from to

Recommendations

Info

CHOLERA Cholera is an acute diarrhoea caused by infection due to ingestion of food or water contaminated with the bacterium Vibrio cholerae. It is endemic in more than 50 countries, mostly in Africa and Asia, and may also cause epidemics. 113 More than 1 billion people are at risk of cholera in endemic countries, with an estimated 2.9 million cholera cases and 95 000 deaths per year. 114 The most recent major cholera epidemic occurred in Haiti in 2010–2011, following an earthquake, causing over 7000 deaths in Haiti and neighbouring Dominican Republic. 115,116 Environmental factors are critical in the epidemiology of cholera. Climate change, war, natural disasters, population movement and urbanization are complicating efforts to control the disease. 117 TRENDS From the reported data on cholera cases it is difficult to ascertain whether progress has been made in reducing global incidence rates, as official reporting is far from complete. Figure 5.24 shows the global and regional numbers of reported cases to WHO during the last two decades. In general, Africa is the most affected continent. Peaks in the numbers of cases occurred in 1991–1992 and 2011, associated with severe outbreaks in the Americas. In 2015, a cholera outbreak was reported in the Kigoma region of the United Republic of Tanzania. Cholera is endemic in the region, but due to a recent influx of thousands of Burundian refugees, overcrowding and poor sanitation, the situation has deteriorated. Figure 5.24 Reported cholera cases by continent, 1989–2014 26 Africa Americas Asia Oceania 700 600 Cases (thousands) 500 400 300 200 100 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 124 HEALTH IN 2015: FROM MDGs TO SDGs
POSITIVE DEVELOPMENTS Water and sanitation: Cholera is a waterborne disease and can be largely prevented when people have access to safe drinking-water and sanitation facilities. A major achievement during the MDG era has been the progress in improving access to safe drinking-water and sanitation in urban and rural populations (MDG 7). 22 Access to an improved drinking-water source jumped from 76% coverage in 1990 to 91% in 2015, an increase of 2.6 billion people. On the sanitation front, progress has been less impressive. Open defecation decreased from 24% to 13% between 1990 and 2015, and 2.1 billion people gained access to improved sanitation, but one third of the global population is still without access in 2015. Case management: Alongside progress in cholera prevention, there have also been advances in the ability to effectively manage cholera. In particular, the use of oral rehydration therapy has become a more widely applied standard of care. Very severely dehydrated patients require administration of intravenous fluids. Such patients also require appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed and shorten the duration of V. cholerae excretion. Recommended control methods, including standardized case management, have proven effective in reducing the case-fatality rate and reduce the mortality of severe cholera to less than 1%, even in resource-limited settings. 118 CHALLENGES New strains: The majority of cholera outbreaks are caused by one strain – V. cholera, but recently new variant strains have been detected in several parts of Africa and Asia. Observations suggest that these strains cause more severe cholera with higher case fatality rates. The main reservoirs of V. cholerae are people and aquatic sources such as brackish water and estuaries. Recent studies indicate that global warming creates a favourable environment for the bacteria. 119 Prevention: Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met. The consequences of a disaster – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission should the bacteria be present or introduced. Vaccination: A review of recent studies shows levels of protective effectiveness ranging from 23–58% (overall 37%) 120 and there is also evidence of some beneficial indirect effects on the unvaccinated population. 121 However, the use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the high occurrence of severe adverse reactions. Very few countries have vaccination programmes. Preparedness: Early in cholera epidemics mortality rates can still exceed 10% before appropriate response mechanisms, such as local treatment centres become available to improve rapid access to therapy and minimize the time to initial rehydration, as the incubation time and the time between onset of symptoms and dehydration and death is short. 122,123 STRATEGIC PRIORITIES In 2011, the WHO Member States unanimously agreed that cholera needs to be recognized as an increasing public health threat for many countries and regions, as it is on the rise due to climate change. 124 This requires prevention, epidemic preparedness and response. Proper, timely and solid surveillance systems, improved environmental management – in particular, access to clean water and proper sanitation – and the adequate use of cholera vaccines as a complementary measure are essential. Cholera prevention requires access to safe water, adequate sanitation, adequate food safety, appropriate hygiene and a community-based approach. An internationally licensed oral cholera vaccine is currently available on the market in limited stocks and is suitable for travellers. WHO recommends that it should always be used as an additional public health tool, but should not replace usually recommended control measures such as improved water supplies, adequate sanitation and health education. Countries neighbouring an area affected by cholera should improve preparedness to rapidly respond to an outbreak and improve surveillance for risk assessment and early detection of outbreaks. Cholera is recognized as a clear marker of environmental management, as well as an indicator of how the global public health community should engage with the IHR and conduct surveillance. INFECTIOUS DISEASES 125
Page 1:
from M I L L E N N I U M DEVELOPMEN
Page 4 and 5:
WHO Library Cataloguing-in-Publicat
Page 6 and 7:
CONTENTS vii Abbreviations 1 1 From
Page 8 and 9:
7 153 Mental health and substance u
Page 10 and 11:
IHR IPCC ITN LLIN MCV MDG MDR TB mh
Page 13 and 14:
SUMMARY This report aims to describ
Page 15 and 16:
sourced development finance. 11 The
Page 17 and 18:
Despite their overall success, the
Page 19 and 20:
The 13 targets that underpin the br
Page 21 and 22:
Box 1.1 Life expectancy improvement
Page 23:
40 Advanced research on European he
Page 27 and 28:
SUMMARY The SDGs position health as
Page 29 and 30:
Figure 2.2 Trends in fertility by r
Page 31 and 32:
Ageing Populations around the world
Page 33 and 34:
The recent influx of refugees into
Page 35 and 36:
and implementing policies and progr
Page 37 and 38:
that dialogue is to demonstrate an
Page 39 and 40:
One of the challenges we face as we
Page 41 and 42:
Most recently, the right to health
Page 43 and 44:
2100 Figure 2.15 Global average sur
Page 45 and 46:
Figure 2.17 Proportion of health fa
Page 47 and 48:
42 World development report 2014: r
Page 49:
3 UNIVERSAL HEALTH COVERAGE
Page 52 and 53:
UHC is coverage that provides peopl
Page 54 and 55:
Figure 3.4 Per capita government he
Page 56 and 57:
living in poverty, are pushed furth
Page 58 and 59:
integration of all SDG health targe
Page 60 and 61:
GOVERNANCE Governance in the health
Page 62 and 63:
HEALTH FINANCING A country’s heal
Page 64 and 65:
HEALTH WORKFORCE Health systems and
Page 66 and 67:
MEDICAL PRODUCTS Access to quality
Page 68 and 69:
HEALTH INFORMATION Health informati
Page 70 and 71:
SERVICE DELIVERY In order to achiev
Page 72 and 73:
RESEARCH FOR UHC Research evidence
Page 74 and 75:
NOTES AND REFERENCES 1 World health
Page 76 and 77:
89 Implementing the Commission on I
Page 78 and 79:
173 Labrique A, Vasudevan L, Chang
Page 81 and 82:
SUMMARY Deaths among pregnant women
Page 83 and 84: Figure 4.3 MDG and SDG targets rela
Page 85 and 86: have declined from 25% to 14% betwe
Page 87 and 88: Chapter 5). As noted above, there h
Page 89 and 90: Figure 4.8 Wealth-related inequalit
Page 91 and 92: young children. 61 Specific indicat
Page 93 and 94: CHALLENGES Access to skilled care a
Page 95 and 96: CHALLENGES Scaling up effective int
Page 97 and 98: CHALLENGES Leaving no country behin
Page 99 and 100: CHALLENGES Endemic countries: Polio
Page 101 and 102: Figure 4.22 Prevalence of stunting
Page 103 and 104: CHALLENGES Spurring action in count
Page 105 and 106: CHALLENGES Ending child marriage: D
Page 107 and 108: 43 Financing global health 2014: sh
Page 109: 5 INFECTIOUS DISEASES
Page 112 and 113: Infectious and parasitic diseases a
Page 114 and 115: Figure 5.4 Global number of deaths
Page 116 and 117: International TB funding increased
Page 118 and 119: Improving quality of care: The qual
Page 120 and 121: Table 5.1 Summary of specific targe
Page 122 and 123: HIV/AIDS More than 30 years since t
Page 124 and 125: TUBERCULOSIS TB is a treatable and
Page 126 and 127: MALARIA Almost half the world’s p
Page 128 and 129: NEGLECTED TROPICAL DISEASES NTDs 89
Page 130 and 131: HEPATITIS Viral hepatitis is caused
Page 132 and 133: WATERBORNE DISEASES Waterborne dise
Page 136 and 137: SEXUALLY TRANSMITTED INFECTIONS STI
Page 138 and 139: NOTES AND REFERENCES 1 Global Healt
Page 140 and 141: 84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151 and 152: CHALLENGES Despite declines in mort
Page 153 and 154: CHALLENGES Lack of access to effect
Page 155 and 156: CHALLENGES Diabetes is an increasin
Page 157 and 158: CHALLENGES Increasing use in some r
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 168 and 169: the effectiveness of task sharing b
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 176 and 177: SUBSTANCE USE AND SUBSTANCE USE DIS
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
Page 181: 8 INJURIES AND VIOLENCE
Page 184 and 185:
Injuries, whether sustained acciden
Page 186 and 187:
due to limited data. However, the s
Page 188 and 189:
aiming to stop the predicted increa
Page 190 and 191:
ROAD TRAFFIC INJURIES Every year, a
Page 192 and 193:
VIOLENCE AND HOMICIDE There were an
Page 194 and 195:
WAR AND CONFLICT In 2012, an estima
Page 196 and 197:
DISASTERS Disasters are often assoc
Page 198 and 199:
NOTES AND REFERENCES 1 Global repor
Page 201 and 202:
SUMMARY In September 2015, heads of
Page 203 and 204:
A 10-page declaration precedes the
Page 205 and 206:
THE PLACE OF HEALTH IN THE SDGs 1 H
Page 207 and 208:
that health systems providing integ
Page 209 and 210:
FOLLOW-UP AND REVIEW 9 Monitoring t
Page 211 and 212:
NOTES AND REFERENCES 1 Transforming
Page 213 and 214:
WHO South-East Asia Region: Banglad
Page 216:
ISBN 978 92 4 156511 0
show all

from to

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?