The objective of the study was to determine the prevalence of musculoskeletal conditions (MSC) and the functional implications in a sample of people attending community health centres in Cape Town, South Africa. It was conducted in clinics in two resource poor communities. A total of 1,005 people were screened. Of these, 362 (36%) reported MSC not due to injury in the past three months. Those with MSC had higher rates of co-morbidities in every category than those without. The mean Disability Index for those with MSC was mild to moderate, and moderate to severe in those aged over 55 years. In conclusion, although the sample may not be representative of the general community, the prevalence is considerably greater than those reported elsewhere, even when the population of the catchment area is used as a denominator. The common presentation of MSC with co-morbid diabetes and hypertension requires holistic management by appropriately trained health care practitioners. Any new determination of burden of disease due to MSC should recognise that these disorders may be more prevalent in developing countries than previously estimated.
Equitable health services
South Africa remains the country with the greatest burden of HIV-infected individuals and the second highest estimated tuberculosis (TB) incidence per capita worldwide. This study reviewed records of consecutive HIV-infected people initiated onto ART between 1 January 2005 and 31 March 2006. Patients were screened for TB at initiation and incident episodes recorded. CD4 counts, viral loads and follow-up status were recorded; data was censored on 5 August 2008. Geographic cluster analysis was performed using spatial scanning. Eight hundred and one patients were initiated. TB prevalence was 25.3%, associated with lower CD4 and prior TB. Prevalent and incident TB were significantly associated with mortality. Incident TB was associated with a non-significant trend towards viral load >25copies/ml. A low-risk cluster for incident TB was identified for patients living near the local hospital in the geospatial analysis. The study concluded that there is a large burden of TB in the population. Rate of incident TB stabilises at a rate higher than that of the overall population. This data highlights the need for greater research on strategies for active case finding in rural settings and the need to focus on strengthening primary health care.
In this study, 167 people (59 people with epilepsy [PWE], 62 relatives of PWEs and 46 villagers) were interviewed at a local hospital and in the community with a semi-structured validated questionnaire regarding the prevailing attitude towards traditional medicine for treatment of epilepsy in a rural area of northern Tanzania. Various traditional healing methods (THM) could be ascertained, namely traditional herbal medicine, spiritual healing, scarifications and spitting. In total, 44.3% the interviewed people were convinced that epilepsy could be treated successfully with THM. Interestingly, 34.1% thought that Christian prayers could cure the cause and/or treat symptoms of epilepsy. Significantly more PWE and their relatives were in favour of THM compared to villagers not knowing about or not immediately affected by epilepsy. Further factors influencing people’s attitudes towards THM were gender, tribe, religion and urbanity of people’s dwellings. This study demonstrates that not only THM but also prayers in the Christian sense seem to play an important role in people’s beliefs regarding successful treatment of epilepsy. Factors influencing this belief system have been identified and are discussed.
South Africa's Medicines Control Council (MCC) is sitting on a seven-year backlog of nearly 3,000 medicines, which could take another two years to be registered for use in the country. The medicines include treatments for life-threatening conditions such as HIV and AIDS, cancer, tuberculosis and diabetes, as well as antibiotics for bacterial infections. Pharmaceutical companies need to have their drugs registered with the MCC after being licensed to produce them. Only then can they be sold in the country. A task team, put in place by former health minister Barbara Hogan late last year, is busy clearing the backlog and transforming the MCC, and has registered about 200 medicines so far. The team, led by Nicholas Crisp of Benguela Health, includes 12 technical assistants and 24 clerks and has already audited the entire backlog and clinically evaluated nearly 800 medicines. About R13.5 million has so far been spent on the backlog project. Pharmaceutical representatives said they welcomed the task team's work. 'We have seen an increase in the numbers of medicines corresponded to the MCC,' said Shivani Patel, a regulatory affairs pharmacist at Merck's. Part of the project was the development of a new public entity, the South African Health Products Regulatory Authority, although what its role would be was unclear.
In this study, reports were reviewed from nationally representative surveys in African malaria-endemic countries from 2006 through 2008 to understand how reported intervention coverage rates reflect access by the most at-risk populations. These included 27 demographic and health surveys (DHSs), multiple indicator cluster Surveys (MICSs), and malaria indicator surveys (MISs) during this interval with data on household intervention coverage by urban or rural setting, wealth quintile, and sex. Household ownership of insecticide-treated mosquito nets (ITNs) varied from 5% to greater than 60%, and was equitable by urban/rural and wealth quintile status among 13 (52%) of 25 countries. Malaria treatment rates for febrile children under five years of age varied from less than 10% to greater than 70%, and while equitable coverage was achieved in 8 (30%) of 27 countries, rates were generally higher in urban and richest quintile households. Recent efforts to scale up malaria intervention coverage have achieved equity in some countries (especially with ITNs), but delivery methods in other countries are not addressing the most at-risk populations.
According to this report, timely sharing of surveillance information about highly pathogenic avian influenza viruses, as well as ensuring equitable access to effective vaccinations, medicines and related technology, are important ingredients of global readiness to respond to the influenza pandemic. The Pandemic Influenza Preparedness Framework is an international mechanism designed by the World Health Organization to implement a fairer, more transparent, equitable and efficient system to improve pandemic influenza preparedness and strengthen the protection against the spread of pandemic influenza. It is intended to result in sharing H5N1 and other influenza viruses with human pandemic potential and sharing the benefits arising from the use of H5N1 and other influenza viruses with human pandemic potential, including the generation of information, diagnostics, medicines vaccines and other technologies. In developing countries, critical success factors include support for national integrated human and animal influenza action plans and building national minimum core capacity for detection, risk assessment, laboratory confirmation and rapid containment.
This report presents results from a total population survey of malaria infection and intervention coverage in a rural area of eastern Uganda, with a specific focus on how risk factors differ between demographic groups in this population. In 2008, a cross-sectional survey was conducted in four contiguous villages in Mulanda, sub-county in Tororo district, eastern Uganda, to investigate the risk factors of Plasmodium species infection. All permanent residents were invited to participate, with blood smears collected from 1,844 individuals aged between six months and 88 years (representing 78% of the population). Overall, 709 individuals were infected with Plasmodium, with prevalence highest among 5-9 year olds (63.5%). In total, 68% of households owned at least one mosquito net, although only 27% of school-aged children reported sleeping under a net the previous night. These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria among school-aged children. Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds. Taken together, these findings emphasise the importance of increasing net coverage, especially among school-aged children.
This study conducted an audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa. It took the form of a retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre. The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up. The study concludes that cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default.
This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving lay or community health workers (LHWs). Articles were retrieved if the title, keywords or abstract included terms related to 'lay health workers', 'vaccination' and 'economics'. Reference lists of studies assessed for inclusion were also searched and attempts were made to contact authors of all studies included in the Cochrane review. Of the 2,616 records identified, only three studies fully met the inclusion criteria, while an additional 11 were retained as they included some cost data. There was insufficient data to allow any conclusions to be drawn regarding the cost-effectiveness of LHW interventions to promote vaccination uptake. Studies focused largely on health outcomes and did illustrate to some extent how the institutional characteristics of communities, such as governance and sources of financial support, influence sustainability. Further studies on the costs and cost-effectiveness of vaccination programmes involving LHWs should be conducted, and these studies should adopt a broader and more holistic approach.
An unsafe environment is a risk factor for child injury and violence. Among those injuries that are caused by an unsafe environment, the accidental ingestion of corrosive substances is significant, especially in developing countries where it is generally underreported. By reviewing current literature and field trials from developing countries, the authors of this study developed a flowchart for management of this clinical condition. Timely admission was observed in 19.5% of 148 patients studied. A gastrostomy was performed on 62.1% of patients, 42.8% had recurrent strictures and 19% were still on a continuous dilatation programme. Perforation and death rate were respectively 5.6% and 4%. The majority of oesophageal caustic strictures in children are observed late, when dilatation procedures are likely to be more difficult and carry a significantly higher recurrence rate.