South Africa's Medicines Control Council (MCC) is sitting on a seven-year backlog of nearly 3,000 medicines, which could take another two years to be registered for use in the country. The medicines include treatments for life-threatening conditions such as HIV and AIDS, cancer, tuberculosis and diabetes, as well as antibiotics for bacterial infections. Pharmaceutical companies need to have their drugs registered with the MCC after being licensed to produce them. Only then can they be sold in the country. A task team, put in place by former health minister Barbara Hogan late last year, is busy clearing the backlog and transforming the MCC, and has registered about 200 medicines so far. The team, led by Nicholas Crisp of Benguela Health, includes 12 technical assistants and 24 clerks and has already audited the entire backlog and clinically evaluated nearly 800 medicines. About R13.5 million has so far been spent on the backlog project. Pharmaceutical representatives said they welcomed the task team's work. 'We have seen an increase in the numbers of medicines corresponded to the MCC,' said Shivani Patel, a regulatory affairs pharmacist at Merck's. Part of the project was the development of a new public entity, the South African Health Products Regulatory Authority, although what its role would be was unclear.
Equitable health services
Human papillovirus (HPV) types 16 and 18 are responsible for about 70% of all cervical cancer cases worldwide. This report provides key information for Kenya on cervical cancer, other anogenital cancers and head and neck cancers, HPV-related statistics, factors contributing to cervical cancer, cervical cancer screening practices, HPV vaccine introduction, and other relevant immunisation indicators. The report is intended to strengthen the guidance for health policy implementation of primary and secondary cervical cancer prevention strategies in the country. Kenya has a population of 10.32 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that, every year, 2,635 women are diagnosed with cervical cancer and 2,111 die from the disease. Cervical cancer ranks as the most frequent cancer among women in Kenya, and the second most frequent cancer among women between 15 and 44 years of age. About 38.8% of women in the general population are estimated to harbour cervical HPV infection at a given time, and 60.9% of invasive cervical cancers are attributed to HPVs 16 or 18.
In this study, researchers compared vaccine coverage achieved by two different delivery strategies for the quadrivalent human papillomavirus (HPV) vaccine in Tanzanian schoolgirls. In a cluster-randomised trial, 134 primary schools were randomly assigned to class-based or age-based vaccine delivery. Of the 3,352 and 2,180 eligible girls included in the study, HPV vaccine coverage was 84.7% for dose 1, 81.4% for dose 2, and 76.1% for dose 3. For each dose, coverage was slightly higher in class-based schools than in age-based schools. Vaccine-related adverse events were rare. Reasons for not vaccinating included absenteeism (6.3%) and parent refusal (6.7%). In conclusions, the authors argue that HPV vaccine can be delivered with high coverage in schools in sub-Saharan Africa. Compared with age-based vaccination, class-based vaccination located more eligible pupils and achieved higher coverage. HPV vaccination did not increase absenteeism rates in selected schools. Innovative strategies will also be needed to reach out-of-school girls.
This report aimed to identify health-care and provider-related determinants of diabetes and hypertension patients attending public sector community health centres (CHCs). A random sample of eighteen CHCs in the Cape Peninsula, South Africa, providing hypertension and diabetes care was selected. Twenty-five diabetes and 35 hypertension patients were selected per clinic and interviewed by trained fieldworkers and their medical records audited. Knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the diabetes and 11.4% of the hypertension patients. Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This highlights the urgent need to improve health care for patients with these conditions in the public sector of the Cape Peninsula.
In this study, researchers aimed to estimate the prevalence, awareness, management and control of hypertension and associated factors in an adult population in Dande, Northern Angola. They conducted a community-based survey of 1,464 adults, following the World Health Organisation's Stepwise Approach to Chronic Disease Risk Factor Surveillance, and selected a representative sample of subjects, stratified by sex and age (18–40 and 41–64 years old). Prevalence of hypertension was 23% in the sample. A follow-up consultation confirmed the hypertensive status in 82% of the subjects who had a second measurement on average 23 days after the first. Amongst hypertensive individuals, 21.6% were aware of their status. Only 13.9% of those who were aware of their condition were under pharmacological treatment, of which approximately one-third were controlled. Greater age, lower level of education, higher body mass index and abdominal obesity were found to be significantly associated with hypertension. The authors conclude that there is an urgent need for strategies to improve prevention, diagnosis and access to adequate treatment in Angola, where massive economic growth and its consequent impact on lifestyle risk factors could lead to an increase in the prevalence of hypertension and cardiovascular disease.
High blood pressure in South Africa is estimated to have caused 46,888 deaths and 390,860 disability-adjusted life years in 2000. Yet, according to this paper, detection and management of hypertension remains suboptimal due to inadequate public health care facilities. Mass rural to urban migration and rapid changes in lifestyle and risk factors account for the rising prevalence of hypertension, but genetic factors may also play an important contributory role. Black South Africans also appear to be more prone to complications of hypertension, particularly stroke, heart failure, and hypertensive nephrosclerosis, and respond poorly to ACE inhibitors as monotherapy. Proactive public health interventions at a population level need to be introduced to control this growing epidemic.
Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual’s acceptance and use of ICTs: usefulness and ease of use. It is evident that more effective use of ICTs as part of e-health initiatives at the rural healthcare centres was seen to be distinctly possible, but only if perceived shortcomings with regard to structural variables were addressed. Especially relevant was better access to more e-facilities, more health-related information made available via ICTs, ongoing ICT skills training programs and policies for improved technology maintenance and support. In conclusion, all structural and psychological factors investigated were seen to impinge to some extent on effective use of ICT applications as e-health solutions in the rural healthcare centres involved in the study. Furthermore, there was a distinct interplay between the various variables, with perceived ICT-related shortcomings having a negative impact on perceived usefulness and ease-of-use variables and thus decreasing the likelihood of effective e-health solutions. This means that to increase effective use of ICTs that form part of e-health initiatives in the healthcare centres, a vital first step is to address reported perceived shortcomings.
The authors aimed to estimate the effective coverage of key maternal and newborn health interventions in rural parts of the United Republic of Tanzania and to identify bottlenecks in implementation. They used data from an observational, cross-sectional study that was performed in Tandahimba and Newala districts in south-eastern United Republic of Tanzania. They investigated five key maternal and newborn health interventions: (i) syphilis screening; (ii) pre-eclampsia screening; (iii) use of a partograph to monitor labour; (iv) active management of the third stage of labour; and (v) postpartum care in a health facility. The largest bottleneck in Tandahimba was health facility readiness, which was associated with a 52% reduction in coverage. Clinical practice was another large bottleneck, with an attrition of 35%. In Newala, clinical practice was the largest bottleneck, causing an attrition of 57%. The authors provide a framework that could help operationalize measurements and track progress towards universal health coverage in all areas of health care.
In a double move hailed as a milestone for public health, African leaders have launched an agency to tackle global threats such as Ebola and pledged to make immunisation available throughout the continent by 2020. Under the twin commitments, African heads of state will establish regional health centres around the continent, increase funding for immunisation, improve supply chains and delivery, and prioritise vaccines as part of broader efforts to strengthen health systems. At the heart of the new health push will be the Africa Centres for Disease Control and Prevention, which will help countries across the continent to deal with major health emergencies by establishing systems for early warning and response surveillance. Based in Addis Ababa, the new organisation will liaise with regional centres in Zambia, Gabon, Kenya, Nigeria and Egypt. Dr Matshidiso Moeti, the World Health Organization’s (WHO) regional director for Africa, said the announcements, made on Tuesday at the African Union summit in Addis Ababa, demonstrated a strong commitment by African leaders to “save lives across the continent”. “This is a very important milestone,” said Moeti. “We are extremely excited to have got here with the immunisation declaration. It’s something we worked on for quite a few months with a range of partners, and it includes commitments with heads of state and partners in mobilising finances for the vaccines.
“It shows leaders reiterating their commitments to saving the lives of children across the continent, and contributing their own funding, as they transition into middle-income states.”
Research presented at the Eighteenth International AIDS Conference, held from 19–27 July in Vienna, Austria, appears to indicate that the impact of HIV spending on other major health problems, particularly the Millennium Development Goals on child mortality and maternal mortality, has been limited to date, despite compelling evidence of the impact of HIV on child and maternal mortality, particularly in southern Africa. Other studies presented at the Conference were less clear-cut in their findings. For example, research in Rwanda, which compared 26 pairs of health centres – one providing HIV care and the other not – found that, although centres providing HIV care showed a trend towards better outcomes with regard to a range of indicators including child immunisation, adult and child hospitalisation and curative visits to the health centre, the only indicator on which HIV clinics did significantly better was providing BCG vaccinations to all patients. Researchers agreed that more research was needed, looking in particular at a wider range of settings and services, and taking into account the effects of other recent global health initiatives, notably GAVI, which has been supporting the purchase of vaccines for child immunisation.