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Once thought nearly conquered, tuberculosis (TB) is now a global epidemic. With the combined threats of HIV, diabetes, and other chronic diseases, as well as the emergence of multi-drug resistant TB, the challenges of the disease are overwhelming national health systems. Yet TB is preventable, diagnosable, and curable.

Afghanistan faces a burden of tuberculosis (TB) among the highest in the world, according to the World Health Organization (WHO). An estimated 60,000 new cases arise yearly, with 110,000 Afghans now living with TB; 14,000 Afghans died from the disease in 2015. Only about two in three presumed patients are found, and the treatment success rate is only 49 percent on average in the country.

Afghanistan faces a burden of tuberculosis (TB) among the highest in the world, according to the World Health Organization (WHO).

At the beginning of the HEAL TB project in 2011, culture and drug susceptibility testing (DST) using solid media was available to the program in two regions to detect drug-resistant tuberculosis (DR-TB) and for monitoring treatment response, which made identifying drug- resistance patterns possible and allowed health care workers to provide more appropriate drug treatment for DR-TB patients.

In Bangladesh tea and rubber garden workers and indigenous communities live in isolated areas with difficulties to access government health facilities. In addition, the level of poverty of some of these groups put them at risk of getting TB.

GeneXpert has revolutionized the diagnosis of tuberculosis (TB) and drug resistant TB (DR-TB) by effectively detecting M. tuberculosis in clinical specimens and RMP resistance in less than two hours without sophisticated laboratories. This enables patients to begin treatment for rifampicin resistant TB on the same day, rather than after several months of ineffective treatment.

The e-TB Manager was used for drug resistant TB case management from 2010. The number of active DR-TB cases being managed in the system increased from 23 in 2010 to 1,037 in 2016.

Challenge TB was implemented in Ethiopia as part of Management Sciences for Health’s (MSH’s) Innovation Challenge Fund (INCH)2 initiative designed to encourage innovative interventions across MSH supported projects. MSH used the ExpandNet Framework3 to scale up the innovation.

Together with Borena and Guji zonal health department and the Oromia Regional Health Bureau (RHB), MSH, through the HEAL TB project (December 2015-June 2016) and now through Challenge TB (December 2016-present), identified six districts within the mining areas. Six woreda coordinators were trained and deployed to coordinate case finding and treatment observation.

Despite challenges of operating in emergency settings, the South Sudan Challenge TB project has been able to support improvements in case notification and other TB-related indicators. This technical highlight showcases implementation strategies, results, lessons, and reflections on the way forward.

Afghanistan has made remarkable improvements in health indicators since 2005. However, a wide range of barriers prevent rural communities in Afghanistan from accessing tuberculosis (TB) and other health services.

Since adopting Option B+ in 2011, Malawi has made significant progress in identifying and treating pregnant women living with HIV, thereby reducing vertical transmission. During the same time period, follow-up, diagnosis, and care of babies born to HIV-infected mothers also improved.

Malawi has a population of 18 million, with an adult HIV prevalence of 10.6%. The country has made remarkable progress toward achieving the UNAIDS 90-90-90 goals, achieving the first goal remains a challenge. The Malawi HIV program estimated Malawi’s progress on achieving the 90-90-90 goals at 88-78-86 by June 2017.

Malawi adopted the 90-90-90 strategy as part of the National Strategic Plan to end HIV/AIDS by 2030 which calls for: identifying 90% of people living with HIV (PLHIV); initiating and retaining on antiretroviral therapy (ART) 90% of PLHIV identified; and achieving 90% viral suppression for ART patients.

Malawi is among the countries hardest hit by the HIV pandemic. The country has a national HIV prevalence rate of 10.6% of the adult population aged 15–64 years (12.8% women vs 8.2% in men). With 85% of Malawians living in rural areas, access to health services is difficult because of long distances, poverty, and other social factors.

HIV has been a global challenge over the past several decades, particularly in developing countries such as Malawi, where adult HIV prevalence is about 10.6%.

Malawi has a significant youth and adolescent population, with nearly two-thirds of the country’s estimated 17.2 million people under the age of 24. Youth and adolescents, aged 10-24, account for about 50% of new HIV infections in Malawi.

Cervical cancer affects an estimated 527,624 women worldwide each year, killing more than half of them. About 85% of the global disease burden occurs in developing countries, and Southern Africa is one of the highest-risk regions in the world.

Twelve Stories of How MSH Is Advancing Health around the World

This technical brief examines the relative contribution of community health volunteers to reach people, particularly women of reproductive age, and children under the age of ve years, with primary health care services and examines the role of community health volunteers in assuring a continuum of care for pregnant women and young children between 2014 and 2016.

In Madagascar, despite years of efforts to improve maternal health, the maternal mortality ratio remains as high at 487 deaths per 100,000 live births, whereas the average for developing countries is 235. Additionally, only 51% of pregnant women receive four antental care (ANC) visits, which is the recommended number to prevent and manage possible pregnancy complications.

Strong and resilient health systems are essential for accelerating progress toward a world safe from the threat of infectious disease outbreaks. In countries with robust health systems, essential health services are delivered within the context of ongoing response activities, and outbreaks can be prevented or identified and contained quickly.

There are more than one million Malawians (HIV prevalence of 10.6%) living with HIV. Nearly 85% of people live in rural or hard-to-reach areas of the country and the sparsely located health facilities are unable to meet their needs.

In 2017, with funding by UK aid from the British people, Management Sciences for Health (MSH) launched the Lea Mimba project to address gaps in the quality of antenatal care (ANC) and to support women's and adolescents' use of maternal and newborn health services in Kakamega County, Kenya.

In 2011, Malawi pioneered an ambitious test-and-treat approach for pregnant and breastfeeding women, known as Option B+. Under this strategy, all HIV-infected pregnant and breastfeeding women are provided with lifelong antiretroviral therapy (ART) regardless of their CD4 count or clinical stage.

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