RESUMEN

BACKGROUND: One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as "a document containing recommendations for clinical practice or public health policy." Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. OBJECTIVE: The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. METHODS: The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module's creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. RESULTS: The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman's health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. CONCLUSIONS: This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module's implementation will inform the WHO's ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

Asunto(s)

RESUMEN

Wastewater use for irrigation is expanding globally, and information about the fate and transport of pathogens in wastewater systems is needed to complete microbial risk assessments and develop policies to protect public health. The lack of maintenance for wastewater treatment facilities in low-income areas and developing countries results in sludge accumulation and compromised performance over time, creating uncertainty about the contamination of soil and crops. The fate and transport of pathogens and fecal indicators was evaluated in waste stabilization ponds with direct reuse for irrigation, using two systems in Bolivia as case studies. Results were compared with models from the literature that have been recommended for design. The removal of Escherichia coli in both systems was adequately predicted by a previously-published dispersed flow model, despite more than 10years of sludge accumulation. However, a design equation for helminth egg removal overestimated the observed removal, suggesting that this equation may not be appropriate for systems with accumulated sludge. To assess the contamination of soil and crops, ratios were calculated of the pathogen and fecal indicator concentrations in soil or on crops to their respective concentrations in irrigation water (termed soil-water and crop-water ratios). Ratios were similar within each group of microorganisms but differed between microorganism groups, and were generally below 0.1mLg(-1) for coliphage, between 1 and 100mLg(-1) for Giardia and Cryptosporidium, and between 100 and 1000mLg(-1) for helminth eggs. This information can be used for microbial risk assessments to develop safe water reuse policies in support of the United Nations' 2030 Sustainable Development Agenda.

Asunto(s)

RESUMEN

El agua dulce es un recurso vital pero cada día está más escaso debido al crecimiento demográfico, la urbanización y la industrialización, a lo que se suman los conflictos asociados a los cambios climáticos. El propósito de este estudio es aportar información actualizada sobre las guías de la OMS para el uso seguro de las aguas residuales en la agricultura. Se identificaron 33 documentos relacionados con el tema, de ellos se seleccionaron 13 publicados entre 1994 y 2007, que contemplan informes de la UNESCO, guías y manual de la OMS y revisiones críticas del tema. Se resume información sobre las guías de la OMS y la importancia de su incorporación paulatina en Cuba, se destacan, dentro de los Objetivos del Desarrollo del Milenio, aquellos relacionados con el uso seguro de aguas residuales y excretas para la agricultura y acuicultura, que justifican la actual importancia de las nuevas guías propuestas. El uso de aguas residuales en la agricultura puede aportar beneficios, pero su uso no controlado generalmente está relacionado con impactos negativos sobre la salud humana. En Cuba, el reuso del agua es poco utilizado pues si bien la agricultura urbana se ha desarrollado últimamente, se realiza con agua potable. Se debe considerar en el país las guías de la OMS para la futura valoración del uso de las aguas residuales tratadas en la agricultura sin riesgo para la salud y obtener resultados beneficiosos para la población y el ambiente. En resumen, se enumeran aspectos a considerar para el uso seguro de las aguas residuales en la agricultura en Cuba, necesarios para implementar programas nacionales de vigilancia sanitaria y de agricultura con énfasis en los aspectos microbiológicos(AU)

Drinking water is a vital but increasingly dwindling resource due to the population growth, housing planning, industrialization associated to new potential demands upon the existing water resources, to which climatic change-related events are added. The objective of this study was to provide updated information on the WHO guidelines for the safe use of wastewater in agriculture. A total of 33 documents about this topic were identified; 13 of them published from 1994 to 2007 were selected since they included UNESCO reports, WHO guidelines and manual and critical reviews. Information was summarized on the WHO guidelines and the importance of their gradual application in Cuba. Among the Millennium Development Goals, those related to the safe use of wastewater and excreta for agriculture and aquaculture were underscored because they supported the present importance of the new suggested guidelines. The use of wastewaters in agriculture may bring about benefits, but their use without restriction is generally related to negative impact on the human health. The water reuse is not very common in Cuba; although the agriculture in urban areas has developed in the last few years, it depends on drinking water. The WHO guidelines must be taken into consideration for the future assessment of the use of treated wastewater in agriculture without causing any risk for health, and for the benefits it may bring to the environment and the population as well. In summary, some aspects to be considered to safely use wastewater in the Cuban agriculture, which are also necessary to implement national health and agricultural surveillance programs centered on microbiological aspects, were listed(AU)

Asunto(s)

RESUMEN

El agua dulce es un recurso vital pero cada día está más escaso debido al crecimiento demográfico, la urbanización y la industrialización, a lo que se suman los conflictos asociados a los cambios climáticos. El propósito de este estudio es aportar información actualizada sobre las guías de la OMS para el uso seguro de las aguas residuales en la agricultura. Se identificaron 33 documentos relacionados con el tema, de ellos se seleccionaron 13 publicados entre 1994 y 2007, que contemplan informes de la UNESCO, guías y manual de la OMS y revisiones críticas del tema. Se resume información sobre las guías de la OMS y la importancia de su incorporación paulatina en Cuba, se destacan, dentro de los Objetivos del Desarrollo del Milenio, aquellos relacionados con el uso seguro de aguas residuales y excretas para la agricultura y acuicultura, que justifican la actual importancia de las nuevas guías propuestas. El uso de aguas residuales en la agricultura puede aportar beneficios, pero su uso no controlado generalmente está relacionado con impactos negativos sobre la salud humana. En Cuba, el reuso del agua es poco utilizado pues si bien la agricultura urbana se ha desarrollado últimamente, se realiza con agua potable. Se debe considerar en el país las guías de la OMS para la futura valoración del uso de las aguas residuales tratadas en la agricultura sin riesgo para la salud y obtener resultados beneficiosos para la población y el ambiente. En resumen, se enumeran aspectos a considerar para el uso seguro de las aguas residuales en la agricultura en Cuba, necesarios para implementar programas nacionales de vigilancia sanitaria y de agricultura con énfasis en los aspectos microbiológicos

Drinking water is a vital but increasingly dwindling resource due to the population growth, housing planning, industrialization associated to new potential demands upon the existing water resources, to which climatic change-related events are added. The objective of this study was to provide updated information on the WHO guidelines for the safe use of wastewater in agriculture. A total of 33 documents about this topic were identified; 13 of them published from 1994 to 2007 were selected since they included UNESCO reports, WHO guidelines and manual and critical reviews. Information was summarized on the WHO guidelines and the importance of their gradual application in Cuba. Among the Millennium Development Goals, those related to the safe use of wastewater and excreta for agriculture and aquaculture were underscored because they supported the present importance of the new suggested guidelines. The use of wastewaters in agriculture may bring about benefits, but their use without restriction is generally related to negative impact on the human health. The water reuse is not very common in Cuba; although the agriculture in urban areas has developed in the last few years, it depends on drinking water. The WHO guidelines must be taken into consideration for the future assessment of the use of treated wastewater in agriculture without causing any risk for health, and for the benefits it may bring to the environment and the population as well. In summary, some aspects to be considered to safely use wastewater in the Cuban agriculture, which are also necessary to implement national health and agricultural surveillance programs centered on microbiological aspects, were listed

Asunto(s)