At least 50 people have been quarantined in Tanzania's northern district of Mbulu to curb the spread of influenza H1N1, a highly contagious viral disease that killed one person last week, say health officials. The death is the first in East Africa. ‘We are struggling to control [the] further spread of the disease,’ said Anael Pallangyo, Mbulu District Medical Officer. All 18 dispensaries in the district were now on alert and about 50 patients placed in isolation wards. Tanzanian health authorities have stepped up surveillance at all the country's entry points, where people with flu-related symptoms such as coughing, fever and sneezing are taken to hospital for screening and treatment. The ministry of health recently announced 172 confirmed cases of H1N1 at the end of September.
Equitable health services
According to this article, in sub-Saharan Africa, co-infection of syphilis and HIV is a serious public health challenge, with women and young children among the most vulnerable groups. Unfortunately, although HIV testing has become more accessible for pregnant women in sub-Saharan Africa as part of routine antenatal care, in many countries, including Uganda and Zambia, syphilis testing must still be accessed at separate sites. The researchers in this study identified high rates of syphilis and HIV co-infection in pregnant women in both countries: in Uganda 14.3% of syphilis-positive pregnant women also tested positive for HIV, and the rate was 24.2% in Zambia. But newly devised rapid syphilis testing has made it easier to integrate syphilis screening into services provided at antenatal clinics to prevent mother-to-child transmission (PMTCT) of HIV. As a result, there has been swift and direct policy change in Uganda and Zambia to further the goal of eliminating congenital syphilis and pediatric HIV and AIDS, as the Ministries of Health in Uganda and Zambia, are incorporating rapid syphilis testing into their standard package of PMTCT services and antenatal care.
This retrospective study of the introduction of district-wide community-level malaria rapid diagnostic test (RDT) was conducted in Livingstone District, Zambia, to assess its impact on malaria reporting, incidence of mortality and on district anti-malarial consumption. Reported malaria declined from 12,186 cases in the quarter prior to RDT introduction in 2007 to an average of 12.25 confirmed and 294 unconfirmed malaria cases per quarter over the year to September 2009. Consumption of artemisinin-based combination therapy (ACT) dropped dramatically at all levels, but remained above reported malaria, declining from 12,550 courses dispensed by the district office in the quarter prior to RDT implementation to an average of 822 per quarter over the last year. From these results, it’s clear that RDT introduction led to a large decline in reported malaria cases and in ACT consumption in Livingstone district. Reported malaria mortality declined to zero, indicating safety of the new diagnostic regime, although adherence and/or use of RDTs was still incomplete. However, a deficiency is apparent in management of non-malarial fever, with inappropriate use of a lowc-ost single dose drug, SP, replacing ACT. While large gains have been achieved, the authors conclude that the full potential of RDTs will only be realised when strategies can be put in place to better manage RDT-negative cases.
The world’s first malaria vaccine has been given the green light by European regulators and could protect millions of children in sub-Saharan Africa from the life-threatening disease. The European Medicines Agency (EMA) recommended that RTS,S, or Mosquirix, should be licensed for use in young children in Africa who are at risk of the mosquito-borne disease. The shot has been developed by GlaxoSmithKline (GSK) and part-funded by the Bill and Melinda Gates Foundation. It has taken 30 years to develop vaccine, at a cost of more than $565m (£364m) to date. It will now be assessed by the World Health Organisation, which has promised to give its guidance on how and where it should be used before the end of the year. GSK will then apply to the WHO for a scientific review of the vaccine, which will be used by the UN and other agencies to help make purchasing decisions. The roll-out of the vaccine, which also has to be approved by national health authorities in sub-Saharan Africa, is likely to be funded by GAVI.
An ongoing Phase 3 study of the efficacy, safety and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries, including Ghana, Kenya, Malawi, Mozambique and Tanzania. From March 2009 through January 2011, 15,460 children were enrolled in two age categories - 6 to 12 weeks and 5 to 17 months old - for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. After 250 children had an episode of severe malaria, researchers evaluated vaccine efficacy in both age categories. Vaccine efficacy in the combined age categories was 34.8% during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalised convulsive seizures after vaccination was 1.04 per 1,000 doses. The researchers conclude that the RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children.
An ongoing Phase 3 study of the efficacy, safety and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries, including Ghana, Kenya, Malawi, Mozambique and Tanzania. From March 2009 through January 2011, 15,460 children were enrolled in two age categories - 6 to 12 weeks and 5 to 17 months old - for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. After 250 children had an episode of severe malaria, researchers evaluated vaccine efficacy in both age categories. Vaccine efficacy in the combined age categories was 34.8% during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalised convulsive seizures after vaccination was 1.04 per 1,000 doses. The researchers conclude that the RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children.
Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, the authors reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, the authors propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. The authors call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems, resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). The authors also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that there is a need to accept and embrace vulnerability, rather than strive for stronger and more responsive systems. They observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems.
In 2007, the Doris Duke Charitable Foundation approved $60 million for the African Health Initiative to support a small portfolio of diverse approaches to health systems strengthening over a period of five to seven years (until 2015). Five projects in sub-Saharan countries were selected. While the Partnerships have all drawn on the World Health Organisation’s six building blocks approach to health systems strengthening, implementation has shown that dynamic, interactive elements of the system are not reflected in the six building blocks, specifically the important role of communities in promoting their own health, nor the growing role of community health workers in primary health care delivery. While not designed to address this question, the interventions offer a range of strategies. Some community health workers undergo several months of training, others just a few weeks. The cadres are drawn varyingly from the communities they serve and have different levels of educational attainment. Their connection to the formal health sectors varies —some are volunteers, others are employees, others received compensation but are not salaried. In addition, whether households are approached singly or through a community mobilisation process also varies. These variations offer a chance to reflect on how different approaches may have a bearing on implementation.
Health policy has tended to export models of health systems from developed nations to low-income countries without questioning their appropriateness and adaptability. Debates about the roles of public and private providers are meaningless in poor countries that do not have the institutional framework to govern a market economy and where government has little capacity to regulate providers of health services. The lack of appropriately contextualised debate and language hampers national and international efforts to address major health challenges. Health systems, like other systems of producing social goods, are ways of producing and organising access to expert knowledge and the technologies that derive from it. Their failure, in many contexts, to serve the interests of the poor means we should also be exploring different ways of producing and delivering services rather than simply intensifying efforts to recreate existing ones.
Most cases of gender-based violence (GBV) reported to the Nairobi Gender Violence Recovery Centre between April 2009 and March 2010 occurred in the capital's city centre, according to the centre's annual report, which also recorded an increase in gang rapes. 'A disturbing trend of GBV in the reported year is the continued number of gang rapes where the number of perpetrators per act increased from [a range of] 2-11 [perpetrators] to 2-20,' Teresa Omondi, the centre's executive director said. The centre, at the Nairobi Women's Hospital, registered 2,487 GBV survivors between April 2009 and March 2010, 52% (1,285) of whom were women, 45% (1,125) children and 3% men (77). According to the centre, neighbours topped the list of perpetrators named by survivors. Husbands and friends came second and third. Others included boyfriends, fathers, other relatives (uncles, aunts and cousins), house helps, teachers and classmates.