Bulletin of the World Health Organization

Public health round-up

Bulletin of the World Health Organization 2014;92:80-81. doi: http://dx.doi.org/10.2471/BLT.14.010214

Officially polio free – India’s last case


India was officially declared polio free on 13 January after no cases of poliomyelitis were reported for three years. Four-year-old Rukhsar Khatoon from West Bengal (pictured) had the country’s last case of polio. India, along with the rest of the South-East Asia Region, is on track to be certified polio-free next month.

China drafts smoke-free law

China's health authorities are working on a new law banning smoking in all indoor public places, according to the National Health and Family Planning Commission.

Such bans already exist in China, but the Commission said that they are often ignored and that national lawmakers had started drafting the law last year to tighten these restrictions and clarify punishments.

News about the new law came last month, just days after the Communist Party of China’s (CPC) Central Committee and the General Office of the State Council called for tougher action to make people respect bans on smoking in public places.

“Compared with the damage to health brought by smoking, the economic benefits brought by tobacco are trivial, so we are greatly promoting legislation on smoking control,” Commission spokesman Mao Qun’an told a news conference in Beijing.

China is the world`s largest producer and consumer of cigarettes: there are more than 300 million smokers in the country – about 28% of the adult population.

Tobacco is responsible for about one million deaths in China annually, and this figure is expected to increase to 3 million by 2050 if current smoking rates are not reduced.

China ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005. The FCTC requires indoor public places to be 100% smoke free, but implementation has been uneven across the vast country of more than 1.3 billion people.

“WHO looks forward to working with the Chinese government to support the CPC and State Council's policy and the development of a comprehensive national smoke-free law in China,” WHO said in a statement.


Halt in polio vaccination draws condemnation

Representatives of the World Health Organization and the United Nations Children’s Fund (UNICEF) in the Syrian Arab Republic condemned the interruption of a polio immunization campaign there last month due to intense fighting.

Following an outbreak of polio in the Syrian Arab Republic, WHO and UNICEF have been coordinating a mass vaccination campaign that was launched in December 2013 targeting 22 million children across the Middle East.

The campaign is part of a comprehensive outbreak response after 17 polio cases due to wild poliovirus type 1 were confirmed in the country in November last year.

In a joint resolution, all Member States in the WHO Eastern Mediterranean Region declared polio eradication to be an ‘emergency’.

“The fighting did not only interrupt the polio immunization campaign, but is also increasing the suffering of the Syrian people, not least women and children,” the agencies’ representatives said in a statement. “We call on all parties to cease fighting immediately and permit completion of the life-saving polio campaign and delivery of other life-saving humanitarian interventions.”

At the end of December and in early January, WHO delivered two shipments with more than 125 tons of medical equipment and medicines to health providers in the Syrian city of Aleppo – to both government- and opposition-controlled areas.

Since the beginning of the crisis in the Syrian Arab Republic the health situation has been deteriorating with shortages of medicines and health workers, the destruction of health facilities and difficult access to health care.

In spite of the challenges, WHO has been working with local health and community partners to strengthen health services there. Over the past year it has distributed medicines and supplies to meet the needs of 6.1 million people and has trained over 2000 Syrian health workers.


Displaced at risk in South Sudan

The humanitarian situation in South Sudan deteriorated following an outbreak of violence in the sub-Saharan country on 15 December last year.

A total of 413 000 persons have been displaced from the four states of Central Equatoria, Jonglei, Unity and Upper Nile, and 66 500 of them were taking shelter in United Nations (UN) peace-keeping bases in Juba, Bor, Malakal and Bentiu while an estimated 84 000 others were displaced in Aweriel County Lakes state.

WHO warned of a “looming risk” of disease outbreaks following the mass population displacement, especially for water-borne diseases.

“The poor water, sanitation and hygiene conditions in the camps, coupled with a shortage of health workers, poses health risks to thousands of displaced persons in the UN camp bases,” says Dr Abdi Aden Mohammed, WHO’s Country Representative in South Sudan.

To minimize the risk of outbreaks, WHO is working closely with the South Sudanese health authorities and other health partners, including the United Nations Mission in South Sudan (UNMISS) medical team, to identify health workers in the camps for internally displaced persons (IDP) who can provide primary health care services, as well as support health education and promotion among all displaced persons.

WHO has provided trauma management and emergency health kits to the UNMISS clinics and to other partners engaged in the management of trauma cases in the four states. It has also delivered essential drugs and medical supplies to UNMISS clinics to help them in the management of common illnesses. As of 14 January, more than 2705 wounded people were treated at across 21 treatment facilities in six states of South Sudan. Besides trauma, diarrhoea and malaria are the most common health problems reported at the IDP camps.


Cover photo

WHO/GAVI /Asad Zaidi

Shankotila Bai (right) and her friend return from the well in their village in the Sindh province of Pakistan. Bai is one of the country’s 100 000 Lady Health Workers: married women who balance the daily responsibilities of running a household with those of a community health worker.

Huge unmet need for palliative care

An estimated 40 million people worldwide are in need of palliative care, but fewer than 10% of them (about 3 million) are receiving it, according to a new report that was released last month.

Half of the 40 million people need palliative care at the end of their lives, while the rest need it earlier for mainly chronic conditions, according to the Global Atlas of Palliative Care at the End of Life.

Most palliative care is provided in high-income countries but almost 80% of the global need for palliative care is in low- and middle-income countries.

The report, compiled by WHO in collaboration with the Worldwide Palliative Care Alliance, is the first to assess the need for palliative care and to chart the availability of services globally. The new estimates for unmet need are based on WHO global figures from 2011.

While about one third of the people who need palliative care have some form of cancer, most of them have other illnesses such as cardiovascular diseases, chronic respiratory diseases, AIDS, diabetes and other chronic and life threatening illnesses.

WHO promotes the integration of palliative care across diseases and all levels of care, with emphasis on community/home-based care. According to the report, only 20 countries (8%) have fully integrated palliative care into their health-care systems.

“The huge unmet need for palliative care is due to several factors,” said Dr Shanthi Mendis, coordinator of the Chronic Diseases Prevention and Management unit at WHO in Geneva, citing the policies recognizing the importance of palliative care, the lack of access to essential medicines – especially pain relievers, the lack of education for health-care professionals and the public about the benefits of palliative care, and the lack of resources.

Last month, WHO’s Executive Board considered a report calling for more attention to be given to palliative care particularly in low- and middle-income countries.



Two WHO offices re-open

Relative calm last month allowed humanitarian agencies to resume their work in the cities of Bouar and Kaga Bandoro in the Central African Republic where WHO re-opened two field offices.

Health-care delivery in the sub-Saharan country has been deteriorating since the coup d’état there on 24 March 2013. But last month, WHO managed to resume work with all the health providers in these areas to improve people's access to health services.

On their return, WHO teams brought with them emergency medical supplies that were delivered to local health authorities in the two cities, where an upsurge of violence erupted in December. Health services in the two regions are stretched.

The United Nations Office for the Coordination of Humanitarian Affairs said in a situation report issued on 7 January that around 935 000 people had been uprooted throughout the country and that more than 512 000 of them have been internally displaced in Bangui alone.


Looking ahead

24 March – World Tuberculosis Day

7 April – World Health Day devoted to the vector-borne diseases

25 April – World Malaria Day

23–30 April – World Immunization Week

17–18 May – Conference hosted by the World Health Professions Alliance entitled Health professional regulation – facing challenges to acting in the public interest, Geneva, Switzerland

19–24 May – Sixty-seventh World Health Assembly

31 May – World No Tobacco Day