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Harvard T.H. Chan School of Public Health Case-Based Teaching & Learning Initiative

Teaching cases & active learning resources for public health education, case library.

The Harvard Chan Case Library is a collection of teaching cases with a public health focus, written by Harvard Chan faculty, case writers, and students, or in collaboration with other institutions and initiatives.

Use the filters at right to search the case library by subject, geography, health condition, and representation of diversity and identity to find cases to fit your teaching needs. Or browse the case collections below for our newest cases, cases available for free download, or cases with a focus on diversity.

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Atkinson, M.K. , 2023. Organizational Resilience and Change at UMass Memorial , Harvard Business Publishing: Harvard T.H. Chan School of Public Health. Available from Harvard Business Publishing Abstract The UMass Memorial Health Care (UMMHC or UMass) case is an examination of the impact of crisis or high uncertainty events on organizations. As a global pandemic unfolds, the case examines the ways in which UMMHC manages crisis and poses questions around organizational change and opportunity for growth after such major events. The case begins with a background of UMMHC, including problems the organization was up against before the pandemic, then transitions to the impact of crisis on UMMHC operations and its subsequent response, and concludes with challenges that the organization must grapple with in the months and years ahead. A crisis event can occur at any time for any organization. Organizational leaders must learn to manage stakeholders both inside and outside the organization throughout the duration of crisis and beyond. Additionally, organizational decision-makers must learn how to deal with existing weaknesses and problems the organization had before crisis took center stage, balancing those challenges with the need to respond to an emergency all the while not neglecting major existing problem points. This case is well-suited for courses on strategy determination and implementation, organizational behavior, and leadership.

The case describes the challenges facing Shlomit Schaal, MD, PhD, the newly appointed Chair of UMass Memorial Health Care’s Department of Ophthalmology. Dr. Schaal had come to UMass in Worcester, Massachusetts, in the summer of 2016 from the University of Louisville (KY) where she had a thriving clinical practice and active research lab, and was Director of the Retina Service. Before applying for the Chair position at UMass she had some initial concerns about the position but became fascinated by the opportunities it offered to grow a service that had historically been among the smallest and weakest programs in the UMass system and had experienced a rapid turnover in Chairs over the past few years. She also was excited to become one of a very small number of female Chairs of ophthalmology programs in the country.

Dr. Schaal began her new position with ambitious plans and her usual high level of energy, but immediately ran into resistance from the faculty and staff of the department. The case explores the steps she took, including implementing a LEAN approach in the department, and the leadership approaches she used to overcome that resistance and build support for the changes needed to grow and improve ophthalmology services at the medical center.

This case describes efforts to promote racial equity in healthcare financing from the perspective of one public health organization, Community Care Cooperative (C3). C3 is a Medicaid Accountable Care Organization–i.e., an organization set up to manage payment from Medicaid, a public health insurance option for low-income people. The case describes C3’s approach to addressing racial equity from two vantage points: first, its programmatic efforts to channel financing into community health centers that serve large proportions of Black, Indigenous, People of Color (BIPOC), and second, its efforts to address racial equity within its own internal operations (e.g., through altering hiring and promotion processes). The case can be used to help students understand structural issues pertaining to race in healthcare delivery and financing, to introduce students to the basics of payment systems in healthcare, and/or to highlight how organizations can work internally to address racial equity.

Kerrissey, M.J. & Kuznetsova, M. , 2022. Killing the Pager at ZSFG , Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business Publishing Abstract This case is about organizational change and technology. It follows the efforts of one physician as they try to move their department past using the pager, a device that persisted in American medicine despite having long been outdated by superior communication technology. The case reveals the complex organizational factors that have made this persistence possible, such as differing interdepartmental priorities, the perceived benefits of simple technology, and the potential drawbacks of applying typical continuous improvement approaches to technology change. Ultimately the physician in the case is not able to rid their department of the pager, despite pursuing a thorough continuous improvement effort and piloting a viable alternative; the case ends with the physician having an opportunity to try again and asks students to assess whether doing so is wise. The case can be used in class to help students apply the general concepts of organizational change to the particular context of technology, discuss the forces of stasis and change in medicine, and to familiarize students with the uses and limits of continuous improvement methods.

Yatsko, P. & Koh, H. , 2021. Dr. Joan Reede and the Embedding of Diversity, Equity, and Inclusion at Harvard Medical School , Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business Publishing Abstract For more than 30 years, Dr. Joan Reede worked to increase the diversity of voices and viewpoints heard at Harvard Medical School (HMS) and at its affiliate teaching hospitals and institutes. Reede, HMS’s inaugural dean for Diversity and Community Partnership, as well as a professor and physician, conceived and launched more than 20 programs to improve the recruitment, retention, and promotion of individuals from racial and ethnic groups historically underrepresented in medicine (UiMs). These efforts have substantially diversified physician faculty at HMS and built pipelines for UiM talent into academic medicine and biosciences. Reede helped embed the promotion of diversity, equity, and inclusion (DEI) not only into Harvard Medical School’s mission and community values, but also into the DEI agenda in academic medicine nationally. To do so, she found allies and formed enduring coalitions based on shared ownership. She bootstrapped and hustled for resources when few readily existed. And she persuaded skeptics by building programs using data-driven approaches. She also overcame discriminatory behaviors and other obstacles synonymous with being Black and female in American society. Strong core values and sense of purpose were keys to her resilience, as well as to her leadership in the ongoing effort to give historically marginalized groups greater voice in medicine and science.

Cases Available for Free Download

This multimedia module includes three clinical case videos demonstrating a variety of geriatric patient circumstances. Participants will view each case with attention to the medical care provided, as well as the impact of the social determinants of health (SDOH) in each scenario. The provider, in each case, models how to integrate the SDOH into the care plan to optimize the patient’s health and functionality.

Facilitators who utilize this module will develop panels from local community and state agencies to follow each case. The panels serve to deepen the learning experience through discussion and linking the participants to local experts. This strengthens the participant’s ability to apply lessons learned from this module in the clinical community contexts they serve.

The learning objectives for this module are directly related to Healthy People 2020 with the core SDOH categories including: economic stability; social and community context; health and healthcare; neighborhood and built environment; and environmental conditions.

Gordon, R. , 2014. Who Owns Your Story? , Harvard University: Global Health Education and Learning Incubator. Access online Abstract This case uses a role play simulation to illustrate ethical implications when research practices violate cultural taboos and norms. In Who Owns Your Story? the Trilanyi - a fictional Native American tribe based on a real community that is not identified or located in the case – is adversely affected by a high prevalence of diabetes. They ask a university professor with whom they have a close relationship to study their tribe, and they agree to give samples of their blood – which they consider sacred – for the study. Tribe members signed a consent form to participate but it was unclear whether they realized that the consent covered the university potentially using their blood for other possible research topics beyond diabetes. Ultimately, the study does not discover that the tribe has a genetic predisposition to diabetes. Years later, however, tribe members learn that their samples had also been used to study topics they considered objectionable. The case is based on true events between the Havasupai tribe and the University of Arizona which ultimately led to a legal suit that was settled out of court. In the case, students are asked to develop and simulate role play negotiations toward an acceptable resolution for all the parties involved.

Chai, J., Gordon, R. & Johnson, P. , 2013. India's Daughter: The Rape that Galvanized a Nation , Harvard University: Global Health Education and Learning Incubator. Access online Abstract This case explores the national, global, and social media response to a woman’s brutal rape in India in late 2012. The young woman was raped by strangers while taking a private bus after attending an event with a male friend, and subsequently died from her injuries. India’s Daughter: The Rape that Galvanized a Nation is a part of a case series on violence against women that illustrate the critical role for leadership through an examination of how factors within a society influence women’s health, in particular gender based violence. Students analyze the situations described by considering the circumstances that placed each protagonist in vulnerable positions. Participants examined the commonalities and differences of these situations in an effort to understand the circumstances that affect women’s well-being. Additionally, using the cases as a framework, students analyze the connections between collective outrage, reactive action, and leadership.

Guerra, I., et al. , 2019. SALUDos: Healthcare for Migrant Seasonal Farm Workers , Harvard University: Social Medicine Consortium. Download free of charge Abstract The SALUDos program began in 2008 as a response to an influx of migrant seasonal farm workers (MSFWs) at a mobile medical unit serving homeless persons in Santa Clara County in Northern California. The program offered patients free and low-cost primary care services, linkage to resources, and advocacy. As the farm workers involved in this program became more involved in their primary care, they advocated for evening hours, transportation, linkage to coverage programs, and health education resources to better understand their medical and psychological conditions. During continual modifications of the SALUDos program, the team sought to understand and address large-scale social forces affecting migrant health through interventions to mitigate health inequities. Teaching note available for faculty/instructors.

"The foundation of Integrated Health Services is the relentless pursuit of value. Our fundamental purpose is to help IBM win in the marketplace through the health and productivity of our workforce." ---Martín Sepúlveda

Martín Sepúlveda, Vice President of Integrated Health Services at IBM, had played a central role in establishing IHS as a vital and ongoing contributor to the corporation's success. IBM's IHS organization, as it had come to be known in 2008, was a global team of approximately 250 occupational medicine, industrial hygiene, safety, health benefits and wellness professionals responsible for ensuring the health and well-being of IBM's over 400,000 employees worldwide. This case, set in 2011, highlights the many challenges and his team faced in developing strategies and approaches to creating a culture of health within IBM, and maintain its commitment to the well-being of every employee.

Focus on Diversity, Equity, and Inclusion

Johnson, P. & Gordon, R. , 2013. Hauwa Ibrahim: What Route to Change? , Harvard University: Global Health Education and Learning Incubator. Access online Abstract This case explores Nigerian attorney Hauwa Ibrahim’s defense of a woman charged with adultery by Islamic Shariah law. One of Nigeria’s first female lawyers, Ibrahim develops a strategy to defend a young married woman, Amina Lawal, against adultery charges that could potentially, if the court judged against her, result in her death. While many Western non-governmental organizations and advocacy groups viewed Lawal’s case as an instance of human rights abuse and called for an abolition of the Shariah-imposed punishment, Ibrahim instead chose to see an opportunity for change within a system that many – especially cultural outsiders – viewed as oppressive. Ibrahim challenged the dominant paradigm by working within it to create change that would eventually reverberate beyond one woman’s case. Willing to start with a framework that saw long-term opportunity and possibility, Ibrahim developed a very measured change approach and theory framed in seven specific principles. Additionally, Ibrahim’s example of challenging her own internal paradigms while also insisting that others do the same invites students to examine their own internal systems and paradigms.

On February 1, 2020, Jessie Gaeta, the chief medical officer for Boston Health Care for the Homeless Program (BHCHP), received news that a student in Boston had tested positive for the novel coronavirus virus that causes COVID-19 disease. Since mid-January, Gaeta had been following reports of the mysterious virus that had been sickening people in China. Gaeta was concerned. Having worked for BHCHP for 18 years, she understood how vulnerable people experiencing homelessness were to infectious diseases. She knew that the nonprofit program, as the primary medical provider for Boston’s homeless population, would have to lead the city’s response for that marginalized community. She also knew that BHCHP, as the homeless community’s key medical advocate, not only needed to alert local government, shelters, hospitals, and other partners in the city’s homeless support network, but do so in a way that spurred action in time to prevent illness and death.

The case study details how BHCHP’s nine-person incident command team quickly reorganized the program and built a detailed response, including drastically reducing traditional primary care services, ramping up telehealth, and redeploying and managing staff. It describes how the team worked with partners and quickly designed, staffed, and made operational three small alternative sites for homeless patients, despite numerous challenges. The case then ends with an unwelcome discovery: BHCHP’s first universal testing event at a large city shelter revealed that one-third of nearly 400 people there had contracted COVID-19, that most of the infected individuals did not report symptoms, and that other large city shelters were likely experiencing similar outbreaks. To understand how BHCHP and its partners subsequently popped up within a few days a 500-bed field hospital, which BHCHP managed and staffed for the next two months, see Boston Health Care for the Homeless (B): Disaster Medicine and the COVID-19 Pandemic.

Yatsko, P. & Koh, H. , 2017. Dr. Jonathan Woodson, Military Health System Reform, and National Digital Health Strategy , Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business Publishing Abstract Dr. Jonathan Woodson faced more formidable challenges than most in his storied medical, public health, and military career, starting with multiple rotations in combat zones around the world. He subsequently took on ever more complicated assignments, including reforming the country’s bloated Military Health System (MHS) in his role as assistant secretary of defense for health affairs at the U.S. Department of Defense from 2010 to 2016. As the director of Boston University’s Institute for Health System Innovation and Policy starting in 2016, he devised a National Digital Health Strategy (NDHS) to harness the myriad disparate health care innovations taking place around the country, with the goal of making the U.S. health care system more efficient, patient-centered, safe, and equitable for all Americans. How did Woodson—who was also a major general in the U.S. Army Reserves and a skilled vascular surgeon—approach such complicated problems? In-depth research and analysis, careful stakeholder review, strategic coalition building, and clear, insightful communication were some of the critical leadership skills Woodson employed to achieve his missions.

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Browse our case library

Sirali, Y. & Bhabha, J. , 2016. Turkey’s Child Protection Crisis and the Mother Child Education Foundation (Anne Çocuk Eğitim Vakfı—AÇEV), Parts A & B , Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business Publishing Abstract While violence against children in Turkey was widespread, people across the country were shocked by the news of seven atrocious child molestation cases,one after another over the course of a week in April 2010. Ayşen Özyeğin, Founder and President of the Mother Child Education Foundation (in Turkish, Anne Çocuk Eğitim Vakfı—AÇEV), a nonprofit organization devoted to supporting disadvantaged children and their families and promoting early childhood education, called a Board meeting to discuss whether the organization should assume a role in addressing the child protection crisis. ACEV’s leaders prepared to present recommendations to their fellow Board Members and to consider decisions critical for both the agency’s future and for Turkey’s children.

This case describes and explores the development of the first medical transitions clinic in Louisiana by a group of community members, health professionals, and students at Tulane Medical School in 2015. The context surrounding health in metro New Orleans, the social and structural determinants of health, and mass incarceration and correctional health care are described in detail. The case elucidates why and how the Formerly Incarcerated Transitions (FIT) clinic was established, including the operationalization of the clinic and the challenges to providing healthcare to this population. The case describes the central role of medical students as case managers at the FIT clinic, and how community organizations were engaged in care provision and the development of the model. The case concludes with a discussion of the importance of advocacy amongst health care professionals.

Teaching note available for faculty/instructors .

Reich, M. , 2014. Mexico: Negotiating Health Reform , Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business Publishing Abstract In April 2003, Dr. Julio Frenk, the Minister of Health of Mexico, prepared for the debate on his health reform bill to begin in the Senate. Since becoming Minister of Health in President Vicente Fox’s administration in 2000, Dr. Frenk had worked tirelessly to build support for his vision of health reform and his goals of re-structuring the health care system in Mexico and providing universal access to care for 50 million uninsured in Mexico. The Senate debate on his bill was a rare political opportunity to fundamentally transform Mexico’s health system. Dr. Frenk had to figure out how to deal with the opposition to his reform and how to get his bill adopted by the Mexican Congress.

Quelch, J.A. & Rodriguez, M.L. , 2015. Mérieux NutriSciences: Marketing Food Safety Testing , Harvard Business Publishing. Available from Harvard Business Publishing

Singer, S. , 2013. Surgical Safety Simulation Exercise , Harvard T.H. Chan School of Public Health. Abstract In this simulation exercise, students are given the opportunity to think critically about the role of motivation and organizational context in implementing a process innovation. Students work in teams of four to six people to develop recommendations for a hospital president on the best ways to implement a surgical safety checklist. Simulation available upon request from author .

In the aftermath of the atrocities endured by the Cambodian people, Friends-International (FI) was established in 1994 to address some of the many protection needs faced by the country’s marginalized children and youth. In the intervening quarter century, FI has grown substantially, both in the scope and complexity of its operations. The organization’s core mission consists of providing comprehensive, innovative, and high quality services to children, youth, and their families, based on a child rights-based approach that informs all of the organization’s programs. FI has established a strong and highly respected presence in Cambodia, building social services for children, operating effective social businesses , and initiating the global ChildSafe Movement. Over time , they have expanded their community-based model to multiple countries. But amidst their expansion, FI has continued to face financial insecurity and a constantly shifting landscape of challenging child protection concerns. At what point might they have been trying to do too much, possibly unduly stretching themselves across too many sectors and borders? Innovation had been a core strength of FI, but was it always appropriate to innovate? The case addresses these common problems.

Wang, M. , 2017. Sugary Drink Legislation in Massachusetts , Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business Publishing Abstract In the fall of 2016, with the January 2017 deadline to file bills fast approaching, State Senator Jason Lewis was contemplating the details of a sugary drink legislative proposal in the Commonwealth of Massachusetts. Senator Lewis had a particular interest in legislative efforts to contain healthcare costs and prevent chronic disease through prevention and wellness approaches. He was particularly concerned about the rising levels of sugary drink consumption and associated conditions of obesity, diabetes, and dental caries, considering such drinks “a uniquely toxic food.” As an experienced legislator he knew he was facing a tough battle and wanted to take an approach that would give the bill the best chance of succeeding. Senator Lewis explained, “Massachusetts should be leading the legislative effort to reduce sugary drink consumption in the Northeast. Significant opposition from the beverage industry is expected, but we have a real chance of making progress at the local and state levels.”

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Case Study 3: The World Health Organization (WHO)

Björn alexander lindemann.

Universität Tübingen, Tübingen, Germany

The WHO is the UN specialized agency for health and was formally established on April 7, 1948 (Lee 2009: 1-45; Burci and Vignes 2004: 15-19). Its ultimate goal is the “attainment by all peoples of the highest possible level of health” as stipulated in Article 1 of the WHO constitution. The broad definition of health as one of the fundamental human rights of all peoples and the principle of universality are key elements in the constitution of the WHO, which makes frequent reference to “all peoples”, stipulates that membership is open to “all states” and, in contrast to other UN organizations, allows membership based on a simple majority of votes in the WHA, instead of on a two-thirds majority. As of April 2012, the WHO had 193 member states and two associate members.

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Business case for WHO immunization activities on the African continent 2018-2030

While Africa has seen tremendous progress towards access to immunization, one in five African children still lack access to all the World Health Organization (WHO) recommended life-saving vaccines, a threat not only to the health of families, but also to the strength of economies and equity in African societies.

The Global Vaccine Action Plan (GVAP) 2011-2020, endorsed by Member States during the May 2012 World Health Assembly, has set ambitious targets to improve access to immunization and tackle vaccine-preventable diseases. This responsibility has been translated into firm commitments in February 2016, through the signature of the Addis Declaration on Immunization (ADI) by African Ministers and subsequently endorsed by the Heads of States from across Africa at the 28th African Union Summit held in January 2017. This commitment from the highest level of government comes as a catalyst to immunization efforts on the continent to deliver on the promise of universal immunization coverage.

With the GVAP 2020 targets approaching and the ADI roadmap being implemented, accelerated efforts are required to improve immunization systems. In parallel, the Global Polio Eradication Initiative (GPEI) and Gavi the Vaccine Alliance transitions require a plan to mitigate the consequences of this imminent and drastic reduction in resources.

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Utilization of injury care case studies: a systematic review of the World Health Organization's "Strengthening care for the injured: Success stories and lessons learned from around the world"

Affiliations.

1 Harborview Injury Prevention and Research Center, Seattle, USA; University of Pittsburgh, Pittsburgh, USA. Electronic address: [email protected].
2 University of Washington, Seattle, USA.
3 Khon Kaen Regional Trauma Center, Khon Kaen, Thailand.
4 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
5 World Health Organization, Geneva, Switzerland.
6 Universidad El Bosque, Bogota, Colombia.
7 Harborview Injury Prevention and Research Center, Seattle, USA; University of Washington, Seattle, USA.
PMID: 30195833
PMCID: PMC6432919
DOI: 10.1016/j.injury.2018.08.013

Objective: Translation of evidence to practice is a public health priority. Worldwide, injury is a leading cause of morbidity and mortality. Case study publications are common and provide potentially reproducible examples of successful interventions in healthcare from the patient to systems level. However, data on how well case study publications are utilized are limited. To our knowledge, the World Health Organization (WHO) published the only collection of international case studies on injury care at the policy level. We aimed to determine the degree to which these injury care case studies have been translated to practice and to identify opportunities for enhancement of the evidence-to-practice pathway for injury care case studies overall.

Methods: We conducted a systematic review across 19 databases by searching for the title, "Strengthening care for the injured: Success stories and lessons learned from around the world." Data synthesis included realist narrative methods and two authors independently reviewed articles for injury topics, reference details, and extent of utilization.

Findings: Forty-seven publications referenced the compilation of case studies, 20 of which included further descriptions of one or more of the specific cases and underwent narrative review. The most common category utilized was hospital-based care (15 publications), with the example of Thailand's quality improvement (QI) programme (10 publications) being the most commonly cited case. Also frequently cited were case studies on prehospital care (10 publications). There was infrequent utilization of case studies on rehabilitation (3 publications) and trauma systems (2 publications). No reference described a case translated to a new scenario.

Conclusions: The only available collection of policy-level injury care case studies has been utilized to a moderate extent however we found no evidence of case study translation to a new circumstance. QI programs seem especially amenable for knowledge-sharing through case studies. Prehospital care also showed promise. Greater emphasis on rehabilitation and health policy related to trauma systems is warranted. There is also a need for greater methodologic rigor in evaluation of the use of case study collections in general.

Keywords: Case studies; Global injury care; Global trauma; Prehospital care; Realist review; Trauma quality improvement.

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Case study: World Health Organisation (WHO)

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Case Study 3: The World Health Organization (WHO)

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Lindemann, B. (2014). Case Study 3: The World Health Organization (WHO). In: Cross-Strait Relations and International Organizations. Ostasien im 21. Jahrhundert. Springer VS, Wiesbaden. https://doi.org/10.1007/978-3-658-05527-1_6

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The impact of non-dysentery shigella infection on the growth and health of children over time (insight)—a prospective case–control study protocol.

1. Introduction

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Click here to enlarge figure

Study Day/Month (M)	1	3	5	9	14	M1	M2	M3	M4	M5	M6	M7	M8	M9	M10	M11	M12
Enrolment	X
* Morbidity	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
* Stool collection for analysis of microbiology	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Sociodemographic, sanitation, and hygiene questionnaire assessments		X									X
Urine L:R ratio measurement		X			X			X			X						X
Stool collection for analysis of inflammatory/immune markers	X	X	X	X	X	X		X			X			X			X
Blood collection for analysis of inflammatory/immune markers	X			X		X		X			X			X			X
Anthropometry measurements	X				X	X	X	X	X	X	X	X	X	X	X	X	X
Bayley or WPPSI assessment		X						X									X
HOME assessment		X

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Chakraborty, S.; Dash, S.; Antara, N.A.; Roy, B.R.; Mamun, S.A.; Ali, M.; Naz, F.; Johura, F.-T.; Lewis, J.; Afroze, F.; et al. The Impact of Non-Dysentery Shigella Infection on the Growth and Health of Children over Time (INSIGHT)—A Prospective Case–Control Study Protocol. Microorganisms 2024 , 12 , 1677. https://doi.org/10.3390/microorganisms12081677

Chakraborty S, Dash S, Antara NA, Roy BR, Mamun SA, Ali M, Naz F, Johura F-T, Lewis J, Afroze F, et al. The Impact of Non-Dysentery Shigella Infection on the Growth and Health of Children over Time (INSIGHT)—A Prospective Case–Control Study Protocol. Microorganisms . 2024; 12(8):1677. https://doi.org/10.3390/microorganisms12081677

Chakraborty, Subhra, Sampa Dash, Nowrin Akbar Antara, Bharati Rani Roy, Shamim Al Mamun, Mohammad Ali, Farina Naz, Fatema-Tuz Johura, Jade Lewis, Farzana Afroze, and et al. 2024. "The Impact of Non-Dysentery Shigella Infection on the Growth and Health of Children over Time (INSIGHT)—A Prospective Case–Control Study Protocol" Microorganisms 12, no. 8: 1677. https://doi.org/10.3390/microorganisms12081677

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Published: 16 August 2024

Prevalence and associated factors of TB and HIV coinfections among adult inmates with presumptive pulmonary TB in a Kenyan prison

Suleiman Athuman Mwatenga 1 , 3 ,
Ali A. Musa 2 ,
Margaret W. Muturi 1 &
Abednego Moki Musyoki ORCID: orcid.org/0000-0003-1221-3735 3

Tropical Medicine and Health volume 52 , Article number: 54 ( 2024 ) Cite this article

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Tuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control interventions in correctional facilities is limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections in our study setting.

This was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay.

The overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37–16.91% (16/157), HIV 19.1%, 95% CI 13.73–25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37–16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners . The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044).

We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains the second leading infectious disease killer worldwide after Corona Virus Disease (COVID) 2019 [ 1 ]. Globally, there were an estimated 10.6 million TB cases and about 1.3 million deaths, including 167,000 people with human immunodeficiency virus (HIV) in 2022. The TB burden was disproportionately higher in the World Health Organization (WHO) South-East Asia (46%) and Africa (23%) regions, with Kenya in the global list of the 30 high-TB and TB and HIV burden countries [ 1 ].

In the face of the sluggish development of new TB vaccines, the emerging multidrug-resistant TB, and the rising global challenges, including COVID-19, energy and food insecurity, as well as the ongoing war in Ukraine and Gaza, multisectoral action to combat the TB pandemic remains a top global health priority [ 1 ]. TB epidemiology is attributable to comorbidities that impair immunity, such as diabetes and HIV infections, malnutrition, smoking (especially among men), household air pollution, poverty, and imprisonment [ 2 ].

Prisoners are reportedly at increased risk of contracting TB, with the burden being more than ten times higher than in the general population [ 3 ]. The global estimate of TB incidence in prisons is 15 cases per 100 person-years and is highest in the WHO African region (2190 cases per 100,000 person-years) [ 4 ]. In a recent systematic review and meta-analysis by Mera and others on the prevalence and predictors of pulmonary TB among prisoners in sub-Saharan Africa, the pooled pulmonary TB prevalence was 7.7% [ 2 ]. Further, HIV-infected inmates are at higher risk of developing TB than their HIV-negative counterparts [ 5 ]. HIV infection is the most significant risk factor for reactivating latent TB to active disease, and coinfection accelerates immunological function decline, increasing mortality in untreated cases [ 6 ]. Globally, the pooled prevalence of TB and HIV coinfections among prisoners ranges from 2.4 to 73.1% [ 5 ]. In Africa, few studies have documented TB and HIV coinfections, with prevalence ranging from 1.13 to 58 per cent, in prisons. These studies were conducted in Ethiopia [ 7 , 8 ], Zambia [ 9 , 10 ], Nigeria [ 11 , 12 ], Cameroon [ 13 , 14 ], Tanzania [ 15 ] and South Africa [ 16 , 17 , 18 ], Uganda [ 18 ]. There is limited data on TB and HIV coinfections in Kenyan prisons [ 19 ].

The high TB and HIV burden among prisoners is attributable to the lack of quality healthcare, such as TB diagnostic services and active case screening, occasioned by low priorities by policymakers, poor infrastructural designs that favour inadequate ventilation and overcrowding, undernutrition, HIV infection, alcohol use disorders and smoking [ 2 , 3 ]. The World Health Assembly in 2014 adopted the WHO End TB strategy as part of the newly established Sustainable Development Goals (SDGs) to attain a 90% reduction in the TB incidence rate and a 95% reduction in the absolute number of TB deaths by 2035, with priorities on TB Key populations, including refugees, the poor, refugees, people living with HIV, and prisoners [ 1 ].

Inmates can serve as reservoirs for Mtb transmission within the prison and the communities after their release [ 2 , 20 ]; as such, there is a need for systematic and continuous surveillance to curb the spread of infections, especially those caused by multidrug-resistant strains, through early case detection and treatment initiation. In many resource-constrained settings, such as Kenya, prisons are often neglected and excluded from the national health statistics [ 21 ]; therefore, epidemiological data to inform TB infection prevention interventions are limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections among adult (aged 18 years or more) inmates with presumptive pulmonary TB in a Kenyan prison.

Materials and methods

Study area, design, and population.

We adopted a prospective cross-sectional study at Shimo-La Tewa Health Centre, a 24-bed facility that serves inmates from Shimo Latewa Maximum Security Prison, located along Malindi Road in Shanzu, Mombasa County, Kenya. The prison has a capacity of 1500 inmates drawn from all over the country. All adult (aged ≥ 18 years) inmates presenting with signs and symptoms suggestive of TB (such as prolonged cough with or without blood, chest pain, fatigue, weight loss, fever, or night sweats) at the Shimo la Tewa prison chest clinic were eligible for enrolment. The study participants were recruited from January to June 2023, excluding those with a history of anti-TB drug use or on treatment follow-up, as well as those who declined to participate.

Samples collection

This study collected data on participants’ demographic and clinical characteristics using a pretested structured questionnaire administered through face-to-face interviews. All participants were requested to provide sputum (early morning and spot) samples in 2 consecutive days. We instructed the patients to rinse their mouth twice with water, inhale deeply, cough vigorously, and expectorate into a clean and sterile 50-ml falcon tube. The samples were received and processed immediately. In case of delay, samples were stored at 4 °C and processed within 3 days [ 7 ].

Laboratory analysis

The sputum samples were screened for TB using Xpert® MTB/RIF (Cepheid, Sunnyvale, CA, USA), following the manufacturer’s instructions. Compared to culture, the sensitivity and specificity of Xpert MTB/RIF are reported at 85% and 98%, respectively [ 22 ]. Briefly, 0.5 ml of sputum sediments were resuspended with 1.5 ml Xpert/RIF sample reagent, thoroughly shaken 15 times, and incubated for 10 min at room temperature. After incubation, we thoroughly shook the mixture and re-incubated it for 5 min. The liquefied sample was transferred into an Xpert MTB/RIF cartridge labelled with the patient ID, loaded in Xpert MTB/RIF, run for one hour, and read the results from the machine-generated printouts.

After counselling by a professional counsellor, patients were screened for HIV using Determine™ HIV-1/2 Kits (Abbott Laboratories, USA), with positive samples confirmed by First Response HIV-1–2 (Premier Medical Corporation Ltd., Kachigam, India) per the Kenya Ministry of Health algorithm. The Determine™ HIV-1/2 Kit has a sensitivity of 100% and a specificity higher than 99% [ 23 ], while First Response HIV-1–2 has a sensitivity and specificity of 100% [ 24 ].

Data analysis

The data were coded and entered into password-protected MS Excel 2013, checked for completeness, and exported and analysed in Epi-info 7, with categorical data presented in tables as frequencies and percentages and continuous data as median and interquartile range. We investigated the normality for age using the Shapiro–Wilk test and obtained a p -value < 0.001, indicating a non-normal distribution. We used Stata 17 to calculate 95% Confidence Intervals (CI) for proportion. After assessing the collinearity and interaction of variables, we developed bivariate models to explore the association between TB and HIV coinfections and patients’ demographic and clinical characteristics, with associations with p -values ≤ 0.2 subjected to a multivariable analysis using binary logistic regression. Interactions between education level, smoking status, and illegal drug use to determine their significance and potential impact on the study outcome were assessed, with variables showing significant interaction (smoking and drug use) subjected to a multivariable model and those with non-significant interaction removed to maintain model parsimony. We checked for multicollinearity using the Variance Inflation Factor (VIF), with education level (VIF = 1.07), use of illegal drugs (VIF = 1.06), and drug use (VIF = 1.01) showing low to moderate (1 < VIF < 5) multicollinearity, which is typically acceptable [ 25 ]. The statistical significance level was at p < 0.05 [95% confidence interval (95% CI)], and statistically significant associations are bolded in Table 2 .

Demographic and clinical characteristics of study participants

Of 165 adult (aged ≥ 18 years) inmates presenting with signs and symptoms suggestive of TB at the Shimo la Tewa prison chest clinic, we excluded 4.8% (8/165) because they declined to grant the study informed consent (75%, 6/8) and had previous TB history (25%, 2/8). In total, we recruited 157 participants, with a median age of 37 (interquartile range [IQR]: 30–46.5) years, and predominated by males (89.8%) aged 31 to 41 years, and those with normal BMI (62.4%) (Table 1 ).

Prevalence of TB and HIV coinfections

The overall prevalence of TB among the study participants with presumptive pulmonary TB was 10.2%, 95% CI 6.37–16.91% (16/157), HIV 19.1%, 95% CI 13.73–25.97% (30/157). All TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2% 95% CI 6.37–16.91% (16/157), and there was no rifampicin resistance. The TB and HIV coinfection prevalence was highest among prisoners who were underweight (100%, 16/16) and with a smoking history [68.8%, 95% CI 66.04–91.46% (11/16)] (Fig. 1 ).

Prevalence of TB and HIV coinfections: %: percentage; #: number of cases; HIV: human immunodeficiency virus

Factors associated with TB and HIV coinfections

The study bivariate analysis showed that education level, smoking, and use of illegal drugs were significantly associated with TB and HIV coinfections among the prisoners (Table 2 ). Participants aged ≥ 45 years were 88% likely to have a TB and HIV coinfection compared to those aged between 18 and 29 years [crude odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.02–0.93, p = 0.042]; however, this was not an independent association [adjusted OR = 0.15, 95% CI 0.02–1.25, p = 0.079].

Multivariate analysis established that those with primary or secondary education were 83–85% less likely to have TB and HIV coinfections (adjusted OR = 0.17, 95% CI 0.05–0.61, p = 0.007) when compared with those having no formal education. Participants with a smoking history were three times more likely to have TB and HIV coinfections (adjusted OR = 3.01, 95% CI 1.83–10.94, p = 0.009) when compared with those with the history. Further, prisoners with an illegal drug use history were five times more likely to have TB and HIV coinfections (adjusted OR = 4.55, 95% CI 1.04–19.81, p = 0.044) compared to those without such a history (Table 2 ).

In this study, the prevalence of tuberculosis (TB) among prisoners presenting with presumptive pulmonary TB was 10.2%, higher than reported elsewhere in Ethiopia (2.8–8%) [ 7 , 26 , 27 ], Uganda (2.02%) [ 28 ], South Africa (2.7–3.5%) [ 29 , 30 ], Brazil (3.9%) [ 31 ], and in Central Region of China (1.2%) [ 32 ] prisons. TB prevalence in the current study was 33 times higher than reported in the general population by the latest Kenyan National TB Prevalence Survey of 2016 [ 21 ]. Our finding is consistent with other reports that TB incidence is 5 to 70 times greater in prisons than in communities [ 33 , 34 ]. Inmates with TB can serve as hotspots for TB transmission within prison walls and outside communities after their release [ 20 ], highlighting the public health importance of interventions targeting this key population in national and global efforts to eradicate TB. The high TB burden in prisons is attributable to low health services priorities by public health policymakers, infrastructural designs that favour overcrowding with no sufficient ventilation, and prisoners’ vulnerability due to malnutrition, HIV infection, smoking and alcohol use disorders [ 3 ].

In our study, all the TB cases were positive for HIV (16/16, 100%), with a higher HIV prevalence (19.1%) compared to the national prevalence (5.9%) in Kenya [ 35 ]. The TB/HIV coinfection of 10.2%, in the current study, was higher than reported in East Gojjam Zone (1.13%) [ 7 ] and Gondar Zone (3.6%) [ 8 ] in Northwest Ethiopia, Zambia (1 to 6.4%) [ 9 , 10 , 36 ], and Nigeria (4.2%) [ 11 ], but lower than documented in Tanzania (25.9%) [ 15 ], Uganda (57.1%) [ 18 ], Nigeria (24.4%) [ 12 ], Cameroon (25%) [ 14 ], and South Africa (46.6 to 58%) [ 16 , 17 , 37 ]. A global systematic review by Edge and others (2016) on prisoners coinfected with TB and HIV estimated a coinfection prevalence ranging from 2.4 to 73.1% [ 5 ]. There exists a significant association between HIV and TB [ 7 ], as well as a patient’s history of prison and TB/HIV coinfection [ 38 ]. Notably, prisoners infected with HIV are at high risk of developing TB, but the magnitude of the risk varies between different prisons and countries [ 5 ]. Therefore, local epidemiological data on TB and HIV coinfections in prisons remain critical to guide infection prevention intervention in line with the World Health Organization (WHO) ‘End TB Strategy’, endorsed by the Sixty-seventh World Health Assembly in 2014 [ 1 ]. This strategy is part of the newly established SDGs to attain a 90% reduction in the TB incidence rate and a 95% reduction in the absolute number of TB deaths by 2035, with priorities on TB Key populations, including prisoners [ 1 ].

The TB and HIV coinfection cases were highest among prisoners who were underweight (100%, 16/16) and with a smoking history (68.8%, 11/16), which are considered risk factors for the acquisition of TB [ 9 , 39 ]. Further, participants who had primary or secondary education were 83–85% less likely to have TB and HIV coinfections (adjusted OR = 0.17, 95% CI 0.05–0.61, p = 0.007) when compared with those having no formal education. Our finding corroborates that of previous studies in prisons by Valença and colleagues in southern Brazil [ 40 ], Biadglegne and others in Northern Ethiopia [ 41 ], and Shimeles and colleagues in the Ethiopian general population [ 42 ], where illiterate persons were more than twice as likely to develop TB compared to those who could at least read and write [ 40 ]. Education improves knowledge, skills, reasoning, effectiveness, and a broad range of other abilities that can improve health [ 43 ], suggesting a need for health education interventions to alleviate the TB burden in the current study settings and beyond.

In the current study, prisoners with a history of illegal drug use were five times more likely to harbour TB and HIV coinfections (adjusted OR = 4.55, 95% CI 1.04–19.81, p = 0.044) compared to those without such a history. A study by Arroyave and colleagues showed a similar association where Prison Guards with a history of drug use at least once in a lifetime were two times at risk of latent TB [ 44 ]. Similarly, in Southern Brazil, the burden of TB was highest among prisoners with a history of illegal drug use [ 45 ]. Drug users are more likely to be infectious and take longer to achieve negative culture, with physiological effects of drug use, such as direct impairment of the cell-mediated immune responses by opiates, along with the environment and risk behaviours of drug users likely playing a critical role in TB epidemiology among drug users [ 46 ].

Our study findings showed that prisoners with a smoking history were three times more likely to have a TB and HIV coinfection (adjusted OR = 3.01, 95% CI 1.83–10.94, p = 0.009) when compared with those without such a history. A similar association was documented in Ethiopia [ 47 ], South Africa [ 30 , 37 ], southern Brazil [ 40 ], and Pakistan [ 48 ] prisons. Smoking is a contributor to the high TB burden in prisons, for it increases the risk of infection, developing the active form of the disease and ultimately dying from it, negatively influencing the response to treatment and increasing the risk of relapse [ 1 , 49 ].

We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfections. The authorities should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use. Multicentric studies with large sample sizes are needed to substantiate the findings further.

Study limitations

Despite being a single-centre study with a small sample size, which may limit the generalization of the findings in similar settings, our research offers insight into the significant burden of TB and HIV coinfections in prisons, particularly in resource-constrained countries where national health surveys often exclude correctional facilities.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on request.

Abbreviations

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Multidrug resistance

Mycobacterium tuberculosis

Human immunodeficiency virus

World Health Organization

Corona Virus Disease 2019

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Acknowledgements

We acknowledge Hezron Baya, Laboratory manager and other Shimo La Tewa Health Center laboratory staff, specifically Khamisi Kithi and Chris Bisarara, for technical support and providing essential protocol guidelines, making the execution of this study successful.

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SAM, MWM and AMM conceived and designed the study, and SAM and AAM collected data. SAM and AMM analysed and interpreted the data and wrote the manuscript. All authors read and approved the final manuscript.

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The study obtained ethical clearance from the Kenyatta University Ethical Review Committee (Protocol no. PKU/2292/2014) and a research permit from the National Commission for Science and Innovation (License No. NACOSTI/P/23/25865) and Kenya Prisons (Approval Ref. PRIS 1/41/VOL.1 (TY/142)). The authors obtained informed written consent from each patient. There were no monetary gains for the study participation or any penalty for declining to participate. We shared all the critical findings with the treating physician promptly.

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Mwatenga, S.A., Musa, A.A., Muturi, M.W. et al. Prevalence and associated factors of TB and HIV coinfections among adult inmates with presumptive pulmonary TB in a Kenyan prison. Trop Med Health 52 , 54 (2024). https://doi.org/10.1186/s41182-024-00623-2

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Overview This case study examines country-level primary health care (PHC) systems in Peru. The case study is part of a collection of case studies providing critical insights into key PHC strengths, challenges and lessons learned using the Astana PHC framework, which considers integrated health services, multisectoral policy and action, and people and communities.
Case Study 3: The World Health Organization (WHO)
Abstract. The WHO is the UN specialized agency for health and was formally established on April 7, 1948 (Lee 2009: 1-45; Burci and Vignes 2004: 15-19). Its ultimate goal is the "attainment by all peoples of the highest possible level of health" as stipulated in Article 1 of the WHO constitution. The broad definition of health as one of the ...
Business case for WHO immunization activities on the African continent
The World Health Organization (WHO) is building a better future for people everywhere. Health lays the foundation for vibrant and productive communities, stronger economies, safer nations and a better world. Our work touches lives around the world every day - often in invisible ways. As the lead health authority within the United Nations (UN) system, we help ensure the safety of the air we ...
Research
Health research entails systematic collection or analysis of data with the intent to develop generalizable knowledge to understand health challenges and mount an improved response to them. The full spectrum of health research spans five generic areas of activity: measuring the health problem; understanding its cause(s); elaborating solutions; translating the solutions or evidence into policy ...
Utilization of injury care case studies: a systematic review of the
To our knowledge, the World Health Organization (WHO) published the only collection of international case studies on injury care at the policy level. We aimed to determine the degree to which these injury care case studies have been translated to practice and to identify opportunities for enhancement of the evidence-to-practice pathway for ...
PDF 6 Case Study 3: The World Health Organization (WHO)
6 Case Study 3: The World Health Organization(WHO)The WHO is the UN specialized agency for health and was formally established on April 7, 948 (Lee 200. oples of the highest possible level of health". asstipulated in Article 1 of the WHO constitution. The broad definition of health as one of the fundamental human rights of all peoples and the ...
Case study: World Health Organisation (WHO)
The World Health Organization (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."
Case Study I: The World Health Organisation, by Ana Mulió Álvarez
I have chosen the World Health Organization (henceforth: WHO) as the institution to analyze for many reasons. First, it is a well-established institution with a lot of reliable information that can provide a robust analysis. ... Friend, M.I. (2022). Case Study I: The World Health Organisation, by Ana Mulió Álvarez. In: The Institutional ...
Case Study 3: The World Health Organization (WHO)
Abstract. The WHO is the UN specialized agency for health and was formally established on April 7, 1948 (Lee 2009: 1-45; Burci and Vignes 2004: 15-19). Its ultimate goal is the "attainment by all peoples of the highest possible level of health" as stipulated in Article 1 of the WHO constitution. The broad definition of health as one of the ...
COP26 Case Studies on Climate Change and Health
Moreover, the public health motives for action have a strong science basis and are well evidenced and compelling. In this briefing pack, a series of case studies and opportunities for sharing experiences on climate change and health are highlighted across five priority areas of climate action: adaptation & resilience, energy transitions, nature ...
The Impact of Non-Dysentery Shigella Infection on the Growth and Health
The World Health Organization recommends the use of antibiotics when diarrhea is bloody, leaving most NDSD cases untreated. The absence of dysentery may not indicate a low risk of death and severe morbidity. ... a case-control study in severely malnourished children in Bangladesh assessing Shigella mortality stratified by the presence of ...
6 conditions that highlight the women's health gap
For instance, the women's health gap equates to 75 million years of life lost due to poor health or early death each year. Closing the gap would give the 3.9 billion women in the world today an extra seven healthy days a year, or an average of 500 days over a lifetime. This gap has economic consequences as well.
PDF Case studies
with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Edited by Ashley Craig Book design by Marta Pasqualato Printed in Italy by ...
Country case study on the integrated delivery of long-term care: Denmark
Abstract. This report describes the current state of the delivery of long-term care services in Denmark. Overall, older people enjoy comprehensive high-quality health and long-term care. There is high coverage, low rates of preventable hospitalizations, short waiting times and high beneficiary satisfaction. There is high level of integration of ...
Prevalence and associated factors of TB and HIV coinfections among
Tuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control ...
Primary Health Care Country Case Study Compendium
The primary health care (PHC) country case study compendium is a global resource that aims to enhance ease of access to PHC country case studies published across WHO, international development partners and other global stakeholders. Country cases are regularly added to the compendium. See below for details on how to submit a new case.
Mpox is officially a global emergency. Here's everything ...
The World Health Organization (WHO) has declared a new global health emergency as Africa grapples with a fast-spreading and deadly outbreak of mpox. The virus has been detected for the first time in numerous countries in Africa and is disproportionately affecting children. It has killed at least 517 ...
WHO declares mpox outbreak a global health emergency
The mpox outbreak ravaging the Democratic Republic of the Congo (DRC) is now a global health emergency, according to the World Health Organization (WHO). "The detection and rapid spread of a new ...
Long-term care in developing countries : ten case studies / editors: J
Brodsky, Jenny, Habib, Jack, Hirschfeld, Miriam J, World Health Organization & WHO Collaborating Centre for Health and Long-Term Care Policy and Research. (‎2003)‎. Long-term care in developing countries : ten case studies / editors: J. Brodsky, J. Habib and M. Hirschfeld. World Health Organization.
Global research on coronavirus disease (COVID-19)
Global research on coronavirus disease (COVID-19) WHO is bringing the world's scientists and global health professionals together to accelerate the research and development process, and develop new norms and standards to contain the spread of the coronavirus pandemic and help care for those affected. The R&D Blueprint has been activated to ...
Open Knowledge Repository
Open Knowledge Repository
PDF Casebook on Ethical Issues in International Health Research
mended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this ...
WHO offers new online course on building resilient health systems
In 2022, the World Health Organization (WHO) introduced a new online course aimed at strengthening health systems resilience in the face of public health challenges. The course - available through OpenWHO - addresses both acute shocks, such as infectious disease outbreaks and environmental disasters, and chronic stressors like non-communicable diseases and antimicrobial resistance.Course ...

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Business case for WHO immunization activities on the African continent 2018-2030

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Utilization of injury care case studies: a systematic review of the World Health Organization's "Strengthening care for the injured: Success stories and lessons learned from around the world"

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Prevalence and associated factors of TB and HIV coinfections among adult inmates with presumptive pulmonary TB in a Kenyan prison

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