This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa. Through a household survey, 5,837 adults were interviewed. Eighty-three per cent of the respondents had used condoms before, of which 38% always used them, 61% used them during the last sexual intercourse and 9% had refused in the past to use them. The analysis indicated that the strongest predictor of condom use was its perceived need, followed by 'knowledge of correct use of condom' and condom availability, as well as being young in age, single and having a higher education. The strongest predictor of condom refusal was shame associated with condoms, as well as lacking knowledge about the use of condoms. The authors conclude that further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms.
Equitable health services
The World Health Organisation’s (WHO) Department of HIV/AIDS has developed public health guidelines, called GRADE, for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines. The development of the guidelines followed the WHO guideline development process, which utilises the GRADE approach. The authors identified, categorised and labelled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication. The paper describes how the researchers dealt with the following challenges: heterogeneous and complex interventions; paucity of trial data; selecting outcomes of interest; using indirect evidence; integrating values and preferences; considering resource use; addressing social and legal barriers; wording of recommendations; and developing global guidelines. In conclusion, the researchers were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development, they recommend.
In this study, researchers consider the contribution by non government organisations (NGOs) towards the control of onchocerciasis (river blindness) in Cameroon, Mali, Nigeria and Uganda. The four case studies presented here illustrate some key contributions the NGOs made to the development of "community directed treatment with ivermectin" -CDTI, in Africa, which became the approved methodology within the African Programme for Onchocerciasis Control (APOC). The partnership between the international, multilateral, government institutions and the NGDO Coordination Group was the backbone of the APOC programme's structure and facilitated progress and scale-up of treatment programmes. Contributions included piloting community-based methodology in Mali and Nigeria; research, collaboration and coordination on treatment strategies and policies, coalition building, capacity building of national health workforce and advocacy at the national and international level. The NGOs used a community-based methodology which was also aimed at strengthening community health systems. The researchers argue that similar partnerships may be useful in other countries affected by onchocerciasis.
NEPAD and the East African Community (EAC) launched the EAC Medicines Registration Harmonisation (MRH) Project on 30 March 2012 in Arusha, Tanzania. The EAC MRH Project will promote the harmonisation of medicines registration in the region, which is expected to allow the public health sector to rapidly access good quality, safe and effective medicines for priority diseases. The EAC Secretariat, working in close collaboration with representatives from the National Medicines Regulatory Authorities (NMRAs) of all five partner states, will implement the project. Partner states agreed to co-operate in the initial stages of the project, including drawing up the draft implementation work plan and budgets, and the draft operational manual. Stakeholders hope that successful implementation of the EAC project will serve as a model for other countries and regions considering harmonised regulations for their populations.
With two decades of research behind it, the "invisible economy" of care is a critical area of scientific enquiry and policy action. However, far from being global, much of the public debate has been limited to advanced industrialised countries. Meanwhile, governments in developing countries - where economic restructuring raises perennial concerns about social reproduction, and women's increasing burdens of unpaid care work - are experimenting with new ways of responding to care needs in their societies. In this book, contributors from a wide range of backgrounds discuss and debate the care economy in the developing world at a moment when existing systems are under strain and new ideas are coming into focus. Empirically grounded case studies of countries as diverse as China, Nicaragua, India and South Africa shed new light both on existing care arrangements and changing policies.
In 2007 Madagascar implemented a sentinel surveillance system for influenza-like illness (ILI) based on data collected from sentinel general practitioners, launching an innovative case reporting system based on the use of cell phones. Encrypted short message service (SMS), which costs less than US$2 per month per health centre, is now being used by sentinel general practitioners for the daily reporting of cases of fever and ILI seen in their practices. To validate the daily data, practitioners also report epidemiological and clinical data (e.g. new febrile patient’s sex, age, visit date, symptoms) weekly to the epidemiologists on the research team using special patient forms. Madagascar’s sentinel ILI surveillance system represents the country’s first nationwide ‘real-time’ surveillance system. The authors of this paper argue that it has proved the feasibility of improving disease surveillance capacity through innovative systems despite resource constraints. They recommend this type of syndromic surveillance for detecting unexpected increases in the incidence of ILI and other syndromic illnesses.
This study was conducted working with community-owned resource persons to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated. the study found that with basic training and supervision, community-owned resource persons successfully provided early diagnosis and treatment and reduced unnecessary consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested before treatment.
This study aimed to compare factors that influence women's choice in contraception and women's knowledge and attitudes towards the intra-uterine device (IUD) and female sterilisation in a high HIV-prevalence setting in Cape Town, South Africa. A quantitative cross-sectional survey was conducted using an interviewer-administered questionnaire amongst 265 HIV-positive and 273 HIV-negative postpartum women. Women's knowledge and attitudes towards long-acting and permanent methods (LAPMs), as well as factors that influence their choice in contraception, were examined. Current use of contraception was found to be high, with no difference by HIV status (89.8% HIV-positive and 89% HIV-negative). Most women were using short-acting methods, primarily the three-monthly injectable. Method convenience and health care provider recommendations were found to most commonly influence method choice. A small percentage of women (6.44%) were using LAPMs (all chose sterilisation). The researchers conclude that poor knowledge regarding LAPMs is likely to be contributing to their poor uptake . They recommend improving contraceptive counselling to include LAPMs and strengthening services for these methods. Given that HIV positive women were found to be more favourable to future use of the IUD, it is possible that there may be more uptake of the IUD amongst these women, they argue.
Pneumonia is a leading cause of morbidity and mortality worldwide. Effective vaccine and non-vaccine interventions to prevent and control pneumonia are urgently needed to reduce the global burden of the disease. In this paper, researchers explore practical strategies and policies for integrating interventions to prevent and treat pneumonia with routine immunisation services, and investigate the challenges involved in such integration. They identify three primary pneumonia prevention and treatment strategies that should be implemented during routine childhood immunisation visits: vaccination of children against the disease, caretaker education and referral of children to medical services when necessary.
The authors of this article argue that a high prevalence of neglected tropical diseases (NTDs) in sub-Saharan Africa promotes susceptibility to the HIV virus and can worsen the clinical course and progression of AIDS. They highlight emerging evidence to provide a scientific rationale for combining treatment programmes for NTDs with programmes for the treatment of HIV andAIDS. They argue that improved NTD control could both decrease susceptibility to HIV infection and improve morbidity levels in seropositive individuals. Improved efficiency and cost- effectiveness of integrating NTD programmes into a wider framework to provide HIV care would require careful co-ordination and collaboration among concerned NGOs, private entities and Ministries of Health. Major stakeholders should be encouraged to establish operational links between HIV and AIDS and NTD activities.