World Health Statistics 2009 contains the World Health Organization’s (WHO's) annual compilation of data from its 193 member states, and includes a summary of progress towards the health-related millennium development goals and targets. This edition also contains a new section on reported cases of selected infectious diseases. It provides a comprehensive summary of the current status of national health and health systems including; mortality and burden of disease, causes of death, reported infectious diseases, health service coverage, risk factors, health systems resources, health expenditures, inequities and demographic and socioeconomic statistics. The section on inequities presents statistics on the distribution of selected health outcomes and interventions within countries, disaggregated by sex, age, urban and rural settings, wealth and educational level. It is an integral part of WHO’s ongoing effort to inform better measures of population health and national health systems.
Monitoring equity and research policy
In a major step forward for the open access movement, universities at Berkeley, Cornell, Dartmouth and Harvard, as well as the Massachusetts Institute of Technology, have announced a joint commitment to provide their researchers with central financial assistance to cover open access publication fees, and encouraged other academic institutions to join them. The aim of the Compact for Open Access Publication Equity (COPE) is to create a level playing field between subscription-based journals (which institutions support centrally via library budgets) and open access journals (which often depend on publication fees). The Compact commits each university ‘the timely establishment of durable mechanisms for underwriting reasonable publication charges for articles written by its faculty and published in fee-based open-access journals and for which other institutions would not be expected to provide funds.’
The goal of this book is to offer a glimpse in to the world of global health research through an indigenous peoples’ population lens. The symposium began with a presentation on Bridging Indigenous and Global Health, and the opening presenter made a plea for research into healthy equity to take a new direction by including distal determinants in the analysis. She noted that ‘it is the causes of the causes that have to be addressed… [ ] A distal determinant does not mean an unimportant determinant. This is where we have to head if we are truly going to address inequities… [ ] … because long-standing structures of disadvantage are at play in creating inequities.’ Thereafter, a number of plenary sessions were held. Two sessions covered work of direct relevance to east, southern and central Africa, namely: Mental Health Research in Africa: Lessons Learned; and Tackling Inequities in Health: Lessons from the Work of the Regional Network on Equity in Health in East and Southern Africa. Climate change and its impact on developing nations was also discussed.
Scenarios where the results of well-intentioned scientific research can be used for both good and harmful purposes give rise to what is now widely known as the ‘dual-use dilemma’. Four recent cases involving of dual-use discoveries have been particularly controversial: the development of a super strain of mouse pox, the synthesis of a polio virus from scratch, a case of genetically engineering a smallpox virus and the use of techniques of synthetic genomics (similar to those used in the polio study) to ‘reconstruct’ the Spanish flu virus, which killed between 20 and 100 million people in 1918–1919. Research may not only produce cures for modern diseases but may also be used to produce biological weapons. Though they understood the dangers, the scientists and editors involved defended their actions. It is questionable, however, whether reliance on voluntary self-governance of the scientific community in matters of censorship is advisable. Because scientists generally lack training in security studies, they may lack the expertise required for assessment of the security risks of publication in any given case.
This multi-cohort study of eleven anti-retroviral therapy (ART) programmes monitored the South African National Antiretroviral Treatment Programme, 2003–2007, in Gauteng, the Western Cape, Free State and KwaZulu-Natal. Subjects were all adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008. Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35 years and 42.5 months respectively. Of adults, 68% were female. Between 2003 and 2007, enrolment increased eleven-fold in adults and three-fold in children. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.
A mine safety audit report detailing the high number of injuries and fatalities in South Africa’s mines each year has been released by the Department of Minerals and Energy, revealing serious gaps in the safety standards in the mining industry. In the past three years, unsafe working conditions have led to the death of 200 mine workers annually, in addition to the almost 5,000 people who are injured annually. Many of these injuries are so severe that limbs need to be amputated which leads to a significant reduction in standards of living and ability to earn an income. In terms of Occupational Health and Safety, the mining industry scored a dismal 59% compliance, while also scoring only 56% for health risk management, while public health and safety in mines received 65% compliance. Singling out particular mining sectors, the diamond sector scored a low 47% compliance with health risk management regulations. The gold industry also scored a dismal 53% compliance when it came to health risk management.
So will open access build a bridge to reduce health inequity? The potential is certainly great but the digital divide remains large, with estimates that only 13% of the developing world uses the internet, often on slow and expensive connections. Therefore, the inequity in accessing information and communication technology infrastructure will need to improve to allow people to get a foot onto the information bridge. But even once they are there, they will still only be able to access information that has been paid for – even when that information was created using taxpayers’ money. There is a role for more research funders and donors to support open access as an integral cost of undertaking the research itself to ensure public access. While the United Nations might be seen as having a ‘slow bandwidth’ approach to this issue, things are moving ahead with the work of the International Telecommunications Union on promoting greater access to information and communication technology worldwide and the newly developed World Health Organization strategy on research for health.
This study assessed the completeness and accuracy of routine prevention of mother-to-child transmission of HIV (PMTCT) data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa, covering 316 clinics and hospitals. Data elements were reported only 50.3% of the time and were ‘accurate’ (within 10% of reconstructed values) 12.8% of the time. The data element ‘Antenatal Clients Tested for HIV’ was the most accurate element (consistent with the reconstructed value) 19.8% of the time, while ‘HIV PCR testing of baby born to HIV positive mother’ was the least accurate, with only 5.3% of clinics meeting the definition of accuracy. Data collected and reported in the public health system across three large, high HIV-prevalence districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality.
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Major inequities were noted between urban and rural areas, as rural areas were usually underserved. Some of the inequities highlighted by the District Health Barometer (DHB) can be traced to differences in health spending, with different districts spending different amounts. The uneven distribution of HIV infection in South Africa also influenced ratings: higher rates of Caesareans were linked to higher HIV rates in pregnant women. Writing in the DHB, Dr Tanya Doherty attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990, to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ she wrote.
What is the current status of occupational health and safety (OHS) in southern African? Of an estimated 14 million injuries per year, a mere 93,000 injuries are reported. This brief notes that more data is needed, which should be analysed and reported regularly. In existing compensation systems, there is too much focus on financial governance and not on the production of information to prevent accidents and disease. It recommends that social security/compensation and reporting systems need to be introduced where these do not exist. Active surveillance methods need to be introduced through surveys already carried out by national statistical offices, or by adding occupational health components to future labour force or health and demographic surveys. In addition, targeted research needs to be funded and supported. It will take many years and a lot of resources for southern African countries to develop information systems as sophisticated as those in Western countries.