WHO issues new guidance on how to provide contraceptive information and service

6 March 2014 | GENEVA - In advance of International Women’s Day on 8 March 2014, WHO is launching new guidance to help countries ensure human rights are respected in providing more girls, women, and couples with the information and services they need to avoid unwanted pregnancies.

An estimated 222 million girls and women who do not want to get pregnant, or who want to delay their next pregnancy, are not using any method of contraception. Access to contraception information and services will allow better planning for families and improved health.

WHO guidance recommendations

“Ensuring availability and accessibility to the information and services they need is crucial, not only to protect their rights, but also their health.”

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

The guidance recommends that everyone who wants contraception should be able to obtain detailed and accurate information, and a variety of services, such as counselling as well as contraceptive products. It also underlines the need for no discrimination, coercion or violence, with special attention given to assuring access to those who are disadvantaged and marginalized.

Other key measures are scientifically accurate sex education programmes for young people, including information on how to use and acquire contraceptives. The guidance states that adolescents should be able to seek contraceptive services without having to obtain permission from parents or guardians. It also recommends that women be able to request services without having to obtain authorization from their husbands. It emphasizes the importance of respecting the privacy of individuals, including confidentiality of medical and other personal information.

“A lack of contraception puts 6 out of 10 women in low-income countries at risk of unintended pregnancy,” says Dr Flavia Bustreo, WHO’s Assistant Director-General for Family, Women, and Children’s Health. “Ensuring availability and accessibility to the information and services they need is crucial, not only to protect their rights, but also their health. These unintended pregnancies can pose a major threat to their own and their children’s health and lives.”

Access to contraception

In low- and middle-income countries, complications of pregnancy and childbirth are among the leading cause of death in young women aged 15–19 years. Stillbirths and death in the first week of life are 50% higher among babies born to mothers younger than 20 years than among babies born to mothers 20–29 years old.

Access to contraception allows couples to space pregnancies and enables those who wish to limit the size of their families to do so. Evidence suggests that women who have more than four children are at increased risk of death from complications of pregnancy and childbirth.

Many people who cannot currently access contraception services are young, poor, and live in rural areas and urban slums. Efforts are under way to address this need. The 2012 London Summit on Family Planning committed to extend family planning services to at least 120 million more people by the year 2020.

“Global targets are stimulating much needed action to increase access to modern contraception,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “But we have to be careful that our efforts to meet those targets do not lead to human rights infringements. It is not just about increasing numbers, it’s also about increasing knowledge. It is vital for women—and men—to understand how contraception works, be offered a choice of methods, and be happy with the method they receive.”

The International Conference on Population and Development held in Cairo in 1994 highlighted the importance of a rights-based approach to family planning. The past 20 years have seen a large amount of work demanding and defining a rights-based approach to health services—including contraception. Yet there has been comparatively little practical advice how to do so. WHO’s new guidance aims to address that gap.

The guidance also suggests ways to improve supply chains and affordability, recommends additional training for health workers, and outlines a series of steps to improve access in crisis settings, in HIV clinics, and during pre-natal and post-natal care.

The new guidance complements existing WHO recommendations for sexual and reproductive health programmes, including guidance on maternal and newborn health, sexuality education, prevention of unsafe abortion, and core competencies for primary health care.

For more information, please contact:

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

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WHO issues new guidance for treating children with severe acute malnutrition

27 November 2013 | GENEVA - WHO today released new treatment guidelines for the almost 20 million children under-five worldwide who have severe acute malnutrition.

Severe acute malnutrition is when children suffer severe wasting that may or may not be accompanied by swelling of the body from fluid retention. It occurs when infants and children do not have adequate energy, protein and micronutrients in their diet, combined with other health problems such as recurrent infections. It is diagnosed when the circumference of the upper arm is less than 115 mm or when the weight for height of a child is severely reduced.

Children with severe acute malnutrition are among the most vulnerable people in the world. They are very thin: most of their fat and muscle has been used by their bodies to stay alive.

Main recommendations

The updated WHO guidelines recommend that children with severe acute malnutrition who do not have health complications that require hospitalization, receive special, high-energy food and antibiotics to treat infection. This allows them to recover at home with their families. They also give guidance on how to treat them for HIV and, if necessary make recommendations on how to treat severely malnourished infants under six months.

“The guidelines are critical because many national health plans currently overlook children with severe acute malnutrition... If these children don’t get the right medical and nutritional care, very often they die,”

Dr Francesco Branca, Director, WHO Department of Nutrition for Health and Development

“The guidelines are critical because many national health plans currently overlook children with severe acute malnutrition. This can be fatal. If these children don’t get the right medical and nutritional care, very often they die,” says Dr Francesco Branca, Director of WHO’s Department of Nutrition for Health and Development.

New guidelines reflect new opportunities and technologies

The new guidelines supersede those issued by WHO in 1999 which recommended that all severely malnourished children be hospitalized, given fortified formula milk and appropriate treatment including antibiotics. The guidelines have been updated to reflect new opportunities and technologies that allow severely malnourished children who have an appetite and no evident medical complications to be effectively treated at home with specially-formulated foods that provide energy and nutrients and antibiotic medicines.

“It’s generally better for children and better for their families if they’re treated as outpatients,” says Dr Elizabeth Mason, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “It can be easier for families who need to continue providing and caring for other children, and it allows vulnerable, malnourished children to stay home and avoid the risk of getting hospital infections.”

The proactive use of antibiotics is important because the immune system of a child who is severely malnourished can virtually shut down. This lack of immune response means both that the body cannot fight off infection and that tests may not detect infection, even when one is present. Evidence shows that giving a broad spectrum antibiotic such as amoxicillin enables the child’s body to fight off common infections like pneumonia and urinary tract infections which can be fatal to this group of children.

However, the new recommendation is specifically for children with severe acute malnutrition—not those who are simply undernourished. Widespread use of antibiotics among children who do not need them would increase the risk of infections becoming resistant to lifesaving antibiotics—a situation that would harm the health and survival of all children.

Severely malnourished children with HIV

Another new aspect of the guidelines relates to the treatment of severely malnourished children with HIV. The 1999 guidelines did not recommend HIV testing of children with severe acute malnutrition. At that time, there was poor availability and little experience of treating children with antiretroviral drugs. Circumstances today are very different. We now know that antiretrovirals significantly increase survival of children with HIV, and access to these drugs is improving. The new guidelines recommend that children with severe acute malnutrition in countries where HIV is common be routinely tested for the virus, and those who are positive should start on antiretroviral drugs as well as special foods and antibiotics to treat their severe malnutrition.

Infants under 6 months with severe acute malnutrition

The other group whose needs are addressed for the first time in these guidelines are infants under 6 months with severe acute malnutrition. WHO recommends that all babies under 6 months are exclusively breastfed for optimal nutrition and protection against infections. This is particularly important for babies who are severely malnourished. Health services should give special support to mothers of these infants to breastfeed as well as treating the child with antibiotics. If there is no realistic prospect of a severely malnourished baby being breastfed, the family may need breast milk from another woman, e.g. a family member, a neighbour, a wet nurse or a milk bank. If this is not possible, they will need infant formula and support to prepare and use it safely.

For more information please contact:

Fadela Chaib
Communications Officer/Spokesperson
WHO
Telephone: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int

View the original article here

WHO releases guidance on mental health care after trauma

6 August 2013 | GENEVA - WHO is releasing new clinical protocols and guidelines to health-care workers for treating the mental health consequences of trauma and loss.

Mental disorders are common, disabling and usually untreated, and WHO’s "Mental Health Global Action Programme (mhGAP)" was developed in 2008 to scale-up care for mental, neurological and substance use disorders with simple treatment protocols that can be offered by primary health-care doctors and nurses.

New care protocols for post-traumatic stress disorder and others

Now, WHO is extending this programme by including care for post-traumatic stress disorder (PTSD), acute stress and bereavement within its global programme.

“We have received numerous requests for guidance for mental health care after trauma and loss” says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “Primary health-care providers will now be able to offer basic support consistent with the best available evidence. They will also learn when to refer to more advanced treatment.”

Traumatic events and loss a common experience

Traumatic events and loss are common in people’s lives. In a previous WHO study of 21 countries, more than 10% of respondents reported witnessing violence (21.8%) or experiencing interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) or trauma to a loved one (12.5%). An estimated 3.6% of the world's population has suffered from post-traumatic stress disorder (PTSD) in the previous year, the study showed.

Using the new protocol, which is co-published with the United Nations High Commissioner for Refugees (UNHCR), primary health-care workers can offer basic psychosocial support to refugees as well as people exposed to trauma or loss in other situations.

Types of support offered can include psychological first aid, stress management and helping affected people to identify and strengthen positive coping methods and social supports.

In addition, referral for advanced treatments such as cognitive-behavioural therapy (CBT) or a new technique called eye movement desensitization and reprocessing (EMDR) should be considered for people suffering from PTSD. These techniques help people reduce vivid, unwanted, repeated recollections of traumatic events. More training and supervision is recommended to make these techniques more widely available.

Warnings against some popular treatments

Primary health care staff are also warned against certain popular treatments. For example, benzodiazepines, which are anti-anxiety drugs, should not be offered to reduce acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event.

“PTSD needs to be managed along with other common mental disorders” reports Dr Mark van Ommeren, Scientist in the WHO Department of Mental Health and Substance Abuse. “This new, simple WHO-UNHCR treatment protocol will guide health workers around the world to help adults and children who suffer from conditions specifically related to stress.” The new guidelines and protocol were published today in an article in "The Journal of the American Medical Association".

Additional information

There is no evidence on the benefits of benzodiazepines, a common anti-anxiety drug, on symptoms of traumatic stress after a recent potentially traumatic event. Benzodiazepines may slow down the time to recover from potentially traumatic events.

Key concerns about the use of benzodiazepines are that many people develop tolerance to their effects, gain little therapeutic benefit from chronic consumption, become dependent on them and suffer a withdrawal syndrome when they stop taking them.

Thus, the WHO recommendation is that benzodiazepines should not be offered to adults to reduce acute traumatic stress symptoms associated with significant impairment in daily functioning in the first month after a potentially traumatic event.

The WHO recommendation also notes that benzodiazepines can have their use for other mental disorders.

For more information please contact:

Daniel Epstein
Communications Officer
WHO, Geneva
Telephone: +41 22 791 4458
Mobile: +41 79 475 5536
E-mail: epsteind@who.int

Ms Fadela Chaib
Communications Officer
WHO, Geneva
Telephone: +41-22-7913228
Mobile: +41-79-3676214
E-mail: chaibf@who.int

View the original article here

WHO releases guidance on mental health care after trauma

6 August 2013 | GENEVA - WHO is releasing new clinical protocols and guidelines to health-care workers for treating the mental health consequences of trauma and loss.

Mental disorders are common, disabling and usually untreated, and WHO’s "Mental Health Global Action Programme (mhGAP)" was developed in 2008 to scale-up care for mental, neurological and substance use disorders with simple treatment protocols that can be offered by primary health-care doctors and nurses.

Now, WHO is extending this programme by including care for post-traumatic stress disorder (PTSD), acute stress and bereavement within its global programme.

“We have received numerous requests for guidance for mental health care after trauma and loss” says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “Primary health-care providers will now be able to offer basic support consistent with the best available evidence. They will also learn when to refer to more advanced treatment.”

Traumatic events and loss are common in people’s lives. In a previous WHO study of 21 countries, more than 10% of respondents reported witnessing violence (21.8%) or experiencing interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) or trauma to a loved one (12.5%). An estimated 3.6% of the world's population has suffered from post-traumatic stress disorder (PTSD) in the previous year, the study showed.

Using the new protocol, which is co-published with the United Nations High Commissioner for Refugees (UNHCR), primary health-care workers can offer basic psychosocial support to refugees as well as people exposed to trauma or loss in other situations.

Types of support offered can include psychological first aid, stress management and helping affected people to identify and strengthen positive coping methods and social supports.

In addition, referral for advanced treatments such as cognitive-behavioural therapy (CBT) or a new technique called eye movement desensitization and reprocessing (EMDR) should be considered for people suffering from PTSD. These techniques help people reduce vivid, unwanted, repeated recollections of traumatic events. More training and supervision is recommended to make these techniques more widely available.

Primary health care staff are also warned against certain popular treatments. For example, benzodiazepines, which are anti-anxiety drugs, should not be offered to reduce acute traumatic stress symptoms or sleep problems in the first month after a potentially traumatic event.

“PTSD needs to be managed along with other common mental disorders” reports Dr Mark van Ommeren, Scientist in the WHO Department of Mental Health and Substance Abuse. “This new, simple WHO-UNHCR treatment protocol will guide health workers around the world to help adults and children who suffer from conditions specifically related to stress.” The new guidelines and protocol were published today in an article in "The Journal of the American Medical Association".

There is no evidence on the benefits of benzodiazepines, a common anti-anxiety drug, on symptoms of traumatic stress after a recent potentially traumatic event. Benzodiazepines may slow down the time to recover from potentially traumatic events.

Key concerns about the use of benzodiazepines are that many people develop tolerance to their effects, gain little therapeutic benefit from chronic consumption, become dependent on them and suffer a withdrawal syndrome when they stop taking them.

Thus, the WHO recommendation is that benzodiazepines should not be offered to adults to reduce acute traumatic stress symptoms associated with significant impairment in daily functioning in the first month after a potentially traumatic event.

The WHO recommendation also notes that benzodiazepines can have their use for other mental disorders.

Daniel Epstein
Communications Officer
WHO, Geneva
Telephone: +41 22 791 4458
Mobile: +41 79 475 5536
E-mail: epsteind@who.int

Ms Fadela Chaib
Communications Officer
WHO, Geneva
Telephone: +41-22-7913228
Mobile: +41-79-3676214
E-mail: chaibf@who.int

View the original article here