Investing 1 dollar per person per year could save 7 million lives in low- and lower-middle-income countries – WHO

A new WHO report shows that close to 7 million deaths could be prevented by 2030 if low- and lower-middle-income countries were to make an additional investment of less than a dollar per person per year in the prevention and treatment of noncommunicable diseases (NCDs).

NCDs – including heart disease, diabetes, cancer and respiratory disease – currently cause 7out of every 10 deaths around the world.

Yet their impact on lower income countries is often underestimated, despite the fact that 85% of premature deaths (between ages 30–69) from NCDs occur in low- and middle-income countries, making them a huge health and socioeconomic burden.

The vast majority of those deaths can be prevented using WHO’s tried and tested NCD Best Buy interventions. These include cost effective measures to reduce tobacco use and harmful use of alcohol, improve diets, increase physical activity, reduce risks from cardiovascular diseases and diabetes, and prevent cervical cancer.

Keeping people healthy reduces health costs, increases productivity and leads to longer and healthier lives.

Saving lives, spending less: the case for investing in noncommunicable diseases focuses on 76 low- and lower-middle-income countries. The report explains the NCD Best Buys and shows how every dollar invested in scaling up Best Buy actions in these countries could generate a return of up to US$ 7 – potentially US$ 230 billion by 2030.

“With the right strategic investments, countries that bear a significant amount of the NCD burden can change their disease trajectory and deliver significant health and economic gains for their citizens,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “In a world filled with uncertainty, one thing we can be certain of is that without action, NCDs will continue to be a significant threat to global health. Investing in these evidence-based policies is an investment in a healthy future.”

The report emphasizes the urgency of investing in NCD prevention and management given that the COVID-19 pandemic has highlighted how many of these diseases can worsen outcomes for COVID-19.

By investing in the 16 recommended Best Buy policies, countries will not only protect people from NCDs, but also reduce the impact of infectious diseases like COVID-19 in the future.

“Noncommunicable diseases take a terrible health and economic toll, especially on countries that can least afford it,” says WHO Global Ambassador for NCDs and Injuries Michael R. Bloomberg. “We know the prevention measures that work best, and hopefully this new report leads more governments to take the smart, cost-effective actions that can help save millions of lives around the world.”

Best Buy actions include increasing health taxes, restrictions on marketing and sales of harmful products, information and education, and vaccination. They also include actions connected to managing metabolic risk factors, such as hypertension and diabetes, in order to prevent more severe disease or complications.

The interventions are all relatively inexpensive and require little capital investment but could help avoid much of the high cost of treatment in future. The report also indicates that while each of the interventions can be implemented individually, the effects are stronger and produce a greater return on investment when introduced together. With marginalized groups often at greater risk from the physical and financial impact of NCDs, the interventions may also help to reduce health and economic inequalities.

The interventions have already been used successfully in many countries around the world, with some of the success stories highlighted in the report. International donors have also begun to use the arguments to catalyse investment in this area: in 2019 the Norwegian Government launched the first ever international development strategy on NCDs.

“Saving lives, spending less: the case for investing in noncommunicable diseases sets out a path on which countries can follow to deliver the next generation a better and healthier world. The impact of COVID-19 on people living with cardiovascular diseases, diabetes, cancer and lung diseases shows that it’s more important than ever to prioritize the investment of prevention and management of NCDs,” says Dr Bente Mikkelsen, Director for NCDs at WHO. “We call on all our partners to follow examples like Norway, who have stepped up funding and action. In a world where financial resources are increasingly constrained, this report shows where the best investments can be made and where millions of lives can be saved.”

Sierra Leone new Health Minister determined to improve the health sector

Newly appointed Minister of Health of Sierra Leone, Dr. Austin Hinga Demby, said he is confident and determined to improve the health sector in Sierra Leone.

“The burden of disease is predominantly communicable disease, with 25% of deaths due to malaria, 9% due to hypertension and 9% due to maternal causes. In outpatients, the predominant conditions are tuberculosis, human immunodeficiency virus, hepatitis, hypertension and diabetes.” (Primary Health Care and Family Medicine in Sierra Leone – by Colan Robinson).

Dr. Hinga subscribed to the oath of office as Minister of Health and Sanitation before His Excellency President Dr Julius Maada Bio, and assured that he is bringing a wealth of experience to the job. 

Dr. Hinga taking the oath of office at State House

Before his recent appointment, the US and UK trained health expert, with specialties in microbiology, epidemiology, and biostatistics, served as Deputy Director, Office of Global Health at Health Resources and Services Administration in the United States. He had also worked with the Centres for Disease Control and Preventions abroad for many years  

Dr Demby described the ceremony of his swearing-in as a milestone, adding that with his wealth of experience having served in various parts of the world, he was confident and determined to deliver. He thanked the President for the opportunity to help him transform the health sector of the small west African nation. 

“Mr. President let me assure you that I am ready for the job and I am willing to give my best. If someone is ready 100%, I am ready 200%. Sierra Leoneans are resilient people and they have demonstrated that during various challenging times such as Ebola and now COVID-19,” he said. 

In his brief remarks, the President congratulated him and wished him well, adding that his was a daunting task but with which he was remarkably familiar after helping the country during the Ebola outbreak in 2014/15 and now the with the COVID-19 pandemic.

He reminded the new minister that the country was battling with the COVID-19 and that he was taking up a ministry with challenges which he must surmount to ensure that the government realised a major pillar of its human capital development. 

Broadly protective antibodies could lead to better flu treatments and vaccines

A newly identified set of three antibodies could lead to better treatments and vaccines against influenza, according to a paper published this week in Science. 

Researchers supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, isolated the antibodies from a person sick with the flu five days after the onset of symptoms.

They found that the antibodies, which bind to neuraminidase (NA) proteins on the surface of influenza viruses, provided broad protection against several different strains of influenza when tested both in vitro and in mice.

Most influenza vaccines are designed to stimulate an immune response against another protein found on the surface of the influenza virus called hemagglutinin (HA). However, HA proteins change frequently as the virus evolves. As a result, people must receive a new seasonal influenza vaccination every year to be protected against currently circulating influenza viruses. NA proteins change more slowly than HA proteins and thus could be a good target for an influenza vaccine that provides long-term protection.

In the new study, the researchers took antibody-producing cells from the blood of a volunteer sick with H3N2 influenza and screened for monoclonal antibodies (mAbs). Monoclonal antibodies are antibodies which are designed to bind to a single target. The mAbs the researchers found were tested in the laboratory for their ability to bind to different kinds of influenza proteins. Of 45 mAbs tested, three bound to NA proteins of an H3N2 influenza virus strain. Upon further testing, these three mAbs also bound to NA proteins from multiple other types of influenza viruses.

To see whether these three mAbs could help prevent the influenza virus from infecting mammalian cells, the researchers treated mice with the mAbs and then infected them with different types of influenza viruses. The mAbs inhibited many kinds of NA proteins from different types of influenza viruses, and protected most of the mice from severe influenza infections. Mice given lethal doses of H3N2 influenza virus survived when treated with low doses of the three antibodies.

If additional testing supports these early results, the researchers suggest that these potent mAbs could become the basis for a new antiviral treatment. Additionally, the antibodies could inform development of new influenza vaccines designed to induce similar antibodies that could provide broader and longer-lasting immunity than current HA-based influenza vaccines.

Democratic Republic of Congo: Cholera vaccination campaign targets 1.2 million

Phase 2 of the biggest ever oral vaccination campaign against cholera is scheduled to take place from 3-8 July 2019 in 15 health districts in the four central provinces of the Democratic Republic of the Congo (DRC) – Kasaï, Kasaï Oriental, Lomami et Sankuru.

The second dose of vaccine confers lasting immunity against cholera, and is being targeted at 1 235 972 people over 1 year of age. The 5-day, door-to-door campaign will involve 2632 vaccinators recruited mainly from local communities, whose job it is to administer the oral cholera vaccine, fill in vaccination cards and tally sheets, and compile a daily summary of the teams’ progress.

In parallel, 583 community mobilizers have been selected – 1 mobilizer for every 3 teams in urban areas and 1 mobilizer for every 2 teams in rural districts.

Their job is to alert local people that vaccinators will visit their homes. They will use loudspeakers to spread the message, particularly in the early evening.

The campaign is organized by the Ministry of Health with technical, logistic and financial support from WHO, Gavi, the Vaccine Alliance and the Global Task Force on Cholera Control (GTFCC).

It is the second such campaign in this central region of the DRC. 1 224 331 people over 1 year of age were vaccinated during the first round in late December 2018.

The purpose of the vaccination campaign is to contain the serious epidemic which resulted in 9154 presumed cases and 458 deaths (case-fatality rate of 5%) in the 5 affected provinces in Kasaï region between January and December 2018.

This cholera vaccination campaign marks the intensification of our response in the DRC,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, “WHO and our partners are working with national authorities to rollout the vaccine, which comes in addition to multiple interventions introduced since the beginning of the cholera epidemic, including sanitation and water quality control in the affected areas, many of which have little access to a safe water supply.”

Right now, with the second dose, the preventive campaign for which 1 235 972 doses of oral vaccine have been laid in will ensure coverage of all at-risk areas in this central region of the DRC. The vaccines have been provided from global cholera vaccine stocks managed by Gavi, the Vaccine Alliance.

“This vaccination campaign will play a key role in bringing this cholera outbreak under control,” said Dr Seth Berkley, CEO of Gavi. “The DRC is currently going through an unprecedented combination of deadly epidemics, with Ebola and measles outbreaks also causing untold misery across the country. It is vital that the global effort to control these outbreaks continues to receive support: we cannot allow this needless suffering to continue.”

In 2018 the DRC reported a cumulative total of 29 304 suspected cholera cases and more than 930 deaths (case-fatality rate 3.17%). Since the start of 2019 and up to epidemiological week 23 (3-9 June), at least 12 247 suspected cases of cholera and 279 deaths (case-fatality rate 2.2%) have already been reported in 137 health districts in 20 of the 26 provinces of the DRC. Cholera is a highly contagious communicable disease transmitted via contaminated water or food. It causes severe diarrhoea and dehydration which must be treated immediately to avoid death after only a few hours and to stop the disease from spreading on a massive scale throughout an environment at risk.

“This cholera vaccination campaign in the 4 central provinces of the DRC is crucial to stop the disease from gaining a permanent foothold in the target areas of Kasaï, Lomami and Sankuru. The vaccinators will visit every household, even in the remotest areas, to administer the second dose vital for ensuring long-term protection against cholera,” explains Dr Deo Nshimirimana, Acting WHO Representative in the DRC.

“We must not forget that oral cholera vaccine works in conjunction with other effective prevention measures such as improvement of sanitary conditions, individual and collective hygiene including regular hand-washing (with soap) after going to the bathroom or before meals, and lobbying authorities to improve access to drinking water.”

Women are more affected by HIV/AIDS than men in many Sub-Saharan African countries

The World Bank new dashboards in the Health, Nutrition and Population Portal  has provided a window into the healthcare challenges affecting countries through which efforts could be made with more effective approaches to address the health needs of a particular country.

---

Women are more vulnerable to HIV than men, especially in Sub-Saharan Africa. In 20 Sub-Saharan African countries, more than 60 percent of the HIV affected population are women. In other regions, less than half of the HIV affected population are women (South Asia: 33%, Latin America and Middle East: 38%). According to the UNAIDS, structural, behavioral and biological factors are compounding the risk of HIV infection among women.

Source: Health Dashboard > Topic > HIV/AIDS http://datatopics.worldbank.org/health/health

Changes are seen in Cause of Death in low-income countries

Cause of Death is mainly classified into three categories:

1. Communicable diseases and maternal, prenatal and nutrition conditions,
2. Non-communicable diseases, and
3. Injury.

In high-income countries, the majority of deaths are caused by non-communicable diseases such as ischaemic heart disease and stroke, while the majority of deaths are caused by communicable diseases in low-income countries. However, we can see changes in the cause of death in low-income countries for the past 16 years. In Zambia, Kenya, Malawi, Niger and Botswana, with the highest proportion of cause of death by communicable diseases, more than 78 percent of the deaths were caused by communicable diseases in 2000. However, the proportion of cause of death by non-communicable diseases has increased in these countries in 2016. In Botswana, the number of deaths caused by communicable disease has rapidly declined, but the deaths by non-communicable diseases has increased between 2000 and 2016.

The risk of impoverishing expenditure for surgical care is very low in North America and Europe, but high in Sub-Saharan Africa and South Asia

The risk of impoverishing expenditure for surgical care is high in many countries in Sub-Saharan Africa and South Asia. The majority of people in these regions cannot afford to pay for surgical care. People in these regions are at risk of being pulled into poverty when they pay for surgical and anesthesia care, due to direct out-of-pocket payments for the care. In North America and Europe the risk is very low because of their risk-sharing system.

Many people still live in households without basic hand washing facilities

Safe hygiene practices are crucial for human health. Hand washing with soap and water is used to monitor Sustainable Development Goal 6 (Clean water and sanitation), and is considered one of the most cost-effective interventions to prevent diarrhea and respiratory infections, especially among children. In 38 of the 70 countries with data, less than half of the people live in households without basic hand washing facilities in 2015.

Source: Health Dashboard > Topic > Water and Sanitation http://datatopics.worldbank.org/health/health

 

Culled from http://blogs.worldbank.org

BY HARUNA KASHIWASE . CO-AUTHORS: YATAO LU, EMI SUZUKI, YING CHI