Early identification of tuberculosis (TB) treatment failure using cost effective means is urgently needed in developing nations. The authors of this study set out to describe affordable predictors of TB treatment failure in an African setting by determining the predictors of treatment failure among patients with sputum smear-positive pulmonary TB clinic at Mulago Hospital in Kampala, Uganda. This was an unmatched case control study where fifty patients with a diagnosis of TB treatment failure (cases) and 100 patients declared cured after completing anti-TB treatment (controls) were recruited into the study. Cases were compared with controls to determine predictors of treatment failure. Significant predictors of treatment failure in this study included a positive sputum smear at two months of TB treatment and poor adherence to anti-TB treatment. The authors found that positive sputum smear at two months of TB treatment and poor adherence to anti TB treatment were reliable and affordable predictors of TB treatment failure. These predictors may be used in resource-limited settings for early recognition of those at risk and early intervention, they conclude.
Equitable health services
In this study, researchers prospectively assessed the functional impairments and rehabilitation needs of Africans admitted to a regional trauma centre in Ghana. It also acts as a pilot study to demonstrate the practical use of the Language Independent Functional Evaluation (L.I.F.E.) software in an acute hospital setting. A five-page questionnaire was used to gather demographic data, cause of disability/injury, severity of disability or functional impairment, and rehabilitation treatment received. Functional status on discharge was evaluated with the L.I.F.E. scale. A total of 84 consecutive consenting subjects were recorded. The predominant disability/injury of respondents involved the lower extremities (70%), followed by upper extremities (23%). The mechanisms of injury were largely related to auto accidents (69%). Falls made up 17% of these injuries and 14% were related to violence. Eleven subjects had disability measured using L.I.F.E and all were classified as having major disabilities. Only 14 patients (17%) received any rehabilitation therapy which consisted of only physical therapy provided at a frequency of once a day for less than one week duration. The researchers found that most persons admitted to a sophisticated trauma unit in Ghana are discharged without adequate rehabilitation services, and that the level of disability experienced by these people can be measured, even while they are still sick and in the hospital, using L.I.F.E. The researchers call on African trauma units to measure the long-term outcomes from their treatments and provide the inpatient medical rehabilitation services that are a standard of care for trauma victims elsewhere in the world.
The Global Immunisation Vision and Strategy (GIVS 2006-2015) aims to reach and sustain high levels of vaccine coverage, provide immunisation services to age groups beyond infancy and to those currently not reached, and to ensure that immunisation activities are linked with other health interventions and contribute to the overall development of the health sector. The objective of this study was to examine mid-term progress (through 2010) of the immunisation coverage goal of the GIVS for 194 countries or territories with special attention to data from 68 countries which account for more than 95% of all maternal and child deaths. The study presents national immunisation coverage estimates for the third dose of diphtheria and tetanus toxoid with pertussis (DTP3) vaccine and the first dose of measles-containing vaccine (MCV) during 2000, 2005 and 2010. Results show that globally DTP3 coverage increased from 74% during 2000 to 85% during 2010, and MCV coverage increased from 72% during 2000 to 85% during 2010. A total of 149 countries attained or were on track to achieve the 90% coverage goal for DTP3 (147 countries for MCV coverage). The researchers conclude that progress towards GIVS goals highlights improvements in routine immunisation coverage, yet they voice concern that some priority countries showed little or no progress during the past five years. These results highlight that further efforts are needed to achieve and maintain the global immunisation coverage goals.
This statement was delivered at the World Conference on Social Determinants of Health, held from 19-21 October 2011 in Rio de Janeiro, Brazil. According to Kenya’s Minister for Public Health and Sanitation, there are a number of steps that the Kenyan government has taken to reduce inequities in health. In 201 out of the country’s 210 constituencies, a model health facility is being constructed, with an additional 50 health workers employed per constituency, totaling 12,000 additional health workers. The Community-led Total Sanitation (CLTS) project for urban areas is also being rolled out, with government aiming at attaining full coverage by 2013. The Health Sector Service Fund has also been established, through which funds are being disbursed directly to health facilities that are run by local committees, and intersectoral co-ordinating mechanisms for thematic areas like child health, sanitation and malaria have been created. However, the Minister identified challenges in providing universal access to health services, including inadequate funding to the health sector, the influx of refugees from neighbouring countries with weak health systems, high levels of rural-urban migration, the emerging threat of non-communicable diseases, and hard-to-reach terrains which hinder access to health facilities. With regards to the medical brain drain, the Minister urged the developed countries that are the major beneficiaries of health worker migration to support training of health workers in developing countries.
An ongoing Phase 3 study of the efficacy, safety and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries, including Ghana, Kenya, Malawi, Mozambique and Tanzania. From March 2009 through January 2011, 15,460 children were enrolled in two age categories - 6 to 12 weeks and 5 to 17 months old - for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. After 250 children had an episode of severe malaria, researchers evaluated vaccine efficacy in both age categories. Vaccine efficacy in the combined age categories was 34.8% during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalised convulsive seizures after vaccination was 1.04 per 1,000 doses. The researchers conclude that the RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children.
The authors of this paper argue that the importance of strong health care systems to fragile nations and the damage done to these systems during conflict receive less attention than they should. They note that the impact of the cycle of violence and poverty on health and health care in fragile states is enormous, to the extent that no low-income fragile or conflict-affected country has yet achieved a single Millennium Development Goal. Although the international community spends billions of dollars each year in aid to these nations, gains have generally been small – without infrastructure and stability, much of this aid is wasted. In conclusion, the authors argue that adequate and equitable provision of quality health care will be met only if health systems and structures are preserved and developed, and if health care personnel have the freedom and safety to provide necessary care to those who need it.
The purpose of this paper was to assess the epidemiology of endemic health care-associated infection (HAI) in Africa. Three databases (PubMed, the Cochrane Library, and the WHO regional medical database for Africa) were searched, of which 19 articles were included in this study, and four abstracts of leading international infection control conferences were also included. The hospital-wide prevalence of HAI varied between 2.5% and 14.8%; in surgical wards, and the cumulative incidence ranged from 5.7% to 45.8%. The largest number of studies focused on surgical site infection, whose cumulative incidence ranged from 2.5% to 30.9%. Data on causative pathogens were available from a few studies only and highlighted the importance of Gram-negative rods, particularly in surgical site infection and ventilator-associated pneumonia. The authors note that limited information is available on the endemic burden of HAI in Africa, even though its frequency is much higher than in developed countries. There is an urgent need to identify and implement feasible and sustainable approaches to strengthen HAI prevention, surveillance and control in Africa.
To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, the university has developed a demand and supply side strategy by working with local communities and national stakeholders. This quasi-experimental trial was conducted in two districts in Eastern Uganda. The supply side component included health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involved vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery and postnatal care. Analysis from routine health information systems showed that motorcyclists in the community organised themselves to accept vouchers in exchange for transport for maternal care and have become actively involved in ensuring that women obtain care. Maternal care improved, with the number of safe deliveries in the intervention area immediately jumping from less than 200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues were used to obtain needed supplies and to pay health workers, ensuring their availability at a time when workloads are increasing. The researchers conclude that transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care.
This briefing paper provides an overview of existing literature on the mental health effects of sexual violence and rape, a summary of effective interventions, and outlines a brief research agenda for mental health responses to sexual violence in resource-poor settings. The authors found that, in resource-poor settings, most efforts to strengthen responses to survivors of sexual violence have so far focused on the training of specialised staff based in hospitals or crisis centres who administer limited services – immediate care and a forensic exam – before referring patients to mental health practitioners or social workers for mental health interventions, if the latter are available. Most therapies and treatments for mental health problems have been implemented in the developed world and may require multiple counselling sessions over the long-term with professional staff, but developing countries generally lack capacity to provide psychological interventions. Of the various approaches, evidence consistently points to cognitive behavioural therapies as being more effective in reducing symptoms of post-traumatic stress than counselling. Sexual violence is an under-researched area across the globe but there is a particular lack of research from resource poor countries on the mental health aftermath of sexual violence. The authors call for further research, providing a basic research agenda at the end of the paper.
In this study, researchers examined the factors associated with use of nets owned in Ghana. The data was derived from an August 2008 survey in Ghana of households with a pregnant woman or a guardian of a child under five, conducted during the rainy season. A total of 1,796 households were included, which generated a sample of 1,852 mosquito nets. The final multivariate model consisted of ten variables statistically associated with whether or not the net was used the prior night: rural location, lower socio-economic status, not using coils for mosquito control, fewer nets in the household, newer nets and those in better condition, light blue colour, higher level of education of the guardian of the child under five, knowing that mosquitoes transmit malaria, and paying for the net instead of obtaining it free of charge. The results of this study suggest that net use would increase in Ghana if coloured nets were made available in mass distributions as well as in the commercial market; if programmes emphasise that malaria is caused only by night-biting mosquitoes, and that nets protect against mosquitoes better than coils and need to be used even if coils are burning; if donated nets are replaced more frequently so that households have nets that are in good condition; and if there were support for the commercial market so that those who can afford to purchase a net and want to choose their own nets can do so.