Bulletin of the World Health Organization

Public health round-up

Outside Africa

WHO/Stephenie Hollyman

This poster encourages people to sleep under anti-mosquito nets. Raising public awareness is one of the measures Cambodia has taken in recent years to combat the rise of resistant malaria. While Africa carries the greatest burden of malaria, the disease presents a significant public health problem in 51 countries elsewhere in the world. This is the subject of a new report entitled Defeating malaria in Asia, the Pacific, Americas, Middle East and Europe. In 2010, there were an estimated 34 million cases of malaria outside Africa leading to some 46 000 deaths. The five countries most affected are India, Indonesia, Myanmar, Pakistan and Papua New Guinea, according to the report, which was published last month by WHO on behalf of the Roll Back Malaria partnership.

One in five missing out

Four in five children (83%) worldwide received the recommended three doses of diphtheria–tetanus–pertussis (DTP) vaccine during infancy in 2011, according to new data published in the Morbidity and Mortality Weekly Report of the US Centers for Disease Control and Prevention and in WHO’s Weekly Epidemiological Record.

Diphtheria–tetanus–pertussis vaccination in infants up to the age of 12 months is an important indicator of the extent to which vaccination programmes are reaching children with life-saving vaccines. The new data also show the progress that has been made since WHO’s Expanded Programme on Immunization (EPI), of which DTP vaccination is a core part, was established nearly 40 years ago, when fewer than 5% of the world’s children were being vaccinated against these three deadly diseases.

Prizes for new WHO books

Two WHO publications, the Global status report on alcohol and health and the Burden of disease from environmental noise: quantification of healthy life years lost in Europe were highly commended in the 2012 BMA Medical Book Competition, public health category, this year.

The global status report is the most comprehensive summary to date of consumption of alcohol, patterns of drinking, health consequences and policy responses in WHO’s 194 Member States. http://www.who.int/substance_abuse/publications/global_alcohol_report

The second publication summarizes the evidence on the relationship between environmental noise and health effects, including cardiovascular disease, cognitive impairment, sleep disturbance and tinnitus. http://www.euro.who.int/en/what-we-publish/abstracts/burden-of-disease-from-environmental-noise.-quantification-of-healthy-life-years-lost-in-europe

Atlas of health and climate

As the world’s climate changes, hazards to human health abound. Droughts, floods and cyclones affect the health of millions of people every year. Climate variability and extreme conditions, such as floods, can trigger epidemics of diseases such as malaria, dengue and meningitis.

A new publication gives practical examples of how governments can use weather and climate information to help them protect public health. The Atlas of health and climate, published jointly by WHO and the World Meteorological Organization illustrates some of the most pressing challenges in this field.

“Prevention and preparedness are the heart of public health,” said WHO Director-General Dr Margaret Chan. “Risk management is our daily bread and butter. Information on climate variability and climate change is a powerful scientific tool that assists us in these tasks.”

Rehab in Uganda

International Federation for Spina Bifida and Hydrocephalus/Io Cooman

Community worker Ambrose Ganshanga examines a baby who has had surgery for spina bifida at the Cure Children’s hospital in Mbale, eastern Uganda, which specializes in treating children with disabilities. Spina bifida is a birth anomaly in which the spinal column does not develop normally during the first weeks of pregnancy. In his work to improve the survival and quality of life of those with spina bifida and other disabilities in rural Uganda, Ganshanga uses WHO guidelines on community-based rehabilitation. WHO works closely with the International Federation for Spina Bifida and Hydrocephalus on prevention, care and treatment of people with these conditions.

Health policy and systems research

A new WHO strategy calls on governments to make better use of health policy and systems research to help them move towards universal health coverage and equity. The document, entitled Strategy on health policy and systems research: changing mindsets, was launched at the Second Global Symposium on Health Systems Research in Beijing last month. It seeks to bring researchers and policy-makers closer together and to clarify the scope and role of health policy and systems research. It looks at the processes by which health policy and systems research generates evidence and how that evidence is used in decision-making. http://www.who.int/healthsystems

R&D growing in middle-income countries

Middle-income countries are becoming increasingly engaged in innovative activities ranging from early stage research to clinical development of pharmaceutical products, according to a report focusing on Brazil, China, Colombia, India, Malaysia, the Republic of Korea, the Russian Federation and South Africa.

The report, entitled Policies that encourage innovation in middle-income countries, was commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) to find the factors that stimulate and drive innovation in these countries. It was carried out by consultants Charles River Associates (CRA).

The report found that the key success factor for increasing innovative activities was establishing a consistent long-term policy and legal frameworks. These, it said, should be coupled with effective coordination of national industrial and health policies, encouragement of collaborations between stakeholders and adequate intellectual property protection. Their success was defined both by the level of engagement in domestic innovation activities as well as countries’ ability to attract international research and development activities.

“Our report documents how targeted, coordinated and consistent government policies, tailored to a country’s capabilities, are key components for success,” said Tim Wilsdon, CRA Vice President. “Other enabling factors include strong research institutions and medical schools and an environment that encourages partnership between the different stakeholders.”

Some of the eight countries focus on a particular stage in the innovation process. Brazil, India and the Russian Federation, for example, have attracted clinical trials from outside, it notes, while China and the Republic of Korea have been successful in encouraging early stage innovative activities. In addition, the report noted that while these countries are investing more in research and development, companies in high-income countries have also increased their research and development investment in these and other middle-income countries.

It noted that between 2005 and 2010, research and development spending by members of Pharmaceutical Research and Manufacturers of America increased by 455% in Asia-Pacific (excluding Japan), 112% in Latin America and 303% in India.

Nine dead in Marburg outbreak

Nine people have died in an outbreak of Marburg haemorrhagic fever in Uganda as of the end of October, according to the Ministry of Health in Kampala. One of them was a health worker.

WHO and other partners – including the US Centers for Disease Control and Prevention, the Uganda Red Cross, the African Field Epidemiology Network and Médecins Sans Frontières – were supporting the national authorities in outbreak investigation and response.

WHO advises that there is no need for any restrictions on travel or trade with Uganda.

Medical device alarms – No. 1 hazard

Health workers should improve the way they handle alarms, according to the USA-based ECRI Institute. Alarms were ranked at the top of the institute’s list of the top 10 most hazardous health devices in a report released last month. The ECRI Institute, a non-profit organization, researches the best ways to improve the safety, quality and cost–effectiveness of patient care in the USA.

Many medical devices use alarms to issue alerts to warn health workers of potential problems with their patients, including physiologic monitors, medical telemetry units, ventilators, infusion pumps and dialysis units. But institute said that while medical device alarms perform an essential patient safety function, the sheer number of them “has itself become problematic”. “The result is that caregivers can become overwhelmed trying to respond to the alarms, or they can become desensitized, which can lead to missed alarms or delayed response, placing patients at risk,” it said in its report, entitled Top 10 health technology hazards for 2013.

Looking ahead

1 December: World AIDS Day http://www.worldaidsday.org

3 December: International Day of Persons with Disabilities http://www.who.int/mediacentre/events/annual/day_disabilities

10 December: Human Rights Day http://www.who.int/mediacentre/events/annual/human_rights_day

21–29 January 2013: WHO Executive Board http://apps.who.int/gb/e/e_eb132.html

30 January 2013: World Leprosy Day http://www.who.int/topics/leprosy