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The World Health Organization (WHO)
Health amid a financial crisis: a complex diagnosis
6 January 2009 -- The global financial crisis could have profound implications for the health spending plans of national governments. Unless countries have safety nets in place, the poor and vulnerable will be the first to suffer, says an article in the WHO Bulletin.
Read the article in the WHO Bulletin
URL;http://www.who.int/bulletin/en/
Ebola haemorrhagic fever in the Democratic Republic of the Congo - update
2 January 2009 -- The Ministry of Health of the Democratic Republic of the Congo (DRC) is continuing to respond to the ongoing outbreak of Ebola haemorrhagic fever in the Mweka health zone, Province of Kasai Occidental with the support of a wide range of international partners.
As of 31st December there has been a total of 3 laboratory-confirmed cases of Ebola haemorrhagic fever. WHO is aware of 36 additional suspected cases including 12 deaths associated with this outbreak. A further 184 contacts have been identified and are being followed up.
Laboratory analysis was undertaken at the the Institut National de Recherches Biomédicales (INRB) in Kinshasa , DRC , the Centre International de Recherches Médicales de Franceville (CIRMF), Gabon, and the National Institute for Communicable Diseases (NICD), South Africa.
The WHO Country Office, Regional Office and Headquarters are supporting the MoH in Kinshasa, in Kananga and in the field at the location of the outbreak. WHO has deployed five vehicles to the field and has sent outbreak response equipment and medical supplies. The local health authorities in the affected area are working closely with social mobilization experts to develop key information messages for the local communities.
The international response to the outbreak includes partners from Caritas (Belgium), the Congolese Red Cross (DRC) , Médecins Sans Frontières (Belgium), UNICEF, the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC), and the World Food Programme (WFP) .
URL;http://www.who.int/csr/don/2009_01_02/en/print.html
WHO warns of rise in deaths, human suffering in Gaza
Statement 29 December 2008
Geneva/ Cairo/ Jerusalem -- WHO calls for an immediate end to hostilities in the Gaza Strip and urges Israel to ensure immediate provision of fuel and critical life-saving/trauma care supplies.
Hundreds of wounded people, including women, children and elderly, lie in hospitals that already lack basic supplies. Over the past two days, violence and military activities in Gaza have killed around 330 people and left 900 injured, according to latest reports.
The inability of the hospitals to cope with a problem of this magnitude, if the situation continues unchanged, will result in a surge in preventable deaths from complications due to trauma. Civilians are paying the price for the prolonged blockade. As a top priority, the shortages of essential and life-saving medicines needs to be abated without delay. The current escalation of the violence only compounds the health situation and unnecessarily exacerbates the fragile status of the civilians caught up in this conflict.
WHO has secured, in collaboration with several Member States, the dispatch of medical kits to cover surgical and trauma interventions. WHO is following up with the Palestinian and Israeli authorities to ensure that health relief supplies, including the medical kits already on hand, reach those who need them.
Negotiations with the Israelis are ongoing to guarantee the passage of urgent medical supplies today. WHO is also coordinating with other UN agencies, donors and nongovernmental organizations to ensure aid arrives to those most in need. The functioning of hospitals and access to health services is critical in order to respond to the mass casualties.
WHO reiterates its call for the immediate discontinuation of the current violence and the removal of blockades so that much-needed food, water, fuel, medicines and other humanitarian aid can reach those in need.
URL;http://www.who.int/mediacentre/news/statements/2008/s15/en/print.html
Cholera in Zimbabwe - update
26 December 2008 -- As of 25 December 2008, a total of 26 497 cases, including 1 518 deaths, have been reported by the Ministry of Health in Zimbabwe. Cases are now being reported from all 10 of the country's provinces. Harare, particularly Budiriro suburb in the south west, accounts for the majority of cases, followed by Beitbridge in Matabeleland South and Mudzi in Mashonaland East. The current outbreak is the largest ever recorded in Zimbabwe and is not yet under control. In fact, the epidemiological week ending 20 December saw over 5 000 new cases - an increase in the number of weekly cases relative to previous weeks - and an increase in deaths outside treatment/health centres.
The overall Case Fatality Rate (CFR) has risen to 5.7% - far above the 1% which is normal in large outbreaks - and in some rural areas it has reached as high as 50%. Mortality outside of healthcare facilities remains very high. This is a clear indication that better case management and access to healthcare is needed - in particular an increased use of oral rehydration therapy with Oral Rehydration Salts in communities very early after onset of the disease.
The outbreak has taken on a subregional dimension with cases being reported from neighboring countries. In South Africa as of 26 December, 1 279 cumulative cases and 12 deaths (CFR of 0.9%) had been recorded, with the bulk of the cases (1 194) in the Limpopo area. Cases have also been reported in Botswana (Palm Tree).
The current situation is closely linked to the lack of safe drinking water, poor sanitation, declining health infrastructure, and reduced numbers of healthcare staff reporting to work. Other current risk factors include the commencement of the rainy season and the movement of people within the country, and possibly across borders, during the Christmas season. WHO, together with the Ministry of Health and partners from the health and Water and Sanitation clusters, has established a cholera outbreak response coordination unit in order to strengthen the reporting and early detection of cases, improve the response mechanism and access to healthcare and ensure proper case management. WHO has also deployed experts in public health, water and sanitation, logistics and social mobilization. In light of the extent and pace of expansion of the outbreak, reinforcing all control activities across the country is critical.
Given the current dynamic of the outbreak and the context of the collapsed health system, a cholera vaccination is not recommended. Moreover, the use of the internationally available WHO prequalified oral cholera vaccine is not recommended once an outbreak has started due to its 2-dose regimen and the time required to reach protective efficacy, high cost and the heavy logistics associated to its use. The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the occurrence of severe adverse events.
In controlling the spread of cholera WHO does not recommend any special restrictions to travel or trade to or from affected areas. However, neighboring countries are encouraged to reinforce their active surveillance and preparedness systems. Mass chemoprophylaxis is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.
URL;http://www.who.int/csr/don/2008_12_26/en/print.html
Avian influenza - situation in Egypt
16 December 2008 -- The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is a 16-year-old female from Assuit Governorate, Upper Egypt whose symptoms began on 8 December 2008. She was initially hospitalized at the district hospital on 11 December and then transferred to the Assuit University Hospital on 13 December where she died on 15 December. Infection with the H5N1 avian influenza virus was diagnosed by PCR at the Egyptian Central Public Health Laboratory and subsequently confirmed by the US Naval Medical Research Unit No. 3 (NAMRU-3) laboratories on 15 December 2008. Investigations into the source of her infection indicate a recent history of contact with sick and dead poultry.
Of the 51 cases confirmed to date in Egypt, 23 have been fatal.
Health system problems aggravate cholera outbreak in Zimbabwe
WHO setting up a cholera control centre, seeking US$ 6 million in support
10 December 2008 | HARARE -- A widespread cholera outbreak, under-resourced and under-staffed health system, and inadequate access to safe drinking water and hygiene are threatening the wellbeing of thousands of Zimbabweans. As of 9 December, 16 141 suspected cases of cholera and 775 resultant deaths (case fatality rate of 4.8%) had been recorded since August in two-thirds of the country's 62 districts.
WHO is establishing a cholera control and command centre, in conjunction with the Ministry of Health and Child Welfare (MoHCW) and other health partners, to respond in a coordinated manner to Zimbabwe's health challenges. WHO is seeking donor support for a US$ 6 million proposal for its cholera response plan.
Approximately half of cholera cases have been recorded in Budiriro, a heavily populated suburb on the western outskirts of the capital, Harare. Other major concentrations of reported cases include Beitbridge, on the South African border, and Mudzi, on the border with Mozambique.
The outbreak could surpass 60 000 cases, according to an estimate by the Zimbabwe Health Cluster, which is a group coordinated by WHO and comprising health providers, nongovernmental organizations and the MoHCW. The estimate is based on six million people, or half of Zimbabwe's 12 million population, potentially being at risk of contracting cholera, with an estimated 1% of those at risk of actually suffering from cholera. With the rainy season commencing and increased transit of people likely due to the Christmas season, there are risks for further spread of cholera if strong measures are not taken.
There are also serious regional implications, with cholera cases crossing into South Africa and Botswana. On 2 December, South African health authorities said the country had recorded 460 cholera cases and nine related deaths, mostly in border areas near Zimbabwe.
"This outbreak can be contained, but it will depend on many factors, in particular a coordinated approach between all health providers to make sure we are providing the right interventions where they are needed most," said Dr Custodia Mandhlate, WHO Representative to Zimbabwe. "Such interventions include prevention, quick case detection and control, and improved treatment."
The major cause of the cholera outbreak is the inadequate supply of clean drinking water and poor levels of hygiene. Shortages of medicines, equipment and staff at health facilities throughout the country are compounding the health challenges. WHO is advocating for improved access to oral rehydration salts for treating moderate dehydration, which is a symptom of cholera. This could help quickly reduce sickness and deaths.
To help Zimbabwean authorities and partners respond to the health emergency, WHO has sent medical supplies to treat 50 000 people for common conditions for three months, as well as 3200 moderate cases of cholera. WHO has also sent epidemiologists, a water and sanitation expert and a logistician to Harare to strengthen response efforts on the ground.
For more information please contact:
Paul Garwood
Communications Officer
WHO, Geneva
Health Action in Crises (HAC)
Mobile (Geneva): +41 79 475 5546
Mobile (Harare): +263 912 433128
E-mail: garwoodp@who.int
Wendy Julias
Communications officer
WHO Zimbabwe
Telephone: +263 425 3724/30
Mobile: +263 91 243 1408
E-mail: JuliasW@zw.afro.who.int
Gregory Hartl
Team Leader, Information Management and Communications
Department of Epidemic and Pandemic Alert and Response (EPR)
WHO, Geneva
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
E-mail: hartlg@who.int
Global measles deaths drop by 74%
Eastern Mediterranean region achieves measles goal three years early
4 December 2008 | ATLANTA/GENEVA/NEW YORK/WASHINGTON –- Measles deaths worldwide fell by 74% between 2000 and 2007, from an estimated 750 000 to 197 000. In addition, the Eastern Mediterranean region*, which includes countries such as Afghanistan, Pakistan, Somalia, and Sudan, has cut measles deaths by a remarkable 90% during the same period. By reducing measles deaths from 96 000 to 10 000, the region has achieved the United Nations goal to reduce measles deaths by 90% by 2010, three years early.
The progress was announced today by the founding partners of the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation (UN Foundation), UNICEF and WHO. The data will be published in the 5 December edition of WHO’s Weekly epidemiological record and CDC’s Morbidity and mortality weekly report.
"This achievement is a tribute to the hard work and commitment of countries in the Eastern Mediterranean region to combat measles" said Dr Margaret Chan, WHO Director-General. "With only two years until the 2010 target date, I urge all countries affected by measles to intensify their efforts to immunize all children against the disease."
The significant decline in measles deaths in the Eastern Mediterranean region was the result of intensified vaccination campaigns including several countries with hard-to-reach areas. In 2007, more than twice the number of children were immunized in the region through such campaigns as compared to 2006.
For more information please contact:
Hayatee Hasan
WHO, Geneva
Telephone: +41 79 351 6330
E-mail: hasanh@who.int
Christian Moen
UNICEF, New York
Telephone: +1 212 326 7516
E-mail: cmoen@unicef.org
Christy Feig
American Red Cross, Washington, DC
Telephone: +1 202 303 5074
E-mail: feigc@usa.redcross.org
Steven Stewart
CDC, Atlanta
Telephone: +1 404 639 8327
E-mail: znc4@cdc.gov
Amy DiElsi
UN Foundation, Washington, DC
Telephone: +1 202 419 3230
E-mail: adielsi@unfoundation.org
Cholera in Zimbabwe
2 December 2008 -- As of 1 December 2008, the Ministry of Health in Zimbabwe has reported a total of 11 735 cholera cases with 484 deaths since August 2008, affecting all provinces in the country. The overall case fatality rate is 4% but has reached up to 20–30% in remote areas. Out of the total number of cases, 50% have been reported from Budiriro, a high density suburb of the capital city, Harare. Beitbridge, a town bordering South Africa, has reported 26% of all cases. In the last two days, two additional areas have been affected: Chegutu (in Mashonaland West province) and Mvuma (in Midlands province). Reports have also been received from the Ministries of Health in neighbouring countries confirming cholera cases have occurred in Musina (South Africa), Palm Tree (Botswana) and Guro district (Mozambique).
Cholera outbreaks have become more frequent in Zimbabwe since the early 1990s. However, with the exception of the large outbreaks that occurred in 1999 and 2002, the disease has been kept under control through intensified prevention and preparedness activities.
Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. Recent interruptions to the water supplies, together with overcrowding, are aggravating factors in this epidemic. ZINWA (Zimbabwe National Water Authority) has pledged to correct the water supply and sewage system as a matter of urgency.
The Ministry of Health and WHO, together with its health sector partners (UNICEF, IOM, OXFAM-GB, Medecins du Monde, ICRC, ACF, MSF‐Spain - Holland & Luxemburg, Plan International, GOAL, Save the Children-UK and others), have established a comprehensive and coordinated cholera response operational plan to address the needs of the population in the affected areas, emphasizing a multi-sectoral response. WHO is procuring emergency stocks of supplies to meet identified gaps and is deploying a full outbreak investigation and response team, including epidemiologists, water and sanitation engineers and social mobilization specialists. In addition, an epidemiologist and three data managers from the WHO Inter-country Support Team in Harare are assisting the WHO Country Office in data monitoring, analysis and mapping.
Communities are being encouraged to protect themselves against cholera by adhering to proper food safety practices as well as to good personal hygiene. Early rehydration at home by using oral rehydration salts is paramount to diminishing mortality.
Mass chemoprophylaxis with antibiotics is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.
Once an outbreak has started, WHO does not recommend the use of the current internationally available WHO prequalified oral cholera vaccine. This is due to its 2-dose regimen, the time required to reach protective efficacy and the high cost and heavy logistics associated with its use.
The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the occurrence of severe adverse events.
In controlling the spread of cholera, WHO does not recommend any special restrictions to travel or trade to or from affected areas. However, neighbouring countries are encouraged to strengthen their active surveillance and preparedness systems.
URL;http://www.who.int/csr/don/2008_12_02/en/print.html
Essential medicines out of reach for most people
Lack of medicines in public sector forcing patients to pay high prices, finds new study
1 December 2008 | GENEVA -- An alarming lack of availability of essential medicines in the public sector drives patients to pay higher prices in the private sector or go without, according to a WHO study reported in today’s online edition of The Lancet. The results confirm that governments must do more to improve access to essential medicines as part of their efforts to make national health systems more efficient and equitable.
The study analysed data from surveys in 36 countries from all WHO geographical regions and World Bank income groups. Results show an average public-sector availability of only 38% across surveys. This forces patients to buy medicines from the private sector where treatments are more expensive and frequently unaffordable. In Africa, for example, the lowest-paid government worker needs to spend two days' salary each month to purchase diabetes treatment using the lowest-priced generic medicine. When the originator brand is used, costs escalate to over eight days' wages.
“You should not have to choose between buying medication for an ailing parent or buying food for your children,” said Carissa Etienne, WHO Assistant Director-General of Health Systems and Services. “It is not fair or necessary. That is why we are calling again for comprehensive primary health care, so that health systems in every country put the real health needs of people and communities first, and families are not impoverished or bankrupted because of health care payments.”
On the pricing side, the study revealed that “cuts” taken by wholesalers, distributors and retailers plus government taxes and duties are driving prices beyond affordability in many countries. In some countries, add-on costs can double the public-sector price of medicine, while in the private sector, wholesale mark-ups ranged from 2% to 380%, and retail mark-ups ranged from 10% to 552%.
“Essentially, multi-layered supply chain costs add up to one thing for patients, no access to essential medicines,” said Dr Richard Laing of the Essential Medicines and Pharmaceutical Policies department at WHO. “When you pull apart the layers of additional charges, the potential solutions for governments to make life-saving medicines more available and accessible are clear – improve financing and distribution efficiency, promote the use of generic products and control supply chain costs by limiting mark-ups and removing duties and taxes.”
The study further asserts that these actions should all be part of national medicine policies that are measured and evaluated against predetermined benchmarks at least every two years, with routine monitoring and reporting more frequently.
The results cover 15 medicines included in at least 80% of surveys, as well as four specific medicines used to treat asthma, diabetes, hypertension and acute infections. The figures are adjusted to account for differences in buying power of local currencies and then compared to international reference prices, allowing for cross-country comparison.
The work is part of an ongoing joint effort between WHO and Health Action International (HAI) to highlight and improve availability and affordability of essential medicines, especially in low- and middle-income countries.
For more information please contact:
Elizabeth Finney
Communications Officer
Essential Medicines and Pharmaceutical Policies
WHO, Geneva
Telephone: +41 22 791 18 66
E-mail: finneye@who.int