The authors of this study compared medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. Nine studies met the inclusion criteria. Complete abortion was achieved by 86–97% of the women who underwent home-based abortion and by 80–99% of those who underwent clinic-based abortion. Pooled analyses from all studies revealed no difference in complete abortion rates between groups. Serious complications from abortion were rare. Women who chose home-based medical abortion were more likely to be satisfied, to choose the method again and to recommend it to a friend than women who opted for medical abortion in a clinic.
Equitable health services
In this paper, using in-depth case studies of Ghanaian and Cameroonian responses, the authors discuss the challenge of developing effective primary and secondary prevention to tackle chronic diseases such as stroke, hypertension, diabetes and cancers. They observe fundamental differences between Ghana and Cameroon in terms of "multi-institutional and multi-faceted responses" to chronic diseases. Whereas Ghana does not have a chronic disease policy, the authors note that it has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. On the other hand, the authors note that Cameroon has a policy on diabetes and hypertension as well as established diabetes clinics across the country and provides training to health workers to improve treatment and education despit lack of community and media engagement. In both countries churches provide public education on major chronic diseases, but neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness. In conclusion, the authors recommend a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. To this end, they outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.
Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual’s acceptance and use of ICTs: usefulness and ease of use. It is evident that more effective use of ICTs as part of e-health initiatives at the rural healthcare centres was seen to be distinctly possible, but only if perceived shortcomings with regard to structural variables were addressed. Especially relevant was better access to more e-facilities, more health-related information made available via ICTs, ongoing ICT skills training programs and policies for improved technology maintenance and support. In conclusion, all structural and psychological factors investigated were seen to impinge to some extent on effective use of ICT applications as e-health solutions in the rural healthcare centres involved in the study. Furthermore, there was a distinct interplay between the various variables, with perceived ICT-related shortcomings having a negative impact on perceived usefulness and ease-of-use variables and thus decreasing the likelihood of effective e-health solutions. This means that to increase effective use of ICTs that form part of e-health initiatives in the healthcare centres, a vital first step is to address reported perceived shortcomings.
This study is a review of public health perspectives of preeclampsia in developing countries and implications for health system strengthening. Literature from Pubmed (MEDLINE), AJOL, Google Scholar, and Cochrane database were reviewed. Results showed that the prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7%. Many challenges exist in the prediction, prevention, and management of preeclampsia. Promising prophylactic measures like low-dose aspirin and calcium supplementation need further evidence before recommendation for use in developing countries. Treatment remains prenatal care, timely diagnosis, proper management, and timely delivery. Overcoming the prevailing challenges in the control of preeclampsia in developing countries hinges on the ability of health care systems to identify and manage women at high risk, the authors conclude.
Coverage for the recommended two intermittent preventive treatment during pregnancy (IPTp) IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage. Data on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Among all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. This study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. Simplified IPTp guidelines for front-line health workers as recommended by the World Health Organisation (WHO) could lead to a 20% increase in IPTp coverage. Pregnant women also need to be educated about the risks of malaria during pregnancy and their right to receive health services.
Malaria vector control by indoor residual spraying was reinitiated in 2006 with DDT in Zambezia province, Mozambique. In 2007, these efforts were strengthened by the President's Malaria Initiative. This paper reports on the monitoring and evaluation of this programme as carried out by the Malaria Decision Support Project. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 15 years. In 2006, the sporozoite rate in Anopheles gambiae s.s. was 4% and this reduced to 1% over 4 rounds of spraying. The sporozoite rate for An. funestus was also reduced from 2% to 0 by 2008. Of the 437 Anopheles arabiensis identified, none were infectious. Overall prevalence of P. falciparum in the sentinel sites fell from 60% to 32% between October 2006 and October 2008. In conclusion, it appears that both An. gambiae s.s. and An. funestus were controlled effectively with the DDT-based IRS programme in Zambezia, reducing disease transmission and burden. However, the discovery of pyrethroid resistance in the province and Mozambique's policy change away from DDT to pyrethroids for IRS may threaten the gains made.
According to this article, inequity is built into western health systems, due to the disease focus that they have. Diseases are only a partial picture of peoples health, and low income populations experience multiple diseases. The author argues that the problems that bother and disable people, such as chronic pain, deserve more attention because many of these problems cannot be related to specific diseases. It is thus more useful for health services to focus on population health, and manage the multiple health challenges that people, especially poor people have, rather than tackle single diseases and leave the wider ill health burden unmanaged. The author calls on primary care physicians to take leadership in moving medical care where it needs to be: to the care of patients and populations and not the care of diseases. Primary health care that integrates disease with other aspects of patient health is seen as the way forward.
Surveys of medicine prices and availability, conducted using a standard methodology, have shown that poor medicine availability, particularly in the public sector, is a key barrier to access to medicines. Public sector availability of generic medicines is less than 60% across WHO regions, ranging from 32% in the Eastern Mediterranean Region to 58% in the European Region. Private sector availability of generic medicines is higher that in the public sector in all regions. However, availability is still less than 60% in the Western Pacific, South-East Asia and Africa Regions. Due to low availability of medicines in the public sector, patients are often forced to purchase medicines in the private sector. When originator brands are prescribed and dispensed for products that are also available in generic form, patients are paying four times more, on average, to purchase the brand. High medicine prices increase the cost of treatment. Low public sector availability can be addressed through improved procurement efficiency, and adequate, equitable and sustainable financing. Medicine prices can be reduced by eliminating duties and taxes on medicines and promoting the use of quality-assured generic medicines. Mark-ups can also be regulated to avoid excessive add-on costs in the supply chain. The most appropriate actions to follow depend on a country’s individual survey results and their underlying determinants, as well as local factors including existing pharmaceutical policies and market situations.
Irrational use of medicines is an extremely serious global problem that is wasteful and harmful, according to the authors of this paper. In developing and transitional countries, in primary care less than 40% of patients in the public sector and 30% of patients in the private sector are treated in accordance with standard treatment guidelines. Antibiotics are misused and over-used in all regions. In developing and transitional countries, while only 70% of pneumonia cases receive an appropriate antibiotic, about half of all acute viral upper respiratory tract infection and viral diarrhoea cases receive antibiotics inappropriately. Patient adherence to treatment regimes is about 50% worldwide and lower in developing and transitional countries. Harmful consequences of irrational use of medicines include unnecessary adverse medicines events, rapidly increasing antimicrobial resistance (due to over-use of antibiotics) and the spread of blood-borne infections such as HIV and hepatitis B/C (due to unsterile injections) all of which cause serious morbidity and mortality and cost billions of dollars per year. Effective interventions to improve use of medicines are generally multi-faceted. They include provider and consumer education with supervision, group process strategies (such as peer review and self-monitoring), community case management (where community members are trained to treat childhood illness in their communities and provided with medicines and supervision to do it) and essential medicines programmes with an essential medicine supply element.
Many developing countries stressed the importance of access to medicines and of addressing the social determinants of health in order to prevent and control non-communicable diseases. Interventions also called for more funding and political commitment, better private sector regulation and policy-making free of conflict of interests. Several Member States also supported the inclusion of mental health in the context of NCDs. This was at the 64th World Health Assembly (WHA) meeting in Geneva on 16-24 May, during a discussion on the prevention and control of non-communicable diseases (NCDs) that considered the WHO Secretariat report on the matter and adopted a resolution sponsored by 61 Member States including EU member countries. The article reports on the debates and the resolution.