This study was conducted working with community-owned resource persons to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated. the study found that with basic training and supervision, community-owned resource persons successfully provided early diagnosis and treatment and reduced unnecessary consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested before treatment.
Equitable health services
Using community-owned resource persons to provide early diagnosis and treatment and estimate malaria burden at community level in north-eastern Tanzania
Rutta AS, Francis F, Mmbando BP, Ishengoma DS, Sembuche SH, Malecela EK et al: Malaria Journal 11(152), 3 May 2012
Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people
Akl EA, Kennedy C, Konda K, Caceres CF, Horvath T, Ayala G et al: BMC Public Health 12(386), 28 May 2012
The World Health Organisation’s (WHO) Department of HIV/AIDS has developed public health guidelines, called GRADE, for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines. The development of the guidelines followed the WHO guideline development process, which utilises the GRADE approach. The authors identified, categorised and labelled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication. The paper describes how the researchers dealt with the following challenges: heterogeneous and complex interventions; paucity of trial data; selecting outcomes of interest; using indirect evidence; integrating values and preferences; considering resource use; addressing social and legal barriers; wording of recommendations; and developing global guidelines. In conclusion, the researchers were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development, they recommend.
Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient–Provider Communication in the START Study
Hirsch-overman Y; Daftary A; Yuengling K; Saito S; Ntoane M; Frederix K; Maama B; Howard A: Journal of Acquired Immune Deficiency Syndromes 74, S37–S43, 2017
mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). The authors describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analysed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualised by monthly adherence data. From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilisation. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.
Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi
Lindgren TG, Deutsch K, Schell E, Bvumbwe A, Hart KB, Laviwa J and Rankin SH: Rural and Remote Health 11(1682), 2011
This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The clinics provide basic HIV, TB STI and pre-natal services. The researchers found that in the project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. The mobile clinics provide services for people who otherwise may not have attended a health centre. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programmes.
Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi
Lindgren TG, Deutsch K, Schell E, Bvumbwe A, Hart KB, Laviwa J and Rankin SH: Rural and Remote Health 11(1682), 2011
This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The clinics provide basic HIV, TB STI and pre-natal services. The researchers found that in the project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. The mobile clinics provide services for people who otherwise may not have attended a health centre. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programmes.
Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya
Echoka E, Dubourg D, Makokha A, Kombe Y, Olsen ØE, Mwangi M, Evjen-Olsen B and Byskov J: International Journal for Equity in Health 13(112), December 2014
Developing countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located. A facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The most common MOI was caesarean section, commonly indicated by Cephalopelvic Disproportion (CPD)–narrow pelvis. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas.
Utilisation and outcomes of cervical cancer prevention services among HIV-infected women in Cape Town
Batra P, Kuhn L, Denny L: South African Medical Journal 100(1): 39–44, January 2010
This study conducted an audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa. It took the form of a retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre. The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up. The study concludes that cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default.
Utilization of health care services in rural and urban areas: A determinant factor in planning and managing health care delivery systems
Oladipo JA: African Health Sciences (2)14: 322-333
Disparities in use of healthcare services between rural and urban areas have been empirically attributed to several factors. This study explores the existence of this disparity and its implication for planning and managing healthcare delivery systems. The objectives determine the relative importance of the various predisposing, enabling, need and health services factors on utilisation of health services; similarity between rural and urban areas; and major explanatory variables for utilisation. A four-stage model of service utilisation was constructed with 31 variables under appropriate model components. Data is collected using cross-sectional sample survey of 1086 potential health services consumers in selected health facilities and resident milieu via questionnaire. Data is analysed using factor analysis and cross tabulation. The 4-stage model is validated for the aggregate data and data for the rural areas with 3-stage model for urban areas. The order of importance of the factors is need, enabling, predisposing and health services. 11 variables are found to be powerful predictors of utilisation. Planning of different categories of health care facilities in different locations should be based on utilisation rates while proper management of established facilities should aim to improve health seeking behaviour of people.
Vaccine fund spending US$500m on ‘innovative’ health systems
Real Health News, 14 May 2008
The US$ multi-billion a year GAVI Alliance is spending a fraction of its budget to help its vaccines get to the end of the track, by strengthening health systems in a group of countries in central America, Africa and Asia. GAVI provides support directly to country governments, not through other agencies. Also its large budget and global nature encourages vaccine manufacturers to take a positive view of developing country markets – and thus add relevant, affordable products to their portfolios.
Vaccine influences the immune response to BCG vaccination
Sartono E, Lisse IM, Terveer EM, van de Sande PJM and Whittle H: PLoS ONE 5(5), 21 May 21 2010
Oral polio vaccine (OPV) is recommended to be given at birth together with BCG vaccine. This study investigated the effect of OPV given simultaneously with BCG at birth on the immune response to BCG vaccine. It compared the in vitro and the in vivo response to PPD in the infants who received OPV and BCG with that of infants who received BCG only. The study is the first to address the consequences for the immune response to BCG of simultaneous administration with OPV. The authors expressed concern that the results indicate that the common practice in low-income countries of administering OPV together with BCG at birth may down-regulate the response to BCG vaccine.