Bulletin of the World Health Organization最新文献

Susana Vázquez Torres talks to Ana Lesher Treviño about AI-guided protein design for antivenoms and her aim to improve access to lifesaving treatments in low-resource settings.

Increasing population intake of fruits, vegetables and legumes could reduce diet-related mortality. The World Health Organization recommends that countries adopt fiscal tools to address the relative affordability of healthy foods, including through taxes and subsidies. Most global agricultural subsidy support has been tied to the production of specific commodities, predominately grains. Heavily embedded financial and regulatory focus on a narrow range of commodities has encouraged monocropping and intensive farming at the expense of dietary diversity. To address this issue, the United Nations recommends that countries phase out distortive policies and subsidies, and repurpose these with more efficient and equitable measures. This would provide an opportunity for the health policy community to engage on the investment needed to promote production, supply and demand for fruit, vegetables and legumes. This article supports this engagement, by describing the current policy context for agricultural subsidies and some of the specific policy options for increasing fruit, vegetable and legume production, supply and demand. The article outlines ways through which the health policy community can support the development of a repurposing policy agenda for fruit, vegetables and legumes by building awareness of the benefits of such an agenda; strategically engaging across sectors to develop a cohesive package of policy measures for increasing fruit, vegetable and legume production, supply and demand; and engaging with agriculture and other sectors to navigate the complexities of a repurposing agenda, ensuring a range of sectoral concerns are addressed.

Problem: Central line-associated bloodstream infections in critically ill neonates are major challenge in neonatal intensive care units.

Approach: In April 2023, a multidisciplinary team, consisting of the infection prevention and control team, the unit head, a neonatal consultant doctor, a senior doctor and a head nurse, introduced the World Health Organization Multimodal Hand Hygiene Improvement Strategy in the neonatal intensive care unit of El-Shatby University Hospital, Egypt. The team introduced an antiseptic handwash and a disinfectant for surfaces and equipment, especially incubators. To highlight the incidence of infections in the unit and illustrate the effectiveness of the newly introduced products, the team offered training programmes for all health workers. Health workers' proper use of the introduced products was monitored and, if necessary, immediate corrective actions were taken. Monthly meetings were held to discuss hand hygiene compliance, infection rates and challenges in infection prevention and control.

Local setting: The neonatal intensive care unit has 70 incubators and 28 beds.

Relevant changes: The central line-associated bloodstream infection rate decreased from 13.85 infections per 1000 device days (95% confidence interval, CI: 10.44-18.03) before the intervention to 9.08 infections per 1000 device days (95% CI: 5.81-11.27). Hand hygiene compliance increased from 58% (70/120) to 71% (88/124) among nurses and from 64% (58/91) to 67% (67/100) among doctors.

Lessons learnt: Implementing a multimodal strategy through a multidisciplinary approach led to positive changes in infection prevention and control practices, and a reduction in central line bloodstream infections.

Objective: To identify factors influencing the completion of a three-dose course of weekly intramuscular benzathine penicillin G injections by adults and adolescents with syphilis of unknown duration or late syphilis.

Methods: We searched medical literature databases for studies reporting on factors influencing treatment completion by patients with syphilis aged 10 years or older and studies involving health professionals administering syphilis treatment. Studies could use quantitative, qualitative or mixed methods approaches. We conducted a systematic review following the JBI Manual for Evidence Synthesis method.

Findings: We identified 24 eligible studies, of which 20 (83%) were published in 2010 or later, 19 (79%) focused on pregnant women, seven (29%) were conducted in Brazil, six (25%) in the United States of America and three (12%) in China. Health-care system-related factors influencing the noncompletion of treatment included the limited supply of, and limited access to, medication and inadequate follow-up systems. Other common factors were patients presenting late to antenatal services and social and economic factors, such as transportation barriers and a low educational level.

Conclusion: A comprehensive systems approach is needed to increase the treatment completion rate for syphilis of unknown duration and late syphilis. Health service interventions, such as improving patient management systems, should be supplemented by actions to address social inequalities and shortages in the supply of benzathine penicillin G. Research is needed to understand barriers to treatment completion in high-income countries and among priority groups, including Indigenous people and men who have sex with men.

Objective: To assess the type and amount of materials used in commercial lateral flow tests.

Methods: We collected and weighed the components of 21 commercial coronavirus disease 2019 (COVID-19) lateral flow tests from the European Union, the United Kingdom of Great Britain and Northern Ireland, the United States of America and the World Health Organization's emergency use listing procedure. We took test kits apart manually, classified components and weighed them individually.

Findings: We found large variations in the total average weights of the lateral flow kits ranging from 13.7 g per test to 84.6 g. The average weight of standard housing in the kits was 4.1 g per casing (range: 2.8-6.5). The packaging made up between 34% and more than 89% of the whole kit and was found to be a large source of weight variations. In the standard kits, plastics made up on average 36% of the total weight, while paper and cardboard accounted for 52% on average. In the non-standard kits, which had newer cassette designs, the opposite was observed.

Conclusion: Wide variation in the weight of components in COVID-19 tests suggests there is scope for manufacturers to reduce the amount of materials, including plastic, in these products. We propose that a quantitative baseline of material usage be introduced in target product profiles for lateral flow tests to limit the large volume of plastic from reaching the market, and reduce the burden of plastic waste from diagnostic testing on local waste management systems.

Problem: The capacity and site readiness for delivering hypertension management services in Mali were unknown, hindering the effective implementation of the World Health Organization (WHO) HEARTS technical package for cardiovascular disease management.

Approach: We selected one tertiary and two secondary hospitals to be assessed. From December 2021 to January 2022, hospital cardiologists collected data on indicators of capacity and site readiness using an adapted version of the WHO service availability and readiness assessment questionnaire. The study team verified the collected data through site inspection and review of administrative documents.

Local setting: Mali, a low-income country with a population of 22 395 489, had an estimated hypertension prevalence among adults of 35% in 2019. Most people with hypertension receive care from primary care clinicians, but there are no national hypertension treatment guidelines.

Relevant changes: The tertiary hospital had a larger workforce (392 personnel) compared to the two other sites (124 and  182 personnel, respectively) and treated approximately three times more patients with high blood pressure (324 patients versus 106 and 132 patients, respectively). Diuretics and centrally acting agents were the only antihypertensive medications available at all three sites. While all three sites had the capacity to diagnose and confirm hypertension, only one site was fully equipped to provide comprehensive hypertension treatment.

Lessons learnt: Political engagement is important for expanding service availability and readiness assessments across health-care facilities, and supporting the implementation and funding of the HEARTS package. Improving access to antihypertensive medications will be essential to ensuring better treatment options for patients.