A cross-sectional study was conducted, based on systematic sampling of consecutive patients with pulmonary tuberculosis (TB) symptoms and who attended the TB clinic for their medication at Ilala District Hospital, Tanzania. Over half the patients (54.3%) admitted that they openly speak about their illness to others but that only one-third (33.3%) of their friends and family responded in a considerate and sympathetic manner. One-third (36.6%) of the friends and relatives became less friendly and the remaining one-third openly portrayed fear and tried to discriminate the patient even after the commencement of medications. The patients' compliance rate was 100%. The counselling received from the health personnel along with the patients' own motivations to improve their health, was the main driving force in seeking treatment and taking daily medication. Discrimination against TB patients by relatives and friends is likely to hinder positive health seeking behaviour and thus impede control of this disease. This paper discusses identified areas where effort is needed to improve the early management of TB patient.
Equitable health services
This research sought to establish the efficacy of the current referral system of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. A 100% sample was obtained; 77% of public and 16% of private hospitals have no IC/HC units. Spread of hospitals was disproportionate across provinces. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. In the private hospitals, the mean time to collect was less than an hour. In public hospitals without an ICU, the distance to an ICU was 100 km or less for about 50% of hospitals, and less than 10% of these hospitals were more than 300 km away. For hospitals with units (public and private), the distance to an appropriate hospital was 100 km or less for about 60% of units while for 10% of hospitals the distance was greater than 300 km. For public hospitals without units most patients were transferred by non-ICU transport. In some instances both public and private hospitals transferred ICU patients from one ICU to another ICU in non-ICU transport. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.
The Klerksdorp/ Tshepong Hospital Complex have introduced an Escorting Project, which will allow nursing assistants to accompany referral patients to Johannesburg hospitals. The project aims to ensure that patients receive quality care and reduce waiting times. The hospital is the largest provincial hospital operating as the referral hospital for Dr K Kaunda District, Ruth Mopati District as well as tertiary services for the entire province. Hospital Chief Executive Officer, Kathy Randeree said that the hospital recently undertook a mini-survey to determine how best to assist patients who are accessing health services in Gauteng Hospitals. She said that the survey recommended the launch of the project with management resolving to have a pool of escorts for Klerksdorp/ Tshepong hospital so that referred patients are able to have the assistance of an allocated escort for the various hospitals and clinics in Gauteng.
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.
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.
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.
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.
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.
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.
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.