In the crowded wards of African hospitals, coughs and bony bodies tell the story of a deadly return. Tuberculosis (TB), supposedly defeated 40 years ago, is back, riding on the AIDS epidemic, and the world is ill-prepared, says the relief agency Medecins Sans Frontieres (MSF). In its study 'Running out of Breath? TB Care in the 21st Century', MSF's Campaign for Access to Essential Medicines urges a radical rethink of the global approach to the disease. TB kills two million people every year, nearly all in developing countries. Yet TB, if detected early and treated, is curable.
Equity in Health
Rethinking health-care systems: a focus on chronicity
Allotey P, Reidpath DD and Yasin RS: The Lancet 377(9764): 450-451, February 2011
The authors explain how health-care systems are currently facing an increasing burden of chronic disease aggravated by ageing populations, by the continuing risk of infectious diseases and by global pandemics. While the authors welcome the timely present focus on health systems, there are gaps in responding to the burden of chronic disease in developing countries. Discussions to date largely centre on delivering the model of acute-centric care, with some concentration on tackling the weaknesses in the six key components of health systems: service delivery, finance, governance, technologies, workforce, and information; and within the context of universal coverage and equity. Although this approach might be appropriate for acute conditions, and arguably for higher-income countries, the paper argues that it is unaffordable and unsustainable given the increasing burden of chronic disease in low income and middle-income countries. The authors concludes that primary health care approaches might have a better chance of success.
Review of causes of maternal deaths in Botswana in 2010
Ray S, Madzimbamuto FD, Ramagola-Masire D, Phillips R, Mogobe KD et al: South African Medical Journal 103(8): 537-542, August 2013
The objective of this study was to investigate the underlying circumstances of maternal deaths in Botswana. Fifty-six case notes from the 80 reported maternal deaths in 2010 were reviewed. Five clinicians reviewed each case independently and then together to achieve a consensus on diagnosis and underlying cause(s) of death. Results indicated that 60% of deaths occurred in Botswana’s two referral hospitals. Cases in which death had direct obstetric causes were fewer than cases in which cause of death was indirect. The main direct causes were haemorrhage (39%), hypertension (22%), and pregnancy-related sepsis (13%). Thirty-six (64%) deaths were in HIV-positive women, of whom 21 (58%) were receiving antiretroviral (ARV) therapy. Nineteen (34%) deaths were attributable to HIV, including 4 from complications of ARVs. Twenty-nine (52%) deaths were in the postnatal period, 19 (66%) of these in the first week. Case-note review revealed several opportunities for improved quality of care, such as: better teamwork, communication and supportive supervision of health professionals; better supply management; and joint management between HIV and obstetric clinicians. The authors argue that integrating HIV management into maternal healthcare is essential to reduce maternal deaths in the region, alongside greater efforts to improve quality of care to avoid direct and indirect causes of death.
Reviewing efforts to control TB
Global efforts to control rising levels of tuberculosis are not working and more needs to be done to reduce infections from the deadly airborne disease, public health experts said on Tuesday. The World Health Organization (WHO) introduced a strategy in 1993 aimed at halving deaths over the next decade from the contagious illness that kills about 2 million people each year. But researchers at Harvard University in the United States said a decade after the DOTS (Directly Observed Treatment, Short-course) plan was introduced, the global burden of TB continues to rise.
Rheumatology in Africa-challenges and opportunities
Mody G: Arthritis Research & Therapy 19(49), 2017, doi: https://dx.doi.org/10.1186%2Fs13075-017-1259-3
Africa faces many health challenges despite sustained growth and development over the past decade. Contributory factors are the lack of financial resources, an inadequate health professional workforce, a high burden of communicable diseases and an increasing burden of non-communicable diseases. Rheumatology services are limited or non-existent in many parts of sub-Saharan Africa. Over the past decade, partnerships with international academic institutions have resulted in some progress in the training of rheumatologists and health professionals and development of rheumatology services in countries such as Kenya, Nigeria, and Zambia. Basic diagnostic tests, biological agents and arthroplasty are either unavailable or not affordable by the majority of the population. Urbanisation has resulted in a change in the epidemiology of rheumatic diseases with an increase in the prevalence of gout, rheumatoid arthritis, systemic lupus erythematosus, and scleroderma over the past four decades. Future growth of rheumatology services will depend on identifying committed individuals in underserved countries for training and supporting them to educate medical students, physicians, and health professionals in their home countries. The author raises that there is a need to develop models of care using all categories of health workers and identify prevention strategies and cost-effective management programs for low resource settings. Africa affords an opportunity for collaborative research, including genetic and epigenetic studies, to improve regional understanding of many of the rheumatic diseases.
Rich country tsunami response 'pathetic'
The initial response by the world's richest countries to the earthquake and tidal wave disaster in Southern Asia has been pathetic. While many of these countries have poured billions into invading and bringing misery to the people of Iraq, they cannot seem to find anywhere near enough money to seriously help the mainly poor people who have been made destitute by this natural disaster, according to this article on the website of the Socialist Alliance.
Related Link:
* Earthquakes, Tsunamis and Nuclear Testing
http://www.counterpunch.org/rajiva12302004.html
Rich Nations Not Doing Much to Help On Aids
Rich nations have done little to help fight HIV-AIDS, the United Nations's top adviser on AIDS in Africa says. Stephen Lewis, the UN Secretary General's Special Envoy for HIV-AIDS in Africa, said the rich nations were "not serious" when it came to contributions towards the Global Fund to Fight AIDS, TB and Malaria.
Rising child deaths illustrate Southern Africa health crisis
When Dr Keith Bolton treated children in the 1990s, the death of a patient was still relatively infrequent. As head of child health at South Africa's Coronation Hospital in Johannesburg, Bolton saw an average of one child die each week. Now, Bolton and his colleagues see one child die every day. "In the past, death was an uncommon event in children, especially after the newborn period," said Bolton. "Now we've seen a complete reversal of the gains we made in the 1960s, '70s and '80s."
RISING COSTS OF MEDICAL DRUGS IMPACTS ON POOR in Zimbabwe
The cost of health care in Zimbabwe finally went beyond the reach of most people this month when medical drug suppliers and pharmacies hiked prices by more than 1,000 percent, citing an increase by the same margin in import costs.
Risk assessment for COVID‐19 transmission at household level in sub‐Saharan Africa: evidence from DHS
Makinde O; Akinyemi J; Ntoimo L; et al: Genus 77:24, 1-20, 2021
Although household habitat conditions matter for disease transmission and control, especially in the case of COVID-19, inadequate attention is being given to these risk factors, especially in Africa, where household living conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa, using a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018, exploring handwashing and self-isolation capacities and households with elderly persons most at risk of the disease. Handwashing capacity was highest in Tanzania (48%), and lowest in Chad (4%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77%), and lowest in Ethiopia (31%). Senegal had the largest proportion of households with an elderly person (42%), while Angola (16%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. The authors propose from the findings that each country needs to use such information on household risk at population level to shape communication and intervention strategies.