorsal slit procedure. Each method is described in a step by step manner with photographic and line drawing illustrations. In addition to the WHO manual of surgical technique a teaching course has been developed and using this course it has been possible in one week to train a circumcision surgeon who has had no or minimal previous surgical experience. Further scaling will require training of circumcision surgeons, monitoring performance, training the trainer workshops as well as advocacy at national, international and government meetings. In addition to proceeding with standardised methods work is in progress to assess novel techniques in adults such as stay on ring devices and policies are being formulated as to how to assess new devices. Also work is in progress to explore efficiencies in surgical processing by task sharing. Proper informed consent and safety remain paramount and great care has to be taken as programmes in Africa scale up. In continental China where the HIV epidemic is at a much earlier stage there may be a case for considering infant circumcision but great care will be needed to ensure that there is no harm.
Current Opinion In HIV and AIDS. 2010 Jan; 5(1):38-47.PURPOSE OF REVIEW: Access to first-line antiretroviral therapy in resource-limited settings has increased rapidly in the last 5 years. Newer medicines with greater potency and better safety profiles open the possibility for improving first-line antiretroviral therapy for developing countries. RECENT FINDINGS: Several medicines offer the potential to improve the simplicity, safety and efficacy of first-line antiretroviral therapy in resource-limited settings. These include tenofovir, raltegravir, elvitegravir, rilpivirine and protease inhibitors. A number of clinical questions are outstanding, particularly regarding safety in pregnancy and compatibility with drugs to treat common coinfections including tuberculosis. SUMMARY: Simple, affordable regimens were key to the initial emergency response, but the long-term response to HIV calls for a reconsideration of current treatment options. Preconditions for widespread use in developing countries include affordability, simplicity and answers to relevant research questions. In the absence of strong pharmacovigilance systems, cohort monitoring will be critical to assessing the safety profile of new drugs in such settings.