Malaria microscopy, while the gold standard for malaria diagnosis, has limitations. Efficacy estimates in drug and vaccine malaria trials are very sensitive to small errors in microscopy endpoints. This fact led to the establishment of a Malaria Diagnostics Centre of Excellence in Kisumu, Kenya. The primary objective was to ensure valid clinical trial and diagnostic test evaluations. Key secondary objectives were technology transfer to host countries, establishment of partnerships, and training of clinical microscopists.
Equitable health services
Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya
Ohrt , Obare P, Nanakorn A, Adhiambo C, Awuondo K, Prudhomme O'Meara W, Remich S, Martin K, Cook E, Chretien J-P, Lucas C, Osoga J, McEvoy P, Owaga ML, Sande Odera J, Ogutu B: Malaria Journal 6:79, 12 June 2007
Establishing standards for obstructed labour in a low-income country
Kongnyuy EJ, Mlava G and van den Broek N: Rural and Remote Health 8 (online): 1022, 2008
This preliminary report from Malawi describes a process of developing standards for maternity care together with a multidisciplinary team of health professionals.Conventionally standards for maternity care are developed by a panel of experts (usually obstetricians) and then implemented by a multidisciplinary team. The present study concerns the feasibility of involving health professionals of all grades in the establishment standards for obstructed labour in Malawi. Standards for obstructed labour were developed by a multidisciplinary team involving all cadres of health professionals working in maternity units, as well as hospital managers and policy makers, using evidence from Malawi national guidelines, World Health Organisation manuals and peer-reviewed journals. The standards addressed different aspects of the management of obstructed labour, namely early recognition of prolonged labour by labouring women and traditional birth attendants, early arrival of women to health facilities during labour, proper use of partograph by healthcare providers, proper management of prolonged labour, proper management of obstructed labour, appropriate management of uterine rupture and early delivery of the baby.
Establishing the Africa Centres for Disease Control and Prevention: responding to Africa's health threat
Nkengasong J; Maiyegun O; Moeti M: The Lancet Global Health 5(3), e246-247, 2017
On Jan 31, 2017, heads of states and governments of the African Union and the leadership of the African Union Commission officially launched the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia. As detailed in the African Union's Africa Agenda 2063—a roadmap for the development of the continent—some of the concerns that justified the establishment and initiation of an Africa-wide public health agency include rapid population growth; increasing and intensive population movement across Africa, with increased potential for new or re-emerging pathogens to turn into pandemics; existing endemic and emerging infectious diseases, including Ebola; antimicrobial resistance; increasing incidence of non-communicable diseases and injuries; high maternal mortality rates; and threats posed by environmental toxins.
Estimated financial and human resources requirements for the treatment of malaria in Malawi
Muula AS, Rudatsikira E, Siziya S and Mataya RH: Malaria Journal 6(168), 19 December 2007
Malaria fever is a common medical presentation and diagnosis in Malawi. The national malaria policy supports self-diagnosis and self-medication for uncomplicated malaria with first line anti-malaria drugs. While a qualitative appreciation of the burden of malaria on the health system is recognised, there is limited quantitative estimation of the burden malaria exacts on the health system, especially with regard to human resources and financial burden on Malawi. The burden of malaria was assessed based on estimated incidence rates for a high endemic country of which Malawi is one. Data on the available human resources and financial resources committed towards malaria from official Malawi government documents and programme reports were obtained. Malaria exacts a heavy toll on the health system in Malawi. The national recommendation of self-medication with first-line drug for uncomplicated malaria is justified as there are not enough clinicians to provide clinical care for all cases. The Malawi Ministry of Healthas promotion of malaria drug prescription including other lower cadre health workers may be justified.
Ethiopia: New programme boosts village health service delivery
Integrated Regional Information Network (IRIN), 29 May 2007
Asmera Getachew had completed a teacher training course when she saw an advert inviting applications from those interested in joining the government Health Service Extension Programme (HSEP). The advert posted on a wall, changed her life. After a one-year training course, she was assigned to Tensyie, a rural village of 5,092 people in North Gonder Zone of Amhara Regional State, to work as a health extension worker. One of 2,800 graduates from 14 HSEP training centres in Ethiopia, quickly settled in to implement a three month plan focusing on health education, environmental health, family health and disease prevention.
Ethiopia: Shortage of vaccines for meningitis
IRIN News, 20 November 2006
The Ethiopian health ministry is short of vaccines to contain the spread of meningitis that has so far claimed 10 lives in the Southern Nations Nationalities and People’s Region (SNNPR) and infected 612 more, a health update said. A meningitis outbreak has been reported in Derashe and Selamago areas of Mursi in the SNNPR region. An earlier outbreak in Wolayita zone of the same region was contained due to the quick response of health ministry and humanitarian partners, according to the update by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).
Evaluation of a national universal coverage campaign of long-lasting insecticidal nets in a rural district in north-west Tanzania
West PA, Protopopoff N, Rowland MW, Kirby MJ, Oxborough RM, Mosha FW et al: Malaria Journal 11(273), 10 August 2012
This study had two purposes: to evaluate the impact of a universal coverage campaign (UCC) of long-lasting insecticidal nets (LLINs) on LLIN ownership and usage, and to identify factors that may be associated with inadequate coverage. In 2011 two cross-sectional household surveys were conducted in 50 clusters in Muleba district, north-west Tanzania. Prior to the UCC 3,246 households were surveyed and 2,499 afterwards. The proportion of households with at least one ITN increased from 62.6% before the UCC to 90.8% afterwards. Eighty percent of households surveyed received LLINs from the campaign. ITN usage in all residents rose from 40.8% to 55.7%, and after the UCC, 58.4% of households had sufficient ITNs to cover all their sleeping places. Households with children under five years and small households were most likely to reach universal coverage, while poverty was not associated with net coverage. The authors conclude that UCC in Muleba district of Tanzania was equitable, greatly improving LLIN ownership and, more moderately, usage. However, the goal of universal coverage in terms of the adequate provision of nets was not achieved. Multiple, continuous delivery systems and education activities are required to maintain and improve bed net ownership and usage.
Evaluation of how integrated HIV and TB programmes are implemented in South Africa and the implications for rural-urban equity
Scott VE and Sanders D: Rural and Remote Health 2165 (Online), 2013
The authors of this study undertook a programme evaluation of HIV and TB prevention and therapeutic services at facility level in South Africa to describe integration and how it is implemented. They evaluated 26 rural and 146 urban public primary-care facilities using secondary data generated from December 2008 and May 2009. Evidence of integration was found across two dimensions: disease programmes and the prevention–therapeutic axis. Smaller rural facilities did not always have staff trained in all the required services, nurses worked without the support of a doctor and supervision was weaker, threatening quality of care. However, in the rural district there were instances of clients receiving more integrated services. The quality of care in the TB programme was high in both districts. In both the districts evaluated, integration across programmes and the prevention-care-rehabilitation axis of services was achieved through co-location at primary-care level. Coupled with health system strengthening, this has the potential to improve access across the HIV/TB/STI cluster of services. The benefit is likely to be greater in rural areas. Quality of care was maintained in the long-established TB programmes in both settings.
Evaluation of medication adherence methods in the treatment of malaria in Rwandan infants
Twagirumukiza M, Kayumba PC, Kips JG, Vrijens B, Vander Stichele R, Vervaet C, Remon JP and Van Bortel LM: Malaria Journal 9(206), 16 July 2010
The objective of this paper was to compare three methods for evaluating treatment adherence in a seven-day controlled treatment period for malaria in children in Rwanda. Fifty-six children younger than five years old with malaria were recruited at the University Hospital of Butare, Rwanda. Three methods to evaluate medication adherence among patients were compared: manual pill count of returned tablets, patient self-report and electronic pill-box monitoring. Medication adherence data were available for 54 of the 56 patients. Manual pill count and patient self-report yielded a medication adherence of 100% for the in- and out-patient treatment periods. Based on electronic pill-box monitoring, medication adherence during the seven-day treatment period was 90.5%. Based on electronic pill-box monitoring inpatient medication adherence (99.3%) was markedly higher than out-patient adherence (82.7%), showing a clear difference between health workers' and consumers' medication adherence. In conclusion, health workers' medication adherence was good. However, a significant lower medication adherence was observed for consumers' adherence in the outpatient setting. This was only detected by electronic pill-box monitoring. Therefore, this latter method is more accurate than the two other methods used in this study.
Evaluation of the influenza sentinel surveillance system in Madagascar, 2009–2014
Rakotoarisoa A; Randrianasolo L; Tempia S; Guillebaud J; Razanajatovo N; Randriamampionona L; Piola P; Halm A; Heraud JM: Bulletin of the World Health Organisation 95(5) 375–381, 2017
Evaluation of influenza surveillance systems is poor, especially in Africa. In 2007, the Institut Pasteur de Madagascar and the Malagasy Ministry of Public Health implemented a countrywide system for the prospective syndromic and virological surveillance of influenza-like illnesses. In assessing this system’s performance, the authors identified gaps and ways to promote the best use of resources. The authors investigated acceptability, data quality, flexibility, representativeness, simplicity, stability, timeliness and usefulness and developed qualitative and/or quantitative indicators for each of these attributes. Until 2007, the influenza surveillance system in Madagascar was only operational in Antananarivo and the observations made could not be extrapolated to the entire country. By 2014, the system covered 34 sentinel sites across the country. At 12 sites, nasopharyngeal and/or oropharyngeal samples were collected and tested for influenza virus. Between 2009 and 2014, 177 718 fever cases were detected, 25 809 (14.5%) of these fever cases were classified as cases of influenza-like illness. Of the 9192 samples from patients with influenza-like illness that were tested for influenza viruses, 3573 (38.9%) tested positive. Data quality for all evaluated indicators was categorised as above 90% and the system also appeared to be strong in terms of its acceptability, simplicity and stability. However, sample collection needed improvement. The influenza surveillance system in Madagascar performed well and provided reliable and timely data for public health interventions. Given its flexibility and overall moderate cost, the authors argue that this system may become a useful platform for syndromic and laboratory-based surveillance in other low-resource settings.