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Free psychological help extended to May 15

GEORGE TOWN: The free psychological first aid offered by Wawasan Open University (WOU) in partnership with the International College of Clinical Hypnotherapy Practitioners (ICCHP) Asia will now be extended until May 15 owing to the overwhelming response received.

The aid comes in view of the mental challenges that the people, especially families, are experiencing during the movement control order (MCO), which has now entered its 52nd day.

A total of 223 people had reached out for help in relation to the Covid- 19 pandemic from April 1 to 25.

The programme is scheduled to continue past the anticipated relaxation of the MCO to handle post-traumatic stress from the prolonged lockdown.

The team from ICCHP Asia assisted callers with tips and skills to better manage their challenging emotions.

Although the free psychological service was set up mainly for the frontliners, there were many calls from the people due to various losses and the restrictions, WOU said in a statement.

Suicidal cases were referred to the team’s on-call psychiatrists for clinical assessment, advanced help and close monitoring.

The team helped to calm distressed callers and enabled them to better cope with the current uncertainties and make informed decisions.

Where practical assistance was needed, they worked with the Members of Parliament in the areas concerned to provide urgent assistance, such as medical emergencies, ambulance services and food aid.

Sixteen professionals from ICCHP Asia, including six psychiatrists, are offering support over the telephone.

All conversations are private and confidential.

Students who are doing complete online learning remotely from their homes or elsewhere are also encouraged to call in if they are feeling stressed during the MCO period.

Feel free to call ICCHP Asia from 9am to 9pm daily from now until May 15 as per below, or email icchpcovid19@gmail.com to arrange a convenient time to chat: 0124447032 / 0169271240/ 0124856404 (9am-12pm);

0123021262 / 0124080675/ 0123741558 (12pm-3pm);

0174777746 / 0124736830 / 0164979876 (3pm-6pm);

0122212906 / 0195645868 / 0124252962 (6pm-9pm)

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May 9, 2020
WHO and European Investment Bank strengthen efforts to combat COVID-19 and build resilient health systems to face future pandemics
- WHO and the European Investment Bank enhance cooperation to support countries in addressing the health impact of COVID-19
- The first phase will address urgent needs and strengthen primary health care in ten African countries
- Enhanced WHO-EIB partnership will scale up financing to assure the chain of essential supplies, including personal protective equipment, diagnostics and clinical management
- New initiative will accelerate investment in health preparedness and primary health care with a focus on health work force, infrastructure, and water, sanitation and hygiene
- The initiative involves measures to address the growing threat of antimicrobial resistance
The World Health Organization and the European Investment Bank will boost cooperation to strengthen public health, supply of essential equipment, training and hygiene investment in countries most vulnerable to the COVID-19 pandemic.

The new partnership between the United Nations health agency and the world’s largest international public bank, announced at WHO headquarters in Geneva earlier today, will help increase resilience to reduce the health and social impact of future health emergencies.

“Combining the public health experience of the World Health Organization and the financial expertise of the European Investment Bank will contribute to a more effective response to COVID-19 and other pressing health challenges,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“WHO looks forward to strengthening cooperation with the EIB to improve access to essential supplies including medical equipment and training, and deliver better water, sanitation and hygiene where most needed. New initiatives to improve primary health care in Africa and support the EU Malaria Fund hint at the potential impact of our new partnership,” Dr Tedros concluded.

“The world is facing unprecedented health, social and economic shocks from COVID-19. The European Investment Bank is pleased to join forces with the World Health Organization as a key part of Team Europe’s efforts to address the global impact of the COVID-19 pandemic. The EU Bank’s new partnership with the WHO will help communities most at risk by scaling up local medical and public health efforts and better protect people around the world from future pandemics. This new cooperation will enable us to combat malaria, address anti-microbial resistance and enhance public health in Africa more effectively,” said Werner Hoyer, President of the European Investment Bank.

Improving local public health efforts to tackle coronavirus

The WHO and the EIB will increase cooperation to help governments in low- and middle-income countries to finance and secure access to essential medical supplies and protective equipment through central procurement.

Building resilient health systems in vulnerable countries across Africa

The WHO and the EIB will reinforce cooperation to support immediate COVID-19 needs and jointly develop targeted financing to enhance health investment and build resilient health systems and primary health care to address public health emergencies as well as accelerate progress towards Universal Health Coverage.

The partnership will benefit from the EIB’s planned 1.4 billion EUR response to address the health, social and economic impact of COVID-19 in Africa.

This will address immediate needs in the health sector and provide both technical assistance and support for medium-term investment in specialist health infrastructure.

The collaboration envisages rapid identification and fast-track approval of financing for health care, medical equipment and supplies.

The first phase of the collaboration will see public health investment in ten African countries.

Long-term collaboration to overcome market failures in global health

The agreement signed today establishes a close collaboration to overcome market failure and stimulate investments in global health, accelerating progress towards Universal Health Coverage. Increased cooperation between the WHO and the EIB will strengthen the resilience of national public health systems and enhance preparedness of vulnerable countries against future pandemics, thanks to investments in primary care infrastructure, health workers and improved water, sanitation and hygiene.

Future cooperation will strengthen the EIB’s 5.2 billion EUR global response to COVID-19 outside the European Union.

Scaling up investment to tackle antimicrobial resistance

The two organisations will also cooperate in an initiative to address investment barriers hindering development of new antimicrobial treatment and related diagnostics. Antimicrobial resistance is amongst the most significant global health threats.

The WHO and the EIB are working on a new financing initiative to support development of novel antimicrobials and address the estimated 1 billion EUR needed to provide medium-term solutions to antimicrobial resistance. Other crucial partners have been invited to join this discussion.

Improving the effectiveness of malaria treatment

Under the new agreement the EIB and WHO will support development of the EU Malaria Fund, a new 250 million EUR public-private initiative intended to address market failures holding back more effective malaria treatment.

Strengthening EIB support for healthcare, life science and COVID-19 investment

In recent years the European Investment Bank has provided more than 2 billion EUR annually for health care and life science investment.

In the context of the COVID-19 pandemic, the EIB is currently assessing over 20 projects in the field of vaccine development, diagnostic and treatment, leading to potential investments in the 700 million EUR range. The EIB will also take part in the EU’s rolling pledging effort for the coronavirus global response that is taking place on May 4th.

Background information

The European Investment Bank (EIB) is the long-term lending institution of the European Union owned by its Member States. It makes long-term finance available for sound investment in order to contribute towards EU policy goals.

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. For updates on COVID-19 and public health advice to protect yourself from coronavirus, visit www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube

WHO’s information site on the COVID-19 pandemic

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May 9, 2020
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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May 9, 2020
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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https://www.who.int/news-room/detail/28-04-2020-new-faqs-address-healthcare-workers-questions-on-breastfeeding-and-covid-19

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May 9, 2020
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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May 9, 2020
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

World Health Assembly resolution on Improving the prevention, diagnosis and clinical management of sepsis

Health Topics

Antimicrobial resistance

Infection Prevention and Control

Water Sanitation Hygiene

Other links

Global Maternal Sepsis Study

SAVE LIVES: Clean Your Hands 5 May 2020

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May 9, 2020
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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May 9, 2020
What matters to women in the postnatal period?

The right to a positive maternity healthcare experience at every stage

Each pregnancy is unique and clinical needs can change across the pregnancy, childbirth and postnatal periods. One thing that never changes is the right to a positive experience at every stage.

Achieving the best possible physical, emotional, and psychological outcomes for every individual and newborn requires health systems to take a human rights-based approach: not only preventing maternal death and morbidity, but prioritising person-centred
care and well-being.

WHO is developing new guidelines for a positive experience of postnatal care, due to be published next year. To inform these guidelines and ensure that postnatal services can better meet the needs of women and their babies, WHO undertook a qualitative
systematic review on what matters to women in the postnatal period.

Joys and challenges in the postnatal period

There is limited research about values and preferences in the postnatal period, defined by WHO as the first six weeks after childbirth. Studies have often focused on the results of specific postnatal interventions, rather than on the individuals who use
them.

‘What matters to women in the postnatal period: A meta-synthesis of qualitative studies,’ published in PLOS ONE, gives long-overdue respect to the authority of women’s own experiences. The authors review first-hand data from 15 countries
and 36 studies published after the year 2000 relating to women’s beliefs, expectations and values at this significant time of life.

These studies affirm that a positive postnatal experience can result in joy, self-confidence and enhanced capacity to thrive as both a person and a parent.

They are also vocal about the potential challenges of adjusting to a ‘new normal’ following childbirth, including changes in self-identity, relationships, and sexual behaviour.

What is a positive postnatal experience?

A positive postnatal experience for a woman will be one that responds to her specific context and preferences.

It will provide the confidence, knowledge and skills women need in the weeks following childbirth, supporting them to adjust to any changes in their intimate relationships and build new family ones. Women will be better equipped to navigate physical and
emotional challenges and to experience the dynamic achievement of personal growth.

This should be a shared responsibility, not a solitary one. Community has a critical role in enabling a positive postnatal experience, including partners, family and elders.

It is crucial that healthcare providers meet each woman’s needs, as well as those of their babies.

Supporting choices and rights to improve postnatal health outcomes

There are an estimated 303 000 maternal deaths annually, according to recent WHO figures. Most of these deaths occur postnatally.

The postnatal period is therefore a vital opportunity to improve both maternal and neonatal health and wellbeing: supporting healthy behaviors, providing life-skills education, facilitating breastfeeding, counselling women about family planning options,
supporting good mental health, preventing and treating childbirth-related complications.

Health care systems that empower individuals by supporting their values, preferences and rights are fundamental to improving maternal and newborn health outcomes.

WHO’s guidance for positive maternity care

WHO has recently released recommendations on antenatal care for a positive pregnancy experience, and on intrapartum care for a positive childbirth experience.

These publications made important clinical updates, including an increase from four to eight recommended antenatal contacts, and a revision to the decision-making process for interventions to accelerate labour.

They also uphold every woman’s right to a positive maternity care experience: one where her pregnancy does not erase her competency, autonomy and right to participate in decision-making for her own care and the care of her newborn.

Women’s choices and rights to sexual and reproductive health care, including maternity care, should be respected at every stage of the continuum of maternal and newborn care. This is true across all income settings, as well as in humanitarian settings
and during public health emergencies.

When WHO’s postnatal guidelines are released next year, they will complete the maternity care series built around what matters to women.

Rather than dividing care into three periods of antenatal, intrapartum and postnatal, these publications can be used to establish a model in which health systems support women, their baby and wider network physically, psychologically, socially and emotionally
through this significant life event.

Other resources

WHO recommendations on antenatal care for a positive pregnancy experience

WHO recommendations: intrapartum care for a positive childbirth experience

Improving early childhood development: WHO guideline

Parenting in the time of COVID-19

Q&A on COVID-19, pregnancy, childbirth and breastfeeding

Clinical management of severe acute respiratory infection when COVID-19 is suspected

Evidence on mistreatment of women during childbirth

Related topic

Breastfeeding

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May 9, 2020
MAEPS quarantine centre in Serdang to receive Covid-19 patients next week

KUALA LUMPUR: The Covid-19 Low-Risk Patient Quarantine and Treatment Centre at the Malaysia Agro Exposition Park Serdang (MAEPS) in Serdang near here is expected to receive patients next week.

Mardi Corp Group chief executive officer Zaidi Shahrim however said so far, it had no information on the exact date when the authorities would send the Covid-19 patients there for quarantine.

“MAEPS will receive low-risk Covid-19 patients from around the Klang Valley, Malacca and several areas in Perak,” he said last night in an interview via Skype that broadcast live on the Bernama 7.45 programme.

On the challenges faced throughout the process of transforming MAEPS into a quarantine centre in just a short period of time, Zaidi said said it was difficult to get supplies from contractors as many were ‘bound’ by the Movement Control Order (MCO).

“We received the instruction during the first phase of the MCO but Alhamdulillah, with the close cooperation between various government agencies such as the Ministry of Health (MOH), Nadma (the National Disaster Management Agency), the Fire and Rescue Department and private companies, we managed to realise it within four days,” he added.

Zaidi said MAEPS is equipped with hospital-like facilities such as beds, bathrooms, dressing room, toilet, lounge and so on.

Among the services provided at the centre are clinical services, ward for Covid-19 patients, resuscitation rooms to stabilise patients in emergency situations, ambulance, pharmacy, X-ray, and pathology laboratory services.

The quarantine centre which has the capacity to place up to 600 patients at any one time is coordinated by Nadma with the cooperation of the MOH, the Malaysian Armed Forces, the Fire and Rescue Department, the Civil Defence Force, the Social Welfare Department and the Public Works Department. — Bernama

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April 11, 2020
Medical Product Alert N°4/2020
This Medical Product Alert relates to a number of confirmed falsified chloroquine products circulating in the WHO region of Africa. Please note that this Medical Product Alert n°4/2020 will be updated as new reports of falsified chloroquine are received and validated by WHO.

Between 31 March and 2 April 2020, the WHO global surveillance and monitoring system on substandard and falsified (SF) medical products received nine reports of confirmed falsified chloroquine products from three countries. All reported products were identified at patient level and all have been confirmed as falsified.

This WHO medical product alert N°4/2020 refers to nine different falsified chloroquine products, with different presentations (see Table 1). It is important to note that widespread vigilance is required from all countries, regardless of where the product was originally identified.

Table 1: List of identified falsified chloroquine products, subject of WHO Alert N°4/2020

All the products listed in Table 1 are confirmed as falsified, on the basis that they deliberately/fraudulently misrepresent their identity, composition or source. Indeed, it can be noted that:
- either: the products do not contain the correct amount of the active pharmaceutical ingredient, based on the results of preliminary or full compendial analysis;
- and/or: the products were not produced by the manufacturer whose name is stated on the product labels, and the variable data (batch number and dates) of the above products do not correspond to genuine manufacturing records;
- and/or: the manufacturer whose name is stated on the product labels does not exist.
Chloroquine phosphate or sulfate is referenced on the WHO Model List of Essential Medicines for the treatment of Plasmodium vivax infection (malaria). Large clinical trials are under way to generate the robust data needed to establish the efficacy and safety of chloroquine and hydroxychloroquine in the treatment of COVID-19. These medicines are currently authorized for malaria and certain autoimmune diseases and it is important that patients do not face shortages caused by stockpiling or use outside the authorized indications.
Both chloroquine and hydroxychloroquine can have serious side effects, especially at high doses or when combined with other medicines.

The SOLIDARITY trial, led by WHO, is reviewing potential treatments for COVID-19. Please refer to WHO medical product alert n°3/2020 for general information on falsified medical products in relation to the management
of COVID-19.

For photographs of products listed in Table 1, please refer to the WHO Medical Product Alert website, and
to the annex of this medical product alert n°4/2020 (see pages 3-7).

WHO requests increased vigilance within the supply chains of countries likely to be affected by these falsified products. Increased vigilance should include hospitals, clinics, health centres, wholesalers, distributors, pharmacies and any other suppliers of medical products.

If you are in possession of the above products, please do not use. If you have used these falsified products, or if you suffer an adverse reaction/event having used these products, you are advised to seek immediate medical advice from a qualified healthcare professional, and to report the incident to the National Regulatory Authorities/National Pharmacovigilance Centre.

All medical products must be obtained from licensed, authentic and reliable sources. Their authenticity and condition should be carefully checked. Seek advice from a healthcare professional in case of doubt.

National regulatory/health authorities are advised to immediately notify WHO if these falsified products are discovered in their country. If you have any information concerning the manufacture, distribution, or supply of these products, please contact: rapidalert@who.int.

WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Products
For more information, please visit: www.who.int/medicines/regulation/ssffc/en/

Annex: Photographs of falsified chloroquine products circulating in the WHO region of Africa, Medical Product Alert N°4/2020

CAMEROON

Photographs of confirmed falsified Chloroquine Phosphate (100mg)

Photographs of confirmed falsified Chloroquine Phosphate (250mg)

Photographs of confirmed falsified Chloroquine Phosphate 250mg

DEMOCRATIC REPUBLIC OF CONGO

Photographs of confirmed falsified CLOROQUINE 250MG

Photographs of confirmed falsified Chloroquine Phosphate 250mg

NIGER

Photographs of confirmed falsified Samquine 100 (100mg)

Photographs of confirmed falsified Chloroquine phosphate tablets B.P 100mg

Photographs of confirmed falsified Niruquine (100mg)

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April 10, 2020