In southern coastal Kenya, insecticide-treated bed net use was negligible in 1997-1998 but since 2001, bed net use has increased progressively and reached high levels by 2009-2010 with corresponding decline in malaria transmission. In this study, researchers evaluated the impact of the substantial increase in household bed net use in this area. Compared to 1997-1998, and following more than five years of 60-86% coverage with bed nets, the density, human biting rate and entomological inoculation rate of indoor-resting mosquitoes were reduced by more than 92% for Anopheles funestus and by 75% for An. gambiae. In addition, the host feeding choice of both vectors shifted more toward non-human vertebrates. Besides bed net use, malaria vector abundance was also influenced by type of house construction and according to whether one sleeps on a bed or a mat (both of these are associated with household wealth). Mosquito density was positively associated with presence of domestic animals. The researcher conclude that, while increasing bed net coverage beyond the current levels may not significantly reduce the transmission potential of An. arabiensis, they anticipate that increasing or at least sustaining high bed net coverage will result in a diminished role for An. funestus in malaria transmission.
Equitable health services
This study identified childbirth information needs of Malawian women as perceived by Malawian mothers and midwives in order to design a childbirth education programme. A total of 150 first-time mothers who attended antenatal clinics at selected central, district and mission hospitals were interviewed. Four focus group discussions were conducted with four different types of midwives, followed by individual interviews with midwives in key positions in government and non-governmental organisations. Results indicated the view that the content of the childbirth education programme for pregnant mothers should include: self-care during pregnancy, nutrition during pregnancy, common discomforts of pregnancy, danger signs of pregnancy, sexually transmitted diseases and preparation for delivery. It was also proposed that programmes address possible complications during labour and birth, caesarean birth and non-pharmaceutical pain relief measures in labour, as well as self-care during postnatal period, exclusive breast feeding, care of the newborn baby, danger signs of puerperium, care of the newborn baby and family planning.
The primary aim of this study was to identify progress and challenges in mental healthcare in South Africa, as well as future mental health services research priorities. A systematic literature review of mental health services research was conducted, including studies from January 2000 to October 2010. Hand searches of key local journals were also conducted. Of 215 articles retrieved, 92 were included. The authors found that, while progress in epidemiological studies has been good, there was a paucity of intervention and economic evaluation studies. Most studies reviewed were on the status of mental healthcare services, which indicated some progress in decentralised care for severe mental disorders, but also insufficient resources to adequately support community-based services, resulting in the classic ‘revolving-door’ phenomenon. Common mental disorders remain largely undetected and untreated in primary healthcare. Cross-cutting issues included the need for promoting culturally congruent services, as well as mental health literacy to assist in improving help-seeking behaviour, stigma reduction, and reducing defaulting and human rights abuses. Intervention research is needed to provide evidence of the organisational and human resource mix requirements, as well as cost-effectiveness of a culturally appropriate, task shifting and stepped care approach for severe and common mental disorders at primary healthcare level.
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.
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.