Recent calls have been made by several international organisations for stronger links between sexual and reproductive health and HIV policies, programmes and services. However, implementers of PMTCT and other HIV programmes have been constrained in translating these goals into practice. The obstacles include: the narrow focus of current PMTCT programmes on treating HIV-positive women who are already pregnant; separate, parallel funding mechanisms for sexual and reproductive health and HIV programmes; political resistance from major HIV funders and policy-makers to include sexual and reproductive health as an important HIV programme component; and gaps in the evidence base regarding effective approaches for integrating sexual and reproductive health and HIV services. However, new opportunities exist to address these essential links. More supportive political views in the United States of America and the emergence of health systems strengthening as a priority global health initiative provide important springboards for advancing the agenda on links between sexual and reproductive health and HIV. There is need to tap into these platforms for advocating and continue to invest in research.
Equitable health services
This book documents the largest-ever independent, laboratory-based evaluation of rapid diagnostic tests (RDTs) for malaria. It shows that some tests on the market perform exceptionally well in tropical temperatures and can detect even low parasite densities in blood samples, while other tests were only able to detect the parasite at high parasite densities. Testing was performed at the US Centres for Disease Control and Prevention (CDC). Forty-one commercially available RDTs went through a blinded laboratory evaluation. The findings will serve as a tool for countries to make informed choices, from among the dozens of tests commercially available, on the purchase and use of rapid diagnostics that are best suited to local conditions. This performance evaluation will also inform procurement and prioritisation for diagnostic test entry into the World Health Organization (WHO) Prequalification Diagnostics Programme and WHO Procurement Schemes. Donor agencies also regularly refer to WHO recommendations on diagnostics when making their own purchases.
This paper examined the Global Fund database for elements and indicators of sexual and reproductive health in all approved HIV-related proposals (214) submitted by 134 countries, from rounds 1 to 7, and in an illustrative sample of 35 grant agreements. At least 70% of the HIV-related proposals included one or more of the four broad elements: sexual and reproductive health information, education and communication; condom promotion/distribution; diagnosis and treatment of sexually transmitted infections; and prevention of mother-to-child transmission of HIV. Between 20% and 30% included sexual health counselling, gender-based violence, and the linking of voluntary counselling and testing for HIV with sexual and reproductive health services. Less than 20% focused on adolescent sexual and reproductive health, the rights and needs of people living with HIV, or safe abortion services. Country coordinating mechanisms and national-level stakeholders see in funding for sexual and reproductive health a means to address the problem of HIV infection in their respective national settings. However, the paper highlights some missed opportunities for linking HIV and sexual and reproductive health services.
This special report on health care and technology describes how developing countries are using mobile phones to provides personalised medicine. Drawing from experiences of various countries, the authors demonstrate how new technologies help to tackle the health problems of the world’s poorest. The authors argue that given their ubiquity, personal convenience and interactivity, mobile phones offer an innovative way to reach reticent HIV sufferers. With demonstrated success in the use of mobiles for health (mHealth) in the likes of Uganda, Kenya, Rwanda and Mexico, the authors recommend that the visible face of any mHealth or e-health scheme, regardless of where it operates, needs to be as simple and user-friendly as possible, whereas the hidden back end should use sophisticated software and hardware. The authors conclude that the poor clearly benefit from technical improvements that cut the cost of manufacturing medical devices, make drugs more effective, or eliminate the need for refrigerating vaccines, as well as through big technical breakthroughs that save many millions of lives. Mobile phones, as demonstrated from the examples in this report, can aid early detection, effective early responses, and remote medicine.
In sub-Saharan Africa, more than 90% of children with sickle-cell anaemia die before the diagnosis can be made. The causes of death are poorly documented, but bacterial sepsis is probably important. This study examined the risk of invasive bacterial diseases in children with sickle-cell anaemia. It was undertaken in a rural area on the coast of Kenya, with a case-control approach. Blood cultures were undertaken on all children younger than 14 years who were admitted from within a defined study area to Kilifi District Hospital between 1 August 1998 and 31 March 2008 – those with bacteraemia were defined as cases. The study detected 2,157 episodes of bacteraemia in 38,441 admissions (6%). 1,749 of these children with bacteraemia (81%) were typed for sickle-cell anaemia, of whom 108 (6%) were positive as were 89 of 13,492 controls (1%). The study concludes that the organisms causing bacteraemia in African children with sickle-cell anaemia are the same as those in developed countries. Introduction of conjugate vaccines against S pneumoniae and H influenzae into the childhood immunisation schedules of African countries could substantially affect survival of children with sickle-cell anaemia.
Surgical intervention is necessary if children with cataract are to regain their sight. In many low- and middle-income countries, cataract is the leading cause of avoidable blindness among children. This article in considers the gender dimensions of surgery and the background to the situation in Tanzania where many children are not brought for surgery in a timely fashion and follow up is often poor. Girls have a significantly lower rate of surgery with only half as many girls receiving treatment as boys and tended to be bought for surgery much later than boys. In poor or struggling communities, sons are often seen as a source of income and financial security for parents when they get older, whereas girls are seen as a financial burden. Analysis showed that women’s level of education, their socioeconomic status, and the decision-making power they had within their household and their community all played a major role in determining whether and when their children would receive cataract surgery and whether they would be taken for follow-up visits. A number of ways forward are discussed including mass media efforts which may provide the first opportunity for rural villagers to learn about the need for early referral of young children with vision loss.
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%.
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.