Equitable health services

Contribution of the one health approach to strengthening health security in Uganda: a case study
Bakiika H, Obuku E, Bukirwa J, et al: BMC Public Health 23:1498, 1-11, 2023

This study assessed the contribution of the One Health approach to strengthening health security in Uganda. A process evaluation was done between 25th September and 5th October 2020, using a mixed–methods case study. Funding and implementation status from the National Action Plan for Health Security 2019–2023 launch in August 2019 to October 2020 was assessed with a One Health lens. Full funding was available for 36.5% of activities while 40.6% were partially funded and 22.9% were not funded at all. The majority of the activities were still in progress, whereas 8.6% were fully implemented and 14.2% were not yet done. In workforce development, several multi-sectoral trainings were conducted including the frontline public health fellowship program, the One Health fellowship and residency program, advanced field epidemiology training program, in-service veterinary trainings and 21 district One Health teams’ trainings. Real Time Surveillance was achieved through incorporating animal health events reporting in the electronic integrated disease surveillance and response platform. The national and ten regional veterinary laboratories were assessed for capacity to conduct zoonotic disease diagnostics, two of which were integrated into the national specimen referral and transportation network. Multi-sectoral planning for emergency response and the actual response to prioritized zoonotic disease outbreaks was done jointly. This study demonstrates the contribution of ‘One Health’ implementation in strengthening Uganda’s health security.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons
Fawol O, Bello S, Adebowale A, et al: BMC Public Health 23:835, 1-15, 2023

Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda had variable COVID-19 responses. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, with learning synthesized across the countries. Surveillance approaches across countries included case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travellers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. The authors recommend investments to enhance surveillance approaches and systems including decentralising surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also noted to be critical.

Routine health check-ups for adolescents in Mwanza City, Tanzania: stakeholders’ recommendations on its content, venue, and mode of delivery
Sedekia Y, Mshana G, Nsanya M, et al: BMC Public Health 23:1015,1-14, 2023

This study was conducted in 2020 to inform research to define the content and delivery strategies for health check-ups to be performed in young and older adolescents, and to assess whether such services are likely to be acceptable and feasible in Tanzania, using a semi-structured guide with purposively selected stakeholders from government departments, non-governmental and community-based organisations, schools and health facilities. Stakeholders interviewed were supportive of introducing routine health check-ups among adolescents and recommended focusing on non-communicable diseases, physical disabilities, common mental health problems, reproductive health problems, specific communicable diseases, and hygiene-related problems. They also recommended combining counselling and family planning information with these check-ups. Three venues were proposed: schools, community settings, and youth-friendly health facilities. The authors propose further implementation research and cost benefit analysis to help guide policy on this.

Non-communicable disease burden among inpatients at a rural district hospital in Malawi
Olds P, Kachimanga C, Talama G,et al: Global Health Research and Policy 8:4;1-10, 2023

The authors sought to understand the burden of non communicable diseases (NCDs) among inpatients in a rural district hospital in Malawi between 2017 and 2018. The definition of NCDs was broadened beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. A retrospective chart review was conducted of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. Of 2239 total visits at the hospital, 28% were patients with NCDs, making up 40% of total hospital time. Two distinct populations of NCD patients were identified. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. High rates of NCDs in the younger population were noted.

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021
Pillay Y; Museriri H; Barron P; et al: South African Medical Journal 13:1;17-23. 2023

In this article the authors explore the extent to which the third and fourth waves of the COVID-19 pandemic in South Africa affected routine public sector services, drawing on 2019, 2020, and 2021 DHIS data. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached - suggesting a slow recovery and continuing impact of the pandemic. Impact indicators of maternal and neonatal mortality continued to worsen in 2021. The authors note that if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goal targets.

South African Health Review 2021
Health Systems Trust, South Africa, 2022

When it comes to service delivery and access in both the public and private health sectors, COVID-19 has put everything to the test. It has demonstrated how central public health security is to health and livelihoods, and how pandemic health emergencies expose the weaknesses and vulnerabilities of health systems, costing lives and causing immeasurable damage to economies. This edition of the South African Health Review considers the government's and broader health sector's response to COVID-19, explores the current challenges facing the health system at this unprecedented time, and reflects on lessons learnt for future for public health emergencies. The chapters offer information on the challenges of balancing lives with livelihoods, and the impact of COVID-19 on different healthcare workers, especially Community Health Workers who found themselves at the forefront of the COVID-19 response. Other areas covered include the impact of COVID-19 on vulnerable populations.

Trends in inequality in maternal and child health and health care in Uganda: Analysis of the Uganda demographic and health surveys
Kakama A K; Basaza R: BMC Health Services Research 22(1269), 1-12, 2022

This study analyses data from Demographic and Health Surveys conducted in 2006, 2011, and 2016 in Uganda, to assess trends in inequality for a variety of mother and child health and health care indicators. The indicators included infant and child mortality, underweight status, stunting, and prevalence of diarrhoea. Antenatal care, skilled birth attendance, delivery in health facilities, contraception prevalence, full immunization coverage, and medical treatment for child diarrhoea and Acute Respiratory tract infections were health care indicators. Two metrics of inequity were used: the quintile ratio, which evaluates discrepancies between the wealthiest and poorest quintiles, and the concentration index, which utilizes data from all five quintiles. The study found universal improvement in population averages in most of the indices, ranging from the poorest to the wealthiest groups, between rural and urban areas. However, significant socioeconomic and rural-urban disparities persist. Under-five mortality, malnutrition in children, the prevalence of anaemia, mothers with low Body Mass Index, and the prevalence of acute respiratory tract infections were found to have worsening inequities. Healthcare utilization measures such as skilled birth attendants, facility delivery, contraceptive prevalence rate, child immunization, and Insecticide Treated Mosquito Net usage were found to show significantly lower disparity levels. Three healthcare utilization indicators, namely medical treatment for diarrhoea, for acute respiratory tract infections, and for fever, demonstrated perfect equity. Increased use of health services among poor and rural populations was found to leads to improved health status and the elimination of income and residential disparities.

Childhood immunization services accessibility and utilization during the COVID-19 pandemic in Africa
Dzinamarira T; Moyo E; Moyo P; et al: Journal of Infection, doi: https://doi.org/10.1016/j.jinf.2022.07.020, 2022

The authors present findings of a synthesis of available evidence on the accessibility and utilization of child immunization services (CIS) in Africa during the COVID-19 pandemic period. Data were independently extracted from eligible studies from online journals. The review revealed that CIS was disrupted in some countries and that uptake fell in most sub-Saharan African countries during the pandemic. In some CIS completely ceased during the lockdowns, yet in others, there were no significant changes. The authors propose strengthened monitoring of childhood immunization during pandemics to plan early catch-up vaccination activities.

Determinants of COVID-19 vaccine behaviour intentions among the youth in Kenya: a cross-sectional study
Osur J O; Chengo R; Muinga E; et al: Archives of Public Health 80(159), 1-13, 2022

This study assessed COVID-19 vaccine youth behaviour intentions and their determinants in Kenya using a cross-sectional survey and focus group discussions across 47 urban, peri-urban ad rural counties. The findings indicated that only 42% of the youth were ready to be vaccinated, with 52% adopting a wait and see approach to what happens to those who had received the vaccine and 6% totally unwilling to be vaccinated. Hesitancy was higher among females, some religious groups and those with post-secondary education. Lack of information and concerns around vaccine safety and effectiveness were main cause of vaccine hesitancy. Social media was the major information source in hesitancy. Other contributors to hesitancy included low trust in the health ministry, and belief that mass vaccination is not helpful. The authors raise that these causes of vaccine hesitancy are modifiable and suggest that health systems engage with young people to reduce vaccine hesitancy.

There is nowhere to take the child: a qualitative study of community members’ views on managing early childhood substance use in Mbale, Uganda
Skylstad V; Engebretsen I M S; Nalugya S J; et al: BMC Public Health 22(1192), 1-13, 2022

This study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in in Mbale District, Uganda. this area. Three main themes were identified: ‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights. ‘There is nowhere to take the child’: Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child. ‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act. Despite concern about childhood alcohol and substance use, the complexity and magnitude of the problem left community members feeling incapacitated in responding. The authors propose measures that address leadership, service, and legal deficits and that support collective agency to act on the issue in communities.