Risk communication guidelines widely used in public health are based on the psychometric paradigm of risk, which focuses on risk perception at the level of individuals. However, infectious disease outbreaks and other public health emergencies are more than public health events and occur in a highly charged political, social and economic environment. This study examines other sociological and cultural approaches from scholars such as Ulrich Beck and Mary Douglas for insights on how to communicate in such environments. It recommends developing supplemental tools for outbreak communication to deal with issues such as questions of blame and fairness in risk distribution and audiences who do not accept biomedical explanations of disease.
Equitable health services
Risk and outbreak communication: lessons from alternative paradigms
Abraham T: Bulletin of the World Health Organization 87(8): 604–607, August 2009
Risk factors for incomplete vaccination and missed opportunity for immunisation in rural Mozambique
Jani1 JV, De Schacht C, Jani IV, Bjune g: BMC Public Health 8(161), 16 May 2008
Inadequate levels of immunisation against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunisation services are poorly understood. This study aimed at finding out the reasons for non-vaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in southern Mozambique. Mothers of children under two years of age (N = 668) were interviewed in a cross-sectional study. The Road-to-Health card was utilised to check for completeness and correctness of vaccination schedule as well as for identifying the appropriate use of all available opportunities for vaccination. The chi-square test and the logistic regression were used for statistical analysis. The researchers found that 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. Efforts to increase vaccination coverage should take into account factors that contribute to the incomplete vaccination status of children. Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility, specially in those countries where health services do not have 100% of coverage.
Risk factors for VIA positivity and determinants of screening attendances in Dar es Salaam, Tanzania
Kahesa C, Kjaer SK, Ngoma T, Mwaiselage J, Dartell M, Iftner T, Rasch V: BMC Public Health 12(1055), 7 December 2012
In response to a high incidence of cervical cancer, Tanzania implemented “visual inspection of the cervix after acetic acid application” (VIA) as a regional cervical cancer screening strategy in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this research paper presents the results from a comparative analysis performed among women who are reached and not reached by the screening programme. Researchers studied 14,107 women aged 25–59 enrolled in a cervical cancer screening programme in Dar es Salaam in the period 2002–2008. The women underwent VIA examination and took part in a structured questionnaire interview. Results indicated that women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. Although women who participated in the screening were more likely to be HIV positive in comparison with women who had never attended screening, the authors point out that this may be due to a referral link that exists between the HIV programme and the cervical cancer screening programme, which means that HIV positive were more likely to participate in the cervical cancer screening programme than HIV negative women.
Risks and Challenges in Medical Tourism: Understanding the Global Market for Health Services
Hodges JR, Kimball AM and Turner L: Praeger, July 2012
This book provides an in-depth, comprehensive assessment of the benefits and risks when health care becomes a global commodity. The collection includes contributions from leading scholars in law and public policy, medicine and public health, bioethics, anthropology, health geography, and economics. Contributors examine how government agencies, medical tourism companies, international hospital chains, and other organisations promote medical tourism and the globalisation of health care. The topics explored include the legal remedies available to medical tourists when procedures go awry; potential consequences when patients cross borders for medical procedures that are illegal in their home countries; the relationship of medical tourism to international spread of infectious disease; and the lack of adequate transnational policies and regulations governing the global market for health services.
Ritual and the organisation of care in primary care clinics in Cape Town, South Africa
Lewin S and Green J: Social Science and Medicine 68(8):1464–1471, April 2009
This paper explores the organisation of health care work in primary care clinics in Cape Town by analysing two elements of clinic organisation as rituals: a formal, policy-driven element of care – directly observed therapy for tuberculosis patients – and an informal ritual – morning prayers in the clinic. Seven clinics providing care to people with tuberculosis were sampled. Findings suggest that, rather than seeing the ritualised aspects of clinic activities as merely traditional elements of care that potentially interfere with the application of good practice, it is essential to understand their symbolic value if their contribution to health care organisation is to be recognised. These rituals embody the conflicting values of patients and staff in these clinics and reinforce asymmetrical relations of power between different constituencies, strengthening conventional modes of provider-patient interaction.
River blindness drug trial launched
PlusNews: 1 July 2009
Researchers are launching a clinical trial with 1,500 people infected with onchocerciasis (river blindness) in Liberia, Ghana and the Democratic Republic of Congo to test a remedy that could help stop transmission. Onchocerciasis is one of the leading causes of blindness in Africa, according to World Health Organization (WHO), and more than 100 million people, mostly in Africa, are at risk of infection, according to WHO, which estimates that there are about half a million people, mostly in Africa, who are blind due to onchocerciasis. The primary prevention method is black fly control, while treatment has been through annual doses of ivermectin, which might successfully treat individuals, but it does not stop the infection from spreading. If adult worms are not killed they continue to lay eggs in the skin and the disease can be passed on. The drug moxidectin is being studied for its potential to kill adult worms carrying the disease and to wipe out the disease in any high-risk area within six years. The upcoming clinical trials are expected to last two and a half years and will cost about US$6 million.
Role of maternity waiting homes in the reduction of maternal death and stillbirth in developing countries and its contribution for maternal death reduction in Ethiopia: a systematic review and meta-analysis
Dadi T; Bekele B; Kasaye H; et al: BMC Health Services Research 18(748)1-10, 2018
This study synthesised the best available evidence on effectiveness of maternity waiting homes on the reduction of maternal mortality and stillbirth in developing countries. In developing countries, maternity waiting homes users were 80% less likely to die than non-users and there was 73% less occurrence of stillbirth among users. In Ethiopia, there was a 91% reduction of maternal death among maternity waiting homes users unlike non-users and it contributes to the reduction of 83% stillbirth unlike non-users. Maternity waiting home contributes more than 80% to the reduction of maternal death among users in developing countries and Ethiopia. Its contribution for reduction of stillbirth is good. More than 70% of stillbirth is reduced among the users of maternity waiting homes. In Ethiopia maternity waiting homes contributes to the reduction of more than two third of stillbirths.
Roll Back Malaria and the New Partnership for Africa's Development (NEPAD): Is there potential for synergistic collaboration in partnerships?
Kamau EM: African Journal of Health Sciences 13(1-2):22-27, 2008
This paper highlights and promotes the enormous potential that exists between these two initiatives that seek to address closely related issues and targeting the same populations at risk within a fairly well defined geographical setting. It also attempts to argue that malaria control, just like HIV-Aids control be given high priority in the New Partnership for Africa's Development (NEPAD) health agenda, as current statistics indicate that malaria is again on the rise. While much attention and billions of dollars have rightly been given to HIV and Aids research, treatment and prevention, malaria, and not Aids, is the region's leading cause of morbidity and mortality for children under the age of five years. This is the bad news. The good news is that unlike Aids, malaria treatment and prevention are relatively cheap. In addition, there is a payback to fighting malaria; support aimed directly at improving health, rather than poverty reduction, may be a more effective way of helping Africa to thrive. Robust and sustained growth may come to Africa through a mosquito net, Artemisinin-based Combination Therapies (ACTs) or a malaria vaccine, rather that a donor's cheque for economic development initiatives.
Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility.
Kankasa C, Carter RJ, Briggs N, Bulterys M, Chama E, Cooper ER, Costa C, Spielman E, Katepa-Bwalya M, M'soka T, Ou CY, Abrams EJ. J Acquir Immune Defic Syndr. 2009 Jun 1;51(2):202-8
The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Design: We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. METHODS: Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. RESULTS: From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001). CONCLUSIONS: Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
SADC Minimum Standards for Child and Adolescent HIV, TB and Malaria Continuum of Care: 2011-2012
Southern African Development Community: 2012
When Southern African Development Community (SADC) member states signed the SADC Protocol on Health in 2008, they committed themselves to dealing with communicable diseases - particularly HIV, tuberculosis (TB) and malaria - in a harmonised manner. However, until now, the key regional strategic frameworks and minimum standards developed to guide action in the control of these three diseases did not adequately cover children and adolescents. To address this shortcoming, SADC commissioned a regional assessment in the 14 active SADC Member States between October 2011 and July 2012. On the basis of this data, the SADC Secretariat developed the SADC Minimum Standards for Child and Adolescent HIV, TB and Malaria Continuum of Care. It establishes the minimum package of services that member states should have in place to achieve a common response in the region. Because of the bi-directional links between the HIV, TB and malaria and child vulnerability, it is crucial that access to services such as health, education, social and child protection, food security and nutrition and psychosocial services are adequately integrated into this response, as established in the SADC Strategic Framework and Programme of Action for Orphans and Vulnerable Children and Youth.