The authors of this study aimed to establish delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya, to determine whether mothers were receiving appropriate delivery care. A hospital-based cross-sectional survey was conducted among 409 mothers who had delivered while in the study area between August and October 2009. A total of 1,170 deliveries were reported, with 51.8% attended by unskilled birth attendants and 11.7% self administered. Mothers who had unskilled birth attendance were more likely to have less than three years of education and more than three deliveries in a lifetime. The authors conclude that, among the mothers interviewed, utilisation of skilled delivery attendant services was still low. They call for cost effective and sustainable measures to improve the quality of maternal health services.
Equitable health services
The objective of this study was to investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. Data on the availability of 30 commonly-surveyed medicines – 15 for acute and 15 for chronic conditions – were obtained from facility-based surveys conducted in 40 developing countries. The researchers found that availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector and the private sector. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups. Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases.
The aim of this study was to assess factors associated with birth-preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda. This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. The authors observed that male involvement in birth preparedness and complication readiness for obstetric emergencies is still low. Individual women, their spouses, their families and their communities need to be empowered to contribute positively to making pregnancy safer by making and implementing a birth plan.
In this literature review, researchers investigated the systems and tools used by public health to generate public health emergency preparedness and response (PHEPR) communications to health care providers (HCPs), and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications. After a systematic review of peer- and non-peer-reviewed literature, they identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. They found that detailed descriptions of PHEPR messaging from public health to HCPs are scarce in the literature and, even when available, are rarely evaluated in any systematic fashion. Only one study compared the effectiveness of the delivery format, device or message itself. To meet present-day and future information needs for emergency preparedness, the authors argue that more attention needs to be given to evaluating the effectiveness of these systems in a scientifically rigorous manner.
The authors of this article argue that surgery can and should be recognised as an important global health intervention. To achieve this goal, they emphasise that it is critical to improve the local surgical capacity in low- and middle-income countries. While the accomplishment of this goal will not be easy it is certainly possible, especially when doctors join forces with providers and policy-makers that set the direction of a public health movement that has seen a dramatic change and increase in its authority over the past decade. The authors call on the World Health Organisation to exercise its leadership in advancing the status of surgical care in global health by organising action plans to meet unmet surgical burdens.
Traditional medicines, including herbal medicines, have been, and continue to be, used in every country around the world in some way. In much of the developing world, a large share of the population rely on these traditional medicines for primary care. The global market for traditional medicines was estimated at US$ 83 billion annually in 2008, with an exponential rate of increase. Traditional medicines are used as prescription or over-the-counter (OTC) medications, as self-medication or self-care, as home remedies, or as dietary supplements, health foods, functional foods, phytoprotectants, and under any of many other titles in different jurisdictions, with only minimal consistency between the definitions of these terms from country to country and significant communication issues as a result. It is difficult to control quality and to ensure safety and efficacy in production of traditional medicines. WHO, in cooperation with the WHO Regional Offices and Member States, has produced a series of technical documents in this field, including publications on Good Agricultural and Collection Practices (GACP) and Good Manufacturing Practices (GMP), along with other technical support, to assist with standardization and creation of high quality products. Regulation of traditional medicines is a complicated and challenging issue as it is highly dependent upon experience with use of these products. Model countries such as China, India, and South Africa present usable templates, as do the guidelines on regulation and registration of traditional or herbal medicines produced in the WHO African, Eastern Mediterranean, and South-East Asian regions and in the European Union.
During 2004-2008, several FIDELIS projects (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) in Tanzania were conducted by the National Tuberculosis and Leprosy Programme to strengthen tuberculosis (TB) diagnostic and treatment services. The authors of this study assessed the duration and determinants of treatment delay among new smear-positive pulmonary TB patients in FIDELIS projects, and compared delay according to provider visited prior to diagnosis. They included 1,161 cases, 10% of all patients recruited in the FIDELIS projects in Tanzania. Median delay was 12 weeks. Compared to Hai district, Handeni had patients with longer delays and Mbozi had patients with shorter delays. Urban and rural patients reported similar delays. In conclusion, half of the new smear positive pulmonary tuberculosis patients had a treatment delay longer than 12 weeks. Delay was similar in men and women and among urban and rural patients, but longer in the young and older age groups. Patients using traditional healers had a 25% longer median delay.
The authors of this study compared medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. Nine studies met the inclusion criteria. Complete abortion was achieved by 86–97% of the women who underwent home-based abortion and by 80–99% of those who underwent clinic-based abortion. Pooled analyses from all studies revealed no difference in complete abortion rates between groups. Serious complications from abortion were rare. Women who chose home-based medical abortion were more likely to be satisfied, to choose the method again and to recommend it to a friend than women who opted for medical abortion in a clinic.
In this paper, using in-depth case studies of Ghanaian and Cameroonian responses, the authors discuss the challenge of developing effective primary and secondary prevention to tackle chronic diseases such as stroke, hypertension, diabetes and cancers. They observe fundamental differences between Ghana and Cameroon in terms of "multi-institutional and multi-faceted responses" to chronic diseases. Whereas Ghana does not have a chronic disease policy, the authors note that it has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. On the other hand, the authors note that Cameroon has a policy on diabetes and hypertension as well as established diabetes clinics across the country and provides training to health workers to improve treatment and education despit lack of community and media engagement. In both countries churches provide public education on major chronic diseases, but neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness. In conclusion, the authors recommend a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. To this end, they outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.
Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual’s acceptance and use of ICTs: usefulness and ease of use. It is evident that more effective use of ICTs as part of e-health initiatives at the rural healthcare centres was seen to be distinctly possible, but only if perceived shortcomings with regard to structural variables were addressed. Especially relevant was better access to more e-facilities, more health-related information made available via ICTs, ongoing ICT skills training programs and policies for improved technology maintenance and support. In conclusion, all structural and psychological factors investigated were seen to impinge to some extent on effective use of ICT applications as e-health solutions in the rural healthcare centres involved in the study. Furthermore, there was a distinct interplay between the various variables, with perceived ICT-related shortcomings having a negative impact on perceived usefulness and ease-of-use variables and thus decreasing the likelihood of effective e-health solutions. This means that to increase effective use of ICTs that form part of e-health initiatives in the healthcare centres, a vital first step is to address reported perceived shortcomings.