Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many regions with high maternal mortality. In this study, the authors combined a detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana. They estimated journey-time for all women of childbearing age (WoCBA) to their nearest health facility. Findings indicated that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. The authors conclude that their approach, using detailed data assembly combined with geospatial modeling, can provide accurate nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes, they argue, because they fail to take account of the location and accessibility of services relative to the women they serve.
Equitable health services
The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services amongst women living in rural villages in Bugesera District, Eastern Province, Rwanda. Using census data, researchers selected 30 villages for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Their analysis of 3,106 lifetime deliveries from 859 respondents showed a sharp increase in the percentage of health facility deliveries in recent years. The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health centre.
In response to a high incidence of cervical cancer, Tanzania implemented “visual inspection of the cervix after acetic acid application” (VIA) as a regional cervical cancer screening strategy in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this research paper presents the results from a comparative analysis performed among women who are reached and not reached by the screening programme. Researchers studied 14,107 women aged 25–59 enrolled in a cervical cancer screening programme in Dar es Salaam in the period 2002–2008. The women underwent VIA examination and took part in a structured questionnaire interview. Results indicated that women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. Although women who participated in the screening were more likely to be HIV positive in comparison with women who had never attended screening, the authors point out that this may be due to a referral link that exists between the HIV programme and the cervical cancer screening programme, which means that HIV positive were more likely to participate in the cervical cancer screening programme than HIV negative women.
When Southern African Development Community (SADC) member states signed the SADC Protocol on Health in 2008, they committed themselves to dealing with communicable diseases - particularly HIV, tuberculosis (TB) and malaria - in a harmonised manner. However, until now, the key regional strategic frameworks and minimum standards developed to guide action in the control of these three diseases did not adequately cover children and adolescents. To address this shortcoming, SADC commissioned a regional assessment in the 14 active SADC Member States between October 2011 and July 2012. On the basis of this data, the SADC Secretariat developed the SADC Minimum Standards for Child and Adolescent HIV, TB and Malaria Continuum of Care. It establishes the minimum package of services that member states should have in place to achieve a common response in the region. Because of the bi-directional links between the HIV, TB and malaria and child vulnerability, it is crucial that access to services such as health, education, social and child protection, food security and nutrition and psychosocial services are adequately integrated into this response, as established in the SADC Strategic Framework and Programme of Action for Orphans and Vulnerable Children and Youth.
Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade – in 2001 and again in 2006. The authors of this study assessed health workers‟ attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: children below 5; older children and adults; and pregnant women. A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. Results showed that following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members’ malaria episode. This indicates that factors other than providers’ attitude may have more influence in their personal treatment practices.
The authors of this study assessed barriers related with long-lasting insecticide treated net (LLIN) use at the household level in Ethiopia from October to November 2010. A total of 2,867 households were selected and data were collected by interviewing women, direct observation of LLINs conditions and use, and in-depth interviewing of key informants. Results indicated that only about one third of LLIN owned households are actually using at least one LLIN for protection against mosquito bite. Thus, most of the residents are at higher risk of mosquito bite and acquiring of malaria infection. Households living in fringe zone are not benefiting from the LLIN protection. Further progress in malaria prevention can be achieved by specifically targeting populations in fringe zones and conducting focused public education to increase LLIN use, the authors recommend.
Feasible universal health coverage in South Africa seems ever more remote, according to this article, as a dysfunctional Department of Public Works continues to stymie vital public hospital revitalisation projects, and five provinces have proved grossly incapable of spending their health budgets. Meanwhile, hospitals fall into disrepair and programmes are not expanded. Health Minister, Aaron Motsoaledi told parliament that the national ‘failure to spend’ was due to delays in the awarding of tenders, rolling over of budgets, poor performance of contractors (and the consequent termination of contracts and ensuing court challenges). Against this background, Dr Olive Shisana, Chairperson of the NHI ministerial advisory task team, argued that quality-based health facility accreditation is pivotal to the South African national health insurance (NHI) model. Dr Ravindra Rannan-Eliya, Director for Health Policy in Colombo, Sri Lanka, added that for an NHI to succeed in South Africa, public sector service quality and availability would need to ‘at least’ reach current medical scheme levels.
Since 2002, an estimated 4.7 million long-lasting insecticide-treated nets (LLINs) have been distributed in the Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia among a population of approximately 10 million people at risk for contracting malaria. This study sought to determine the status of current net ownership, utilisation and rate of long-lasting insecticide-treated nets (LLIN) loss in the previous three years. A total of 750 household respondents were interviewed in SNNPR. Approximately 67.5% of households currently owned at least one net. An estimated 31% of all nets owned in the previous three years had been discarded by owners, most of whom considered the nets too torn, old or dirty. Households reported that one-third of nets (33.7%) were less than one year old when they were discarded. These results suggest that the life span of nets may be shorter than previously thought, with little maintenance by their owners. With the global move towards malaria elimination it makes sense to aim for sustained high coverage of LLINs, the authors argue. However, in the current economic climate, it also makes sense to use simple tools and messages on the importance of careful net maintenance, which could increase their lifespans.
In sub-Saharan Africa, shortages of trained health workers, limited diagnostic equipment, inadequate anti-epileptic drug supplies, cultural beliefs, and social stigma contribute to the large treatment gap for epilepsy. This paper examines the state of epilepsy care and treatment in sub-Saharan Africa and discusses priorities and approaches to scale up access to medications and services for people with epilepsy. In the last decade, the disproportionate majority of global health funding has been allocated to vertical programmes targeting HIV and AIDS, malaria, and tuberculosis. The renewed calls for action to raise the priority of chronic non-communicable diseases in global health planning and research are encouraging, however, the authors note. Funding commitments from domestic governments, international funders, nongovernmental organisations, industry, and private philanthropists will be critical, the authors argue, to scaling up access to anti-epileptic medications and building capacity in human resources for epilepsy care in sub-Saharan Africa. A Global Fund for Epilepsy should be established to accelerate support from external funders and coordinate programme development and implementation.
This retrospective study of the introduction of district-wide community-level malaria rapid diagnostic test (RDT) was conducted in Livingstone District, Zambia, to assess its impact on malaria reporting, incidence of mortality and on district anti-malarial consumption. Reported malaria declined from 12,186 cases in the quarter prior to RDT introduction in 2007 to an average of 12.25 confirmed and 294 unconfirmed malaria cases per quarter over the year to September 2009. Consumption of artemisinin-based combination therapy (ACT) dropped dramatically at all levels, but remained above reported malaria, declining from 12,550 courses dispensed by the district office in the quarter prior to RDT implementation to an average of 822 per quarter over the last year. From these results, it’s clear that RDT introduction led to a large decline in reported malaria cases and in ACT consumption in Livingstone district. Reported malaria mortality declined to zero, indicating safety of the new diagnostic regime, although adherence and/or use of RDTs was still incomplete. However, a deficiency is apparent in management of non-malarial fever, with inappropriate use of a lowc-ost single dose drug, SP, replacing ACT. While large gains have been achieved, the authors conclude that the full potential of RDTs will only be realised when strategies can be put in place to better manage RDT-negative cases.