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Levels and trends in child malnutrition. UNICEF/ WHO / World Bank Group joint child malnutrition estimates: key findings of the 2017 edition.
New York, New York, UNICEF, 2017. 16 p.The inter-agency team released new joint estimates for child stunting, overweight, underweight, wasting and severe wasting (May 2017 edition) using the same methodology as in previous years. These new estimates supersede former analyses results published by UNICEF, WHO and the World Bank Group. Given that country data are at maximum available from surveys conducted in the year previous to when the modelling exercise takes place, in 2017 the joint estimates were derived up to 2016 with extrapolation for stunting until 2025.
New York, New York, UNICEF, 2017 Mar. 80 p.Climate change is one of many forces contributing to an unfolding water crisis. In the coming years, the demand for water will increase as food production grows, populations grow and move, industries develop and consumption increases. This can lead to water stress, as increasing demand and use of water strain available supplies. One of the most effective ways to protect children in the face of climate change is to safeguard their access to safe water and sanitation. This report shares a series of solutions, policy responses and case studies from UNICEF’s work around the world.
New York, New York, UNICEF, 2017 May. 64 p.Among the millions of children on the move worldwide, many – including hundreds of thousands of unaccompanied children and adolescents – undertake dangerous journeys. This report shows how the lack of safe and legal pathways for refugee and migrant children feeds a booming market for human smuggling and puts them at risk of violence, abuse and exploitation. Building on recent UNICEF policy proposals, it sets out ways that governments can better protect these vulnerable children.
New York, New York, UNICEF, 2017 Jul. 32 p.This report provides compelling new evidence that backs up an unconventional prediction UNICEF made in 2010: The higher cost of reaching the poorest children with life-saving, high-impact health interventions would be outweighed by greater results. This new study combines modelling and data from 51 countries. The results indicate that the number of lives saved by investing in the most deprived is almost twice as high as the number saved by equivalent investment in less deprived groups.
[New York, New York], UNICEF, 2017 May. 20 p.As part of a series highlighting the challenges faced by children in current crisis situations, this UNICEF Child Alert examines the impact of the reforms, economic growth and national reconciliation process in Myanmar. It also looks at the investments in children’s health, education and protection that Myanmar is making, and shows how children in remote, conflict-affected parts of the country have yet to benefit from them.
The state of food security and nutrition in the world 2017: building resilience for peace and food security.
Rome, Italy, FAO, 2017. 133 p.This report has been jointly published by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP) and the World Health Organization (WHO). The 2017 edition marks the beginning of a new era in monitoring efforts to achieve a world without hunger and malnutrition within the framework of the Sustainable Development Goals (SDGs). The report will henceforth monitor progress towards the targets on both ending hunger (SDG Target 2.1) and ending all forms of malnutrition (SDG Target 2.2). It will also include analyses of how food security and nutrition are related to progress on other SDG targets.
New York, New York, UNICEF, 2017 Sep. 92 p.This report presents data and outlines best practices and policies that can put governments on the path to providing every child with the best start in life. It outlines the neuroscience of early childhood development (ECD), including the importance of nutrition, protection and stimulation in the early years. And it makes the case for scaling up investment, evaluation and monitoring in ECD programmes. The report concludes with a six-point call to action for governments and their partners to help maximize the potential of the children who will build the future – by making the most of the unparalleled opportunities offered by the early moments in life.
An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011.
Human Resources For Health. 2017 Jan 26; 15(1):9.BACKGROUND: An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (<2.5 health workers per 1000 population) and have a high HIV burden (HIV prevalence 5.6 with 15.2% in Nyanza province). We set out to determine the optimum number of clinicians required to provide quality consultancy HIV care services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, JOOTRH, HIV Clinic, the premier HIV clinic in Nyanza province with a cumulative client enrolment of PLHIV of over 20,000 persons. CASE PRESENTATION: The World Health's Organization's Workload Indicators of Staffing Needs (WISN) was used to compute the staffing needs and sufficiency of staffing needs at the JOOTRH HIV clinic in Kisumu, Kenya, between January and December 2011. All people living with HIV (PLHIV) who received HIV care services at the HIV clinic at JOOTRH and all the clinicians attending to them were included in this analysis. The actual staffing was divided by the optimal staff requirement to give ratios of staffing excesses or shortages. A ratio of 1.0 indicated optimal staffing, less than 1.0 indicated suboptimal staffing, and more than 1 indicated supra optimal staffing. The HIV clinic is served by 56 staff of various cadres. Clinicians (doctors and clinical officers) comprise approximately one fifth of this population (n = 12). All clinicians (excluding the clinic manager, who is engaged in administrative duties and supervisory roles that consumes approximately one third of his time) provide full-time consultancy services. To operate at maximum efficiency, the clinic therefore requires 19 clinicians. The clinic therefore operates with only 60% of its staffing requirements. CONCLUSIONS: Our assessment revealed a severe shortage of clinicians providing consultation services at the HIV clinic. Human resources managers should oversee the rational planning, training, retention, and management of human resources for health using the WISN which is an objective and reliable means of estimating staffing needs.
Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT.
PloS One. 2017; 12(5):e0178297.BACKGROUND: Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm). METHODS AND FINDINGS: 124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm. CONCLUSION: Our findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.
Introducing an accountability framework for polio eradication in Ethiopia: results from the first year of implementation 2014-2015.
Pan African Medical Journal. 2017; 27(Suppl 2):12.INTRODUCTION: the World Health Organization (WHO), Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in 2014 with the aim of improving the program's performance. Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework. METHODS: the impact of the WHO accountability framework was reviewed after its first year of implementation from June 2014 to June 2015. We analyzed selected program and staff performance indicators associated with acute flaccid paralysis (AFP) surveillance from a database available at WHO. Data on managerial actions taken were also reviewed. Performance of a total of 38 staff was evaluated during our review. RESULTS: our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts. CONCLUSION: the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance.
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.
Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group.
Vaccine. 2017 Oct 13; 35(43):5738-5750.From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs. Copyright (c) 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Pretreatment HIV-1 drug resistance in Argentina: results from a surveillance study performed according to WHO-proposed new methodology in 2014-15.
Journal of Antimicrobial Chemotherapy. 2017 Feb; 72(2):504-510.BACKGROUND: In Argentina, current national guidelines recommend starting with NNRTI-based regimens. Recently, there have been some local reports regarding concerning levels of NNRTI-transmitted resistance, but surveillance has never been carried out at a national level. OBJECTIVES: To determine the prevalence of HIV drug resistance in people starting ART in Argentina using a WHO-proposed methodology. METHODS: This was a cross-sectional, nationally representative study. Twenty-five antiretroviral-dispensing sites throughout the country were randomly chosen to enrol at least 330 persons starting ART, to generate a point prevalence estimate of resistance-associated mutations (RAMs) with a 5% CI (for the total population and for those without antiretroviral exposure). All consecutive patients older than 18 years starting or restarting ART in the chosen clinics were eligible. Samples were processed with Trugene and analysed using the Stanford algorithm. RESULTS: Between August 2014 and March 2015, we obtained 330 samples from people starting ART. The mean +/- SD age was 35 +/- 11 years, 63.4% were male, 16.6% had prior antiretroviral exposure and the median (IQR) CD4 count was 275 cells/mm3 (106-461). The prevalence of RAMs found was 14% (+/-4%) for the whole population (3% NRTI-RAMs; 11% NNRTI-RAMs and 2% PI-RAMs) and 13% (+/-4%) for those without prior antiretroviral exposure (3%, 10% and 2%, respectively). The most common mutation was K103N. CONCLUSIONS: This surveillance study showed concerning levels of HIV drug resistance in Argentina, especially to NNRTIs. Due to this finding, Argentina's Ministry of Health guidelines will change, recommending performing a resistance test for everyone before starting ART. If this is taken up properly, it also might function as a continuing surveillance tool. (c) The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: email@example.com.
Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016).
PloS One. 2017; 12(5):e0177338.BACKGROUND: Sub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa. METHODS: Cross-sectional data from the most recent Demographic and Health Surveys (2006-2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2. RESULTS: Stunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa. CONCLUSION: The prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.
Contraceptives and condoms for family planning and STI & HIV prevention external procurement support report.
New York, New York, United Nations Population Fund [UNFPA], 2014 Dec. 86 p.Access to reproductive health, including family planning, is recognized as a human right. Support from donors is critical to improving and ensuring the security of essential contraceptives and other life-saving reproductive health commodities. Contraceptives procured through external support constitute a significant contribution to reproductive health, including family planning and, through the dual protection provided by condoms, the prevention of sexually transmitted infections (STIs) including HIV. This report, updated annually, is a rich source of data for development that can drive good planning for contraceptive supply, advocacy and resource mobilization. The report contains dozens of figures, tables, and graphs, along with information and analysis that can influence policy dialogue, advocacy and interagency work. It aims to enhance coordination among donors, improve partnerships between donors and national governments, and mobilize the resources needed to accelerate progress towards universal access to sexual and reproductive health, and in particular to reduce the unmet need for family planning. The report also analyses data received from individual donors and partner organizations about the support they have provided directly to developing countries for the procurement of contraceptives and condoms.
The evaluation of comprehensive sexuality education programmes: a focus on the gender and empowerment outcomes.
New York, New York, UNFPA, 2015. 64 p.Repeated evaluations have demonstrated that comprehensive sexuality education does not foster earlier sexual debut or unsafe sexual activity. By contrast, programmes that teach only abstinence have not proved to be effective. Additionally, recent research demonstrates that gender norms are a “gateway factor” for a range of adolescent health outcomes. Comprehensive sexuality education curricula that emphasize critical thinking about gender and power – the empowerment approach – are far more effective than conventional “gender-blind” programmes at reducing rates of sexually transmitted infections (STIs) and unintended early pregnancy. These studies also indicate that young people who adopt more egalitarian attitudes about gender roles, compared to their peers, are more likely to delay sexual debut, use condoms and practise contraception. They are also less likely to be in relationships characterized by violence. This report, The Evaluation of Comprehensive Sexuality Education Programmes: A Focus on the Gender and Empowerment Outcomes, represents an important milestone in our understanding of advances in the field of comprehensive sexuality education evaluation. It offers an extensive review and analysis of a wide range of evaluation studies of different comprehensive sexuality education programmes, at different stages of development and from different contexts and setting across the globe. It enriches our knowledge of new methodologies, available questionnaires and instruments that can be applied in future assessments and evaluations, most particularly to measure the gender empowerment outcome of comprehensive sexuality education programmes. It addresses the adaptation of the methodology to various contexts and age-specific groups of young people and children. This report is co-sponsored by UNFPA, the United Nations Educational, Scientific and Cultural Organization, the World Health Organization and the International Planned Parenthood Federation.
New York, New York, UNFPA, 2015. 56 p.This report, the first such published by the United Nations Population Fund (UNFPA), looks at FGM through the lens of population dynamics and the demographic dividend, based on current evidence and data. It offers quantitative information that both supports evidence-based programming, and frames financial implications for Member States and international donors. Evidence to define the size of the target population and orient actions around areas of greatest impact is of high value in developing interventions and formulating policies. UNFPA remains strongly committed to engaging with Member States, civil society, UN agencies and all other stakeholders to accelerate the elimination of FGM worldwide. Protecting girls upholds their sexual and reproductive health and rights, and enables them to realize their full potential.
Geneva, Switzerland, World Health Organization [WHO], 2015. 44 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This technical brief is one in a series addressing four young key populations. It is intended for policy-makers, donors, service-planners, service-providers and community- led organizations. This brief aims to inform discussions about how best to provide services, programmes and support for young people who sell sex. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young people who sell sex; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of young people.
Geneva, Switzerland, World Health Organization [WHO], 2015. 40 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This technical brief is one in a series addressing four young key populations. It is intended for policy-makers, donors, service-planners, service-providers and community-led organizations. This brief aims to inform discussions about how best to provide health services, programmes and support for young MSM. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young MSM; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build to the strengths, competencies and capacities of young MSM.
Geneva, Switzerland, World Health Organization [WHO], 2015. 36 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This brief aims to inform discussions about how best to provide health services, programmes and support for young transgender people. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young transgender people; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of these young people.
Geneva, Switzerland, World Health Organization [WHO], 2015. 34 p.Key populations at higher risk of HIV include people who sell sex, men who have sex with men (MSM), transgender people and people who inject drugs. Young people who belong to one or more of these key populations – or who engage in activities associated with these populations – are made especially vulnerable to HIV by factors including widespread discrimination, stigma and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs. This brief aims to inform discussions about how best to provide health services, programmes and support for young people who inject drugs. It offers a concise account of current knowledge concerning the HIV risk and vulnerability of young people who inject drugs; the barriers and constraints they face to appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies and capacities of young people who inject drugs.
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.
Paris, France, UNESCO, 2015. 47 p.Comprehensive sexuality education (CSE) has attracted growing interest and attention over recent years. This is demonstrated and reinforced by increased political commitment globally and the development of expert guidance, standards, curricula and other tools to strengthen the implementation of CSE in practice. Across the world, there are a wide range of different approaches to delivering sexuality education; at this stage in the evolution of the field, it is timely to take stock of the evidence, practice and lessons learned to date. This report provides an overview of the status of CSE implementation and coverage on a global level, drawing on specific information about the status of CSE in 48 countries, generated through analysis of existing resources and studies. Best practice in terms of providing CSE continues to develop. The current report examines the evidence base for CSE and, through a series of case studies from every region, explores initiatives that are setting the standard and pioneering new practices in the delivery of CSE. It represents the first in a series of periodic reports that aims to monitor the global implementation of CSE. Comprehensive life skills-based sexuality education helps young people to gain the knowledge and skills to make conscious, healthy and respectful choices about relationships and sexuality.
New York, New York, UNFPA, 2016 Apr. 78 p.This training manual enables a journalist or other trainer to conduct a two- or three-day training workshop. The first part of the curriculum begins with training and group discussion about basic concepts and principles that will help participants develop a clear understanding of the meaning of the term ‘gender-based violence’. The programme continues with detailed information about the consequences of gender-based violence and the survivor support services needed. The trainer will also cover the causes and contributing factors, shining a light on prevention and how best to develop effective prevention strategies. The second part of the curriculum focuses on the ethical principles of reporting on gender-based violence, including what to do and what to avoid. It also includes tips for the journalists to consider during interviews and when to report on gender-based violence related issues.
Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions.
New York, New York, UNDP, 2016 Apr. 212 p.This publication provides guidance to programme designers, implementers, policymakers and decision-makers on how to meaningfully engage adolescents in the AIDS response and in broader health programming. It also demonstrates why adolescents and youth are critical in efforts to end the AIDS epidemic by 2030. The publication additionally highlights what steps should be taken to implement programmes and policies that improve adolescent health outcomes (including for HIV) at the national, regional and global levels.