Many countries lack capacity to prevent and treat hearing loss

28 February 2014 | GENEVA - Many of the countries who responded to a new WHO survey lack the capacity to prevent and care for hearing loss, according to a report published on International Ear Care Day, 3 March.

Results of the survey

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level.”

Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability

WHO estimates that over 5% of the world’s population – 360 million people - has disabling hearing loss. The highest prevalence is found in the Asia Pacific, South Asia and sub-Saharan Africa. About half of all cases of hearing loss worldwide are easily prevented or treated.

A leading cause for hearing loss in younger ages, particularly in low- and middle-income countries, is untreated ear infections, which often presents with discharge from the ear. Vaccine-preventable infectious diseases such as rubella, meningitis, measles, or mumps can also lead to hearing loss.

Just 32 of the 76 countries who responded have developed plans and programmes to prevent and control ear diseases and hearing loss. According to the report, many lack trained health personnel, educational facilities, data and national plans to address the needs of those living with ear and hearing problems. The information received also indicates that the gap between need and services is greatest in sub-Saharan Africa.

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level,” says Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability. “The programmes must aim to benefit all, including disadvantaged parts of the population who are least able to access hearing services.”

Prevention and treatment of hearing loss at primary level

Good ear care practices, such as reducing exposure to noise and avoiding insertion of objects into the ears, can prevent many from developing ear and hearing problems. A large percentage of people living with hearing loss can benefit from early identification and appropriate treatment.

For example, screening programmes for infant hearing can minimize the impact of hearing loss on a child’s development.

“Ear and hearing problems and the use of hearing aids are often associated with myths and misconceptions”, says Dr Shelly Chadha of the WHO unit for the Prevention of Blindness and Deafness. “National programmes should therefore not only focus on prevention and service provision but also on awareness raising.”

The national plans that already exist in some countries can serve as a model for countries that still lack strategies to better address disabling hearing loss. However, each country needs to develop a unique plan based on its specific situation, the prevalent causes of hearing loss as well as the available health infrastructure.

For more information please contact:

Tarik Jasarevic
WHO, Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int

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Progress in diagnosing multidrug-resistant tuberculosis

20 March 2014 | Geneva - Almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in 2012, yet less than one in 4 of these people was diagnosed, mainly due to a lack of access to quality diagnostic services.

But with an innovative international project, 27 countries are making promising progress in diagnosing MDR-TB, says WHO in the lead-up to World TB Day, 24 March.

The project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, helped to triple the number of MDR-TB cases diagnosed in participating countries.

“Earlier and faster diagnosis of all forms of TB is vital,” says Dr Margaret Chan, WHO Director-General. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.”

World TB Day 2014: Reach the 3 million

"Earlier and faster diagnosis of all forms of TB is vital. It improves the chances of people getting the right treatment and being cured...”

Dr Chan, WHO Director-General

The theme for World TB Day 2014 is “Reach the 3 Million”. One third of the estimated 9 million people falling ill with TB each year do not get the care they need. In many countries, it is hard for people to access diagnostic services – particularly for MDR-TB. Some countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In some cases, patient samples have to be sent to other countries for testing. Moreover, traditional diagnostic tests can take more than 2 months to get results.

But the situation is beginning to change. New technologies can rapidly diagnose TB and drug-resistant TB in as little as two hours.

“The MDR-TB story is being transformed by a fertile mix of collaborators, including those working on access to diagnosis,” says Philippe Meunier, the French Government’s Ambassador for the fight against HIV/AIDS and communicable diseases. “Increased capacity and reduced prices mean more patients can be served, and global health risks would be diminished.”

In 2009, UNITAID provided US$ 87 million to support the EXPAND-TB multi-partner project to enable effective and sustained access, and use of recommended new TB diagnostic technologies in 27 low- and middle-income countries. These countries together carry 40% of the estimated global MDR-TB burden.

The project delivers positive results

The project has delivered impressive results. Over 30% of the MDR-TB cases detected globally in 2012 were from EXPAND-TB countries. 90% of India’s detected MDR-TB cases were through EXPAND-TB supported services. Use of these tests requires strengthened laboratory services. By the end of 2013, 92 laboratories were fully operational. From 2009 to 2013, the number of MDR-TB cases diagnosed in the 27 countries tripled, with 36 000 diagnosed in 2013 alone.

The project has enabled more patients to be treated with quality-assured second-line TB medicines. Through that demand, the project has helped to reduce the price of individual medicines and MDR-TB treatment regimens by one third. Prices have also dropped for diagnostic commodities.

Project partners are WHO and the Global Laboratory Initiative (GLI), the Stop TB Partnership’s Global Drug Facility and FIND. Project funds have been used to purchase testing equipment and commodities, and to train laboratory technicians.

The EXPAND-TB project complements investments in laboratory infrastructure and diagnostic services from international partners, including The Global Fund to Fight AIDS, TB and Malaria, The World Bank and the United States Government.

“The gap in access to TB diagnostics and care is far from filled, but is narrowing. With the impetus of modern laboratories, we are on the right track finally to handle MDR-TB,” says Dr Mario Raviglione, Director of WHO’s Global TB Programme.

Ministries of health are now working on securing domestic funding for the medium-term and working with partners to fill financing shortfalls for quality diagnostic tests and services.

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Note to editors

EXPAND-TB Partners, and additional quotes from participants in the 20 March press briefing

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

UNITAID is a global health initiative launched in 2006 by the Governments of Brazil, Chile, France, Norway and the United Kingdom to provide sustainable funding for the fight against HIV/AIDS, malaria and tuberculosis. About 70% of UNITAID’s funds come from a small levy on airline tickets. Through implementers, UNITAID finances the purchase of quality-assured drugs and diagnostics for patients in poor countries, using its market power to expand supply, promote development of new and better products, cut delivery lead times and reduce prices.

Dr Philippe Duneton, Executive Director a.i., UNITAID said, “The EXPAND-TB project has been an important part of UNITAID’s TB investment portfolio as identifying cases has been, and remains, essential. To reach the missing three million, we must continue to find and use ever-better diagnostics technologies, but also enable access for low- and middle-income countries to the new medicines now available.”

The Stop TB Partnership’s Global Drug Facility (GDF) coordinates and manages procurement and delivery of TB commodities like quality assured medicines, diagnostic equipment and supplies to eligible countries, offering as well technical assistance for building more sustainable supply chain systems. The GDF has procured and distributed diagnostics and laboratory equipment for the project and, by pooling the global demand for Second Line anti-TB Drugs within one single procurement platform, has reached up to 32% cost reduction for MDR-TB treatment, bringing a broader basis of suppliers producing quality assured medicines and allowing more market competition.

“We need to ensure that diagnostics are accessible and closer to people. This project is a successful multi-partner strategic approach where diagnostic, treatment capacity and medicines supply have been linked together, showing the path for a stronger fight against MDR-TB " said Dr Joel Keravec, GDF Special Advisor.

FIND is an international non-profit organization that drives development and delivery of innovative diagnostic solutions for poverty-related diseases. As the main implementing partner for EXPAND-TB, FIND works closely with national TB programmes and multiple international and local partners to build laboratory capacity, accelerate uptake and establish the know-how needed for correct use of new TB technologies. FIND helps ensure that all the key components that are needed for successful diagnostic implementation are put in place, and aims to maximise patient impact.

Dr Catharina Boehme, FIND’s Chief Executive Officer, said “Without diagnostics, medicine is blind. The EXPAND TB project is critical for scaling up the capacity to detect TB drug resistance. It has also laid the ground for rapid uptake and proper use of future diagnostic innovations that are urgently needed to effectively fight TB and drug resistance. Continued commitment from the global health community in support of new tools, especially point-of-care diagnostics, should remain a high priority.”

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For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Tel.: +41 22 791 5099
Email: jasarevict@who.int

View the original article here

7 million premature deaths annually linked to air pollution

25 March 2014 | Geneva - In new estimates released today, WHO reports that in 2012 around 7 million people died - one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives.

New estimates

In particular, the new data reveal a stronger link between both indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischaemic heart disease, as well as between air pollution and cancer. This is in addition to air pollution’s role in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases.

The new estimates are not only based on more knowledge about the diseases caused by air pollution, but also upon better assessment of human exposure to air pollutants through the use of improved measurements and technology. This has enabled scientists to make a more detailed analysis of health risks from a wider demographic spread that now includes rural as well as urban areas.

Regionally, low- and middle-income countries in the WHO South-East Asia and Western Pacific Regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution.

“Cleaning up the air we breathe prevents non-communicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly...”

Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health

“Cleaning up the air we breathe prevents noncommunicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly,” says Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health. “Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves.”

Included in the assessment is a breakdown of deaths attributed to specific diseases, underlining that the vast majority of air pollution deaths are due to cardiovascular diseases as follows:

Outdoor air pollution-caused deaths – breakdown by disease:

• 40% – ischaemic heart disease;
• 40% – stroke;
• 11% – chronic obstructive pulmonary disease (COPD);
• 6% - lung cancer; and
• 3% – acute lower respiratory infections in children.

Indoor air pollution-caused deaths – breakdown by disease:

• 34% - stroke;
• 26% - ischaemic heart disease;
• 22% - COPD;
• 12% - acute lower respiratory infections in children; and
• 6% - lung cancer.

The new estimates are based on the latest WHO mortality data from 2012 as well as evidence of health risks from air pollution exposures. Estimates of people’s exposure to outdoor air pollution in different parts of the world were formulated through a new global data mapping. This incorporated satellite data, ground-level monitoring measurements and data on pollution emissions from key sources, as well as modelling of how pollution drifts in the air.

Risks factors are greater than expected

“The risks from air pollution are now far greater than previously thought or understood, particularly for heart disease and strokes,” says Dr Maria Neira, Director of WHO’s Department for Public Health, Environmental and Social Determinants of Health. “Few risks have a greater impact on global health today than air pollution; the evidence signals the need for concerted action to clean up the air we all breathe.”

After analysing the risk factors and taking into account revisions in methodology, WHO estimates indoor air pollution was linked to 4.3 million deaths in 2012 in households cooking over coal, wood and biomass stoves. The new estimate is explained by better information about pollution exposures among the estimated 2.9 billion people living in homes using wood, coal or dung as their primary cooking fuel, as well as evidence about air pollution's role in the development of cardiovascular and respiratory diseases, and cancers.

In the case of outdoor air pollution, WHO estimates there were 3.7 million deaths in 2012 from urban and rural sources worldwide.

Many people are exposed to both indoor and outdoor air pollution. Due to this overlap, mortality attributed to the two sources cannot simply be added together, hence the total estimate of around 7 million deaths in 2012.

“Excessive air pollution is often a by-product of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to health-care cost savings as well as climate gains,” says Dr Carlos Dora, WHO Coordinator for Public Health, Environmental and Social Determinants of Health. “WHO and health sectors have a unique role in translating scientific evidence on air pollution into policies that can deliver impact and improvements that will save lives.”

The release of today’s data is a significant step in advancing a WHO roadmap for preventing diseases related to air pollution. This involves the development of a WHO-hosted global platform on air quality and health to generate better data on air pollution-related diseases and strengthened support to countries and cities through guidance, information and evidence about health gains from key interventions.

Later this year, WHO will release indoor air quality guidelines on household fuel combustion, as well as country data on outdoor and indoor air pollution exposures and related mortality, plus an update of air quality measurements in 1600 cities from all regions of the world.

For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Telephone: +41 22 791 5099
E-mail: jasarevict@who.int

Glenn Thomas
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

Nada Osseiran
Communications Officer, Department of Public Health, Environmental and Social Determinants of Health
Telephone: +41 22 791 4475
Mobile: +4179 445 1624
E-mail: osseirann@who.int

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