In this study, the authors examine the importance of national female literacy on women’s maternal health care use in sub-Saharan Africa, using data from the 2002-2003 World Health Survey. They found that, within the various countries, individual age, education, urban residence and household income were associated with lack of maternal health care. National female literacy modified the association of household income with lack of maternal health care use. The strength of the association between income and lack of maternal health care was weaker in countries with higher female literacy. The study concludes with the observation that higher national levels of female literacy may reduce income-related inequalities through a range of possible mechanisms, including women’s increased labour participation and higher status in society. National policies that are able to address female literacy and women’s status in sub-Saharan Africa may help reduce income-related inequalities in maternal health care use.
Equity in Health
In this study, researchers investigated whether depression, psychological distress and alcohol use are associated with sexual risk behaviours in young Ugandan adults. They sampled households in two Ugandan districts, recruiting 646 men and women aged 18-30 years. Participants were assessed for depression and psychological distress, as well as alcohol use and sexual behaviour risk. Researchers found that depression was associated with a greater number of lifetime partners and, among women, with having concurrent partners. Psychological distress was associated with a greater number of lifetime partners in both men and women but was only marginally associated with having concurrent partners among women. Psychological distress was associated with inconsistent condom use among men. Alcohol use was associated with a greater number of lifetime partners and with having concurrent partners in both men and women, with particularly strong associations for both outcome measures found among women. The researchers conclude that poor mental health is associated with sexual risk behaviours in a low-income sub-Saharan African setting. They argue that HIV preventive interventions should consider including mental health and alcohol use reduction components into their intervention packages, especially in settings where depression, psychological distress and alcohol use are common.
Health research consists of multiple disciplines that conceptualise and operationalise health in different ways, making integration of knowledge difficult, according to the authors of this paper. They argue that, to help researchers and practitioners study and intervene on complex health processes, comprehensive integrative frameworks linking multiple disciplines and bodies of knowledge must be developed. To this end, they propose a conceptual framework of health that integrates multiple elements from biomedical, psychosocial, behavioural, and spiritual research, using a ‘transdisciplinary’ approach. The framework includes discipline-specific constructs and domains, outlines their interactions, and links them to a global or holistic concept of health. In this context, health is seen as an emergent individual experience, transcending objective and subjective classifications of health and disease.
According to this editorial from the Bulletin of the World Health Organisation, most of the literature on gender differences in smoking has focused on differences in traditional sex roles. These roles have translated historically into social norms, such as disapproval of female smoking, and gender-specific personal characteristics, such as greater rebelliousness among men, which is linked to higher smoking rates. However, countries can vary widely in their actual experience with the smoking epidemic. For example, smoking levels among Chinese women have always been low and even dropped during the 20th century. In the 21st century, the situation is changing, the author argues, noting that social norms that slowed the diffusion of smoking among women are diminishing in most parts of the developing world, an unintended consequence of gender empowerment and economic growth, which allow women to freely make choices and furnish them with the economic resources to pursue those choices. A clue to the changing demographics of smokers is found in the narrowing gender gap in the rates of smoking experimentation and adoption among teenagers around the world. The author call for more research on how women view triggers that could lead to smoking adoption, such as peer pressure and role models, how addiction develops in female smokers, and how they weigh the costs and benefits of smoking.
On World Health Day, 7 April 2011, the focus will be on antimicrobials. According to the World Health Organisation (WHO), the use and misuse of antimicrobials in human medicine and animal husbandry over the past 70 years have increased the number and types of micro organisms resistant to these medicines, causing deaths, greater suffering and disability, and higher health-care costs. If this phenomenon continues unchecked, WHO warns, many infectious diseases risk becoming uncontrollable and could derail progress made towards reaching the health-related United Nations Millennium Development Goals for 2015. Furthermore, the growth of global trade and travel allows resistant organisms to spread worldwide within hours. WHO calls on governments and stakeholders to implement the policies and practices needed to prevent and counter the emergence of highly resistant micro-organisms.
The author predicts significant adjustments in the global health status quo in the coming year and identifies seven forces that are converging towards what appears to be an inevitable tipping point. Some changes will be gradual, others may appear as sudden shifts. Each of these forces has the potential to make a significant difference in its own right, but as they begin to interact and influence one another, business as usual is an unlikely outcome. Within the health sector the forces include a shift in public health priorities towards maternal and child health, non-communicable diseases, urban health promotion and primary health care renewal, as well as a shift in national health programmes and global public health initiatives from delivering the downstream interventions that constitute traditional health care services towards addressing the social determinants of health. Also included is the increased focus on health system strengthening, and continued growth in domestic health funding, particularly in the middle-income countries that are experiencing economic growth. The author also points to a change in the locus of global health governance, as countries with emerging economies, like Brazil, China, India and South Africa, exert an increasing influence on global health policies and agendas, linking them increasingly to foreign policy priorities. The author predicts other major forces affecting the global health status quo will be the new global financial reality, where international assistance for health will continue to grow, but the new fiscal prudence will bring stringent accountability and demand for aid effectiveness.
The primary objective of this paper was to review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys and trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007).
This paper reports on the prevalence of latent tuberculosis infection (LTBI) and risk factors for a positive tuberculin skin test (TST) among gold miners in South African gold mines. Among 429 participants, the estimated prevalence of LTBI was 89%; 45.5% of HIV-positive participants had a zero TST response compared to respectively 13% and 13.5% in the HIV-negative and status unknown participants. In participants with TST > 0, there was no significant difference between size of response by HIV status. Factors independently associated with a TST < 10 mm were positive HIV status and not working underground. The authors conclude that the prevalence of LTBI is very high in gold miners in South Africa. HIV-infected individuals are more likely to have a negative TST, but HIV infection does not affect the size of TST response.
With four years to go, Tanzania still lags behind other East African countries towards the realisation of the Millennium Development Goals (MDGs), according to this article, only surpassing war-torn Burundi. The minister for Health and Social Welfare, Dr Haji Mponda, admitted that he was aware of the problem and expressed the government’s willingness to ensure that some of the targets are fully realised by 2015. He highlighted the achievements made by the government, specifically in 2007, when the rate of HIV prevalence dropped from 7% to 5% and that of 2004 to 2005, when the number of maternal deaths went down from 98 to 51 out of every 1,000 deaths. The report comes exactly 10 years since the UN's adoption of the goals and twenty years since the recording of most baseline data surface. Despite an extraordinary public campaign to mobilize support for the MDGs, there has been surprisingly little effort to track, record, and disseminate information regarding progress toward the goals at the country level, the authors of the report argued. Reacting to Tanzania’s poor performance, the head of Twaweza, an information advocacy organization, expressed concern that Tanzania still lagged behind its peer East African neighbours. He challenged the government to review each of the eight MDGs by involving stakeholders in health, poverty reduction, environment and other sectors that are related to the MDGs. He also called for independent evaluation bodies of these strategies, with stakeholders involved and not just the government officials and added reports ought to be made available in the public domain, so that citizens know where the country is headed.
The United Nations predicts that the world's urban population will almost double from 3.3 billion in 2007 to 6.3 billion in 2050. Most of this increase will be in developing countries. Exponential urban growth is having a profound effect on global health. Because of international travel and migration, cities are becoming important hubs for the transmission of infectious diseases, as shown by recent pandemics. Physicians in urban environments in developing and developed countries need to be aware of the changes in infectious diseases associated with urbanization, the authors of this review argue. Furthermore, health should be a major consideration in town planning to ensure urbanisation works to reduce the burden of infectious diseases in the future.