According to this article, in sub-Saharan Africa, co-infection of syphilis and HIV is a serious public health challenge, with women and young children among the most vulnerable groups. Unfortunately, although HIV testing has become more accessible for pregnant women in sub-Saharan Africa as part of routine antenatal care, in many countries, including Uganda and Zambia, syphilis testing must still be accessed at separate sites. The researchers in this study identified high rates of syphilis and HIV co-infection in pregnant women in both countries: in Uganda 14.3% of syphilis-positive pregnant women also tested positive for HIV, and the rate was 24.2% in Zambia. But newly devised rapid syphilis testing has made it easier to integrate syphilis screening into services provided at antenatal clinics to prevent mother-to-child transmission (PMTCT) of HIV. As a result, there has been swift and direct policy change in Uganda and Zambia to further the goal of eliminating congenital syphilis and pediatric HIV and AIDS, as the Ministries of Health in Uganda and Zambia, are incorporating rapid syphilis testing into their standard package of PMTCT services and antenatal care.
Equitable health services
The authors of this study conducted a national retrospective case control study to identify factors associated with tuberculosis treatment default in South Africa using programme data from 2002 and a standardised patient questionnaire. The sample included 3,165 TB patients from eight provinces; 1,164 were traceable and interviewed. Significant risk factors associated with default among both groups included poor health care worker attitude and changing residence during TB treatment. New TB patients that defaulted were more likely to report having no formal education, feeling ashamed to have TB, not receiving adequate counseling about their treatment, drinking any alcohol during TB treatment, and seeing a traditional healer during TB treatment. Among retreatment patients, risk factors included stopping TB treatment because they felt better, having a previous history of TB treatment default, and feeling that food provisions might have helped them finish treatment. In conclusion, risk factors for default differ between new and re-treatment TB patients in South Africa. Addressing default in both populations with targeted interventions is critical to overall programme success.
In this study, researchers set out to outline mental health service accessibility, estimate the treatment gap and describe service utilisation for people with schizophrenic disorders in 50 low- and middle-income countries. They found that the median annual rate of treatment for schizophrenic disorders in mental health services was 128 cases per 100,000 population. The median treatment gap was 69% and was higher in participating low-income countries (89%) than in lower-middle-income and upper-middle-income countries (69% and 63%, respectively). Of the people with schizophrenic disorders, 80% were treated in outpatient facilities. The availability of psychiatrists and nurses in mental health facilities was found to be a significant predictor of service accessibility and treatment gap. In conclusion, the treatment gap for schizophrenic disorders in the 50 low- and middle-income countries in this study is disconcertingly large and outpatient facilities bear the major burden of care. The significant predictors found suggest an avenue for improving care in these countries.
This study reported on a participatory quality improvement intervention designed to evaluate TB, HIV and STI priority programmes in primary health care (PHC) clinics in a rural district in KwaZulu-Natal, South Africa. A participatory quality improvement intervention with district health managers, PHC supervisors and researchers was used to modify a TB/HIV/STI audit tool for use in a rural area, conduct a district-wide clinic audit, assess performance, set targets and develop plans to address the problems identified. The researchers highlighted weaknesses in training and support of staff at PHC clinics, pharmaceutical and laboratory failures, and inadequate monitoring of patients as contributing to poor TB, HIV and STI service implementation. Eighty percent of the facilities experienced non-availability of essential drugs and supplies; polymerase chain reaction (PCR) results were not documented for 54% of specimens assessed, and the mean length of time between eligibility for anti-retroviral therapy and starting treatment was 47 days. Through a participatory approach, a TB/HIV/STI audit tool was successfully adapted and implemented in a rural district. It yielded information enabling managers to identify obstacles to TB, HIV and STI service implementation and develop plans to address these. The audit can be used by the district to monitor priority services at a primary level.
Ownership of insecticidal mosquito nets has dramatically increased in Ethiopia since 2006, but the proportion of persons with access to such nets who use them has declined. The authors of this study argue that it is important to understand individual level net use factors in the context of the home to modify programmes so as to maximise net use. They investigated net use using individual level data from people living in net owning households from two surveys in Ethiopia: baseline 2006 included 12,678 individuals from 2,468 households and a sub-sample of the Malaria Indicator Survey (MIS) in 2007 included 14,663 individuals from 3,353 households. In both surveys, they found that net use was more likely by women, if nets had fewer holes and were at higher net per person density within households. School-age children and young adults were much less likely to use a net. Increasing availability of nets within households (i.e. increasing net density), and improving net condition while focusing on education and promotion of net use, especially in school-age children and young adults in rural areas, are crucial areas for intervention to ensure maximum net use and consequent reduction of malaria transmission.
An ongoing Phase 3 study of the efficacy, safety and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries, including Ghana, Kenya, Malawi, Mozambique and Tanzania. From March 2009 through January 2011, 15,460 children were enrolled in two age categories - 6 to 12 weeks and 5 to 17 months old - for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. After 250 children had an episode of severe malaria, researchers evaluated vaccine efficacy in both age categories. Vaccine efficacy in the combined age categories was 34.8% during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalised convulsive seizures after vaccination was 1.04 per 1,000 doses. The researchers conclude that the RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children.
While hospitals and health clinics are not a specific focus of mitigation assessment by the Intergovernmental Panel on Climate Change, this policy brief notes that adoption of safe and sustainable building measures by health facilities will offer more health co-benefits than the same measures applied to other commercial buildings. This is partly due to health facilities’ large demands for reliable energy, clean water and temperature/air flow control in treatment and infection prevention. Significant health gains also can be expected from specific interventions, such as the use of natural ventilation as an effective energy-saving and infection-control measure. Resilience of health care services may be enhanced through use of (clean) onsite energy co-generation that ensures more reliable energy supply in cities where frequent energy outages occur, and particularly in remote, resource-poor settings, where a basic electricity supply will allow life-saving procedures to be performed. Health risks to health workers, patients and communities will be reduced by improved management of health care and waste – and so will the carbon footprint. The health care sector is well-positioned to ‘lead by example’, the World Health Organisation argues, in terms of reducing climate change pollutants and by demonstrating how climate change mitigation can yield tangible, immediate health benefits.
In southern coastal Kenya, insecticide-treated bed net use was negligible in 1997-1998 but since 2001, bed net use has increased progressively and reached high levels by 2009-2010 with corresponding decline in malaria transmission. In this study, researchers evaluated the impact of the substantial increase in household bed net use in this area. Compared to 1997-1998, and following more than five years of 60-86% coverage with bed nets, the density, human biting rate and entomological inoculation rate of indoor-resting mosquitoes were reduced by more than 92% for Anopheles funestus and by 75% for An. gambiae. In addition, the host feeding choice of both vectors shifted more toward non-human vertebrates. Besides bed net use, malaria vector abundance was also influenced by type of house construction and according to whether one sleeps on a bed or a mat (both of these are associated with household wealth). Mosquito density was positively associated with presence of domestic animals. The researcher conclude that, while increasing bed net coverage beyond the current levels may not significantly reduce the transmission potential of An. arabiensis, they anticipate that increasing or at least sustaining high bed net coverage will result in a diminished role for An. funestus in malaria transmission.
This study identified childbirth information needs of Malawian women as perceived by Malawian mothers and midwives in order to design a childbirth education programme. A total of 150 first-time mothers who attended antenatal clinics at selected central, district and mission hospitals were interviewed. Four focus group discussions were conducted with four different types of midwives, followed by individual interviews with midwives in key positions in government and non-governmental organisations. Results indicated the view that the content of the childbirth education programme for pregnant mothers should include: self-care during pregnancy, nutrition during pregnancy, common discomforts of pregnancy, danger signs of pregnancy, sexually transmitted diseases and preparation for delivery. It was also proposed that programmes address possible complications during labour and birth, caesarean birth and non-pharmaceutical pain relief measures in labour, as well as self-care during postnatal period, exclusive breast feeding, care of the newborn baby, danger signs of puerperium, care of the newborn baby and family planning.
The primary aim of this study was to identify progress and challenges in mental healthcare in South Africa, as well as future mental health services research priorities. A systematic literature review of mental health services research was conducted, including studies from January 2000 to October 2010. Hand searches of key local journals were also conducted. Of 215 articles retrieved, 92 were included. The authors found that, while progress in epidemiological studies has been good, there was a paucity of intervention and economic evaluation studies. Most studies reviewed were on the status of mental healthcare services, which indicated some progress in decentralised care for severe mental disorders, but also insufficient resources to adequately support community-based services, resulting in the classic ‘revolving-door’ phenomenon. Common mental disorders remain largely undetected and untreated in primary healthcare. Cross-cutting issues included the need for promoting culturally congruent services, as well as mental health literacy to assist in improving help-seeking behaviour, stigma reduction, and reducing defaulting and human rights abuses. Intervention research is needed to provide evidence of the organisational and human resource mix requirements, as well as cost-effectiveness of a culturally appropriate, task shifting and stepped care approach for severe and common mental disorders at primary healthcare level.