WHO South-East Asia journal of public health最新文献

Migrant health has been the subject of various international agreements in recent years. In parallel, there has been a growth in academic research in this area. However, this increase in focus at international level has not necessarily strengthened the capacity to drive evidence-informed national policy and action in many low- and middle-income countries. The Migration Health South Asia (MiHSA) network aims to challenge some of the barriers to progress in the region. Examples include the bias towards institutions in high-income countries for research funding and agenda-setting and the overall lack of policy-focused research in the region. MiHSA will engage researchers, funders and policy-makers in collectively identifying the most pressing, yet feasible, research questions that could help strengthen migrant and refugee health relevant to the region's national contexts. In addition, policies and provisions for different migrant populations in the region will be reviewed from the health and rights perspectives, to identify opportunities to strategically align research agendas with the questions being asked by policy-makers. The convergence of migration policy with other areas such as health and labour at global level has created a growing imperative for policy-makers in the region to engage in cross-sector dialogue to align priorities and coordinate responses. Such responses must go beyond narrow public health interventions and embrace rights-based approaches to address the complex patterns of migration in the region, as well as migrants' precarity, vulnerabilities and agency.

Background: The Early Warning and Response System (EWARS) is Indonesia's national syndromic and early warning surveillance system for the rapid detection of infectious diseases and outbreaks. We evaluated EWARS in the remote West Papua province of Indonesia.

Methods: Structured telephone interviews were conducted with 11 key informants from West Papuan health services. EWARS data were analysed for usefulness of reporting.

Results: Most respondents reported that EWARS is important and useful in improving early detection of outbreaks. The system has led to increased disease control coordination among health jurisdictional levels in the province. However, respondents noted that the limited number of districts involved in the system affected representativeness, and some stated that only about 30-35% of districts in each regency were involved and trained in EWARS reporting, partly owing to lack of a mobile telephone network. Barriers to complete reporting and response to alerts included limited human and funding resources for surveillance, lack of epidemiological training, and technical limitations imposed by limited internet and mobile communication infrastructure in this remote region.

Conclusion: Great progress has been made in integrating West Papua into a nationally consistent disease and outbreak detection system. Strategies for addressing barriers resulting from remoteness, constrained human, funding and laboratory resources, lack of training, and limited internet and communications infrastructure are needed if EWARS in West Papua is to advance.

Background: Chiang Rai province in northern Thailand is a site of many people travelling among nearby countries and areas, including Yunnan province, China. In February 2020, there was concern about the population's vulnerability to coronavirus disease 2019 (COVID-19).

Methods: A cross-sectional study was conducted in 15 villages less than 10 km from a border. A questionnaire was developed and tested for reliability and validity; 48 questions covered participant characteristics, plus knowledge about, attitudes to and preparedness for COVID-19. Chi-squared tests were used to detect any significant association between variables. Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of various factors with participants' level of reported knowledge, attitudes and preparedness.

Results: A total of 520 participants were recruited of whom 320 (61.5%) were women. The age range was 18-90 years; the average age was 45.2 years. Variables with an association with good to moderate preparedness for COVID-19 prevention and control that remained after adjustment were: women were better prepared than men (adjusted odds ratio (OR_adj) = 2.52; 95% CI = 1.36-4.68); those aged 18-30 years (OR_adj = 4.26; 95% CI = 1.18-15.30), 31-45 years (OR_adj = 4.60; 95% CI = 1.59-13.32) or 46-60 years (OR_adj = 2.69; 95% CI = 1.16-6.26) were better prepared than those aged 60-90 years; and, compared with those with no formal education, those educated to primary school level (OR_adj = 2.43; 95% CI = 1.09-5.43) or to university level (OR_adj = 3.18; 95% CI = 1.06-9.51) were better prepared.

Conclusion: Effective communication of essential, accurate and up-to-date information regarding COVID-19 prevention and control is essential in this population - especially for men, older age groups and those lacking formal education.

Emergency preparedness is a continuous process in which risk and vulnerability assessments, planning and implementation, funding, partnerships and political commitment at all levels must be sustained and acted upon. It relates to health systems strengthening, disaster risk reduction and operational readiness to respond to emergencies. Strategic interventions to strengthen the capacities of countries in the World Health Organization (WHO) South-East Asia Region for emergency preparedness and response began in 2005. Efforts accelerated from 2014 when emergency risk management was identified as one of the regional flagship priority programmes following the pragmatic approach "sustain, accelerate and innovate". Despite increased attention and some progress on risk management, the existing capacities to respond to health emergencies are inadequate in the face of prevailing and increasing threats posed by multiple hazards, including climate change and emerging and re-emerging diseases. The setting up of a "preparedness stream" under the South-East Asia Regional Health Emergency Fund in July 2016 was an important milestone. The endorsement of the Five-year regional strategic plan to strengthen public health preparedness and response - 2019-2023 by Member States was another step forward. Furthermore, ministerial-level commitment, in the form of the Delhi Declaration on Emergency Preparedness, adopted in September 2019 in the 72nd session of the WHO Regional Committee for South-East Asia, is in place to facilitate Member States to invest resources in the protection and safety of people and systems and in overall emergency risk management through national action plans for health security. It is essential now to turn these commitments into actions to strengthen emergency preparedness in countries of the region.

The Asia-Pacific region is vulnerable to a wide range of emergencies and natural disasters that are becoming more frequent because of seismic activity, climate change and changes in human development. For the rural poor in low-income settings, animals are valued beyond their financial worth as a fundamental part of human existence and livelihoods. Despite this recognition, animals are rarely included in national disaster plans and investments, and their needs are rarely factored into relief operations. Any natural disaster has short-term and long-term consequences that affect animals along with humans. For example, post-disaster community rehabilitation programmes may be strengthened by factors such as compensation for livestock losses. Emergency and disaster preparedness, response and recovery planning should follow the One Health approach by considering animal welfare, including rehabilitation and economic recovery.

Basic packages of health services (BPHSs) are often envisaged primarily as political statements of intent to provide access to care, in an era of commitment to universal health coverage. They are often produced with little attention paid to health systems' capacity to deliver these benefit packages or other implementation challenges. Many countries of the World Health Organization (WHO) South-East Asia Region have invested in developing BPHSs. This perspective paper reflects on the issues that do not receive enough attention when packages are developed, which can often jeopardize their implementation. Countries of the region refer to burden-of-disease assessments and consider the cost-effectiveness of the listed interventions during their BPHS design processes. Some also conduct a costing study to generate "price tags" that are used for resource mobilization. However, important implementation challenges such as weak supply-side readiness, limited scope for reallocation of existing resources and management not geared for accountability are too often ignored. Implementation and its monitoring is further hampered by the limitations of existing health information systems, which are often not ready to collect and analyse data on emerging interventions such as noncommunicable disease management. Among the countries of the WHO South-East Asia Region, those with better chances of executing their BPHSs have adapted their packages to their implementation, financing and monitoring capacities, and have considered the need for a modified service delivery model able to provide the agreed services.

Background: Influenza causes seasonal outbreaks each year and periodically causes a pandemic. The World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS) has contributed to global understanding of influenza patterns, but limited regional analysis has occurred. This study describes the virological patterns and influenza surveillance systems in the 11 countries of the WHO South-East Asia Region.

Methods: Virological data were extracted in January 2018 from FluNet, GISRS's web-based reporting tool, for 10 of the 11 countries that had data available for the years 2009 to 2017. Descriptive data for 2017 on influenza surveillance systems, including the number of sentinel sites, case definitions and reporting frequency, were collected through an annual questionnaire.

Results: Data on surveillance systems were available for all 11 Member States, and 10 countries reported virological data to FluNet between 2009 and 2017. Influenza surveillance in the region and national participation increased over the 8 years. Seasons varied between countries, with some experiencing two peak seasons and others having one main predominant season. Bangladesh, Indonesia and Myanmar have only one season: Bangladesh and Myanmar have a mid-year pattern and Indonesia an end-year pattern. Influenza A was the predominant circulating type for all years except 2012 and 2016, when A and B co-circulated. Influenza A(H1N1)pdm09 was dominant in 2009 and 2010 (77% and 76%, respectively), 2015 (72%) and 2017 (54%); influenza A(H3) accounted for approximately half of the positive specimens in 2011 (46%), 2013 (51%) and 2014 (47%); and influenza B (lineage not determined) made up over 49% of positive specimens in 2012.

Conclusion: Although the timings of peaks varied from country to country, the viruses circulating within the region were similar. Influenza surveillance remains a challenge in the region. However, timely reporting and regional sharing of information about influenza may help countries that have later peaks to allow them to prepare for the potential severity and burden associated with prevailing strains.

Background: Drought is an extreme weather event. Drought-related health effects can increase demands on hospitals while restricting their functional capacity. In July 2017, Sri Lanka had been experiencing prolonged drought for around a year and data on the resilience of hospitals were required.

Methods: A cross-sectional survey was done in five of the most drought-affected and vulnerable districts using two specially developed questionnaires. Ninety hospitals were assessed using the Baseline Hospital Drought Resilience Assessment (BHDRA) tool, of which 24 purposefully selected hospitals were also assessed using the more detailed Comprehensive Hospital Drought Resilience Assessment (CHDRA) tool and observation visits.

Results: Of the hospitals assessed, 73 and 77 reported having adequate supplies of drinking and non-drinking water, respectively. Of the 24 hospitals studied using the CHDRA tool, bacteriological water quality testing was done in 8, with samples from only 4 hospitals being satisfactory. Adequate electricity supply was reported by 77 hospitals, of which 72 had at least one generator. None of the hospitals used rainwater or storm water harvesting, water recycling, or solar or wind power. Of the 24 hospitals selected for detailed analysis, awareness materials on safeguarding water or electricity and avoiding wasting water or electricity were displayed in only 6 hospitals; disaster preparedness plans were available in 9; and drought was considered as a hazard only in 6.

Conclusion: The findings indicate that drought needs to be considered as an important hazard in hospital risk assessments. Drought preparedness, response and recovery should be embedded in hospital disaster preparedness plans to ensure the continuity of essential health services during emergencies.

One Health refers to the collaborative efforts of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and our environment. The One Health approach is increasingly popular in the context of growing threats from emerging zoonoses, antimicrobial resistance and climate change. The Food and Agriculture Organization of the United Nations, World Organisation for Animal Health and World Health Organization have been working together in the wake of the avian influenza crisis in the Asia-Pacific region to provide strong leadership to endorse the One Health concept and promote interagency and intersectoral collaboration. The programme on highly pathogenic emerging diseases in Asia (2009-2014) led to the establishment of a regional tripartite coordination mechanism in the Asia-Pacific region to support collaboration between the animal and human health sectors. The remit of this mechanism has expanded to include other priority One Health challenges, such as antimicrobial resistance and food safety. The mechanism has helped to organize eight Asia-Pacific workshops on multisectoral collaboration for the prevention and control of zoonoses since 2010, facilitating advocacy and operationalization of One Health at regional and country levels. The tripartite group and international partners have developed several One Health tools, which are useful for operationalization of One Health at the country level. Member States are encouraged to develop a One Health strategic framework taking into account the country's context and priorities.

The World Health Organization (WHO) emergency medical team (EMT) mentorship and verification process is an important mechanism for providing quality assurance for EMTs that are deployed internationally during medical emergencies. To be recommended for classification, an organization must demonstrate compliance with guiding principles and core standards for international EMTs and all technical standards for their declared type, in accordance with a set of globally agreed minimum standards. A rigorous peer review of a comprehensive documentary evidence package, combined with a 2-day verification site visit by WHO and independent experts, is conducted to assess an EMT's capacity. Key requirements include having sufficient systems, equipment and procedures in place to ensure an EMT can deploy rapidly, providing clinical care according to internationally accepted standards, being able to be fully self-sufficient for a period of 14 days and being able to fully integrate into the emergency response coordination structure and the health system of the country affected during deployment. Through the WHO mentorship programme, each EMT is provided with a mentor team, which guides and supports it during the preparatory process. The process typically takes around 1 to 2 years to complete. The Thailand EMT is the first team from the WHO South-East Asia Region to successfully complete the WHO mentorship and verification process. The experience of this process in Thailand can serve as an example for other countries in the South-East Asia Region and encourage them to strengthen their emergency preparedness and operational readiness by getting their national EMTs verified.