Guidance for Institutions of Higher Education with Students Participating in International Travel or Study Abroad Programs
The World Health Organization’s first global report on sepsis finds that the effort to tackle millions of deaths and disabilities due to sepsis is hampered by serious gaps in knowledge, particularly in low- and middle-income countries. According to recent studies, sepsis kills 11 million people each year, many of them children. It disables millions more.
But there’s an urgent need for better data. Most published studies on sepsis have been conducted in hospitals and intensive care units in high-income countries, providing little evidence from the rest of the world. Furthermore, the use of different definitions of sepsis, diagnostic criteria and hospital discharge coding makes it difficult to develop a clear understanding of the true global burden of sepsis.
“The world must urgently step up efforts to improve data about sepsis so all countries can detect and treat this terrible condition in time,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This means strengthening health information systems and ensuring access torapid diagnostic tools, and quality care including safe and affordable medicines and vaccines.”
Sepsis occurs in response to an infection. When sepsis is not recognized early and managed promptly, it can lead to septic shock, multiple organ failure and death. Patients who are critically ill with severe COVID-19 and other infectious diseases are at higher risk of developing and dying from sepsis.
Even sepsis survivors are not out of danger: only half will completely recover, the rest will either die within 1 year or be burdened by long-term disabilities.
A serious complication of infection
Sepsis disproportionately affects vulnerable populations: newborns, pregnant women and people living in low-resource settings. Approximately 85.0% of sepsis cases and sepsis-related deaths occur in these settings.
Almost half of the 49 million cases of sepsis each year occur among children, resulting in 2.9 million deaths, most of which could be prevented through early diagnosis and appropriate clinical management. These deaths are often a consequence of diarrhoeal diseases or lower respiratory infections.
Obstetric infections, including complications following abortion or infections following caesarean section, are the third most common cause of maternal mortality. Globally, it is estimated that for every 1000 women giving birth, 11 women experience infection-related, severe organ dysfunction or death.
The report also finds that sepsis frequently results from infections acquired in health care settings. Around half (49%) of patients with sepsis in intensive care units acquired the infection in the hospital. An estimated 27% of people with sepsis in hospitals and 42% of people in intensive care units will die.
Antimicrobial resistance is a major challenge in sepsis treatment as it complicates the ability to treat infections, especially in health-care associated infections.
Improving the prevention, diagnosis and treatment of sepsis
Improved sanitation, water quality and availability, and infection prevention and control measures, such as appropriate hand hygiene can prevent sepsis and save lives - but must be coupled with early diagnosis, appropriate clinical management, and access to safe and affordable medicines and vaccines. These interventions could prevent as many as 84% of newborn deaths due to sepsis.
So WHO calls on the global community to:
- Improve robust study designs and high-quality data collection, especially in low- and middle-income countries.
- Scale-up global advocacy, funding and the research capacity for epidemiological evidence on the true burden of sepsis.
- Improve surveillance systems, starting at the primary care level, including the use of standardized and feasible definitions in accordance with the International Classification of Diseases (ICD-11), and leveraging existing programmes and disease networks.
- Develop rapid, affordable and appropriate diagnostic tools, particularly for primary and secondary levels of care, to improve sepsis identification, surveillance, prevention and treatment.
- Engage and better educate health workers and communities not to underestimate the risk of infections evolving to sepsis, and to seek care promptly in order to avoid clinical complications and the spread of epidemics.
Two years into the World Health Organization’s (WHO) ambitious effort to eliminate industrially produced trans fats from the global food supply, the Organization reports that 58 countries so far have introduced laws that will protect 3.2 billion people from the harmful substance by the end of 2021. But more than 100 countries still need to take actions to remove these harmful substances from their food supplies.
Consumption of industrially produced trans fats are estimated to cause around 500,000 deaths per year due to coronary heart disease.
“In a time when the whole world is fighting the COVID-19 pandemic, we must make every effort to protect people’s health. That must include taking all steps possible to prevent noncommunicable diseases that can make them more susceptible to the coronavirus, and cause premature death,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Our goal of eliminating trans fats by 2023 must not be delayed.”
Fifteen countries account for approximately two thirds of the worldwide deaths linked to trans fat intake. Of these, four (Canada, Latvia, Slovenia, United States of America) have implemented WHO-recommended best-practice policies since 2017, either by setting mandatory limits for industrially produced trans fats to 2% of oils and fats in all foods or banning partially hydrogenated oils (PHO).
But the remaining 11 countries (Azerbaijan, Bangladesh, Bhutan, Ecuador, Egypt, India, Iran, Mexico, Nepal, Pakistan, Republic of Korea) still need to take urgent action.
The report highlights two encouraging trends. First, when countries do act, they overwhelmingly adopt best-practice policies rather than less restrictive ones. New policy measures passed and/or introduced in the past year in Brazil, Turkey and Nigeria all meet WHO’s criteria for best-practice policies. Countries, such as India, that have previously implemented less restrictive measures, are now updating policies to align with best practice.
Second, regional regulations that set standards for multiple countries are becoming increasingly popular, emerging as a promising strategy for accelerating progress towards global elimination by 2023. In 2019, the European Union passed a best-practice policy, and all 35 countries that are part of the WHO American Region/Pan American Health Organization unanimously approved a regional plan of action to eliminate industrially produced trans fats by 2025. Together, these two regional initiatives have the potential to protect an additional 1 billion people in more than 50 countries who were not previously protected by trans fat regulations.
“With the global economic downturn, more than ever, countries are looking for best buys in public health,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives. “Making food trans fat-free, saves lives and saves money, and, by preventing heart attacks, reduces the burden on health care facilities.”
Despite the encouraging progress, important disparities persist in policy coverage by region and country income level. Most policy actions to date, including those passed in 2019 and 2020, have been in higher-income countries and in the WHO Regions of the Americas and Europe. Best-practice policies have been adopted by seven upper-middle-income countries and 33 high-income countries; no low-income or lower-middle-income countries have yet done so.
Note to editors:
Industrially produced trans fats are contained in hardened vegetable fats, such as margarine and ghee, and are often present in snack food, baked foods, and fried foods. Manufacturers often use them as they have a longer shelf life and are cheaper than other fats. But healthier alternatives can be used that do not affect taste or cost of food.
WHO recommends that trans fat intake be limited to less than 1% of total energy intake, which translates to less than 2.2 g/day with a 2,000-calorie diet. To achieve a world free of industrially produced trans fats by 2023, WHO recommends that countries:
- develop and implement best-practice policies to set mandatory limits for industrially produced trans fats to 2% of oils and fats in all foods or to ban partially hydrogenated oils (PHO);
- invest in monitoring mechanisms, e.g. lab capacity to measure and monitor trans fats in foods; and
- advocate for regional or sub-regional regulations to expand the benefits of trans fat policies.
This report launches during 2020 Global Week for Action on Noncommunicable Diseases (NCDs) from 7 to 13 September. This year's theme is accountability to ensure that commitments made by governments, policy makers, industries, academia, and civil society become a reality.
Link to Report:
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
About Resolve to Save Lives
Resolve to Save Lives, an initiative of the global health organization Vital Strategies, focuses on preventing deaths from cardiovascular disease and by preventing epidemics. Resolve to Save Lives is funded by Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. It is led by Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention. To find out more, visit: https://www.resolvetosavelives.org or Twitter @ResolveTSL and @DrTomFrieden
About Vital Strategies
Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible. To find out more, please visit www.vitalstrategies.org or Twitter @VitalStrat.
COVID-19 could reverse decades of progress toward eliminating preventable child deaths, agencies warn
With the number of under-five deaths at an all-time recorded low of 5.2 million in 2019, disruptions in child and maternal health services due to the COVID-19 pandemic are putting millions of additional lives at stake
The number of global under-five deaths dropped to its lowest point on record in 2019 – down to 5.2 million from 12.5 million in 1990, according to new mortality estimates released by UNICEF, the World Health Organization (WHO), the Population Division of the United Nations Department of Economic and Social Affairs and the World Bank Group.
Since then, however, surveys by UNICEF and WHO reveal that the COVID-19 pandemic has resulted in major disruptions to health services that threaten to undo decades of hard-won progress.
“The global community has come too far towards eliminating preventable child deaths to allow the COVID-19 pandemic to stop us in our tracks,” said Henrietta Fore, UNICEF Executive Director. “When children are denied access to health services because the system is overrun, and when women are afraid to give birth at the hospital for fear of infection, they, too, may become casualties of COVID-19. Without urgent investments to re-start disrupted health systems and services, millions of children under five, especially newborns, could die.”
Over the past 30 years, health services to prevent or treat causes of child death such as preterm, low birthweight, complications during birth, neonatal sepsis, pneumonia, diarrhea and malaria, as well as vaccination, have played a large role in saving millions of lives.
Now countries worldwide are experiencing disruptions in child and maternal health services, such as health checkups, vaccinations and prenatal and post-natal care, due to resource constraints and a general uneasiness with using health services due to a fear of getting COVID-19.
A UNICEF survey conducted over the summer across 77 countries found that almost 68 per cent of countries reported at least some disruption in health checks for children and immunization services. In addition, 63 per cent of countries reported disruptions in antenatal checkups and 59 per cent in post-natal care.
A recent WHO survey based on responses from 105 countries revealed that 52 per cent of countries reported disruptions in health services for sick children and 51 per cent in services for management of malnutrition.
Health interventions such as these are critical for stopping preventable newborn and child deaths. For example, women who receive care by professional midwives trained according to internationals standards are 16 per cent less likely to lose their baby and 24 per cent less likely to experience pre-term birth, according to WHO.
"The fact that today more children live to see their first birthday than any time in history is a true mark of what can be achieved when the world puts health and well-being at the centre of our response,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Now, we must not let the COVID-19 pandemic turn back remarkable progress for our children and future generations. Rather, it’s time to use what we know works to save lives, and keep investing in stronger, resilient health systems.”
Based on the responses from countries that participated in the UNICEF and WHO surveys, the most commonly cited reasons for health service disruptions included parents avoiding health centers for fear of infection; transport restrictions; suspension or closure of services and facilities; fewer healthcare workers due to diversions or fear of infection due to shortages in personal protective equipment such as masks and gloves; and greater financial difficulties. Afghanistan, Bolivia, Cameroon, the Central African Republic, Libya, Madagascar, Pakistan, Sudan and Yemen are among the hardest hit countries.
Seven of the nine countries had high child mortality rates of more than 50 deaths per 1000 live births among children under five in 2019. In Afghanistan, where 1 in 17 children died before reaching age 5 in 2019, the Ministry of Health reported a significant reduction in visits to health facilities. Out of fear of contracting the COVID-19 virus, families are de-prioritizing pre- and post-natal care, adding to the risk faced by pregnant women and newborn babies.
Even before COVID-19, newborns were at highest risk of death. In 2019, a newborn baby died every 13 seconds. Moreover, 47 per cent of all under-five deaths occurred in the neonatal period, up from 40 per cent in 1990. With severe disruptions in essential health services, newborn babies could be at much higher risk of dying. For example, in Cameroon, where 1 out of every 38 newborns died in 2019, the UNICEF survey reported an estimated 75 per cent disruptions in services for essential newborn care, antenatal check-ups, obstetric care and post-natal care.
In May, initial modelling by Johns Hopkins University showed that almost 6,000 additional children could die per day due to disruptions due to COVID-19.
These reports and surveys highlight the need for urgent action to restore and improve childbirth services and antenatal and postnatal care for mothers and babies, including having skilled health workers to care for them at birth. Working with parents to assuage their fears and reassure them is also important.
“The COVID-19 pandemic has put years of global progress to end preventable child deaths in serious jeopardy,” said Muhammad Ali Pate, Global Director for Health, Nutrition and Population at the World Bank. “It is essential to protect life-saving services which have been key to reducing child mortality. We will continue to work with governments and partners to reinforce healthcare systems to ensure mothers and children get the services they need.”
"The new report demonstrates the ongoing progress worldwide in reducing child mortality,” said John Wilmoth, Director of the Population Division of the United Nations Department of Economic and Social Affairs. “While the report highlights the negative effects of the COVID-19 pandemic on interventions that are critical for children’s health, it also draws attention to the need to redress the vast inequities in a child's prospects for survival and good health.”
These links will go live after 00.01 GMT 9 September.
Main report landing page: https://data.unicef.org/resources/levels-and-trends-in-child-mortality/
About UN IGME
The United Nations Inter-agency Group for Child Mortality Estimation or UN IGME was formed in 2004 to share data on child mortality, improve methods for child mortality estimation, report on progress towards child survival goals and enhance country capacity to produce timely and properly assessed estimates of child mortality. UN IGME is led by UNICEF and includes the World Health Organization, the World Bank Group and the United Nations Population Division of the Department of Economic and Social Affairs. For more information visit: http://www.childmortality.org/
When a woman has access to trusted emotional, psychological and practical support during labour and childbirth, evidence shows that both her experience of childbirth and her health outcomes can improve.
In Companion of choice during labour and childbirth for improved quality of care, WHO and HRP present updated information on the benefits of labour companionship for women and their newborns, and how it can be implemented as part of efforts to improve quality of maternity care.
The current COVID-19 pandemic is no exception.
WHO Clinical management of COVID-19: interim guidance strongly recommends that all pregnant women, including those with suspected, probable or confirmed COVID-19, have access to a companion of choice during labour and childbirth.
The importance of a chosen companion during labour and childbirth – latest evidence
Again and again, research shows that women greatly value and benefit from the presence of someone they trust during labour and childbirth.
A companion of choice can give support in practical and emotional ways.
They can bridge communication gaps between a woman in labour and the healthcare workers around her, offer massage or hand-holding to help relieve pain, and provide reassurance to help her feel in control. As an advocate, a labour companion can witness and safeguard against mistreatment or neglect.
The benefits of labour companionship can also include shorter length of time in labour, decreased caesearean section and more positive health indicators for babies in the first five minutes after birth.Implementing labour companionship as part of respectful maternal and newborn care
WHO is committed to improving women’s and newborns’ experience of care as an integral component of better maternal and newborn health, and to helping countries put evidence-based global guidance into practice.
Support for labour companionship is presented in four different WHO guidelines: intrapartum care for a positive childbirth experience, health promotion interventions for maternal and newborn health, augmentation of labour, and clinical management of COVID-19.
The new Companion of choice updates a 2016 version with an expanded section on implementing companionship during labour and childbirth. It includes a logic model to support the integration of labour companions into maternal care programmes, and case studies from Egypt, Lebanon and the Syrian Arab Republic showing design and implementation in practice.
“From global actors to professional organizations, healthcare providers to community networks and womens’ groups, everyone has a role to play in advocating for labour companions – and for ensuring every women has a right to a companion of her choice to support her during labour and childbirth. Our experience from implementation research shows that women, communities, health workers and management can be engaged to transform health services and find labour companionship solutions,” said Annie Portela, Technical Officer in the WHO Department of Maternal, Newborn, Child and Adolescent Health and Ageing.
The way forward
Many countries do not yet have policies in favour of labour companionship, and many healthcare facilities do not allow women to have a companion.
Raising awareness, engaging in discussion, and providing physical infrastructure such as curtains for privacy and a chair for the companion, are all important steps for ensuring every woman can have a chosen birth companion if she wants one.
Global efforts to improve maternal health – such as the emphasis on increasing facility-based childbirth – do not end with the reduction of maternal mortality and morbidity. Women’s preferences during childbirth must be known and must be supported.COVID-19 and labour companionship
Most health systems around the world are facing challenges of increased demand for care of people COVID-19, compounded by fear, misinformation and limitations on movement that disrupt access to care.
As countries identify ways to address COVID-19, integrating human rights protections and guarantees is not only a moral imperative, it is essential to successfully addressing public health concerns.
“Pregnancy is not put on pause in a pandemic, and neither are fundamental human rights. A woman’s experience of childbirth is as important as her clinical care,” said Dr Ӧzge Tunçalp, scientist at WHO/HRP.
“In the ‘new normal’ of COVID-19, WHO strongly recommends that the emotional, practical and health benefits of having a chosen labour companion are respected and accommodated. The pandemic must not disrupt every woman’s right to high-quality, respectful maternity care.”
Accountability Breakfast 2020: Advancing women’s, children’s and adolescents’ health during COVID-19
Hosted by The Partnership for Maternal, Newborn & Child Health (PMNCH), White Ribbon Alliance and Every Woman Every Child, the event will build on outcomes from the recent “Lives in the Balance” COVID-19 summit, and bring together a wide range of stakeholders from governments to grass-roots organizations, people with power to make changes and people calling for those changes to be made.
How have country-based malaria experts adapted to the double challenge of malaria and COVID-19? What successes have they achieved, and where are the remaining gaps? In a virtual forum on 3 September, 10 Ministry of Health representatives shared their experiences and reflections; you can watch their presentations below.
On 4 September, participants heard from senior political and health leaders from 2 regions that are heavily impacted by malaria; you will find below the presentations of WHO’s Regional Director for Africa, India’s Health Secretary and the Ugandan Minister of Health. See, also, our photo story with images and quotes from global health leaders participating in the forum.
- Dr Matshidiso Moeti, WHO Regional Director for Africa
- Dr Rajesh Bhushan, Health Secretary, Ministry of Health and Family Welfare, India
- Dr Jane Ruth Aceng, Minister of Health, Uganda
- Dr Jimmy Opigo, Ministry of Health, Uganda
- Dr Paola Marchesini, Ministry of Health, Brazil
- Dr Sovannaroth Siv, Ministry of Health, Cambodia
- Dr Dorothy Achu, Ministry of Health, Cameroon
- Dr Baltazar Candrinho, Ministry of Health, Mozambique
- Dr Harriet Pasquale, Ministry of Health, South Sudan
- Dr Neeraj Dhingra, Ministry of Health, India
- Dr Mariam Adam, WHO, Sudan
- Dr Helene Hiwat, Ministry of Health, Suriname
- Dr Olugbenga Mokuolu, Ministry of Health, Nigeria
Ending Preventable Maternal Mortality online consultation for coverage targets for Ending Preventable Maternal Mortality
Ending Preventable Maternal Mortality (EPMM) is a global initiative with the ultimate goal of ending preventable maternal mortality to support achievement of Sustainable Development Goals (SDGs) targets to attain an average global maternal mortality ratio (MMR) of less than 70 per 100 000 live births by 2030.
By 2030, all countries should reduce their Maternal Mortality Ratio (MMR) by at least two thirds of their 2010 baseline level.
The supplementary national target is that no country should have an MMR greater than 140 per 100 000 live births by 2030.
Many countries have been successful at reducing MMR, but efforts are needed to accelerate progress to achieve SDG targets in all countries. Between 2000 and 2017, the average annual rate of reduction in global maternal mortality was 2.9%, which is far short of what is needed to achieve the global SDG targets.
The EPMM management team, chaired by WHO and UNFPA, is in the process of refining the EPMM initiative. In addition to mortality reduction targets, EPMM is establishing coverage targets and milestones to track progress for 2020 to 2025. As maternal and newborn health are inextricably linked, the coverage targets will be linked with the Every Newborn Action Plan (ENAP) targets as feasible, to provide countries with opportunities for accelerating implementation of integrated country level maternal and newborn health programmes.
The purpose of this open consultation is to solicit feedback from maternal and newborn stakeholders on the proposed EPMM coverage targets for 2020-2025. Each indicator will have a global target and a national target. Sub-national targets will be defined based on the national targets identified by this online consultation.
Please click here for participating to the survey (opened until September 30, 2020).
WHO and UNFPA (on behalf of the EPMM Management Team)