The World Health Organization (WHO) today issued new global guidance for the use of insecticide-treated mosquito nets to protect people from malaria. For the first time, WHO recommends that insecticidal nets be long-lasting, and distributed either free or highly subsidized and used by all community members. Impressive results in Kenya, achieved by means of the new WHO-recommended strategy, show that free mass distribution of long-lasting insecticidal nets is a powerful way to quickly and dramatically increase coverage, particularly among the poorest people. This is the first demonstration of the impact of large-scale distribution of insecticide treated mosquito nets under programme conditions, rather than in research settings, where, in different parts of Africa, reduction observed in overall mortality has ranged from 14 % up to 60 %.
Equitable health services
Implementation of known effective interventions could reduce the malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scale-up efforts should be concentrated. They also provide baseline data against which to compare future scale-up of interventions. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes.
This eleventh annual WHO report on Tuberculosis (TB) assesses whether national TB control programmes (NTP) around the world met the 2005 targets of 70 per cent case detection and 85 per cent cure, and examines the effectiveness of the Stop TB strategy. The paper finds that TB is still a major cause of death worldwide, but the global epidemic is on the threshold of decline – in 2005 the TB incidence rate was stable or in decline in all six WHO regions, and had reached a peak worldwide. Most government health services now recognise that TB control must go beyond DOTS (the recommended strategy for controlling TB), however, the broader Stop TB Strategy is not yet fully operational in most countries.
This paper reports on a meeting co-organised by the World Health Organization, UNAIDS and international organisations, to accelerate an effective and joint response to the epidemic of HIV-related tuberculosis (TB). The paper highlights the achievements of the global TB/HIV working group from the Stop TB Partnership, and discusses the concept of universal access to HIV services and its importance and contribution to TB prevention, diagnosis and treatment services. It also highlights some critical issues that have been neglected in the global response to HIV-related TB, including the optimal treatment regimens to use when treating TB and HIV at the same time.
This article reviews the progress made on a three-year tuberculosis (TB)/HIV plan implemented in Malawi between 2003 and 2005. The objectives of the plan were to scale up HIV testing among TB patients and, for HIV-positive TB patients, to provide cotrimoxazole preventive therapy (which provides protection against bacterial infections including pneumonia) and facilitate access to antiretroviral (ARV) treatment. The paper finds that the proportion of TB patients tested for HIV increased from 15 per cent in 2003 to 47 per cent in 2005. During this time, most HIV-positive TB patients started cotrimoxazole preventative therapy.
The level and longevity of protective antibodies elicited by a measles vaccine is significantly shortened by HIV infection in Zambian children. Measles still remains a significant cause of childhood mortality in sub-Saharan Africa despite the availability of a vaccine. Barriers to successful measles control by vaccination include poor logistics and insufficient resources, lack of political will, and HIV/AIDS. Successful measles control in southern Africa with a high HIV prevalence suggests that the HIV epidemic is not a bottleneck to control. The determinants of this success must be identified so that it is replicated in other regions. Specifically, how can a high population immunity be achieved in regions with high HIV prevalence so that measles can be eliminated?
This article reviews how commitments to antiretroviral (ARV) treatment affect tuberculosis (TB) control and sets out the changes needed to address HIV and TB in a coordinated manner. The article examines the burden of HIV and TB in Africa and how the HIV epidemic has challenged the Directly Observed Treatment Strategy (DOTS) as a way of controlling tuberculosis. The authors argue that collaboration between TB and HIV/AIDS treatment programmes is needed, along with a unified public-health vision towards the prevention and treatment of these interacting diseases.
Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.
In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we studied the management of the drug supplies for common and life threatening diseases such as pneumonia and malaria in a random selection of health centres.
In early 2007, the Indonesian government decided to withhold its bird flu virus samples from WHO’s collaborating centers pending a new global mechanism for virus sharing that had better terms for developing countries. The 60th World Health Assembly subsequently resolved to establish an international stockpile of avian flu vaccines, and mandated WHO to formulate mechanisms and guidelines for equitable access to these vaccines. Are there analogous opportunities for study volunteers or donors of biological materials in clinical trials or other research settings to exercise corresponding leverage to advance health equity? This paper will appear in Development in Practice 18(1), February 2008 and also shortly as a UN-DESA working paper.