Some 35% of antimalarial drugs sold in six major African cities failed basic quality tests. The cities were in Ghana, Kenya, Nigeria Rwanda, Tanzania and Uganda. Artemisinin monotherapies, which the World Health Organisation explicitly rejects as substandard, remain common in Africa. Substandard antimalarial drugs cause an estimated 200,000 avoidable deaths each year.
Equitable health services
One in three malaria drugs failing in Africa
Health-e, 6 May 2008
Referral pattern of patients received at the national referral hospital: Challenges in low-income countries
Mbembati NAA, Museru LM, Lema LEK: East African Journal of Public Health 5(1), May 2008
The study aimed to examine the medical referral pattern of patients received at the Muhimbili National Hospital (MNH) in Tanzania to inform the process of strengthening the referral system. This prospective study was conducted at MNH during a 10-week study period from January to March 2004. The study sample consisted of patients referred to MNH. Of the 11,412 patients seen, 72.5% were self-referrals. More than 70% of the patients seen required admission, though not necessarily at tertiary level. Only 0.8% came from outside the Dar es Salaam region. More than 70% of the patients seen required admission. Surgical services were required by 66.8% of patients, with obstetric conditions being most prominent (24.6% of all patients). For those who were formally referred from other health services, lack of expertise and equipment were the most common reasons given for referral (96.3%). Efforts to improve referral systems in low-income countries require that the primary and secondary level hospitals services be strengthened and increased to limit inappropriate use of national referral hospitals.
Vaccine fund spending US$500m on ‘innovative’ health systems
Real Health News, 14 May 2008
The US$ multi-billion a year GAVI Alliance is spending a fraction of its budget to help its vaccines get to the end of the track, by strengthening health systems in a group of countries in central America, Africa and Asia. GAVI provides support directly to country governments, not through other agencies. Also its large budget and global nature encourages vaccine manufacturers to take a positive view of developing country markets – and thus add relevant, affordable products to their portfolios.
A comparison of the behavioral and emotional disorders of primary school-going orphans and non-orphans in Uganda
Musisi S, Kinyanda E, Nakasujja N, Nakigudde J: African Health Sciences 7(4): 202-213
The authors investigated the emotional and behavioral problems of orphans in Rakai District, Uganda and suggested interventions. Most lived in big poor families with few resources, faced stigma and were frequently relocated. Community resources were inadequate. Compared to non-orphans, more orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy, insecure, poor, exploited, abused or neglected. Most lived in poverty with elderly widowed female caretakers. But they showed high resilience in coping. To comprehensively address these problems, we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families, a National Child Protection Agency for all Children, Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children.
A review of internal medicine re-admissions in a peri-urban South African hospital
Stanley A, Graham N, Parrish A: South African Medical Journal 98(4):291-294, 2008
The re-admission rate and the number of preventable re-admissions in a secondary-level South African hospital were measured to identify factors predictive of re-admission. The admission register for the medical wards at Cecilia Makiwane Hospital (CMH) was used to identify re-admitted patients, whose folders were then reviewed. A comparison group of patients who were not re-admitted was randomly generated from the same register. One in twelve general medical patients was readmitted. Chronic diseases and inadequate patient education and discharge planning accounted for the largest group of re-admissions in older patients. Re-admission of HIV/AIDS patients has generated a second peak in younger individuals, and the impact of the antiretroviral roll-out on admission rates warrants further scrutiny.
Global tuberculosis control: Surveillance, planning, financing: TB remains a major cause of illness and death worldwide
World Health Organization, 2008
This report on global tuberculosis (TB) control compiles data from over 200 countries to monitor the scale and direction of TB epidemics, implementation and the impact of the Stop TB Strategy. Whilst there has been progress in HIV testing among TB patients, implementation of interventions to reduce the burden of TB in HIV-positive people is far below the targets set in the Global plan in 2006. Overall, there are several signs that global progress in TB control is slowing and that there are parts of the world where much more needs to be done to achieve the global targets that have been set. The report recommends that renewed effort to increase the rate of progress in global TB control in line with the expectations of the Global Plan, backed up by intensified resource mobilisation from domestic and international donors, is required.
Guidelines and mindlines: Why do clinical staff over-diagnose malaria in Tanzania? A qualitative study
Chandler CIR, Jones C, Boniface G: Malaria Journal 7: 53, 2 April 2008
Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the variety of social influences into account.
Implementing primary health care in Africa: challenges and recommendations
Regional Office for Africa, World Health Organisation, 2008
This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies the strategic interventions required to cope with the new challenges facing the health systems in the 21st century. The review addresses PHC policy formation and implementation, the resources that are available for PHC implementation, monitoring and review. PHC policy formation had been well articulated in the national health policies by most countries, however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will. The key recommendations of the review include to: harmonise health sector reforms with PHC to ensure that initiatives promote equity and quality in health services; improve the fairness of financing policies and strategies and service coverage for the poor; support countries to address their particular human resource needs through clear articulation of human resources policies, plans, development and strengthening of national management systems and employment policies; support countries to identify and put in place mechanisms for attracting and retaining health personnel.
Key issues in clinic functioning – a case study of two clinics
Couper ID, Hugo FM, Tumbo JM, Harvey BM, Malete NH: South African Medical Journal 97(2): 124-129, 2007
The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management. Data were collected in a government and an NGO clinic in the North West province of South Africa. Key findings included: (i) there are attitudinal differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture. A respectful and caring approach to patients, and an organisational culture which supports and enables staff, can achieve much of this without any additional resources.
Oral health status of school children in Mbarara, Uganda
Batwala, B; Mulogo, EM; Arubaku, W: African Health Sciences 7(4): 232-238
Despite the need for oral health morbidity surveys to aid in reviewing of the oral health services, dental data of Ugandan children is scanty. This paper set out to describe the magnitude and distribution of selected oral health conditions among primary school children in Mbarara, Uganda. The oral hygiene of school children was poor, with high plaque prevalence demonstrating a lack of established oral hygiene practices. A comprehensive community-focused oral health care intervention that includes oral health education in homes and the strengthening of school health programme is needed to improve the oral health status of children in Mbarara.