This prevalence survey – based on blood samples from 34,000 pregnant women who attended antenatal clinics in 52 health districts in South Africa – measured HIV prevalence at 29.3%, compared to 29.4% in 2007 and 29% in 2006. Prevalence among women aged 15 to 40 declined slightly from 22.1% in 2007 to 21.7% in 2008, but the infection rate among women in the 30 to 34 age group rose from 39.6% in 2007 to 40.4% in 2008. Age was found to be the most important risk factor, with women of 22 years or older significantly more likely to be HIV-infected. In this age group, race was the next most important factor, with 37.6% of African women infected, compared to 6.8% of white, Asian and coloured (mixed race) women. The figures revealed wide variations between the country's nine provinces: as in previous years, KwaZulu-Natal Province recorded the highest prevalence (38.7%) and Western Cape the lowest (16.1%); at district level the disparities were even greater - in some the infection rate was as high as 45%, in others as low as 5%. The survey authors strongly recommended that the health department conduct more in-depth epidemiological surveys to investigate the causes of these wide disparities.
Monitoring equity and research policy
Since 1986, Uganda has made substantial progress in promoting good governance at the political and economic fronts. It recorded sustained economic growth averaging 6% over the last two decades, moving from recovery and reconstruction toward sustainable growth and poverty reduction. Macroeconomic stability remains a cornerstone of the country’s reform efforts. According to Uganda Official Statistics, the proportion of people living in absolute poverty, declined from 56% to 35% between 1992 and 2005/06, although per capita income gains have been modest because of the country’s high population. Nonetheless, significant challenges persist, and these include the fight against poverty and corruption, the resolution of the conflict in the North and other forces that hamper Uganda’s democratisation and economic development process. They call for a concerted effort from all interested parties across the country. The major challenge ahead consists in sustaining the momentum of the peer review process through the successful implementation of the National Programme of Action (NPOA) emanating from the exercise. The Forum will receive Annual Progress Reports in this regard and maintain sustained interest in the implementation process.
Several South African organisations have recently joined together to form the Budget and Expenditure Monitoring Forum (BEMF). The forum advocates for reasonable and sufficient funds to be allocated to health care based on the best evidence available, particularly for HIV programmes, and for those funds to be spent in a reasonable and constitutionally valid manner. It will work to ensure that there are no further treatment interruptions and moratoriums, that there is proper monitoring and evaluation of the highly active antiretroviral treatment (HAART) and prevention of mother-to-child transmission (PMTCT) programmes, and that the national departments of health and finance intervene in provinces not delivering these programmes adequately. In the last financial year several budgeting decisions were made which the member organisations of the BEMF believe violated the legal rights of individuals. The most visible was the moratorium on the initiation of patients onto HAART in the Free State from November 2008 through March 2009. The Southern African HIV Clinicians Society estimated that at least 30 lives a day were lost as a result this decision.
The overarching aim of this study is to develop a GIS-based planning approach that contributes to equitable and efficient provision of urban health services in cities in sub-Saharan Africa. The broader context of the study is the 'urban health crisis', namely the disparity between the increasing need for medical care in urban areas and declining carrying capacity of existing public health systems. The analysis proposes a 'what if' type of planning approach designed to evaluate and improve the spatial performance of the Dar es Salaam governmental health care system. It illustrates how more sophisticated GIS-based analytical techniques can be usefully applied to strategic spatial planning of urban health services delivery. Its evaluation framework appraises the performance of the existing Dar es Salaam governmental health delivery system on the basis of generic quantitative accessibility indicators, while its intervention framework explores how existing health needs can better be served by proposing alternative spatial arrangements of provision using scarce health resources. Health planners will be able to detect spatial deficiencies of a given delivery system, propose priority spatial planning interventions and estimate the expected impact of potential interventions on spatial performance.
Recent attempts to integrate geographic information systems (GIS) and participatory techniques have given rise to terminologies such as participatory GIS and community-integrated GIS. Although GIS was initially developed for physical geographic application, it can be used for the management and analysis of health and health care data. Geographic information systems, combined with participatory methodology, have facilitated the analysis of access to health facilities and disease risk in different populations. Little has been published about the usefulness of combining participatory methodologies and GIS technology in an effort to understand and inform community-based intervention studies, especially in the context of HIV. This paper attempts to address this perceived gap in the literature. The authors describe the application of participatory research methods with GIS in the formative phase of a multisite community-based social mobilisation trial, using voluntary counselling and testing and post-test support as the intervention.
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.
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.