Tag: Pregnant

  • Maternal infections in health facilities

    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.

    Logo of the Lancet Global HealthThe
    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

     

     

    Maternal infections in health facilities
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  • WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa

    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.

    WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa
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  • Making available free paediatric medicine can accelerate elimination of congenital Chagas disease

    Making available free paediatric medicine can accelerate elimination of congenital Chagas disease

    The donation of an essential antiparasitic medicine can potentially accelerate the elimination of Chagas disease infection in children. A pediatric presentation of benznidazole with accurate dosage and will soon be made available freely to address
    a long-standing gap in the treatment of congenital infections of Chagas disease.  

    The donation, by the Mundo Sano Foundation1 and INSud Pharma2 group to the World Health Organization (WHO), is expected to become effective soon.

    “Making benznidazole freely available for the treatment of newborns and children until the age of 19 will be a game-changer in the fight against Chagas disease” said Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control
    of Neglected Tropical Diseases. “This can save future generations from developing life-threatening and fatal complications and also boost up diagnosis and treatment contributing to congenital Chagas disease elimination.”

    The three-year agreement will make available 108 000 tablets of benznidazole3 – one of the two antiparasitic medicines against Chagas disease. Treatment4 with benznidazole in the early stages of infection can cure Chagas
    disease, prevent or curb disease progression and prevent congenital transmission in pregnant women.

     “We have now added the systematic detection and treatment of all newborns and children under 19 which was not part of  our recent switch from control to elimination of congenital Chagas disease” said Dr Pedro Albajar
    Vinas, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. “In addition, screening of pregnant women at risk of infection who have not had past antiparasitic treatment provides an excellent opportunity for prevention of posterior transmission throughout pregnancy and birth.”

    Each year, an estimated 15 000 children are born from infected mothers. 

    The agreement

    The donation by Mundo Sano Foundation for the duration of the agreement comprises benznidazole:

    • 105,000 tablets of 100mg
    • 3,000 tablets of 12.5mg

    Furthermore, the Foundation may donate funds to support activities associated with distribution of medicines and is ready to consider extending this agreement beyond the specified duration of three years.

    The disease

    Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi (T. cruzi).

    Although considerable progress has been achieved, particularly in reducing vector transmission and screening of blood and organ supply, reaching, diagnosing and providing healthcare for people most affected has been a challenge.

    Currently, under-diagnosis of Chagas disease cases is as high as 90% and under-diagnosis of congenital and paediatric cases is believed not to be lower.

    Globally, an estimated 6-7 million people are infected with T. cruzi.

    The disease is found mainly in endemic areas of 21 continental Latin American countries5. But movement of people to urban areas and to other continents has expanded its transmission through non vectorial routes, such as blood transfusion,
    congenital transmission, organ transplants and oral transmission through food contamination.

    Considering that neglected tropical disease as a growing public health problem in many countries, the World Health Assembly – WHO’s decision-making body – decided in May 2019 to commemorate World Chagas Disease Day on 14 April.

    The inaugural celebration happens this year.


    1Mundo Sano is a nonprofit international foundation working with the public and private sectors, academia, and other international organizations to provide solutions to the affected communities and generate scientific knowledge.
    In 2012, it led a public-private consortium in 2012 to produce benznidazole in Argentina.

    2Insud Pharma (formerly known as Chemo Group) specializes in research, development, manufacture, sale and marketing of active pharmaceutical ingredients and medicinal products for human and veterinary use.

    3In 2017, the United States Food and Drug Administration (FDA) approved benznidazole for the treatment of children aged 2–12, making it the first treatment approved in the United States for Chagas disease.

    4Nifurtimox is also 100% effective in curing Chagas disease if given soon after onset of infection, including cases of congenital infection. It is donated by Bayer who pledged more than 7.5 million tablets for the period 2012-2021.

    5Argentina, 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).

     

     

     

     

    Making available free paediatric medicine can accelerate elimination of congenital Chagas disease
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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.


    1 Mundo 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.

    2 In 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).

    Chagas disease: providing free paediatric medicine can enhance diagnosis and treatment
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  • 70 pregnant Malaysian women working in S’pore brought home via Johor causeway

    70 pregnant Malaysian women working in S’pore brought home via Johor causeway

    70 pregnant Malaysian women working in S’pore brought home via Johor causeway 1

    SINGAPORE: Seventy pregnant Malaysian women working in Singapore together with 10 kids and other people with disabilities have been brought home at the moment via the Johor causeway.

    The journey was made doable by the Malaysian High Commission in Singapore.

    “They were brought home in two buses. Prior to that, they gathered at the Kranji MRT Station here as early as 10am,” Malaysian Deputy High Commissioner to Singapore Muhd Radzi Jamaluddin instructed Bernama.

    Muhd Radzi stated particular consideration was given to the group as a number of the women have been nearly because of ship.

    “Every effort was taken to ensure their safe return so that their babies could be delivered in their hometowns,” he stated including that a few of them had additionally raised fears that issues would come up if their infants have been to be delivered in the republic

    “This is because both countries have imposed various conditions and restrictions on foreign visitors which were constantly changing thus encouraging them to return to Malaysia as soon as possible,” he stated.

    On March 31, the Malaysian authorities introduced that each one Malaysians who return to the nation from abroad journeys should bear quarantine for 14 days at authorities quarantine centres efficient April 3.

    The Movement Control Order (MCO) interval which took impact from March 18, has additionally compelled some Malaysians who don’t possess automobiles to stroll for about one kilometre throughout the Causeway.

    70 pregnant Malaysian women working in S’pore brought home via Johor causeway
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  • 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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  • Coronavirus: Panic In Delta As Persons With Suspected Symptoms Flood FMC Emergency Ward

    Coronavirus: Panic In Delta As Persons With Suspected Symptoms Flood FMC Emergency Ward

    Coronavirus: Panic In Delta As Persons With Suspected Symptoms Flood FMC Emergency Ward 2

    Coronavirus: Panic In Delta As Persons With Suspected Symptoms Flood FMC Emergency Ward 3


     

    The Federal Medical Centre, Asaba, Delta State, is currently witnessing large influx of visitors with suspected symptoms of Coronavirus.

    A staff of the medical facility, who spoke with SaharaReporters, disclosed that many of the visitors were apprehensive that they might have contracted the virus after feeling unwell.

    “There is serious fear since Monday night, so many persons with suspected symptoms of Coronavirus have been coming into our emergency ward and the number is increasing even though no formal tests had been carried out on such persons.

    “We have been told not to disclose a confirmed case so as to avoid panic in the state.

    “Some of our colleagues working in government hospitals across the state told us that there was nothing on ground to show preparedness for the pandemic.

    “A Lassa fever case was recorded at the facility and the patient, a pregnant woman, was subsequently transferred to Irrua Specialist Hospital in Edo State,” the source said.

    When contacted, Chief Medical Director of the Federal Medical Centre, Asaba, Victor Osiatuma, said that there were no Coronavirus patients at the health facility.

    He said, “Apart from the Lassa fever case of a pregnant woman recorded in our facility, there is no other case or cases of an outbreak of any dreaded disease here.”

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    Coronavirus: Panic In Delta As Persons With Suspected Symptoms Flood FMC Emergency Ward
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  • World TB Day 2020: It’s Time for solidarity

    World TB Day 2020: It’s Time for solidarity

    At this unique time in history when the world is grappling with the COVID-19 pandemic, the WHO Department of Global HIV, Hepatitis and STI Programmes stands in solidarity with governments and communities as they seek to maintain health services
    and continue to address the needs of patients suffering from HIV and tuberculosis (TB). 

    Despite being preventable and treatable, tuberculosis remains the world’s biggest infectious killer and the leading cause of death among people living with HIV (PLHIV), responsible for 32% of the 770 000 lives lost to HIV in 2018. People
    living with HIV are far more vulnerable (nearly 20 times more) to TB infection than people without HIV and are three times more likely to die during TB treatment.  

    While there are proven interventions that reduce TB deaths – such as provision of TB preventive treatment, adoption of novel diagnostics for earlier TB diagnosis and linkage to treatment, and antiretroviral therapy (ART) – we are far behind
    in scaling these up, and diagnostic and treatment gaps remain, with only half of estimated TB cases among PLHIV reaching care in 2018, only half of estimated PLHIV with TB receiving ART, and less than half of PLHIV new on ART initiating TB preventive
    treatment in a subset of countries which reported globally.

    On this World TB Day, WHO highlights two key interventions to reduce unnecessary TB deaths among PLHIV: 

    • (1) provision of TB preventive treatment for all eligible PLHIV; and 
    • (2) increased uptake of newer diagnostic tests such as the lateral flow urine lipoarabinomannan assay (TB-LAM.) 

    As the new Director for the Department of Global HIV, Hepatitis and STI Programmes, I support current efforts to continue and to take to scale TB activities. It’s Time for solidarity!

    -Meg Doherty, Director Global HIV, hepatitis and STI Programmes, WHO

    HIV programmes are encouraged to ensure that TB preventive treatment, including shorter WHO-recommended regimens, with updated guidance launched today, are provided to all eligible PLHIV as part of a routine package of care, including provision of ART, and that treatment completion is ensured.   

    In recent months, WHO has also released guidelines for use of a bedside urine TB-LAM test to accelerate earlier TB diagnosis, with significantly expanded eligibility criteria. As this test is “point of care” with the potential for earlier
    TB diagnosis and treatment initiation, HIV programmes should consider these recommendations as they enhance strategies for TB diagnosis among PLHIV, including as part of a routine package of advanced HIV care. 

    It’s Time to urgently scale up TB preventive treatment and TB diagnosis and strengthen referral and linkages to TB treatment at HIV service delivery points in all countries and continue to scale-up ART among PLHIV with TB. This applies to all populations
    at risk, including children, pregnant women and marginalized groups, to ensure no one is left behind.

    WHO calls for continued collaboration in countries across health programmes for harmonized and integrated policies and service delivery, and engagement with communities and other sectors. Unless HIV programmes scale up interventions to close these
    gaps in prevention, diagnosis and treatment both for TB and HIV, countries and their development partners will not meet our common target: a 75% reduction in TB deaths among PLHIV between 2010 and 2020. HIV mortality cannot be reduced without addressing
    the leading cause: tuberculosis.

     

    World TB Day 2020: It’s Time for solidarity
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    https://www.who.int/news-room/detail/24-03-2020-world-tb-day-2020-it-s-time-for-solidarity

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  • Coronavirus: What we know so far about risks to pregnancy and babies

    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
    Coronavirus: What we know so far about risks to pregnancy and babies
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    https://www.newscientist.com/article/2237352-coronavirus-what-we-know-so-far-about-risks-to-pregnancy-and-babies/?utm_campaign=RSS%7CNSNS&utm_source=NSNS&utm_medium=RSS&utm_content=home

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