Quitting smoking abruptly has best long-term results

People who quit smoking all at once are more likely to be successful than those who cut down on cigarettes gradually, according to a new study. “For many people, the obvious way to quit smoking is to cut down gradually until they stop,” said lead author Nicola Lindson-Hawley, a post-doctoral researcher at the University of Oxford in the U.K. “However, with smoking, the norm is to advise people to stop all at once and our study found evidence to support that,” Lindson-Hawley told Reuters Health by email. “What we found was that more people managed to quit when they stopped smoking all in one go than when they gradually reduced before quitting.”

The researchers randomly assigned almost 700 adult smokers to either an abrupt quitting or gradual reduction group. Each person set a “quit day” of two weeks after they entered the study, and saw a research nurse once a week until then. Half of people preferred to cut down gradually, a third preferred abrupt quitting and the rest had no preference before the study began, but preferences did not affect which group they were sorted into….more


New Film about Obstructed Labour for Midwives

Medical Aid Films is delighted to launch Obstructed Labour: An Introduction for Midwives.  This film was filmed at the Gynocare Centre in Eldoret, Kenya, with funding from the Vitol Foundation.  It explains the main causes of obstructed labour, what happens during obstructed labour, how signs of obstructed labour can be identified, and steps to be taken for effective management. The film follows Kandie, a midwife at the clinic, as she monitors a mother in early labour, and a mother with suspected obstructed labour. This film aims to provide valuable support for midwife training across sub-Saharan Africa.

The film was reviewed by our medical advisor and midwife Zoe Vowles; Liverpool School of Tropical Medicine’s Centre for Maternal and Newborn Health; and midwifery advisor Terri Coates (who previously advised on the BBC’s ‘Call the Midwife’ series).

A huge thanks to our review team and the staff and patients at Gynocare Centre for their support.

We can only continue to make our films free to access if we can demonstrate their use and their value. Please help us by taking 5 minutes to respond to a short questionnaire via this link

What is Obstructed Labour?

Obstructed labour is one of the most common causes of death during childbirth in developing countries.  Labour is considered obstructed when the baby cannot descend through the pelvis, despite strong uterine contractions, which leads to wide-ranging and dangerous complications for both the mother and newborn.

Obstructed labour is especially prevalent in rural areas, particularly among women who are in labour at home for a long time.  It is vital that women can access skilled care in childbirth, and that those health workers have the necessary skills to identify and manage obstructed labour when it occurs. 

The film can be watched or downloaded for free from our website, or you can request it on USB

Please watch the film, share it, and let us know what you think.  And stay in touch via our newsletter, Twitter or Facebook

Films like this are dependent on your donations so please do continue to generously support our work.  Thank you!

Private healthcare: The blame game

The Competition Commission’s inquiry into private healthcare has changed focus, with medical schemes and administrators doing their best to blame others for the cause high price of private care. What is worse that having cancer? Having cancer and discovering in the middle of your treatment that you are liable to pay thousands of rands to your oncologist because he is not part of your medical aid’s “preferred provider” network….more

Universal Health Care: How others do it

GIVING citizens access to health care without enduring financial hardship is known as “universal health care”. Around the world there is growing recognition that health and economic development are inextricably linked. In 2012 the UN called on countries to aim for universal health-care coverage, and included it in its Sustainable Development Goals. Here are some examples of approaches to universal health care…..more

National Health Insurance: A wing and a prayer

GOVERNMENT’S National Health Insurance plan (NHI), which has the noble ambition of extending affordable, quality treatment to all, is based on the most dramatic overhaul of the SA health-care system since the ANC came to power in 1994. But how and when it will come to fruition remains an open question, with gaping holes in the policy framework and implementation strategy….more

Surgical care for disadvantaged populations






Will keep in touch if you are interested

With warm regards

J. Gnanaraj

HIFA profile: J Gnanaraj is an Urologist and laparoscopic surgeon trained from Christian Medical College, Vellore.

Causes of maternal deaths in Rwanda – Understanding why women die

I was interested to see this paper from Rwanda. What such analyses don’t tell us is *why* deaths occurred. We need a better understanding of what some commentators have called the ‘road to death’. This road typically starts from an environment of disadvantage, predisposing to illness, and then continuing through a sequence of decisions, actions and events, often including inappropriate treatments and/or delays in seeking care. These decisions, actions and events continue during the hospital stay and determine whether the mother (and her baby) will live or die.

Maternal death audit in Rwanda 2009-2013: a nationwide facility-based retrospective cohort study

BMJ Open 2016;6:e009734 doi:10.1136/bmjopen-2015-009734



Objective Presenting the results of 5 years of implementing health facility-based maternal death audits in Rwanda, showing maternal death classification, identification of substandard (care) factors that have contributed to death, and conclusive recommendations for quality improvements in maternal and obstetric care.

Design Nationwide facility-based retrospective cohort study.

Settings All cases of maternal death audited by district hospital-based audit teams between January 2009 and December 2013 were reviewed. Maternal deaths that were not subjected to a local audit are not part of the cohort.

Population 987 audited cases of maternal death.

Main outcome measures Characteristics of deceased women, timing of onset of complications, place of death, parity, gravida, antenatal clinic attendance, reported cause of death, service factors and individual factors identified by committees as having contributed to death, and recommendations made by audit teams.

Results 987 cases were audited, representing 93.1% of all maternal deaths reported through the national health management information system over the 5-year period. Almost 3 quarters of the deaths (71.6%) occurred at district hospitals. In 44.9% of these cases, death occurred in the post-partum period. Seventy per cent were due to direct causes, with post-partum haemorrhage as the leading cause (22.7%), followed by obstructed labour (12.3%). Indirect causes accounted for 25.7% of maternal deaths, with malaria as the leading cause (7.5%). Health system failures were identified as the main responsible factor for the majority of cases (61.0%); in 30.3% of the cases, the main factor was patient or community related.

Conclusions The facility-based maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. Rwanda can complement maternal death audits with other strategies, in particular confidential enquiries and near-miss audits, so as to inform corrective measures.

Best wishes, Neil

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

Community Health Workers: Bringing Family Planning Services to Where People Live and Work

‘When appropriately designed and implemented, community health worker (CHW) programs can increase the use of contraception, particularly where unmet need is high, access is low, and geographic or social barriers to use of services exist. The updated HIP brief, Community Health Workers: Bringing family planning services to where people live and work, describes the importance of community-based family planning programs as a means of reducing inequities in access to services and outlines key issues for planning and implementation.’


On page 7 there is a table on ‘Planning, Implementing, and Scaling-Up CHW Programs’, which looks at Factors Contributing to Success or Failure against a range of program approaches. factors contributing to success include (inter alia):

– Broad range of services and commodities that reflect the preferences of the communities served.

– Paid workers perform better than volunteers. Completely voluntary schemes do not work well. If workers are not paid, some other motivational scheme is required, and the scope of work for unpaid volunteers should be realistic.

– CHWs trained and engaged in social and behavior change communication activities.

– Supportive, rather than directive, CHW supervision.

– CHWs linked to and have ongoing relationship with facility-based services.

I look forward to hear from HIFA members about your experience and observations. We are especially keen to hear from CHWs and CHW trainers.

Best wishes, Neil

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

Int J Qual Health Care: Guide to Clinical Practice Guidelines: The Current State of Play

‘Internationally, over the past decade in particular, an industry seems to have developed around CPG development, reporting, adoption, contextualization or adaptation, evaluation and implementation. The growing volume of evidence and the acronyms used in this field can be overwhelming, even for those involved.’

The paper below aims to ‘provide a guide describing common standards, methods and systems used in current international CPG activities and the various activities to produce and communicate them’. I have invited the authors to join us so that we can learn from their experience and expertise.

CITATION: Int J Qual Health Care. 2016 Jan 20. pii: mzv115

Guide to Clinical Practice Guidelines: The Current State of Play.

Kredo T, Bernhardsson S, Machingaidze S, Young T, Louw Q, Ochodo E, Grimmer K.

Full text: http://intqhc.oxfordjournals.org/content/early/2016/01/20/intqhc.mzv115.long

Author contact: tamara.kredo@mrc.ac.za


INTRODUCTION: Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging.

METHODS: This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands.

CONCLUSION: CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed.

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

Social mobile media for health workers – article

Please find below the link to an article in which we describe how mobile and social media can be used to support, manage and educate health workers in LMIC. In particular the section “Practical considerations” where we outline how social mobile media can be anchored in institutional settings may be of interest.

Here is the download link: https://www.researchgate.net/publication/284545650_The_convergence_of_mobile_and_social_media_Affordances_and_constraints_of_mobile_networked_communication_for_health_workers_in_low-and_middle-income_countries

Best, Christoph

University of Applied Sciences and Arts

Northwestern Switzerland FHNW

School of Business

Institute for Information Systems


Global Health Sim is a movement of people committed to developing free open access resources for global health learning.  Resources focus on peace, global health, ethics, and humanitarianism.  Global health issues, both locally and internationally, are some of the most complex concerns facing society. Through engaging role-playing simulations in-person and online, we work to help students and practitioners better understand these complexities.


  • Peace through Health
  • Disaster and Complex Emergency Interventions
  • Local Public Health
  • Healthcare Response to Emergencies
  • Global Health Governance, Actors, and Institutions
  • Global Health Ethics
  • Other Domains in Global Health


Global Health Sim was made possible through a grant from the Canadian Physicians for Research and Education in Peace.  To find out more about their work please see:cprep.ca.

The Lancet Diabetes and Endocrinology: Liberating data: the crucial weapon in the fight against NCDs

Please see a comment from The Lancet Diabetes and Endocrinology on public health data availability. 

It may be of interest.

Summary: ‘The world is facing a rapidly worsening epidemic of non-communicable diseases (NCDs). Unchecked, NCDs will have untold health, social, and economic consequences for individuals and societies, especially in low-income and middle-income countries (LMICs) with weak health systems that are ill prepared to manage the swift epidemiological transition that brought the large and increasing burden of NCDs.’]Best wishes

The full text is freely available here: http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)00037-1/fulltext

Dr Justine Davies MD MRCP MBChB

Editor in Chief, The Lancet Diabetes and Endocrinology


Clinical nursing and midwifery research: grey literature in African countries

CITATION: Int Nurs Rev. 2016 Jan 18. doi: 10.1111/inr.12231.

Clinical nursing and midwifery research: grey literature in African countries.

Sun C, Dohrn J, Omoni G, Malata A, Klopper H, Larson E.

http://onlinelibrary.wiley.com/doi/10.1111/inr.12231/full [restricted access]’

I have now been able to access the full text of the above paper. For me, the most interesting point (not mentioned in the abstract) is that the authors had just published a closely related and complementary article, with a focus on the indexed, peer-reviewed literature.

The citation and abstract of this second article is reproduced below. Again, unfortunately the full text is restricted-access.

CITATION: Clinical nursing and midwifery research in African countries: A scoping review

Carolyn Sun, Elaine Larson



Background: Globally, the nursing shortage has been deemed a crisis, but African countries have been hit hardest. Therefore, it is of utmost importance nurses use the best available evidence and that nursing research is targeted to address gaps in the evidence. To achieve this, an understanding of what is currently available and identification of gaps in clinical nursing research is critical.

Objectives: We performed a scoping review of existing literature to assess clinical nursing research conducted in all African countries over the past decade, identify gaps in clinical nursing and midwifery research, determine whether they match with health priorities for countries, and define priorities for regional clinical nursing research agendas to improve health outcomes.

Design: This is a scoping review of published clinical nursing research conducted in African countries.

Data sources: Systematic searches of literature published between January 01, 2004 and September 15, 2014 were performed in PubMed, Medline, CINHAL, and Embase.

Review methods: Research was included if it was conducted by nurses, included data obtained in African countries or regions within the African continent, published in a peer-reviewed journal with an abstract, and included patient outcomes. Abstracts were independently reviewed for inclusion by two authors. The following data were extracted: countries of publication and study, study type and design, journal, language, and topics of research. Gaps in the literature were identified.

Results: Initially, 1091 papers were identified with a final sample of 73 articles meeting inclusion criteria. Studies used 12 designs, were published in 35 journals published in five countries (including two African countries); 29% of the research was published in a single journal (Curatonis). Research was mostly qualitative (57%) and included twenty countries in Africa (38%). There were 12 major topics of study, most often midwifery/maternal/child health (43%), patient experiences (38%), and human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (36%).

Conclusions: Areas most often studied were associated with funding sources (e.g., a large influx of funds for HIV-related research). Major and common health care problems in African countries (e.g. infectious disease other than HIV, and noncommunicable diseases such as malnutrition, diarrheal disease, hypertension and diabetes) were not subjects of the published literature, indicating a clear gap between health care needs and problems and the focus of the majority of clinical nursing research. Additionally, the shortage of doctorally prepared nurses may contribute to the lack of clinical nursing and midwifery research in African countries.

Best wishes, Neil

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

The Lancet Global Health: Model villages: a platform for community-based primary health care

Kesetebirhan Admasuemail, Taye Balcha, Haileyesus Getahun

Model villages: a platform for community-based primary health care

The Lancet Global Health

DOI: http://dx.doi.org/10.1016/S2214-109X(15)00301-0


Contact: moh@ethionet.et

Extract: ‘Model households refer to families that have embraced locally tailored health behaviour criteria (eg, having children vaccinated, constructing and using latrines, and sleeping under mosquito nets). There is a critical mass of nearly 3 million model households that have graduated over the years. Building on this concept, participatory engagement of women’s groups to disseminate health information and facilitate uptake of critical health services was initiated in 2012. This movement, commonly referred to as the health development army (HDA), is led by a group of women volunteers who are from model households and complement the work of HEWs and further augment the engagement and leadership of community members in their own health.’

Best wishes, Neil

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