Risk communication guidelines widely used in public health are based on the psychometric paradigm of risk, which focuses on risk perception at the level of individuals. However, infectious disease outbreaks and other public health emergencies are more than public health events and occur in a highly charged political, social and economic environment. This study examines other sociological and cultural approaches from scholars such as Ulrich Beck and Mary Douglas for insights on how to communicate in such environments. It recommends developing supplemental tools for outbreak communication to deal with issues such as questions of blame and fairness in risk distribution and audiences who do not accept biomedical explanations of disease.
Equitable health services
Risk and outbreak communication: lessons from alternative paradigms
Abraham T: Bulletin of the World Health Organization 87(8): 604–607, August 2009
Saving Mothers 2005-2007: Fourth report on confidential enquiries into maternal deaths in South Africa
National Committee on Confidential Enquiries into Maternal Deaths: July 2009
South Africa witnessed a 20% increase in maternal deaths between 2005 and 2007, when compared to the previous three-year period, with HIV and AIDS accounting for 43.7% of all deaths. Almost four (38.4%) out of every 10 deaths were ‘clearly avoidable within the health care system’, according to researchers, which means they could have been prevented with proper care. The report recommends that the department of health addresses maternal deaths by: improving health care provider knowledge and skills in providing emergency care and ensuring adequate screening and treatment of the major causes of maternal death; improving the quality and coverage of reproductive health services, namely contraceptive and termination of pregnancy services; better management of staffing and equipment norms, transport and availability of blood for transfusion; and community involvement and empowerment regarding maternal, neonatal and reproductive health in general.
The quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals
McCord C, Mbaruku G, Pereira C, Nzabuhakwa C and Bergstrom S: Health Affairs 28(5): 876–885, 6 August 2009
When considering the declining quality of emergency obstetrical surgery in Tanzania, lack of access to facilities, not a shortage of qualified staff, is the issue, argues this paper. Five countries in sub-Saharan Africa use non-physicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers (AMOs) – secondary school graduates with several years of medical training – perform most of this type of surgery outside the cities. The researchers compared obstetrical surgery performed by Tanzanian AMOs with surgery performed by medical officers (MOs) – medical school graduates with at least one year of internship and a licence to practice medicine and surgery. They found no significant differences between AMOs and MOs in outcomes, risk indicators or quality of care indicators. With 1,300 AMOs now trained for this kind of surgery, there are enough surgeons to meet the need in Tanzania. But hospitals are widely spaced and transport is difficult, so that fewer than one-third of Tanzanian women in need of major obstetrical surgery make it to a hospital that can do the job.
The whole is greater than the sum of the parts: Recognising missed opportunities for an optimal response to the rapidly maturing TB-HIV co-epidemic in South Africa
Perumal R, Padayatchi N and Stiefvater E: BMC Public Health 9(243): 16 July 2009
Despite widely acknowledged WHO guidelines for the integration of tuberculosis (TB) and HIV services, heavily burdened countries have been slow to implement these and thus significant missed opportunities have arisen. The individual-centred, rights-based paradigm of the national AIDS policy remains dissonant with the compelling public-health approach of TB control. The existence of independent and disconnected TB and HIV services wastes scarce health resources, increases burden on patients' time and finances, and ignores evidence of patients' preference for an integrated service, resulting in ongoing missed opportunities, such as failure to maximise collaborative disease surveillance, voluntary counselling and testing, adherence support, infection control, and positive prevention. The full potential of an integrated TB-HIV service has not been fully harvested. Missed opportunities discount existing efforts in both programmes, will perpetuate the burden of disease, and prevent major gains in future interventions. This paper outlines simple, readily implementable strategies to narrow the gap and reclaim existing missed opportunities.
WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses
World Health Organization: 20 August 2009
This document provides advice to clinicians on the use of the currently available antivirals for patients presenting with illness due to influenza virus infection as well the potential use of the medicines for chemoprophylaxis. While the focus is on management of patients with pandemic influenza (H1N1) 2009 virus infection, the document includes guidance on the use of the antivirals for other seasonal influenza virus strains, and for infections due to novel influenza. WHO recommends that country and local public health authorities issue local guidance for clinicians from time to time that places these recommendations in the context of epidemiological and antiviral susceptibility data on the locally circulating influenza strains. It emphasises that healthy people, namely those without chronic or acute diseases, do not need the antivirals.
Delivering post-rape care services: Kenya’s experience in developing integrated services
N Kilonzo, Theobald SJ, Nyamato E, Ajema C, Muchela H, Kibaru J, Rogena E and Taegtmeyer M: Bulletin of the world Health Organization 87(7): 555–559, July 2009
This paper, covering the period 2002–2008, describes how multisectoral teams at district level in Kenya have provided post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. The paper also found that, between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$27, with numbers increasing each year. Almost half (43%) of these were children younger than 15. The paper outlines how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.
Health problems emerge as thousands are displaced in ethnic clashes in southwestern Kenya
PlusNews: 25 June 2009
At least 6,000 people have been displaced by inter-clan fighting in Kenya's southwestern district of Kuria East, on the Tanzania border, according to humanitarian officials. The Red Cross has provided emergency relief aid for the displaced. The worst affected areas include Wagirabosi/Targai location in Ntimaru Division, inhabited by the Buirege clan; and Girigiri sub-location, and the villages of Nguruna, Getongoroma and Kebaroti in Kegonga Division. The Kenyan Red Cross said there were reports of gunshots along the Nyabasi-Buirege border on 22 June and that attacks and counter-attacks since late May had resulted in the displacement of at least 6,290 people and the burning of 765 homes. According to the Red Cross, health services have taken a knock, as there is no ambulance in Kuria East to support referrals and patients, while water and sanitation facilities remain critical, especially in camps for internally displaced people.
Malaria misdiagnosis in Uganda: Implications for policy change
Nankabirwa J, Zurovac D and Njogu JN: Malaria Journal 8(66), June 2009
This study examines the effectiveness of the current methods for the diagnosis of malaria in Uganda. Diagnosis has mainly been through presumptive management, namely diagnosis on the basis of episodes of fever. However, this paper argues that presumptive management has significantly contributed to the misdiagnosis of malaria. Interviews were conducted with patients at 188 facilities and laboratory samples were taken to assess the accuracy of existing diagnoses. Overall prevalence of malaria was around 24.2%, with a rate of 13.9% in adults and 50.5% for children under five, with 96.2 percent of patients with a positive diagnosis receiving treatment, as well as 47.6% of patients with a negative result. The study authors therefore argue for changes in existing public health policy to include the use of laboratory methods such as microscopy and the introduction of malaria rapid diagnostic tests.
Nurse-driven, community-supported HIV/AIDS treatment at the primary health care level in rural Lesotho: 2006-2008 programme report
Médecins Sans Frontières, 2009
In an effort to tackle the challenges related to a severe shortage of human resources, and geographic and financial barriers, that prohibit patients from accessing care and treatment, a decision was taken to decentralise HIV and AIDS services in Lesotho to the primary health care level. This report outlines the community-based approach to the decentralisation of HIV and AIDS services. The Wellspring of Hope was the first programme in Lesotho to provide HIV and AIDS treatment and care through an entire health service area as a result of this initiative. The report discusses a range of topics: the delivery of HIV and AIDS services, specifically testing and counselling, prevention of mother-to-child transmission and antiretroviral therapy, a nurse-driven approach to the provision of antiretroviral therapy at the community level, and gives activities aimed at health systems strengthening challenges associated with the implementation of this model. This innovative approach has proven to be successful in delivering quality HIV and AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas.
River blindness drug trial launched
PlusNews: 1 July 2009
Researchers are launching a clinical trial with 1,500 people infected with onchocerciasis (river blindness) in Liberia, Ghana and the Democratic Republic of Congo to test a remedy that could help stop transmission. Onchocerciasis is one of the leading causes of blindness in Africa, according to World Health Organization (WHO), and more than 100 million people, mostly in Africa, are at risk of infection, according to WHO, which estimates that there are about half a million people, mostly in Africa, who are blind due to onchocerciasis. The primary prevention method is black fly control, while treatment has been through annual doses of ivermectin, which might successfully treat individuals, but it does not stop the infection from spreading. If adult worms are not killed they continue to lay eggs in the skin and the disease can be passed on. The drug moxidectin is being studied for its potential to kill adult worms carrying the disease and to wipe out the disease in any high-risk area within six years. The upcoming clinical trials are expected to last two and a half years and will cost about US$6 million.