After years of wrangling and debates among African leaders, the movement to end female genital mutilation (FGM) is gaining real momentum, with a new action plan signed in August by the Pan African Parliament (PAP) representatives and the U.N. Population Fund (UNFPA) to end FGM as well as underage marriage. The UNFPA has already trained over 100,000 health workers to deal specifically with aiding victims of FGM, while tens of thousands of traditional leaders have also signed pledges against the practice. In some African countries, girls as young as eleven and twelve are forced to marry much older men, leading to an increase in serious health problems, including cervical cancer and a host of social problems. UNFPA East and Southern Africa Deputy Regional Director Justine Coulson said if the current trend continues, the number of girls under 15 who had babies would rise by a million – from two to three million. There are believed to be at least seven million child brides in Southern Africa alone. While underage marriage and childbirth is a major health risk, the Pan African Parliament UNFPA workshop also heard how FGM had led to an increased likelihood girls and women would be exposed to sexually transmitted diseases such as HIV/AIDS. Globally, an estimated 200 million girls and women alive today have undergone some form of FGM. In Africa, FGM is practiced in at least 26 of 43 African countries, with prevalence rates ranging from 98 percent in Somalia to 5 percent in Zaire. The buy-in of African political leadership is argued to be crucial if this latest move is to succeed, with up to 140 million women and girls in sub-Saharan Africa who’ve been forced to submit to FGM. The aim is to influence people on the ground as well as effect legislation banning the practice. There are no health benefits in the process and it can cause severe bleeding, problems urinating, cysts, infections and a host of childbirth complications. The PAP also agreed to work with the UNFPA in seeking to overturn the practice of marrying off children under the age of sixteen. In June 2016, the UNFPA worked with Southern African Development Community Parliamentary Forum representatives at a meeting in Swaziland which voted through a Model Law on eradicating child marriage.
Equity in Health
In the industrialised North, South Africa is seen as an archetypal medical tourism destination, combining a medical (elective) procedure with related travel and tourism activity. Yet this paper shows that the industry is premised on a highly romanticised and stylised image of South Africa, and most medical tourism to South Africa is not from the North: the Global North generated a total of 281,000 medical travellers between 2009 and 2010, while the Global South was the source of over two million. Most patients were middle-class people from East and West Africa, as well as a growing number of patients from South Africa’s neighbouring countries. In some cases, patients go to South Africa for procedures that are not offered in their own countries. In others, patients are referred by doctors and hospitals to South African facilities. But most of the movement is motivated by lack of access to basic healthcare at home. The total annual spend by medical travellers in South Africa amounts to over R1.5 billion (US$191 million). Of this, over 90% is generated by South-South medical travellers from the rest of Africa, powerfully illustrating the overall economic importance of this form of medical travel. In addition, South Africa has entered into bilateral health agreements with eighteen African countries. The authors call for further research on and policy attention for intra-African medical tourism and migration, which is identified as a growing trend.
Although malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study. A health facility-based, age and location-matched, case–control study of children 6–59 months of age was conducted in four urban and two peri-urban health facilities (HF) of Blantyre city, Malawi. Children with fever who sought care from the same HF were tested for malaria parasites by microscopy and PCR. Those testing positive or negative on both were defined as malaria cases or controls, respectively. A total of 187 cases and 286 controls were studied. In univariate analyses, higher level of education, possession of TV, and electricity in the house were negatively associated with malaria illness; these associations were similar in urban and peri-urban zones. Having travelled in the month before testing was strongly associated with clinical malaria, but only for participants living in the urban zones. Use of long-lasting insecticide nets the previous night was not associated with protection from malaria disease in any setting. In multivariate analyses, electricity in the house, travel within the previous month, and a higher level of education were all associated with decreased odds of malaria disease. Only a limited number of Anopheles mosquitoes were found by aspiration inside the households in the peri-urban areas, and none was collected from the urban households. Travel was the main factor influencing the incidence of malaria illness among residents of urban Blantyre compared with peri-urban areas. Identification and understanding of key mobile demographic groups, their behaviours, and the pattern of parasite dispersal is argued to be critical to the design of more targeted interventions for the urban setting.
PHM has released its yearly update one year after PHA II, held in Ecuador a year ago where the Cuenca Declaration was approved unanimously by 1,400 participants. This update discusses progress in the five year plan adopted in the Cuenca Declaration.
This paper explores community perceptions and experiences related to health and health inequality. The authors conducted 12 focus group discussions and 24 in-depth interviews with community stakeholder groups across six rural sites in Jimma Zone, Ethiopia. Participants described being healthy as being disease free, being able to perform daily activities and being able to pursue broad aspirations. Health inequalities were viewed as community issues, primarily emanating from a lack of knowledge or social exclusion. Poverty was raised as a contributor to poor health that could be overcome through community-level responses. Participants described formal and informal mechanisms for supporting disadvantaged people in form of safety net that provide information and emotional, financial and social support. Understanding community perceptions of health and health inequality can serve as an evidence base for community-level initiatives, including for maternal, new-born and child health.
United States pharmaceutical giant Pfizer announced on Wednesday that it would provide unlimited supplies of the drug Diflucan free of charge to treat HIV/AIDS sufferers in 50 of the world's poorest countries. "This is a lifetime of work not just a one-day press release," Dr Henry McKinnell, Chairman and CEO of Pfizer, said at UN headquarters. "We will continue to work with the UN, the WHO and other international organisations on how public/private partnerships like the Diflucan programme can be most effective."
Delegates attending the second people’s health assembly called for the total abolition of patents on essential medicines. “Patents are shortening the lives of people and is a curse for poor people,” said Dr. Eduardo Espinoza, the former dean of University of El Salvador. “There are two serious concerns about essential medicines. Firstly, it is about their availability. Secondly its affordability,” said Mr. Amitava Guha, a trade union leader from India. “The manifestations of the unfair patent regime are taking a heavy toll on poor people, especially those who are infected and affected with HIV / AIDS,” said Mr. Guha, who currently heads the Federation of Medical Representatives Association of India.
Physical, emotional and sexual abuse of children is a major problem in South Africa, with severe negative outcomes for survivors. This study investigated the prevalence and incidence, perpetrators, and locations of child abuse in South Africa using a multicommunity sample. 3515 children aged 10–17 years (56.6% female) were interviewed from all households in randomly selected census enumeration areas in two South African provinces. Child self-report questionnaires were completed at baseline and at 1-year follow-up (97% retention). Prevalence was 56% for lifetime physical abuse (18% past-year incidence), 36% for lifetime emotional abuse (12% incidence) and 9% for lifetime sexual abuse (5% incidence). 69% of children reported any type of lifetime victimisation and 27% reported lifetime multiple abuse victimisation. Main perpetrators of abuse were reported: for physical abuse, primary caregivers and teachers; for emotional abuse, primary caregivers and relatives; and for sexual abuse, girlfriend/boyfriends or other peers. This is the first study assessing current self-reported child abuse through a large, community-based sample in South Africa. Findings of high rates of physical, emotional and sexual abuse demonstrate the need for targeted and effective interventions to prevent incidence and re-abuse.
Rather than call for a new ‘mega-fund’ for NCDs, the author of this article argues that we need to use the growing focus on NCDS to build a global social movement for Universal Health Coverage (UHC) to address all health needs according to national and local epidemiology and priorities. The UHC movement calls on nations to reform their health plans and financing structures toward access to essential diagnostics, prevention, and treatment for all. Strong equitable health systems are the tipping point for universal health coverage. As demographics change and people with communicable diseases live long enough to develop chronic diseases, a responsive, performance-driven, integrated health systems approach will have the greatest health impact. A strong health system grounded in UHC, working to address NCDs must: be coordinated and integrated to reach people who may otherwise go undetected; deliver integrated care and include all players in the health system; have strong information systems and an educated health workforce; and support local private sector health providers.
This study aimed to examine the longitudinal contributions of four political and socioeconomic factors to the increase in life expectancy in less developed countries (LDCs) between 1970 and 2004. Researchers collected 35 years of annual data for 119 LDCs on life expectancy at birth and on four key socioeconomic indicators: economy, educational environment, nutritional status and political regime. Results showed that the LDCs' increases in life expectancy over time were associated with all four factors. Political regime had the least influence on increased life expectancy in initial years but increased over time, while the impact of the other socioeconomic factors was initially stronger and decreased over time. Though authors argue that socioeconomic factors have strong impact on life expectancy, but the long-term impact of democracy should not be underestimated.