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The second WHO report on neglected tropical diseases builds on the growing sense of optimism_x000D__x000D_ generated by the 2012 publication of the WHO Roadmap. Commitments on the_x000D__x000D_ part of ministries of health in endemic countries global health initiatives funding_x000D__x000D_ agencies and philanthropists have escalated since 2010 as have donations of_x000D__x000D_ medicines from pharmaceutical companies and the engagement of the scientific_x000D__x000D_ community. _x000D__x000D_ This report marks a new phase and assesses opportunities and obstacles in the_x000D__x000D_ control elimination and eradication of several of these diseases. Unprecedented_x000D__x000D_ progress over the past two years has revealed unprecedented needs for_x000D__x000D_ refinements in control strategies and new technical tools and protocols. The_x000D__x000D_ substantial increases in donations of medicines made since the previous report_x000D__x000D_ call for innovations that simplify and refine delivery strategies. _x000D__x000D_ However some diseases including especially deadly ones like human African_x000D__x000D_ trypanosomiasis and visceral Leishmaniasis remain extremely difficult and costly_x000D__x000D_ to treat. The control of Buruli ulcer Chagas disease and yaws is hampered by_x000D__x000D_ imperfect technical tools although recent developments for yaws look promising._x000D__x000D_ The report highlights progress against these especially challenging diseases _x000D__x000D_ being made through the development of innovative and intensive management_x000D__x000D_ strategies. _x000D__x000D_ Innovations in vector control deserve more attention as playing a key part in_x000D__x000D_ reducing transmission and disease burden especially for Dengue Chagas disease_x000D__x000D_ and the Leishmaniases. _x000D__x000D_ Achieving universal health coverage with essential health interventions for_x000D__x000D_ neglected tropical diseases will be a powerful equalizer that abolishes distinctions_x000D__x000D_ between the rich and the poor the young and the old ethnic groups and women_x000D__x000D_ and men.

A Development Emergency: the title of this year's Global Monitoring Report, the sixth in an annual series, could not be more apt. The global economic crisis, the most severe since the Great Depression, is rapidly turning into a human and development crisis. No region is immune. The poor countries are especially vulnerable, as they have the least cushion to withstand events. The crisis, coming on the heels of the food and fuel crises, poses serious threats to their hard-won gains in boosting economic growth and reducing poverty. It is pushing millions back into poverty and putting at risk the very survival of many. The prospect of reaching the Millennium Development Goals (MDGs) by 2015, already a cause for serious concern, now looks even more distant. A global crisis must be met with a global response. The crisis began in the financial markets of developed countries, so the first order of business must be to stabilize these markets and counter the recession that the financial turmoil has triggered. At the same time, strong and urgent actions are needed to counter the impact of the crisis on developing countries and help them restore strong growth while protecting the poor. Global Monitoring Report 2009, prepared jointly by the staff of the World Bank and the International Monetary Fund, provides a development perspective on the global economic crisis. It assesses the impact on developing countries, their growth, poverty reduction, and other MDGs. And it sets out priorities for policy response, both by developing countries themselves and by the international community. This report also focuses on the ways in which the private sector can be better mobilized in support of development goals, especially in the aftermath of the crisis.

A comprehensive resource describing innovative technologies and digital health tools that can revolutionize the delivery of health care in low- to middle-income countries, particularly in remote rural impoverished communities  Revolutionizing Tropical Medicine offers an up-to-date guide for healthcare and other professionals working in low-resource countries where access to health care facilities for diagnosis and treatment is challenging. Rather than suggesting the expensive solution of building new bricks and mortar clinics and hospitals and increasing the number of doctors and nurses in these deprived areas, the authors propose a complete change of mindset. They outline a number of ideas for improving healthcare including rapid diagnostic testing for infectious and non-infectious diseases at a point-of-care facility, together with low cost portable imaging devices. In addition, the authors recommend a change in the way in which health care is delivered. This approach requires task-shifting within the healthcare provision system so that nurses, laboratory technicians, pharmacists and others are trained in the newly available technologies, thus enabling faster and more appropriate triage for people requiring medical treatment. This text: * Describes the current burden of communicable and non-communicable diseases in low- to middle-income countries throughout the world * Describes the major advances in healthcare outcomes in low-to middle-income countries derived from implementation of the United Nations/World Health Organisation's 2000 Millennium Development Goals * Provides a review of inexpensive rapid diagnostic point-of-care tests for infectious diseases in low-resource countries, particularly for people living in remote rural areas * Provides a review of other rapid point-of-care services for assessing hematological function, biochemical function, renal function, hepatic function and status including hepatitis, acid-base balance, sickle cell disease, severe acute malnutrition and spirometry * Explores the use of low-cost portable imaging devices for use in remote rural areas including a novel method of examining the optic fundus using a smartphone and the extensive value of portable ultrasound scanning when x-ray facilities are not available * Describes the use of telemedicine in the clinical management of both children and adults in remote rural settings * Looks to the future of clinical management in remote impoverished rural settings using nucleic acid identification of pathogens, the use of nanoparticles for water purification, the use of drones, the use of pulse oximetry and the use of near-infrared spectroscopy * Finally, it assesses the potential for future healthcare improvement in impoverished areas and how the United Nations/World Health Organization 2015 Sustainable Development Goals are approaching this. Written for physicians, infectious disease specialists, pathologists, radiologists, nurses, pharmacists and other health care workers, as well as government healthcare managers, Revolutionizing Tropical Medicine is a new up-to-date essential and realistic guide to treating and diagnosing patients in low-resource tropical countries based on new technologies.

This study aims to synthesize the factors associated with nurse emigration from lower and middle-income countries. Integrative review. An in-depth search of registries and five databases yielded 9466 records. Using the PRISMA guidelines, 11 were chosen after screening by two authors independently. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias. The destination countries were Europe and North America, with an inclination for nurse migration of 14.3%-85%. Emigration factors were poor salary, working conditions, poor quality  healthcare infrastructure; outdated healthcare technologies, lack of employment opportunities, younger age, relationship status (single), living environment, social pressure, urban residence, work experience, insecurity, high crime rates, political corruption and foreign language skills. Healthcare authorities and nursing leaders must implement practical measures to minimize nurse emigration.

Introduction This study assessed prevalence and time trends of pre‐pregnancy obesity in immigrant and non‐immigrant women in Norway and explored the impact of immigrants' length of residence on pre‐pregnancy obesity prevalence. Material and Methods Observational data from the Medical Birth Registry of Norway and Statistics Norway for the years 2016–2021 were analyzed. Immigrants were categorized by their country of birth and further grouped into seven super regions defined by the Global Burden of Disease study. Pre‐pregnancy obesity was defined as a body mass index ≥30.0 kg/m2, with exceptions for certain Asian subgroups (≥27.5 kg/m2). Statistical analysis involved linear regressions for trend analyses and log‐binomial regressions for prevalence ratios (PRs). Results Among 275 609 pregnancies, 29.6% (N = 81 715) were to immigrant women. Overall, 13.6% were classified with pre‐pregnancy obesity: 11.7% among immigrants and 14.4% among non‐immigrants. Obesity prevalence increased in both immigrants and non‐immigrants during the study period, with an average yearly increase of 0.62% (95% confidence interval [CI]: 0.55, 0.70). Obesity prevalence was especially high in women from Pakistan, Chile, Somalia, Congo, Nigeria, Ghana, Sri Lanka, and India (20.3%–26.9%). Immigrant women from “Sub‐Saharan Africa” showed a strong association between longer residence length and higher obesity prevalence (≥11 years (23.1%) vs. <1 year (7.2%); adjusted PR = 2.40; 95% CI: 1.65–3.48), particularly in women from Kenya, Eritrea, and Congo. Conclusions Prevalence of maternal pre‐pregnancy obesity increased in both immigrant and non‐immigrant women from 2016 to 2021. Several immigrant subgroups displayed a considerably elevated obesity prevalence, placing them at high risk for adverse obesity‐related pregnancy outcomes. Particular attention should be directed towards women from “Sub‐Saharan Africa”, as their obesity prevalence more than doubled with longer residence. Pre‐pregnancy obesity prevalence increased in both immigrant and non‐immigrant women during the study period, with an average yearly increase of 0.6%. The highest prevalence of pre‐pregnancy obesity was seen in women from Pakistan, Chile, Somalia, Congo, Nigeria, Ghana, Sri Lanka, and India. Length of residence was an important risk factor for increased prevalence of pre‐pregnancy obesity, particularly in women from Sub‐Saharan Africa.

Introduction Birth asphyxia is a leading cause of neonatal mortality in sub‐Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. Material and methods This was a prospective cross‐sectional study. Data were collected using a perinatal e‐Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks’ gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5‐minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. Clinical Trial: Pan African Clinical Trial Registry 202006793783148. Results Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17–1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34–16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13–1.68) and Uganda (OR 1.29, 95% CI 1.02–1.64), but was non‐significant in Tanzania (OR 1.44, 95% CI 0.81–2.56) and Malawi (OR 0.98, 95% CI 0.67–1.44). Conclusions There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration. Babies of grand multiparous women who are referred intrapartum for hospital delivery had the highest odds of birth asphyxia. These findings confirm that grand multiparas are a high‐risk group in low‐income countries and should be counseled to seek hospital birth.

Inadequate nutrient intakes are prevalent among many populations in sub‐Saharan Africa and increasing fish consumption among pregnant/lactating women and children is one strategy to improve diets and address nutrient deficiencies. We report the nutrient content of two fish‐based recipes—fish powder and fish chutney—that contain dried small fish available in local markets in Zambia. The contribution of a serving of each recipe to the recommended daily intakes of iron, zinc, calcium and docosahexaenoic acid (DHA) for pregnant/lactating women and children 6–24 months was calculated because these nutrients are commonly deficient in African diets. We found that one 10‐g serving of fish powder provides 20% or more of the daily calcium recommendation and 37% or more of the daily DHA recommendation for both pregnant/lactating women and children. A 30‐g serving of fish chutney provides over 40% of the daily calcium recommendation for pregnant women and over 50% for lactating women. Additionally, we investigated the nutrient density (nutrients per kilocalorie) of the fish powder and compared it with the nutrient density of a small‐quantity lipid‐based nutrient supplement plus (SQ‐LNS‐plus). SQ‐LNS‐plus is designed to enhance children's diets by providing micronutrients and DHA. Fish powder is similar to SQ‐LNS‐plus in iron and zinc density and even higher in calcium and DHA density. Consuming dried small fish as part of a daily meal can be a viable strategy for combatting nutrient deficiencies in the first 1000 days.

The revised and updated second edition of Water and Sanitation Related Diseases and the Changing Environment offers an interdisciplinary guide to the conditions responsible for water and sanitation related diseases. The authors discuss the pathogens, vectors, and their biology, morbidity and mortality that result from a lack of safe water and sanitation. The text also explores the distribution of these diseases and the conditions that must be met to reduce or eradicate them.  The text includes contributions from authorities from the fields of climate change, epidemiology, environmental health, environmental engineering, global health, medicine, medical anthropology, nutrition, population, and public health. Covers the causes of individual diseases with basic information about the diseases and data on the distribution, prevalence, and incidence as well as interconnected factors such as environmental factors. The authors cover access to and maintenance of clean water, and guidelines for the safe use of wastewater, excreta, and grey water, plus examples of solutions.  Written for students, and professionals in infectious disease, public health and medicine, chemical and environmental engineering, and international affairs, the second edition of Water and Sanitation Related Diseases and the Changing Environment isa comprehensive resource to the conditions responsible for water and sanitation related diseases.

Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS). To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences. Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted. Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = -7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes. Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.

BACKGROUND Sub‐Saharan Africa (SSA) is experiencing a rapid increase in its aging population, including people living with human immunodeficiency virus (HIV) (PLHIV). The purpose of this study was to determine the prevalence of dementia among PLHIV and people without HIV (POHIV) in Malawi. METHODS We conducted a retrospective medical record review of 400 consecutive patients from a single tertiary health center (200 PLHIV from an HIV clinic and 200 POHIV from an outpatient clinic) in Lilongwe, Malawi. RESULTS The overall rate of dementia was higher in PLHIV than that in POHIV (22% vs 10%; p = 1.4e). Older age, unknown employment or unemployed, and depression were significant risk factors for dementia for PLHIV, while older age and depression were significant among POHIV. DISCUSSION Our study confirmed the increased risk of dementia in PLHIV and provides valuable groundwork for future dementia studies to accurately examine the prevalence and risk factors of dementia in SSA, including Malawi. Highlights Malawians, in SSA, face the double burden of HIV AD and related dementias. We conducted a retrospective medical record review to assess dementia prevalence and risk factors. Dementia prevalence was higher in PLHIV than in POHIV. Older age, unknown employment or unemployed, and depression were risk factors for dementia in PLHIV. Our findings, reflecting the current diagnosing and medical documenting practice in Malawi, provide valuable groundwork for future dementia research in Malawi.