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WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic.

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

Infections with COVID-19, insufficient measures for infection prevention and control, occupational safety and health, mental health and psychosocial support for health workers result in high rates of absenteeism and deplete the health workforce – the most precision resources for stopping the COVID outbreak.

Key Messages and Facts

COVID-19 infections among health workers:
- As of 21 April 2020 countries reported to WHO that over 35, 000 health workers were infected with COVID19. This number is significantly higher because of underreporting.
- The major occupational risks for COVID19 infection among health workers are: late recognition or suspicion of COVID-19 in patients, working in a higher-risk department, longer duty hours, sub-optimal adherence to infection prevention and control measures, such as hand hygiene practices, and lack of or improper use of personal protective equipment (PPE). Other factors have also been documented, such as inadequate or insufficient IPC training for respiratory pathogens, including the COVID-19 virus, as well as long exposure in areas in healthcare facilities where large numbers of COVID-19 patients were being cared for.
- The prevention of infections requires the use of appropriate infection prevention and control measures by all health workers, with a special focus on the adherence to hand hygiene and personal protective equipment when caring for COVID-19 patients, as well as a combination of environmental and administrative controls
- Health workers infected with COVID-19 following exposure in the workplace should have the right to employment injury benefits for occupational disease, including compensation, rehabilitation, and curative services.
Violence and stigma against health workers:
- Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression and social stigma because of their work.
- In the COVID19 crisis, shortage of staff and resources and increasing social tensions result in increased level of violence against health workers and even attacks against health care facilities. Doctors, nurses, security personnel and those who are assisting in testing, tracing contacts and enforcing physical distancing measures to stop COVID-19 experience threats and aggression.
- WHO calls upon governments, employers and workers organizations to institute measures for zero-tolerance to violence against health workers at the workplace and at the way to and from their workplace, and for intensifying social support and respect for health workers and their families.
Long working hours and psychosocial hazards for health workers:
- Many health workers have to work longer or irregular hours because of the increasing demand for health services. In addition, many countries experience shortage of health workers, or junior staff are working in demanding new roles.
- Health workers face psychosocial hazards, which are exacerbated during emergencies where demands increase and they have to experience risk of infection witness higher suffering or mortality.
- Long working hours, shift work, high workload and other psychosocial hazards can lead to fatigue, occupational burnout, increased psychological distress or declining mental health – affecting the health of health workers, and the quality and safety of care delivered.
- WHO calls for adequate staffing levels and clinical rotation in healthcare facilities, measures to minimize psychosocial hazards, and provision of access to mental health and psychosocial support for health workers.
The annual World Day for Safety and Health at Work on 28 April promotes the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.

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https://www.who.int/news-room/detail/28-04-2020-who-calls-for-healthy-safe-and-decent-working-conditions-for-all-health-workers-amidst-covid-19-pandemic

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May 9, 2020
Maternal infections in health facilities

A clearer picture of the global impact

New research from the Global Maternal Sepsis Study (GLOSS), a major WHO/HRP initiative, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.

The
results from GLOSS, published in The Lancet Global Health, are the first to provide data on frequency of maternal infections and
sepsis across the pregnancy and post-pregnancy period, in a large number of health facilities around the world.

Around 11 women per 1000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome – either they died or nearly died – during their hospitalization.

Urgent improvement is needed to manage this life-threatening risk faced by all pregnant and recently pregnant women, wherever they are in the world.

What is maternal sepsis and how does it lead to maternal death?

Maternal sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, child-birth, post-abortion or the postpartum period.

The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, this only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.

Few
previous studies include post-abortion infections. Neither do they address indirect infections such as respiratory and meningitis, which are aggravated by pregnancy but not directly caused by it.

A better understanding of maternal infection

GLOSS was a massive facility-based data collection effort led by WHO, accompanied by a ‘STOP SEPSIS!’ campaign to increase awareness among healthcare providers.

The study gathered data on women who were admitted with suspected or confirmed infection during pregnancy or post-pregnancy over a one-week period in 2017. More than 2800 women participated in the study in 52 countries.

GLOSS included healthcare facilities that care for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but where women could be hospitalized during or after pregnancy, and data on infections
which are not usually recorded as maternal sepsis, including post-abortion and indirect infections.

The result is a more complete understanding of the frequency and impact of maternal infections in health facilities.

GLOSS calls attention not only to the wider range of risks faced by pregnant women but also to the long period of time during which they are at risk.

Putting global numbers on maternal infection and sepsis

Overall, around 70 pregnant or recently-pregnant women per 1000 live births were found to have a maternal infection needing hospital management.

Across the study, 11 women with either direct or indirect infection per 1000 live births developed a severe maternal outcome, but in low- and middle-income countries up to 15 women per 1000 births were affected.

Infections were the underlying cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infections. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
haemorrhage.

This suggests that the contribution of infection to global maternal mortality and morbidity may be larger than current reports of maternal sepsis mortality suggest.

Preventing, identifying and treating maternal infection and sepsis

Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean and post-abortion infections, are largely preventable and treatable.

GLOSS results suggest that current levels of monitoring and clinical care across health facilities are not enough to prevent, identify and treat levels of maternal infection effectively.

For instance, a complete set of vital signs was not reported for a third of the women in the study, on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were frequent.

GLOSS also shows marked differences across countries, with the highest burden in low- and middle-income countries, compared with high-income countries.

This may reflect the impact of broader health determinants in different country contexts. Challenges of overcrowding, limited access to water and sanitation and constraints to safe births by skilled birth attendants can reduce the ability of healthcare
providers to manage the frequency and outcome of maternal infections.

An opportunity to implement evidence-based practice

GLOSS gives healthcare providers, policy-makers, and the public at large an opportunity: to mobilise around these data improve evidence-based practice, and save lives.

WHO has produced a number of resources which can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as the upcoming SAVE LIVES: Clean Your Hands campaign
on 5 May which celebrates the central role played by nurses and midwives in clean health care.

In addition, WHO will publish a global sepsis epidemiology report around the 73rd World Health Assembly (WHA) in May, as requested in the
2017
WHA Resolution on Improving the prevention, diagnosis and clinical managementof sepsis.

Understanding why and how infection affects women is essential for equipping healthcare providers with life-saving knowledge and enabling health care systems to bring down global maternal mortality and morbidity.

Related publications

WHO recommendations for prevention and treatment of maternal peripartum infections

WHO Clinical practice handbook for safe abortion

Global guidelines on the prevention of surgical site infection

WHO statement on maternal sepsis

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

Health Topics

Antimicrobial resistance

Infection Prevention and Control

Water Sanitation Hygiene

Other links

Global Maternal Sepsis Study

SAVE LIVES: Clean Your Hands 5 May 2020

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https://www.who.int/news-room/detail/27-04-2020-maternal-infections-in-health-facilities

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May 9, 2020
WHO reports fivefold increase in cyber attacks, urges vigilance

Since the start of the COVID-19 pandemic, WHO has seen a dramatic increase in the number of cyber attacks directed at its staff, and email scams targeting the public at large.

This week, some 450 active WHO email addresses and passwords were leaked online along with thousands belonging to others working on the novel coronavirus response.

The leaked credentials did not put WHO systems at risk because the data was not recent. However, the attack did impact an older extranet system, used by current and retired staff as well as partners.

WHO is now migrating affected systems to a more secure authentication system.

Scammers impersonating WHO in emails have also increasingly targeted the general public in order to channel donations to a fictitious fund and not the authentic COVID-19 Solidary Response Fund. The number of cyber attacks is now more than five times the number directed at the Organization in the same period last year.

“Ensuring the security of health information for Member States and the privacy of users interacting with us a priority for WHO at all times, but also particularly during the COVID-19 pandemic. We are grateful for the alerts we receive from Member States and the private sector. We are all in this fight together,” said Bernardo Mariano, WHO’s Chief Information Officer.

WHO is working with the private sector to establish more robust internal systems and to strengthen security measures and is educating staff on cybersecurity risks.

WHO asks the public to remain vigilant against fraudulent emails and recommends the use of reliable sources to obtain factual information about COVID-19 and other health issues.

For more information, please visit: www.who.int/covid-19.

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https://www.who.int/news-room/detail/23-04-2020-who-reports-fivefold-increase-in-cyber-attacks-urges-vigilance

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May 9, 2020
Hard fought gains in immunization coverage at risk without critical health services, warns WHO

Shutting down immunization services in the COVID-19 pandemic risks triggering a resurgence of diseases that can be prevented with safe and effective vaccines, warns WHO in the lead-up to World Immunization Week (24-30 April).

When immunization services are disrupted, even for brief periods during emergencies, the risk of vaccine-preventable disease outbreaks, such as measles and polio, increase. Last year’s deadly measles outbreak in the Democratic Republic of the
Congo, which took more than 6000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, such as immunization in times of emergency. Further disease outbreaks will also overwhelm
health systems already battling the impacts of COVID-19.

“Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While the world strives to develop a new vaccine for COVID-19 at record speed,
we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate.”

WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.

But even with an expedited process, development of a vaccine for COVID-19 will take time. Precautionary measures are essential now to help keep us safe from disease, including diseases for which vaccines already protect children and adults.

Too many people are still excluded from the benefits of vaccines

Prior to the COVID-19 pandemic, the world had made immense progress in ensuring that children are vaccinated. In 2018, 86 percent of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and
one dose of the measles vaccine, up from 72 percent in 2000 and 20 percent in 1980. The number of children paralyzed by polio has been reduced by 99.9 percent worldwide.

Yet, global vaccination coverage is still far from the 95 per cent coverage needed to fully protect communities against outbreaks of this vaccine-preventable disease.

In 2018 nearly 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines, such as measles, diphtheria and tetanus. Roughly, 13 million of the children have never received any vaccines, putting them and their communities
at risk of disease and death. The majority of these children live in countries with already fragile health systems, further limiting their access to essential health services when they fall sick.

Measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800 000. In 2020 there are increasing concerns about another
resurgence, especially if vaccination rates fall due to delay or suspension of scheduled immunization activities as a result of COVID-19.

Outbreaks of polio, diphtheria and yellow fever are also of high concern, especially in the countries least able to respond quickly and decisively to address an emerging outbreak, as seen in previous emergencies such as the polio outbreak in Syria in
2013.

Maintaining immunization services during COVID-19

As the response to COVID-19 continues, countries must act now protect immunization services, in order to further minimize disease outbreaks and loss of life. This includes, facilitating urgent catch up programmes in places where
services have been disrupted, ensuring strong supply chains, disease surveillance and trained health workers. Caregivers should also make sure they continue to vaccinate their children in line with national policies.

New WHO guidelines on immunization and COVID-19 recommend that governments temporarily pause preventive immunization
campaigns where there is no active outbreak of a vaccine-preventable disease. But it urges countries prioritize the continuation of routine immunization of children in essential service delivery, as well as adult vaccinations such as influenza
for groups most at risk. If immunization services must be suspended, urgent catch-up vaccinations should be rescheduled as soon as possible, prioritizing those most at risk.

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https://www.who.int/news-room/detail/23-04-2020-hard-fought-gains-in-immunization-coverage-at-risk-without-critical-health-services-warns-who

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

The right to a positive maternity healthcare experience at every stage

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

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

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

Joys and challenges in the postnatal period

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

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

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

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

What is a positive postnatal experience?

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

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

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

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

Supporting choices and rights to improve postnatal health outcomes

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

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

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

WHO’s guidance for positive maternity care

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

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

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

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

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

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

Other resources

WHO recommendations on antenatal care for a positive pregnancy experience

WHO recommendations: intrapartum care for a positive childbirth experience

Improving early childhood development: WHO guideline

Parenting in the time of COVID-19

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

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

Evidence on mistreatment of women during childbirth

Related topic

Breastfeeding

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https://www.who.int/news-room/detail/22-04-2020-what-matters-to-women-in-the-postnatal-period

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May 9, 2020
Blogging for Marketing 101

The average blog reader views 77% more pages than an average user, and believe it or not, those blog readers are likely to have an average income of $75,000 or more according to Clickz. Well that sounds like a great target audience, but with over 50 million blogs out there, how do you get your blog to stand out of the woodwork and get noticed? We’ve been doing some research of our own in an effort to redesign the new Mequoda Daily 2.0 and here’s some fun stuff that research has shown us…

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=74

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April 11, 2020
Steps to Starting an Online Business

I have seen too many people attempt an online business without a well-researched plan. The results have been disastrous–major investments lost and business failures.

As a veteran of online marketing, I have witnessed both failures and successes online. For any of you who are considering a business online, the following article has been developed to help you avoid major pitfalls and navigate the best online opportunities for your business.

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=76

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April 11, 2020
Tools for Maximizing Customer Relationships

Business is tough these days and the economy has caused companies of all sizes to rethink when and how to nurture their relationship with customers. While it may seem like an easy decision to cut back on investing in customer marketing, that may not be the wisest choice. As products and services continue to become commoditized, the only remaining differentiator becomes the vendor‐customer relationship. There?s no getting around that delighting customers and growing revenue will become more heavily based on how well you understand their evolving needs. This article explores three categories of tools used to engage customers and strengthen your relationship with them.

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=77

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April 11, 2020
Lifting restrictions ‘too quickly’ could lead to deadly resurgence of Covid-19: WHO

GENEVA: World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus warned here on Friday that lifting restrictions “too quickly” could lead to a deadly resurgence of Covid-19, Xinhua news agency reported.

Noting at a regular press briefing that “some countries are already planning the transition out of stay-at-home restrictions,“ the WHO chief warned that lifting restrictions too quickly could lead to a deadly resurgence.

“The way down can be as dangerous as the way up if not managed properly,“ he said, underlining that the WHO is working with affected countries on strategies for gradually and safely easing restrictions.

Some European countries are already considering relaxing their restriction measures as they see a slowing trend in the number of Covid-19 infections.

Austria, for instance, aims to gradually ease the exit restrictions and reopen shops and businesses from mid-April. Switzerland also suggested “the first relaxations” by the end of April.

The WHO chief stressed that decision of lifting restrictions should be made on the condition that transmission is controlled; that sufficient public health and medical services are available; that outbreak risks in special settings like long-term care facilities are minimised; that preventive measures are in place in workplaces, schools and other places where it’s essential for people to go; that importation risks can be managed; and that communities are fully aware and engaged in the transition.

Globally, nearly 1.5 million confirmed cases of Covid-19 have now been reported to the WHO, as well as more than 92,000 deaths. — Bernama

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https://www.thesundaily.my/world/lifting-restrictions-too-quickly-could-lead-to-deadly-resurgence-of-covid-19-who-IB2245956

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April 11, 2020
Covid-19: MAF strengthens, tightens nation’s border controls

KUALA LUMPUR: The Malaysian Armed Forces (MAF) will strengthen and tighten the country’s border controls during the Movement Control Order (MCO).

The Chief of Defence Force Gen Tan Sri Affendi Buang (pix) said MAF would always take various factors into consideration in drafting the country’s strategic defence plans to cover any situation, especially since Malaysia was facing the Covid-19 pandemic.

He said they even looked into various possibilities, especially in anticipating the action of foreigners entering Malaysia illegally by using ‘rat lanes’.

“This in turn could have an impact on the rise of Covid-19 cases. While the MCO and enhanced MCO (EMCO) are being implemented, domestic operations will continue as usual.

“The MAF collaborates with the Royal Malaysia Police, especially the General Operations Force as well as other security agencies, to not only carry out border controls in Peninsular Malaysia and East Malaysia but also the nation’s maritime borders,” he said yesterday.

Affendi said that with the latest directive as contained in Prime Minister Tan Sri Muhyiddin Yassin’s special message today, MAF would further strengthen every land, sea and air control to be at the highest level.

Muhyiddin, in his message, directed the Inspector-General of Police Tan Sri Abdul Hamid Bador; MAF chiefs; Malaysian Maritime Enforcement Agency (MMEA) director-general Maritime Admiral Datuk Mohd Zubil Mat Som; Immigration Department; People’s Volunteers Corps (RELA) and other relevant agencies to tighten controls along the country’s borders.

The Prime Minister said this was to avoid the possibility of illegal immigrants entering through ‘rat lanes’ and bringing the virus into the country. — Bernama

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https://www.thesundaily.my/local/covid-19-maf-strengthens-tightens-nation-s-border-controls-MB2245608

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April 11, 2020