Bulletin of the World Health Organization最新文献

Problem: Water, sanitation and waste infrastructure and services in Ukrainian health-care facilities often fail to meet global and national standards, hindering the provision of safe, quality care. The war has worsened existing problems.

Approach: To incrementally improve water, sanitation, hand hygiene, environmental cleaning and health-care waste practices, the World Health Organization (WHO) is working with the health ministry, the Ukrainian Public Health Centre and regional United States Centers for Disease Prevention and Control (CDC) to implement the Water and Sanitation for Health Facility Improvement Tool (WASH FIT). In December 2022, WHO trained staff from the regional CDC, Ukrainian Public Health Centre and nine priority health-care facilities. Facility teams assessed services, and developed and implemented improvement plans in January 2023. Follow-up assessments were conducted after six months.

Local setting: About 4300 health-care facilities operate in Ukraine. Funding for new water and sanitation infrastructure, as well as operating and maintaining existing services, is likely inadequate.

Relevant changes: After implementation, the average WASH FIT score increased from 66 out of a maximum of 100 (range: 57-73) to 83 (range: 69-93). Facilities more effectively managed water-related risks, replaced broken taps, improved waste management practices and installed backup water supply and storage sources.

Lessons learnt: WASH FIT can be used to identify gaps in water, sanitation, hygiene and waste services and track progress towards addressing these gaps. Engaged local leaders, health-based national water, sanitation, hygiene standards, regular on-site training and mentoring drive these improvements. Strengthening public health entities is critical to institutionalize the process.

Noncommunicable diseases are the leading cause of death and disability globally, with suboptimal diet being a significant risk factor. Fiscal policies that promote nutritious foods have been identified as part of a best-practice package of interventions and are a focus for governments in the current context of rising food prices. Price controls are a strategy that governments commonly apply to limit mark-up on prices of specific foods, with the aim of protecting consumers and promoting food security. To date, which specific foods are being placed under price controls is unclear. This paper aimed to provide an overview of the use of food price controls in 10 Member States of the World Health Organization South-East Asia and Western Pacific regions, which have price controls on specific food commodities. The types of foods and beverages under price controls differed considerably. Many of these foods and beverages (for example, sugar-sweetened beverages and instant noodles) were not aligned with global recommendations for healthy diets and the prevention of noncommunicable diseases. Price controls are being implemented by government agencies for finance or commerce, which are generally separate from the agencies overseeing the prevention of noncommunicable diseases. Therefore, an opportunity exists for policy-makers to strengthen policy coherence of price controls on food and the prevention of diet-related noncommunicable diseases.

Access to essential medicines is still suboptimal in many countries. Recent studies examining the registration of medicines at the country level show that a considerable proportion of essential medicines do not have any corresponding products registered for use at the country level and therefore cannot be available at all times. Conversely, many non-essential medicines are registered by regulatory authorities for local markets, potentially facilitating inappropriate drug use and antimicrobial resistance. Addressing this public health gap requires linking the data on national drug registers with national essential medicines lists. Achieving this linkage will necessitate the development of common data variables and standards for both drug registers and essential medicines lists. This linkage would provide medicines regulators and health policy-makers with information on the gaps in the registration of essential medicines and allow them to take steps to prioritize registration of these medicines. This approach would improve availability of essential medicines for public health priorities and prevent over-registration of unnecessary medicines.

Objective: To investigate the associations between sexual health dimensions, and overall health and well-being.

Methods: In February 2024, we systematically searched Scopus, PsyArticles, PsycINFO®, PubMed®, Web of Science and LILACS for articles reporting on associations between sexual health, health and well-being indicators. We applied no language restrictions and followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To assess the risk of bias in the included studies, we used the Risk Of Bias In Non-randomized Studies - of Exposures tool.

Findings: Of 23 930 unique titles identified, 63 studies met the inclusion criteria. We grouped the results into two categories: (i) sexual and physical health; and (ii) sexual and psychological health. The results consistently showed strong correlations between sexual health, overall health and well-being. Almost all studies found significant associations between positive sexual health indicators and lower depression and anxiety, higher quality of life, and greater life satisfaction among men and women, including older adults, pregnant women, and same-sex and mixed-sex couples.

Conclusion: Findings indicate that emphasizing a positive perspective on sexual health and highlighting its benefits should be regarded as an important component of the effort to improve overall health and well-being for everyone.

Considerable investment has been made in recent years to address sexual exploitation, abuse and harassment by aid workers in the humanitarian sector. However, such sexual misconduct remains a persistent, complex challenge with wide-ranging impacts, including on sexual health, for individuals and communities hosting humanitarian responses. This article considers the state of research regarding sexual exploitation, abuse and harassment in humanitarian contexts, and identifies gaps in the evidence base necessary for reinforcing prevention and response efforts. We first report what we know about sexual exploitation, abuse and harassment, including its impacts on sexual health, risk factors and the permissive enabling organizational cultures. We then identify several critical knowledge gaps that must be addressed for more effective future strategies and approaches to prevent and respond to sexual exploitation, abuse and harassment. We discuss system-wide knowledge gaps, such as lack of evidence on programming approaches and effectiveness of prevention and accountability mechanisms. We explore potential options that health-care programming provides for preventing and responding to sexual exploitation, abuse and harassment. We also describe population-level knowledge gaps, including in patterns of perpetration and specific challenges faced by marginalized groups. We conclude with reflections for a future integrated research and policy agenda.

Objective: To evaluate the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania.

Methods: The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application (app) in addition to standard HIV pre-exposure prophylaxis (intervention arm), and 313 from Tanga who received pre-exposure prophylaxis alone (control arm). Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, we conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting.

Findings: Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% (130/470) of participants in the intervention arm and 20.1% (63/313) in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm (risk difference: 11.8 percentage points; 95% confidence interval: 5.3-18.3).

Conclusion: Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.