In Tanzania, parents seeking treatment for children with severe, often malaria-related, fever vary in their choice of care. Their choice is influenced by a range of social and cultural factors that need to be better understood if children are to be successfully treated. In urban and peri-urban areas of Tanzania, many parents would prefer to take their children to a biomedical facility. However, opening and closing times are not always convenient. Consequently, parents often have no choice but to seek out a traditional healer who can provide treatment and comfort at more convenient hours.
Equitable health services
Seeking treatment for childhood fevers in Tanzania
Kamat VR: id21 Research Highlight, 18 July 2006
Seen, Heard and Counted: Rethinking Care in a Development Context
Razavi S: United Nations Research Institute for Social Development, April 2012
With two decades of research behind it, the "invisible economy" of care is a critical area of scientific enquiry and policy action. However, far from being global, much of the public debate has been limited to advanced industrialised countries. Meanwhile, governments in developing countries - where economic restructuring raises perennial concerns about social reproduction, and women's increasing burdens of unpaid care work - are experimenting with new ways of responding to care needs in their societies. In this book, contributors from a wide range of backgrounds discuss and debate the care economy in the developing world at a moment when existing systems are under strain and new ideas are coming into focus. Empirically grounded case studies of countries as diverse as China, Nicaragua, India and South Africa shed new light both on existing care arrangements and changing policies.
Sensitivity of hospital-based surveillance for severe disease: A geographic information system analysis of access to care in Kilifi district, Kenya
Moïsi JC, Nokes DJ, Gatakaa H, Williams TN, Bauni E, Levine OS and Scott JAG: Bulletin of the World Health Organisation (89): 102-111, February 2011
The authors of this study set out to explore the relationship between homestead distance to hospital and access to care and to estimate the sensitivity of hospital-based surveillance in Kilifi district, Kenya. In 2002–2006, clinical information was obtained from all children admitted to Kilifi District Hospital and linked to demographic surveillance data. Travel times to the hospital were calculated and the relationships between travel time, cause-specific hospitalization rates and probability of death in hospital were examined. The analysis included 7,200 admissions (64 per 1,000 child-years). Median pedestrian and vehicular travel times to hospital were 237 and 61 minutes, respectively. Hospitalisation rates decreased by 21% per hour of travel by foot and 28% per half hour of travel by vehicle. Distance was positively associated with the probability of dying in hospital. In this setting, hospital utilisation rates decreased and the severity of cases admitted to hospital increased as distance between homestead and hospital increased. Access to hospital care for children living in remote areas was low, particularly for those with less severe conditions. Distance decay was attenuated by increased levels of maternal education. Hospital-based surveillance underestimated pneumonia and meningitis incidence by more than 45% and 30%, respectively, the researchers found.
Service availability and utilisation and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries
Lora A, Kohn R, Levav I, McBain R, Morris J and Saxena S: Bulletin of the World Health Organisation 90(1): 47-54B, January 2012
In this study, researchers set out to outline mental health service accessibility, estimate the treatment gap and describe service utilisation for people with schizophrenic disorders in 50 low- and middle-income countries. They found that the median annual rate of treatment for schizophrenic disorders in mental health services was 128 cases per 100,000 population. The median treatment gap was 69% and was higher in participating low-income countries (89%) than in lower-middle-income and upper-middle-income countries (69% and 63%, respectively). Of the people with schizophrenic disorders, 80% were treated in outpatient facilities. The availability of psychiatrists and nurses in mental health facilities was found to be a significant predictor of service accessibility and treatment gap. In conclusion, the treatment gap for schizophrenic disorders in the 50 low- and middle-income countries in this study is disconcertingly large and outpatient facilities bear the major burden of care. The significant predictors found suggest an avenue for improving care in these countries.
Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania
Leslie H; Spiegelman D; Zhoub X; et al: Bulletin World Health Organisation 95(11)738–748, 2017
This study evaluates the service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Using existing data from service provision assessments of the health systems of the 10 study countries, the authors calculated a service readiness index for each of 8443 health facilities. This index represents the percentage availability of 50 items that the World Health Organization considers essential for providing health care. For the analysis, the authors used 37–49 of the items on the list. The mean values for the service readiness index were 77% for the 636 hospitals and 52% for the 7807 health centres/clinics. Deficiencies in medications and diagnostic capacity were particularly common. The readiness index varied more between hospitals and health centres/clinics in the same country than between countries. There was weak correlation between national factors related to health financing and the readiness index. Most health facilities in the study countries were insufficiently equipped to provide basic clinical care. The authors argue that if countries are to bolster health-system capacity towards achieving universal coverage, more attention needs to be given to within-country inequities.
Sexual and reproductive health in HIV-related proposals supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria
Lusti-Narasimhan M, Collin C and Mbizvo M: Bulletin of the World Health Organization 87(11): 816–823, November 2009
This paper examined the Global Fund database for elements and indicators of sexual and reproductive health in all approved HIV-related proposals (214) submitted by 134 countries, from rounds 1 to 7, and in an illustrative sample of 35 grant agreements. At least 70% of the HIV-related proposals included one or more of the four broad elements: sexual and reproductive health information, education and communication; condom promotion/distribution; diagnosis and treatment of sexually transmitted infections; and prevention of mother-to-child transmission of HIV. Between 20% and 30% included sexual health counselling, gender-based violence, and the linking of voluntary counselling and testing for HIV with sexual and reproductive health services. Less than 20% focused on adolescent sexual and reproductive health, the rights and needs of people living with HIV, or safe abortion services. Country coordinating mechanisms and national-level stakeholders see in funding for sexual and reproductive health a means to address the problem of HIV infection in their respective national settings. However, the paper highlights some missed opportunities for linking HIV and sexual and reproductive health services.
Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa
Lafort Y; Greener R: Roy A: et al.: Reproductive Health 14 (13) DOI: 10.1186/s12978-017-0277-6, 2017
Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, this paper identified gaps in service utilization in four different. A cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 ‘seeds’ identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. Current use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs’ sociodemographic characteristics. The use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. The authors advise that intervention packages to improve use of contraceptives and SRH services be tailored to gaps in each city.
Sexually transmitted infections among adolescents: The need for adequate health services
Riedner G, Dehne GL: WHO
Attempts to date to promote the sexual health of young people have tended to focus on prevention, education and counselling for those who are not yet sexually active, while the provision of health services to those who have already engaged in unprotected sexual activity and faced the consequences, including pregnancy, STIs or sexual violence, has lagged behind. This document presents a review of the literature documenting existing experience with the provision of services for sexually transmitted infections (STIs) to adolescents.
Shaping the health information supply: Improving media coverage of health issues in Sub-Saharan Africa
Nolen LB, Volmink J: Center for the Advancement of Health, October 2006
The importance of media reporting on health issues in sub-Saharan Africa has gained significant attention over the past several years from media outlets, health development organisations and donors. Although reporting on health issues has increased and improved in recent years, stories with little informational content or based on faulty information still surface far too frequently. Using a combination of interviews, document analysis and Internet research, this report describes some of the challenges in increasing the use of high quality scientific information in health coverage, some of the current efforts to make improvements and where the gaps to success lay.
Short message service (SMS) sentinel surveillance of influenza-like illness in Madagascar, 2008–2012
Rajatonirina S, Heraud J, Randrianasolo L, Orelle A, Razanajatovo NH, Raoelina YN et al: Bulletin of the World Health Organisation 90(5): 385-389, May 2012
In 2007 Madagascar implemented a sentinel surveillance system for influenza-like illness (ILI) based on data collected from sentinel general practitioners, launching an innovative case reporting system based on the use of cell phones. Encrypted short message service (SMS), which costs less than US$2 per month per health centre, is now being used by sentinel general practitioners for the daily reporting of cases of fever and ILI seen in their practices. To validate the daily data, practitioners also report epidemiological and clinical data (e.g. new febrile patient’s sex, age, visit date, symptoms) weekly to the epidemiologists on the research team using special patient forms. Madagascar’s sentinel ILI surveillance system represents the country’s first nationwide ‘real-time’ surveillance system. The authors of this paper argue that it has proved the feasibility of improving disease surveillance capacity through innovative systems despite resource constraints. They recommend this type of syndromic surveillance for detecting unexpected increases in the incidence of ILI and other syndromic illnesses.