Africa

When I worked in Smallpox eradication in the mid-1970s, I traveled all over northern India and Bangladesh. I never took malaria prophylaxis, because malaria had been cleared from those areas. Likewise, I did not take malaria prophylaxis when I worked in the Brazilian Amazon in the late-1970s. At that time, malaria was found only in gold miners in isolated tributaries of the Amazon. Now, due to our financial inability to continue high levels of malaria eradication activities worldwide in that time period, emergence of both anti-malarial and insecticide resistance, and spread of the mosquito vectors, all of these are heavily malaria endemic areas with a high mortality rate for pregnant women and children.

The World Health Organization (WHO) recently released the World Malaria Report 2012, summarizing 2011 data from 104 malaria-endemic countries and citing progress and challenges toward the eradication of malaria.

Tanzanian woman (Photo credit: MSH)Tanzanian woman (Photo credit: MSH)

Management Sciences for Health (MSH) invites you to attend the following sessions and poster presentations at the Global Maternal Health Conference in Arusha, Tanzania --- whether in person at the Arusha International Conference Center, or watching via archived videos online. (All times are listed in Eastern Africa Time: UTC/GMT +3 hours. Sessions will be recorded and available within 24 hours.)

Sessions: Tuesday, January 15

Improving access to essential maternal health medicines (Track 3): 13:30–15:00 · Simba

Moderator: Deborah Armbruster, USAID

A group of young men in Mwene Ditu discuss using a cell phone to access health information. {Photo credit: Overseas Strategic Consulting, Ltd.}Photo credit: Overseas Strategic Consulting, Ltd.

Mobile phones are being used increasingly throughout Africa to improve health. The USAID-funded Democratic Republic of Congo-Integrated Health Project (DRC-IHP) is using mobile phone technology to increase the number of people referred to health centers in the project’s 80 targeted health zones. In Mwene Ditu, project staff observed that low numbers of referrals to health centers would be improved by increasing communication—within the community, between the community and health service providers, and among provincial health officials.

Health for All.Health for All.

The October edition of MSH's Global Health Impact newsletter (subscribe), features stories of people, communities, and countries on the road toward universal health coverage (UHC).

The vital role of the essential package for health impact

On the Road to Universal Health Coverage: The Vital Role of the Essential Package for Health Impact

A woman receiving antenatal care in South Sudan. {Photo credit: J. Warren/Save the Children.}Photo credit: J. Warren/Save the Children.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

"Makasi" after two months of TB treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

Seven-year-old Makasi, an HIV-positive orphan in Tanzania, was diagnosed with advanced tuberculosis (TB) and started on curative treatment. Clinicians at a local health center used standardized TB guidelines to overcome the difficulty of identifying TB in children co-infected with other diseases. In Afghanistan, sixteen-year-old Hamida provides for her family while trying to complete school. Hamida was visited by a community health worker, who identified her TB symptoms, and helped her access appropriate diagnosis and treatment.

Steady Progress Against Daunting Challenges

Tuberculosis mortality has fallen by a third since 1990. Yet TB is still the second leading cause of death from infectious disease worldwide. The vast majority of new cases (8.8 million in 2010) and deaths (1.1 million in 2010) occur in poorer countries. TB’s effects are often most devastating among people in fragile circumstances. Poverty and conflict push people into crowded, unsanitary conditions without appropriate nutrition and health care.

Even more, TB is fast spreading, easy to misdiagnose, often co-morbid with other diseases, and, increasingly, highly drug-resistant.

Uganda. {Photo credit: Paydos/MSH.}Photo credit: Paydos/MSH.

The Ugandan government launched a new prevention of mother-to-child HIV transmission (PMTCT) strategy on September 12.

Uganda will transition from an approach based on the World Health Organization's (WHO) Option A --- which is contingent on an HIV-positive pregnant woman’s CD4 count --- to WHO's newest PMTCT strategy, Option B+.

Option B+ — whereby HIV-positive pregnant women receive lifelong treatment, regardless of their CD4 levels — originated in 2010 when the Malawian government decided to combine antiretroviral therapy (ART) with PMTCT in response to the challenges of providing reliable CD4 testing in remote settings.

The WHO updated its PMTCT guidelines with Option B+ in April of this year.

Health workers listen during the Mahalapye Hospital staff meeting, Botswana. {Photo credit: MSH/}Photo credit: MSH/

“J’mappelle Mompati. Comment t’appelles tu?”

Overcoming my confusion at being greeted by a French-speaking man in Botswana, I smile, take his proffered hand and reply in my rusty, stilted French, “J’mappelle Naume...”

Mompati is Mahalapye Hospital’s dynamic public relations officer. Now that he has my full attention, Mompati wastes no time in telling me about his work linking the hospital and the surrounding community through events and the media. We exchange contacts and he hands me a few copies of his newsletter before dashing off to his duties.

Mahalapye is a small town in the Central District of Botswana on the edge of the Kalahari Desert. Situated along the main road between the capital, Gaborone, and the second largest city, Francistown, Mahalapye is a convenient stopover place.

The hospital has been recently renovated and serves 300 outpatients a day and up to 200 inpatients.

{Photo credit: MSH, South Africa.}Photo credit: MSH, South Africa.

The prospect that we may see the end of AIDS in our lifetime has never been greater. Over the last decade, the global HIV & AIDS community has achieved stunning successes, including a steady decrease in new HIV cases, a massive scale-up of antiretroviral therapy (ART), and proof that treatment is prevention. As we begin the XIX International AIDS Conference, we are also excited by new scientific advances in prevention and treatment, such as Option B+  for prevention of maternal-to-child transmission (PMTCT). As new possibilities develop, we must also build on the successes of the last decade. Only by "turning the tide together" through the simultaneous pursuit of new possibilities, leveraging of proven interventions for scale and sustainability, and strengthening of health systems overall, can we hope to reach our goal of ending the HIV & AIDS epidemic.

Seasoned HIV & AIDS experts gathered at the Center for Strategic and International Studies (CSIS) on Saturday evening, July 21, to weigh in on the President’s Emergency Plan for AIDS Relief (PEPFAR) on the eve of the XIX International AIDS Conference, dubbed "AIDS 2012".

The conference is taking place in the USA for the first time in 20 years thanks to President Obama’s lifting of the travel ban on HIV-positive visitors.

“What has been PEPFAR’s strategic significance?”

An illustrious panel including Ambassador Eric Goosby (United States Global AIDS Coordinator), Ambassador Mark Dybul (former United States Global AIDS Coordinator), and Dr Anthony Fauci (Director of National Institute of Allergy and Infectious Diseases, NIAID) discussed the first topic: “What has been PEPFAR’s strategic significance?”

Dr Fauci, who was one of the architects of PEPFAR, talked of the humanitarian and moral responsibility that George Bush felt. He mentioned an African male comment that “PEPFAR is the best thing that ever happened to Africa.”

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