Bulletin of the World Health Organization最新文献

Bacterial infections are still a main cause of death in children younger than 5 years, yet few age-appropriate antibiotic formulations exist, which limits treatment options and compromises quality of care. In 2023, the World Health Organization (WHO) published its first list of priority paediatric antibiotic formulations to guide research and development for age-appropriate antibiotic formulations. Both azithromycin and nitrofurantoin are on this list. Currently, no dispersible tablets are approved or available for these drugs and existing liquid forms are poorly palatable and/or contain excipients of safety concern. To support the development of age-appropriate formulations for these two antibiotics, we produced target product profiles using WHO's methods. For azithromycin, the optimum age-appropriate formulation and dose is scored 100 mg dispersible tablets or an orodispersible 50 mg multiparticulate formulation, with dispersible 50 mg tablets as the minimum requirement. For nitrofurantoin, the optimum age-appropriate formulation is an orodispersible multiparticulate formulation or scored dispersible tablets, with dispersible tablets as the minimum requirement. Based on the WHO recommended dosage of 4 mg/kg per day for children for nitrofurantoin, the optimum unit dose is 5 mg. If scoring is feasible, a 10 mg unit dose should be developed for dosing flexibility across paediatric age groups. These profiles aim to support regulatory authorities, pharmaceutical developers, health programmes and other stakeholders in advancing safer, effective and child-appropriate antibiotic formulations.

Objective: To validate a crowdsourced, image-based morbidity hotspot method for surveillance of neglected tropical diseases.

Methods: We conducted our crowdsourced surveillance pilot implementation study between November 2022 and October 2024 in 45 communities across three Nigerian states, covering a population of 477 138 people. Three additional states, where the project was not implemented but surveillance data obtained, served as control. Residents self-reported suspected symptoms by using smartphones to capture and transmit images of skin and eye manifestations via digital communication platforms. An expert panel then examined the images to confirm signs of neglected tropical diseases. We used frequency and percentages to present data; we also compared incidence data from both pilot and control locations.

Findings: In total, 512 subjects submitted images, either themselves or via a community focal point. Their mean age was 53  years (standard deviation: 20.7). Forty-six percent (234/512) were women and 55% (281/512) were farmers. Notably, 43% (218/512) had experienced symptoms of neglected tropical diseases for 1-5 years before our study and 85% (437/512) had not received any intervention. Of all photos submitted, 75% (386/512) showed signs of neglected tropical diseases. In Ondo state crowdsourced surveillance led to an average of 54.3 monthly reports, versus traditional surveillance which averaged 6.8 (P < 0.01). Cost analysis showed that crowdsourced surveillance cost 72.4 United States dollars per case detected.

Conclusion: Our surveillance method outperformed traditional surveillance, showing its promise for enhancing neglected tropical disease surveillance. The method's ability to detect emerging conditions and support post-elimination surveillance reinforces its value.

The widespread use of traditional, complementary and integrative medicines (traditional medicine) across the world suggests that integration of traditional medicine into the formal health system is one strategy for extending universal health coverage (UHC). To improve access to and the quality of traditional medicine services will require attention to strengthening the traditional medicine workforce. The challenges associated with making such improvements should not be underestimated due to the many different practices, service delivery models and education systems for traditional medicine, as well as relevant policy and governance frameworks. Countries have adopted varying strategies to integrate traditional medicine into health systems to date. We consider how to strengthen and build capacity of the traditional medicine workforce so it might better contribute to the UHC agenda. We examine key issues and challenges for traditional medicine, and suggest analytical models for understanding the complexity inherent to integration of traditional medicine and making sense of different components of the traditional medicine workforce.

Objective: To evaluate the use of antivenom therapy in Bothrops envenomation in the Region of the Americas and to synthesize data on treatment outcomes, adverse reactions and long-term sequelae.

Methods: We systematically searched Web of Science, Scopus, Lilacs, PubMed® and Google Scholar for studies published up to 5 May 2025 that reported on the effects of antivenom treatment in humans bitten by Bothrops species in the Region of the Americas. We extracted data on patient demographics, adverse reactions, clinical complications and long-term sequelae following antivenom therapy.

Findings: Of 2060 articles identified, 38 met the inclusion criteria. Bothrops envenomations occurred more frequently in men (75.2%; 3247/4320 individuals), predominantly affected the lower limbs (76.5%; 2494/3295) and typically resulted in moderate-grade envenoming (44.6%; 1553/3483 individuals). We found that adverse reactions to antivenom therapy were common: 19.6% (589/2998) experienced early reactions and 1.6% (16/992) delayed reactions, although incidence declined in recent years. Individuals experienced clinical complications, such as severe oedema (23.2%; 239/1032), secondary infections (22.8%; 452/1985) and coagulopathies (20.7%; 357/1724). Some patients also experienced permanent sequelae, though these complications were relatively infrequent (3.3%; 50/1512). For studies reporting on deaths, 0.8% (23/3035) of patients died.

Conclusion: Antivenom therapy remains central to the management of Bothrops envenomation. However, challenges persist in treatment outcomes and long-term sequelae. Addressing these challenges requires ongoing research to strengthen antivenom manufacturing, explore adjunct therapies and improve post-envenomation care. Substantial heterogeneity study methods and reported outcomes, precluded the ability to conduct pooled analyses and generalize findings.

Performing caesarean sections without medical need exposes women and babies to unnecessary risks without clear benefits. Yet the global number of caesarean sections has continued to rise considerably over the years, with caesarean sections increasingly performed before the onset of labour and among women at low risk of birth complications. In recent years, considerable efforts have been made to reduce unnecessary caesarean sections. However, interventions that aim to reduce such births are complex, have mixed outcomes, do not translate well between settings and lack clear evidence on which components or mechanisms drive success. In this article, we outline a three-step pathway for implementing interventions that aim to optimize caesarean use: (i) conduct formative research to identify context-specific needs and priorities; (ii) design evidence-based, multifaceted interventions; and (iii) ensure implementation through meaningful stakeholder engagement. Finally, we emphasize how improving the quality of care during childbirth is key to achieving optimal and equitable use of caesarean sections.

An understanding of the population-level data available on the use of traditional, complementary and integrative medicine is critical for reducing unmet health needs and improving health outcomes. Although research has shown that the existence of unmet health-care needs among people receiving conventional health care can drive the use of traditional medicine, the motivations for its use are complex and often related to cultural traditions, personal preferences and perceptions of effectiveness. At present, only limited population-based data are available on who uses traditional medicine, the reasons for its use, the context in which it is used (even when traditional medicine is a primary choice) and the outcomes of treatment. To address this data gap, we identified and analysed population-based surveys that reported data on traditional medicine use for perceived health problems in the World Health Organization's Region of the Americas. Based on the findings, we discuss how best to analyse available population-based survey data and how survey questions on traditional medicine can be refined to enhance their usefulness. Strengthened data collection on traditional medicine can inform health-care policy on the integration of traditional practices into the health system, aid efforts to educate both health-care providers and the public on traditional medicine, support culturally responsive and people-centred care, and foster the ethical and effective integration of traditional medicine into health systems.

Traditional medicine is used across the world and is deeply rooted in culture, history and local practices. The World Health Organization (WHO) Global traditional medicine strategy 2025-2034 aims to enhance the contribution of traditional, complementary and integrative medicine to achieving universal health coverage by strengthening the integration of evidence-based traditional, complementary and integrative medicine into national health systems. The strategy prioritizes research to build robust evidence; establishes regulatory mechanisms to ensure safety and quality; promotes integration into health-care services; and fosters cross-sectoral collaboration to utilize traditional, complementary and integrative medicine's broader health benefits. Despite progress in integrating traditional medicine, challenges persist. For example, lack of robust research methods suited to traditional, complementary and integrative medicine hinders the generation of evidence; variations in regulatory approaches affect safety and quality; and the misappropriation of traditional knowledge raises concerns over the protection of the rights of Indigenous Peoples. Additionally, the lack of standardized models for integration of traditional, complementary and integrative medicine into health systems is an impediment. Drawing on the experience of WHO's previous strategy on traditional medicine and responding to increased international engagement, the new strategy addresses these challenges and aligns with wider global initiatives on culture, innovation, intellectual property and health governance. The strategy fosters coherence across multilateral agendas and provides a clear path to maximize the contribution of traditional, complementary and integrative medicine while ensuring its safety, quality and accessibility within health-care systems.

Objective: To assess the pattern of traditional medicine use globally for treating hypertension, diabetes and hypercholesterolaemia.

Methods: We pooled individual-level data from 309 745 non-pregnant people aged ≥ 15 years from 71 nationally representative surveys conducted in low- and middle-income countries between 2005 and 2021. We identified individuals with diagnosed hypertension, diabetes and hypercholesterolaemia who reported use of traditional medicine. For each condition, we estimated the prevalence of traditional medicine use at the global, regional and country-income level and the proportion using traditional medicine and biomedicine. We estimated the association between traditional medicine use and individual characteristics.

Findings: The prevalence of traditional medicine use was 14.7% (95% confidence interval, CI: 12.7-16.9) for diabetes, 12.4% (95% CI: 10.0-15.3) for hypercholesterolaemia and 8.1% (95% CI: 7.3-9.0) for hypertension. Most individuals using traditional medicine for diabetes or hypercholesterolaemia also used biomedicine. Associations between sociodemographic characteristics and traditional medicine use varied between regions and health conditions. In the World Health Organization's (WHO) Western Pacific Region, traditional medicine use for diabetes was significantly higher in males and younger adults, whereas use for hypertension was significantly higher in females and older adults. In the WHO African Region, traditional medicine use for diabetes and hypertension was higher in males and individuals with lower education.

Conclusion: Our study shows a high prevalence of traditional medicine use for treating hypertension, diabetes and hypercholesterolaemia in low- and middle-income countries. Our results highlight the need to better understand the clinical interactions and risks of traditional medicine for improved cardiometabolic treatment.