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This manual describes the global situation on malaria in pregnancy as well as the components of provision of high-quality care to prevent and control malaria during pregnancy.

This manual describes the global situation on malaria in pregnancy as well as the components of provision of high-quality care to prevent and control malaria during pregnancy.

The report gives a comprehensive overview of parents’ unique experiences regarding neonatal care provision and the impact of implemented restrictions during the COVID-19 pandemic.

The recommendation in this document thus supersedes the previous WHO recommendation on prophylactic antibiotics for women undergoing caesarean section as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections.

The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.

Summary of clarifying remarks:

• For antibiotic prophylaxis for caesarean section, a single dose of first-generation cephalosporin or penicillin should be used in preference to other classes of antibiotics. This antibiotic choice is based on 1) effectiveness, and 2) as part of efforts to contain antimicrobial resistance.
• However, the choice of an antibiotic should be adapted to the local context: informed by local antimicrobial resistance guidance, local bacteriologic patterns of post-caesarean infectious morbidity, safety profile, the clinician’s experience with that particular class of antibiotics, availability and cost.
• Prophylactic antibiotics are recommended for women undergoing elective or emergency caesarean section and should be given 30–60 minutes prior to skin incision, rather than intraoperatively after umbilical cord clamping.
• Emphasizes the importance of using a simple and short (single dose, 30–60 minutes before surgery) antibiotic regimen for prophylaxis, unless there are other clinical factors for consideration (e.g. high maternal body mass index, prolonged labour, prolonged duration of surgery, extensive surgical manipulation or massive blood loss) that might increase the risk of developing post-caesarean infections. Clinical judgement is needed to evaluate if a different regimen (e.g., higher dose, second dose) of prophylactic antibiotics is warranted in the presence of risk factors.

The recommendation in this document thus supersedes the previous WHO recommendation on vaginal preparation with antiseptic agents for women undergoing caesarean section, as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections. 

The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.

Summary of clarifying remarks:

• All women undergoing caesarean section should have vaginal cleansing with povidone-iodine (1% – 10%), for 30 seconds performed immediately before caesarean section (e.g. directly following preoperative urinary bladder catheterization to minimize the woman’s discomfort).
• While the evidence on vaginal preparation before caesarean section was largely derived from trials using povidone-iodine, benefit was demonstrated overall for any antiseptic (either povidone-iodine or chlorhexidine gluconate) versus no antiseptic. Included trials used varying concentrations of chlorhexidine gluconate (0.05% to 0.25%) or povidone-iodine (1% to 10%), and the base (aqueous or alcohol) was not described. Alcohol-based antiseptic solutions should not be used for vaginal preparation because of concerns around irritation of mucosa.
• This recommendation pertains to all women undergoing caesarean section regardless of their baseline risk of infectious morbidity following surgery (i.e. for caesarean section in women before or during labour, and women with intact or ruptured membranes).
• Vaginal preparation should be performed as close to the start of caesarean section as possible (e.g. directly following preoperative urinary bladder catheterization) to minimize the woman’s discomfort.
• The duration of vaginal preparation varied from 30 seconds to one minute. The Guideline Development Group noted that shorter application, i.e., 30 seconds, and contact time are likely to be associated with less maternal and fetal exposure, which is desirable.

The recommendations in this document thus supersede the previous WHO recommendations for choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections. 

The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.

Summary of clarifying remarks:

• There was a lack of evidence to recommend a specific concentration of chlorhexidine gluconate; however, most trials included used 2% chlorhexidine gluconate in 70% alcohol.
• Where chlorhexidine gluconate is not available, other antiseptic agent such as povidone-iodine can be considered a suitable antiseptic agent for preoperative skin preparation, although it is not as effective as alcohol-based chlorhexidine gluconate.
• A standard preoperative skin preparation technique that is appropriate for the intended skin incision must be followed (e.g., allow antiseptic agent to dry and not wiping off).

The recommendation in this document thus supersedes the previous WHO recommendation on routine antibiotic prophylaxis for women undergoing operative vaginal birth as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections. 

The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.

Summary of clarifying remarks:

• “Operative vaginal birth” is the term used to describe delivery of the fetal head assisted by either vacuum extractor or forceps.
• Available evidence, from high-income countries, strongly supports the use of a single dose of intravenous amoxicillin (1 g) and clavulanic acid (200 mg) administered as soon as possible after birth and no more than 6 hours after birth.
• Intravenous amoxicillin and clavulanic acid may not be readily available or feasible to use in resource-limited settings and suggested that where this combination is not available, providers should consider the use of an appropriate class of antibiotics with similar spectrum of activity, based on local antimicrobial resistance patterns, safety profile (including allergies), the clinician’s experience with that class of antibiotics, availability and cost.
• This recommendation relates to the use of antibiotics for women who are undergoing operative vaginal birth and who are not receiving postpartum antibiotics for other indications.

World Health Organization, 2019.

This 2019 guidance document has been produced by WHO to assist blood services in the development of national plans to respond to any emerging infectious threats to the sufficiency or safety of the blood supply, whether from an existing infectious agent that is changing in incidence and spread, or from a newly identified infectious agent.

Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life. At any one time, up to 7% of patients in developed and 10% in developing countries will acquire at least one HAI. These infections also present a significant economic burden at the societal level. However, a large percentage are preventable through effective infection prevention and control (IPC) measures.

These new guidelines on the core components of IPC programmes at the national and facility level will enhance the capacity of Member States to develop and implement effective technical and behaviour modifying interventions. They form a key part of WHO strategies to prevent current and future threats from infectious diseases such as Ebola, strengthen health service resilience, help combat antimicrobial resistance (AMR) and improve the overall quality of health care delivery. They are also intended to support countries in the development of their own national protocols for IPC and AMR action plans and to support health care facilities as they develop or strengthen their own approaches to IPC.

These are the first international evidence-based guidelines on the core components of IPC programmes. These new WHO guidelines are applicable for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

The primary audience for this guideline is health professionals who are responsible for developing national and local health protocols and policies, as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women, including obstetricians, midwives, nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for both pre- and inservice training of health workers to enhance their delivery of care to prevent and treat maternal peripartum infections.

This guideline, developed by a panel of international experts and informed by a thorough review of existing evidence, provides recommendations on the use of antibiotics for neonates and young infants (0–59 days old) with PSBI in order to reduce young infant mortality rates. This guideline is intended for use in resource-limited settings in situations when families do not accept or cannot access referral. It seeks to provide programmatic guidance on the role of community health workers (CHWs) and home visits in identifying signs of serious infections in neonates and young infants. It also seeks to provide clinical guidance on the simplest antibiotic regimens that are both safe and effective for outpatient treatment of clinical severe infections and fast breathing (pneumonia) in children 0–59 days old.

This guideline will not replace the WHO-recommended inpatient management as the preferred treatment option for young infants who have clinical severe infection or critical illness. Close follow-up is essential for young infants managed on an outpatient basis where referral is not possible.

This guideline will help health care providers make appropriate management decisions about sick young infants whose families cannot access referral care. They will also guide national policy-makers in health ministries, programme managers, and development partners and will inform revisions to current WHO training and reference materials such as the Integrated Management of Childhood Illness (IMCI) Chart Booklet (3) and the Pocket Book of Hospital Care for Children: guidelines for the management of common illnesses (4). 

Key Findings

In cases where hospitalization is not possible at all, critically ill children should be given one of the following treatment regiments until hospitalization becomes possible (for up to 7 days)

1. Twice daily intramuscular ampicillin and once daily intramuscular gentamicin
2. Once daily intramuscular ceftriaxone with or without once daily intramuscular gentamicin
3. Twice daily intramuscular benzyl penicillin and once daily intramuscular gentamicin
4. Once daily intramuscular procaine penicillin and once daily intramuscular gentamicin