Timely tuberculosis treatment initiation and compliance are the two key factors for a successful tuberculosis control programme. However, studies to understand patents’ perspective on tuberculosis treatment initiation and compliance have been limited in Ethiopia. In this qualitative, phenomenological study, researchers conducted 26 in-depth interviews with tuberculosis patients. Results indicated that a lack of geographic access to health facilities, financial burdens, use of traditional healing systems and delay in diagnosis by health care providers were the main reasons for not initiating tuberculosis treatment timely. Lack of geographic access to health facilities, financial burdens, quality of health services provided and social support were also identified as the main reasons for failing to fully comply with tuberculosis treatments. The authors argue that decentralisation of tuberculosis diagnosis and treatment services to peripheral health facilities, including health posts, is of vital importance to make progress toward achieving tuberculosis control targets in Ethiopia.
Equitable health services
The objective of this study was to assess the current integration of TB and HIV services in South Africa, using data from 2011. Forty-nine randomly selected health facilities were included, at which interviewers administered a standardised questionnaire to one staff member responsible for TB and HIV in each facility on aspects of TB/HIV policy, integration and recording and reporting. Of the 49 health facilities 35 (71%) provided isoniazid preventive therapy (IPT) and 35 (71%) offered antiretroviral therapy (ART). Among assessed sites in February 2011, 2,512 patients were newly diagnosed with HIV infection, of whom 1,913 (76%) were screened for TB symptoms, and 616 of 1,332 (46%) of those screened negative for TB were initiated on IPT. Of 1,072 patients newly registered with TB in February 2011, 144 (13%) were already on ART prior to TB clinical diagnosis, and 451 (42%) were newly diagnosed with HIV infection. Of those, 84 (19%) were initiated on ART. Primary health clinics were less likely to offer ART compared to district hospitals or community health centres.
South Africa has no policy to prevent malaria in pregnancy, despite the adverse effects of the disease in pregnancy. However, malaria control measures consisting of indoor residual spraying and specific antimalarial treatment have been in place since the 1970s. This study was conducted to determine if the country needs a specific policy for malaria prevention in pregnancy, by determining the burden of malaria in pregnancy in KwaZulu-Natal (KZN) province, South Africa. Pregnant women were enrolled at their first antenatal care visit to three health facilities in Umkhanyakude health district in northern KZN during May 2004-September 2005 and followed up until delivery. Of the 1,406 study participants, 33.2% of the women were anaemic, but this was not related to malaria. The prevalence and incidence of malaria were very low, and low birth weight was only weakly associated with malaria (1:10). In conclusion, the low burden of malaria in these pregnant women suggests that they have benefited from malaria control strategies in the study area. The implication is that additional measures specific for malaria prevention in pregnancy are not required. However, ongoing monitoring is needed to ensure that malaria prevalence remains low.
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.
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.