Bulletin of the World Health Organization最新文献

Objective: To explore the effect of anticipatory action on outcomes during a cholera outbreak in a hypothetical health zone in the Democratic Republic of the Congo by means of a cholera response model.

Methods: Using a system dynamics approach, we developed a cholera response model for the Democratic Republic of the Congo on the basis of a published cholera response simulation model for Yemen. The model evaluated four intervention scenarios: (i) existing responses to cholera outbreaks; (ii) anticipatory action (that is, immediate interventions); (iii) anticipatory action plus one vaccine dose; and (iv) anticipatory action plus two vaccine doses.

Findings: The model showed that immediate interventions can function as an essential bridge to comprehensive vaccination, particularly in resource-constrained settings where timely coordination is crucial. Moreover, anticipatory action can reduce the total number of cholera cases. However, booster vaccinations are crucial for preventing subsequent waves of infection due to waning immunity following single-dose vaccination.

Conclusion: Anticipatory action can enhance cholera outbreak management in low-resource settings by facilitating synergy between immediate and long-term interventions. The timing and coordination of interventions and the use of booster doses to prevent disease resurgence are all important. Dynamic models are useful for simulating outbreaks and can foster proactive, evidence-based public health planning, thereby supporting the shift from reactive to anticipatory strategies in alignment with the Global Task Force on Cholera Control's 2030 cholera roadmap. Continuous refinement of the model with real-world data will enhance its global applicability and help advance effective disease control strategies.

Objective: To investigate associations between digital maturity in health and primary health care performance globally.

Methods: We conducted a search of publicly available data on digital maturity in health and primary health care performance for the 194 World Health Organization Member States. We identified 14 indicators of digital maturity in health, covering seven core subcomponents. A digital maturity in health index was derived from these indicators. Primary health care performance was assessed using the universal health coverage effective coverage index.

Findings: Digital maturity in health data were missing for 85 of the 194 countries, with considerable variation across subcomponents. The remaining 109 countries were divided into four types by digital maturity in health index. We identified countries leading or lagging in digital maturity and highlighted the strongest and weakest subcomponents. Overall, there was a strong, nonlinear, positive correlation between digital maturity in health and primary health care performance (Spearman correlation: 0.85). However, there were notable exceptions, which indicates digital maturity can enhance primary health care but is not necessary for its improvement. The relationship between health-care expenditure and digital maturity in health and primary health care performance varied among countries with similar spending and digital maturity.

Conclusion: Overall, primary health care performance was positively associated with digital maturity in health and health-care expenditure. However, some countries had a strong primary health care system despite low digital maturity, and some had high digital maturity but a weak primary health care system. The study's findings could help policy-makers prioritize investment in digital health.

Objective: To determine how Escherichia coli contamination of household water affects the probability of stunting and underweight in children younger than 5 years in 29 low- and middle-income countries and territories.

Methods: We used data describing health, nutrition, education, and water, sanitation and hygiene (i.e. E. coli testing) from the global Multiple Indicator Cluster Surveys. We conducted multiple linear regression analyses to estimate the effects of E. coli contamination on the growth outcomes of stunting and underweight in children, and to explore the underlying mechanisms. We also conducted subgroup analyses to examine heterogeneous effects at both the macro- and microlevels.

Findings: Three quarters of the children in our pooled sample (26 498/35 012) were living in households with drinking water contaminated with E. coli. We observed that these children had a 2.3 (95% confidence interval, CI: 0.006 to 0.039) and 1.8 (95% CI: 0.006 to 0.031) percentage point higher probability of experiencing stunting and underweight, respectively, than children living in households with uncontaminated water. Our heterogeneity analyses revealed significant effects of E. coli contamination in girls and in poorer households (microlevel); in low- and lower-middle-income countries and territories; and in the World Health Organization African Region and Region of the Americas (macrolevel). Finally, we identified diarrhoea as a potential mechanism through which E. coli contamination might adversely affect child growth.

Conclusion: Our findings highlight the critical need to eliminate E. coli contamination from household water sources to improve both child health and growth outcomes; changing behaviours related to open defecation remains a key strategy.

The prevalence of Parkinson disease is increasing globally. Despite the existence of effective and affordable medicines for Parkinson disease, access to these medicines is limited in the World Health Organization (WHO) African Region. Several factors influence accessibility, including lack of prioritization of Parkinson disease, shortage of a trained health workforce, barriers to health financing and lack of inclusion of medicines in national essential medicines lists. We determined alignment of the most recent national essential medicines lists of 47 countries in the WHO African Region with the 23rd edition of the WHO Model list of essential medicines for Parkinson disease medicines. Overall, of any formulation or strength, 81% (38/47) of countries included levodopa + carbidopa or levodopa + benserazide as a therapeutic alternative on their national lists; and 79% (37/47) included biperiden or trihexyphenidyl as a therapeutic alternative. Inclusion of specific formulations for medicines was lower; for example, 45% (21/47) of countries included levodopa + carbidopa or levodopa + benserazide in a 4:1 ratio. Furthermore, 11% (5/47) of national essential medicines lists included none of the four medicines. While inclusion of medicines for Parkinson disease in national essential medicines lists provides no guarantee of immediate access, it can encourage procurement, prescribing and use, and can help lower costs, raise awareness of and create political will for Parkinson disease treatment. This analysis provides further evidence of the need for action to improve the accessibility of medicines for Parkinson disease in the WHO African Region.

Many global clinical trials primarily estimate a single overall treatment effect. However, when treatment effects are likely to differ between populations, for example due to differences in the disease, population characteristics or health-care systems, this approach can lead to misleading conclusions and raise ethical concerns. Justice is compromised when research conducted in low-resourced countries benefits primarily or exclusively populations of wealthier countries. A clinical trial design and analysis that focuses on estimating a single treatment effect, assumed to apply to all participating populations, goes against the ethical principle of justice and the positions of the World Health Assembly. To address this issue, we suggest a methodological strategy based on hierarchical modelling. This approach enables researchers to estimate treatment effects that are valid for each participating population, while potentially retaining efficiency comparable to traditional pooled analysis, as we demonstrate in an example. When substantial between-population differences exist, it produces valid, region-specific results. Strategies such as this one, if adopted into the standards for global trials, would allow regulators, funders and other stakeholders to ensure that trials are designed to help preserve justice for all participant populations.