Progress Toward Elimination of Mother-to-Child Transmission of Hepatitis B Virus - Region of the Americas, 2012-2022.

In 2022, an estimated 5 million persons in the World Health Organization Region of the Americas (AMR) were living with chronic hepatitis B virus (HBV) infection, the leading cause of hepatocellular carcinoma and cirrhosis worldwide. Most chronic infections are acquired through mother-to-child transmission (MTCT) or horizontal transmission during childhood and are preventable with hepatitis B vaccination, including a birth dose (HepB-BD), followed by 2-3 additional doses (HepB3) in infancy. The Pan American Health Organization (PAHO) Elimination of MTCT of HBV infection strategy is intended to reduce chronic HBV infection (measured by hepatitis B surface antigen [HBsAg] seroprevalence) to ≤0.1% among children by achieving 1) ≥95% coverage with HepB-BD and HepB3; and 2) ≥80% of pregnant women received testing for HBsAg, and provision of hepatitis B immunoglobulin to HBV-exposed neonates. By 2012, all 51 AMR countries and territories (countries) provided HepB3 nationwide, and by 2021, 34 (67%) provided HepB-BD nationwide. Mathematical models estimate that HBsAg seroprevalence in children is ≤0.1% in 14 (28%) of 51 countries and at the regional level. Three (6%) of 51 countries met the 95% coverage targets for both HepB3 and HepB-BD during both 2021 and 2022. Of these, two have likely met criteria for the elimination of MTCT of HBV infection. However, in 2022, HepB3 coverage had declined by ≥10 percentage points in 15 (37%) of 41 countries with 2012 coverage data for comparison. These declines in HepB3 coverage, as well as the absence of HepB-BD in the routine immunization schedules in 17 countries, threaten PAHO's progress toward the elimination of MTCT of HBV infection. Efforts to introduce HepB-BD and maintain high HepB3 and HepB-BD coverage are needed.

Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.

PURPOSE: To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model. METHODS: Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined. RESULTS: The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (ß = 8.9), total fats (ß = 11.0), saturated fats (ß = 4.6), trans fats (ß = 0.2), and sodium (ß = 1788 for adolescents and adults; ß = 1769 for children 5-10 years; ß = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend. CONCLUSION: The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.

Have countries offered the best data to the Pan American Health Organization? Evidence of potential inconsistencies found in a study on alcohol policies in Brazil.

OBJECTIVE: The objective of this study was to verify the agreement between the alcohol policies score estimated from documental analysis of Brazilian federal regulatory documents (RD), with primary data collection, and the results previously presented by the Pan American Health Organization (PAHO) in its Alcohol Policy Scoring (APS) report. STUDY DESIGN: Document identification and content analysis. METHODS: Documental research was carried out in two phases: a document identification and content analysis. In the first phase, we carried out the search, identification, and systematization of laws, decrees, and federal ordinances in Brazil, with primary data collection. The second phase consisted of three steps: 1) an RD content analysis and classification into the 10 PAHO/World Health Organization (WHO) policy domains; 2) a score estimation of alcohol policies, based on the APS instrument attached to their report; and 3) comparison of the results for Brazil presented at the APS report and the one estimated by the researchers. RESULTS: The study showed divergences between the results for APS published by PAHO about Brazil and the one achieved with primary data collection. 1146 federal promulgated RD were identified, of which 21 were eligible for content analysis. Only the domains "Community and workplace action" (Domain 3) and "Reducing the public health impact of illicit and informally produced alcohol" (Domain 9) had convergent scores. On the other domains, usually the APS score estimated by PAHO differs from the one estimated with the primary data collection. CONCLUSIONS: We conclude that Brazil is not providing the best data for PAHO/WHO estimate its APS report, leading to the dissemination of imprecise results worldwide.

Collaborative Approaches to the Support of People with Disabilities: The Underserved and Unserved.

BACKGROUND: Underserved and unserved people are individuals who lack necessary health services. They can be found in both high- and low-income countries with disabilities in areas such as speech, language, hearing, swallowing, physical, and neurological, as well as other health problems. In addition, academic programs that prepare students to serve underserved or unserved communities do not exist in some countries. Collaborative projects allow those with expertise to share their knowledge, strategies, methods, and technologies with health practitioners, administrators, educators, students, and families. The goal is to assist populations who require special services. Collaborative projects can be interdisciplinary, international, or involve academic institutions or organizations. It is also essential that collaboration projects consider the strengths and assets that are present in the environment and in the population. This asset-based approach supports sustainability as long-term solutions can take advantage of existing strengths. Sustainability is essential so that the goals of projects can continue to contribute to a population. OBJECTIVES: The primary objective of this article is to present collaborative projects that positively impact underserved and unserved populations. The strengths of these projects are also presented as a model for further work. SUMMARY: This article presents several collaborative projects, along with the impact of these efforts.

Multidisciplinary Management of Pediatric Sports-Related Concussion.

OBJECTIVES: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. METHODS: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. RESULTS: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. CONCLUSION: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

Progress towards elimination of trans-fatty acids in foods commonly consumed in four Latin American cities.

OBJECTIVE: To assess progress towards the elimination of trans-fatty acids (TFA) in foods after the 2008 Pan American Health Organization (PAHO) recommendation of virtual elimination of TFA in Latin America. DESIGN: A descriptive, comparative analysis of foods that were likely to contain TFA and were commonly consumed in four cities in Latin America. SETTING: San José (Costa Rica), Mexico City (Mexico), Rio de Janeiro (Brazil), Buenos Aires (Argentina). SUBJECTS: Foods from each city were sampled in 2011; TFA content was analysed using GC. TFA of selected foods was also monitored in 2016. RESULTS: In 2011-2016, there was a significant decrease in the content of TFA in the sampled foods across all sites, particularly in Buenos Aires (from 12·6-34·8 % range in 2011-2012 to nearly 0 % in 2015-2016). All sample products met the recommended levels of TFA content set by the PAHO. TFA were replaced with a mixture of saturated and unsaturated fats. CONCLUSIONS: Our results indicate a virtual elimination of TFA from major food sources in the cities studied. This could be due to a combination of factors, including recommendations by national and global public health authorities, voluntary and/or mandatory food reformulation made by the food industry.

Permanent education actions of nurse facilitators at a nursing education centre. / Ações de educação permanente dos enfermeiros facilitadores de um núcleo de educação em enfermagem.

OBJECTIVE: To identify actions of nurse facilitators of a permanent healthcare education centre of a teaching hospital. METHODS: A single case study with a qualitative approach conducted with eight nurses from a hospital in the state of Rio Grande do Sul, Brazil. The data were generated through document analysis, systematic observation, and a focus group from April to September 2013. RESULTS: The study produced the following categories: powerful strategies to promote permanent healthcare education actions from facilitating nurses and limitations for the development of these actions. CONCLUSIONS: The establishment of a permanent nursing education centre can trigger the Permanent education actions of nurses in teaching hospitals.

Permanent education in primary health care: perception of local health managers. / Educação permanente em saúde na atenção básica: percepção dos gestores municipais de saúde.

OBJECTIVES: To know the health education strategies advocated and developed for workers of primary care, in the view of managers. METHOD: The study is characterized as a qualitative, descriptive and exploratory research. A semistructured interview was used to collect data. The sample population was chosen intentionally, with an audience of 26 municipal health managers ascribed to a regional health coordination office, located in the north/northwest of the Rio Grande do Sul State. RESULTS: The thematic analysis allowed the construction of two empirical categories: educational strategies, compartmentalized, discontinuous and with technicist bases; and the insipience/absence of educational proposals. FINAL CONSIDERATIONS: The results show a reality that needs to be transformed by all people involved in health work process: teachers and students, users, members of health councils, workers and managers. Realistically, there is a quest for change in services, to qualify the comprehensiveness of health care.

[Strengthening the Pan American Network of Official Medicines Control Laboratories]. / Fortalecimiento de la Red Panamericana de Laboratorios Oficiales de Control de Medicamentos.

Objective Official Medicines Control Laboratories (OMCLs) play a critical role in quality assurance. The objective of this work is to describe the actions taken by the Pan American Health Organization (PAHO) to strengthen OMCLs in the Region of the Americas. Methods A descriptive study was conducted by the External Quality Control Program (EQCP) to assess the diagnostic and overall performance of OMCLs; human resource training; measures adopted by the Pan American Network for Drug Regulatory Harmonization (PANDRH) to facilitate prequalification of OMCLs by the World Health Organization (WHO) as reference laboratories for United Nations agencies; and the technical documents developed by the Working Group on Good Laboratory Practice (WGGLP) and their level of implementation. Results The Pan American Network of OMCLs, established in 2005, is currently composed of 28 OMCLs in 23 countries. The EQCP assessed the performance of OMCLs in ten stages; 784 professionals, 313 of them from OMCLs, received training in good laboratory practice (GLP). Guidelines for external evaluation and self-evaluation were developed. Six OMCLs attained WHO prequalification and nine became regional reference laboratories. Conclusions The initiatives undertaken made it possible to strengthen the activity of the OMCLs and to train human resources. Furthermore, they provided tools for continuous improvement through external evaluation and self-evaluation.

[Social determinants of health and convergence in health agendas of regional agencies in South America]. / Determinantes sociales de la salud y convergencias en agendas de salud de organismos regionales de América del Sur.

OBJECTIVE: Characterize areas of interinstitutional cooperation and converging health agendas of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Health Council of the Union of South American Nations (UNASUR), and the Amazon Cooperation Treaty Organization (ACTO) in South America based on social determinants of health. METHODS: A qualitative study based on official documentary sources from the three organizations, using a comparative analysis of the health agendas of these agencies and the Rio Political Declaration on Social Determinants of Health (2011). Information was systematized using an analytical matrix that identifies convergences in the respective agendas. RESULTS: Development of the health agendas of these agencies is influenced by various international forces such as Member States' foreign policy, international cooperation strategies and models, and the institutions' political and strategic guidelines. These agendas reveal efforts to strengthen blocs, cooperation mechanisms, and coordinated programmatic actions. CONCLUSIONS: The agendas of PAHO/WHO, the UNASUR Health Council, and ACTO point towards opportunities for convergence in various programmatic areas, emphasizing social determinants of health. Based on the overall agreements of the Rio Declaration as an analytical framework with recommendations in five decision-making spheres, structural cooperation actions can be carried out in the region's countries, jointly mediated by these agencies.

[Strengthening health regulation in the Americas: regulatory authorities of regional reference]. / Fortalecimiento de la regulación sanitaria en las Américas: las autoridades reguladoras de referencia regional.

Health technology regulation and quality assurance are critical to the development of national pharmaceutical policies, and implementing these actions is the responsibility of national regulatory authorities, whose level of development and maturity affect the quality, safety, and effectiveness of the products made available to the public. On the initiative of the regulatory authorities themselves, together with the Pan American Health Organization, the Region of the Americas promotes the strengthening of health regulation through an evaluation and certification process that allows for the designation of regulatory authorities of regional reference for drugs and biological products. Over the period from its implementation to the present, six authorities have been certified and one is in the process of obtaining certification. These authorities work jointly and promote dialogue and regulatory convergence, information-sharing to facilitate regulatory decision making, and regional cooperation to support the establishment of other authorities in the Region--actions having direct impact on access to effective and quality-assured health technologies. Their combined efforts have led to the recognition of this process of evaluation and certification by the World Health Organization (WHO). Among the actions resulting from the International Consultation on Regulatory Systems Strengthening, WHO recommended taking a close look at this model to assess its potential scale-up at the global level.

Fifty years of the European medicines regulatory network: reflections for strengthening intra-regional cooperation in the Region of the Americas.

This report considers how the experience of the European regulatory system might be applied to help strengthen the regulatory systems for medicines in the Region of the Americas. The work of the European Medicines Agencies (EMA) is carried out through its scientific committees, composed of members from European Economic Area countries. A robust legal framework allows EMA to coordinate resources from Member States' competent authorities, including, for example, assisting candidate countries as they prepare to join the European Union (EU). Capacity-building programs help countries adjust their regulatory systems ahead of full participation in the European medicines regulatory network. These programs facilitate adoption of common technical requirements, identify areas where action might be needed to ensure the smooth transposition of EU pharmaceutical law into national legislation, and prepare candidate countries for participation in EMA committees and the European regulatory network. The methodology of these programs could be of potential interest to the Pan American Health Organization (PAHO), the Regional Office of the World Health Organization for the Americas. Given resolutions adopted by the World Health Assembly and the PAHO Directing Council, there is a strong indication that the countries of the Region of the Americas wish to assemble a system that uses the existing regulatory capacity of some countries to strengthen local regulatory capacities in others.

Role of PAHO/WHO in eHealth Capacity Building in the Americas: Analysis of the 2011-2015 period.

Political will and adoption of measures toward the use of eHealth have been steadily increasing, facilitating mobilization of resources necessary to adopt and implement digital services that will make it possible to improve access, expand coverage, and increase financial efficiency of health care systems. Adoption of the Strategy and Plan of Action on eHealth of the Pan American Health Organization (PAHO) in 2011 by all Member States in the Region of the Americas has led the Region to major progress in this regard, including the following: creation of knowledge networks and development of information sources, establishment of eHealth sustainability models, support for development of electronic health records, promotion of standards on health data and related technologies that ensure exchange of information, use of mobile devices to improve health, and improvement in quality of care through telemedicine. This article details the main actions carried out by PAHO with regard to eHealth, specifically by the office of Knowledge Management, Bioethics, and Research in the 2011-2015 period (first period of implementation of the PAHO eHealth strategy and plan of action), which include research and capacity-building activities, development of technical guidelines, and formation of knowledge networks.

La voluntad política y la adopción de medidas en relación con el uso de la eSalud han ido en aumento de forma constante, favoreciendo la movilización de los recursos necesarios a fin de adoptar y poner en marcha servicios digitales que permitan mejorar el acceso, ampliar la cobertura y aumentar la eficiencia financiera de los sistemas de atención de salud. Con la aprobación de la Estrategia y Plan de Acción de eSalud de la Organización Panamericana de la Salud (OPS) en 2011 por todos los Estados Miembros de la Región de las Américas, se han realizado importantes avances a este respecto en la Región, entre los que se destacan: la creación de redes de conocimiento y desarrollo de fuentes de información, el establecimiento de modelos de sostenibilidad en materia de eSalud, el apoyo al desarrollo de los registros electrónicos de salud, la promoción de normas sobre datos de salud y tecnologías conexas que garanticen el intercambio de información, la utilización de los dispositivos móviles para mejorar la salud y la mejora de la calidad asistencial por medio de la telemedicina. El presente artículo detalla las principales acciones ejecutadas por la OPS en eSalud, específicamente por la Oficina de Gestión del Conocimiento, Bioética e Investigación en el período comprendido entre 2011 y 2015 (primer período de implementación de la estrategia y plan de acción de eSalud de la OPS), entre las que se encuentran actividades de investigación y desarrollo de capacidad, la creación de lineamientos técnicos y la construcción de redes de conocimiento.

Sharing regulatory data as tools for strengthening health systems in the Region of the Americas.

Regulatory transparency is an imperative characteristic of a reliable National Regulatory Authority. In the region of the Americas, the process of building an open government is still fragile and fragmented across various Health Regulatory Agencies (HRAs) and Regional Reference Authorities (RRAs). This study assessed the transparency status of RRAs, focusing on various medicine life-cycle documents (the Medicine Dossier, Clinical Trial Report, and Inspection Report) as tools for strengthening health systems. Based on a narrative (nonsystematic) review of RRA regulatory transparency, transparency status was classified as one of two types: public disclosure of information (intra-agency data) and data- and work-sharing (inter-agency data). The risks/benefits of public disclosure of medicine-related information were assessed, taking into account 1) the involvement and roles of multiple stakeholders (health care professionals, regulators, industry, community, and academics) and 2) the protection of commercial and personal confidential data. Inter-agency data- and work-sharing was evaluated in the context of harmonization and cooperation projects that focus on regulatory convergence. Technical and practical steps for establishing an openness directive for the pharmaceutical regulatory environment are proposed to improve and strengthen health systems in the Americas. Addressing these challenges requires leadership from entities such as the Pan American Health Organization to steer and support collaborative regional alliances that advance the development and establishment of a trustworthy regulatory environment and a sustainable public health system in the Americas, using international successful initiatives as reference and taking into account the domestic characteristics and experiences of each individual country.

[Optimization of registry of deaths from chronic kidney disease in agricultural communities in Central America]. / Optimización del registro de muerte por enfermedad renal crónica en las comunidades agrícolas de América Central.

Several Central American countries are seeing continued growth in the number of deaths from chronic kidney disease of nontraditional causes (CKDnT) among farm workers and there is underreporting. This report presents the results of a consensus process coordinated by the Pan American Health Organization/World Health Organization (PAHO/WHO), the United States Centers for Disease Control and Prevention (CDC), and the Latin American Society of Nephrology and Hypertension (SLANH). This consensus seeks to increase the probability of detecting and recording deaths from these causes. There has been recognition of the negative impact of the lack of a standardized instrument and the lack of training in the medical profession for adequate registration of the cause or causes of death. As a result of the consensus, the following has been proposed: temporarily use a code from the Codes for Special Purposes in the International Classification of Diseases (ICD-10); continue to promote use of the WHO international standardized instrument for recording causes and preceding events related to death; increase training of physicians responsible for filling out death certificates; take action to increase the coverage and quality of information on mortality; and create a decision tree to facilitate selection of CKDnT as a specific cause of death, while presenting the role that different regional and subregional mechanisms in the Region of the Americas should play in order to improve CKD and CKDnT mortality records.