This community survey was conducted in measles high-incidence areas in the Western Cape, South Africa, to assess measles vaccination coverage attained by routine and campaign services among children aged 6 months to 59 months at the time of a mass campaign in the areas. Of 8,332 households visited, there was no response at 3,435 (41.2%); 95.1% of eligible households participated; and 91.2% of children received a campaign vaccination. Before the campaign, 33% of 917-month-olds had not received a measles vaccination, and this was reduced to 4.5% after the campaign. Of a total of 1,587 children, 61.5% were estimated to have measles immunity before the campaign, and this increased to 94% after the campaign. It appears that routine services had failed to achieve adequate herd immunity in areas with suspected highly mobile populations. This study shows that mass campaigns in such areas in the Western Cape significantly increased coverage. The authors conclude that extra vigilance is required to monitor and sustain adequate coverage in these areas.
Equitable health services
This pilot study was conducted to investigate the protective effect of three types of Mosquito netting material against the entry of malarial mosquitoes into village houses in Mozambique. A two-step intervention was implemented in which the gable ends of houses (the largest opening) were covered with one of three materials (four year old mosquito bed nets; locally purchased untreated shade cloth or deltamethrin-impregnated shade cloth) followed by covering both gable ends and eaves with material. Mosquito entry rates were assessed by light-trap collection and the efficacy of the different materials was determined. Results showed that houses treated with mosquito netting or the untreated shade cloth had 61.3% and 70% fewer Anostopheles. funestus in relation to untreated houses, but there was no difference in An. funestus in houses treated with the deltamethrin-impregnated shade cloth compared to untreated houses. Houses treated with mosquito netting reduced entry rates of An. gambiae by 84%, whilst untreated shade cloth reduced entry rates by 69% and entry rates were reduced by 76% in houses fitted with deltamethrin-impregnated shade cloth.
In this study from Rwanda, researchers aimed to establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies. They drew data from 92 self-administered questionnaires and a focus group discussion of 10 purposively selected physiotherapists. The findings revealed that 64% of the participants were physically active both within the work and recreation domains and 65% of the participants had good physical activity promoting practices. Discussing physical activity and giving out information regarding physical activity were most common methods used in promotion of physical activity. Policies on physical activity, cultural influence, and nature of work, time management as well as the environment were the barriers highlighted. In conclusion, although physiotherapists experience barriers to promoting physical activity, they have good physical activity promoting practices.
Little is known about psychological distress of patients on general wards in developing countries. This study aimed to determine the extent and associations of psychological distress among adult in-patients on medical and surgical wards of Mbarara hospital in Uganda. Researchers conducted a cross-sectional descriptive study among 258 adult in-patients. They used the WHO endorsed self report questionnaire (SRQ-25) to assess psychological distress with a cut off of 5/6, as well as the MINI International Neuropsychiatric Interview (MINI) to identify specific psychiatric disorders. Results indicated that 158 individuals (61%) had psychological distress. One hundred and nine (42%) met criteria for at least one major psychiatric diagnosis. Only 6% of these were recognised by the attending health workers. Psychological distress was significantly associated with previous hospitalisations, ward of admission and marital status. The authors conclude that despite high levels of psychological distress among the physically ill, it is often unrecognised and untreated.
This book provides an in-depth, comprehensive assessment of the benefits and risks when health care becomes a global commodity. The collection includes contributions from leading scholars in law and public policy, medicine and public health, bioethics, anthropology, health geography, and economics. Contributors examine how government agencies, medical tourism companies, international hospital chains, and other organisations promote medical tourism and the globalisation of health care. The topics explored include the legal remedies available to medical tourists when procedures go awry; potential consequences when patients cross borders for medical procedures that are illegal in their home countries; the relationship of medical tourism to international spread of infectious disease; and the lack of adequate transnational policies and regulations governing the global market for health services.
Based on research in education, health, water and sanitation, the authors of this paper sought to identify how politics and governance can constrain or enable equitable and efficient service delivery in developing countries, including Malawi, Rwanda and Uganda. Some of these constraints reflect the nature of the wider governance system, and may have similar effects across sectors, for example in how financial resources are used or how human resources are allocated. The authors’ focus was on the interactions at regional, district and community level between local government officials, service providers and users – the ‘missing middle’ of the service delivery chain. Their analysis of four aid programmes suggests that aid-funded activities can facilitate government efforts to address governance constraints in public service delivery. However, it also indicates that the way in which programmes are designed and implemented matters to whether they are able to gain domestic traction and support institutional change. The authors advocate for ‘arm’s length’ aid models, which work through organisations that offer advisory services directly to governments and other public bodies in developing countries and have had some success as brokers of collective action and facilitators of change.
The University of the Witwatersrand in South Africa has announced the formation of the Wits Research Institute for Malaria, (WRIM), strengthening research into one of Africa’s deadliest diseases. The Institute combines three existing research groups from the School of Public Health who are working on malaria vectors, parasites and pharmacology. Africa has very few research institutes that have the capacity to address a host of issues and make an impact on the disease. The WRIM aims to produce leading research and researchers to benefit malaria control in Africa.
The aim of this study was to describe the prevalence and factors associated with obstetric fistula in Ethiopia. A total of 14,070 women of reproductive age group were included in the survey, of whom only 23.2% had ever heard of OF. Among 9,713 women who had given birth, 103 (1.06%) had experienced OF in their lifetime. Those women who are circumcised or lived in urban areas had higher odds of reporting the condition. Women who gave birth 10 or more also had higher odds of developing OF than women with one to four children. It is estimated that in Ethiopia nearly 142,387 obstetric fistula patients exist. The authors conclude that OF is a major public and reproductive health concern in Ethiopia and they call for increased access to emergency obstetric care, expansion of fistula repair service and active recruitment of women through a campaign of ending obstetric fistula.
Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. Therefore, the objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. The top five priorities identified by participants were aligned to three of the World Health Organisation’s health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel made the following policy recommendations: a focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.
In 2010 and 2011, Tanzania ran a universal coverage campaign to distribute long-lasting insecticidal nets (LLINs) nationally and free-of-charge. Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use. A total of 18.2 million LLINs were delivered at an average cost of US$ 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one insecticide-treated net (ITN) increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles. Close collaboration among the Ministry of Health and Social Welfare, external funders, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. The authors predict that, through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania.