The devastating cholera epidemic continues to spread, with a new outbreak in Chegutu Urban, recording more than 378 suspected cases and 121 deaths. As of 15 December, 9 out of 10 provinces (48 out of 62 districts) in the country are affected with a total count of 978 deaths and a Case Fatality Rate (CFR) of 5.3%. So far most cases have been reported in Harare / Budiriro (8,454 cases, 208 deaths and a CFR of 2.5%), followed by Beitbridge (3,456 cases, 91 deaths and a CFR of 2.6%), Mudzi (1,237 cases, 78 deaths and a CFR of 6.3%) and Chitungwiza (551 cases, 99 deaths and a CFR of 18 %). Higher CFRs have been found in other areas. Cholera continues to affect various parts of the Southern African region, with the Republic of South Africa reporting 859 cumulative cases, 11 deaths and a CFR of 1.2%, the bulk of the cases (731) reported in Limpopo province. Cases have also been reported in Botswana, Mozambique, and Zambia, albeit in much smaller numbers. According to the latest WHO figures, there have been 200 human cases of anthrax and 8 deaths reported since November with the consumption of contaminated meat identified as the most likely cause.
Equitable health services
Four days into one-week 'critical' negotiations on pandemic influenza preparedness, World Health Organization members had yet to tackle areas of core disagreement and participants were expressing doubt as to whether consensus can be achieved before the end of the meeting. Details on the definition of 'Pandemic Influenza Preparedness (PIP) Biological Materials', on the content of a standard material transfer agreement for virus sharing and on the interconnection between a mechanism for virus-sharing and a mechanism for sharing of benefits from vaccine development have yet to be discussed or have been pushed until later in the meeting for more substantive discussion and hoped-for consensus. These interrelated topics represent core differences between member states and thus are likely to be most difficult to resolve at the WHO Pandemic Influenza Preparedness Intergovernmental Meeting.
This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care. A mixed methods approach using structured Verbal/Social autopsy interviews and case narratives was employed with 26 caretakers living in the Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. The main barriers to care were misdiagnosis by the caregiver, gender and household financial constraints, and dissatisfaction with providers, reflecting inadequate levels of service. Poverty was identified as the underlying theme. Any improvements in basic health care for children suffering from acute febrile illness are likely to substantially reduce mortality.
The use of insecticide-treated bed nets (ITNs) to protect children from malaria has risen six-fold in the past seven years, but 90 million children still do not have access to this simple protective tool, and remain at risk from the life-threatening disease. When African heads of state met in 2000, the Abuja Declaration stated that they would work towards protecting 60% of their vulnerable populations with insecticide treated nets. This study examines what has been achieved since. Data from 40 African countries which shows that at the time of the Abuja meeting in 2000 just over 3% of Africa’s young children were protected by a treated mosquito net. Seven years later this increased to only 18.5%. The authors report that bed net use increases faster in countries that distribute them free of charge by an average of 25% compared to 4% when people have to pay for them.
Zimbabwe's cholera epidemic has crossed into South Africa, with four confirmed diagnoses in a total of 68 suspected cases in the border town of Musina, according to aid workers as of 19 November 2008. The cholera epidemic in Zimbabwe has flared up in several parts of the country, including the capital, Harare, and its satellite town of Chitungwiza, as a result of the collapse of water and sewerage services, worsened by uncollected refuse and the start of the rainy season. Humanitarian officials have reported that a total of 2,893 people were infected by the waterborne disease between the beginning of August and mid-November, with at least 115 deaths. The UN children's agency, UNICEF, and the World Health Organisation (WHO) have also been assisting in the provision of drinking water.
The objective of this study was to evaluate the impact of rapid diagnostic tests (RDTs) on prescribing behaviours, assess prescribers' and patients' perceptions, and identify operational issues during implementation. Baseline data was collected at six Tanzanian public dispensaries. RDTs were implemented for eight weeks and data collected on frequency of RDT use, results, malaria diagnoses and the prescription of antimalarials. The study found that overprescriptions decreased over the study period. There was a high degree of patient/caregiver and provider acceptance and satisfaction with RDTs. Implementation should include community education, sufficient levels of training and supervision and consideration of the need for additional staff.
Health workers of Parirenyatwa and Harare Central Hospital have issued a petition for urgent action to address the prevailing crisis in Zimbabwe’s public health system. Problems within public health institutions include a serious lack of medical supplies, functional equipment and drugs. Since all hospitals and clinics are closed, Zimbabweans that fall ill have no access to health care, given the high cost of private health care. Problems facing health workers include poor salaries (which should be paid in foreign currency, not Zim dollars), rising transport costs and bad working conditions. The continued failure to address the above issues has resulted in lack of services in public health institutions and health workers failing to come to work. The workers call upon the responsible authorities to take urgent steps to remedy the situation above in consultation with the health workers concerned.
Access to improved sanitation is a matter of human rights, says the UN. There is compelling evidence that sanitation brings the single greatest return on investment of any development intervention (roughly $9 for every $1 spent). Yet it remains the most neglected and most off-track of the Millennium Development Goal (MDG) targets. Sanitation has been considered as the most important medical advance since 1840 – beating antibiotics, vaccines and anaesthesia. Access to sanitation is essential for people to live in dignity, yet 40% of the world still does not have basic sanitation. The scale of the crisis is enormous, according to the United Nations, which reports that 2.5 billion people do not have access to proper sanitation.
The CWGH made a number of resolutions after the 15th National Conference in Harare, including a demand that the right to health be included in the National Constitution. It committed itself to strengthening primary health care and district systems by lobbying for incentives and resources for community health workers from government, getting health institutions to remove high charge barriers and lobbying government for policies to retain health workers. It will also lobby the government to provide free access to safe water as a human right, as well as lobby the Parliamentary Portfolio Committee on health for increased health funding and government for the fair allocation of resources at national level. Community participation should also be promoted. That CWGH will develop a proactive agenda on health issues and forge and strengthen strategic partnership locally and regionally to take this forward, capacitate its districts to enable them to advance and monitor the implementation of these resolutions and ensure that the health delivery system is not used for partisan politics.
Zimbabwe’s overall health service has been steadily declining for the last five years. The Zimbabwean health service today is wracked by critical shortages of essential drugs and skilled and experienced personnel. Another challenge is there has been no comprehensive assessment of Zimbabwe’s health system since 2006, making it difficult to assess its true state. Also, its disease surveillance and early warning system, which depends on a weekly epidemiological system, has been compromised in terms of timeliness and completeness of data, which is only around 30%. Universal access to basic health services is compromised due to deteriorating infrastructure, staffing and financial resources. Reactivating primary health care services should keep being addressed as a matter of emergency. Zimbabwean health facilities face a massive gap – estimated this year at 70% – in required medicines due to reduced local manufacturing capacity, which has been weakened by a lack of foreign currency. This is despite support received from different partners through UNICEF’s procurement systems. A large cholera outbreak is affecting most regions of the country, with more than 11 700 cases and 473 deaths recorded between August and 30 November. This represents a case fatality rate (CFR) of 4.0% nationally, but reached 50% in some areas during the early stages of the outbreak. The CFR benchmark should be below 1%. Cholera outbreaks in Zimbabwe have occurred annually since 1998, but previous epidemics never reached today’s proportions. The last large outbreak was in 1992 with 3000 cases recorded. Cholera cases have also been reported either side of Zimbabwe’s border with South Africa, Botswana and Mozambique, demonstrating the subregional extent of the outbreak.