According to this paper, puerperal sepsis is an infection contracted during childbirth and one of the commonest causes of maternal mortality in developing countries, despite the discovery of antibiotics over eighty years ago. Some developing countries have recently experienced increased use of health facilities for labour and delivery care and there is a possibility that this trend could lead to rising rates of puerperal sepsis. Drug and technological developments need to be combined with effective health system interventions to reduce infections, including puerperal sepsis. The authors review health system infection control measures pertinent to labour and delivery units in developing country health facilities. Organisational improvements, training, surveillance and continuous quality improvement initiatives, used alone or in combination have been shown to decrease infection rates in some clinical settings. There is limited evidence available on effective infection control measures during labour and delivery and from low-resource settings. The authors argue that a health systems approach is necessary to reduce maternal mortality and the occurrence of infections resulting from childbirth. Organisational and behavioural change underpins the success of infection control interventions. A global, targeted initiative could raise awareness of the need for improved infection control measures during childbirth.
Equitable health services
Insecticide-treated bed nets are the preeminent malaria control means, although there is no consensus as to a best practice for large-scale insecticide-treated bed net distribution. In order to determine the paramount distribution method, the author of this review assessed literature on recent insecticide treated bed net distribution programmes throughout sub-Saharan Eastern Africa. She included all studies that had taken place in sub-Saharan Eastern Africa, targeted malaria prevention and control, and occurred between 1996 and 2007. Forty-two studies were identified and reviewed. The results indicate that distribution frameworks varied greatly, and so did outcomes of insecticide-treated bed net use. Studies revealed consistent inequities between urban and rural populations, which were most effectively alleviated through a free insecticide-treated bed net delivery and distribution framework. Cost sharing through subsidies was shown to increase programme sustainability, which may lead to more long-term coverage. Thus, distribution should employ a catch up/keep up programme strategy, the author argues. The catch-up programme rapidly scales up coverage, while the keep-up programme maintains coverage levels.
Each year in Sub-Saharan Africa, South Central Asia and Southeast Asia, 49 million women have unintended pregnancies, leading to 21 million unplanned births, 21 million induced abortions (15 million of which are unsafe), 116,000 maternal deaths and the loss of 15 million healthy years of women’s lives. Seven in 10 women with unmet need for modern contraception in the three regions cite reasons for non-use that could be rectified with appropriate methods. In these three regions, the typical woman with reasons for unmet need that could be addressed with appropriate methods is married, is 25 or older, has at least one child and lives in a rural area. In the short term, women and couples need more information about pregnancy risk and contraceptive methods, as well as better access to high-quality contraceptive services and supplies. In the medium term, adaptations of current methods can make these contraceptives more acceptable and easier to use. Investment in longer-term work is needed to discover and develop new modes of contraceptive action that do not cause systemic side effects, that can be used on demand, and that do not require partner participation or knowledge. Overcoming method-related reasons for non-use of modern contraceptives is projected to reduce unintended pregnancy and its consequences by as much as 59% in these regions.
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.
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.