The cholera epidemic in southern Africa continues to abate, but international and local health authorities stress the need to remain vigilant, the United Nations has reported. There were a total of 4,579 new cases between 3 and 17 April in the nine countries – Angola, Botswana, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe – affected by the often fatal disease since August 2008. During the two weeks preceding 3 April, 6,460 new cases were reported. Authorities warn, however, that cholera could re-appear in the coming one to three weeks, when waters from flooding in the region, which has affected more than 1.2 million people, subside and become stagnant.
Equitable health services
Cholera infection continues to slow in southern Africa, UN says
United Nations: 22 April 2009
Global tuberculosis (TB) report: HIV-related TB deaths higher than past estimates
World Health Organization, 24 March 2009
There were 1.37 million new TB cases in 2007 among HIV-infected people and 456,000 deaths, says a new global TB report by the World Health Organization. One out of four TB deaths is HIV-related, twice as many as previously recognised. Despite an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years, these shocking findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV. According to Dr Margaret Chan, Director-General of WHO, 'We need to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases,' she said.
Health facility-based active management of the third stage of labor: Findings from a national survey in Tanzania
Mfinanga GS, Kimaro GD, Ngadaya E, Massawe S, Mtandu R, Shayo EE, Kahwa A, Achola O, Mutungi A, Stanton C, Armbruster D, Kitua A, Sintasath D and Knight R: Health Research Policy and Systems, 16 April 2009
Haemorrhage is the leading causes of obstetric mortality. Studies show that active management of third stage of labour (AMTSL) reduces post partum haemorrhage. This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Correct practice of AMTSL was observed in only 7% of 251 deliveries. Knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.
Malaria deaths in Zambia down by 66%
Afrique en ligne: 25 April 2009
The World Health Organization (WHO) announced Thursday that Zambia had achieved a major reduction in malaria mortality through accelerated malaria control activities. Malaria deaths reported from health facilities have declined by 66% in Zambia and this result, along with other data, indicates that Zambia has reached the 2010 Roll Back Malaria target of more than 50% reduction in malaria mortality compared to 2000. WHO said Zambia’s efforts would be promoted as a model for other countries to follow. The decline in Zambia was especially steep after 3.6 million long-lasting insecticide nets were distributed between 2006 and 2008. During this period, malaria deaths declined by 47% and nationwide surveys showed that parasite prevalence declined by 53% from 21.8 to 10.2% and the percentage of children with severe anaemia declined by 68% from 13.3 to 4.3%.
Policy characteristics facilitating primary health care in Thailand: A pilot study in a transitional country
Pongpirul Krit, Starfield B, Srivanichakorn S and Pannarunothai S: International Journal for Equity in Health, March 2009
This pilot study in Thailand assessed policies about primary health care (PHC), focusing on how equitably resources are distributed, the adequacy of resources, comprehensiveness of services and co-payment. A questionnaire survey was administered to five policymakers, five academicians and 77 primary care practitioners at a PHC workshop. Responses were consistent: financial resources should be allocated based on different health needs and special efforts must be made to assure PHC to underserved populations. The supply of essential drugs should be adequate, as well, with equitable distribution of services and low out-of-pocket payments. The questionnaire was robust across key stakeholders and feasible for use in transitional or less-developed countries, like those in Africa.
Uganda embraces low-tech test for cervical cancer
Harshbarger R: Women's News, 20 April 2009
Normally, women have to wait a long time for the results of a pap smear. But, in Uganda, a fast, cheap diagnostic test based on vinegar is invigorating the battle against cervical cancer. Health activists are raising money to put it in a mobile clinic and health officials are eyeing a national rollout. A pilot project in Kampala has begun to demonstrate that cervical cancer screening is possible in small health centres. As part of that project, two clinics began screening women with a fast, innovative test that used acetic acid--or vinegar--as the primary active ingredient. The test, called visual inspection with acetic acid (VIA) is reported to not require a pathologist, refrigeration of samples or a microscope. A nurse, midwife, or gynecologist swabs a patient's cervix with acetic acid and then inspects the tissue visually. The author reports that if the cervix has lesions, the tissue turns white.
Implementation of integrated management of childhood illness in Tanzania: Success and challenges
Prosper H, Macha J and Borghi J: Consortium for Research on Equitable Health Systems, 2009
This research report analyses the integrated management of childhood illness (IMCI) policy in Tanzania. Two districts in North-Western Tanzania, Bunda and Tarime, in Mara region, were picked to examine the issues around introduction, planning and implementation by district health managers and at facility levels. The paper found that the percentage in health workers that are trained in IMCI case management varies between districts – Bunda at 44% and Tarime at only 5%. The relatively high levels of training in Bunda might be due to early sensitisation of key actors, a higher health budget per capita, local facilitators and strong external support. However, funding is low and IMCI suffers from poor visibility and challenges of monitoring impact compared to vertical programmes, reducing the potential for attracting donor investment.
Implementing integrated management of childhood illness in Kenya: Challenges and recommendations
Mullei K, Wafula F and Goodman, C: Consortium for Research on Equitable Health Systems, October 2008
This policy brief looks at the challenges of implementing the Integrated Management of Childhood Illness (IMCI) strategy in Kenya. It shows that Kenya has made some progress in rolling out the IMCI strategy; however, implementation remains highly inadequate. The three main challenges to implementation are low training coverage, health workers not following guidelines and barriers to accessing services. These challenges reflect a range of IMCI-specific and broader health system constraints. The authors outline recommendations for increasing IMCI coverage and implementation. They argue that urgent action is needed to review pre-service training, scale up in-service training, address facility-level implementation challenges, improve IMCI supervision and build support for the strategy.
Join the Stop Stock-outs Campaign
Protect access to essential medicines: 2009
Public health facilities in Africa currently stock only about half of a core set of essential medicines, such as those used to treat malaria, pneumonia, diarrhoea, HIV, TB, diabetes and hypertension, which are among the highest causes of death in Africa. The Stop the Stock-outs Campaign is calling on governments and health departments to end stock-outs by providing financial and operational autonomy to the national medicines procurement and supply agency, giving representation of civil society on the board of the agency, ending corruption in the medicine supply chain to stop theft and diversion of essential medicines, providing a dedicated budget line for essential medicines, living up to commitments to spend 15% of national budgets on health care and providing free essential medicines at all public health institutions.
What essential medicines for children are on the shelf?
Robertson J, Forte G, Trapsidac, J and Hillbrand S: Bulletin of the World Health Organization 87(3), March 2009
The objective of this paper was to document the inclusion of key medicines for children in national essential medicines lists (EMLs) and standard treatment guidelines, and to assess the availability and cost of these medicines in 14 countries in central Africa. Surveys were conducted in 12 public and private sector medicine outlets in each country’s capital city. Data was collected on medicine availability on the survey day and on the cost to the patient of the lowest-priced medicine in stock. It found that there was considerable variation in prices, which tended to be higher in retail pharmacies, and the availability of key essential medicines for children was poor. Better understanding of the supply systems in the countries studied and of the pattern of demand for medicines is needed before improvements can be made.