Human papillovirus (HPV) types 16 and 18 are responsible for about 70% of all cervical cancer cases worldwide. This report provides key information for Kenya on cervical cancer, other anogenital cancers and head and neck cancers, HPV-related statistics, factors contributing to cervical cancer, cervical cancer screening practices, HPV vaccine introduction, and other relevant immunisation indicators. The report is intended to strengthen the guidance for health policy implementation of primary and secondary cervical cancer prevention strategies in the country. Kenya has a population of 10.32 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that, every year, 2,635 women are diagnosed with cervical cancer and 2,111 die from the disease. Cervical cancer ranks as the most frequent cancer among women in Kenya, and the second most frequent cancer among women between 15 and 44 years of age. About 38.8% of women in the general population are estimated to harbour cervical HPV infection at a given time, and 60.9% of invasive cervical cancers are attributed to HPVs 16 or 18.
Equitable health services
To detect malaria people might soon be able to chew a stick of gum and swipe it over a magnet or scan a finger with ultra-far infrared light. These are some of the winning proposals for the Bill and Melinda Gates Foundation Grand Challenges awards, which invite researchers to find non-invasive diagnostic alternatives for priority global health conditions such as malaria, tuberculosis and HIV. To date, all commercially available malaria tests require extracting blood, partly because up to now it has been more difficult to detect malaria in other body fluids. Andrew Fung, who is developing the chewing gum test, said: ‘By working in a user's mouth this test will operate at a higher temperature, and millions of microscopic particles will be examined across a small surface area [the gum], increasing the test's sensitivity.’ Winner Lu, from the University of Michigan, is pioneering the infrared option by tapping into body level vibrations rather than testing molecules, making this test highly sensitive too. To date one of the drawbacks of the 60 rapid diagnostic tests currently on the market has been that they are unregulated, so while some are quite sensitive and can provide 95–100% accuracy, others provide far less accurate results.
The shift in emphasis to universal primary health care in post-apartheid South Africa has been accompanied by a process of decentralisation of mental health services to district level, as set out in the new Mental Health Care Act, No. 17 of 2002, and the 1997 White Paper on the Transformation of the Health System. This study sought to assess progress in South Africa with respect to de-institutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The findings suggest that the decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. The paper recommends that, in a similar vein to other low- to middle-income countries, de-institutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
This paper considers new developments to strengthen sexual and reproductive health and HIV links and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these links. It argues that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved significant scale-up of integrated service provision. A lack of common understanding of terminology and clear technical operational guidance, and separate policy, institutional and financing processes continue to represent significant constraints. The paper draws on experience with tuberculosis and HIV integration to highlight some lessons. It concludes that there is little evidence to determine whether funding for health systems is strengthening links, and makes several recommendations to maximise opportunities represented by recent developments.
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.
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.