This study was conducted in Chitungwiza, a high density dormitory town outside Harare, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. Results indicated that of 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to “retreatment other” TB patients. In conclusion, no differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes “retreatment other” TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.
Equitable health services
This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The clinics provide basic HIV, TB STI and pre-natal services. The researchers found that in the project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. The mobile clinics provide services for people who otherwise may not have attended a health centre. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programmes.
The main objective of the study was to conduct an audit of home and community-based care (HCBC) organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. Of the 2,001 HCBC organisations that participated in the audit, most were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. Most of the organisations were faced with challenges such as lack of access to water, electricity and computer equipment and a formal office space. In addition, some organisations were in need of funds for stipends for their community caregivers. Non-availability of funds for stipends and necessary assets might affect the quality of HCBC services rendered. The findings of the study therefore suggest the need for more financial assistance from the Government and other stakeholders for organisations rendering HCBC services, in order for them to afford necessary assets and provide sustainable, high-quality services that can help in reducing HIV impacts in South Africa.
This study aimed to assess the changes in the burden of malaria in Mpumalanga Province during the past eight malaria seasons (2001/02 to 2008/09) and whether indoor residual spraying (IRS) and climate variability had an effect on these changes. This is a descriptive retrospective study based on the analysis of secondary malaria surveillance data (cases and deaths) in Mpumalanga Province. Within the study period, a total of 35,191 cases and 164 deaths due to malaria were notified in Mpumalanga Province. There was a significant decrease in the incidence of malaria from 385 in 2001/02 to 50 cases per 100,000 population in 2008/09. The incidence and case fatality (CFR) rates for the study period were 134 cases per 100,000 and 0.54%, respectively. Mortality due to malaria was lower in infants and children and higher in those >65 years, with the mean CFR of 2.1% as compared to the national target of 0.5%. Mpumalanga Province has achieved the goal of reducing malaria morbidity and mortality by over 70%, partly as a result of scale-up of IRS intervention in combination with other control strategies. These results highlight the need to continue with IRS together with other control strategies until interruption in local malaria transmission is completely achieved. However, the goal to eliminate malaria as a public health problem requires efforts to be directed towards the control of imported malaria cases; development of strategies to interrupt local transmission; and maintaining high quality surveillance and reporting system.
There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aimed to address this gap in knowledge and provide recommendations for regional guideline development. The authors prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. The authors identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, with a median of 58% and 83% respectively. 'Stakeholder involvement' followed with median 39%. The authors recommend that future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process. A regional guideline support committee could harness local capacity to support context appropriate guideline development.
While previous studies have assessed the impact of single conditions on absenteeism, the current study evaluates multiple health factors associated with absenteeism in a large worker population across several sectors in Namibia. From March 2009 to June 2010, a series of cross-sectional surveys of 7,666 employees in seven sectors of industry were conducted in Namibia. Results indicated that, controlling for demographic and job-related factors, high blood glucose and diabetes had the largest effect on absenteeism, followed by anemia and being HIV positive. In addition, working in the fishing or services sectors was associated with an increased incidence of sick days. The highest prevalence of diabetes was in the services sector, with the highest prevalence of HIV in the fishing sector. The authors conclude that both non-communicable disease risk factors and infectious diseases are associated with increased rates of short-term absenteeism of formal sector employees in Namibia. Programmes to manage these conditions could help employers avoid costs associated with absenteeism, they recommend, which could include basic health care insurance including regular wellness screenings.
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.
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.