World Health Organization updates guidance on appropriate antibiotic use.

Earlier this month, The World Health Organization published the WHO AWaRe (Access, Watch, Reserve) antibiotic book, which offers evidence-based, practical guidance regarding the optimal use of antibiotics included in WHO’s Model Lists of Essential Medicines. The book details the appropriate antibiotic, dosage, route of administration, and treatment length for over 30 common clinical infections found in both adults and children in outpatient and hospital settings. Summary infographics and a free mobile app make this information easily accessible to healthcare workers around the world. [WHO]

Artemisinin-based therapy in pregnancy was not associated with embryotoxicity.

Plasmodium falciparum malaria in the first trimester of pregnancy is linked with adverse maternal and fetal outcomes, and the risk of pregnancy loss can be as high as 60 percent. Artemisinin-based combination therapies (ACTs), while effective in the second and third trimesters of pregnancy, have not been recommended for the first trimester due to concerns about potential embryotoxicity. Researchers conducted a systematic review and meta-analysis of seven studies that reviewed over 34,000 pregnancies total in sub-Saharan Africa and Asia. There was no evidence of embryotoxicity by measures of miscarriage, stillbirth, or major congenital anomalies associated with artemisinin-based therapy (ABT) exposure in the first trimester.  Compared with oral non-ABTs, ACTs were associated with a markedly lower risk of adverse pregnancy outcomes (adjusted HR: 0.59; 95% CI; 0.39-0.89). The results align with WHO’s 2022 recommendation to include ACTs as the preferred treatment option for P. falciparum malaria in the first trimester of pregnancy. [The Lancet]

Clear institutional metrics are needed for progress on racial equity.

While institutions, mainly in high-income countries, have reported a commitment against racism, many have not defined parameters by which their progress in providing support and resources to marginalized groups can be measured. Some challenges in developing these metrics include the persistent confusion about the meaning of anti-racism and the struggle to identify simple yet effective metrics. Metrics of progress on racial equity must cover objective and subjective measures and should be organized in time frames to gauge long- and short-term results. [The Lancet]

Predictions of increased COVID-19 transmission after China removes its zero-COVID policy.

In early December, the Chinese government relaxed its strict zero-COVID policy, including isolation guidelines, mass testing requirements, and travel restrictions, maintained over the last three years. While China hopes to reduce the economic and social burden of stringent lockdowns through this new change in policy, researchers caution that the rapid transition might lead to confusion and increased transmission of COVID-19, especially given the limited timeframe to ramp up vaccination among older individuals living in rural and remote areas. [Nature]

Social deprivation in childhood is associated with increased mortality risk.

Researchers conducted a meta-analysis of data collected between April 2019 and March 2020 in England to identify patterns of social deprivation and modifiable factors associated with childhood mortality. Most child fatalities occurred in urban areas and among children with white ethnic backgrounds. The incidence and risk of death were higher in the most deprived decile. Mortality risk in children in the two most deprived deciles more than doubled compared to that in the two least deprived deciles (31.14 vs. 13.25 per 100,000 person-years). Furthermore, the proportion of modifiable social factors, including financial hardships, homelessness, and poor maternal nutrition, increased with increasing deprivation. The researchers note that over one-fifth of all child deaths could be avoided if the most deprived half of the population had the same mortality risk as the least deprived. [BMJ Open]

Vaccinating the elderly could prevent more COVID-19 infections and deaths.

A study analyzing the impact of different vaccination strategies on COVID-19 infections, hospitalizations, and deaths found that the most effective approach is to prioritize the vaccination of the elderly population. Using a simulator to reproduce the propagation of COVID-19 throughout a region, the researchers recreated the population of five million individuals in the Metropolitan Madrid area. The findings revealed that in addition to prioritizing elderly people, spacing the two doses by 56 days (instead of the recommended 21) reduces the final infection rate and the number of deaths by six and three percent respectively. While Spain has mostly completed its vaccine roll-out, the researchers suggest that countries with less developed vaccination programs could implement this approach. [BMJ Open]

Indoor air pollution in rural India significantly reduces cognitive function among older women.

Indoor air pollution (IAP) is a significant environmental risk factor for respiratory illnesses, cancer, cardiovascular disease, adverse fetal outcomes, cataracts, and blindness. Researchers utilized data from the Longitudinal Ageing Study of India (LASI) and isolated female, rural-dwelling participants and analyzed their responses to cognitive tests to assess the impact of IAP from household cooking on rural middle-aged and elderly Indian women. They found that rural women exposed to IAP were significantly less likely to have good cognitive function. This association was stronger among elderly women as compared to middle-aged women. Since 40 percent of Indian households still rely on unclean biomass fuel for domestic cooking, the researchers call for policy changes to reduce IAP in rural India. [BMC Public Health]

The pandemic exposed pre-existing gaps in health service delivery in South Africa.

The COVID-19 pandemic revealed gaps and challenges in healthcare delivery in South Africa that have existed for decades, burdening an already overwhelmed healthcare system. Researchers conducted interviews with community and healthcare workers from two sites in South Africa to evaluate the impact of COVID-19 on healthcare delivery in the country. Overall, participants believed that COVID-19 did not worsen but rather exposed the poor state of health services in South Africa. Healthcare workers specifically reported feeling overwhelmed by the high patient volume during the pandemic, especially when their care went unrecognized or unappreciated. While healthcare and community workers acknowledged efforts made by the South African government to manage COVID-19 transmission, they noted that pre-existing inadequacies in the healthcare system made health service delivery more challenging. [Frontiers in Public Health]

Reproductive and sexual health resources and education for Indian female sex workers are limited.

While research and public health interventions among female sex workers (FSWs) primarily focus on HIV/STI prevention, few resources for FSWs’ reproductive and sexual health (RSH) exist. A new study explored the barriers and facilitators for access and utilization of RSH services among FSWs in urban and rural areas in the Indian state of Maharashtra. Male and female condoms were viewed as a means of HIV/STI prevention, but also as a contraceptive method; the study found that pregnancy was an even greater motivation for condom use among FSWs.  However, condom availability was a challenge for FSWs in rural areas. Furthermore, FSWs in both rural and urban settings reported that many healthcare providers refused to perform medical abortions, so they resorted to using herbal remedies, alcohol, and fruits to induce abortion and viewed hospitals as their last option. [Frontiers in Public Health]

Resistant Enterobacterales are associated with high hospital costs in Singapore.

Researchers estimated the costs of healthcare-associated infection (HAI) by carbapenem-resistant Enterobacterales (CRE) in acute-care hospitals in Singapore in 2019, by accounting for costs of infection prevention and treatment and costs associated with lost bed days. Cost analyses revealed that CRE HAIs cost SGD$12.16 million annually based on infection prevention and treatment costs and SGD$12.33 million annually based on lost bed days. The findings highlighted the greater associated costs of drug resistance; direct costs associated with CRE HAIs were more than three times those associated with carbapenem-sensitive Enterobacterales (CSE) HAIs. [PLOS Global Public Health]

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