This article incudes evidence from a public opinion poll on pandemic preparedness.
It highlights three concrete actions on how we can be better prepared for the next global epidemic. The author states "First, let's ensure that all countries invest in better preparedness. This starts with a strong health system that can deliver essential, quality care; disease surveillance; and diagnostic capabilities. We should expand successful efforts such as those by Ethiopia and Rwanda to train cadres of community health workers, who can expand access to care and serve as the frontline response to future disease outbreaks. The goal must be universal health coverage - both to ensure everyone can get the care they need, and also because those areas without adequate coverage put everyone at risk." He also calls for a smarter, better coordinated global epidemic preparedness and response system that draws upon the expertise of many more players - including a better-resourced WHO; and a pandemic emergency financing facility that can respond more quickly to epidemics.
Equitable health services
The world’s first malaria vaccine has been given the green light by European regulators and could protect millions of children in sub-Saharan Africa from the life-threatening disease. The European Medicines Agency (EMA) recommended that RTS,S, or Mosquirix, should be licensed for use in young children in Africa who are at risk of the mosquito-borne disease. The shot has been developed by GlaxoSmithKline (GSK) and part-funded by the Bill and Melinda Gates Foundation. It has taken 30 years to develop vaccine, at a cost of more than $565m (£364m) to date. It will now be assessed by the World Health Organisation, which has promised to give its guidance on how and where it should be used before the end of the year. GSK will then apply to the WHO for a scientific review of the vaccine, which will be used by the UN and other agencies to help make purchasing decisions. The roll-out of the vaccine, which also has to be approved by national health authorities in sub-Saharan Africa, is likely to be funded by GAVI.
Without addressing HIV among marginalized populations and human rights, this report argues that it will not be possible to end the AIDS epidemic as a public health threat by 2030. A high-level panel, which included UNAIDS Executive Director Michel Sidibé, called on health ministers to remove structural barriers to accessing HIV services and health care for all. Ensuring that marginalized populations are not excluded from the universal health coverage target of the next sustainable development goals was noted to be vital, noting a risk that countries could seek to advance progress towards universal health coverage by focusing on easier to reach populations. In order to ensure that no one is left behind, the report argues that measures will be needed to reduce the discrimination facing all marginalized groups and to ensure their meaningful participation in the development and implementation of health strategies.
In today’s globalised world, rapid urbanisation, mechanisation of the rural economy, and the activities of transnational food, drink and tobacco corporations are associated with an increased risk of chronic non-communicable diseases (NCDs). As a result, population health profiles are rapidly changing. Many low and middle income countries (LMICs) are undergoing rapid changes associated with developing high rates of NCD while concomitantly battling high levels of communicable diseases. This review synthesises evidence on the overlap and interactions between established communicable and emerging non-communicable disease epidemics in LMICs. The review focuses on HIV, TB and malaria and explores the disease-specific interactions with prevalent NCDs in LMICs. The authors highlight the complexity, bi-directionality and heterogeneity of these interactions and discuss the implications for health systems. It is argued to require breaking down barriers between departments within
health ministries that have traditionally designed services and
programs for communicable and NCD separately and integrated multi-sectoral action addressing determinants across the life course.
There is a high disparity in access to perinatal care services between urban and rural areas in Tanzania. This study analysed repeated cross-sectional data from Tanzania to explore the relationship between antenatal care (ANC) visits, facility-based delivery and the reasons for home births in women who had made ANC visits. The relationship between the number of ANC visits (up to four) and facility delivery in the latest pregnancy was explored. For rural women, there was no significant relationship between the number of ANC visits and facility delivery rate. The most frequent reason for home delivery was ‘physical distance to facility’, and a significant proportion of rural women reported that they were ‘not allowed to deliver in facility’. The disconnect between ANC visits and facility delivery in rural areas may be attributable to physical, cultural or familial barriers, and quality of care in health facilities. This suggests that improving access to ANC may not be enough to motivate facility-based delivery, especially in rural areas.
The authors aimed to estimate the effective coverage of key maternal and newborn health interventions in rural parts of the United Republic of Tanzania and to identify bottlenecks in implementation. They used data from an observational, cross-sectional study that was performed in Tandahimba and Newala districts in south-eastern United Republic of Tanzania. They investigated five key maternal and newborn health interventions: (i) syphilis screening; (ii) pre-eclampsia screening; (iii) use of a partograph to monitor labour; (iv) active management of the third stage of labour; and (v) postpartum care in a health facility. The largest bottleneck in Tandahimba was health facility readiness, which was associated with a 52% reduction in coverage. Clinical practice was another large bottleneck, with an attrition of 35%. In Newala, clinical practice was the largest bottleneck, causing an attrition of 57%. The authors provide a framework that could help operationalize measurements and track progress towards universal health coverage in all areas of health care.
Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons’ healthcare disparities in Uganda. This paper reports on factors associated with older persons’ healthcare access in Uganda, using a nationally representative sample. The authors conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. They used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations and fit generalised linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households; and with some or with a lot of walking difficulty. Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages and missed work due to illness for 1–7 and 8–14 days. In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes were more likely to access healthcare during the last 30 days. In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility limitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons.
This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates, policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector. The paper presents global evidence that suggests significant differences between rural and urban populations in health coverage
and access at global, regional and national levels. Based on the evidence provided, place of residence largely determines coverage and access to health care in all regions and within all countries. . Efficient and effective multisectoral policies to address the root causes of rural inequities should consider the specific living and working characteristics of rural populations. The authors argue that if not addressed, the rural/urban disparities identified in access to health care carry the potential to considerably hamper overall socio-economic development in many developing countries.
Severe anemia in children is a leading indication for blood transfusion worldwide. Severe anemia, defined by the World Health Organization as a hemoglobin level <5 g/dL, is particularly common throughout sub-Saharan Africa. Analysis of data from the Fluid Expansion as Supportive Therapy trial offers new insights into the importance of blood transfusion for children with severe anemia. This analysis found that life-threatening anemia in children is a frequent presenting condition in East Africa; that delays in transfusion therapy are lethal; and that inadequate transfusion is probably more common than currently recognized. The findings of this study highlight the need for changes in blood inventory management in sub-Saharan hospitals and the need for more research on transfusion therapy for children in peril.
Over 90% of the world’s severe and fatal Plasmodium falciparum malaria is estimated to affect young children in sub-Sahara Africa, where it remains a common cause of hospital admission and inpatient mortality. Few children will ever be managed on high dependency or intensive care units and, therefore, rely on simple supportive treatments and parenteral anti-malarials. There has been some progress on defining best practice for antimalarial treatment with the AQUAMAT trial in 2010 showing that in artesunate-treated children, the relative risk of death was 22.5% lower than in those receiving quinine. This review highlights the spectrum of complications in African children with severe malaria, the therapeutic challenges of managing these in resource-poor settings and examines in-depth the results from clinical trials with a view to identifying the treatment priorities and a future research agenda.