This research sought to establish the efficacy of the current referral system of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. A 100% sample was obtained; 77% of public and 16% of private hospitals have no IC/HC units. Spread of hospitals was disproportionate across provinces. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. In the private hospitals, the mean time to collect was less than an hour. In public hospitals without an ICU, the distance to an ICU was 100 km or less for about 50% of hospitals, and less than 10% of these hospitals were more than 300 km away. For hospitals with units (public and private), the distance to an appropriate hospital was 100 km or less for about 60% of units while for 10% of hospitals the distance was greater than 300 km. For public hospitals without units most patients were transferred by non-ICU transport. In some instances both public and private hospitals transferred ICU patients from one ICU to another ICU in non-ICU transport. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.
Equitable health services
A descriptive, non-interventive, observational study design was used to audit all public and private sector ICUs and HCUs in South Africa to establish the efficacy of the current system of referral of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.
A descriptive, non-interventive, observational study design was used to audit of all public and private sector ICU and high care units in South Africa to determine the national distribution of intensive care unit (ICU)/high care (HC) units and beds. The most compelling conclusion from this study is the need for regionalisation of ICU services in SA.
Based on this scientific information and WHO recommendations of changing to combination therapy, the Ministry of Health has adopted the use of Artemesinin based Combination Therapy (ACT) as 1st line treatment of uncomplicated malaria. There is therefore need to implement a new antimalarial treatment policy using ACTs. The Ministry of Health has developed these guidelines for malaria diagnosis, treatment and prevention with an aim of improving malaria case management by health workers and having a harmonized approach in efforts aimed at the reduction of morbidity and mortality due to malaria.
Adequate ventilation can reduce the transmission of infection in health-care settings. Natural ventilation can be one of the effective environmental measures to reduce the risk of spread of infections in health care. This guideline first defines ventilation and then natural ventilation. It explores the design requirements for natural ventilation in the context of infection control, describing the basic principles of design, construction, operation and maintenance for an effective natural ventilation system to control infection in health-care settings.
The aim of this paper is to examine the interactions of neglected tropical disease (NTD) control programmes and general health services, focusing particularly on sub-Saharan African countries and reviewing related studies. The authors found that NTDs affect the poorest communities, which are served by the weakest health systems. Further findings suggest that the strategy of integrated control at the community level offers opportunities for enhanced cost-effectiveness and feasibility in low-resource settings, with managers of disease control programmes playing a crucial role in assessing progress. Co-ordinated efforts based on a coherent overall policy, managerial and administrative vision, and a long-term view are required. The article concludes that NTD campaigns have the potential to enhance some elements of the general health services. These may include the health information system, the drug procurement system, the health workforce and the community volunteers. On the other hand, NTD campaigns are at risk of inducing negative effects on health systems. These can be categorised as duplications, distortions and interruptions. As a result, detailed follow-up and documentation of how NTD campaigns and general health services interact is essential, the paper concludes.
This pilot study was conducted to investigate the protective effect of three types of Mosquito netting material against the entry of malarial mosquitoes into village houses in Mozambique. A two-step intervention was implemented in which the gable ends of houses (the largest opening) were covered with one of three materials (four year old mosquito bed nets; locally purchased untreated shade cloth or deltamethrin-impregnated shade cloth) followed by covering both gable ends and eaves with material. Mosquito entry rates were assessed by light-trap collection and the efficacy of the different materials was determined. Results showed that houses treated with mosquito netting or the untreated shade cloth had 61.3% and 70% fewer Anostopheles. funestus in relation to untreated houses, but there was no difference in An. funestus in houses treated with the deltamethrin-impregnated shade cloth compared to untreated houses. Houses treated with mosquito netting reduced entry rates of An. gambiae by 84%, whilst untreated shade cloth reduced entry rates by 69% and entry rates were reduced by 76% in houses fitted with deltamethrin-impregnated shade cloth.
The United Nations Economic Commission for Africa (UNECA) and the World Health Organization (WHO) are joining forces to establish an African-owned and -governed initiative to promote innovation for the research and development of pharmaceuticals and other products to meet the health needs of the continent. The African Network for Drugs and Diagnostics Innovation (ANDI) will be based in Ethiopia and will help build research capacity on the continent and link biomedical innovation to development and public health. Overall, ANDI aims to mobilise Africa health research capability, uncapping African health innovation potential and expanding global partnerships and regional collaborations to accelerate the delivery of quality health care in Africa. Specific goals include increasing research and development collaboration among African institutions and countries, and fostering public-private partnerships within Africa to support the development and manufacture of new drugs and health products. It also aims to generate and manage intellectual property, explore innovative mechanisms to encourage and reward local innovation – including research drawing on traditional medicine – and promote long-term economic sustainability by supporting research and development.
Three global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) for 2016-2021 were adopted by the 2016 World Health Assembly, outlining key actions to be undertaken by countries and WHO, along five strategic directions, over the course of the next six years. The HIV strategy aims to achieve "fast-track" targets by 2020 towards ending AIDS by 2030. The hepatitis strategy – the first of its kind - introduces the first-ever global targets, including the target to eliminate viral hepatitis as a public health threat by 2030. For the HIV strategy, a central element for success will be country efforts to implement "Treat All" recommendations.
To detect malaria people might soon be able to chew a stick of gum and swipe it over a magnet or scan a finger with ultra-far infrared light. These are some of the winning proposals for the Bill and Melinda Gates Foundation Grand Challenges awards, which invite researchers to find non-invasive diagnostic alternatives for priority global health conditions such as malaria, tuberculosis and HIV. To date, all commercially available malaria tests require extracting blood, partly because up to now it has been more difficult to detect malaria in other body fluids. Andrew Fung, who is developing the chewing gum test, said: ‘By working in a user's mouth this test will operate at a higher temperature, and millions of microscopic particles will be examined across a small surface area [the gum], increasing the test's sensitivity.’ Winner Lu, from the University of Michigan, is pioneering the infrared option by tapping into body level vibrations rather than testing molecules, making this test highly sensitive too. To date one of the drawbacks of the 60 rapid diagnostic tests currently on the market has been that they are unregulated, so while some are quite sensitive and can provide 95–100% accuracy, others provide far less accurate results.