2015 Global Reference List of 100 Core Health Indicators

This report from WHO looks to be very useful as countries seek to achieve universal health coverage in the post-2015 era. The indicators do not specifically include access to healthcare information. One could argue that it should be included among the section on ‘Health systems indicators’, alongside indicators such as ‘Availability of essential medicines and commodities’ and ‘Health worker density and distriution’. Or one could argue that the availability and use of healthcare information is so fundamental to all decision-making, whether by governments, health professionals, or citizens, that current failures in the global health information system need to be addressed with even more urgency than many of the specific 100 indicators. What do you think?

(The question of whether the availability and use of healthcare information can or should be recognised as a key health indcator is complicated by the fact that there is no agreement on how this might be measured. Then again, to paraphrase Seth Godin, “Just because something is difficult to measure doesn’t mean it’s not important.”)

2015 Global Reference List of 100 Core Health Indicators

Interagency Working Group on Indicators and Reporting Burden

World Health Organization, 2015

http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf?ua=1

‘The Global Reference List of 100 Core Health Indicators is a standard set of 100 indicators prioritized by the global community to provide concise information on the health situation and trends, including responses at national and global levels. It will be reviewed and updated periodically as global and country priorities evolve and measurement methods improve.’

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Zika Prevention & Community Education Guide

Hesperian’s Zika Prevention & Community Education guide has now been translated into French, Spanish and Portuguese, and will be available in Haitian Kreyol soon. This guide is available online on our HealthWiki and also as a PDF printable handout.

Please share this resource widely with your community:

English: http://en.hesperian.org/hhg/Zika

Spanish: http://es.hesperian.org/hhg/Zika

French: http://fr.hesperian.org/hhg/Zika

Portuguese: http://pt.hesperian.org/hhg/Zika

Best regards,

Rachel Grinstein

Rachel Grinstein

Development and Marketing Associate

Hesperian Health Guides

P: 510.845.1447 | F: 510.845.9141

www.hesperian.org

Hesperian Health Guides in Portugese: Vírus Zika

Congratulations to Hesperian for making this guide available in Portuguese. I have informed our HIFA-Portuguese members, who have been lamenting the lack of information available in Portuguese (which is so clearly the language that is most needed). http://www.hifa2015.org/hifa-pt/

Meanwhile, I learn on BBC news today: ‘More than 220,000 soldiers are being deployed across Brazil to warn people about the risks of the Zika virus… Troops will hand out 4 million leaflets advising people about the risks of the virus, carried by mosquitoes.’

http://www.bbc.co.uk/news/world-latin-america-35568461

This is a clear recognition that meeting the information needs of citizens is vitally important. But is this the best way to go about it? As we have discussed on HIFA through the Ebola outbreak in West Africa, there are some key learning points that are as applicable to Zika as they are to Ebola:

1. Communication should be multi-channel. The Brazilian Government, WHO and the mass media should be collaborating to provide clean, clear, non-conflicting information for the general public through all media – an emphasis on one medium such as printed leaflets will be relatively ineffective.

2. Reaching people with low literacy is a priority – this cannot be done with leaflets.

3. Communication should be community-based wherever possible, engaging community leaders (municipal, religious, celebrities, and others)

4. The channel of communication should be one that is trusted by the people, and such communication should be done sensitively (are soldiers likely to be trusted by the communities? will they be able to work sensitively?)

5. Communication should not be one-way – it should include the opportunity for people to express concerns, ask questions, and work together to take effective community action (such as elimination of stagnant water where mosquitos breed).

6. Every country should prepare its capacity for mass health education in a public health emergency. This is important in any country, and especially in low and middle income countries where such emergencies are inevitable.

On the last point, it would be interesting to compare the annual public health education budget of the Brazil Government with the cost of deployment of 220,000 soldiers.

I look forward to hear from other HIFA members, especially those who have experience in public health education.

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Angola says 37 dead in yellow fever outbreak

http://mobile.reuters.com/article/idUSKCN0VK0FQ?utm_campaign=KFF-2016-Daily-GHP-Report&utm_source=hs_email&utm_medium=email&utm_content=26159936&_hsenc=p2ANqtz-8y40tw3eYZouHgOXkAhFNjGxyeb5MZFOxrjTFzFLDEEakHjYynNpMzYmKHNmw5mUlcaYGU_gifn-w6wiTglGVqzkK62w&_hsmi=26159936

LUANDA (Reuters) – A yellow fever outbreak in Angola has killed 37 people since December with eight new cases reported in the last 24 hours, the country’s national director of health Adelaide de Carvalho said late on Wednesday. The outbreak of yellow fever, which is transmitted by mosquito bites, began in the Luanda suburb of Viana but has spread to other areas of the southern African country with 191 people infected so far. De Carvalho said health officials were monitoring suburbs around the capital of Luanda where infections have been worsened by unsanitary conditions caused by a garbage collection backlog.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

Zika Outbreak: WHO’s Global Emergency Response Plan

http://www.who.int/emergencies/zika-virus/response/en/

WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.

WHO says $56 million is required to implement the Strategic Response Framework and Joint Operations Plan, of which $25 million would fund the WHO/AMRO/PAHO response and $31 million would fund the work of key partners. In the interim, WHO has tapped a recently established emergency contingency fund to finance its initial operations.

As part of WHO’s new emergency programme, the agency’s headquarters activated an Incident Management System to oversee the global response and leverage expertise from across the organization to address the crisis. WHO is tapping a recently established emergency contingency fund to finance its initial operations.

WHO’s Regional Office for the Americas (AMRO/PAHO) has been working closely with affected countries since May 2015, when the first reports of Zika virus disease emerged from northeastern Brazil. AMRO/PAHO and partner specialists were deployed to help health ministries detect and track the virus, contain its spread, advise on clinical management of Zika and investigate the spikes in microcephaly and Guillain-Barré syndrome in areas where Zika outbreaks have occurred. AMRO/PAHO will continue to work with partners to manage the response in the Americas.

WHO is issuing regular information and guidance on the congenital and neurological conditions associated with Zika virus disease, as well as related health, safety and travel issues.

Working with partners, WHO is also mapping efforts to develop vaccines, therapies, diagnostic tests and new vector control tactics and putting in place mechanisms to expedite data sharing, product development and clinical trials.

On 1 February 2016, based on recommendations of the International Health Regulations Emergency Committee, WHO declared the increasing cases of neonatal and neurological disorders, amid the growing Zika outbreak in the Americas, a Public Health Emergency of International Concern.

All my best regards.

Mrs Isabelle Wachsmuth, Project manager, Health Information & System (HIS)

Service Delivery & Safety, Emerging Issues, Universal Health Coverage & Quality

Moderator of Global Francophone Forum – Health Information For All (HIFA-Fr)

Tel. direct: +41 22 791 3175 / Mail: hugueti@who.int

World Health Organization, 20, avenue Appia, CH-1211 Geneva 27

Tel: +41 22 791 2111 / Fax: +41 22 791 3111 / Visit WHO at: www.who.int

__________________________________________________________

EBSCO has made available free access to a comprehensive summary of the clinical evidence related to Zika virus in DynaMed Plus.

You can view it at https://health.ebsco.com/dynamed-content/zika-virus without logging in, or you can see it inside DynaMed Plus at http://www.dynamed.com/topics/dmp~AN~T909469/Zika-virus-infection — this topic will include evidence and guidelines, and be updated frequently.

Brian S. Alper, MD, MSPH, FAAFP

__________________________________________________________

Founder of DynaMed, Vice President of EBM Research and Development, Quality & Standards / http://www.dynamed.com/

Evidence Aid (www.evidenceaid.org) is developing a resource for Zika containing systematic reviews, randomised controlled trials and guidelines. If you know of any SRs, RCTs or guidelines you think should be considered for this collection, please send them directly to me (callen@evidenceaid.org).

Many thanks,

Claire Allen

Operations Manager, Evidence Aid: Winner of the Unorthodox Prize 2013 ($10,000)

Email: callen@evidenceaid.orgSkype: claireallencochrane, Website: www.evidenceaid.org

Twitter: @evidenceaid, Facebook: Evidence Aid

WONCA E-update 19 FEBRUARY 2015

WONCA E-Update

Friday 19th February 2016

WONCA News – February 2016

The latest WONCA News is available via the WONCA website, packed with WONCA news, views and events.

Policy Bite: Public-Private Partnerships for PHC

“All governments have to decide how to meet the needs of their peoples, and most political elections are based on different beliefs as to how this can best be done. Fundamental issues about how to finance investment for health care and other public sectors require clear thinking and recurrent review of decisions made.”

In this month’s Policy Bite Professor Amanda Howe looks at a number of financing models for PHC delivery and discusses the pros and cons of each.

WONCA Special Interest Group on Health Equity

Professor William Wong, Convener of WONCA’s SIG on Health Equity, reports on the enthusiastic discussions which took place during the Health Equity workshop during WONCA Europe in Istanbul in October 2015.  He also encourages members to visit the newly affiliated journal: International Journal for Equity in Health for up to date health equity research and news from around the world whilst Global Focus looks especially at Bangladesh, Uganda and Taiwan

WONCA conferences

The first WONCA conference of the year – the South Asia Region conference in Colombo, Sri Lanka – took place last weekend, with over 600 delegates enjoying a very interesting and varied programme.  There are still several other WONCA conferences throughout 2016, including Dubai, Costa Rica and Copenhagen before the “big one” – the World Conference in Rio de Janeiro in November.  Full details of all WONCA events can be found on the website.

And don’t forget that if you enroll as a WONCA Direct Member you are entitled to discounted conference registration at all regional and world events.  Rio de Janeiro is offering especially attractive discounts to Direct Members, so why not sign up now?  Details of how to apply are available on the WONCA website

Or contact Arisa, in the WONCA Secretariat on admin@wonca.net.

RCGP publication on managing uncertainty in medical practice

The Royal College of General Practitioners (RCGP) has just published guidance to help clinicians understand uncertainty in medical practice, help them manage it effectively and improve their stress levels and resilience as a result. The book has wide appeal – clinicians in all specialties whether experienced or in training, or wherever in the world they are practising.

• Full details can be found on the RCGP website.

Read a sample chapter.

• Copies can be purchased online from the RCGP Medical Bookshop.

Web server changeover

Finally we will be changing web server next week, prior to an update of the WONCA website.  There will thus be no e-update next week, and WONCA News will appear on Friday 5th March.  We hope that this will be a seamless changeover, but please bear with us if any glitches occur.

Cochrane evidence on supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother & baby

Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD010647. DOI: 10.1002/14651858.CD010647.pub2

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010647.pub2/abstract

The Plain Language Summary states:

“The benefits and risks of multiple-micronutrient supplementation during lactation are not clear from randomised controlled studies. Key vitamins and minerals, particularly iodine, iron and zinc, are required in small amounts to ensure normal body metabolism, physical growth and development. Nutrient deficiency affects nearly one third of the world’s population, especially in low- and middle-income countries. Breastfeeding mothers need higher levels than usual in order to provide sufficient vitamins and minerals for their own health and that of their babies, particularly for normal functioning and the growth and development of the baby.

Previous studies have assessed supplementation of individual micronutrients. This review looked at the use of multiple-micronutrient supplements for breastfeeding women for improving outcomes for the mother and her baby. We searched for studies on 30 September 2015 and identified two small studies (involving 52 women) for inclusion in this review. The studies were carried out in Brazil and the USA and included women who had a low socioeconomic status. The studies were poorly reported and this lack of information made it difficult to determine whether the studies were at risk of bias. Neither of the studies provided data for any of this review’s important outcomes: maternal illness (fever, respiratory infection, diarrhoea), adverse effects of micronutrients within three days of taking them, infant death (defined as a child dying before reaching one year of age).

Similarly, there were no data for any of the other outcomes that we were interested in. For the mother, these outcomes were maternal anaemia, and women’s satisfaction. For the baby, these outcomes were micronutrient deficiency; illness episodes (fever, respiratory infection, diarrhoea, other), adverse effects of micronutrients within three days of the woman receiving the supplement. However, one of the included studies reported that multiple-micronutrient supplementation was effective for lactating women recuperating from anaemia.

There is a need for high-quality studies to assess the effectiveness and safety of multiple-micronutrient supplementation for breastfeeding women for improving outcomes for the mother and her baby. Larger studies with longer-term follow-up would improve the quality of studies and provide stronger evidence. Further research should focus on whether multiple-micronutrient supplementation during lactation (compared with no supplementation, a placebo or supplementation with fewer than two micronutrients) is beneficial to the mother and her baby and any associated adverse effects of the intervention. Further studies should report on important outcomes such as those listed in this review and consider the risks of excess supplementation. Future studies could more precisely assess a variety of multiple-micronutrient combinations and different dosages and look at how these effect outcomes for the mother and her baby.”

Best wishes,

Holly

Holly Millward

Communications and Engagement Officer

Cochrane UK

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria

CITATION: Hum Resour Health. 2016 Feb 12;14(1):5. doi: 10.1186/s12960-016-0100-4.

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study.

Otu A, Ebenso B, Okuzu O, Osifo-Dawodu E.

Abstract

BACKGROUND: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa.

METHODS: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease.

RESULTS: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P?<?0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola.

CONCLUSIONS: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products

CITATION: Syst Rev. 2016 Feb 10;5(1):28. doi: 10.1186/s13643-016-0204-x.

What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products.

Miake-Lye IM, Hempel S, Shanman R, Shekelle PG.

Abstract

BACKGROUND: The need for systematic methods for reviewing evidence is continuously increasing. Evidence mapping is one emerging method. There are no authoritative recommendations for what constitutes an evidence map or what methods should be used, and anecdotal evidence suggests heterogeneity in both. Our objectives are to identify published evidence maps and to compare and contrast the presented definitions of evidence mapping, the domains used to classify data in evidence maps, and the form the evidence map takes.

METHODS: We conducted a systematic review of publications that presented results with a process termed “evidence mapping” or included a figure called an “evidence map.” We identified publications from searches of ten databases through 8/21/2015, reference mining, and consulting topic experts. We abstracted the research question, the unit of analysis, the search methods and search period covered, and the country of origin. Data were narratively synthesized.

RESULTS:

Thirty-nine publications met inclusion criteria. Published evidence maps varied in their definition and the form of the evidence map. Of the 31 definitions provided, 67 % described the purpose as identification of gaps and 58 % referenced a stakeholder engagement process or user-friendly product. All evidence maps explicitly used a systematic approach to evidence synthesis. Twenty-six publications referred to a figure or table explicitly called an “evidence map,” eight referred to an online database as the evidence map, and five stated they used a mapping methodology but did not present a visual depiction of the evidence.

CONCLUSIONS:

The principal conclusion of our evaluation of studies that call themselves “evidence maps” is that the implied definition of what constitutes an evidence map is a systematic search of a broad field to identify gaps in knowledge and/or future research needs that presents results in a user-friendly format, often a visual figure or graph, or a searchable database. Foundational work is needed to better standardize the methods and products of an evidence map so that researchers and policymakers will know what to expect of this new type of evidence review.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda.

CITATION: BMC Health Serv Res. 2014 Dec 18;14:639. doi: 10.1186/s12913-014-0639-5.

Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda.

Nabyonga-Orem J, Ssengooba F, Mijumbi R, Tashobya CK, Marchal B, Criel B.

http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-014-0639-5

Abstract

BACKGROUND: Several countries in Sub Saharan Africa have abolished user fees for health care but the extent to which such a policy decision is guided by evidence needs further exploration. We explored the barriers and facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT). Application of the MRT to the case of abolition of user fees contributes to its refining.

METHODS: Employing a theory-driven inquiry and case study approach given the need for in-depth investigation, we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed whether evidence was available, had or had not been considered in policy development and the reasons why and; assessed how the actors and the context shaped the uptake of evidence.

RESULTS: Symbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research, politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the partnerships for KT were informal. The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and had varying levels of support and influence impacting the uptake of evidence.

CONCLUSION: Evidence will be taken up in policy development in instances where the MoH leads the KT process, there are partnerships for KT in place, and the overall government policy and the political situation can be expected to play a role. Different actors will be influenced by different types of evidence and their level of support and influence will impact the uptake of evidence. In addition, the extent to which a policy issue is contested and, whether stakeholders share similar opinions and preferences will impact the uptake of evidence.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

New Lancet Series: Breastfeeding

New Lancet Series: Breastfeeding

The Lancet, Published: January 28, 2016

http://www.lancet.com/series/breastfeeding

“With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and chidren across the globe. The two papers in this Series will describe past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions.”

The web page above includes an audio podcast where Cesar Victora discusses new data highlighting the health benefits and promotion priorities for breastfeeding worldwide. Cesar was one of the authors of a game-changing 1987 Lancet paper that showed the benefits of exclusive breastfeeding. Since then breastfeeding has been shown to have benefits for children not only in infancy but also for their lifetime, and benefits for mothers too (including reduced risk of breast and ovarian cancer). Breast milk has been described as ‘exquisite, personalised medicine’ – something that could never be imitated by formula feeding. The 50 researchers prepared 28 meta-analyses over 2 years for the current Series. Breasfeeding is more prevalent in LMICs than in HICs and is increasing, currently about 40% in LMICs. The figures show that infants who have exclusive breastfeeding in the first 6 months has ‘seven times lower mortality than one not [exclusively] breastfed’. How better to promote breastfeeding? “It is a societal issue not an individual mother issue.” Infant formula companies continue to make things difficult by providing free samples to mothers. Need more supportive work environments and more support/understanding from health workers. The authors call for action: Everybody needs breast milk and we should do more to promote it. More funding is needed. “We want to put breasfeeding back near the top of the health agenda.”

One of the papers in the series ‘Why invest, and what it will take to improve breastfeeding practices?’ has the following key messages:

– The world is still not a supportive and enabling environment for most women who want to breastfeed.

– Countries can rapidly improve breastfeeding practices by scaling up known interventions, policies, and programmes.

– Success in breastfeeding is not the sole responsibility of a woman — the promotion of breastfeeding is a collective societal responsibility.

– The breastmilk substitute industry is large and growing, and its marketing undermines efforts to improve breastfeeding.

– The health and economic costs of suboptimal breastfeeding are largely unrecognised. Investments to promote breastfeeding, in both rich and poor settings, need to be measured against the cost of not doing so.

– Political support and financial investment are needed to protect, promote, and support breastfeeding to realise its advantages to children, women, and society.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

New free e-learning course on Palliative Care in India

ecancer has just launched a new 20 module e-learning course which covers all aspects of palliative care, particularly relating to India.  The course includes symptom management, paediatric care, malignant and non-malignant disease, pain management, psychosocial care and communication and counselling skills.

These modules have been developed in association with the Bangalore Hospice Trust – Karunashraya and Cardiff Palliative Care Education and aree all free to use.  Access them here http://ecancer.org/education/course/16-palliative-care-e-learning-course-for-healthcare-professionals-in-india.php

HIFA profile: Katie Foxall is Head of Publishing at eCancer, Bristol, UK. katie AT ecancer.org

NPR: Can A Bath Of Milk And Honey Replace Female Genital Mutilation?

Below are extracts of an article on the NPR (National Public Radio, US) website. Substitution of female genital mutilation with non-harmful rituals looks to be increasingly successful. It is notable that traditional cutters are also willingly involved. It’s clearly also important that national health policies are supportive of such efforts.

http://www.npr.org/sections/goatsandsoda/2016/02/23/467687101/can-a-bath-of-milk-and-honey-replace-female-genital-mutilation

‘The new traditions are taking hold in Maasai and Samburu communities in Kenya and Tanzania. After two or three days of preparatory sessions for the girls, the celebration culminates with communal singing and dancing and blessings by the village elders, who pour a mixture of milk and honey and water over the heads of the girls…

‘And at the center of the celebration are the girls themselves. During the two to three days preceding the celebration, participating girls in the alternative rites of passage are secluded, in a school dormitory or village hut, where they learn about womanhood: lessons which now include sex education, information about STDs and violence against women, and presentations emphasizing the importance of continuing education for girls’ and women’s rights. The traditional cutters who had in the past performed the cut also are usually present, discussing their role in the past — and explaining the health reasons for abandoning the practice. “They will say, ‘We did this because we believed in it, but now we want to encourage girls to go back to school,’ ” says Leng’ete.

‘… It can take six months or more of meetings before a community agrees to abandon FGM and accept alternative rites.’

Wikipedia indicates 5 countries with an especially high prevalence: Egypt, Guinea, Mali, Somalia, Sudan. FGM is prohibited by law in Egypt, Guinea and Sudan, but clearly there is a failure of implementation, while Somalia and Mali appear not to have yet banned the practice.

https://upload.wikimedia.org/wikipedia/commons/e/eb/2013_Female_Genital_Mutilation_Cutting_Circumcision_FGM_World_Map_UNICEF.SVG

According to the UNFPA website, it seems FGM is prohibited in fewer than half (23/48) of sub-Saharan African countries.

http://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions#banned_by_law

UNFPA describes FGM as ‘a cultural rather than a religious practice. In fact, many religious leaders have denounced it.’ http://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions#religions

It would be interesting to learn more about health policymaking in different countries on this issue. Who are the main stakeholders that seek to maintain the status quo, and how do they have such influence?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Malaria Journal: Factors affecting adherence to national malaria treatment guidelines among public healthcare workers in Uganda

CITATION: Factors affecting adherence to national malaria treatment guidelines in management of malaria among public healthcare workers in Kamuli District, Uganda.

Malaria Journal 2016; 15:112. DOI: 10.1186/s12936-016-1153-5

http://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1153-5

ABSTRACT

Background: Malaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda. Consequently, malaria control remains a major public health priority in endemic countries such as Uganda. Experiences from other countries in Africa that revised their malaria case management suggest that health workers adherence may be problematic.

Methods: A descriptive, cross-sectional design was used and collected information on health system, health workers and patients. Using log-binomial regression model, adjusted prevalence risk ratios (PRRs) and their associated 95 % confidence intervals were determined in line with adherence to new treatment guidelines of parasitological diagnosis and prompt treatment with artemisinin combination therapy (ACT).

Results: Nine health centres, 24 health workers and 240 patient consultations were evaluated. Overall adherence to national malaria treatment guidelines (NMTG) was 50.6 % (122/241). It was significantly high at HC III [115 (53 %)] than at HC IV (29 %) [PRR = 0.28 (95 % CI 0.148 0.52), p = 0.000]. Compared to the nursing aide, the adherence level was 1.57 times higher among enrolled nurses (p = 0.004) and 1.68 times higher among nursing officers, p = 0.238, with statistical significance among the former. No attendance of facility malaria-specific continuing medical education (CME) sessions [PRR = 1.9 (95 % CI 1.29 2.78), p = 0.001] and no display of malaria treatment job aides in consultation rooms [PRR = 0.64 (95 % CI 0.4 1.03), p = 0.07] was associated with increased adherence to guidelines with the former showing a statistical significance and the association of the latter borderline statistical significance. The adherence was higher when the laboratory was functional [PRR = 0.47 (95 % CI 0.35 0.63)] when the laboratory was functional in previous 6 months. Age of health worker, duration of employment, supervision, educational level, and age of patient were found not associated with adherence to new treatment guidelines.

Conclusion: Adherence to malaria treatment guidelines in Uganda is sub-optimal. There is an urgent need for deliberate interventions to improve adherence to these guidelines. Possible interventions to be explored should include: provision of job aides and improved access to laboratory services. There is also a need for continuous medical educational sessions for health workers, especially those at higher-level facilities and higher cadres, on adherence to guidelines in management of fever, including management of other causes of fever.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

BBC: Ebola still “devastates” survivors

More than 17,000 people in West Africa have survived Ebola infection.  The evidence, being presented at the annual meeting of the Academy of Neurology, is an early glimpse at a much wider study of long-term health problems after Ebola. The initial analysis, on 82 survivors, showed most had had severe neurological problems at the height of the infection, including meningitis, hallucinations or falling into a coma. Six months later, new long-term problems had developed.  About two-thirds had body weakness, while regular headaches, depressive symptoms and memory loss were found in half of patients. Two of the patients had been actively suicidal at the time of the assessment.

Dr Lauren Bowen, from the National Institute of Neurological Disorders and Stroke, told the BBC: “It was pretty striking, this is a young population of patients, and we wouldn’t expect to have seen these sorts of problems. “When people had memory loss, it tended to affect their daily living, with some feeling they couldn’t return to school or normal jobs, some had terrible sleeping problems. Ebola hasn’t gone away for these people.”

http://www.bbc.com/news/health-35652095

Private care exposed as costly, insensitive

skinculture4-300x169After a week of public hearings into private healthcare, medical aids came out looking insensitive, while fees charged by hospitals and specialists were also hammered. A man mortgages his house to pay his hospital bill after a heart attack, although his medical aid is supposed to pay the entire bill. Another waits 18 months for medical aid approval for a life-saving procedure and only gets it after his specialist lodges a complaint. Cancer patients’ benefits run out in the middle of chemotherapy, yet if they’re hospitalised for cancer-related complications, this will be paid for….more

Erectile dysfunction not just for those ‘silver foxes’

fatherhood-300x178Erectile dysfunction is not just for older men. While studies show that even younger men battle the condition, most men may not be ready to talk about it.  Vusani Mudau, 34, says he has struggled with erectile dysfunction (ED) since he was a teenager. “I was doing my grade 12 and I realised that my penis did not function or get hard as it was supposed to,” he said. “I was too ashamed to tell my parents or even my peers. I really feared that they would laugh at me.” “I kept my ED secret for years, but it got worse when I got to tertiary,” he tells OurHealth. “My peers used to brag about how they were enjoying their sex lives…..more

Motsoaledi does not want NHI to limit choices

SOUTH African Health Minister Aaron Motsoaledi has distanced himself from a controversial proposal in the White Paper on National Health Insurance (NHI) to slash the benefits offered by medical schemes, saying the state should not limit patients’ choices. He has also dismissed the paper’s cost projections, saying NHI is a long term-project that should be financed on a programme-by-programme basis….more