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Chagas disease: providing free paediatric medicine can enhance diagnosis and treatment
Documentation resulting in the donation of an important antiparasitic medicine for the treatment of Chagas illness to the World Health Organization (WHO) is within the ultimate stage of preparation.

A 3-year settlement, between the Mundo Sano Foundation¹ (Brazil) and WHO, is anticipated to make obtainable 108 000 tablets of the paediatric formulation of benznidazole² – a first-line medicine towards Chagas illness. Treatment³ with benznidazole within the early levels of an infection can treatment Chagas illness.

“Making benznidazole freely obtainable for the treatment of newborns till the age of 18 might be a game-changer within the battle towards Chagas illness” mentioned Dr Mwelece Ntuli Malecela, Director, WHO Department of Control of Neglected Tropical
Diseases. “This is not going to solely save future generations from growing life-threatening and deadly issues however can even increase up diagnosis and treatment.”

Each yr, an estimated 15 000 youngsters are born from contaminated moms. A freely obtainable paediatric presentation of benznidazole with correct dosage is essentially anticipated to contribute to deal with congenital infections.

“Treating newborns and youngsters was the lacking hyperlink, as we transfer decisively to advocate for the mixing of diagnosis of an infection amongst pregnant ladies and women of child-bearing age into different surveillance programmes, together with HIV and syphilis” mentioned Dr Pedro Albajar Vinas, Medical Officer with WHO’s Department of Control of Neglected Tropical Diseases. “Diagnosing and treating ladies of this age group earlier than being pregnant can increase successfully stop congenital transmission.”

The settlement

The donation by Mundo Sano Foundation at some point of the settlement includes benznidazole:
- 105,000 tablets of 100mg
- 3,000 tablets of 12.5mg
Furthermore, the Foundation might donate funds of as much as US$100 000 at some point of the settlement to help actions related to distribution of medicines and conferences. The Foundation additionally makes provision for an extension of this settlement past
the required length of three years.

The illness

Chagas illness, often known as American trypanosomiasis, is a doubtlessly life-threatening sickness brought on by the protozoan parasite Trypanosoma cruzi (T. cruzi).

Although appreciable progress has been achieved, significantly in decreasing vector transmission and screening of blood and organ provide, reaching and diagnosing individuals most affected has been a problem.

Currently, under-diagnosis of Chagas illness instances is as excessive as 90% and under-diagnosis of congenital transmission is believed to be even greater.

Globally, an estimated 6-7 million individuals are contaminated with T. cruzi.

The illness is discovered primarily in endemic areas of 21 continental Latin American international locations⁴. But motion of individuals to city areas and to different continents has expanded its transmission by means of non vectorial routes, akin to blood transfusion, congenital
transmission, organ transplants and oral meals contamination.

Considering the illness as a rising public well being drawback in lots of international locations, the World Health Assembly – WHO’s decision-making physique – determined in May 2019 to commemorate World Chagas Disease Day on 14 April.

The inaugural celebration occurs this yr.

¹Mundo Sano is a nonprofit worldwide basis working with the general public and personal sectors, academia, and different worldwide organizations to supply options to the affected communities and generate scientific information. In 2012, it led a public-private consortium in 2012 to provide benznidazole in Argentina.

²In 2017, the United States Food and Drug Administration (FDA) accepted benznidazole for the treatment of kids aged 2–12, making it the primary treatment accepted within the United States for Chagas illness.

³ Nifurtimox can be 100% efficient in curing Chagas illness if given quickly after onset of an infection, together with instances of congenital an infection. It is donated by Bayer who pledged greater than 7.5 million tablets for the interval 2012-2021.

⁴ Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela
(Bolivarian Republic of).

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April 3, 2020
WHO to continue support for Chagas disease programme that promotes patient self-care
The World Health Organization (WHO) and the Catalan Ministry of Health say they’ll collectively support the dissemination of a programme that gives support to sufferers affected by Chagas disease to handle their very own well being and promote self-care.

The Catalonian ‘Expert Patient Programme on Chagas disease’ includes interplay and sharing of knowledge amongst individuals affected by the disease and is performed by an knowledgeable patient. The programme is taken into account to have completed very properly because it was first initiated in 2017.

“Over the previous few years we now have seen exceptional improve in consciousness and confidence amongst sufferers to pursue medical care and follow-up with physicians” stated Dr Pedro Albajar Vinas, who’s accountable for WHO’s Chagas disease programme. “When sufferers discuss to each other there may be higher deal with general perceptions of well being, life-style, bettering shallowness, self-care and particular person satisfaction.”

The programme additionally encourages self-responsibility and features as a part of the Chronic Disease Prevention and Care Programme of the Government of Catalonia. It is predicated on three key approaches:
- support supplied by sufferers and observing professionals to these in power part of the disease;
- promote interplay in teams by 9 fastidiously deliberate periods;
- consider efficiency of previous periods by questionnaires earlier than a brand new session begins.
Many individuals who attended the programme over time say they might suggest it to household and associates because it vastly helps to enhance information about disease.

Initiators of the programme are assured that the methodology used, and classes discovered can type a part of a broader technique to push for complete care for a disease that continues to be largely uncared for. For instance, regardless of the efforts of the previous decade, the worldwide detection fee for Chagas disease is lower than 10%.

Through this settlement, WHO will present support in facilitating the interpretation of supplies and paperwork in languages utilized in its Member States in addition to help within the improvement of any mobile-based software if the necessity arises. The Government of Catalonia will print and distribute for advocacy functions.

To promote international advocacy for the disease, the World Health Assembly – WHO’s decision-making physique – in 2019 adopted a call to have a good time World Chagas Disease Day on 14 April.

The disease

Chagas disease was as soon as confined to rural areas of Latin American international locations the place the primary route of transmission is vectorial transmission.

But over the previous many years, the disease has been more and more reported in lots of international locations exterior Latin America primarily due to motion of populations and migration.

According to WHO estimates, round 6-7 million individuals are contaminated with Trypanosoma cruzi – the protozoan parasite that causes Chagas disease.

Vectorial transmission happens when people are available in contact with the faeces or urine of triatomine bugs (referred to as ‘kissing bugs’, amongst many different native names).

These bugs – the vectors that carry the parasites – reside within the wall or roof cracks of properties – the place they disguise in the course of the day and lively at evening after they feed on human blood. They often chew an uncovered space of pores and skin such because the face (therefore its widespread identify ‘kissing bug’).

Right after a chew, the bug defecates/urinates shut to the chew space. The parasites enter the physique when the particular person instinctively reacts to the chew and smears the bug faeces or urine into the chew, the eyes, the mouth, or into any pores and skin break.

The parasite may also be transmitted by:
- consumption of meals contaminated with T. cruzi by, for instance, contact with faeces or urine of contaminated triatomine bugs or marsupials (this type of transmission sometimes causes outbreaks with extra extreme morbidity and better mortality – infecting teams of individuals concurrently with extra frequent instances of extreme disease and better variety of deaths);
- blood or blood product transfusion from contaminated donors;
- passage from an contaminated mom to her new child throughout being pregnant or childbirth;
- some organ transplants utilizing organs from contaminated donors; and
- laboratory accidents.
There is not any vaccine in opposition to Chagas disease. Domiciliary vectorial management and transfusional management, along with congenital transmission, stay the simplest strategies of stopping transmission in Latin America.

Chagas disease was named after Carlos Ribeiro Justiniano Chagas, a Brazilian doctor and researcher who found the disease in 1909.

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April 3, 2020
Legal Issues Arising From Management Of Covid-19 Patients By Ahmed Adetola-Kazeem

A lot of legal issues are bound to arise as an aftermath of the outbreak of Coronavirus otherwise referred to as COVID-19. There is therefore a need to shed light on some of the issues that may arise and how to navigate them. This article will x-ray the rights of patients, the rights of health workers and the basic minimum obligations of the government.

The Code of Medical Ethics in Nigeria 2008 lists acts that constitute professional negligence. Rule 29.4 of the Code outlines some of these acts as follows:-

a)      Failure to attend promptly to a patient requiring urgent attention when the practitioner was in a position to do so;

b)     Manifesting incompetence in the assessment of a patient;

c)      Making an incorrect diagnosis particularly when the clinical features were so glaring that no reasonable skillful practitioner could have failed to notice them;

d)     Failure to advise, or proffering wrong advice to a patient on the risk involved in a particular operation or course of treatment, especially if such an operation or course of treatment is likely to result in serious side effects like deformity or loss of organ, or function;

e)      Failure to obtain the informed consent of the patient before proceeding on any surgical procedure or course of treatment when such consent was necessary;

f)       Making a mistake in treatment e.g. amputation of the wrong limb, carelessness that results in the termination of a pregnancy, prescribing the wrong drug, or dosage in error for a correctly diagnosed ailment, etc;

g)     Failure to refer, or transfer a patient in good time, when such a referral or transfer was necessary;

h)     Failure to do anything that ought reasonably to have been done under any circumstance for the good of the patient;

i)       Failure to see a patient as often as his medical condition warrants or to make appropriate comments in the case notes of the practitioner’s observations and prescribed treatment during such visits. It also includes failure to communicate with the patient or with his relatives as may be necessary with regards to any developments, progress or prognosis in the patient’s condition.

Rule 11.2 of the 2008 Code of Medical Ethics in Nigeria provides that, “A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died.”

             Rule 44 of the Code of Medical Ethics has extensive provisions on Confidentiality and when disclosure of information can be made. The Rule provides in part that:

“Disclosure of information on the patient by the doctor can only be made following an informed consent of the patient in writing. It is clear that the ethic covers even such information as induced abortion, venereal disease, attempted suicide, concealed birth and drug dependence but would exclude situations in which a discretionary breach of confidentiality is necessary to protect the patient or the community from danger and this must be made clear to the patient at the time of the confidential disclosure. Where statutory notification of disease is involved, the consent of the patient is not required.”

            Confidentiality: To Disclose Identity Of Covid-19 Patients Or Not To Disclose?

COVID-19 is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.[1]

The Federal Ministry of Health confirmed the first case of COVID-19 in Nigeria on the 27th of February 2020. It is the case of an Italian citizen who works in Nigeria and returned from Milan, Italy to Lagos, Nigeria on the 25th of February 2020. In reaction to the report, the social was divided between those who want the name of the Italian disclosed and those that preferred it remains confidential. The outcry was even more when the Chief of Staff to the President tested positive according to reports from various media houses[2], but the Minister of Health decided to keep mute on the identity of the President’s aide who contacted the virus, citing confidentiality.

It will ordinarily be wrong to disclose the medical status of someone infected with COVID-19, for instancethe case of the Italian who was the index case. However in view of the proviso to Rule 44 of the Code of Medical Ethics 2008 which provides that a discretionary breach of confidentiality is necessary in order to protect the community from danger, I am of the view that the test results of popular figures who hold strategic offices like the Chief of Staff to the President or a Governor must be disclosed to guaranty public safety. This is necessary in view of the countless number of people from all works of life they come in contact with on a daily basis. It will be correct to have made their status public in the overriding interest of the public, since it will enable those who have come in contact with them isolate, just like we have seen in the cases of the British Prime Minister, the Bauchi State Govenor, Prince Charles, the First Lady of Canada and many more. We must commend those who announced their status in public themselves-it is the best thing to do in the interest of humanity

The World Health Organization (WHO) provides additional guidelines for the management of coronavirus patients specifically.[3]

Health workers should:

•follow established occupational safety and health procedures, avoid exposing others to health and safety risks and participate in employer-provided occupational safety and health training;

•use provided protocols to assess, triage and treat patients;

•treat patients with respect, compassion and dignity;

•maintain patient confidentiality;

•swiftly follow established public health reporting procedures of suspect and confirmed cases;

•provide or reinforce accurate infection prevention and control and public health information, including to concerned people who have neither symptoms nor risk;

•put on, use, take off and dispose of personal protective equipment properly;

•self-monitor for signs of illness and self-isolate or report illness to managers, if it occurs;

•advise management if they are experiencing signs of undue stress or mental health challenges that require support interventions; and

•report to their immediate supervisor any situation which they have reasonable justification to believe presents an imminent and serious danger to life or health.

Doctors and health workers in Nigeria must endeavor to digest the guidelines in the Code of Medical Ethics as well as the WHO Guidelines for management of Coronavirus victims and ensure they work strictly by their provisions. A breach of these duties have dire consequences.

Options Available To Covid-19 Patients Who Are Victims Of Medical Negligence

A Coronavirus patient who has suffered medical negligence has a number of options:

1. He could file a complaint with the regulatory body (e.g. the Medical and Dental Council of Nigeria, in the cases involving a Doctor). The Doctor will in the first instance be investigated by the Medical and Dental Practitioners Investigation Panel, after which he will be tried by the Medical and Dental Practitioners Disciplinary Tribunal. If found culpable, the Doctor may be warned, suspended from practicing for a period not exceeding 6 months or in very serious cases, have his name can be removed from the Register of Medical Practitioners. The Medical and Dental Practitioners’ Disciplinary Tribunal does not award monetary damages.

2. A suit can be filed against the Medical Doctor, the Hospital, Agency or Government in the High Court for Medical Negligence and monetary damages will be awarded if the Defendant(s) are found culpable.

      3. If there is an element of Crime, a report could be made to the Police who would conduct Criminal Investigation and where the investigation reveals gross negligence, recklessness or wanton disregard for life of the victim, the police can prosecute or forward the case file to the office of the Attorney General of the State for possible prosecution in deserving cases.

A Need To Do More For Doctors And Other Professionals In The Health Sector

Health workers are at the front line of any outbreak response and as such are exposed to hazards that put them at risk of infection with an outbreak pathogen (in this case COVID-19). Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.

During the outbreak of Ebola more than 500 health care workers died in Guinea, Liberia and Sierra-Leone alone. We also lost some of our finest doctors and health workers to the disease in Nigeria, the most prominent being Dr. Stella Adadevoh, who is credited with having curbed a wider spread of the Ebola virus in Nigeria by placing the index patient, Patrick Sawyer, in quarantine despite pressures from the Liberian government. As we speak, The coronavirus is waging a war of attrition against health care workers throughout the world, but nowhere is it winning more battles at the moment than in Italy and in Spain, where protective equipment and tests have been in severely short supply for weeks. In Spain 13.6% (6500) of those affected with the coronavirus are health workers and in Italy 10% (7400) of those affected with the virus are health workers. [4] In New York dozens of health workers have been affected with the virus, while hundreds are in quarantine.[5] According to reports filtering in as the time of concluding this article, three health workers have been infected with COVID-19 in Abuja, Nigeria.[6]

Human Rights Watch research into health system collapse in Hungary and Venezuela suggests the nations’ mismanaged, underfunded, and understaffed public healthcare system is poorly equipped to handle a COVID-19 outbreak. Patients and medical experts described a lack of basic hygiene protocol, lack of isolation rooms, and a shortage of health professionals, doctors and nurses, and medical supplies in general.

The situation is not too different in Nigeria at the moment and except something drastic is done we might be witnessing a devastating effect of the pandemic. Nigeria’s, public health capacity has been diminished by large scale public sector corruption. Medical personnel lack surgical masks and local supplies have been diverted and shipped to other markets partly due to corruption. Many states are ill-prepared to combat the impeding surge in patients. A senior health worker with a government hospital in Abuja, in an interview with Sahara Reporters, lamented the lack of quality Personal Protective Equipment for them, adding that government must invest in the protection of health workers at the frontline of the battle against the virus. He said, “The unfortunate thing is that the government is not providing us with what to work with. It is sad that our PPE are not up to the world standard and can be penetrated by viruses. Some of us (health workers) have to use our personal funds to purchase gloves as we do not trust the ones government supplied. Nigerians should please remember us in their prayers and government should provide us with what we really need to work.” [7]

There was report that in Bauchi State a Coronavirus patient rejected the isolation centre at the Bauchi Specialist Hospital and went back home while describing it as “too dirty”.[8]

It is disappointing to hear that the hazard allowance for doctors and health workers is N5,000 per month in Nigeria. The amount is very paltry compared to the risks and the attendant emotional and psychological stress suffered by the health-care workers (HWCs) particularly during monumental outbreaks like this. Unfortunately, when a patient is mismanaged, these doctors and health workers bear the burden of paying huge compensation and sometimes losing their jobs. More importantly, the brain-drain in the health sector is monumental, almost all my friends who are doctors, work abroad. Unfortunately, there are concerted efforts by the US Government to engage foreign Doctors to further fortify its health work force as COVID-19 ravages. Many young Nigerian doctors are already considering the offers because the Nigerian government has paid little attention to their welfare and the welfare of the general health workforce. To stop the exodus of our doctors, who are already in short supply, the government must act fast by improving their welfare packages in line with acceptable international standards.

The psychological needs of doctors and health workers are also often ignored. Unsafe working conditions contribute to health worker attrition in many countries due to work-related illness and injury and the resulting fear of health workers of occupational infection, including from HIV and Tuberculosis. The 2006 World Health Report – Working Together for Health reported on a severe health workforce crisis in fifty-seven countries, most of them in Africa and Asia. [9]

Protecting the occupational health of health workers is critical to having an adequate workforce of trained and healthy health personnel. Governments at the Federal and State levels are urged to do more by complying fully with the World Health Organization’s guidelines regarding the Rights of Health Workers while combating COVID-19. Some of the rights are:

·         assume overall responsibility to ensure that all necessary preventive and protective measures are taken to minimize occupational safety and health risks;

·         provide information, instruction and training on occupational safety and health, including; Refresher training on infection prevention and control(IPC); and Use, putting on, taking off and disposal of personal protective equipment(PPE);

·         provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for suspected or confirmed COVID-19 patients, such that workers do not incur expenses for occupational safety and health requirements;

·         not be required to return to a work situation where there is continuing orserious danger to life or health, until the employer has taken any necessary remedial action;

·         allow workers to exercise the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health. When a health worker exercises this right, they shall be protected from any undue consequences;

·         honour the right to compensation, rehabilitation and curative services if infected with COVID-19 following exposure in the workplace. This would be considered occupational exposure and resulting illness would be considered an occupational disease,

·         provide access to mental health and counselling resources; and

·         enable co-operation between management and workers and/or their representatives. Etc.

In conclusion, professional care givers for COVID-19 patients should uphold four basic principles formulated by Beauchamp and Childress in their book ‘Principles of Biomedical Ethics’ in order to protect themselves from liability for negligence. The four basic principles are autonomy, beneficence, non-maleficence and justice.

Autonomy: People have the right to control what happens to their bodies. This principle simply means that an informed, competent adult patient can refuse or accept treatments, drugs, and surgeries according to their wishes. People have the right to control what happens to their bodies because they are free and rational. And these decisions must be respected by everyone, even if those decisions aren’t in the best interest of the patient.

Beneficence: All healthcare providers must strive to improve their patient’s health, to do the most good for the patient in every situation. But what is good for one patient may not be good for another, so each situation should be considered individually. And other values that might conflict with beneficence may need to be considered.

Non-maleficence: “First, do no harm” is the bedrock of medical ethics. In every situation, healthcare providers should avoid causing harm to their patients. You should also be aware of the doctrine of double effect, where a treatment intended for good unintentionally causes harm. This doctrine helps you make difficult decisions about whether actions with double effects can be undertaken.

Justice: The fourth principle demands that you should try to be as fair as possible when offering treatments to patients and allocating scarce medical resources. You should be able to justify your actions in every situation. For instance, it will amount to a professional misconduct for a Health-care Worker to remove a poor man from the ventilator because a Senator was rushed in.

Ahmed Adetola-Kazeem is a partner in Adetola-Kazeem Legal Practice and specializes in Medical and Health Law

Email: aadetolakazeem@gmail.com;aadetolakazeem@gaklp.com

[1] https://www.who.int/health-topics/coronavirus#tab=tab_1(Accessed on the 28th of March 2020)

[2] https://businessday.ng/coronavirus/article/abba-kyari-tests-positive-for-coronavirus-buhari-negative/

https://www.channelstv.com/2020/03/24/buharis-chief-of-staff-abba-kyari-reportedly-tests-positive-for-coronavirus/ (Accessed on the 28th of March 2020)

[3] Coronavirus Disease (Covid-19) Outbreak: Rights, Roles and Responsibilities Of Health workers, Including Key Considerations For Occupational Safety And Health”. https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-respon-hw-covid-19.pdf?sfvrsn=bcabd401_0   (Accessed on the 26th of March 2020)

[4] https://abcnews.go.com/Health/wireStory/collapsing-virus-pummels-medics-spain-italy-69789413 (Accessed on 26th March 2020)

[5] https://www.washingtonpost.com/health/covid-19-hits-doctors-nurses-emts-threatening-health-system/2020/03/17/f21147e8-67aa-11ea-b313-df458622c2cc_story.html (Accessed on 28th of March 2020)

[6] http://saharareporters.com/2020/03/28/exclusive-two-nurses-one-doctor-infected-coronavirus-abuja-hospital

[7] Supra

[8] https://www.dailytrust.com.ng/coronavirus-patient-rejects-bauchi-isolation-centre-returns-home.html (Accessed on 28th March 2020)

[9] https://www.who.int/occupational_health/topics/hcworkers/en/(Accessed on 26th March 2020)

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April 2, 2020
WHO releases guidelines to help countries maintain essential health services during the COVID-19 pandemic

The COVID-19 pandemic is straining health systems worldwide. The rapidly increasing demand on health facilities and health care workers threatens to leave some health systems overstretched and unable to operate effectively.

Previous outbreaks have demonstrated that when health systems are overwhelmed, mortality from vaccine-preventable and other treatable conditions can also increase dramatically. During the 2014-2015 Ebola outbreak, the increased number of deaths caused
by measles, malaria, HIV/AIDS, and tuberculosis attributable to health system failures exceeded deaths from Ebola
^[1,2].

“The best defense against any outbreak is a
strong health system,” stressed WHO Director-General Tedros Adhanom Ghebreyesus.
“COVID-19 is revealing how fragile many of the world’s health systems and
services are, forcing countries to make difficult choices on how to best meet
the needs of their people.”

To help countries navigate through these challenges, the World Health Organization (WHO) has updated operational planning guidelines in balancing the demands of responding directly to COVID-19 while maintaining essential health service delivery, and mitigating
the risk of system collapse. This includes a set of targeted immediate actions that countries should consider at national, regional, and local level to reorganize and maintain access to high-quality essential health services for all.

Countries should identify essential services that will be prioritized in their efforts to maintain continuity of service delivery and make strategic shifts to ensure that increasingly limited resources provide maximum benefit for the population. They
also need to comply with the highest standard in precautions, especially in hygiene practices, and the provision of adequate supplies including personal protective equipment This requires robust planning and coordinated actions between governments
and health facilities and their managers.

Some examples of essential services include: routine vaccination; reproductive health services including care during pregnancy and childbirth; care of young infants and older adults; management of mental health conditions as well as noncommunicable diseases
and infectious diseases like HIV, malaria and TB; critical inpatient therapies; management of emergency health conditions; auxiliary services like basic diagnostic imaging, laboratory services, and blood bank services, among others.

Well-organized and prepared health systems can continue to provide equitable access to essential service delivery throughout an emergency, limiting direct mortality and avoiding increased indirect mortality.

The guidelines stress the importance of keeping up-to-date information. This requires frequent transparent communications with the public, and strong community engagements so the public can maintain trust in the system to safely meet their
essential needs and to control infection risk in health facilities. This will help ensure that people continue to seek care when appropriate, and adhere to public health advice.

1. Elston, J. W. T., Cartwright, C., Ndumbi, P., & Wright, J. (2017). The health impact of the 2014–15 Ebola outbreak. Public Health, 143, 60-70.

2. Parpia, A. S., Ndeffo-Mbah, M. L., Wenzel, N. S., & Galvani, A. P. (2016). Effects of response to 2014–2015 Ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerging infectious diseases, 22(3), 433.

For interviews please contact: Tarik Jasarevic

To access the full guidance please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/maintaining-essential-health-services-and-systems

For further information and guidance on COVID-19 please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

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March 31, 2020
WHO urges countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic

The COVID-19 pandemic is testing the resilience of robust health systems around the world. Recognizing the heavy toll that malaria exacts on vulnerable populations in sub-Saharan Africa, as well as the region’s fragile health infrastructure, WHO underlines the critical importance of sustaining efforts to prevent, detect and treat malaria.

“As COVID-19 continues its rapid spread, WHO would like to send a clear message to malaria-affected countries in Africa,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “Do not scale back your planned malaria prevention, diagnostic and treatment activities. If someone living in a place with malaria develops a fever, he or she should seek diagnosis and care as soon as possible.”

Ensuring access to core malaria prevention measures is an important strategy for reducing the strain on health systems; these include vector control measures, such as insecticide-treated nets and indoor residual spraying, as well as chemoprevention for pregnant women and young children (intermittent preventive treatment in pregnancy, intermittent preventive treatment in infants and seasonal malaria chemoprevention). Additional special measures could ease the burden on health systems in the context of COVID-19, such as presumptive malaria treatment and mass drug administration.

Any interventions must consider the importance of both lowering malaria-related mortality and ensuring the safety of communities and health workers. WHO will provide guidance for countries to safely maintain essential health services in the context of the COVID-19 response.

About COVID-19

COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. Essential information on the COVID-19 pandemic can be found in a dedicated WHO site.

About malaria

Malaria is a preventable and treatable disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2018, there were an estimated 228 million cases of malaria worldwide and 405 000 malaria-related deaths. For more on malaria, visit: www.who.int/malaria

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March 26, 2020
Coronavirus: What we know so far about risks to pregnancy and babies

Pregnant people don’t seem to be at greater risk of experiencing severe covid-19, and the virus doesn’t seem to pass to fetuses, but there’s still a lot we don’t know

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March 16, 2020
The unmet need for social context in family planning

New evidence on the relationship between sexual health and social context finds a strong association between gender equality, education and family planning

Twenty-five years ago, two global events – the International Conference on Population and Development and the Fourth World Conference on Women in Beijing – formally recognized that women’s health and reproductive choices cannot be separated from the social context of their lives.

Now, researchers have created a dataset which brings together national surveys from 74 countries, representing 3 million women. For the first time, it allows them to describe trends in demand/use of modern contraceptives alongside social and economic indicators.

The data is published in The Lancet Global Health and is authored by the London School of Hygiene & Tropical Medicine and the World Health Organization.

It shows that, over time, women are more likely to have their demand for modern contraception met in countries where gender equality and their educational opportunities improve.

Gender equality and education increases access to modern contraception

Trends in sexual activity and demand for use and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys finds that met need for modern contraception is strongly correlated with positive shifts in social structures.
For every 0.1-point increase in a country’s gender development index, it found a 6.7% rise in women who were sexually active and did not want to conceive. Of those women, an additional 13.5% used modern methods to prevent a pregnancy.

Expectations of every girl’s right to education also made a difference. Each extra year in schooling is linked to an increase of 2.3% in demand, and a 4.7% increase in use of modern contraceptive methods.

“This study shows how every woman must negotiate her reproductive autonomy within the social framework in which she lives, responding to barriers and opportunities as they emerge,” says Dr Lale Say, one of the authors of the study and Unit Head at WHO and HRP.

“Gender equality is both a precondition and a driving force for securing women’s reproductive health and rights – as well as the sustainable development targets, which are our best chance for delivering health and well-being for all.”

Global trends reveal new challenges in family planning

Overall, the data reinforce global trends: more time spent sexually-active and single, postponement of parenthood, and the near-universal desire for smaller families.

The study also highlights where action is needed at country-level to avoid family planning services falling behind demand.

Out of the 74 countries analyzed, 42 showed an increase in demand for contraception. Only 37 countries show an increase in use of a modern method to prevent pregnancy.

Although unmet need for contraception declined in 34 countries, it increased in 14 countries. Significantly more progress is needed, and faster, to ensure each girl and woman is able to access the sexual and reproductive health services she needs.

Barriers and solutions to reproductive health and rights

Gender equality can affect contraceptive use in many ways. From the personal and political degree to which women are free to choose their sexual activity, to accessing family planning services it can also shape any power imbalances within personal relationships. This study supports recent efforts by WHO to adopt a broader, integrated concept of sexual and reproductive health – and to translate it into a framework for policy and practice.

The authors argue that family planning targets in the 2030 Agenda for Sustainable Development will not be met without a profound shift: from focus on ‘access to contraception’, to broader aspects of sexual health and social context.

Since reproductive health and women’s empowerment are intertwined, trends in contraceptive use can also reveal progress towards another global target: progress towards gender equality.

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https://www.who.int/news-room/detail/10-03-2020-the-unmet-need-for-social-context-in-family-planning

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March 11, 2020
E-cigarettes are harmful to health
Globally, there are 1.1 billion adult smokers, 60% of them want or intend to quit. Much has been written and said about the potential of electronic nicotine delivery systems (ENDS) such as e-cigarettes to help tobacco users quit. While the evidence is still inconclusive, e-cigarettes are often used along with one or more tobacco products. As this is the practice with many ENDS users, the health effects of two or more products are combined. Governments who want to weigh the potential benefits and risks of e-cigarettes for their population should consider the following:
1. Regarding the potential health effects for which the evidence is mounting, there is insufficient data to understand the full breadth of their impact on health as devices have not been on the market long enough. Especially the long-term effects of using e-cigarettes or being exposed to them are yet unknown.
2. Nevertheless, the evidence is clear that the aerosols of the majority of ENDS contain toxic chemicals, including nicotine and substances that can cause cancer.ENDS on their own are associated with increased risk of cardiovascular diseases and lung disorders and adverse effects on the development of the fetus during pregnancy. ENDS are undoubtedly harmful, should be strictly regulated, and, most importantly, must be kept away from children. Nicotine is highly addictive and found in most e-cigarettes. Both tobacco products and e-cigarettes pose risks to health and the safest approach is not to consume either.
3. It is of particular public health concern that increasingly children and adolescents take up the use of e-cigarettes in some countries. Most ENDS can be manipulated by the user. Some manufacturers also hold patents to remotely manipulate nicotine dosages and toxicant delivery. Furthermore, there is a growing body of evidence in some countries that never-smoker adolescents who use ENDS at least double their chance of starting to smoke cigarettes later in life. Exposing children and adolescents to nicotine can have long-lasting, damaging effects on brain development and lead to nicotine addiction.
WHO continues to monitor the evidence and technological developments and will adapt this statement accordingly.

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https://www.who.int/news-room/detail/05-02-2020-e-cigarettes-are-harmful-to-health

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February 27, 2020
Pregnancy and breastfeeding during an Ebola virus outbreak

Women who are pregnant or breastfeeding in an Ebola outbreak face similar challenges as other population groups, but they have specific health needs which must be met.

As the second largest Ebola outbreak in history continues in the Democratic Republic of Congo, WHO has released new clinical guidelines for healthcare providers supporting pregnant or breastfeeding women in the context of Ebola virus disease.

Improving clinical care and reducing mortality

Clear and coherent guidance is needed to meet the combined needs of women requiring Ebola treatment, pregnancy care and management of complications.

Information on how to protect breastfeeding children and other members in the community from transmission of the disease is also critical.

Limited scientific evidence on how to best manage these needs has previously been a challenge for affected countries. In addition, misconceptions that pregnant women have a higher mortality rate than other populations with Ebola may in some contexts have put pregnant women at risk of not receiving standard care.

WHO’s Guideline on the management of pregnant and breastfeeding women in the context of Ebola virus reviews existing evidence and provides a single set of recommendations on the care continuum for women exposed to, diagnosed with, or recovered from Ebola.

This will enable healthcare providers, emergency response teams and health policy-makers to improve prevention and treatment measures in an Ebola outbreak.

Obstetric care at an Ebola Treatment Centre

Optimal supportive care should be offered to all pregnant women with Ebola. Likewise, they should be offered experimental treatment and vaccination under the same conditions as non-pregnant populations.

Ebola virus disease does increase the risk of miscarriage and early labour, requiring close clinical management at Ebola treatment centres. It is important to engage both obstetric providers and those trained in Ebola response.

This dual expertise is also important because early Ebola and pregnancy-related symptoms can overlap. Pregnant women should be prioritised for testing to confirm an Ebola infection.

Ebola virus can persist in pregnancy related fluids as well as breastmilk. If healthcare providers are not clear on how to manage Ebola infection risk, they may be less willing to provide care. This stigma can be life-threatening for women who experience complications during delivery.

The new WHO guidelines advise healthcare workers on how to protect themselves while caring for pregnant women with Ebola virus disease. This includes induced labour or surgical procedures, which carry greater risk of transmission in cases of acute infection. Any invasive treatments should be carried out in full personal protective equipment.

Breastfeeding recommendations in an Ebola outbreak

WHO recommends that women with suspected or confirmed Ebola immediately stop breastfeeding and are prioritised for diagnostic testing. Any child exposed to Ebola through breast milk should be placed into safe care, closely monitored for symptoms over a 21-day period and fed with an appropriate breast milk substitute.

The guidelines strongly recommend that breastfeeding is only restarted following two consecutive negative tests of breast milk, separated by 24 hours.

A breast milk substitute should be used even if infection is confirmed for both the mother and her child. Exceptions can be made for infants under 6 months of age who are already infected, if breast milk substitutes are not feasible, affordable, sustainable or safe and separation cannot be implemented safely.

Women’s health and rights in a disease outbreak

A disease outbreak does not change women’s and adolescent girls’ fundamental human right to sexual and reproductive healthcare, including evidence-based care during pregnancy and childbirth.

Women need support to make informed reproductive health care choices for themselves and their children. Women living in an Ebola outbreak should have access to all relevant reproductive options, regardless of economic, cultural, racial or religious status, including contraception and safe abortion to the full extent of the law.

Pregnant and breastfeeding women across affected communities need equitable and respectful care that considers the risks they face and supports the choices they make.

Accessing the guidelines and further research

These guidelines are now available online and may be freely downloaded. The executive summary will be available in French.

WHO will closely monitor new data as it emerges, as there is still a pressing need to prioritise ongoing research related to Ebola virus transmission.

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https://www.who.int/news-room/detail/10-02-2020-pregnancy-and-breastfeeding-during-an-ebola-virus-outbreak

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February 27, 2020
Can Enzyme Therapy Heal Breast Cancer?

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That is a million dollar question, isn't it? I can speak from my personal and professional experience, and say that I have seen Enzyme Therapy play a very important role in healing Breast Cancer, and many other types of cancers. What are enzymes and why do they work?

Let's start by understanding cancer cells and what is called the Trophoblast Theory, discovered by Dr. John Beard in the early 1900's. Trophoblasts are specialized cells of the placenta that multiply rapidly, invade the wall of the uterus and create its own blood supply. Cancer cells function in the same way: they multiply rapidly, invade other tissues and create their own blood flow.

Trophoblasts produce the hormone HCG which is the basis for the widely used pregnancy test. Cancer cells also produce HCG, as confirmed by a study done in 1977 by Dr. Robert Williams. He reported the presence of HCG, 2 and 3 years before a cancer diagnosis. There have been other studies indicating that this "pregnancy hormone" is present with various forms of cancer. (Learn how to STOP cancer before it starts with sensitive blood cancer markers, such as this one in references)

The placental Trophoblast cells continue to multiply and grow until something very interesting happens. On day 56 after conception, the fetus begins to secrete pancreatic enzymes . This STOPS the replication of the Trophoblasts and the placenta no longer continues to grow.

But as adults, don't we secrete pancreatic enzymes, specifically protease enzymes like trypsin? We do, but not in sufficient quantities. Our pancreas is over worked because of excess sugar and carbohydrate consumption. Eating cooked and processed food also puts a strain on our pancreas.

Years of application by various doctors such as Dr. William Kelley, Dr. Kelly Raber and Dr. Gonzales have proven time and time again, that Enzyme Therapy is extremely beneficial for cancer patients.

All enzymes accelerate reactions, or even permit reactions that otherwise would not happen, while the enzymes themselves end up unchanged. Enzymes therefore are catalysts and can act over and over again doing the same thing. The protease group of enzymes (trypsin, chymotrypsin) are specifically directed to proteins. Amylase attacks carbohydrates while lipases attack fats.

Cancer cells act as enzyme-inhibitors by secreting a number of substances that reversibly inhibit the proteases manufactured by the pancreas in the body (this is one of the reasons that high levels of pancreatin are needed to defeat cancer). Glyco-proteins in the form of lactate (a precursor to lactic acid) are also released from the cancer cells that also act as enzyme-inhibitors. That is only 1 of many reasons why one may need large doses of Pancreatic Enzymes.

Secondly, the theory is that pancreatic enzymes attack the proteins on the cancer cell membrane, making them weaker and more vulnerable to the Immune System. The electrical charge of the cancer cells seems to "attract" these enzymes, while our healthy cells repel them.

Slowly but surely, Enzyme Therapy is gaining recognition in the scientific journals. A study conducted in Colonge, Germany in cancer patients suffering from Breast and Colo-rectal Cancers, documented promising result with enzymes. The therapy significantly decreased tumor-induced and therapy induced side effects and complaints. They found that the enzymes had the following properties:

Boost the Immune System
Anti-inflammatory
Anti-infectious
Anti-tumor
Anti-metastatic

Enzyme Therapy has worked with thousands of people and all types of cancers.

Unfortunately, this type of therapy will never gain FDA approval because you can't patent an enzyme and make billions of dollars. The cancer industry is a sickness-based industry that will never find a "cure". The cure is already here and it can be found in lifestyle changes, organic nutrition, ingestion of cancer killing herbs, detoxification and emotional healing, or as I have coined the term, The 7 Essentials.

To learn more about Enzyme Therapy, visit the Cancer X Products in my store. Email me directly if you have any questions. Always consult with a professional and experienced health care provider that is familiar with enzymes – don't guess when it comes to your health.

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Source by Veronique D Desaulniers

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January 29, 2020