A cross-sectional survey was conducted in neonatal and maternity units of five Kenyan district public hospitals. Data for 1 year were obtained: A fifth of the admitted neonates died. Compared with normal birth weight, odds of death were significantly higher in all of the low birth weight (LBW, <2500 g) categories, with the highest odds for the extremely LBW (<1000 g) category. The observed maternal mortality, stillbirths and neonatal mortality rates are argued to call for implementation of the continuum of care approach to intervention delivery with particular emphasis on LBW babies.
Equitable health services
Delivery outcomes and patterns of morbidity and mortality for neonatal admissions in five Kenyan hospitals
Aluvaala J et al: Journal of Tropical Medicine 61(4), 255-259, 2015,
Emergency care in 59 low- and middle-income countries: a systematic review
Obermeyer Z; Abujaber S; Makar M; Stoll S; Kayden SR; Wallis LA; Reynolds TA; the Acute Care Development Consortium: Bulletin of the World Health Organization 93 (8), August 2015
This systematic review of emergency care in low- and middle-income countries (LMICs) analysed reports published from 1990 onwards. The authors identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.
A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa
Murphy K; Chuma T; Mathews C; Steyn K; Levitt N: BioMed Central 15(303), 1 August 2015
Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. This study explored patients’ current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change. The study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status. The concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients’ perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients’ motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care. In accordance with other similar studies, most of the hypertensive and diabetic patients interviewed were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers.
Are We Prepared for the Next Global Epidemic? The Public Doesn't Think So
Kim JY: World Post, 5 August 2015
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.
First malaria vaccine given green light by European regulators
Kollewe J: The Guardian, July 2015
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.
Ensuring universal health coverage for key populations
UNAIDS: Geneva 2015
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.
Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition
Oni T; Unwin N: International Health 7(4), June 2015
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.
Do antenatal care visits always contribute to facility-based delivery in Tanzania? A study of repeated cross-sectional data
Choe SA; Kim J; Kim S; Park Y; Kullaya SM; Kim CY: Health Policy and Planning, June 2015, doi: 10.1093/heapol/czv054
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.
Identifying implementation bottlenecks for maternal and newborn health interventions in rural districts of the United Republic of Tanzania
Baker U; Peterson S; Marchant T; Mbaruku G; Temu S; Manzi F; Hanson C: Bulletin of World Health Organization 93, 22 April 2015, http://dx.doi.org/10.2471/BLT.14.141879
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.
Determinants of access to healthcare by older persons in Uganda: a cross-sectional study
Wandera SO; Kwagala B; Ntozi J: International Journal for Equity in Health, 14(26), 2015
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.