The authors of this study set out to identify the progress made by the Tanzanian Ministry of Health and Social Welfare (MOHSW) in achieving the objective it had set in its National Adolescent Health and Development Strategy: 2002–2006, namely to systematise and extend the reach of Adolescent Friendly Health Services (AFHS) in the country. They reviewed plans and reports from the MOHSW and journal articles on AFHS. Results showed that the MOHSW identified four key problems with what was being done to make health services adolescent friendly in the country – firstly, it was not fully aware of the various efforts under way; secondly, there was no standardised definition of AFHS; thirdly, it had received reports that the quality of the AFHS being provided by some organisations was poor; and fourthly, only small numbers of adolescents were being reached by the efforts that were under way. The MOHSW responded to these problems by mapping existing services, developing a standardised definition of AFHS, charting out what needed to be done to improve their quality and expand their coverage, and integrating AFHS within wider policy and strategy documents and programmatic measurement instruments. It has also taken important preparatory steps to stimulate and support implementation. The authors argue that the focus of the effort must now shift from the national to the regional, council and local levels, with substantial and ongoing support from the Ministry.
Equitable health services
Timely access within 24 hours to an authorised artemisinin-based combination treatment (ACT) outlet is one of the determinants of effective malaria treatment coverage. In this study, timely access was assessed in two district health systems in rural Tanzania: Kilombero-Ulanga and Rufiji. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data was collected on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. In Kilombero-Ulanga 41.8% and in Rufiji 36.8% of fever cases had access to an authorised ACT provider within 24 hours of fever onset. In neither site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. The poor results fly in the face of government interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. The authors call for more innovative interventions to raise effective coverage of malaria treatment in Tanzania.
The objective of this study was to investigate factors, including uptake of the offer of HIV testing, associated with availability and utilisation of healthcare by TB patients in a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal. Three hundred TB patients at primary healthcare clinics (PHC) were randomly selected for the study. Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test during their current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic. About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis. The study demonstrates high HIV testing rates among TB patients and the authors suggest appropriate management of HIV-TB co-infected patients.
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.
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.