EQUITABLE HEALTH SERVICES
PHYSICAL ACTIVITY AND HEALTH PROMOTION STRATEGIES AMONG PHYSIOTHERAPISTS IN RWANDA
Frantz JM And Ngambare R: African Health Sciences 13 (1): 17-23, March 2013
In this study from Rwanda, researchers aimed to establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies. They drew data from 92 self-administered questionnaires and a focus group discussion of 10 purposively selected physiotherapists. The findings revealed that 64% of the participants were physically active both within the work and recreation domains and 65% of the participants had good physical activity promoting practices. Discussing physical activity and giving out information regarding physical activity were most common methods used in promotion of physical activity. Policies on physical activity, cultural influence, and nature of work, time management as well as the environment were the barriers highlighted. In conclusion, although physiotherapists experience barriers to promoting physical activity, they have good physical activity promoting practices.
PSYCHOLOGICAL DISTRESS AMONG ADULTS ADMITTED TO MEDICAL AND SURGICAL WARDS OF A REGIONAL REFERRAL HOSPITAL, UGANDA
Rukundo ZG, Nakasujja N And Musisi S: African Health Sciences 13(1): 82-86, March 2013
Little is known about psychological distress of patients on general wards in developing countries. This study aimed to determine the extent and associations of psychological distress among adult in-patients on medical and surgical wards of Mbarara hospital in Uganda. Researchers conducted a cross-sectional descriptive study among 258 adult in-patients. They used the WHO endorsed self report questionnaire (SRQ-25) to assess psychological distress with a cut off of 5/6, as well as the MINI International Neuropsychiatric Interview (MINI) to identify specific psychiatric disorders. Results indicated that 158 individuals (61%) had psychological distress. One hundred and nine (42%) met criteria for at least one major psychiatric diagnosis. Only 6% of these were recognised by the attending health workers. Psychological distress was significantly associated with previous hospitalisations, ward of admission and marital status. The authors conclude that despite high levels of psychological distress among the physically ill, it is often unrecognised and untreated.
THE IMPACT OF UNIVERSAL COVERAGE SCHEMES IN THE DEVELOPING WORLD
Giedion U, Alfonso EA And Diaz Y: World Bank, January 2013
This review indicates that universal health coverage (UHC) interventions in low- and middle-income countries improve access to health care. It also shows, though less convincingly, that UHC often has a positive effect on financial protection, and that, in some cases it seems to have a positive impact on health status. The effect of UHC schemes on access, financial protection, and health status varies across contexts, UHC scheme design, and UHC scheme implementation processes. Regarding UHC design features, there are several common features across countries and regions, such as the coexistence of UHC schemes, heterogeneity in design and organisation, a widespread effort to include the poor in the schemes, and the prevalence of mixed financing sources (contributions plus taxes). Yet, in most cases, evidence is scarce and inconclusive on the impact of specific UHC design features on their intended outcomes. Four lessons are highlighted: affordability is important but may not be enough; target the poor, but keep an eye on the non-poor; benefits should be closely linked to target populations' needs; and highly focused interventions can be a useful initial step toward UHC.
A POPULATION BASED SURVEY IN ETHIOPIA USING QUESTIONNAIRE AS PROXY TO ESTIMATE OBSTETRIC FISTULA PREVALENCE: RESULTS FROM DEMOGRAPHIC AND HEALTH SURVEY
Biadgilign S, Lakew Y, Reda AA And Deribe K: Reproductive Health 10(14), 25 February 2013
The aim of this study was to describe the prevalence and factors associated with obstetric fistula in Ethiopia. A total of 14,070 women of reproductive age group were included in the survey, of whom only 23.2% had ever heard of OF. Among 9,713 women who had given birth, 103 (1.06%) had experienced OF in their lifetime. Those women who are circumcised or lived in urban areas had higher odds of reporting the condition. Women who gave birth 10 or more also had higher odds of developing OF than women with one to four children. It is estimated that in Ethiopia nearly 142,387 obstetric fistula patients exist. The authors conclude that OF is a major public and reproductive health concern in Ethiopia and they call for increased access to emergency obstetric care, expansion of fistula repair service and active recruitment of women through a campaign of ending obstetric fistula.
YELLOW FEVER VACCINATION COVERAGE FOLLOWING MASSIVE EMERGENCY IMMUNISATION CAMPAIGNS IN RURAL UGANDA, MAY 2011: A COMMUNITY CLUSTER SURVEY
Bagonza J, Rutebemberwa E, Mugaga M, Tumuhamye N And Makumbi I: BMC Public Health 13(202), 7 March 2013
This paper reports on yellow fever vaccination coverage following massive emergency immunisation campaigns in the Pader district, northern Uganda, in 2010. A total of 680 respondents were included in the sample and vaccination status was assessed in a survey using self reports and vaccination card evidence. Of the 680 respondents, 654 (96.3%) reported being vaccinated during the last campaign but only 353 (51.6%) had valid yellow fever vaccination cards. Of the 280 children below five years of age, 96.1% were vaccinated. The main reasons for not being vaccinated were: having travelled out of Pader district during the campaign period (40%), lack of transport to immunisation posts (28%) and sickness at the time of vaccination (16%). These results show that actual yellow fever vaccination coverage was high and met the desired minimum threshold coverage of 80% designated by the World Health Organisation. Active surveillance is necessary for early detection of yellow fever cases.
DESIGN, IMPLEMENTATION AND EVALUATION OF A NATIONAL CAMPAIGN TO DELIVER 18 MILLION FREE LONG-LASTING INSECTICIDAL NETS TO UNCOVERED SLEEPING SPACES IN TANZANIA
Renggli S, Mandike R, Kramer K, Patrick F, Brown NJ, McElroy PD Et Al: Malaria Journal 12(85), 4 March 2013
In 2010 and 2011, Tanzania ran a universal coverage campaign to distribute long-lasting insecticidal nets (LLINs) nationally and free-of-charge. Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use. A total of 18.2 million LLINs were delivered at an average cost of US$ 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one insecticide-treated net (ITN) increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles. Close collaboration among the Ministry of Health and Social Welfare, external funders, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. The authors predict that, through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania.
BUILDING CONSENSUS ON KEY PRIORITIES FOR RURAL HEALTH CARE IN SOUTH AFRICA USING THE DELPHI TECHNIQUE
Versteeg M, Du Toit L, Couper I And Mnqapu M: Global Health Action 6(19522), 24 January 2013
Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. Therefore, the objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. The top five priorities identified by participants were aligned to three of the World Health Organisation’s health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel made the following policy recommendations: a focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.
HYPERTENSION IN NORTHERN ANGOLA: PREVALENCE, ASSOCIATED FACTORS, AWARENESS, TREATMENT AND CONTROL
Pires JE, Sebastião YV, Langa AJ And Nery SV: BMC Public Health 13(90), 31 January 2013
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.
QUALITY OF ANTENATAL CARE IN ZAMBIA: A NATIONAL ASSESSMENT
Kyei NAN, Chansa C And Gabrysch S: BMC Pregnancy And Childbirth 12(151), 13 December 2012
Little conceptual or empirical work exists on the measurement of antenatal care (ANC) quality at health facilities in low-income countries. To address this gap, researchers in this study developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. They included 1,299 antenatal facilities in the study and compared the quality of ANC received by 4,148 mothers between 2002 and 2007. Results showed that only 45 antenatal facilities (3%) fulfilled the study’s developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. The authors argue that these results indicate missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect the “quality gap” where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress.
ACCESS TO HEALTH CARE IN MOZAMBIQUE
Ravenscroft J: Global Health Check, 4 February 2013
This film examines the barriers that people face in accessing healthcare in rural Mozambique, specifically the rural area of Tsangano in the province of Tete, a huge region in the centre of the country. In the film, you can see how the examples of Tsangano and Tete clearly show that all parts of a health system need to come together in order for the system as a whole to function. The film advocates for an end to out-of-pocket payments by health service users. To ensure this, the ‘key ingredients’ that will make user fee removal a success must also be addressed – the financing for the system as a whole and ensuring increased investment in transport and infrastructure – particularly in rural areas – a bigger, stronger health workforce, universal access to medicines and better information for the population to demand their right to health.