Bulletin of the World Health Organization最新文献

[This corrects the article on p. 650 in vol. 102, PMID: 39219771.].

Food insecurity and malnutrition are rising worldwide due to disruptions in food systems related to interconnected health-, climate- and conflict-related crises. Although governments globally are committed to addressing nutritional challenges, policy responses have increasingly focused on food security and, particularly, on food affordability. However, these short-term measures often overlook the necessity of integrating nutritious foods into the food system to ensure improved long-term nutrition. By drawing on the United Nations Committee on World Food Security's Voluntary guidelines on food systems and nutrition, this article outlines opportunities for policy-makers to integrate nutrition into key elements of the crisis response. Key policy areas where nutrition could be further integrated include social protection, agricultural investment, trade policy and urban planning. Strengthening the focus of nutrition in these measures will be essential to establish long-term incentives that support food systems transformation for improved nutrition. Drawing on theories of the policy process, I propose that stronger governance and cross-sectoral dialogue will be critical to achieve sustained nutritional outcomes. Health policy-makers can play a leadership role in supporting cross-sectoral policy change by carefully framing the policy issues, advocating for institutional structures that promote collaboration across sectors to prioritize nutrition, and strengthening the management of conflicts of interest in food system policy-making.

Objective: To investigate the relationship between the Responsible Parenthood and Reproductive Health Law in the Philippines and women's unmet needs for contraception.

Methods: The study involved data on women aged 18 to 49 years from the 2013 (n = 14 053), 2017 (n = 21 835) and 2022 (n = 24 253) Philippine Demographic and Health Surveys. The Responsible Parenthood and Reproductive Health Law was enacted in 2012, but not fully implemented until 2017. Survey-weighted logistic regression was used to estimate the association between variables and an unmet need for contraception, and the probability that women in different wealth quintiles would have an unmet need.

Findings: We observed a persistent gap in unmet needs between women in the lowest and highest wealth quintiles in all years. In 2013, the odds of unmet needs for women in the lowest quintile compared with those in the highest were 1.288 (standard error (SE): 0.124); and in 2022, it was 1.287 (SE: 0.113). Nevertheless, the weighted proportion of women with unmet needs declined between 2013 and 2022; in the lowest wealth quintile, it fell from 18.4% to 10.6%. Moreover, the probability of having an unmet need declined across all wealth quintiles between 2013 and 2022; the largest decline was from 0.146 (95% confidence interval, CI: 0.131-0.162) to 0.088 (95% CI: 0.079-0.098) in the lowest quintile.

Conclusion: The unmet needs for contraception declined substantially following implementation of a new reproductive health law. However, there was a persistent gap in unmet needs between the lowest and highest wealth quintiles.

Objective: To identify the barriers preventing manufacturers of similar biotherapeutic human insulin from submitting their products to the World Health Organization (WHO) for prequalification.

Methods: We used a self-administered questionnaire to collect data from companies producing similar biotherapeutic human insulin. We included questions about the insulin products manufactured, knowledge of WHO prequalification requirements, export of the products and compliance with good manufacturing practices. Companies had the possibility to provide additional relevant information. We sent the questionnaire to 20 manufacturers in total. We evaluated responses and organized the data into themes.

Results: We had a response rate of 55% (11/20 companies). Five broad themes emerged: (i) manufacturers and products; (ii) expressions of interest awareness and participation; (iii) need for technical assistance and training; (iv) market and supply chain challenges; and (v) approval for good manufacturing practices. The most important reasons for manufacturers' lack of response to WHO's expression-of-interest invitation were absence of a mechanism to guarantee return on investment, and perceived complexity of prequalification requirements for insulin-similar biotherapeutic products.

Conclusion: To encourage greater participation in the WHO prequalification programme, international procurement agencies associated with the programme should consider establishing a platform to enter into advance purchasing agreements with manufacturers. In addition, WHO's Local Production and Assistance Unit should provide companies with ongoing technical assistance on the development of their human insulin products and improvement of their production facilities to comply with the WHO requirements for good manufacturing practices.

The World Health Organization (WHO) plays an important role in developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE-Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations.

A toolkit for emergency care is being adapted for use across a wide range of countries and is having a significant impact on outcomes. Gary Humphreys reports.

Problem: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reliable, globally applicable recommendations for safe and continuous school operations were lacking.

Approach: In October 2020, the German Association of Scientific Medical Societies' task force for COVID-19 guidelines and public health researchers at Ludwig-Maximilians-Universität München initiated the rapid development of a living evidence- and consensus-based guideline to reduce severe acute respiratory syndrome coronavirus 2 transmission in schools. To facilitate transparent, structured and comprehensive decision-making with a whole-of-society perspective, they applied the WHO-INTEGRATE evidence-to-decision framework. This framework supported a broad, multisectoral composition of the guideline panel. The panel used newly synthesized evidence on nine school measures. Participating medical societies or the guideline secretariat completed evidence-to-decision tables. They also drafted recommendations for the guideline panel, who discussed and revised them during moderated consensus conferences.

Local setting: In Germany, each state is responsible for organizing schooling. The German Association of Scientific Medical Societies coordinates development of evidence- and consensus-based guidelines.

Relevant changes: The first version of the guideline was published in February 2021, and the guideline dissemination created much media attention. Of the 16 state education ministries, almost all knew about the guideline, nine recognized it as a relevant source of information and five used it to check existing directives.

Lessons learnt: The WHO-INTEGRATE framework facilitated a comprehensive assessment of school measures from the start of guideline development, considering the broad societal impact of the measures. Using the framework in rapid mode was feasible, but it fell short of its potential.

Problem: The Malaita and Western provinces in Solomon Islands had low routine immunization coverage due to disruptions in health services caused by the coronavirus disease 2019 pandemic in early 2022.

Approach: The country introduced the World Health Organization (WHO) Reaching Every District (RED) approach in 2002. Between July and September 2022, we strengthened supportive supervision, monitoring and use of data for decision-making, especially for microplanning and re-establishing outreach to prioritized areas. Health workers were supported to identify key concerns and develop strategies to improve performance. Monthly updates of reported immunization coverage, reporting completeness and fieldwork findings were widely disseminated.

Local setting: Solomon Islands' population is 748 606 people, of whom 165 345 reside in Malaita and 105 367 in Western Province.

Relevant changes: In Malaita Province, reported coverage of third dose of pentavalent vaccine and first dose of measles-rubella vaccine increased from 40% (757/1892) of eligible children to 121% (1144/946) and from 30% (568/1892) to 159% (1504/946), respectively; and in Western Province reported coverage increased from 38% (443/1165) to 191% (1113/583) and from 44% (513/1165) to 149% (868/583), respectively. Reported coverage for the remaining provinces increased from 64% (3380/5282) to 88% (2325/2641) and from 59% (3116/5282) to 137% (3619/2641), respectively. These findings led the programme on immunization to re-expand the WHO RED approach nationwide.

Lessons learnt: Supportive supervision, systematic monitoring and use of data for decision-making helped restoring reported immunization coverage in two low-coverage provinces. However, sustaining these results at a national level is necessary. The WHO RED approach remains relevant, even during a pandemic.