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PubMed2006

Orphan care in Botswana's working households: growing responsibilities in the absence of adequate support.

OBJECTIVES: Botswana has one of the world's highest HIV-prevalence rates and the world's highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans. METHODS: We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving. RESULTS: Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income. CONCLUSIONS: The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana's orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.

Adolescent↗

PubMed2006

"It's like Tuskegee in reverse": a case study of ethical tensions in institutional review board review of community-based participatory research.

Community-based participatory research (CBPR) addresses the social justice dimensions of health disparities by engaging marginalized communities, building capacity for action, and encouraging more egalitarian relationships between researchers and communities. CBPR may challenge institutionalized academic practices and the understandings that inform institutional review board deliberations and, indirectly, prioritize particular kinds of research. We present our attempt to study, as part of a CBPR partnership, cigarette sales practices in an inner-city community. We use critical and communitarian perspectives to examine the implications of the refusal of the university institutional review board (in this case, the University of California, San Francisco) to approve the study. CBPR requires expanding ethical discourse beyond the procedural, principle-based approaches common in biomedical research settings. The current ethics culture of academia may sometimes serve to protect institutional power at the expense of community empowerment.

Adult↗

PubMed1991

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Disasters, the environment, and public health: improving our response.

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.

Disaster Planning↗

PubMed1995

Pharmacoepidemiology in practice. Current status and future trends.

Pharmacoepidemiology is the application of epidemiological reasoning, methods and knowledge to the study of the uses and effects (beneficial and adverse) of drugs in human populations. As referred to by the term 'pharmacoepidemiology', the discipline now enters into its second decade, although its origins go back to the beginnings of this century. This article reviews the opinions of leading pharmacoepidemiologists on the scope and prospects for pharmacoepidemiology, and summarises the most important challenges that the discipline faces on its way towards the next century. The future of pharmacoepidemiology requires the development of research methods more able to cope with the specific problems posed by the study of drugs, notably the issue of confounding by indication and the ability to adjust accurately for severity of disease. Capacity building should also continue during the next years; training of professionals, the optimisation of computerised databases for research purposes and their joint use with more traditional epidemiological methods are major challenges. From a public health perspective, a critical task is to assess the impact that vaccines and drugs have on the overall patterns of disease in well defined populations.

Cost-Benefit Analysis↗

PubMed2004

Business Ethics 101 for the biotech industry.

Biotechnology companies face ethical challenges of two distinct types: bioethical challenges faced on account of the nature of work in the life sciences, and corporate ethical challenges on account of their nature as commercial entities. The latter set of challenges has received almost no attention at all in the academic literature or media. This paper begins to remedy that lacuna, examining ethical issues that arise specifically on account of the status of biotech companies as commercial entities. The focus here is on three representative issues: product safety, corporate social responsibility, and corporate governance. It is argued that each of these issues poses particular ethical challenges for companies in the biotech sector. In the area of product safety, it is noted that biotech companies face particular challenges in determining what counts as a "safe" product, given the contentious nature of what might count as a "harm" in the biotech field. In the area of corporate social responsibility, the adoption of a "stakeholder approach" and an attempt to manage the social consequences of products pose special challenges for biotech companies. This is due to the enormous range of groups and individuals claiming to have a stake in the doings of such companies, and the trenchant controversies over just what the social consequences of various biotechnologies might be. In the area of corporate governance, biotech companies need to seek out and follow best practices regarding the ways in which information, authority, and influence flow between a company's shareholders, managers, and Board of Directors, if they are to avoid duplicating the ethical and financial scandal that brought down ImClone. An important meta-issue, here--one that renders each of these corporate ethical challenges more vexing--is the difficulty of finding the appropriate benchmarks for ethical corporate behavior in a field as controversial, and as rapidly evolving, as biotechnology. Three programmatic suggestions can be made: Firstly, scholars and others interested in the ethical performance of the biotech sector must seek out and build opportunities for richer interdisciplinary collaboration. Secondly, companies within the biotech sector must seek out expertise and build capacity and competency in dealing with the corporate ethical issues that arise in their sector. Finally, companies in the biotech sector should explore the opportunities for collective problem solving afforded by the existence of local, national, and international industry associations such as the Biotechnology Industry Organization, BIOTECanada, and EuropaBio.

Benchmarking↗

PubMed2005

Barriers to the equitable funding of primary healthcare in South Africa.

Over 25 years after Alma-Ata, available evidence suggests that in low- and middle-income countries (LMIC) the funding and coverage of primary care is still inequitable. This article reviews the progress that has been made towards the equitable funding of primary healthcare (PHC) in South Africa and evaluates barriers to future progress. The South African experience is assessed to consider implications for other LMIC. The results show that substantial inequities in funding persist (albeit using a narrow definition of PHC). Underlying causes relate to fiscal austerity, the lack of protection of PHC funding, incremental resource allocation and the belief that poorer districts are not able to use extra funds effectively. These results match the experience in other LMIC. Central governments have a critical role to play in lobbying for and protecting resources for PHC, maintaining more control over decentralised resource allocation and building capacity to benefit in poorer areas.

Financing, Government↗

PubMed2005

HIV-1 prophylactic vaccine trials in Thailand.

The HIV epidemic has resulted in medical, social and economic consequences. There is general agreement that a safe, effective and affordable preventive HIV vaccine is urgently needed to control the epidemic. To date, over 60 phase I/II trials of about 30 candidate vaccines have been conducted worldwide. In 1991, Thailand was selected by WHO, UNAIDS as one of the countries for potential HIV vaccine evaluation sites, and 10 projects with HIV phase I, II and III trials have been conducted since 1994. Strong national commitment, collaboration both at national and international levels together with infrastructure strengthening and capacity building, are very important for success. The vaccine designs pursued included synthetic peptides, recombinant protein and recombinant viral vectors followed by or with boosting doses of recombinant proteins. All phase I/II trials indicated that the candidate vaccines were safe and produced binding and a certain level of neutralizing antibodies. The recombinant vector vaccines produced both humoral and cell-mediated responses. The AIDSVAX phase III trial conducted in 1999 was the first efficacy trial of HIV vaccine in Thailand that brought valuable information for further HIV vaccine development. Recently, a phase III trial of ALVAC-HIV priming with AIDSVAX B/E boosting was launched in 2003, and the findings of this trial will be shared with the international community. With committed parties in medical science, government, industry and the community, we hope that we can achieve success in developing a safe and effective HIV vaccine in the near future.

AIDS Vaccines↗

PubMed1999

What women say about antenatal care in St Petersburg, Russian Federation.

A capacity building program for professionals in maternal and child health care in St Petersburg, Russian Federation, commenced in 1994. The program was designed to provide 12 workshops in evidence-based antenatal and intrapartum care, as well as appropriate preparation of parents for pregnancy, birth and parenthood, for health care professionals in the city. As part of this program women's observations on the quality of their maternity care services during their transition to parenthood were explored. These reports reflect maternity care practices in the former Soviet Union.

Adult↗

PubMed1996

Health learning materials support in South Africa compared with other developing countries.

Actions to promote media use for education at all levels in developing countries have to cope with a number of deterrents like the lack of appropriate audiovisual materials and a media support infrastructure. In the early eighties the World Health Organization and United Nations Development Programme initiated a capacity building project to enable developing countries to generate sufficient instructional and learning materials for medical and health education. Since South Africa is still a non-participator in the programme, this article presents the findings of a recent survey to get a global picture of health learning materials support in developing countries as a possible model for South Africa.

Developing Countries↗

PubMed2006

Animals as sentinels of bioterrorism agents.

We conducted a systematic review of the scientific literature from 1966 to 2005 to determine whether animals could provide early warning of a bioterrorism attack, serve as markers for ongoing exposure risk, and amplify or propagate a bioterrorism outbreak. We found evidence that, for certain bioterrorism agents, pets, wildlife, or livestock could provide early warning and that for other agents, humans would likely manifest symptoms before illness could be detected in animals. After an acute attack, active surveillance of wild or domestic animal populations could help identify many ongoing exposure risks. If certain bioterrorism agents found their way into animal populations, they could spread widely through animal-to-animal transmission and prove difficult to control. The public health infrastructure must look beyond passive surveillance of acute animal disease events to build capacity for active surveillance and intervention efforts to detect and control ongoing outbreaks of disease in domestic and wild animal populations.

Animals↗

PubMed2005

Experiences from three community health promotion projects in Greenland.

OBJECTIVES AND METHODS: Three community health promotion projects have been implemented in Greenland in the municipalities of Upernavik, Ittoqqortoormiit and Qasigiannguit. Based on project reports and other written material, this paper describes experiences from the three projects and discusses the implications of the differences in project design and organization for potential outcomes. RESULTS: None of the three projects were formally evaluated. They all experienced problems and have only been partially successful in reaching their goals. The Upernavik and the Ittoqqortoormiit projects were organised with strong leadership and a central organisation, whereas the Qasigiannguit project was designed as a community project with population participation in all phases of the project. The two former projects have probably had a greater direct change impact on the community, whereas the latter has strengthened aspects of community capacity building. CONCLUSION: We need to learn more about how to employ the resources of communities, how to achieve better partnerships and how to support people in their efforts in order to secure population participation at all project stages. It is important to build coalitions with broad representation in the community and to secure population participation in order to disseminate the efforts and reach the needs of the whole community.

Community Health Services↗

PubMed2006

Barriers and supports for healthy eating and physical activity for First Nation youths in northern Canada.

OBJECTIVES: To investigate barriers and supports for healthy eating and physical activity in youths in a remote sub-arctic community, Fort Albany First Nation, Ontario, Canada. STUDY DESIGN: A qualitative multi-method participatory approach. METHODS: The study included a purposive convenience sample of two adult (n = 22) and three youths (n = 30; students in grades 6 to 8) focus groups, unstructured one-on-one interviews with adult key informants (n = 7), and a scan of the community environment. Data were coded and analysed by hand and using NVivo software. Hurricane thinking and concept mapping were used to illustrate findings and relationships between concepts. RESULTS: Dominant emerging themes included empowerment, trust, resources, barriers and opportunities, while major sub-themes included food security, cost, accessibility/availability, capacity building, community support, programs/training and the school snack/breakfast program. CONCLUSIONS: Numerous barriers to healthy nutrition and physical activity exist in this community and are possibly similar in other remote communities. Empowerment is a core issue that should be considered in the design of public health interventions for First Nations youths in remote sub-arctic communities.

Adolescent↗

PubMed2005

[Development and testing of a sexually transmitted diseases prevention program in at-risk prostitutes].

PURPOSE: The purpose of the study was to test the effectiveness of an 8 session intervention program to prevent sexually transmitted diseases (STDs) among at-risk prostitutes. METHOD: An experimental research design was employed. Subjects were 59 prostitutes (29 in the control group and 30 in the experimental group) who agreed to participate in this study. An STD Prevention Framework derived from Cox's Interaction Model of Client Health Behavior guided the overall intervention and the components. The intervention had 8 sessions with STD-prevention strategies and was led by Public Health Nurses. Analysis included change scores, chi(2)-test, and t-test. RESULT: The results revealed significant increase in feelings and skills of condom use, peer belief on condom use, condom use practice, and satisfaction with service at public health centers (PHC) on STDs knowledge and skills in the experimental group. However, newly contracted STDs were not significant statistically between groups. CONCLUSION: The 8 session STDs prevention program showed a effect on emotions, skills and behaviors of condom use even with the limitation of methodological rigors because of subject-specific conditions. In the future, a capacity-building model based on collaborating networks among community-based organizations will be needed to develop in effective STDs prevention.

Adult↗

PubMed1996

Quality improvement in health care--a fundamental analysis and South African perspective.

This article is based on the opening address that was delivered at a national conference with the launching of the South African Society for Quality in Health Care (SASQuaH). The quality improvement process and principles are analyzed, as well as an exposition of the South African situation. The concepts regarding quality, quality improvement and quality assurance are clarified, the different stakeholders in formalised quality improvement explained, as well as the motives for and principles of quality improvement in health services. The different external and internal mechanisms in quality improvement are analyzed, including the principle of community ownership and international collaboration. Continuous development and capacity building regarding quality improvement is recommended at all levels of health service delivery.

Accreditation↗

PubMedDate not supplied

A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine.

PURPOSE: This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine. PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control. The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. RESEARCH METHODS USED: Qualitative methods were used in a cross-case comparison of the six field sites. In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention program models: Stage 1: conducting a community needs assessment; Stage 2: analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5: producing process outcomes; and Stage 6: institutionalizing the project. The analysis focused on how each of the six communities traversed these stages. SUMMARY OF FINDINGS: Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study: 1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization. CONCLUSIONS: Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies. To be optimally effective, however, these strategies need refinement based on systematic study in field settings. Because this study was limited to six sites in Maine, some of these findings may have limited generalizability.

Chronic Disease↗

PubMed2003

Quality of glycaemic control in ambulatory diabetics at the out-patient clinic of Kenyatta National Hospital, Nairobi.

BACKGROUND: Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. OBJECTIVE: To determine the glycaemic control of ambulatory diabetic patients. DESIGN: Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. SETTING: Kenyatta National Hospital. METHODS: Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. RESULTS: A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c < or = 8% while 60.5% had HbA1c > or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. CONCLUSION: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and deteriorating diabetes. There is need to empower patients with knowledge and resources to enhance their individual participation in diabetes self-care. Diabetes care providers and facilities also need capacity building to improve care of patients with diabetes.

Adolescent↗

PubMedDate not supplied

Pre-marital HIV testing in couples from faith-based organisations: experience in Port Harcourt, Nigeria.

BACKGROUND: This descriptive cross-sectional study was conducted among prospective couples referred from Faith-Based Organisations in Port Harcourt, Nigeria for pre-marital HIV screening. The study sought to establish the sero-prevalence of human immunodeficiency virus (HIV) in this peculiar study group. METHODS: A total of 84 healthy heterosexual couples who required pre-marital HIV screening were tested between January 2000 and December 2003 using a Double ELISA confirmatory test of Immunocomb and Genscreen HIV I&II Kits. RESULTS: Amongst the 168 individuals tested, 35 (20.8%) were found positive. Seroprevalence was significantly higher among females 23 (27.4%) compared to males 12 (14.3%). Infection rate was highest in the 25-29 years group (29.7%, n=22) and lowest in those of 35-39 years (6.1 %, n=2), though this difference was not statistically significant (p-value=0.058). Infection rate was significantly higher among females (p-value=0.036); among prospective couples from Orthodox churches (p-value=0.021); couples with prolonged courtship (>6 months) (p-value=0.0001); couples with history of premarital sex (p-value=0.0001); and couples with history of cohabitation (p-value=0.0001). CONCLUSION: Our findings prompt a wake-up call for faith-based organizations (FBOs) to urgently initiate or be more receptive of measures that emphasize behavioural and social changes amongst members. Government and non-governmental organizations should organise capacity building training for religious based organizations to enable them cope with the challenges of HIV/AIDS. The outcomes of this study further underscores the value of voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing.

AIDS Serodiagnosis↗