In an effort to tackle the challenges related to a severe shortage of human resources, and geographic and financial barriers, that prohibit patients from accessing care and treatment, a decision was taken to decentralise HIV and AIDS services in Lesotho to the primary health care level. This report outlines the community-based approach to the decentralisation of HIV and AIDS services. The Wellspring of Hope was the first programme in Lesotho to provide HIV and AIDS treatment and care through an entire health service area as a result of this initiative. The report discusses a range of topics: the delivery of HIV and AIDS services, specifically testing and counselling, prevention of mother-to-child transmission and antiretroviral therapy, a nurse-driven approach to the provision of antiretroviral therapy at the community level, and gives activities aimed at health systems strengthening challenges associated with the implementation of this model. This innovative approach has proven to be successful in delivering quality HIV and AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas.
Equitable health services
The Klerksdorp/ Tshepong Hospital Complex have introduced an Escorting Project, which will allow nursing assistants to accompany referral patients to Johannesburg hospitals. The project aims to ensure that patients receive quality care and reduce waiting times. The hospital is the largest provincial hospital operating as the referral hospital for Dr K Kaunda District, Ruth Mopati District as well as tertiary services for the entire province. Hospital Chief Executive Officer, Kathy Randeree said that the hospital recently undertook a mini-survey to determine how best to assist patients who are accessing health services in Gauteng Hospitals. She said that the survey recommended the launch of the project with management resolving to have a pool of escorts for Klerksdorp/ Tshepong hospital so that referred patients are able to have the assistance of an allocated escort for the various hospitals and clinics in Gauteng.
This paper aimed to provide a better understanding of obstacles to accessing malaria treatment so as to develop practical and cost-effective interventions. After intensive health education, the biomedical concept of malaria has largely been adopted by the community. At last 80% of the fever cases in children and adults were treated with one of the recommended antimalarials. But only 22.5% of children and 10.5% of adults received prompt and appropriate antimalarial treatment. A clear preference for modern medicine was reflected in frequent use of antimalarials. Yet, case-management and functioning exemption mechanims were far from satisfactory for the main risk group. Private drug retailers played a central role in complementing existing formal health services. Health system factors like these must be tackled urgently to translate the high efficacy of artemisinin-based combination therapy into equitable community-effectiveness and health-impact.
An unsafe environment is a risk factor for child injury and violence. Among those injuries that are caused by an unsafe environment, the accidental ingestion of corrosive substances is significant, especially in developing countries where it is generally underreported. By reviewing current literature and field trials from developing countries, the authors of this study developed a flowchart for management of this clinical condition. Timely admission was observed in 19.5% of 148 patients studied. A gastrostomy was performed on 62.1% of patients, 42.8% had recurrent strictures and 19% were still on a continuous dilatation programme. Perforation and death rate were respectively 5.6% and 4%. The majority of oesophageal caustic strictures in children are observed late, when dilatation procedures are likely to be more difficult and carry a significantly higher recurrence rate.
Some 35% of antimalarial drugs sold in six major African cities failed basic quality tests. The cities were in Ghana, Kenya, Nigeria Rwanda, Tanzania and Uganda. Artemisinin monotherapies, which the World Health Organisation explicitly rejects as substandard, remain common in Africa. Substandard antimalarial drugs cause an estimated 200,000 avoidable deaths each year.
This paper reports on the strategies, achievements and challenges of the past and contemporary malaria vector control efforts in Zambia. Researchers reviewed all available information and accessible archived documentary records on malaria vector control in Zambia. They also conducted a retrospective analysis of routine surveillance data from the Health Management Information System (HMIS), data from population-based household surveys and various operations research reports on implementing policies and strategies. Results suggested that Zambia has made great progress in implementing the World Health Organisation’s integrated vector management (IVM) strategy within the context of the IVM Global Strategic framework with strong adherence to its five key attributes. In conclusion, the country has solid, consistent and coordinated policies, strategies and guidelines for malaria vector control. The authors highlight the Zambian experience as a successful example of a coordinated multi-pronged IVM approach effectively operationalised within the context of a national health system.
This report provides an overview of the continuum of care for maternal, newborn and child health (MNCH) in Africa. The report investigates the prevalence and causes of neonatal deaths and highlights the gaps in coverage of care through the pre-pregnancy, pregnancy, childbirth and postnatal period. It also discusses how to integrate care with key programmes aimed at preventing mother to child transmission of HIV, controlling malaria, and immunisation. The report presents case studies of six African countries which have progressively reduced newborn death rates despite low gross national income. The authors find that two thirds of the 1.6 million newborn deaths in sub-Saharan Africa could be avoided if essential interventions already in policy reached 90 per cent of African mothers and newborns.
This study aimed to evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. The authors performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplified cold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras. Vaccination coverage with at least one dose was 79.5%, on the lake shores, 99.3% on the islands and 84.7% on zimboweras. Coverage with two doses was 53.0% 91.1% and 78.8% in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies. Vaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term.
In October 2016, the Mozambique Ministry of Health implemented a mass vaccination campaign using a two- dose regimen of the ShancholTM OCV in six high-risk neighborhoods of Nampula city, in Northern Mozambique. Overall 193,403 people were targeted by the campaign, which used a door-to-door strategy. During campaign follow-up, a population survey was conducted to assess oral cholera vaccine coverage, frequency of adverse events following immunization, vaccine acceptability and reasons for non-vaccination. In the absence of a household listing and clear administrative neighborhood delimitations, the authors used geospatial technology to select households from satellite images and used the support of community leaders. One person per household was randomly selected for interview. In total, 636 individuals were enrolled in the survey. The overall vaccination coverage with at least one dose was 69.5% and the two-dose coverage was 51.2%. The campaign was well accepted. Among the 185 non-vaccinated individuals, 83 did not take the vaccine because they were absent when the vaccination team visited their houses. Among the 451 vaccinated individuals, 47 reported minor and non-specific complaints, and 78 mentioned they did not receive any information before the campaign. In spite of overall coverage being slightly lower than expected, the use of a mobile door-to-door strategy remains a viable option even in densely-populated urban settings. The authors’ results suggest that campaigns can be successfully implemented and well accepted in Mozambique in non-emergency contexts in order to prevent cholera outbreaks.
With limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed. In 2017, Malawi integrated oral cholera vaccine into its national cholera control plan. The process started with a desk review and analysis of previous surveillance and risk factor data. At a consultative meeting, researchers, national health and water officials and representatives from nongovernmental and international organizations reviewed the data and local epidemiological knowledge to determine priority districts for oral cholera vaccination. The final stage was preparation of an application to the global oral cholera vaccine stockpile for non-emergency use. Malawi collects annual data on cholera and most districts have reported cases at least once since the 1970s. The government’s application for 3.2 million doses of vaccine to be provided over 20 months in 12 districts was accepted in April 2017. By April 2018, over 1 million doses had been administered in five districts. Continuing surveillance in districts showed that cholera outbreaks were notably absent in vaccinated high-risk areas, despite a national outbreak in 2017–2018. Augmenting advanced mapping techniques with local information helped to extend priority areas beyond those identified as high-risk based on cholera incidence reported at the district level. Involvement of the water, sanitation and hygiene sectors is key to ensuring that short-term gains from cholera vaccine are backed by longer-term progress in reducing cholera transmission.