World Health Organization

About: World Health Organization is a government organization based out in Islamabad, Pakistan. It is known for research contribution in the topics: Population & Public health. The organization has 13330 authors who have published 22232 publications receiving 1322023 citations. The organization is also known as: World Health Organisation & WHO.

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update.

Abstract: Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.

Global assessment of exposure to faecal contamination through drinking water based on a systematic review

Abstract: Objectives: To estimate exposure to faecal contamination through drinking water as indicated by levels of Escherichia coli (E. coli) or thermotolerant coliform (TTC) in water sources. Methods: We estimated coverage of different types of drinking water source based on household surveys and censuses using multilevel modelling. Coverage data were combined with water quality studies that assessed E. coli or TTC including those identified by a systematic review (n = 345). Predictive models for the presence and level of contamination of drinking water sources were developed using random effects logistic regression and selected covariates. We assessed sensitivity of estimated exposure to study quality, indicator bacteria and separately considered nationally randomised surveys. Results: We estimate that 1.8 billion people globally use a source of drinking water which suffers from faecal contamination, of these 1.1 billion drink water that is of at least ‘moderate’ risk (>10 E. coli or TTC per 100 ml). Data from nationally randomised studies suggest that 10% of improved sources may be ‘high’ risk, containing at least 100 E. coli or TTC per 100 ml. Drinking water is found to be more often contaminated in rural areas (41%, CI: 31%–51%) than in urban areas (12%, CI: 8–18%), and contamination is most prevalent in Africa (53%, CI: 42%–63%) and South-East Asia (35%, CI: 24%–45%). Estimates were not sensitive to the exclusion of low quality studies or restriction to studies reporting E. coli. Conclusions: Microbial contamination is widespread and affects all water source types, including piped supplies. Global burden of disease estimates may have substantially understated the disease burden associated with inadequate water services. Objectifs: Estimer l'exposition a la contamination fecale par l'eau potable, telle qu'indiquee par les quantites d’Escherichia coli (E. coli) ou de coliformes thermo-tolerants (CTT) dans les sources d'eau. Methodes: Nous avons estime l’etendue de la couverture en differents types de sources d'eau potable a partir d'enquetes sur les menages et des recensements a l'aide de la modelisation a multi-niveaux. Les donnees de couverture ont ete combinees avec des etudes de qualite de l'eau evaluant E. coli ou les CTT y compris celles identifiees par une revue systematique (n = 345). Les modeles predictifs pour la presence et le niveau de contamination des sources d'eau potable ont ete developpes en utilisant la logistique de regression a effets aleatoires et une selection de covariables. Nous avons evalue la sensibilite de l'exposition estimee pour etudier la qualite, les bacteries indicatrices et avons separement considere des etudes nationales randomisees. Resultats: Nous estimons que 1,8 milliard de personnes dans le monde utilisent une source d'eau potable porteuse de contamination fecale. Parmi celles-ci 1,1 milliard boivent de l'eau avec un risque assez «modere» (>10 E. coli ou CTT par 100 ml). Les donnees des etudes nationales randomisees indiquent que 10% des sources ameliorees pourraient etre a risque «eleve», i.e. contenant au moins 100 E. coli ou CTT par 100 ml. L'eau potable se trouve etre plus souvent contaminee dans les zones rurales (41%, IC: 31–51) qu'en milieu urbain (12%, IC: 8–18) et la contamination est la plus repandue en Afrique (53%, CI: 42–63) et en Asie du sud-est (35%, IC: 24–45). Les estimations n’etaient pas affectees par l'exclusion des etudes de faible qualite ou par la restriction aux etudes rapportant sur E. coli. Conclusions: La contamination microbienne est tres repandue et affecte tous les types de sources d'eau, y compris les fournitures par tuyauterie. Les estimations de la charge mondiale des maladies pourraient avoir sensiblement sous-estime la charge de morbidite associee a des services d'eau inadequats. Objetivos: Calcular la exposicion a la contaminacion fecal a traves del agua para consumo, segun los niveles de Escherichia coli (E. coli) o coliformes termotolerantes (CTT) en las fuentes de agua. Metodos: Utilizando modelos multinivel, hemos calculado la cobertura de diferentes tipos de fuentes de agua para consumo basandonos en encuestas a hogares y censos. Los datos de cobertura se combinaron con estudios de calidad del agua que evaluaron niveles de E. coli o CTT, incluyendo aquellos identificados mediante una revision sistematica (n = 345). Los modelos predictivos para la presencia y nivel de contaminacion de las fuentes de agua para consumo se desarrollaron utilizando una regresion logistica de efectos aleatorios y covariables seleccionadas. Evaluamos la sensibilidad de la exposicion calculada segun la calidad del estudio, la bacteria utilizada como indicador y tuvimos en cuenta de forma separada los ensayos nacionales aleatorizados. Resultados: Hemos calculado que 1.8 billones de personas a nivel global utilizan una fuente de agua para beber que sufre de contaminacion fecal; de estas 1.1 billones consumen agua que es al menos de riesgo “moderado” (>10 E. coli o CTT por 100 mL). Datos de estudios nacionales aleatorizados sugieren que un 10% de las fuentes de agua mejoradas pueden ser de‘alto’ riesgo, al contener al menos 100 E. coli o CTT por 100 mL. El agua para consumo se encuentra mas a menudo contaminada en areas rurales (41%, IC: 31–51%) que en areas urbanas (12%, IC: 8–18%) y la contaminacion es mas prevalente en Africa (53%, IC: 42–63%) y el Sudeste Asiatico (35%, CI: 24–45%). Los calculos no eran sensibles a la exclusion de estudios de mala calidad o a la restriccion de estudios en los que se reporta E. coli. Conclusiones: La contaminacion microbiana esta ampliamente extendida y afecta todos los tipos de agua, incluyendo la distribuida a traves de tuberias. Los calculos de la carga global de enfermedad podrian haber subestimado sustancialmente la carga de enfermedad por servicios de agua inadecuados.