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.
Equitable health services
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.
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.
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.
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.
This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies 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. The review finds that 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.
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
The US House of Representatives passed HR5501, the US Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2008 on April 2 by a vote of 308-116. Amongst other things, the bill: authorises US$50billion for AIDS, TB, and malaria programs including US$9billion for TB and malaria; links AIDS, TB, and malaria programs to broader health and development programs; formalises activities currently operating under the President’s Malaria Initiative which includes a five-year malaria strategy and a malaria coordinator; calls for enhanced coordination within US government agencies in planning and implementing all three disease areas and with other global health and development programs.