1.Early essential newborn care: a healthy start for every newborn baby in the Western Pacific Region
Mannava PRIYA ; Sobel L. HOWARD
Chinese Journal of Perinatal Medicine 2019;22(8):540-549
To improve newborn survival and ensure a healthy start for every baby, Member States of World Health Organization endorsed the Action Plan for Healthy Newborn Infants (2014-2020) in the Western Pacific Region in 2013. The focus of which is on implementation of early essential newborn care (EENC). Such items, regional approach to introducing, sustaining and scaling up EENC; progress in EENC implementation;mobilizing social support for newborn care; best practice, lessons learned and future directions, were summarized in this editorial. Efforts are being undertaken in China, which would help to achieve the Sustainable Development Goal targets on maternal and child health and universal health coverage.
2.Integrating HIV, hepatitis B and syphilis screening and treatment through the Maternal, Newborn and Child Health platform to reach global elimination targets
Joseph WOODRING ; Naoko ISHIKAWA ; Mari NAGAI ; Maya MALARSKI ; Yoshihiro TAKASHIMA ; Howard SOBEL ; Ying-Ru LO
Western Pacific Surveillance and Response 2017;8(4):1-5
Every year, an estimated 180 000 babies in the Western Pacific Region are infected by hepatitis B, 13 000 by syphilis and 1400 by HIV through mother-to-child transmission.1 These infections can be largely prevented by antenatal screening, treatment and timely vaccination for newborns. Despite challenges in controlling each disease, major achievements have been made. National immunization programmes have reduced the regional hepatitis B prevalence from over 8% in 1990 to 0.93% among children born in 2012. In addition, HIV testing and treatment have helped keep the regional prevalence of HIV infections at 0.1%. In contrast, the number of maternal syphilis cases is still high in the Western Pacific Region, with an estimated 45 million cases in 2012. Elimination of mother-to-child transmission of these infections cannot be achieved through vertically applied programming and require using and augmenting to the shared Maternal, Newborn and Child Health platform to coordinate, integrate and enable cost efficiencies for these elimination efforts. The Regional Framework for Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018–2030 offers such a coordinated approach towards achieving the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis and provides guidance for decision-makers, managers and health professionals working in programmes addressing maternal, newborn and child health, HIV, hepatitis, sexually transmitted infections and immunization.
3.Experiences in COVID-19 clinical management and health-care pathways in the Western Pacific
Saho Takaya ; Ji Young Lee ; Takeshi Nishijima ; Masahiro Zakoji ; Howard L Sobel
Western Pacific Surveillance and Response 2023;14(5):29-32
The coronavirus disease (COVID-19) pandemic has transformed clinical practice and health systems. This paper provides an overview of COVID-19 clinical management and health-care pathway challenges that the World Health Organization and its Member States in the Western Pacific Region have faced. The experiences and lessons identified can help countries to better prepare for future pandemics.
4.Implementation of maternal death audits and changes in maternal health care in Cambodia, 2010–2017
Rathavy Tung ; Rattana Kim ; Matthews Mathai ; Kannitha Cheang ; Howard L Sobel
Western Pacific Surveillance and Response 2024;15(4):26-34
Objective: Cambodia is one of seven countries globally that met Millennium Development Goal 5A: reduction of maternal deaths by at least 75% between 1990 and 2015. To support improving maternal care, the Maternal Death Audit (MDA) was instituted in 2004. This report highlights changes in maternal health services and MDA implementation in Cambodia between 2010 and 2017.
Methods: International experts and the national MDA Committee assessed all case abstracts, investigation questionnaires and audit meeting minutes covering all maternal deaths reported in Cambodia in 2010 and 2017 for quality of classification, data, care and recommendations. They convened provincial MDA committees to conduct similar assessments and develop evidence-informed recommended actions.
Results: In 2010 and 2017, 176 and 59 maternal death cases were reported, respectively. Cases were more likely in 2017 than in 2010 to have antenatal care (90.0% vs 68.2%, P = 0.004), give birth in a facility (81.6% vs 55.3%, P = 0.01) and receive a prophylactic uterotonic (95.7% vs 73%, P < 0.05) for postpartum haemorrhage (PPH) and magnesium sulfate (66% vs 37%, P = 0.18) for pre-eclampsia/eclampsia. However, additional interventions and improved timeliness of referral with equipped and competent staff were identified as critical. Data quality prevented classifying one-fourth of cases during both periods. MDA recommendation quality improved from 2.8% in 2011 to 42% in 2018.
Discussion: Improvements in maternal care are reflected in the increased antenatal care, facility births and better PPH and preeclampsia-eclampsia management. However, additional care management improvements are highlighted. The MDA reporting needs improved data completeness and more specific recommendations to address causes of death.
5.Urgent actions to save lives when ICU bed needs approach or exceed capacity: lessons from Mongolia
Buyantogtokh Batsukh ; Bund-Ochir Khishigsaikhan ; Dulamragchaa Buyanbaatar ; Gerelmaa Danzan ; Nansalmaa Munkhtur ; Ariuntuya Ochirpurev ; Takeshi Nishijima ; Howard Sobel ; Masahiro Zakoji
Western Pacific Surveillance and Response 2023;14(5):01-04
This report illustrates how the Government of Mongolia responded to a rapid surge of COVID-19 cases during 2021 and took urgent actions to minimize preventable mortality. The analytical framework on efficient ICU bed management through a systems approach would be useful in similar settings.
6.How Ho Chi Minh City adapted its care pathway to manage the first large-scale community transmission of COVID-19
Ngoc Khue Luong ; Trong Khoa Nguyen ; Anh Duong Vuong ; Thi Hong Hien Do ; Satoko Otsu ; Kim Quang Phung ; Dereje Abera Ayana ; Saho Takaya ; Howard L Sobel ; Quang Hieu Vu
Western Pacific Surveillance and Response 2023;14(5):05-08
Ho Chi Minh City, Viet Nam undertook a series of measures in response to the fourth and largest wave of COVID-19. The care pathway was continuously reconfigured through leadership from all levels of government and engagement of the community. This resulted in a shift towards integrated severity-based care consisting of multiple levels of health-care facilities and home care. This flexible approach based on the rapidly changing local context enabled Ho Chi Minh City to limit the extent to which health-care capacity was overwhelmed.
7.Maintaining health-system functionality in response to the surge of COVID-19 cases due to the Omicron variant, Japan
Yuki Moriyama ; Saho Takaya ; Takeshi Nishijima ; Howard L Sobel ; Norio Ohmagari
Western Pacific Surveillance and Response 2023;14(5):23-28
Problem: The Omicron variant of severe acute respiratory syndrome coronavirus 2 caused the largest surge of coronavirus disease (COVID-19) cases in Japan starting in the summer of 2022. We describe the mechanisms introduced to provide appropriate health care to all Omicron cases, provide appropriate health care to all non-COVID-19 patients, and protect health-care workers (HCWs) while providing necessary health services. Optimization of care for elderly patients was particularly important.
Context: Japan is home to 125 million people, of whom 28.6% are 65 years or older. Between January and June 2022, the country experienced 4.3 times more COVID-19 cases than in the previous 2 years (7.3 million vs 1.7 million).
Action: To adjust care pathways, inpatient treatment capacity was increased, a home-based care system was established, and an on-site treatment scheme at long-term care facilities was started. Among essential health services, disruption of emergency care became most noticeable. Administrative and financial support was provided to hospitals with emergency departments to maintain emergency medical services. To protect HCWs while maintaining hospital services, flexible exemptions were introduced to enable those who became close contacts to return to work, and broadly targeted contact tracing and testing in case of nosocomial outbreaks were all helpful.
Outcome: As a result of the adjustments made to inpatient capacity and patient flow, bed occupancy for COVID-19 patients decreased, mostly because many patients were cared for at home or in temporary-care facilities.
Discussion: From this study, we extracted two essential lessons to aid in current and future health emergencies: how to balance the provision of acute medical care for elderly patients and maintain their well-being; and how to maintain essential health services.