Three years ago, the Church of Scotland Hospital in the rural Umsinga area of South Africa's KwaZulu-Natal Province was the epicentre of a deadly outbreak of extremely drug-resistant tuberculosis (XDR-TB). It was reported that 52 of the 53 patients initially diagnosed died within a month of contracting this strain of TB, which is resistant to both of the first-line antibiotics used to treat the disease, as well as two classes of second-line drugs. At the peak of the epidemic in 2006, Umsinga was contributing more than two-thirds of the XDR-TB and multi-drug resistant TB (MDR-TB) cases in the province, but Dr Tony Moll, Principal Medical Officer at the Church of Scotland Hospital, is credited with leading efforts to turn the tide against the deadly new TB strains. Since then, 488 cases of XDR-TB and 356 cases of MDR-TB have been diagnosed. ‘The TB prevalence rate is still very high in the area,’ Moll said. ‘We get about 150 new TB cases every month.’ In 2008, the hospital achieved a TB cure rate of 83%, compared to the national cure rate of about 60%.
Equitable health services
Traditionally, standards of care have been developed by a panel of experts and then implemented by a multidisciplinary team. This paper considered the feasibility of involving health professionals of all grades and policymakers in the establishment of standards for postpartum hemorrhage (PPH) in Malawi. The team established these standards using evidence from Malawi national guidelines and World Health Organization (WHO) manuals. They agreed on ten objectives and developed the structure, process, and outcome for each objective. The standards addressed different aspects of prevention, diagnosis and treatment. The involvement of both health professionals and policymakers might promote ownership, sustainability and allocation of resources for implementation.
At least 50 people have been quarantined in Tanzania's northern district of Mbulu to curb the spread of influenza H1N1, a highly contagious viral disease that killed one person last week, say health officials. The death is the first in East Africa. ‘We are struggling to control [the] further spread of the disease,’ said Anael Pallangyo, Mbulu District Medical Officer. All 18 dispensaries in the district were now on alert and about 50 patients placed in isolation wards. Tanzanian health authorities have stepped up surveillance at all the country's entry points, where people with flu-related symptoms such as coughing, fever and sneezing are taken to hospital for screening and treatment. The ministry of health recently announced 172 confirmed cases of H1N1 at the end of September.
There has been an increase in the number of pandemic HIN1 influenza cases being reported in the East African region, say medical officials. Some of the new cases have been recorded in schools. ‘Some 350 H1N1 influenza cases have been confirmed in Kenya,’ said Shahnaaz Sharif, the Director of Public Health, adding that the cases had been mild. ‘There may be more cases out there.’ So far, no deaths have been reported. Children, young adults and pregnant women, as well as those with pre-existing medical conditions, such as asthma, AIDS, diabetes, heart and blood diseases, are at increased risk of severe and sometimes fatal illness. Sharif said the affected schools in the Nairobi and Central regions had been provided with guidelines and other assistance on disease control. In Uganda, at least 33 H1N1 cases have been confirmed, mainly in the western district of Bushenyi. Health ministry spokesman, Paul Kagwa, said that nine seminarians at the Kitabi Catholic Seminary in Bushenyi had tested positive, while another 300 people were undergoing treatment for flu-related symptoms.
In 2007, a randomised controlled study was performed among a cohort of French soldiers returning from Cote d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Among 424 volunteers randomised to the study, 47.6 % were assigned to the SMS group and 52.3 % to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. In conclusion, SMSes did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. Another study should be done to confirm these results on soldiers or other types of individual travellers.
This interview was conducted with Dr John Seffrin, CEO of the American Cancer Society (ACS), who spoke about the cancer challenges facing Africa. By next year cancer is set to become the biggest killer in the world, killing more people than HIV/AIDS, TB and malaria combined. In Africa, people are dying of cancers that are curable in the developed world. Cancer is a growing problem in Africa but is given little attention as the continent is overwhelmed by many other problems. There are relatively low cancer prevalence rates in Africa, but a high growth of the cancer burden. This is argued to call for health promotion for people who don’t have cancer and palliative care for people who have late-stage disease.
This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion. It used qualitative research methods to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Complex patterns of service delivery were prevalent throughout many of the health care facilities and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre- and post-abortion counselling, including contraceptive counselling and provision. To sustain a pool of abortion providers, programmes that both attract prospective abortion providers and retain existing providers, need to be developed and financial compensation for abortion care providers needs to be considered.
Health officials in Tanzania are confident they are on track to eradicate malaria deaths by 2015, even if significant challenges stand in the way of the target. The National Malaria Control Programme (NMCP) says malaria is a leading killer in the East African country, infecting about 18 million people annually, and 30–40% of attendance at health centres and hospitals are related to malaria cases, burdening overstretched facilities. Malaria, according to the National Planning Commission (NPC) costs the country an estimated loss that is equivalent to 3.4% of gross domestic product. Alex Mwita, a senior NMCP official, said initiatives being implemented under the Roll Back Malaria programme, such as insecticide-treated bed nets and indoor residual spraying (IRS), had helped reduce malaria cases, along with deaths of children under five and infants (younger than one). ‘Under-five deaths have dropped to 91 per 1,000 live births in 2008, down from 147 in 1999,’ he said. Although the decline could not be attributed to a fall in malaria cases alone, research showed a decline in prevalence of the disease had a big impact on childhood and maternal mortality.
Between a quarter and half of maternal, neonatal, and child deaths in South Africa’s national audits have an avoidable health-system factor contributing to the death. Using the LiST model, the researchers estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is US$220 million per year. Such progress would put South Africa squarely on track to meet Millennium Development Goal (MDG) 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision.
South Africa’s burden of non-communicable diseases will probably increase as the roll-out of antiretroviral therapy takes effect and reduces mortality from AIDS. The scale of the challenge posed by the combined and growing burden of HIV and AIDS and non-communicable diseases demands an extraordinary response that South Africa is well able to provide. Concerted action is needed to strengthen the district-based primary health-care system, to integrate the care of chronic diseases and management of risk factors, to develop a national surveillance system, and to apply interventions of proven cost-effectiveness in the primary and secondary prevention of such diseases within populations and health services. The researchers urge the launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess and implement integrated care interventions for chronic infectious and non-communicable diseases.