This paper seeks to determine the prevalence of chronic respiratory diseases in urban and rural Uganda and to identify risk factors for these diseases. The population-based, cross-sectional study included adults aged 35 years or older. All participants were evaluated by spirometry according to standard guidelines and completed questionnaires on respiratory symptoms, functional status and demographic characteristics. The presence of four chronic respiratory conditions was monitored: chronic obstructive pulmonary disease, asthma, chronic bronchitis and a restrictive spirometry pattern. The age-adjusted prevalence of any chronic respiratory condition was 20.2%; the age-adjusted prevalence of chronic obstructive pulmonary disease was significantly greater in rural than urban participants, whereas asthma was significantly more prevalent in urban participants: 9.7% versus 4.4% in rural participants. The age-adjusted prevalence of chronic bronchitis was similar in rural and urban participants, as was that of a restrictive spirometry pattern. For chronic obstructive pulmonary disease, the population attributable risk was 51.5% for rural residence, 19.5% for tobacco smoking, 16.0% for a body mass index over 18.5 kg and 13.0% for a history of treatment for pulmonary tuberculosis. The prevalence of chronic respiratory disease was high in both rural and urban Uganda.
Equity in Health
This paper reports on the prevalence of latent tuberculosis infection (LTBI) and risk factors for a positive tuberculin skin test (TST) among gold miners in South African gold mines. Among 429 participants, the estimated prevalence of LTBI was 89%; 45.5% of HIV-positive participants had a zero TST response compared to respectively 13% and 13.5% in the HIV-negative and status unknown participants. In participants with TST > 0, there was no significant difference between size of response by HIV status. Factors independently associated with a TST < 10 mm were positive HIV status and not working underground. The authors conclude that the prevalence of LTBI is very high in gold miners in South Africa. HIV-infected individuals are more likely to have a negative TST, but HIV infection does not affect the size of TST response.
This report provides an overview of progress in implementing the action plan for the global strategy for the prevention and control of non-communicable diseases since its endorsement by the Sixty-first World Health Assembly in May 2008. The action plan aims to: map the emerging epidemics of non-communicable diseases and analyse their social, economic, behavioural and political determinants; reduce the level of exposure of individuals and populations to the common modifiable risk factors; and strengthen health care for people with non-communicable diseases by developing evidence-based norms, standards and guidelines for cost-effective interventions and by orienting health systems to respond to the need for effective management of diseases of a chronic nature. The plan covers six objectives, each with two sets of proposed actions, for member states and international partners, and one set of actions for the WHO Secretariat. Its implementation is to be reviewed at the end of the first biennium.
Health security must be addressed with great urgency, and health-system strengthening is one of the surest routes to health security. We are not secure when the difference in life expectancy between the poorest and the richest countries exceeds 40 years, or when annual governmental expenditure on health ranges from US$20 per person to well over $6000. We are not secure when more than 40% of the population in sub-Saharan Africa is living on less than a dollar a day. Medicine has never before possessed such sophisticated treatments and procedures for curing disease and prolonging life. Yet, each year, nearly 10 million young children and pregnant women have their lives cut short, largely by preventable causes. Economic development will not automatically protect people who are poor or guarantee universal access to health care. Health systems will not automatically gravitate toward greater fairness and efficiency. International trade and economic agreements will not automatically consider effects on health. Deliberate policy decisions are needed in all these areas.
Health security must be addressed with great urgency, and health-system strengthening is one of the surest routes to health security. The world is not secure when the difference in life expectancy between the poorest and the richest countries exceeds 40 years, or when annual governmental expenditure on health ranges from US$20 per person to well over $6000. It is not secure when more than 40% of the population in sub-Saharan Africa is living on less than a dollar a day. We will not be able to reach the health-related MDGs unless we return to the values, principles, and approaches of primary health care. There are striking inequities in health outcomes, access to care, and what people pay for care. Many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet people's needs and expectations.
Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.
The growing global burden of non-communicable diseases (NCDs) is now killing 36 million people each year and needs urgent and comprehensive action, according to this article. The authors provide an overview of key critical issues that need to be resolved to ensure that recent political commitments are translated into practical action. These include categorising and prioritising NCDs in order to inform external funding commitments and priorities for intervention, and finding the right balance between the relative importance of treatment and prevention to ensure that responses cover those at risk in addition to those who are already sick. Governments should also define the appropriate health systems response to address the needs of patients with diseases characterised by long duration and often slow progression, and address research needs, in particular translational research in the delivery of care, as well as ensure sustained funding to support the global NCD response.
Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities. We recommend that highest priority be given to research in five general areas; described in detail in this article.
Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organisation (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. This report analysed the experiences of cities in implementing Urban HEART to inform how the tool could support local stakeholders better in addressing health inequities. Independent evaluations were conducted in 2011–12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues.
This paper assesses the patterns and levels of physical intimate partner violence (PIPV) against women and its association with problem drinking of their sexual partners in a nationwide survey in Uganda. The data came from the women's dataset in the Uganda Demographic and Health Survey of 2006. Results show that 48% of the women had experienced PIPV while 49.5% reported that their partners got drunk at least sometimes. The prevalence of both PIPV and problem drinking significantly varied by age group, education level, wealth status, and region and to a less extent by occupation, type of residence, education level and occupation of the partner. Women with a higher wealth status or education level were less likely to experience violence. Women whose partners got drunk often were six times more likely to report violence compared to those whose partners never drank alcohol. The authors conclude that problem drinking among male partners is a strong determinant of PIPV among women in Uganda. PIPV prevention measures should address reduction of problem drinking among men. Long-term prevention measures should address empowerment of women including ensuring higher education, employment and increased income.