This study analysed factors affecting variations in the quality of antenatal and sick-child care in primary-care facilities in seven African countries, using service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania in 2006–2014. Based on World Health Organization protocols, they created indices of process quality for antenatal care (first visits) and for sick-child visits and assessed national, facility, provider and patient factors that might explain variations in quality of care. Overall, health-care providers performed a mean of 62% of eight recommended antenatal care actions and 55% of nine sick-child care actions at observed visits. The quality of antenatal care was higher in better-staffed and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined. The authors conclude that the quality of two essential primary-care services for women and children was weak and varied across and within the countries. They observe that analysis of reasons for variations in quality could identify strategies for improving care.
Equitable health services
This study analysed factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven African countries. The authors pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006-2014). Based on World Health Organisation protocols, the authors created indices of process quality for antenatal care (first visits) and for sick-child visits. They assessed national, facility, provider and patient factors that might explain variations in quality of care, using separate multilevel regression models of quality for each service. Data were available for 2594 and 11 402 observations of clinical consultations for antenatal care and sick children, respectively. Overall, health-care providers performed a mean of 62.2% of eight recommended antenatal care actions and 54.5% of nine sick-child care actions at observed visits. Quality of antenatal care was higher in better-staffed and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined. The quality of two essential primary-care services for women and children was weak and varied across and within the countries. Analysis of reasons for variations in quality could identify strategies for improving care
This study analysed factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven African countries. The authors pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006-2014). Based on World Health Organisation protocols, the authors created indices of process quality for antenatal care (first visits) and for sick-child visits. The authors assessed national, facility, provider and patient factors that might explain variations in quality of care. Quality of antenatal care was higher in better-staffed and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined. The quality of two essential primary-care services for women and children was weak and varied across and within the countries. The authors propose that analysis of reasons for these variations in quality could identify strategies for improving care.
The objective of this study was to assess the relationship between the prevalence of vitamin A deficiency among pregnant women and the effect of neonatal vitamin A supplementation on infant mortality. The study’s literature review revealed that studies of neonatal supplementation with vitamin A have yielded contradictory findings with regard to its effect on the risk of infant death, possibly owing to heterogeneity between studies. One source of that heterogeneity is the prevalence of vitamin A deficiency among pregnant women, which the study examined using meta-regression techniques on eligible individual and cluster-randomised trials. The meta-regression analysis revealed a statistically significant linear relationship between the prevalence of vitamin A deficiency in pregnant women and the observed effectiveness of vitamin A supplementation at birth. In regions where at least 22% of pregnant women have vitamin A deficiency, the study recommends giving neonates vitamin A supplements to help protect against infant death.
What does the reproductive health (RH) situation among the conflict-affected populations of northern Uganda look like? The Women’s Commission for Refugee Women and Children and the United Nations Population Fund assessed this question in February 2007 and visited the districts of Kitgum and Pader and also a youth center and clinic in Gulu.
The authors investigated whether sub-Saharan African countries have succeeded in reducing wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions, using post 1995 survey data from 36 countries, grouped into Central, East, Southern and West Africa subregions. Wealth-related inequalities were prevalent in all subregions, highest for West Africa and lowest for Southern Africa. Absolute income was not a predictor of coverage, as higher coverage was observed in Southern (around 70%) compared with Central and West (around 40%) subregions for the same income. Wealth-related inequalities in coverage were reduced by the greatest amount in Southern Africa, and no evidence was found of inequality reduction in Central Africa. The data show that most countries in sub-Saharan Africa have succeeded in reducing wealth-related inequalities in the coverage of essential health services, even in the presence of conflict, economic hardship or political instability
The devastating cholera epidemic continues to spread, with a new outbreak in Chegutu Urban, recording more than 378 suspected cases and 121 deaths. As of 15 December, 9 out of 10 provinces (48 out of 62 districts) in the country are affected with a total count of 978 deaths and a Case Fatality Rate (CFR) of 5.3%. So far most cases have been reported in Harare / Budiriro (8,454 cases, 208 deaths and a CFR of 2.5%), followed by Beitbridge (3,456 cases, 91 deaths and a CFR of 2.6%), Mudzi (1,237 cases, 78 deaths and a CFR of 6.3%) and Chitungwiza (551 cases, 99 deaths and a CFR of 18 %). Higher CFRs have been found in other areas. Cholera continues to affect various parts of the Southern African region, with the Republic of South Africa reporting 859 cumulative cases, 11 deaths and a CFR of 1.2%, the bulk of the cases (731) reported in Limpopo province. Cases have also been reported in Botswana, Mozambique, and Zambia, albeit in much smaller numbers. According to the latest WHO figures, there have been 200 human cases of anthrax and 8 deaths reported since November with the consumption of contaminated meat identified as the most likely cause.
The study seeks to improve understanding of maternity health seeking behaviours in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.
The objective of this paper was to document the inclusion of key medicines for children in national essential medicines lists (EMLs) and standard treatment guidelines, and to assess the availability and cost of these medicines in 14 countries in central Africa. Surveys were conducted in 12 public and private sector medicine outlets in each country’s capital city. Data was collected on medicine availability on the survey day and on the cost to the patient of the lowest-priced medicine in stock. It found that there was considerable variation in prices, which tended to be higher in retail pharmacies, and the availability of key essential medicines for children was poor. Better understanding of the supply systems in the countries studied and of the pattern of demand for medicines is needed before improvements can be made.
COVID-19 has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self- organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community- based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.