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The Sorry State Of Nigeria’s Judiciary Among Others Makes The Battle Cry For A Revolution Inevitable By Francis Adewale
Lawyers“Those who make peaceful revolution impossible will make violent revolution inevitable.”
– President John F. Kennedy (1962)This week may be one of the worst weeks for Nigerian judiciary and they might have made the much vaunted Sowore’s revolution inevitable. The first salvo was the list of judges released by the National Judicial Council replete with the names of their sons and daughters as well as hangers on. Second is the farcical decision in EFCC vs Kalu where the Supreme Court “suo motu” created a new section to the constitution of Nigeria by vacating a conviction duly given under an extant law. The strange rationale by the Supreme Court is that the presiding judge, now elevated to the Court of Appeal should not have pronounced the sentence. The Court conveniently ignored the fact that the accused counsel had invited the judge to come back and continue the hearing by a formal letter!
Gone are the days when Nigerian judiciary is famously celebrated as the last bastion of defense for the common man. The days of Kayode Esho, Chukwudifu Oputa, Muhammed Uwais is long gone. Our judiciary is no more like Caesar’s wife, above board. The problem however is not necessarily down to the hydra headed monster of corruption alone but a more sinister evil called, nepotism. It is my humble opinion that an opaque process for selection of judges led us to where we found ourselves this week. And the problem did not start with the current chief justice. The dysfunction and bastardization have been long in coming, and as we will find out in this piece, the cancer has eaten deep into the fabric of this nation. The revolution is inevitable.
Lawyers
What precipitate this write up is a social media post by a good friend of mine and I obtained his permission to repost his comment with my personal edits:
“It took Orji Kalu only 4 months including Covid lockdown challenge to move from the High Court to Supreme Court to get his so called sound judgment from Supreme Court while it took ten years to get his case completed at the High Court level. Ten good years! And we are told justice in Nigeria is not cash and carry? The Supreme Court is preparing the ground for a revolution and very soon something extraordinary will take place. The same Supreme Court that will give 2021 and 2022 court date for poor defendants, sat and summarily decide a case within 4 months while cases of those facing a life sentence languish in the labyrinth of jungle justice!”My first response to the post, is to retort that the problem did not start with judiciary, but they seem to have led the “nunc dimitis” for the internment of democracy in Nigeria. The judiciary may have pushed us to the praecipe but they were not the only one. We all recalled the impunity days of PDP rule and how they ride roughshod on people’s right, celebrating acquisition of jets obtained from corrupt practices while hordes of masses suffer the indignity of scrapping for foods from the gutter. Towards the end of that era, we all thought, if we can just get a man of integrity into Aso Rock, someone who will brook no atom of corruption, we will change the country. The election of 2015 seems to have lulled Nigerians into thinking that all we need is someone or a duo with integrity, so we elect Buhari and Osinbajo, a puritan and a pastor and went home satiated. What we were not prepared for or more appositely choose to ignore is the fact that the vehicle that brought them into governance is none other than the decrepit system that PDP used to feather their nest. In the first 4 years, we were told that the problem is with the National Assembly where the legistlooters shifted their control of the vortex of power in Abuja, opposing every anti-corruption moves of the executives. Then come the last election where the ruling party now controls the executive and legislative arm, but corruption runs through the gamut of the judiciary and Aso Rock looks the other way while nepotism festers in its rank.
It is as if the cancer has completely swallowed up the entire fabric of the nation. Cases involving the poor dragged on for years while those who can afford senior advocate can get quick justice. Many warned that this will sound the death knell of democracy in Nigeria. Every attempt to even build on free and fair election has been truncated by the judiciary. What with the recent confounding judgment from Imo and Bayelsa. Our two gargantuan political parties now owned our judiciary lock, stock and barrel. They sit in smoke filled rooms to determine who will be governors, legislators and judges, and those who will play ball are readily appointed as pawns in the chest board of the Nigerian ruling class, wives, nephews, cousins, sons and daughters are made judges and senior advocates overnight without recourse to any modicum of meritocracy. A friend of mine recently quipped that the problem of nepotism is not just that it defeats meritocracy and breeds mediocrity but that it infects the entire body politics and renders it comatose. Corruption can be traced, and ill-gotten wealth recovered but nepotism is more sinister. Those who obtain position of power and authority through nepotism hold fealty only to their masters who appointed them. Such appointee will readily twist the constitution, made up section that does not exist all at the behest of their “godfather”. It is insidious and evil.
I graduated from Nigerian Law School 30 years ago, after an excellent stint at Great Ife. My class at Ife, drawn from the north, east, west middle belt and south-south has in its rank some of the best legal minds any country will be proud of. We graduated with high hopes to take on the world and change the land. Few of us found ourselves abroad on scholarship where we flourish and excel. Those in legal practice in Nigeria, either at the federal or state ministry of justice or private practice are the ones my heart bleeds for, especially those without access to members of the National Judicial Council. I have had the privilege to advance my career abroad as an attorney and public defender. I frequently sit on panels that recommend colleagues for appointment as judges in a fair, open and transparent process; something my colleagues in Nigeria could only dream of.
When I look at the state of Nigerian legal practice my heart bleeds. The career growth of colleagues in the legal profession in Nigeria is stunted not for lack of excellence but influence in the right place. Influence peddling is an art form in Nigeria and politicians used to have the exclusive preserve of selling it to the highest bidder, but our Judicial Council seems to have mastered the art. The problem will not be this pronounced if the sons and daughters they are foisting on Nigerian judiciary are steeped in the Nigerian experience or have a modicum of merit. As many of my colleagues are apt to complain, majority of the recent appointees hardly spend few years in Nigeria. They all went to schools abroad. Totally devoid of the Nigerian experience, and constantly removed from the everyday life Nigerians suffers under. Majority of them lives in the gilded mansions of their forbears in Abuja and other state capitals, where they are rarely touched by the “better angels of our nature” to use the phrase coined by Abraham Lincoln. It is therefore no surprise that they care only for what their “godfather” demand.
Let me however warns that the biggest mistake we could make is to think that the rot is only in the heart of our judiciary. Think again. Nepotism is next door, next street, next town and everywhere in Nigeria. It rampages through the land, be it North, East or West. Just look at our churches and mosques, who do you see minister or lead the prayers when the founder/visioner is not around? You guess right, if you say their sons and daughters. Gone are the days when Pa Fadayomi push to have a meritorious doctor of aerodynamics succeed him. Gone are the days when the leader of the faithful in Nigeria is selected by their aptitude in the knowledge of the Quaran. Nowadays, the exit of the leader is the beginning of the reign of the progeny. It has infected our colleges and universities, scholarship and opportunities that used to be available on merit are now exclusive preserve of the vice chancelor’s children and family members. Woe betide the school senate members that dare ask questions. Advertisement for jobs that has already been reserved for the children of the privileged are means to extort money in the form of application fees a la Abba Moro immigration recruitment scheme. A recent recruitment without advertisement at our apex bank reported by Sahara Reporters shows that successful applicants names were picked out of the rolodex of the governor. Commercial Banks staff are not an exemption, they are either recruited based on sex appeal or influential ministers/senators’ “recommendation” which doesn’t come easy for the educated but less privileged applicants.
A friend concluded an animated discussion on social media on this issue with a distinctively Nigerian resignation: “It is clear that those who do not want things to work properly in Nigeria are more powerful than those who are working towards finding solutions to our problems.” Again, my response is what do we have to lose if we embrace Omoyele Sowore’s revolution, even with its youthful disdain for experience? Especially when our current experienced leadership seems to treat the Nigerian masses with contempt. Look at it this way: They do not need our votes to win election, as they could procure midnight judgment in Abuja a la Bayelsa and Imo. They do not need to legislate to fill any lacunae in our constitutional experience as the Supreme Court proved in Kalu’s case. In fact, as long as oil flows and they have the means to fill their Cayman Island bank accounts, we may as well not exist. Greed and avarice have become the directive principle of Nigerian ruling class. To rescue ourselves from their vice grip, we need revolution now!
Francis Adewale
Tioluwanimi@gmail.comAddThis
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Compendium of research projects at the interface of tuberculosis and COVID-19
As the world comes together to tackle the COVID-19 pandemic, it is important to ensure that tuberculosis (TB) prevention and care approaches are adapting appropriately to ensure continuous and safe delivery of high-quality TB services. Considering the overlaps in TB and COVID-19 in disease presentation and transmission, the pandemic presents many questions for the TB field that may require learning through research and innovation.
To better understand challenges and opportunities in this space, the World Health Organization Global TB Programme is collating information on ongoing research at the interface of TB and COVID-19 (i.e. research which would improve TB prevention and care approaches in the context of the COVID-19 pandemic). We are developing a living compendium (listing), which will be updated periodically to make ongoing research projects and publications visible on its website. With your consent we would like to include any study you have in this compendium.
To fulfill these objectives, we need the cooperation of organizations and individuals engaged in TB/COVID-19 research to complete this one page template before 20 May 2020. We encourage you to please share this in your network, so we can reach all stakeholders widely.
We thank you in advance for your cooperation, and please do not hesitate to contact us if you have any questions.
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Statement on the third meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of coronavirus disease (COVID-19)
The third meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19), took place on Thursday, 30 April 2020, from 12:00 to 17:45 Geneva
time (CEST).Proceedings of the meeting
Members and advisors of the Emergency Committee were convened by teleconference. Membership of the Emergency Committee was expanded
to reflect the nature of the pandemic and the need to include additional areas of expertise.The Director-General welcomed the Committee, thanked them for their commitment to enhancing global public health, and provided an overview of the major achievements in the COVID-19 response since the last Emergency Committee meeting on 30 January 2020.
Representatives of the legal department and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities.The Ethics Officer from CRE provided the members and advisers with an overview of the WHO Declaration of Interest process. The members and advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests
of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and
the work of the committee. Only those committee members and advisers who were not considered to have any perceived or direct conflict of interest participated in the meeting.The Secretariat turned the meeting over to the Chair, Professor Houssin. He also welcomed the Committee and reviewed the objectives and agenda of the meeting.
The WHO Regional Emergency Directors and the Executive Director of the WHO Health Emergencies Programme (WHE) provided regional and the global situation overview. After ensuing discussion, the Committee unanimously agreed that the outbreak still constitutes
a public health emergency of international concern (PHEIC) and offered advice to the Director-General.The Director-General declared that the outbreak of COVID-19 continues to constitute a PHEIC. He accepted the advice of the Committee to WHO and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR.
The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General. The Director-General thanked the Committee for its work.
Advice to WHO
Coordination, planning, and monitoring
- Continue to lead and coordinate the global response to the COVID-19 pandemic in collaboration with countries, the United Nations (UN), and other partners.
- Work with fragile states and vulnerable countries that require additional technical, logistical and commodity support.
- Establish mechanisms to compile lessons learned from country and partner experiences and WHO missions and share the best practices and updated recommendations.
- Provide further guidance to countries about adjusting public health measures, taking into account the different epidemiological situations of the pandemic.
- Promote the inclusion of all interested countries, including low- and middle-income countries from all regions, in the Solidarity clinical trials for therapeutics and vaccines.
- Continue efforts with partners to obtain equitable access to personal protective equipment, diagnostics, and biomedical equipment essential to the pandemic COVID-19 response.
- Continue to coordinate global expert networks in epidemiology, laboratory, vaccines, clinical care, infection prevention and control, social sciences, and operational research; modelling; and other technical support.
One Health
- Work with the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including
the possible role of intermediate hosts. This should be accomplished through efforts such as scientific and collaborative field missions, which will enable targeted interventions and a research agenda to reduce the risk of similar events. - Work closely with OIE and FAO to provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.
- Work with partner organizations and countries to strengthen the global food supply chain, protect food workers, properly manage food markets, and mitigate possible disruptions to the food supply.
Essential Health Services
- Support countries to assess and manage the unintended consequences of public health measures implemented to control the COVID-19 pandemic, including gender-based violence and child neglect.
- Support countries to monitor their ability to provide and strengthen essential health services throughout a likely extended COVID-19 response. This should include, but is not limited to, essential prevention for communicable diseases, particularly
vaccination; services related to reproductive health, including care during pregnancy and childbirth; care of vulnerable populations, such as young infants and older adults; provision of medications and supplies for the ongoing management of chronic
diseases, including mental health conditions; continuity of critical inpatient therapies; management of emergency health conditions and common acute presentations that require time-sensitive intervention; and auxiliary services, such as basic
diagnostic imaging, laboratory services, and blood bank services. - Support countries to address shortages of essential medicines and health products, personal protective equipment, and other medical supplies and to establish sustainable risk management practices to prevent future shortages.
Risk communication and community engagement
- Continue risk communications and community engagement activities through the WHO Information Network for Epidemics (EPI-WIN) and other platforms to counter rumours and misinformation.
- Continue to regularly communicate clear messages, guidance, and advice about the evolution of the COVID-19 pandemic, how to reduce transmission, and save lives.
- Work with partners and countries to articulate potential long-term consequences of COVID-19 pandemic, emphasizing the need for strengthened cross-sectoral preparedness, transparency and global coordination.
Surveillance
- Clarify the testing strategy, support countries to increase testing capacity, and aim to provide equitable access to diagnostic tests and supplies in light of market failures and global shortages.
- Continue to provide guidance on monitoring disease trends using Severe Acute Respiratory Infections (SARI) and Influenza Like Illness (ILI) surveillance systems in anticipation of the co-circulation of influenza viruses.
- Develop qualitative and quantitative indicators that countries can use to assess and monitor SARS-CoV-2 transmission at all levels of public health response.
- Continue to support countries and partners by providing technical and operational guidance, training platforms, and tools such as Go.Data,to enhance case identification and contact tracing capacity, strengthen the public health workforce, and engage
communities for contact tracing. - Provide clear qualitative and quantitative indicators to monitor SARS-CoV-2 transmission to inform the adjustment of public health and social measures.
Travel and Trade
- Continue working with countries and partners to enable essential travel needed for pandemic response, humanitarian relief, repatriation, and cargo operations.
- Develop strategic guidance with partners for the gradual return to normal operations of passenger travel in a coordinated manner that provides appropriate protection when physical distancing is not feasible.
- Update recommendations on appropriate travel measures and analyze their effects on international transmission of COVID-19, with consideration of the balance between benefits and unintended consequences, including entry and exit screening, education
of travelers on responsible travel behaviour, case finding, contact tracing, isolation, and quarantine, by incorporating evidence on the potential role of pre-symptomatic and asymptomatic transmission.
To all States Parties
Coordination and Collaboration
- Support WHO leadership and continue to collaborate with WHO at all levels of the organization and with other countries to enable effective global COVID-19 pandemic preparedness and response.
- Participate in global solidarity efforts to enable access to essential supplies for all.
- Document and share lessons learned from efforts to control the pandemic, including the timing, pace, and sequencing of the application and lifting of public health measures.
Preparedness
- Strengthen preparedness for health emergencies, and build resilient health systems, incorporating lessons learned during different stages of the pandemic, and sharing experiences with other countries.
Surveillance
- Work with WHO and multisectoral partners to interrupt transmission by maintaining robust surveillance systems; enhancing capacities for case detection, testing, isolation of cases, contact tracing, quarantine of contacts, and rapid response; strengthening
the public health workforce; and actively engaging communities for contact tracing, with a particular focus on high risk areas. - In settings where testing a large proportion of suspected cases is not possible, monitor overall trends; undertake early detection through laboratory confirmation of a limited number of cases with a focus on health workers; and rapidly implement
public health measures. - Share with WHO all data necessary to conduct global risk assessments through data platforms, such as the Global Influenza Surveillance and Response System and the IHR mechanism. These data should include SARI and ILI where available.
- Use the WHO qualitative and quantitative indicators to assess and monitor SARS-CoV-2 transmission at all levels of public health response.
Additional Health Measures
- Avoid restrictions on international transport of food, medical and other essential supplies and permit the safe movement of essential personnel required for an effective pandemic response.
- Implement appropriate travel measures with consideration of their public health benefits, including entry and exit screening, education of travelers on responsible travel behaviour, case finding, contact tracing, isolation, and quarantine, by
incorporating evidence on the potential role of pre-symptomatic and asymptomatic transmission. - Implement and monitor case finding and contact tracing of travellers, using digital tools where appropriate.
- Continue to review travel and trade measures based on regular risk assessments, transmission patterns at origin and destination, cost-benefit analysis, evolution of the pandemic, and new knowledge of COVID-19.
- Engage in global efforts to respond to the challenges of COVID-19 in managing maritime vessels.
- Do not implement trade restrictions beyond those considered to be of public health importance in accordance with relevant international agreements.
- Continue to provide appropriate public health rationale to WHO for additional health measures in accordance with IHR.
Health Workers
- Prioritize the protection of the health workforce through access to training and provision of personal protective equipment, infection prevention and control measures, improved working conditions, application of WHO recommended testing strategies,
and prevention of stigma and attacks on health workers.
Food Security
- Work with WHO and partners to strengthen the global food supply chain, protect food workers, properly manage food markets, and mitigate possible disruptions to the food supply, especially for vulnerable populations.
One Health
- Promote sound practices to manage risks of trade of live animals in food markets and regulate trade of exotic wildlife.
Risk Communications and Community Engagement
- Continue to engage communities to address rumours and misinformation and keep the public informed, with a focus on vulnerable populations.
Research and development
- Address research gaps such as: routes of transmission, including the role of asymptomatic and pre-symptomatic infection droplet, contact, fomite and aerosol transmission; and viral shedding; and animal source and intermediate hosts, in collaboration
with partners. - Continue to support and conduct COVID-19 research, in line with the WHO Research and Development Blueprint, and the road map for COVID-19 vaccines, diagnostics, and therapeutics.
- Continue sharing full genome sequences to increase global understanding of virus evolution and phylogenetics and their application to public health practices.
Essential Health Services
- Maintain essential health services throughout a likely extended COVID-19 response. This should include essential prevention for communicable diseases, particularly vaccination; services related to reproductive health, including care during pregnancy
and childbirth; care of vulnerable populations, such as young infants and older adults; provision of medications and supplies for the ongoing management of chronic diseases, including mental health conditions; continuity of critical inpatient
therapies; management of emergency health conditions and common acute presentations that require time-sensitive intervention; and auxiliary services, such as basic diagnostic imaging, laboratory services, and blood bank services. - Continue to track and document the impact of COVID-19 on essential health services.
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New FAQs address healthcare workers questions on breastfeeding and COVID-19
Mothers and healthcare workers who support them have many questions and concerns about whether it is safe for mothers with confirmed or suspected COVID-19 to be close to and breastfeed their babies during the pandemic.
To address their questions, WHO has released a list of Frequently asked questions: Breastfeeding and COVID-19. The FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection when COVID-19 is suspected and draws upon other WHO recommendations on infant and young child feeding.
The FAQs aim to provide information to healthcare workers supporting mothers and families in maternity services and community settings, and communicate how the interim guidance should be implemented. Additionally, the FAQs provide information about the protective effects of breastfeeding and skin-to-skin contact, and the harmful effects of inappropriate use of infant formula milk.
Accompanying the FAQs is a decision tree which provides step-by-step guidance to health workers on how to support mothers with confirmed or suspected COVID-19 to breastfeed. It provides advice on what to do if mothers are not well enough to breastfeed, as well as appropriate hygiene measures for mothers, including wearing a medical mask if available, to reduce the possibility of the COVID-19 virus being spread to her infant.
Benefits of breastfeeding outweigh potential risks
The COVID-19 virus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. Researchers continue to test breastmilk from mothers with the infection.
WHO recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also reduces the risk of breast and ovarian cancer for the mother. Skin-to-skin contact, including kangaroo mother care, reduces neonatal mortality, especially for low birth weight newborns.
While infants and children can contract COVID-19, they are at low risk of infection. The few confirmed cases of COVID-19 in young children to date have experienced only mild or asymptomatic illness.
WHO’s recommendations on the care and feeding of infants whose mothers have confirmed or suspected COVID-19 aim to improve the immediate and lifelong survival, health and development of their newborns and infants. These recommendations consider the likelihood and potential risks of COVID-19 in infants and also the risks of serious illness and death when infants are not breastfed or when infant formula milk are used inappropriately.
WHO’s Q&A on breastfeeding and COVID-19 also provides additional infection prevention advice to mothers with confirmed or suspected COVID-19.
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New GDO country profiles available
Countries across the six WHO regions are participating in the Global Dementia Observatory (GDO), a data and knowledge exchange platform. The GDO provides easy access to country-level key dementia data and functions as the monitoring mechanism of the Global dementia action plan on the public health response to dementia 2017-2025.
GDO country profiles offer a baseline summary of countries’ progress on dementia actions outlined in the global dementia action plan. They provide an easy read snapshot of the more comprehensive data submitted by Member States across three key domains related to dementia: policies, service delivery, and information and research. GDO country profiles can be used to inform policy, service planning and health and social care systems decisions for dementia. Additional country profiles will be added as data becomes available.
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WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic.
Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.
Infections with COVID-19, insufficient measures for infection prevention and control, occupational safety and health, mental health and psychosocial support for health workers result in high rates of absenteeism and deplete the health workforce – the most precision resources for stopping the COVID outbreak.
Key Messages and Facts
COVID-19 infections among health workers:
- As of 21 April 2020 countries reported to WHO that over 35, 000 health workers were infected with COVID19. This number is significantly higher because of underreporting.
- The major occupational risks for COVID19 infection among health workers are: late recognition or suspicion of COVID-19 in patients, working in a higher-risk department, longer duty hours, sub-optimal adherence to infection prevention and control measures, such as hand hygiene practices, and lack of or improper use of personal protective equipment (PPE). Other factors have also been documented, such as inadequate or insufficient IPC training for respiratory pathogens, including the COVID-19 virus, as well as long exposure in areas in healthcare facilities where large numbers of COVID-19 patients were being cared for.
- The prevention of infections requires the use of appropriate infection prevention and control measures by all health workers, with a special focus on the adherence to hand hygiene and personal protective equipment when caring for COVID-19 patients, as well as a combination of environmental and administrative controls
- Health workers infected with COVID-19 following exposure in the workplace should have the right to employment injury benefits for occupational disease, including compensation, rehabilitation, and curative services.
Violence and stigma against health workers:
- Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression and social stigma because of their work.
- In the COVID19 crisis, shortage of staff and resources and increasing social tensions result in increased level of violence against health workers and even attacks against health care facilities. Doctors, nurses, security personnel and those who are assisting in testing, tracing contacts and enforcing physical distancing measures to stop COVID-19 experience threats and aggression.
- WHO calls upon governments, employers and workers organizations to institute measures for zero-tolerance to violence against health workers at the workplace and at the way to and from their workplace, and for intensifying social support and respect for health workers and their families.
Long working hours and psychosocial hazards for health workers:
- Many health workers have to work longer or irregular hours because of the increasing demand for health services. In addition, many countries experience shortage of health workers, or junior staff are working in demanding new roles.
- Health workers face psychosocial hazards, which are exacerbated during emergencies where demands increase and they have to experience risk of infection witness higher suffering or mortality.
- Long working hours, shift work, high workload and other psychosocial hazards can lead to fatigue, occupational burnout, increased psychological distress or declining mental health – affecting the health of health workers, and the quality and safety of care delivered.
- WHO calls for adequate staffing levels and clinical rotation in healthcare facilities, measures to minimize psychosocial hazards, and provision of access to mental health and psychosocial support for health workers.
The annual World Day for Safety and Health at Work on 28 April promotes the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.
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Maternal infections in health facilities
A clearer picture of the global impact
New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.
The
results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world.Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization.
Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world.
What is maternal sepsis and how does it lead to maternal death?
Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.
The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.
Few
previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.A better understanding of maternal infection
GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.
The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.
GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
which are not usually recorded as maternal sepsis, including post-abortion and indirect infections.The result is a more complete understanding of the frequency and impact of maternal infections in health facilities.
GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk.
Putting global numbers on maternal infection and sepsis
Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management.
Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.
Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
haemorrhage.This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.
Preventing, identifying and treating maternal infection and sepsis
Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.
GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively.
For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.
GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.
This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
providers to manage the frequency and outcome of maternal infections.An opportunity to implement evidence-based practice
GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives.
WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
on 5 May which celebrates the central role played by nurses and midwives in clean health care.In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
2017
WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.
Related publications
WHO recommendations for prevention and treatment of maternal peripartum infections
WHO Clinical practice handbook for safe abortion
Global guidelines on the prevention of surgical site infection
WHO statement on maternal sepsis
Health Topics
Infection Prevention and Control
Other links
SAVE LIVES: Clean Your Hands 5 May 2020
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WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa
Severe disruptions to insecticide-treated net campaigns and in access to antimalarial medicines could lead to a doubling in the number of malaria deaths in sub-Saharan Africa this year compared to 2018, according to a new modelling analysis released by
WHO and partners ahead of World Malaria Day (25 April).WHO urges countries to move fast and distribute malaria prevention and treatment tools at this stage of the COVID-19 outbreak in sub-Saharan Africa, and to do their utmost to safely maintain these essential malaria control services.
The analysis considers nine scenarios for potential disruptions in access to core malaria control tools during the pandemic in 41 countries, and the resulting increases that may be seen in cases and deaths.
Under the worst-case scenario, in which all insecticide-treated net (ITN) campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach
769 000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen 20 years ago.According to the World malaria report 2019, sub-Saharan Africa accounted for approximately 93% of all malaria cases and 94% of deaths in 2018. More than two-thirds of deaths were among children under the age of five.
A window of opportunity
To date, the number of reported cases of COVID-19 in sub-Saharan Africa has represented only a small proportion of the global total, though cases are increasing every week. This means that countries across the region have a critical window of opportunity
to minimize disruptions in malaria prevention and treatment and save lives at this stage of the COVID-19 outbreak.Mass vector control campaigns should be accelerated, while ensuring that they are deployed in ways that protect health workers and communities against potential COVID-19 transmission. WHO and partners commend the leaders of Benin, the Democratic Republic of the Congo, Sierra Leone and Chad
for initiating ITN campaigns during the pandemic. Other countries are adapting their net distribution strategies to ensure households receive the nets as quickly and safely as possible.Preventive therapies for pregnant women and children must be maintained. The provision of prompt diagnostic testing and effective antimalarial medicines are also essential to prevent a mild case of malaria from progressing to severe illness and death.
WHO and partners have developed guidance to ensure that those suffering from malaria can safely receive the care they need within the package of essential health services to be delivered in COVID-19 settings. Tailoring malaria interventions in COVID-19 response includes guidance on the prevention of infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chain and laboratory activities.
Note to the editor
The modelling analysis was conducted by WHO in close collaboration with partners, including PATH, the Malaria Atlas Project and the Bill & Melinda Gates Foundation.
The analysis is subject to uncertainties. It does not consider, for example, the effects of an interruption in indoor residual spraying or seasonal malaria chemoprevention (except in Burkina Faso); a suspension of these core malaria prevention tools would
also lead to considerable loss of life.In addition, there is limited understanding of the spread of COVID-19, its epidemiology and interactions with malaria. The model will be updated as such data become available, and countries will be provided with relevant information to tailor their responses
accordingly.
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