‘Hundreds of millions of people live with diabetes today. Many of them do not know it, and many of those who do lack access to the necessary medicines or information’, says a Comment in this week’s Lancet [1].

The comment refers to a major study published in the same issue on Worldwide trends in diabetes since 1980 [2], which concludes: ‘Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide.’

The authors also note:

‘Diabetes and its macrovascular and microvascular complications account for more than 2 million deaths every year, and are the seventh leading cause of disability worldwide.’

‘Low-income and middle-income countries, including Indonesia, Pakistan, Mexico, and Egypt, replaced European countries, including Germany, Ukraine, Italy, and the UK, on the list of the top ten countries with most adults with diabetes’

An accompanying editorial says: ‘Immediate action is needed to avert this escalating health disaster.’ The full text of all articles is freely accessible.

1. Trends in diabetes: sounding the alarm

Krug, Etienne G

The Lancet , Volume 387 , Issue 10027 , 1485 – 1486

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30163-5/fulltext

2. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

The Lancet , Volume 387, Issue 10027 , 1513 – 1530

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00618-8/fulltext

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http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/centres/globalhealth/newssummary/news_18-4-2016-17-6-44

‘At the Patient Safety Global Action Summit last month, the global health community, led by the Dr Margaret Chan – the Director General of the World Health Organization, Jeremy Hunt MP – the UK Secretary of State for Health, Professor the Lord Ara Darzi – Director of the NIHR Imperial Patient Safety Translational Research Centre (PSTRC) and seven health ministers and ministerial delegates from 12 other health systems gathered in London to kick-off a global movement for patient safety, which aimed to jump-start coordinated global action to reduce avoidable harm caused to patients by the health services….’

Many of the above themes were captured in the report Patient Safety 2030

http://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/centre-for-health-policy/Patient-Safety-2030-Report-VFinal.pdf

Below are extracts from the executive summary:

EXECUTIVE SUMMARY

“First do no harm.” This principle remains central to the provision of high-quality healthcare. The mission to make care safer unites professionals and patients alike, and safety is a key component of any quality initiative. Yet there are still too many avoidable errors…

The increased complexity of care creates new risks of error and harm to patients…

In recent years, healthcare budgets have tightened across OECD countries, a necessity to ensure sustainability while facing reduced economic growth. However, this limits expenditure on resources that are crucial for patient safety, such as staffing levels and investment in appropriate facilities and equipment.

Appropriate deployment of governance and regulation, improved use of data and information, stronger leadership, and enhanced education and training all promote safer care. Moreover, emerging approaches – including behavioural insights and digital health – will add new options to the patient safety toolkit…

1. A systems approach. The approach to reduce harm must be integrated and implemented at the system level.

2. Culture counts. Health systems and organisations must truly prioritise quality and safety through an inspiring vision and positive reinforcement, not through blame and punishment.

3. Patients as true partners. Healthcare organisations must involve patients and staff in safety as part of the solution, not simply as victims or culprits.

4. Bias towards action. Interventions should be based on robust evidence. However, when evidence is lacking or still emerging, providers should proceed with cautious, reasoned decision-making rather than inaction.

For safety to triumph, we must make a global commitment to improve the safety of the care we provide. Patient safety is a shared goal of health systems all over the world. However, there is significant untapped potential in this global movement. To capture this potential, three ingredients are necessary:

1. Global: the movement should be truly global and include low- and middle-income countries that have so far been at its margins.

2. Focused: while safety is a common goal across countries, some issues are more dependent on the local context and require tailored solutions. International collaboration should focus on identifying high-level trends and raising awareness of common issues, including measurement of a core set of high-level indicators.

3. Coordinated: to maximise their impact and avoid duplication of efforts, the patient safety movement should be coordinated across all stakeholders…

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

Why a yellow fever outbreak in Angola is a “potential threat for the entire world”

‘Yellow fever, a much-feared mosquito-borne virus, has sickened thousands of people and killed hundreds in Angola over the past five months. A cluster of cases first appeared in Angola’s capital, Luanda, in December, and the virus has now sickened people in 16 of the country’s 18 provinces. People infected in Angola have already taken the virus to China, Kenya, Mauritania, and the Democratic Republic of the Congo (where at least 21 people have died), a pattern that has the World Health Organization very worried. “This outbreak,” the agency said this week, “constitutes a potential threat for the entire world.” A leading researcher of mosquito-borne diseases, Duane Gubler at Duke-NUS Medical School, is gravely concerned about the outbreak too. “We’re sitting on a time bomb waiting for it to blow,” he said, “and we’re really not doing anything about it.” As scientists try to get a grip on the outbreak in Angola, one fact is already clear: Many other countries are at risk because they’re not adequately prepared. Yellow fever is part of an uptick in mosquito-borne diseases all over the world that are suddenly threatening global heath in new and scary ways.’

http://www.vox.com/2016/4/15/11432522/yellow-fever-virus-outbreak-angola

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

Please find here a new report on global aging:

An Aging World: 2015

http://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf

‘The world population continues to grow older rapidly as fertility rates have fallen to very low levels in most world regions and people tend to live longer. When the global population reached 7 billion in 2012, 562 million (or 8.0 percent) were aged 65 and over. In 2015, 3 years later, the older population rose by 55 million and the proportion of the older population reached 8.5 percent of the total population…’

This ageing population will place increasing demands on health systems and health professionals. Old age brings a much higher burden of disease with co-existence of multiple morbidity, including cardiovascular disease, diabetes, cancer and dementia. Health professionals will need more than ever to have the skills, information, medicines and resources to deal with increasingly complex cases.

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 South African Medical Association Trade Union (Samatu) has vowed not to dissolve the federation as it the only union that is representing the rights of doctors in the country….more

NEW YORK — Mark Ewell was at the St Louis airport waiting for a flight and lamenting that he had not had time to work out that day. So he paid a shoeshine guy $10 to watch his bag, laced up his running shoes and spent 15 minutes running through the concourse. Mr Ewell, a realtor in Colorado Springs, often does a boot camp-style exercise video or runs for an hour or more. But when he is short on time, he will do 50 push-ups or run up the stairs 10 times in the model home where he works. The short bursts allow him to complete a bit of physical activity every day. “What it’s about is eliminating excuses,” he says…..more

The electronic bed management system unveiled by Gauteng department of health is set to eliminate patients having to wait for up to 36 hours for a hospital bed or dying while ambulances drive around trying to locate a hospital with an available bed…..more

Read here

Read here

See more here

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

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

Private hospital and specialists’ fees need to be regulated to contain costs for medical scheme members, according to the Board of Healthcare Funders (BHF). These fees take the “lion’s share” of members’ contributions, BHF Executive Director Dr Humphrey Zokufa told the Competition Commission’s marketinquiry into private healthcare yesterday…..more

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

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

TWO YOUNG patients, from very different walks of life, illustrate all that is good and bad about SA’s deeply inequitable healthcare system…..more

http://mdcurrent.in/primary-care/diagnostic-surgical-camps-cost-effective-way-address-surgical-needs-poor-marginalized/

http://mdcurrent.in/primary-care/enjoy-your-donations-while-those-in-need-benefit-the-surgical-services-initiative/

http://mdcurrent.in/practice-management/task-specific-credentialing-and-training-for-the-rural-surgical-workforce-a-proposal/

http://mdcurrent.in/practice-management/meeting-surgical-needs-rural-areas-supply-chain-concept/

http://mdcurrent.in/primary-care/take-home-messages-from-the-2015-who-global-initiative-for-emergency-and-essential-surgical-care-gieesc-meeting-in-geneva/

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.

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

http://bit.ly/1Pvd5HV

Abstract

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.

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Best wishes, Neil

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