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Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

“We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
Prevention and Control, Ministry of Health Indonesia. “Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
remarkable progress.

In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
disease prevention and management.

“In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
blood preventing mosquitoes to transmit¹ the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
as its implementation unit.

In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole² which are
largely distributed by volunteer community health workers³.

“Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”.

Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
insufficient medicines.

Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
States.

Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
Leptospirosis (not classified as NTD) is also widespread.

Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

Global progress

The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

Sixteen countries⁴ and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.

Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

The disease

Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
system and the kidneys and alter the body’s immune system.

When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

¹Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
in endemic islands in the Pacific.

²In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
It is recommended annually in settings where its use is expected to have the greatest impact.

³Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
communities to educate families. Their contribution in promoting health has been significant in the country.

⁴Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

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https://www.who.int/news-room/detail/29-04-2020-indonesia-firmly-committed-to-eliminating-lymphatic-filariasis-as-a-public-health-problem

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May 9, 2020
Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies
Our Vision and Mission

Grounded in a vision of a planet protected from human suffering
and the devastating social and economic consequences of
COVID-19, we, an initial group of global health actors (BMGF,
CEPI, Gavi, Global Fund, UNITAID, Wellcome Trust, WHO) and
private sector partners and other stakeholders, are launching
a landmark, global and time-limited collaboration to accelerate the
development, production and equitable global access to new COVID-19 essential health technologies.

We know that as long as anyone is at risk from this virus, the entire
world is at risk – every single person on the planet needs to be
protected from this disease.

We agree that alongside evidence-based public health measures,
innovative COVID-19 diagnostics, therapeutics and vaccines are
needed – in record time and at record scale and access – to save
millions of lives and countless trillions of dollars, and to return
the world to a sense of ‘normalcy’.

We recognize the significant amount of critical work, investment
and initiatives already ongoing around the world to expedite
the development and deployment of innovative COVID-19 related
products and interventions.

We appreciate that while development and deployment of
innovative products is essential, it will not be enough. We must
simultaneously and urgently accelerate the strengthening of
sustainable health systems and capacities to enable delivery of
the new COVID-19 tools to those who need them and to mitigate
the knock-on impact on other diseases.

We remember lessons from the past, which have shown that even
when effective tools are available to the world, too often some
are protected, while others are not. This inequity is unacceptable –
all tools to address COVID-19 must be available to all. In the fight
against COVID-19, no one should be left behind.

We understand we cannot do this alone, and that we need to
work together in unprecedented and inclusive partnership with all
stakeholders – political leaders, public and private sector partners,
civil society, academia, and all other stakeholders across society
– jointly leveraging our comparative strengths and respective
voices to drive towards collective solutions, an accelerated path,
and access for all. We are stronger, faster and more effective
working together.

Our Mission is not only accelerated development and availability
of new COVID-19 tools – it is to accelerate equitable global access
to safe, quality, effective, and affordable COVID-19 diagnostics,
therapeutics and vaccines, and thus to ensure that in the fight
against COVID-19, no one is left behind.

Our Commitment
1. We commit to the shared aim of equitable global
  access to innovative tools for COVID-19 for all.
2. We commit to an unprecedented level of partnership
  – proactively engaging stakeholders, aligning and
  coordinating efforts, building on existing collaborations, collectively devising solutions, and grounding
  our partnership in transparency, and science.
3. We commit to create a strong unified voice to
  maximize impact, recognizing this is not about
  singular decision-making authority, but rather
  collective problem-solving, interconnectedness and
  inclusivity, where all stakeholders can connect and
  benefit from the expertise, knowledge and activities
  of this shared action-oriented platform.
4. We commit to build on past experiences towards
  achieving this objective, including ensuring that
  every activity we undertake is executed through the
  lens of equitable global access, and that the voices
  of the communities most affected are heard.
5. We commit to be accountable to the world, to
  communities, and to one another. We are coming
  together in the spirit of solidarity, and in the service
  of humanity, to achieve our mission and vision.
Our Call

We ask the global community and political leaders to
support this landmark collaboration, and for donors to
provide the necessary resources to accelerate achievement
of the objectives of this global collaboration, capitalizing
on the opportunity provided by the rolling pledging
campaign that will start on 4 May 2020.

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https://www.who.int/news-room/detail/24-04-2020-commitment-and-call-to-action-global-collaboration-to-accelerate-new-covid-19-health-technologies

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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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https://www.who.int/news-room/detail/23-04-2020-who-urges-countries-to-move-quickly-to-save-lives-from-malaria-in-sub-saharan-africa

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May 9, 2020
A meeting on digital innovations, TB and implementation research organised by WHO and the European Respiratory Society

WHO’s Global Tuberculosis Programme (WHO/GTB) and the European Respiratory Society convened a technical meeting on digital innovations, TB and implementation research, in Geneva on 7 February 2020. This meeting brought together funders,
partners, representatives of national TB programmes, civil society and scientists to discuss the challenges and opportunities when evaluating, integrating and scaling up digital technologies under programmatic settings. Specifically, this meeting
sought to receive input on the elements of a toolkit on implementation research that is currently being developed by WHO/GTB and the Special Programme for Research and Training in Tropical Diseases (TDR) to support evidence-informed use of
digital technologies under programmatic settings. Th etoolkit will be launched in mid-2020. Considering that several countries are updating their national TB strategic plans and preparing funding proposals for submission to the Global Fund, this meeting
also sought to create mutual understanding on the importance of resourcing implementation science to bridge the divide between research and practice.

This present meeting, is the latest in a series of efforts by WHO/GTB to facilitate the meaningful use of digital technologies for TB prevention and care. It
was preceded by a one-day workshop on 6 February held at the same venue for partner agencies of the ASCENT project. ASCENT is a UNITAID-funded project that started in 2019 with the aim of increasing demand and adoption of affordable digital technologies for TB medication adherence. The project is led by KNCV in partnership with Aurum Institute for Health
Research, PATH and the London School of Hygiene and Tropical Medicine. Activities are running in Ethiopia, the Philippines, South Africa, Ukraine and Tanzania UR. This was the first in a series of annual meetings that will be coordinated by the WHO/GTB
to assess progress in implementation of country activities and results from the interventions.

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https://www.who.int/news-room/detail/26-04-2020-a-meeting-on-digital-innovations-tb-and-implementation-research-organised-by-who-and-the-european-respiratory-society

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April 10, 2020
Glossary of Youth: Its Education, Regimen, and Hygiene, by G. Stanley Hall

GLOSSARY

AGAMIC. Unmarried; unmarriageable, sometimes non-sexed.

AGENIC. Lacking in reproductive power; sterile.

AMPHIMIXIS. That form of reproduction which involves the mingling of substance from two individuals so as to effect a mixture of hereditary characteristics. It includes the phenomena of conjugation and fertilization among both unicellular and multicellular organisms.

ANABOLISM. See METABOLISM.

ANAMNESIC. Pertaining to or aiding recollection.

ANEMIC. Deficient in blood; bloodless.

ANTHROPOMORPHISM. The attributing of human characteristics to natural, supernatural, or divine beings.

ANTHROPOMETRY. Science of measurement of the human body.

ARTIFACT. Any artificial product.

APHASIA. Impairment or lose of the ability to understand or use speech.

ASSOCIATIONISM. The psychological theory which regards the laws of association as the fundamental laws of mental action and development.

ATAVISTIC. Pertaining to reversion through the influence of heredity to remote ancestral characteristics.

ATAXIC. Pertaining to inability to coördinate voluntary movements; irregular.

CALAMO-PAPYRUS. Reed papyrus or pen-paper.

CATABOLISM. See METABOLISM.

CATHARSIS. Purgation or cleansing. Aristotle’s esthetic theory that little renders immune for much.

CEREBRATION. Brain action, conscious or unconscious.

CHOREA. St. Vitus’s dance; a nervous disease marked by irregular and involuntary movements of the limbs and face.

CHRESTOMATHY. A collection of extracts and choice pieces.

CHRISTENTHUM. The Christian belief; the spirit of Christianity.

COMMANDO EXERCISES. Gymnastic exercises whose order is dependent upon the spoken command of the director.

CORTEX. The gray matter of the brain, mostly on its surface.

CORTICAL. Pertaining to the cortex.

CRANIOMETRY. The measurement of skulls.

CRYPTOGAMOUS. Having an obscure mode of fertilization; or, of plants that do not blossom.

CULTUS. A system of religious belief and worship.

DEUTSCHENTHUM. The spirit of the German people.

DIATHESIS. A constitutional predisposition.

EPHEBIC. Pertaining to the Greek system of instruction given to young men to fit them for citizenship; adolescent.

EPIGONI. Successors; followers who only follow.

EPISTEMOLOGY. The theory of knowledge; that branch of logic which undertakes to explain how knowledge is possible and to define its limitations, meaning, and worth.

EUPEPTIC. Having good digestion.

EUPHORIA. The sense of well-being; of fullness of life.

EVIRATION. Emasculation; loss of manly characteristics.

FERAL. Wild by nature; untamed; undomesticated.

FORMICARY. An artificial ants’ nest.

GEMÜTH. Disposition; the entire affective soul and its habitual state.

HEBETUDE. Dullness; stupidity.

HEDONISTIC. Relating to hedonism, that form of Greek philosophy which taught that pleasure is the chief end of existence.

HETAERA. A Greek courtesan. This class was often highly trained in music and social art, and represented the highest grade of culture among Greek women.

HETEROGENY. (1) The spontaneous generation of animals and vegetables, low in the scale of organization, from inorganic elements. (2) That kind of generation in which the parent, whether plant or animal, produces offspring differing in structure or habit from itself, but in which after one or more generations the original form reappears.

HETERONOMOUS. Having a different name.

HOROLOGY. The science of measuring time and of constructing instruments for that purpose.

HYGEIA. The Greek goddess of health; health.

HYPERMETHODIC. Methodic to excess; overmethodic.

HYPERTROPHY. Excessive growth.

INDISCERPTIBLE. Incapable of being destroyed by separation of parts.

INHIBITION. Interference with the normal result of a nervous excitement by an opposing force.

IRRADIATION. The diffusion of nervous stimuli out of the path of normal discharge which, as a result of the excitation of a peripheral end organ may excite other central organs than those directly connected with it.

KINESOLOGICAL. Pertaining to the science of tests and measurements of bodily strength.

KINESOMETER. An instrument for measuring muscular strength.

MEDULLATION. The investment of nerve fibers with a protective covering or medullary sheath, consisting of white, fat-like matter.

MERISTIC. Pertaining to the levels or spinal and cerebral segments of the body.

METABOLISM. The act or process by which, on the one hand, dead food is built up into living matter—anabolism, and by which, on the other, the living matter is broken down into simpler products within a cell or organism—catabolism.

METAMORPHOSIS. Change of form or structure; transformation.

METEMPSYCHOSIS. The doctrine of the transmigration of the soul from one body to another.

MONOPHRASTIC. Pertaining to or consisting of a single phrase.

MONOTECHNIC. Pertaining to a single art or craft.

MORPHOLOGY. The science of form and structure of plants and animals without regard to function.

MYOLOGY. The scientific knowledge of the muscular system.

MYTHOPOEIC. Producing or having a tendency to produce myths.

NOETIC. Of, pertaining to, or conceived by, mind.

NUANCE. Slight shade; difference; distinction; degree.

ORTHOGENIC. Pertaining to right beginning and development.

ORTHOPEDIC. Relating to the art of curing deformities.

OSSUARY. A depository of dry bones.

PALEOPSYCHIC. Pertaining to the antiquity of the soul.

PANTHEISTIC. Relating to that doctrine which holds that the entire phenomenal universe, including man and nature, is the ever-changing manifestation of God, who rises to self-consciousness and personality only in man.

PATRISTICS. That department of study occupied with the doctrines and writings of the fathers of the Christian Church.

PHOBIA. Excessive or morbid fear of anything.

PHYLETICALLY. In accordance with the phylum or race; racially.

PHYLETIC. Pertaining to a race or clan.

PHYLOGENY. The history of the evolution of a species or group; tribal history; ancestral development as opposed to ontogeny or the development of the individual.

PHYLUM. A term introduced by Haeckel to designate the great branches of the animal and vegetable kingdoms. Each phylum may include several classes.

PICKELHAUBE. The spiked helmet of the German army.

PLANKTON. Sea animals and plants collectively; distinguished from coast or bottom forms and floating in a great mass.

POLYGAMIC (LOVE). Pertaining to the habit of having more than one mate of the opposite sex.

POLYPHRASTIC. Having many phrases; pertaining to rambling, incoherent speech.

POST-SIMIAN. Pertaining to an age later than that in which simian or monkey-like forms prevailed.

PRENUBILE. Pertaining to the age before sexual maturity or marriageability is reached.

PRIE DIEU. A praying desk.

PROPEDEUTIC. Preliminary; introductory.

PROPHYLACTIC. Any medicine or measure efficacious in preventing disease.

PSEUDOPHOBIAC. Pertaining to a morbid condition in which the subject is continually in fear of having said something not strictly true.

PSYCHOGENESIS. The origin and development of soul.

PSYCHONOMIC. Pertaining to the laws of mind.

PSYCHOSIS. Mental constitution or condition; any change in consciousness, especially if abnormal.

PUBERTY. The age of sexual maturity.

PUBESCENT. Relating to the dawning of puberty.

PYGMOID. Of pygmy size and form.

RABULIST. A chronic wrangler; one who argues about everything.

SCHEMA. A synopsis; a summary. In the Kantian sense, a general type.

SCHEMATISM. An outline of any systematic arrangement; an outline.

SUPERFOETATION. A second conception some time after a prior one, by which two foetuses of different age exist together in the same female. Often used figuratively.

TEMIBILITY. (From Italian temibile, to be feared.) The principle of adjustment of penalty to crime in just that degree necessary to prevent a repetition of the criminal act.

TIC. A nervous affection of the muscles; a twitching.

TRANSCENDENTAL. In the Kantian system having an a priori character, transcending experience, presupposed in and necessary to experience.

TRAUMATA. Wounds.

TRAUMATISM. A wound; any morbid condition produced by wounds or other external violence.

VERBIGERATION. The continual utterance of certain words or phrases at short intervals, without reference to their meaning, as seen in insane Gedankenflucht or rapid flight of thought.

Extract from Youth: Its Education, Regimen, and Hygiene, by G. Stanley Hall

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April 9, 2020