Epilepsy is the most common chronic neurological disorder, affecting over 65 million people worldwide, of whom 80% are estimated to live in low- or middle-income countries (LMICs). Anti-epileptic drugs are very effective in controlling seizures, but most people with epilepsy in LMICs do not receive appropriate treatment. According to this review, this 'treatment gap' is influenced by factors such as limited knowledge, poverty, cultural beliefs, stigma, poor health delivery infrastructure, and shortage of trained health care workers. Several studies implementing interventions at the community level (for example, training programmes for primary health care workers) have successfully improved the identification of people with epilepsy and reduced the treatment gap. The sustainability of these interventions needs to be addressed, however, and efforts must be made to ensure a continuous supply of anti-epileptic drugs.
Equitable health services
It is estimated that about 41.7 million people need treatment for schizophrenia and related disorders in low- and middle-income countries (LMICs). The majority of these cases are concentrated in Asia (70%) and Africa (16%). In countries with low resources, general physicians and primary health care workers can be trained to recognise and treat people with psychotic disorders in the community. This study found that health systems can scale up such interventions across all routine-care settings by training general physicians and primary health care workers to recognise and treat clients with schizophrenia with effective, evidence-based interventions. In addition, first- and second-generation antipsychotics (FGAs and SGAs) are similarly effective in the acute treatment of psychotic symptoms. In addition, a number of trials have shown the efficacy of psycho-educational strategies to improve adherence to antipsychotics, to decrease relapse and readmission rates, and to have a positive impact in social functioning of family members and patients. The study recommends a package of care combining low doses of conventional antipsychotics along with brief and simple psycho-educational interventions as an important strategy to decrease the treatment gap for schizophrenia in LMICs. The combination of FGAs and psycho-educational interventions are more cost-effective than the use of drugs alone.
This report from the African Palliative Care Association (APCA) identifies a number of problems with the delivery of pain-relief drugs to people with HIV and AIDS. The survey found that the key problems were inadequate and unreliable supplies of drugs, restrictive legislation, poor levels of education and training about prescribing such drugs among clinical staff, and practical problems such as high costs and inadequate storage facilities. The key challenges to overcoming these problems were identified as a lack of political will, the need for education and cultural change among medical practitioners and a lack of resources.
According to this report, timely sharing of surveillance information about highly pathogenic avian influenza viruses, as well as ensuring equitable access to effective vaccinations, medicines and related technology, are important ingredients of global readiness to respond to the influenza pandemic. The Pandemic Influenza Preparedness Framework is an international mechanism designed by the World Health Organization to implement a fairer, more transparent, equitable and efficient system to improve pandemic influenza preparedness and strengthen the protection against the spread of pandemic influenza. It is intended to result in sharing H5N1 and other influenza viruses with human pandemic potential and sharing the benefits arising from the use of H5N1 and other influenza viruses with human pandemic potential, including the generation of information, diagnostics, medicines vaccines and other technologies. In developing countries, critical success factors include support for national integrated human and animal influenza action plans and building national minimum core capacity for detection, risk assessment, laboratory confirmation and rapid containment.
The South African parliament’s social services select committee has welcomed the investigation into the death of 36 psychiatric patients in Gauteng. This comes after Gauteng Health MEC Qedani Mahlangu revealed during an oral reply to questions in the legislature that 36 psychiatric patients, who had been transferred from Life Healthcare Esidimeni, had died while in the care of NGOs. The psychiatric patients were relocated to 122 NGOs after the department cancelled its contract with Life Healthcare, which looked after almost 2 000 patients. Health Minister Aaron Motsoaledi has called for the Office of the Health Ombudsman to investigate the allegations. The committee conveyed its condolences to the families of the patients. "While the Committee is cognisant of the need to find alternative measures to care for patients, these measures should have been made with the clear understanding and guarantees that the care of patients will not deteriorate. Every decision that is made must have as its central pillar the delivery of quality care for our people," committee chairperson Cathy Dlamini said in a statement. The committee called for the investigation to be sped up, in order to avoid further loss of life. They would engage with the health department at national and provincial levels to ensure quality care of all patients, the committee said.
Influential women from all over the globe have come together in London to urge the world to redouble efforts and boost investments to reduce the global burden of maternal and newborn death. The policy makers and parliamentarians from developing and developed countries are meeting to mark UK Mother's Day on 18 March 2007. Key participants include Cherie Blair, wife of the UK Prime Minister and international lawyer, Hilary Benn, MP, Secretary of State, Department for International Development, UK, Liya Kebede, Supermodel and World Health Organization Goodwill Ambassador for Maternal, Newborn and Child Health, and the First Lady of Lesotho, Mrs Mathato S. Mosisilli. A Global Plan of Action agreed at the meeting calls for a universal right to health for mothers and their babies by ensuring equitable skilled care. The plan calls on governments to take the lead in fighting maternal and newborn illness and death.
Using the data from the South African World Health Survey (WHS), this study aimed to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa. Data was used from a population-based survey of 2,352 male and female participants, which was conducted in South Africa in 2003. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care –16.8% versus 3.2%. Health care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.
The objective of this study was to establish the feasibility and reliability of a questionnaire for healthcare service satisfaction and a questionnaire for satisfaction with information received about TB medicines among adult TB patients attending public and private programme clinics in Kampala, Uganda. Researchers recruited 133 patients of known HIV status and confirmed pulmonary TB who were receiving care at public and private hospitals in Kampala, Uganda. A translated and standardised 13-item patient healthcare service satisfaction questionnaire (PS-13) and the Satisfaction with Information about Medicines Scale (SIMS) tool were administered by trained interviewers. Of the 133 participants, 35% were starting, 33% had completed two months, and 32% had completed eight months of TB therapy. The male to female and public to private hospital ratios in the study population were 1:1. The PS-13 and the SIMS tools were highly acceptable and easily administered. Patients that were enrolled at the public hospital had relatively lower PS-13 satisfaction scores for technical quality of care and responsiveness to patient preferences when compared to patients that were enrolled at the private hospital. The authors conclude that their study provides preliminary evidence that the PS-13 service satisfaction and the SIMS tools are reliable measures of patient satisfaction in TB programmes. Satisfaction score findings suggest differences in patient satisfaction levels between public and private hospitals, as well as between patients starting and those completing TB therapy.
The objective of this study was to establish the feasibility and reliability of a questionnaire for healthcare service satisfaction and a questionnaire for satisfaction with information received about TB medicines among adult TB patients attending public and private programme clinics in Kampala, Uganda. Researchers recruited 133 patients of known HIV status and confirmed pulmonary TB who were receiving care at public and private hospitals in Kampala, Uganda. A translated and standardised 13-item patient healthcare service satisfaction questionnaire (PS-13) and the Satisfaction with Information about Medicines Scale (SIMS) tool were administered by trained interviewers. Of the 133 participants, 35% were starting, 33% had completed two months, and 32% had completed eight months of TB therapy. The male to female and public to private hospital ratios in the study population were 1:1. The PS-13 and the SIMS tools were highly acceptable and easily administered. Patients that were enrolled at the public hospital had relatively lower PS-13 satisfaction scores for technical quality of care and responsiveness to patient preferences when compared to patients that were enrolled at the private hospital. The authors conclude that their study provides preliminary evidence that the PS-13 service satisfaction and the SIMS tools are reliable measures of patient satisfaction in TB programmes. Satisfaction score findings suggest differences in patient satisfaction levels between public and private hospitals, as well as between patients starting and those completing TB therapy.
The authors of this study conducted a national retrospective case control study to identify factors associated with tuberculosis treatment default in South Africa using programme data from 2002 and a standardised patient questionnaire. The sample included 3,165 TB patients from eight provinces; 1,164 were traceable and interviewed. Significant risk factors associated with default among both groups included poor health care worker attitude and changing residence during TB treatment. New TB patients that defaulted were more likely to report having no formal education, feeling ashamed to have TB, not receiving adequate counseling about their treatment, drinking any alcohol during TB treatment, and seeing a traditional healer during TB treatment. Among retreatment patients, risk factors included stopping TB treatment because they felt better, having a previous history of TB treatment default, and feeling that food provisions might have helped them finish treatment. In conclusion, risk factors for default differ between new and re-treatment TB patients in South Africa. Addressing default in both populations with targeted interventions is critical to overall programme success.