Publications

Routine HIV screening of prisoners is generally recommended, but rarely implemented in low-resource settings. Targeted screening can be used as an alternative. Both strategies may provide an opportunity to start HIV treatment but no formal comparisons have been done of these two strategies. The paper aims to discuss these issues.

Background In India, the poor are increasingly forced to live in highly populated urban dwellings with inadequate living conditions including deficient service provision. This in turn affects their food security and negatively influences their health. In December 2012, Dilli Annashree Yojna (DAS), an unconditional cash transfer scheme was launched for the urban poor in Delhi to address food security and, ultimately, nutrition and health. Our study attempts to explore DAS for new elements like unconditionality and transfer to female head of family, use of benefits, operational issues and perceptions on its influence on health.

Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff.

The WHO has approved a post-2015 Global End Tuberculosis Strategy for tuberculosis (TB) 50 prevention, care and control. Countries need to respond by adapting and enhancing their TB control activities. Justifying investment in effective TB control strategies in a country can be achieved in part by defining and monitoring the (MDR) TB epidemic to identify appropriate interventions.

An association between onchocerciasis and epilepsy was suspected as early as the 1930’s in Mexico and later reports were published showing clustering of epilepsy in several African onchocerciasis foci. Ecological studies carried out in onchocerciasis endemic areas in West, Central and East Africa found a strong association between the prevalence of onchocerciasis and of epilepsy. In previous case-control studies this association was less clear, but this was probably due to shortcomings in study design and the selection of comparison groups. Moreover there seems to be an association between epilepsy and the degree of infection with Onchocerca volvulus. Indeed, in a study in Cameroon, performed before the introduction of annual ivermectin treatment (to control Onchocerciasis), the prevalence of epilepsy and the community microfilarial load were closely related. Moreover a case-control study demonstrated that the microfilarial loads (microfilariae per skin snip) in the epileptic group were significantly higher than in the control group.

There is increasing interest amongst donors in investing in the health sectors of fragile and conflict-affected states, although there is limited research evidence and research funding to support this. Agreeing priority areas is therefore critical. This paper describes an 18-month process to develop a consultative research agenda and questions for health systems research, providing reflections on the process as well as its output.

With a maternal mortality ratio of 789 per 100,000 live births, and a contraceptive prevalence rate of 4.7%, South Sudan has one of the worst reproductive health situations in the world. Understanding the social norms around sexuality and reproduction, across different ethnic groups, is key to developing and implementing locally appropriate public health responses.

Most armed conflicts over the past decades have been characterised by prolonged civil strife, disproportionally affecting the civil population. Displacement, affected livelihoods, deteriorated health status and economic decline are only some of the consequences. Morbidity and mortality may increase substantially, due to the direct effects of warfare, but often predominantly due to indirect effects as a result of deteriorating determinants of health, including malnutrition, increased epidemic risks, and declines in preventive and curative health services. The government, usually party to the conflict, is often not able or willing to protect its citizens.

Sub-Saharan Africa has the greatest burden of HIV with 25 million people living with HIV by the end of 2012 . Knowledge of HIV status is imperative for prevention and timely start of HIV care [2–4]. About 30 % of people in sub-Saharan countries have never been tested for HIV. To achieve universal HIV testing, the World Health Organization (WHO) recommends provider initiated testing and counselling (PITC) to facilitate timely diagnosis and access to HIV related services.

The aim of combination antiretroviral therapy (cART) is to suppress plasma human immunodeficiency virus (HIV) viral load (VL) to undetectable levels. The usual median time to achieve full viral suppression is about 100 days. Most HIV patients, both in high-income and in resource-poor countries, also display an immunological response to treatment, measured as an increase in CD4 count. In 14–25% of patients CD4 count does not rise substantially
despite successful viral suppression. This phenomenon has been referred to as an immunological discordant treatment response

Tuberculosis (TB) is a global health problem. In 2014, an estimated 9.6 million people developed TB and 1.5 million died from the disease Currently, 22 high burden countries account for over 80% of world’s TB cases. Notification data in these countries often do not reflect the actual number of cases in the country due to incomplete coverage and absence of appropriate surveillance systems. Thus, direct measurement of the burden of disease through TB prevalence surveys remains key for understanding the spread and extent of the disease and aid in developing appropriate control measures in these settings

There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students’ motivation to practise in rural areas of low-income and middle-income countries following graduation.

This report provides the result of an evaluation of the Universal Health Coverage Partnership (UHC‐P), a collaboration between the EU, Luxembourg and the WHO. As a formative evaluation, the focus is on lessons learnt, rather than on accountability. This review was carried out between March and September 2016 by KIT, the Royal Tropical Institute in Amsterdam, and mandated by WHO headquarters.

Rural agricultural advisory services to facilitate farmers’ access to information have made a remarkable comeback on the international development agenda. After years of neglect, much attention has recently been devoted to the emergence of pluralistic service systems (PSS), in which advisory services are provided by different actors and funded from different sources. Private companies, non-governmental organizations (NGOs) and producer organizations (POs) today play more active roles alongside traditional public sector providers.

A growing variety of public and private rural advisory services (Box 1) are available today, leading to increasingly “pluralistic service systems” (PSS), where advisory services are provided by different actors and funded from different sources (Wongtschowski et al., 2013). This is generally regarded as an important step forwards, away from reliance on monolithic, mostly state-led service systems.

What does empowerment of women and girls mean? The White Paper that was developed as the first component of this project sought to address this question. A conceptual model on empowerment of women and girls was developed in close partnership with the Bill and Melinda Gates Foundation. The model aims to provide conceptual clarity and a common language on what empowerment of women and girls means for the foundation. The White Paper defines empowerment of women and girls as ‘the expansion of choice and strengthening of voice through the transformation of power relations, so women and girls have more control over their lives and futures. It is both a process and an outcome’.

In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving ‘Empowerment of communities’. To be able to empower the communities they serve, we argue, it is essential that CHWs themselves be, and feel, empowered. We present here a critique of how diverse national CHW programs affect CHW’s empowerment experience.

In South Sudan, women disproportionately bear the burden of morbidity and mortality related to sexual and reproductive health, with a maternal mortality ratio of 789 deaths per 100,000 live births.

With a maternal mortality ratio of 789 per 100,000 live births, and a contraceptive prevalence rate of 4.7%, South Sudan has one of the worst reproductive health situations in the world. Understanding the social norms around sexuality and reproduction, across different ethnic groups, is key to developing and implementing locally appropriate public health responses.

There is increasing global interest in how best to support the role of community health workers (CHWs) in building bridges between communities and the health sector. CHWs’ intermediary position means that interpersonal relationships are an important factor shaping CHW performance. This study aimed to obtain in-depth insight into the facilitators of and barriers to interpersonal relationships between health surveillance assistants (HSAs) and actors in the community and health sector in hard-to-reach settings in two districts in Malawi, in order to inform policy and practice on optimizing HSA performance.