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Press releases Saturday 1 October 2005
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(1) NEW STRATEGY COULD PREVENT LEADING CAUSE OF MATERNAL DEATH IN AFRICA
(2) INTERMITTENT PROPHYLAXIS PREVENTS MALARIA IN INFANTS
(3) WHY ARE THE BEST MALARIA DRUGS NOT BEING USED IN AFRICA?
(4) TRAINING LOCAL HEALTH WORKERS IMPROVES TB CONTROL IN SOUTH AFRICA
(5) WHY ARE SO FEW HIV/AIDS TRIALS CONDUCTED IN AFRICA?
(6) SCRAPPING HEALTH CARE FEES IN AFRICA COULD PREVENT OVER 200,000 CHILD DEATHS A YEAR
(1) NEW STRATEGY COULD PREVENT LEADING CAUSE OF MATERNAL
DEATH IN AFRICA
(Effect of sublingual misoprostol
on severe postpartum haemorrhage in a primary health centre in Guinea-Bissau:
randomised double blind clinical trial)
http://bmj.com/cgi/content/full/331/7519/723
A relatively cheap and easy to use drug could save the lives of thousands of women in the developing world, according to a study in this week’s BMJ.
Postpartum haemorrhage (excessive blood loss after childbirth) is the leading cause of maternal death in Africa. Several drugs reduce blood loss, but in poor areas they are often inaccessible, too expensive, and too difficult to use.
The study took place in Guinea-Bissau, West Africa, where maternal death is more than 8 per 1000 live births. Immediately after delivery, 330 women received misoprostol tablets and 331 received placebo (dummy pills).
Significantly fewer women in the misoprostol group experienced severe blood loss.
In rural Guinea-Bissau, 75% of women give birth at home, and worldwide only about 50% of women give birth in health facilities. So strategies are needed to increase the safety of deliveries attended by unskilled birth attendants, say the authors.
“Our trial suggests that misoprostol would play an important part in such a strategy to reduce complications of delivery and maternal mortality,” they conclude.
Contact:
Lars Hoj, Department of Obstetrics
and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
Email: lars.hoj@dadlnet.dk
(2) INTERMITTENT PROPHYLAXIS PREVENTS MALARIA IN INFANTS
(Cluster randomised trial
of intermittent preventive treatment for malaria in infants in areas of high,
seasonal transmission in Ghana)
http://bmj.com/cgi/content/full/331/7519/727
Giving infants preventive treatment for malaria can reduce malaria and anaemia even in seasonal, high transmission areas such as Ghana, finds a study in this week’s BMJ.
But concern exists about a possible rebound when treatment is stopped, warn the authors.
The study followed over 2,400 infants in Ghana who were given a preventive treatment for malaria or a placebo (dummy pill) when they received routine vaccinations and at 12 months of age.
Preventive treatment reduced malaria by 25% and anaemia by 35% up to age 15 months. However, malaria levels increased 20% when treatment was stopped in the second year of life.
The protective effect was also substantially lower than that reported from previous studies in Tanzania.
Because these findings run counter to earlier studies, the authors suggest that more data are needed to decide on the appropriate dose schedule for preventive drugs in areas with high seasonal transmission and its interaction with insecticide treated bed nets.
However, intermittent preventive treatment in infants, linked to the expanded programme of immunisation schedule, has the potential to reduce the burden of malaria even in areas with high seasonal transmission, they conclude.
Contact:
Daniel Chandramohan, Clinical Senior
Lecturer, London School of Hygiene and Tropical Medicine, London, UK
Email: daniel.chandramohan@lshtm.ac.uk
(3) WHY ARE THE BEST MALARIA DRUGS NOT BEING USED IN AFRICA?
(Treatment of paediatric
malaria during a period of drug transition to artemether-lumefantrine in
Zambia: cross sectional study)
http://bmj.com/cgi/content/full/331/7519/734
(Editorial: Antimalarial
treatment with artemisinin combination therapy in Africa)
http://bmj.com/cgi/content/full/331/7519/706
Despite changes in policy in many African countries, most cases of malaria are still treated with old drugs that often fail, say researchers in this week’s BMJ.
The steady increase of drug-resistant malaria across Africa has prompted many countries to adopt artemisinin combination therapies (ACTs) as policy. These drug combinations are highly effective, and appear to be safe and well tolerated.
Yet a study from Zambia, one of the first adopters of ACTs, shows that only 22% of children eligible for ACTs actually received them. Although the use of chloroquine was successfully discontinued, the change in drug policy does not necessarily translate into adequate use of this drug at the point of care, the authors conclude.
These challenges are discussed in an accompanying editorial. Dr Christopher Whitty and colleagues believe that the primary problem with deployment of ACTs in Africa is cost, but equally challenging is how to deploy ACTs to maximise their effectiveness and cost effectiveness.
The clear tension between the need to restrict drug use to slow the development of drug resistance, and the need to expand access so that malaria is treated before it becomes severe, is also a formidable barrier, they add.
All of these problems can only be solved through partnership between African ministries and regional and local international researchers, they write. “ACT deployment has the potential to be one of the major public health interventions for Africa in this decade. We must get it right.”
Contacts:
Paper: Professor Bob Snow, Malaria
Public Health and Epidemiology Group, KEMRI/Wellcome Trust Collaborative
Programme, Nairobi, Kenya
Email: rsnow@wtnairobi.mimcom.net
Editorial: Christopher Whitty,
Senior Lecturer, Gates Malaria Partnership, London School of Hygiene and
Tropical Medicine, London, UK
Email: christopher.whitty@lshtm.ac.uk
(4) TRAINING LOCAL HEALTH WORKERS IMPROVES TB CONTROL IN SOUTH AFRICA
(Effect of educational outreach
to nurses on tuberculosis case detection and primary care of respiratory
illness: pragmatic cluster randomised controlled trial)
http://bmj.com/cgi/content/full/331/7519/750
Educational outreach training for health workers improves the quality of tuberculosis care and control without requiring extra staff, finds a study from South Africa in this week’s BMJ.
Tuberculosis is a growing problem in lower and middle income countries, including South Africa. The World Health Organization estimates that about two thirds of people with tuberculosis are never diagnosed and so cannot benefit from treatment, leaving the epidemic unchecked despite global treatment programmes.
Lack of trained staff is thought to be the most important constraint on the control of tuberculosis, but training is of doubtful effectiveness.
Eight specially trained nurses delivered educational outreach training to clinical staff in 20 primary care clinics in the Free State province, South Africa. Staff in another 20 clinics received no training. Detection and treatment of respiratory illness in almost 2,000 patients was monitored over a five-month period.
Detection and treatment of tuberculosis and asthma were higher in the outreach clinics, suggesting that educational outreach training improves the quality of tuberculosis and asthma care without interrupting services, and without the need for extra staff.
The Free State and other provinces are adapting educational outreach for HIV/AIDS and implementing it widely, say the authors. They suggest that in other lower and middle income countries, where non-physicians provide primary care, equipping middle managers as outreach trainers is feasible within existing constraints on staff and could improve quality of care.
Contacts:
Lara Fairall, Research Fellow, Knowledge Translation Programme, University of Cape Town Lung Institute, Cape Town, South Africa
or
Merrick Zwarenstein, Senior Scientist,
Knowledge Translation Programme, University of Toronto at St Michael’s Hospital,
Toronto, Canada
Email: merrick.zwarenstein@ices.on.ca
(5) WHY ARE SO FEW HIV/AIDS TRIALS CONDUCTED IN AFRICA?
(Randomised controlled trials
in Africa of HIV and AIDS: descriptive study and spatial distribution)
http://bmj.com/cgi/content/full/331/7519/742
People in sub-Saharan Africa carry the heaviest burden of HIV and AIDS, yet very few trials have been conducted on the African continent over the past two decades, say researchers in this week’s BMJ.
This study confirms previous findings that HIV/AIDS trials are under-represented in sub-Saharan research and suggests that publication of trial results continues to be driven by researchers external to the continent.
The team identified and mapped all randomised controlled trials on HIV and AIDS conducted wholly or partly in Africa and reported before 2004.
After extensive searching, they identified 77 trials published or reported from 1987 to 2003. Most of the trials were funded by government agencies outside Africa, pharmaceutical companies and international non-government or inter-government organisations. Few principal investigators were based in African countries and there was no mention of ethical approval or informed consent in 19 and 17 trials, respectively.
The relatively small number of HIV/AIDS trials conducted in Africa is not commensurate with the burden of disease, say the authors. This may reflect a lack of economic ability, political will, or research capacity.
Geographical mapping as an adjunct to prospective trial registration is a useful tool for researchers and decision makers to track existing and future trials, they conclude.
Contact:
Nandi Siegfried, South African Nuffield
Medical Fellow, UK Cochrane Centre, Oxford, UK
Email: nsiegfried@cochrane.co.uk
(6) SCRAPPING HEALTH CARE FEES IN AFRICA COULD PREVENT OVER 200,000 CHILD DEATHS A YEAR
(Impact on child mortality
of removing user fees: simulation model)
http://bmj.com/cgi/content/full/331/7519/747
(Removing user fees for primary
care in Africa: the need for careful action)
http://bmj.com/cgi/content/full/331/7519/762
Abolishing user fees (charges for health care at the point of use) could prevent approximately 233,000 child deaths annually in 20 African countries, say researchers in this week’s BMJ.
User fees are in place in most sub-Saharan African countries. They were introduced to tackle severe under-funding, but evidence shows that such fees do not generate much revenue, are unlikely to improve efficiency, and disproportionately affect poor people.
Using a simulation model, researchers in London analysed how many child deaths might be prevented if user fees were removed in 20 African countries.
They calculated that elimination of user fees could have an immediate and substantial impact on child mortality, preventing an estimated 233,000 deaths annually in children aged under 5 in 20 African countries (estimate range 153,000-305,000). This amounts to 6.3% of deaths in children under 5 in these countries.
Most of these lives would be saved by increased use of simple curative interventions, such as antimalarials and antibiotics combating dysentery and pneumonia, say the authors.
However, they stress that these gains will only be sustainable if policy makers establish viable alternative financing mechanisms, which also account for increased demand for services.
Replacing user fees with more equitable financing methods should be seen as an effective first step towards improving children’s access to healthcare services and achieving the millennium development goals for health, they conclude.
But in another article, Lucy Gilson and colleagues from South Africa warn that removing user fees must be carefully managed to avoid negative impacts on the wider health system. “Fee removal must be accompanied by increased national budgets for health care to protect the quality of health care in the face of increased utilisation,” they write.
And they also emphasise the need to engage key groups such as health workers in the implementation of this policy change.
Contacts:
Paper 1: Dave Ward, Media Officer,
Save the Children, London, UK
Email: d.ward2@savethechildren.org.uk
Paper 2: Lucy Gilson, Associate
Professor, Centre for Health Policy, University of Witwatersrand, Johannesburg,
South Africa
Email: lucy.gilson@nhls.ac.za
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