Despite the need for oral health morbidity surveys to aid in reviewing of the oral health services, dental data of Ugandan children is scanty. This paper set out to describe the magnitude and distribution of selected oral health conditions among primary school children in Mbarara, Uganda. The oral hygiene of school children was poor, with high plaque prevalence demonstrating a lack of established oral hygiene practices. A comprehensive community-focused oral health care intervention that includes oral health education in homes and the strengthening of school health programme is needed to improve the oral health status of children in Mbarara.
Equitable health services
Oral health status of school children in Mbarara, Uganda
Batwala, B; Mulogo, EM; Arubaku, W: African Health Sciences 7(4): 232-238
Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya
Oji Oti S; van de Vijver S; Gomez G; Agyemang C; Egondi T; Kyobutungi C; Stronks K: Bulletin of the World Health Organization 94(7) 501-509, 2016
Cardiovascular diseases are the leading cause of death globally, killing 17.5 million people per year and 80% of deaths from these diseases occur in low- and middle-income countries. Evidence suggests that the main drivers of the global cardiovascular disease epidemic are urbanisation and industrialisation, which lead to an increase in sedentary lifestyles, unhealthy dietary patterns, tobacco consumption and increased alcohol consumption. Hypertension is a leading risk factor for cardiovascular diseases, and its prevalence is increasing worldwide – from 25% in 2000 to a projected 40% in 2025. The rising burden of hypertension in low- and middle-income countries is amplified by the public’s low levels of awareness, treatment and control of this condition, particularly among slum residents, who typically constitute a large portion of neglected urban populations in such settings. Studies in slum populations suggest that when people are made aware of having hypertension they do tend to seek care. However, the level of adherence to treatment for hypertension remains low for several reasons, including, but not limited to, the high costs of treatment and to patients’ perceptions of a low risk of cardiovascular diseases and belief in a one-time cure for disease rather than to lifelong preventive treatment and monitoring. In response to the rising burden of cardiovascular disease risk factors in slum populations in Kenya, a community-based intervention was developed and implemented in the capital city, Nairobi. This intervention, known as SCALE UP (the sustainable model for cardiovascular health by adjusting lifestyle and treatment with economic perspective in settings of urban poverty), has been described in detail elsewhere. The intervention had multiple components with the overall aim of reducing cardiovascular diseases risk through awareness campaigns, improvements in access to screening and standardised clinical management of hypertension. This paper shares experiences of implementing a comprehensive intervention for primary prevention of hypertension in a slum setting and to examine the processes, outcomes and costs of the intervention. It raises lessons for policy-makers and other stakeholders looking to implement similar interventions in highly resource-constrained settings.
Outcomes of antiretroviral treatment programmes in rural Lesotho: Health centres and hospitals compared
Labhardt N, Sello M, Lejone I and Pfeiffer K: Journal of the International AIDS Society 16:18616. November 2013.
Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres HCs) to scale up the provision of antiretroviral therapy (ART). This paper compares outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.
Over diagnosis and treatment of malaria in Kenya
id21 Health News, 21 November 2006
Clinicians often diagnose and treat patients for malaria in Africa when they do not have the disease. Over diagnosis and treatment may be acceptable when the drugs are cheap and safe. However, new more expensive drugs whose side effects are less well known are now being used. Over diagnosis in these circumstances would not be appropriate.
Overcoming the ‘tyranny of the urgent’: integrating gender into disease outbreak preparedness and response
Smith K: Gender and Development 27(2) 355-369, 2019
This article provides a multi-level analysis of gender-related gaps in outbreak responses and illustrates the national and local impacts of failures to challenge gender assumptions and incorporate gender as a priority. The implications of neglecting gender dynamics, as well as the potential of equity-based approaches to disease outbreak responses, is illustrated through a case study of the Social Enterprise Network for Development (SEND) Sierra Leone, a non-government organisation (NGO) based in Kailahun, during the Ebola outbreak. Global policy responses can learn from examples such as SEND Sierra Leone. SEND did not include a gendered approach in its response as an afterthought; it was at the heart of the response because SEND had an established gender strategy. The authors argue that all levels of outbreak response need specific policies to ensure sexual and reproductive health.
Ownership and usage of insecticide-treated bed nets after free distribution via a voucher system in two provinces of Mozambique
De Oliveira AM, Wolkon A, Krishnamurthy R, Erskine M, Crenshaw DP, Roberts J and Saúte F: Malaria Journal 9(222), 4 August 2010
During a national immunisation campaign in Mozambique, vouchers, which were to be redeemed at a later date for free insecticide-treated nets (ITNs), were distributed in Manica and Sofala provinces. A survey to evaluate ITN ownership and usage post-campaign was conducted. Four districts in each province and four enumeration areas (EAs) in each district were selected using probability proportional to size. Valid interviews were completed for 947 of the 1,024 selected households (HHs). HH ownership of at least one bed net of any kind was, in Manica and Sofala respectively, 20.6% and 35.6% pre-campaign and 55.1% and 59.6 post-campaign. The researchers conclude that ITN distribution increased bed net ownership and usage rates. Integration of ITN distribution with immunisation campaigns presents an opportunity for reaching malaria control targets and should continue to be considered.
Packages of care for alcohol use disorders in low- and middle-income countries
Benegal V, Chand PK and Obot IS: Public Library of Science Medicine 6(10), 27 October 2009
Alcohol use disorders (AUDs) – conditions that range from hazardous and harmful alcohol use to alcohol dependence – are a low priority in low- and middle-income countries (LMICs), despite causing a large health burden. Most alcohol-related harm is attributable to hazardous/harmful drinkers who make disproportionate use of primary health care systems, but often go undetected and untreated for long periods, even though brief, easily delivered interventions are effective in this group of people. Health care systems in LMICs currently focus on providing tertiary care services for the treatment of dependence (where there is often a poor outcome). This study indicates that the focus needs to shift towards the cost-effective strategy of providing brief interventions for early AUDs. Effective evidence-based combinations of psychosocial and pharmacological treatments for AUDs are available in LMICs but are costly to implement. Policy makers need to ensure that people with AUDs are offered the most appropriate services using stepped-care solutions that start with simple, structured advice for risky drinkers and progress to specialist treatment services for more serious AUDs. LMICs also need to improve their implementation of proven population-level preventive measures to reduce the health burden due to AUDs. An international Framework Convention on Alcohol Control may help them do this.
Packages of care for attention-deficit hyperactivity disorder in low- and middle-income countries
Flisher AJ, Sorsdahl K, Hatherill S and Chehil S: Public Library Of Science Medicine 7(2), 23 February 2010
Attention-deficit/hyperactivity disorder (AD/HD) is a multidimensional disorder that, although commonest in childhood and adolescence, can be diagnosed across the age span. Worldwide prevalence is about 5%. This study recommends an appropriate package of treatment for AD/HD in low- and middle-income countries (LMICs), which should include screening of high-risk groups, psychoeducational interventions with caregivers, methylphenidate, and behavioural interventions. Strategies to facilitate the delivery of effective interventions in LMICs should increase demand for services, access to AD/HD interventions, and the capacity of health care teams, as well as improve recognition of AD/HD, develop community-based and practice-based programs, and address the impact of AD/HD on other health and social outcomes. Interventions to address AD/HD should be part of a more comprehensive package of services for mental disorders.
Packages of care for dementia in low- and middle-income countries
Prince MJ, Acosta D, Castro-Costa E, Jackson J and Shaji KS: Public Library of Science Medicine 6(11), 3 November 2009
Two-thirds of people with dementia live in low- and middle-income countries (LMICs), where there are few services available and levels of awareness and help-seeking are low. After early diagnosis, the principal goals for management of dementia are optimising physical health, cognition, activity, and wellbeing; detecting and treating behavioural and psychological symptoms (BPSD); and providing information and long-term support to carers. This study recommends that routine packages of continuing care should comprise diagnosis coupled with information, regular needs assessments, physical health checks, and carer support, and where necessary carer training, respite care, and assessment and treatment of BPSD. Care can be delivered by trained primary care teams working in a collaborative care framework. Continuing care with practice-based care coordination, and community outreach are essential components of this model. Efficient care delivery in LMICs involves integrating dementia care with that of other chronic diseases and community-support programmes for the elderly and disabled.
Packages of care for depression in low- and middle-income countries
Patel V, Simon G, Chowdhary N, Kaaya S and Araya R: Public Library of Science Medicine 6(10), 6 October 2009
Depression is clearly a global health priority. Improving the recognition of this disorder in clinical populations in LMICs is aided by the successful adaption of depression-screening instruments from HIC settings into settings with few resources and weaker health systems. This review suggests that evidence-based treatments such as antidepressants and psychotherapy are effective in managing depression; it is important, however, that such treatments are adapted when used in LMICs to increase their acceptability, accessibility, and manage their costs. The review proposes two packages of care on the basis of the availability of mental health specialist resources. The delivery of these treatments should ideally be carried out through an integration of depression programmes into existing health services or community settings with task-shifting to non-specialist health workers to deliver front-line care and a supervisory framework of appropriately skilled mental health workers.