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Fadhil I.,WHO | Lyons G.,WHO | Payne S.,Lancaster University
The Lancet Oncology | Year: 2017

The 22 countries of WHO's Eastern Mediterranean Region are experiencing an increase in the burden of non-communicable diseases (NCDs), including cancer. Of the six WHO regions, the Eastern Mediterranean Region is projected to have the greatest increase in cancer incidence in the next 15 years. Furthermore, most cancers are diagnosed at a late stage, resulting in a lower cancer survival rate than in the European Region and the Region of the Americas. With increasing numbers of deaths from cancer, palliative care should be available to relieve suffering in patients with advanced disease and at the end of life. However, in the Eastern Mediterranean Region, the palliative care available is variable and inconsistent. Several barriers exist to the development and expansion of palliative care delivery in this region, including the absence of palliative care in national policies, little partnership working, insufficient palliative care education for health-care professionals and volunteers, poor public awareness, and gaps in access to essential pain-relief medicines. In this Review, we explore data and evidence from published literature, WHO meeting reports, cancer control mission reports, and the WHO global NCD country capacity survey to identify the status of palliative care in the Eastern Mediterranean Region, including the challenges and opportunities for development. © 2017 Elsevier Ltd


--:          On Saturday, May 13, Ventura County letter carriers will be caravanning more than just incoming and outgoing mail and community members won't have to venture far from their doorsteps to help solve hunger. The day will mark the 25annual National Association of Letter Carriers' "Stamp Out Hunger" food drive –the largest single-day food drive—when thousands of letter carriers across the country will collect residences' food donations for their local food banks.Ventura County residents are asked to leave non-perishable, protein-rich foods in a bag next to their mailboxes for letter carriers to pick up while on their daily route. The donations will then be collected from participating post offices and taken to FOOD Share's distribution site in Oxnard.  Canned tuna, chicken, meats, fruits, and vegetables as well as spaghetti, rice, dry beans, macaroni and cheese, and peanut butter are all nutritious food sought by the regional food bank.:          Saturday May 13, 9am – 6pm (Hours of collection are the same as normal residential postal routes):          Participating Post Offices Include:·         Thousand Oaks Main Post Office, 3435 E. Thousand Oaks Blvd., Thousand Oaks·         East Ventura Post Office, 41 S. Wake Forrest Dr., Ventura·         Ventura Main Post Office, 675 E. Santa Clara St., Ventura·         Oxnard Main Post Office, 1961 N. "C" St., Oxnard·         Port Hueneme Post Office, 560 E. Pleasant Valley Road, Port Hueneme·         Fillmore Post Office, 333 Central Ave., FillmoreThe National Association of Letter Carriers benefitting FOOD Share of Ventura County.


Tate J.E.,Centers for Disease Control and Prevention | Burton A.H.,WHO | Boschi-Pinto C.,WHO | Steele A.D.,PATH | And 2 more authors.
The Lancet Infectious Diseases | Year: 2012

Background: WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection. Methods: We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates. Findings: Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453 000 deaths (95% CI 420 000-494 000) in children younger than 5 years-37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98 621 deaths). Interpretation: Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced. Funding: None. © 2012 Elsevier Ltd.


Mangal T.D.,Imperial College London | Aylward R.B.,WHO | Mwanza M.,WHO | Gasasira A.,WHO | And 3 more authors.
The Lancet Global Health | Year: 2014

Background: The completion of poliomyelitis eradication is a global emergency for public health. In 2012, more than 50% of the world's cases occurred in Nigeria following an unanticipated surge in incidence. We aimed to quantitatively analyse the key factors sustaining transmission of poliomyelitis in Nigeria and to calculate clinical efficacy estimates for the oral poliovirus vaccines (OPV) currently in use. Methods: We used acute flaccid paralysis (AFP) surveillance data from Nigeria collected between January, 2001, and December, 2012, to estimate the clinical efficacies of all four OPVs in use and combined this with vaccination coverage to estimate the effect of the introduction of monovalent and bivalent OPV on vaccine-induced serotype-specific population immunity. Vaccine efficacy was determined using a case-control study with CIs based on bootstrap resampling. Vaccine efficacy was also estimated separately for north and south Nigeria, by age of the children, and by year. Detailed 60-day follow-up data were collected from children with confirmed poliomyelitis and were used to assess correlates of vaccine status. We also quantitatively assessed the epidemiology of poliomyelitis and programme performance and considered the reasons for the high vaccine refusal rate along with risk factors for a given local government area reporting a case. Findings: Against serotype 1, both monovalent OPV (median 32·1%, 95% CI 26·1-38·1) and bivalent OPV (29·5%, 20·1-38·4) had higher clinical efficacy than trivalent OPV (19·4%, 16·1-22·8). Corresponding data for serotype 3 were 43·2% (23·1-61·1) and 23·8% (5·3-44·9) compared with 18·0% (14·1-22·1). Combined with increases in coverage, this factor has boosted population immunity in children younger than age 36 months to a record high (64-69% against serotypes 1 and 3). Vaccine efficacy in northern states was estimated to be significantly lower than in southern states (p≤0·05). The proportion of cases refusing vaccination decreased from 37-72% in 2008 to 21-51% in 2012 for routine and supplementary immunisation, and most caregivers cited ignorance of either vaccine importance or availability as the main reason for missing routine vaccinations (32·1% and 29·6% of cases, respectively). Multiple regression analyses highlighted associations between the age of the mother, availability of OPV at health facilities, and the primary source of health information and the probability of receiving OPV (all p<0·05). Interpretation: Although high refusal rates, low OPV campaign awareness, and heterogeneous population immunity continued to support poliomyelitis transmission in Nigeria at the end of 2012, overall population immunity had improved due to new OPV formulations and improvements in programme delivery. Funding: Bill & Melinda Gates Foundation Vaccine Modeling Initiative, Royal Society. © 2014 Mangal et al.


Mitja O.,University of Barcelona | Mitja O.,Lihir Medical Center International | Asiedu K.,WHO | Mabey D.,London School of Hygiene and Tropical Medicine
The Lancet | Year: 2013

Yaws is an infectious disease caused by Treponema pallidum pertenue-a bacterium that closely resembles the causative agent of syphilis-and is spread by skin-to-skin contact in humid tropical regions. Yaws causes disfiguring, and sometimes painful lesions of the skin and bones. As with syphilis, clinical manifestations can be divided into three stages; however, unlike syphilis, mother-to-child transmission does not occur. A major campaign to eradicate yaws in the 1950s and 1960s, by mass treatment of affected communities with longacting, injectable penicillin, reduced the number of cases by 95% worldwide, but yaws has reappeared in recent years in Africa, Asia, and the western Pacific. In 2012, one oral dose of azithromycin was shown to be as effective as intramuscular penicillin in the treatment of the disease, and WHO launched a new initiative to eradicate yaws by 2020.


Ma Z.,Global Alliance for TB Drug Development | Lienhardt C.,WHO | McIlleron H.,University of Cape Town | Nunn A.J.,Medical Research Council Clinical Trials Unit | Wang X.,Tianjin Centres for Disease Control and Prevention
The Lancet | Year: 2010

Drugs for tuberculosis are inadequate to address the many inherent and emerging challenges of treatment. In the past decade, ten compounds have progressed into the clinical development pipeline, including six new compounds specifically developed for tuberculosis. Despite this progress, the global drug pipeline for tuberculosis is still insufficient to address the unmet needs of treatment. Additional and sustainable efforts, and funding are needed to further improve the pipeline. The key challenges in the development of new treatments are the needs for novel drug combinations, new trial designs, studies in paediatric populations, increased clinical trial capacity, clear regulatory guidelines, and biomarkers for prediction of long-term outcome. Despite substantial progress in efforts to control tuberculosis, the global burden of this disease remains high. To eliminate tuberculosis as a public health concern by 2050, all responsible parties need to work together to strengthen the global antituberculosis drug pipeline and support the development of new antituberculosis drug regimens. © 2010 Elsevier Ltd. All rights reserved.


Soerjomataram I.,International Agency for Research on Cancer | Lortet-Tieulent J.,International Agency for Research on Cancer | Parkin D.M.,University of Oxford | Ferlay J.,International Agency for Research on Cancer | And 3 more authors.
The Lancet | Year: 2012

Background Country comparisons that consider the effect of fatal and non-fatal disease outcomes are needed for health-care planning. We calculated disability-adjusted life-years (DALYs) to estimate the global burden of cancer in 2008. Methods We used population-based data, mostly from cancer registries, for incidence, mortality, life expectancy, disease duration, and age at onset and death, alongside proportions of patients who were treated and living with sequelae or regarded as cured, to calculate years of life lost (YLLs) and years lived with disability (YLDs). We used YLLs and YLDs to derive DALYs for 27 sites of cancers in 184 countries in 12 world regions. Estimates were grouped into four categories based on a country's human development index (HDI). We applied zero discounting and uniform age weighting, and age-standardised rates to enable cross-country and regional comparisons. Findings Worldwide, an estimated 169·3 million years of healthy life were lost because of cancer in 2008. Colorectal, lung, breast, and prostate cancers were the main contributors to total DALYs in most world regions and caused 18-50% of the total cancer burden. We estimated an additional burden of 25% from infection-related cancers (liver, stomach, and cervical) in sub-Saharan Africa, and 27% in eastern Asia. We noted substantial global differences in the cancer profile of DALYs by country and region; however, YLLs were the most important component of DALYs in all countries and for all cancers, and contributed to more than 90% of the total burden. Nonetheless, low-resource settings had consistently higher YLLs (as a proportion of total DALYs) than did high-resource settings. Interpretation Age-adjusted DALYs lost from cancer are substantial, irrespective of world region. The consistently larger proportions of YLLs in low HDI than in high HDI countries indicate substantial inequalities in prognosis after diagnosis, related to degree of human development. Therefore, radical improvement in cancer care is needed in low-resource countries.


The social model of disability has been fruitful in promoting human rights of people with disabilities, but has been associated with a downplaying of the health dimension of disability. Adequate accounts of disability should make space for medical, psychological, social, and political factors in the lives of people with disabilities. Disability is almost always connected to a health condition; civil rights law needs to be anchored in a robust definition of the protected class; failure to meet health needs constitutes an important aspect of the discrimination faced by people with disabilities. © 2012 Elsevier Inc.


Noor A.M.,Kenya Medical Research Institute | Noor A.M.,University of Oxford | Kinyoki D.K.,Kenya Medical Research Institute | Mundia C.W.,Kenya Medical Research Institute | And 6 more authors.
The Lancet | Year: 2014

Background Over a decade ago, the Roll Back Malaria Partnership was launched, and since then there has been unprecedented investment in malaria control. We examined the change in malaria transmission intensity during the period 2000-10 in Africa. Methods We assembled a geocoded and community Plasmodium falciparum parasite rate standardised to the age group 2-10 years (PfPR2-10) database from across 49 endemic countries and territories in Africa from surveys undertaken since 1980. The data were used within a Bayesian space-time geostatistical framework to predict PfPR2-10 in 2000 and 2010 at a 1 × 1 km spatial resolution. Population distribution maps at the same spatial resolution were used to compute populations at risk by endemicity class and estimate population-adjusted PfPR2-10 (PAPfPR2-10) for each of the 44 countries for which predictions were possible for each year. Findings Between 2000 and 2010, the population in hyperendemic (>50% to 75% PfPR2-10) or holoendemic (>75% PfPR2-10) areas decreased from 218·6 million (34·4%) of 635·7 million to 183·5 million (22·5%) of 815·7 million across 44 malaria-endemic countries. 280·1 million (34·3%) people lived in areas of mesoendemic transmission (>10% to 50% PfPR 2-10) in 2010 compared with 178·6 million (28·1%) in 2000. Population in areas of unstable or very low transmission (<5% PfPR 2-10) increased from 131·7 million people (20·7%) in 2000 to 219·0 million (26·8%) in 2010. An estimated 217·6 million people, or 26·7% of the 2010 population, lived in areas where transmission had reduced by at least one PfPR2-10 endemicity class. 40 countries showed a reduction in national mean PAPfPR2-10. Only ten countries contributed 87·1% of the population living in areas of hyperendemic or holoendemic transmission in 2010. Interpretation Substantial reductions in malaria transmission have been achieved in endemic countries in Africa over the period 2000-10. However, 57% of the population in 2010 continued to live in areas where transmission remains moderate to intense and global support to sustain and accelerate the reduction of transmission must remain a priority. Funding Wellcome Trust. Copyright © Noor et al.


To review epidemiological surveillance approaches used during Ebola and Marburg hemorrhagic fever epidemics in Africa in the past fifteen years. Overall, 26 hemorrhagic epidemic outbreaks have been registered in 12 countries; 18 caused by the Ebola virus and eight by the Marburg virus. About 2551 cases have been reported, among which 268 were health workers (9,3%). Based on articles and epidemic management reports, this review analyses surveillance approaches, route of introduction of the virus into the population (urban and rural), the collaboration between the human health sector and the wildlife sector and factors that have affected epidemic management. Several factors affecting the epidemiological surveillance during Ebola and Marburg viruses hemorrhagic epidemics have been observed. During epidemics in rural settings, outbreak investigations have shown multiple introductions of the virus into the human population through wildlife. In contrast, during epidemics in urban settings a single introduction of the virus in the community was responsible for the epidemic. Active surveillance is key to containing outbreaks of Ebola and Marburg viruses Collaboration with those in charge of the conservation of wildlife is essential for the early detection of viral hemorrhagic fever epidemics. Hemorrhagic fever epidemics caused by Ebola and Marburg viruses are occurring more and more frequently in Sub-Saharan Africa and only an adapted epidemiological surveillance system will allow for early detection and effective response.

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