The aim of this paper is to examine the interactions of neglected tropical disease (NTD) control programmes and general health services, focusing particularly on sub-Saharan African countries and reviewing related studies. The authors found that NTDs affect the poorest communities, which are served by the weakest health systems. Further findings suggest that the strategy of integrated control at the community level offers opportunities for enhanced cost-effectiveness and feasibility in low-resource settings, with managers of disease control programmes playing a crucial role in assessing progress. Co-ordinated efforts based on a coherent overall policy, managerial and administrative vision, and a long-term view are required. The article concludes that NTD campaigns have the potential to enhance some elements of the general health services. These may include the health information system, the drug procurement system, the health workforce and the community volunteers. On the other hand, NTD campaigns are at risk of inducing negative effects on health systems. These can be categorised as duplications, distortions and interruptions. As a result, detailed follow-up and documentation of how NTD campaigns and general health services interact is essential, the paper concludes.
Equitable health services
This field study investigated the potential stress-reducing effects of exposure to real or artificial nature on patients in a hospital waiting room. Additionally, it was investigated whether perceived attractiveness of the room could explain these effects. In this between-patients experimental design, patients were exposed to one of the following: real plants, posters of plants, or no nature (control). These conditions were alternately applied to two waiting rooms. The subjects consisted of 457 patients (60% female and 40% male) who were scheduled for various health services, such as echocardiogram and x-ray. Patients exposed to real plants, as well as patients exposed to posters of plants, report lower levels of experienced stress compared to the control condition. Further analyses show that these small but significant effects of exposure to nature are partially mediated by the perceived attractiveness of the waiting room. In conclusion, natural elements in hospital environments have the potential to reduce patients' feelings of stress. By increasing the attractiveness of the waiting room by adding either real plants or posters of plants, hospitals can create a pleasant atmosphere that positively influences patients' well-being.
The authors of this study conducted an external quality assessment of laboratories in Africa that routinely investigate epidemic-prone diseases. Since 2002, three surveys comprising specimens and questionnaires associated with bacterial enteric diseases, bacterial meningitis, plague, tuberculosis and malaria have been sent annually to test participants’ diagnostic proficiency. Identical surveys were sent to referee laboratories for quality control. The authors found that between 2002 and 2009, participation increased from 30 to 48 Member States of the World Health Organisation and from 39 to 78 laboratories. Results of performance evaluations were mixed. Laboratories correctly identified bacterial enteric diseases and meningitis components 65% and 69% of the time, respectively, but their serotyping and antibiotic susceptibility testing and reporting were frequently unacceptable. Microscopy was acceptable for 73%, with tuberculosis microscopy excelling, as 87% of responses received acceptable scores. In the malaria component, 82% of responses received acceptable scores for species identification but only 51% of parasite quantitation scores were acceptable.
Eye injuries that occur in the workplace are more common in developing countries like South Africa where appropriate eye protection might be lacking. The purpose of this paper is to assist the occupational health care provider to correctly assess damage to the eye and interpret the findings to make a diagnosis and appropriate decisions for primary care. The authors argue that examination of the eyes by health-care doctors and nurses should be systematic, assessing all the structures in order to determine appropriate treatment and referral. The most urgent condition is a chemical burn in which minutes matter and immediate irrigation can prevent long-term vision loss. Lid lacerations are usually easy to identify but penetrating globe injuries or intraocular foreign bodies may be missed and result in permanent loss of vision and disability. Many injuries can be adequately managed by primary care health workers, either medical doctors or nurses, and do not require referral, the authors conclude.
The main goal of this study was to provide robust empirical evidence on the causal link from national levels of health system coverage to population outcomes. The authors assembled annual data for the period 1995-2008 encompassing 153 developing and developed countries. Taken together, the results strongly indicate that expansions in health system coverage lead, on average, to improved general population health. Higher government health spending per capita is consistently found to reduce both child and adult mortality rates, the authors argue. The estimated gains are the largest when under-five mortality is examined and are larger for low- and middle-income countries than in the full sample. Based on the results for under-five mortality and public health spending, the implied marginal cost of saving a year of life is just around US$1,000 in the full sample of countries. For the average country, pre-paid public spending seems more effective in reducing mortality than prepaid private insurance funds. Higher immunisation coverage was also found to decrease mortality rates.
In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. In this literature review, researchers conducted a systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. Social class was determined by patient's income, education or occupation. Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. The researchers found that the literature on the social gradient in doctor-patient communication that was published in the last decade addresses new issues and themes. Firstly, most of the found studies emphasise the importance of the reciprocity of communication. Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. By increasing the doctors' awareness of differences in communication and by empowering patients to express concerns and preferences, a more effective communication could be established, the researchers conclude.
This article reports on health centres in Arua district, at Entebbe hospital and Jinja referral hospital in Uganda that were paralyzed after the facility ran short of water, displacing patients to other services. The author argues that frequent load shedding and water shortages have had devastating effects on health service ability to deliver adequate care. The author argues that government should reconstruct wrecked health facilities, and construct more new bore holes and water storage tanks, and provide standard by power sources like solar energy and generators for emergencies cases.
This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The clinics provide basic HIV, TB STI and pre-natal services. The researchers found that in the project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. The mobile clinics provide services for people who otherwise may not have attended a health centre. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programmes.
This report aims to present the evidence that supports the case for expanded access to cancer care and control (CCC) in low and middle income countries (LMICs), and describe innovative models for achieving this goal. The document summarises information from 56 countries. The report emphasises that innovation in delivery systems, increased access to affordable vaccines and medications, innovative financing mechanisms to make care accessible and affordable are of great importance in terms of CCC. The authors call for promoting prevention policies that reduce cancer risk, mobilising all public and private stakeholders in the cancer arena, and expanding training opportunities for researchers in LMICs. They recommend that national cancer control programmes in LMICs must work systematically to adapt global guidelines for national cancer prevention, treatment, and palliation programmes. Also, they must strengthen procurement and distribution systems and ensure regulation of quality and safety. Cancer detection and treatment should be made more accessible and affordable through diagnostic tests and medications that are more easily delivered in remote settings. Governments must expand access across the cancer care control continuum through universal financial protection for health, and efficient use of all levels of care.
For many decades, the cornerstone of malaria management in Africa was to treat all febrile children with chloroquine. With high-level resistance to chloroquine and improved means of malaria diagnosis, recommendations for the management of malaria in Africa have changed in two important ways in the last few years. First, recommended therapy for uncomplicated falciparum malaria has moved to highly effective artemisinin-based combination therapies. Second, it is now recommended that the treatment of malaria be confined to parasitologically confirmed cases. This recommendation requires the availability of reliable diagnostic tests. The gold standard test for the diagnosis of malaria is microscopy. Evaluation of Giemsa-stained thick smears, when performed by expert microscopists, provides accurate diagnosis of malaria, although assuring expert slide preparation and reading can be difficult. Indeed, microscopy is often unavailable, especially in rural settings. In this regard, the advent of rapid diagnostic tests (RDTs) for malaria is an important advance. Multiple immunochromatographic tests, incorporating a number of different parasite antigens and produced by many different manufacturers, are now available. At best, these tests offer a simple, fairly inexpensive, and reliable means of diagnosis that can be performed by healthcare workers with limited training. However, concerns with RDTs include potential unreliability because of inconsistent manufacture or poor storage, uncertain supply, and potential misreading of results by unskilled health workers. An additional, generally unappreciated concern when considering RDTs is differences between available tests.