Clinics are overwhelmed by diabetes and hypertension epidemics, yet government recently weakened proposals to tax sugary drinks driving this epidemic. In a pattern similar to HIV two decades ago, government clinics are being swamped by 40,000 new patients a month suffering from hypertension and diabetes. By late last year, over 25,000 new hypertensive patients and over 15,000 new diabetic patients were being seen every month at public clinics, according to the health department’s District Health Information System. Last week, Statistics SA (StatsSA) reported that diabetes became the biggest killer of South African women in 2015, and the second biggest killer overall. Two years previously, diabetes was only the fifth biggest killer. Non-communicable diseases (NCDs), many related to us being too fat, are now responsible for well over half of all deaths (55,5%)…..more

Drugmaker Otsuka Pharmaceutical won’t charge South Africa for using its new tuberculosis (TB) drug in a pilot programme, but South Africa’s free deal is unlikely to last.

The drug, delamanid, is one of the first new TB medicines to be developed in 50 years. In unpublished research by international humanitarian organisation  Doctors Without Borders (MSF) delamanid has been shown to cut drug-resistant TB treatment times by two-thirds when used in combination with existing remedies, says MSF advocacy and communications officers in Swaziland Zanele Zwane.

Current treatments for drug-resistant TB can take up to two years and patients have to take handfuls of pills daily that put them at risk of deafness or psychosis. More than half of patients with the most extreme form of drug-resistant TB, also known as extensively drug-resistant TB, will die, according to University of Cape Town studies….more

What Is High Blood Pressure?: High blood pressure, also known as hypertension, is the most common cardiovascular disease. Blood pressure refers to the force of blood pushing against artery walls as it courses through the body. Like air in a tire or water in a hose, blood fills arteries to a certain capacity. Just as too much air pressure can damage a tire or too much water pushing through a garden hose can damage the hose, high blood pressure can threaten healthy arteries and lead to life-threatening conditions such as heart disease and stroke….more

Video Understanding Hypertension

Studies find worrying over- and underuse of medicine worldwide

By Kate Kelland

LONDON – Up to 70 percent of hysterectomies in the United States, a quarter of knee replacements in Spain and more than half the antibiotics prescribed in China are inappropriate, overused healthcare, researchers said on Monday.

Experts who carried out a series of studies across the world found that medicine and healthcare are routinely both over- and underused, causing avoidable harm and suffering and wasting precious resources.

The studies, commissioned by The Lancet journal and conducted by 27 international specialists, also found rates of Caesarian section deliveries are soaring – often in women who do not need them – while the simple use of steroids to prevent premature births has lagged for 40 years.

“A common tragedy in both wealthy and poor countries is the use of expensive and sometimes ineffective technology while low-cost effective interventions are neglected,” the experts wrote in a statement about their findings.

The World Health Organization estimates that 6.2 million excess C-sections are performed each year – 50 percent of them in Brazil and China alone.

Vikas Saini, one of the lead authors of the study series and president of the U.S. Lown Institute in Boston, said factors driving the global failure to the right level of care include “greed, competing interests and poor information”, which he said combine to create “an ecosystem of poor healthcare delivery.”

Co-lead researcher Shannon Brownlee added: “Patients and citizens need to understand what’s at stake here if their health systems fail to address these twin problems. In the U.S., we are wasting billions of dollars that should be devoted to improving the nation’s health.”

The study series analyzed the scope, causes and consequences of underuse and overuse of healthcare around the world. It found that both can occur in the same country, the same organization or health facility, and even afflict the same patient.

The researchers noted that a study in China found 57 percent of patients received inappropriate antibiotics; that inappropriate hysterectomies in the United States range from 16 to 70 percent; and inappropriate total knee replacement rates were 26 percent in Spain and 34 percent in the United States.

Underuse leaves patients “vulnerable to avoidable disease and suffering” the researchers said, while overuse causes avoidable harms from tests or treatments at the same time as wasting resources better spent on much-needed services.

(Editing by Raissa Kasolowsky)

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Lucas F.M. van der Hoeven

Heuvel 20

5101 TD Dongen

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lucas@cbsm.nl

One of the fiercest fights happening within the Republican Party right now is what to do about Obamacare’s Medicaid expansion.

The Affordable Care Act broadened Medicaid eligibility to cover millions more low-income Americans, and offered states federal money to recoup the costs.

But only 16 states with Republican governors expanded Medicaid, including Ohio’s John Kasich, who recently met with Trump and has advocated continuing expansion. Seventeen governors rejected the option, though, often with the justification that Medicaid doesn’t actually improve people’s health.

So does it? With 10 million people in the program right now, and the future of the ACA at stake, the question seems worth parsing.

We actually have some pretty good data out of Oregon about Medicaid’s effects on health. There, researchers from Harvard tracked what happened to the winners and losers of a state lottery that offered Medicaid to 10,000 randomly selected Oregonians in 2008. This is the closest we have to a randomized trial on health insurance — the gold-standard study methodology — so it’s been a treasure trove of information for researchers. The study also gives us a pretty good picture of how exactly Medicaid impacts people’s health — and where it falls short……more

More

Hundreds of youth who formed part of a multimillion-rand skills project that President Jacob Zuma personally launched, have been languishing at home with nothing to do for seven months.

The 800 unplaced War on Leaks project’s trainees have been getting their R1500 stipends each month from the Department of Water and Sanitation, despite doing nothing.

This means the department, currently in the news for allegedly being broke, would have paid roughly R8.4-million to the unplaced trainees by the end of this month.

The trainees were supposed to be placed in municipalities or private companies.

Sowetan gathered that Rand Water, the project’s implementing agency, failed to place the youth for practical training after they completed their theoretical studies in July last year.

Zuma’s spokesman Bongani Ngqulunga referred Sowetan to the water and sanitation department. Department spokesman Sputnik Ratau said there were 800 youths who still had nowhere to train…..more

See article

Dear all,

See the current version of the Kampala statement from the first international symposium on Community Health Workers held from 21st to 23rd February 2017 in Kampala, Uganda. [here]

Best wishes,

Dr. David Musoke

Department of Disease Control and Environmental Health

School of Public Health

Makerere University College of Health Sciences

P. O. Box 7072, Kampala, Uganda

Email:  dmusoke@musph.ac.ug ; sokidavi@yahoo.com

Mobile: +256712987736 ; +256704814265

http://chwsymposium.musph.ac.ug/

In the midst of helping victims of xenophobic attacks in KwaZulu-Natal, the South African Red Cross launched an app on 8 April, that they believe will change the lives of many people.

The official ‘First Aid’ app of The South African Red Cross Society gives you instant access to information that will assist you during the most common emergencies such as what to do when someone starts choking, how to treat snake and spider bites, Cardiopulmonary Resuscitation (CPR) and First Aid.

The app is tailored specifically for South Africans. It contains preloaded content that can be accessed instantly anytime and anywhere, even without airtime. Once the app is downloaded, it can operate without reception or internet connection.

The app is said to include videos and interactive quizzes that can help save a life and is free on iOS devices.

“This App is a life saving machanism. It can be used by anyone from the age of 10 to 60 years. And we will in the next months introduce Zulu and Afrikaans to the videos on the App,” said Red Cross SA marketing director Deshika Daya.

It contains simple step-by-step instructions to guide you through everyday first aid scenarios. It is fully integrated with 10177 ambulance services that you can call from the app at any time.

There are videos and animation, making learning first aid fun and easy. The videos include information on Tuberculosis, and HIV/AIDS among other diseases.

The app also includes safety tips for extreme weather conditions and disasters that will help you in effectively preparing for emergencies.

COHRED Africa aims to promote the growth of LMIC capacity in research and innovation that will definitely change the way collaborative contracts, partnerships and ethical review takes place. [ http://africa.cohred.org/ ] We are giving you an early update of our activities we hope will make impact in 2017! Today, we would like to introduce you to three of our key developments currently underway in Africa as we strive to optimize health, equity and development in research and innovation. We would be delighted to hear from you – there are many exciting ways and opportunities for partnering and hope you will join us in exciting ventures in Africa and globally. We are ALL about GLOBAL IMPACT

FAIR RESEARCH CONTRACTING (FRC)

The goal of FRC is to inform and educate research partners, particularly in developing countries, on building sustainable, equitable partnerships by bridging the gap where there is limited:

• Research contracting knowledge
• Legal and policy implementation

We can assist by translating legal knowledge, policy and practice into strategic research frameworks. Fair Research Contracting has designed a number of solutions to assist your research institution’s infrastructure by enhancing your competitive advantage and building effective, sustainable research partnerships.

We currently offer services in the form of :

• Workshops
• Consultancy (contracting support)
• Booklets
• Guidelines and checklists
• An online toolkit
• Learn more: http://frc.cohred.org/

RESEARCH FAIRNESS INDEX (RFI)

The aim of the RFI is to create a reporting system that encourages governments, business, organisations and funders to describe how they take measures to create trusting, lasting, transparent and effective partnerships in research and innovation. We prioritize its application in global health because there are so many urgent health-related issues, but the RFI can be applied in any other setting as well.

In practice the RFI operates by providing a guide to high quality reporting on measures and conditions that promote fair research partnerships, the RFI encourages all stakeholders in research and innovation for health to describe what is done within their organisation to promote fair partnerships. Through our extensive global consultative process, we have identified 17 key areas of relevance to effective and lasting partnerships.

The RFI acknowledges that successful partnerships often start at personal level but are then continued at institutional or national levels. While mutual admiration, respect and friendship are essential to create the foundation of effective partnerships – it is the institutional and national dimensions of research collaboration that define how, ultimately, benefits are shared.

Learn more: http://rfi.cohred.org/

RHinnO Ethics

RHinnO ethics is a high quality, efficient and technology-driven software that enables the review of research protocols. This ensures that Research Ethics Committees (RECs) remain compliant to the demand of the 21st century “digital” researchers.  RHInnO Ethics provides a one stop shop which enables administrators, researchers and reviewers to comprehensively manage the entire review cycle, including protocol submission, reviewing protocols, approval and follow-up through an online platform.

RHInno has the following advantages for 3 important stakeholders :

For Researchers, RHInnO Ethics can:

• Submit protocols and support documents online.
• Track the progress of your protocol.
• Receive automated notifications on the status of your protocol.
• Access reviewers’ comments online.
• Access institutional resources such as templates and policy guidelines electronically.

For Ethics Reviewers, RHInnO Ethics can:

• Receive and accept/decline invitations to review protocols electronically.
• Access assigned protocols and supporting documents electronically.
• Comment on assigned protocols and send your review report to the administrator electronically.
• Access available guidelines and policies for RECs electronically.

For Administrators, RHInnO Ethics can:

• Receive notifications when new protocols are submitted.
• Coordinate the beginning and end of a review cycle electronically (cycle management).
• Conduct a quick appraisal of protocols before sending to reviewers (internal review).
• Invite reviewers to review protocols electronically.
• Collate reviewers’ comments electronically and send to researchers.
• Monitor progress of protocol review online and alert reviewers of delays.

Learn more: http://www.rhinnolabs.com/

Please feel free to contact us if you have any questions, comments or suggestions. For a detailed discussion on how FRC, RFI and RHInnO can help you organization, please contact us COHRED Africa  

Jacintha Toohey Executive DirectorBusiness Manager   +27 33 260 5770   toohey@cohred.org 

Ms Nivedhna Singh+27 33 260 6165 nivedhna@cohred.org

STAY CONNECTED http://www.cohred.org   http://africa.cohred.org

Council on Health Research for Development, Africa (COHRED Africa), Suite 281, Private Bag X6,, Cascades, Pietermaritzburg, 3202 South Africa

New research has just been published on what differentiates authors who publish in low- and high-impact journals

Some interesting findings in a new study by authors in Brazil show that significant linguistic and financial inequalities still exist for researchers worldwide.  The authors, Carlos Eduardo Paiva et al, collected responses from 269 participants who had published in 30 medical journals which they grouped according to low and high impact factor.  

The main indicator for the increased likelihood of publishing in a higher impact factor journal was living in a country where English is the official language, which was associated with an almost threefold greater chance of publication.

The level of English language was more relevant than being located in a wealthy country.  However, living in a country with a higher per capita gross domestic product was still associated with a greater chance of being published in a high-impact journal.

http://ecancer.org/journal/11/full/718-what-are-the-personal-and-professional-characteristics-that-distinguish-the-researchers-who-publish-in-high-and-low-impact-journals-a-multi-national-web-based-survey.php

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

It’s good to see the collaboration between Cochrane and Wikipedia going from strength to strength:

‘Cochrane has partnered with Wikipedia to improve the evidence base of Wikipedia health articles…’

http://www.cochrane.org/news/cochrane-and-wikipedia-working-together-improve-access-health-evidence

Best wishes, Neil

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

Below are extracts fro a WHO news release. Full text here:

http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/

27 February 2017 – WHO’s list of antibiotic-resistant “priority pathogens” include bacteria that pose the greatest threat to human health. The list is intended to guide and promote research and development of new antibiotics in an effort to address growing global resistance to antimicrobial medicines.

‘Dr Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation. “Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.”…

‘The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia.

‘These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria.

‘While more R&D is vital, alone, it cannot solve the problem. To address resistance, there must also be better prevention of infections and appropriate use of existing antibiotics in humans and animals, as well as rational use of any new antibiotics that are developed in future.’

Cochrane review: Support for health professionals reduces unnecessary use of antibiotics in hospitals

‘An updated Cochrane Review published 9 February has identified effective and safe ways to reduce unnecessary use of antibiotics in hospitals. Guidelines and policies that promote better targeting of antibiotics in patients who need them have the greatest impact when they are supported by the most effective ways to change doctors’ behaviour…

‘The researchers found 221 studies from the US, Europe, Asia, South America, and Australia. The interventions were aimed at healthcare professionals who prescribe antibiotics to hospital in-patients receiving acute care, and those undergoing planned surgery. The interventions broadly fell into two categories. ‘Restrictive’ techniques applied rules to make physicians prescribe properly, whilst ‘enabling’ techniques provide advice or feedback to help physicians make more informed prescribing decisions…

‘Interventions that included enabling or restrictive techniques were consistently more effective than interventions that relied on simple education alone (e.g. meetings or distribution of guidelines)…’

http://www.cochrane.org/news/support-health-professionals-reduces-unnecessary-use-antibiotics-hospitals

—

Comment (Neil PW): This is a useful review but it appears the vast majority of the 221 studies were conducted in high-income countries where prescribers have good access to reliable information on medicines. Globally, and especially in low and middle income countries, we know that ‘most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO, 2011. Also, the review looks at hospital prescribing, where access to reliable, update information is generally better than in primary health care.

It is common sense that access to reliable and approapriate information on medicines is a sine qua non for rational prescribing. Yes, there are many porescribers who have aberrant prescribing habits despite good access to information, and this is what this systematic review seems to be largely about (not the majority of prescribers, particularly in primary care in LMICs, who practise with inadequate access to information).

As other HIFA members have said frequently, ‘Context is everything’.

Best wishes, Neil

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

Full text: http://www.who.int/hepatitis/news-events/hepatitis-testing-guidelines-news/en/

‘The World Health Organization (WHO) issued its first-ever global guidance on testing for chronic viral hepatitis B and C on 16 February 2017. Viral hepatitis causes an estimated 1.4 million deaths worldwide each year. The guidelines were released in a special session at the 26th Conference of the Asian Pacific Association for the Study of the Liver (APASL), held in Shanghai, China.

‘WHO estimates that more than 300 million people are chronically infected with hepatitis B or C worldwide. However, less than 5% of these people have been tested or are aware of their diagnosis.

‘”Many people, especially those in low- and middle-income countries, don’t know they are infected, so they cannot access the right treatment,” said Dr Marc Bulterys, Team Lead of WHO’s Global Hepatitis Programme. “Improving access to hepatitis testing is critical to increasing access to life-saving treatments.”…’

Guidelines: http://www.who.int/hepatitis/publications/guidelines-hepatitis-c-b-testing/en/

Best wishes, Neil

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

‘Successful disease control requires deep and meaningful engagement with local communities.’ This is the conclusion of a systematic review looking at the role of nurses and community health workers in confronting neglected tropical diseases in sub-Saharan Africa.

In our recent thematic discussion on CHWs we noted the wider issue of investment in CHWs versus investment in other primary health workers (including nurses). This is perhaps beyond the remit of this systematic review, but if anyone knows any research in this area, please let us know.

The authors also note (in the full text): ‘A lack of education of community members and CHWs was a major theme of the literature, and the importance of community education done by community nurses and CHWs is difficult to overemphasize.’

PLoS Negl Trop Dis. 2016 Sep 15;10(9):e0004914. doi: 10.1371/journal.pntd.0004914. eCollection 2016.

The Role of Nurses and Community Health Workers in Confronting Neglected Tropical Diseases in Sub-Saharan Africa: A Systematic Review.

Corley AG1, Thornton CP2, Glass NE1.

https://www.ncbi.nlm.nih.gov/pubmed/27631980

Corresponding author:  acorley3@jhu.edu

ABSTRACT

INTRODUCTION:

Neglected tropical diseases produce an enormous burden on many of the poorest and most disenfranchised populations in sub-Saharan Africa. Similar to other developing areas throughout the world, this region’s dearth of skilled health providers renders Western-style primary care efforts to address such diseases unrealistic. Consequently, many countries rely on their corps of nurses and community health workers to engage with underserved and hard-to-reach populations in order provide interventions against these maladies. This article attempts to cull together recent literature on the impact that nurses and community health workers have had on neglected tropical diseases.

METHODS:

A review of the literature was conducted to assess the role nurses and community health workers play in the primary, secondary, and tertiary prevention of neglected tropical diseases in sub-Saharan Africa. Articles published between January 2005 and December 2015 were reviewed in order to capture the full scope of nurses’ and community health workers’ responsibilities for neglected tropical disease control within their respective countries’ health systems.

RESULTS:

A total of 59 articles were identified that fit all inclusion criteria.

CONCLUSIONS:

Successful disease control requires deep and meaningful engagement with local communities. Expanding the role of nurses and community health workers will be required if sub-Saharan African countries are to meet neglected tropical disease treatment goals and eliminate the possibility future disease transmission. Horizontal or multidisease control programs can create complimentary interactions between their different control activities as well as reduce costs through improved program efficiencies-benefits that vertical programs are not able to attain.

KEY MESSAGES

Workforce considerations

• SSA countries should ensure that their nurses’ education and scope of practice are sufficient for the NTD control measures they are asked to undertake.
• Program managers must consider the same workforce factors for CHWs as they would with formal health care personnel.

Treating urban and mobile pastoralist populations

• Ethnic diversity and a weaker social fabric are theorized barriers to increasing intervention coverage rates in urban populations.
• Health structures ill equipped to meet mobile pastoralist populations’ needs create a barrier to their treatment.

Intervention integration and horizontal program planning

• Vertical disease control programs, while potentially effective, can affect the capacity of already strained health systems to care for other conditions and populations.
• Combining multiple NTD control programs and better integrating such programs into countries’ primary care systems are strategies that could serve to create further service delivery efficiencies and improve overall capacity.

—

Best wishes, Neil

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

‘Many people with depression and other mental health problems can be treated successfully by community health workers, but so far no country has scaled up this approach. Vikram Patel talks to Fiona Fleck…’

Full text (WHO Bulletin, March 2017): http://www.who.int/bulletin/volumes/95/3/17-030317.pdf

Prime Article Prime Site

Selected quote: ‘The idea is to train millions of community health workers and people in communities worldwide to deliver evidence-based psychosocial interventions.’

Best wishes, Neil

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

Editorial: Strengthening health systems to provide rehabilitation services

Etienne Krug & Alarcos Cieza, Bull World Health Organ 2017;95:167 Published online: March 2017

Abstract / Resumen:

The world faces new challenges in light of health and demographic trends: populations are ageing, and the number of people living with noncommunicable diseases and the consequences of injuries is increasing.1–3 The health, social and economic consequences of these trends should serve as a call to policy-makers to invest not only in health services that reduce mortality and morbidity, but also in those that improve functioning and consequently well-being. These latter outcomes are at the core of rehabilitation, yet rehabilitation services are often underdeveloped, underresourced and undervalued….

Keep reading this editorial / Siga leyendo el editorial: click here.

http://www.who.int/bulletin/volumes/95/3/17-191809.pdf?ua=1

Visit the Portal/Blog of the PAHO/WHO Equity List & Knowledge network : http://equity.bvsalud.org