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.
Equitable health services
The purpose of this study was to describe the results of eight human papillovirus (HPV) vaccination programmes conducted in seven lowest-income countries, including Lesotho, through the Gardasil Access Programme (GAP), which provides free HPV vaccines to organisations and institutions working in those countries. The eight programmes initially targeted a total of 87,580 girls, of which 76,983 received the full three-dose vaccine course, with mean programme vaccination coverage of 87.8%, while the mean adherence between the first and third doses of vaccine was 90.9%. Mixed models consisting of school-based and health facility-based vaccinations were found to record better overall performance compared with models using just one of the methods. Increased rates of programme coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year to limit the number of girls lost to follow-up. This study is intended to provide lessons for development of public health programmes and policies as countries go forward in national decision-making for HPV vaccination.
This report highlights the systemic problems that prevent women, men and young people from accessing reproductive health supplies, and provide recommendations on moving forward. The authors call for increased funding for reproductive health and argue that reproductive health must be incorporated into national health plans and budgeted for accordingly. Additionally, governments should create an enabling environment for sexual and reproductive health and rights. The authors make several recommendations for health service provision. Governments should ensure that a wide range of reproductive health supplies are included in the national essential drug list, while health system-strengthening initiatives and national health plans must include provisions for monitoring the distribution of reproductive health supplies. Capacity for quality of care should be built among all health professionals that deliver supplies, including health care providers, pharmacists and nurses, and there should be more investment in adequate storage facilities at national and municipal levels, and implementation of logistics management systems.
This qualitative study explored in detail the ability of output-based aid (OBA) voucher programmes to increase access to gender-based violence recovery (GBVR) services. It was conducted in 2010 and data was gathered through in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five programme sites in Kenya. The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services, such as lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. The researchers also found that accreditation of only hospitals to offer GBVR services undermined access to the services in rural areas, and low provider knowledge on GBVR services and lack of supplies undermined effective provision and management of GBVR services. They argue that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA programme to promote the GBVR services voucher, and conduct widespread community education programmes aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.
Intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. This study was conducted alongside a cluster-randomised trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast. Six out of the 51 schools receiving the IST intervention were purposively sampled, and 22 focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Results showed that the use of alternative anti-malarial drugs with simpler regimens was generally preferred. General consensus was that health workers were best placed to undertake the screening and provide treatment, and although teachers' involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST. Future research should carefully consider the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens.
Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, posing a threat to vulnerable populations and jeopardising progress in combating malaria. In this study, the authors reviewed published and unpublished studies reporting chemical analyses and assessments of packaging of antimalarial drugs. Of 1,437 samples of drugs in five classes from seven countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and 450 (36%) of 1,260 were classified as falsified. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan Africa, 796 (35%) of 2,297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were classified as falsified. Data were insufficient to identify the frequency of substandard (products resulting from poor manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a multifaceted approach are needed to define and eliminate criminal production, distribution, and poor manufacturing of antimalarial drugs. Empowering national medicine regulatory authorities to protect the global drug supply is more important than ever, the authors conclude.
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.
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.