This book discusses a range of case studies in trauma care, including pre-hospital, hospital-based, rehabilitation and system-wide settings, from all regions of the world and at all socioeconomic levels. It aims to share some of the valuable lessons learned and focuses on practical, affordable and sustainable efforts to improve trauma care, identifying useful methods and strategies that could be adapted for use in other places. It also seeks to dispel the view that little can be done to improve trauma care in low- and middle-income countries. Improvements in care may be measured using outcomes data on decreased mortality or other tangible patient benefits, such as decreased morbidity, improved functional outcome or decreased costs. Performance may also be measured in terms of how much time is devoted to emergency procedures, appropriate use of particular life-saving procedures and greater availability of the human and physical resources needed to provide quality care. The book calls for improvements in training, supervision and monitoring of staff, increased political commitment and timely and accurate data to better inform policy decisions.
Equitable health services
Although progress has been made in strengthening laboratory capacity to support programmes such as poliomyelitis eradication, HIV prevention and control, and measles elimination, this study notes that challenges remain. These include the lack of national policy and strategy for laboratory services, insufficient funding, inadequately trained laboratory staff, weak laboratory infrastructure, old or inadequately serviced equipment, lack of essential reagents and consumables, and limited quality assurance and control protocols. Laboratories are usually given low priority and recognition in most national health delivery systems. The study identifies the main challenge as the need to develop a comprehensive national laboratory policy that addresses the above issues. Other recommendations include improving laboratory leadership, strengthening the laboratory supply and distribution system, improving monitoring, providing adequate training for staff, strengthening information systems and putting in place effective monitoring and evaluation systems.
According to this report, 4.4 million children and 265,000 mothers die in sub-Saharan Africa every year, which amounts to half of the world's maternal, newborn and child deaths. It identifies the five biggest challenges for maternal, newborn and child health in sub-Saharan Africa as pregnancy and childbirth complications, newborn illness, childhood infections, malnutrition, and HIV and AIDS. Many scientifically proven health interventions are available for maternal, newborn, and child health such as medicines, immunisations, insecticide-treated bed nets, and equipment for emergency obstetric care. Yet many African governments are currently underutilising existing scientific knowledge to save women's and children's lives. The report recommends a scientific approach based on local epidemiological and coverage data that will prioritise the highest impact and most appropriate interventions in a given context. Although most countries in sub-Saharan Africa are behind in achieving the Millennium Development Goals (MDGs) for maternal and child health by 2015, progress in several low-income countries demonstrates that the MDGs could still be attained through immediate strategic investments in selected evidence-based interventions and targeted health systems strengthening.
A targeted mass distribution of free LLINs to children under five and pregnant women was implemented in Zanzibar between August 2005 and January 2006. The outcomes of this distribution among children under five are evaluated in this study, four to nine months after implementation. Two cross-sectional surveys were conducted in May 2006 in two districts of Zanzibar: Micheweni (MI) on Pemba Island and North A (NA) on Unguja Island. Household interviews were conducted with 509 caretakers of under-five children, who were surveyed for socio-economic status, the net distribution process, perceptions and use of bed nets. The overall proportion of children under five sleeping under any type of treated net was 83.7% in MI and 91.8% in NA. The LLIN usage was 56.8% in MI and 86.9% in NA. Overall system effectiveness was 49% in MI and 87% in NA, and equity was found in the distribution scale-up in NA. In both districts, the predicting factor of a child sleeping under an LLIN was because caretakers had received a LLIN or considered LLINs to be better than conventional nets. In conclusion, targeted free mass distribution of LLINs can result in high and equitable bed net coverage among children under five. However, in order to sustain high effective coverage, there is need for complimentary distribution strategies between mass distribution campaigns. Considering the community's preferences prior to a mass distribution and addressing the communities concerns through information, education and communication, may improve the LLIN usage.
The Algiers Declaration on Narrowing the Knowledge Gap to Improve Africa’s Health was adopted during a Conference held in Algiers, Algeria, in June 2008. The Conference, which brought Ministers from the African Region together with researchers, non-governmental organisations, donors and the private sector, renewed commitments to narrow the knowledge gap in order to improve health development and health equity in the Region. This paper describes the background to the Algiers Declaration and the Framework for its implementation and their significance in assisting efforts by countries in the Region to strengthen their health systems. The paper argues that countries should implement the series of steps in the Algiers Framework to strengthen their health systems. These steps will help them to develop the content, processes and use of technology aimed at improving: the availability of relevant and timely health information; the management of health information through better analysis and interpretation of data; the availability of relevant, ethical and timely research evidence; the use of evidence by policy-makers and decision-makers; improving dissemination and sharing of information, evidence and knowledge; access to global health information; and the use of information and communication technologies.
In this study, limited autopsies were conducted on young adults dying in a single public hospital in the province of KwaZulu-Natal between October 2008 and August 2009 in order to estimate the magnitude of deaths attributable to tuberculosis. A representative sample was taken of 240 adult inpatients (aged 20–45 years) who died after admission to Edendale Hospital. Ninety-four% of the study cohort was HIV seropositive and 50% of decedents had culture-positive tuberculosis at the time of death. Fifty percent of the participants were on treatment for tuberculosis at the time of death and 58% of these treated individuals remained culture positive at the time of death. Of the 50% not receiving tuberculosis treatment, 42% were culture positive. Seventeen percent of all positive cultures were multidrug resistant and 16% of patients dying during the initiation phase of their first ever course of tuberculosis treatment were infected with multidrug-resistant bacilli. The findings reveal the immense toll of tuberculosis among HIV-positive individuals in KwaZulu-Natal, as well as suggesting that the diagnosis of tuberculosis was made too late to alter the fatal course of the infection for many of the individuals. The study also revealed a significant burden of undetected multidrug-resistant tuberculosis among HIV-co-infected individuals dying in this setting. It recommends new public health approaches that improve early diagnosis of tuberculosis and accelerate the initiation of treatment.
According to this article, placing essential medicines at the centre of global health priorities is not without its risks. The geography of access is closely linked to other structural determinants of inequality, few of which can be fixed merely by providing a pipeline of medicines. Access to essential medicines is therefore a necessary condition but is not sufficient on its own for the amelioration of broad health disparities in global health. On the other hand, to truly engage the social factors that determine the development, production, regulation, distribution, utilisation and consumption of essential medicines is to engage with the project of understanding health disparities and the challenges of strengthening health systems at the most detailed level. As essential medicines programmes continue to expand, this article argues that it is crucial that they have the resources and leadership to realise this vision in the broadest sense possible.
A consortium of AIDS organisations has given the South African government three months to deliver on promises to integrate tuberculosis (TB) and HIV services. A local AIDS lobby group, the Treatment Action Campaign (TAC), international medical charity Medicines Sans Frontiers (MSF) and the AIDS and Rights Alliance for Southern Africa (ARASA), a regional partnership of non-governmental organisations, were among civil society groups that issued the deadline at the South African TB Conference in Durban, which took place from 1–4 June 2010. MSF spokesperson Lesley Odendal called the three-month deadline 'generous' because TB and HIV care should have been integrated by 1 April 2010, according to newly adopted national antiretroviral (ARV) treatment guidelines, but the Department of Health has yet to issue an implemention plan. TAC Deputy Secretary General, Lihle Dlamini, noted that integrating TB and HIV care would lead to earlier diagnosis of TB, especially strains of the disease occurring outside the lungs, which are common in co-infected patients. It would also help health workers become more familiar with the potentially severe interactions between antiretroviral (ARV) and TB drugs.
Most cases of gender-based violence (GBV) reported to the Nairobi Gender Violence Recovery Centre between April 2009 and March 2010 occurred in the capital's city centre, according to the centre's annual report, which also recorded an increase in gang rapes. 'A disturbing trend of GBV in the reported year is the continued number of gang rapes where the number of perpetrators per act increased from [a range of] 2-11 [perpetrators] to 2-20,' Teresa Omondi, the centre's executive director said. The centre, at the Nairobi Women's Hospital, registered 2,487 GBV survivors between April 2009 and March 2010, 52% (1,285) of whom were women, 45% (1,125) children and 3% men (77). According to the centre, neighbours topped the list of perpetrators named by survivors. Husbands and friends came second and third. Others included boyfriends, fathers, other relatives (uncles, aunts and cousins), house helps, teachers and classmates.
The objective of this study is to measure socio-economic inequalities in access to maternal health services in Namibia and propose recommendations relevant for policy and planning. Data from the Namibia Demographic and Health Survey 2006-07 was analysed for inequities in the utilisation of maternal health. Regions with relatively high human development index were found to have the highest rates of delivery by skilled health service providers. The rate of caesarean section in women with post secondary education is about seven times that of women with no education. Women in urban areas are delivered by skilled providers 30% more than their rural counterparts. High-income households use the public health facilities 30% more than poor households for child delivery. The paper concludes that, in the presence of inequities, it is difficult to achieve a significant reduction in the maternal mortality ratio needed to realise the Millennium Development Goal 5 targets. This is not achievable if a large segment of society has inadequate access to essential maternal health services and other basic social services.