Tropical medicine & international health : TM & IH
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Trop. Med. Int. Health · Oct 2009
ReviewEpidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review.
To identify the gaps of knowledge and highlight the challenges and opportunities for controlling cervical cancer in sub-Saharan Africa (SSA). ⋯ Additional data are needed to strengthen ICC as a public health priority to introduce, implement and sustain effective cervical cancer control in Africa.
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Trop. Med. Int. Health · Sep 2009
ReviewA comprehensive approach to risk assessment and surveillance guiding public health interventions.
Tools are required to identify 'multi-endemic' population segments - in order to benefit the most vulnerable people and to make public health interventions cost-effective. The article suggests a comprehensive risk assessment and surveillance system approach based on a combination of epidemiological, environmental and social determinants. Such a cross-disciplinary approach will combine the advantages of forecasting upcoming disease 'hot spots' with provision of evidence for long-term planning under more stable conditions, and it may in principle apply to any combination of public health problems depending on the local context.
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Trop. Med. Int. Health · May 2009
ReviewCommunity health insurance in sub-Saharan Africa: what operational difficulties hamper its successful development?
In recent years, a number of reviews have generated evidence on the potential of community health insurance (CHI) to increase access to care and offer financial protection against the cost of illness for poor people excluded from formal insurance systems. Field experience, however, shows that in sub-Saharan Africa (SSA), a series of operational difficulties still hampers the successful development of CHI, yielding negative effects on potential progress towards increased access to care and improved financial protection. ⋯ Our review of the literature reveals that the major difficulties currently faced by CHI in SSA are operational in nature and cluster around five areas: (i) lack of clear legislative and regulatory framework; (ii) low enrolment rates; (iii) insufficient risk management measures; (iv) weak managerial capacity; and (v) high overhead costs. Consequently, our review calls for appropriate policy interventions, specifically: (i) greater commitment towards the development of adequate legislation in support of CHI; (ii) increasing uptake of measures to expand equitable enrolment; (iii) the adoption of adequate risk management measures in all schemes; (iv) substantial investments from host countries as well as from sponsoring agencies to improve managerial capacity; and (v) collective efforts to contain overhead costs.
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Critical care in low-income countries remains rudimentary. When defined as all aspects of care for patients with sudden, serious, reversible disease, critical care is not disease or age specific and includes triage and emergency medicine, hospital systems, quality of care and Intensive Care Units. This review collates the literature on critical care in low-income countries and explores how the care can be both feasible and effective. ⋯ Oxygen is a cheap and effective treatment for pneumonia and other severe disease, but is not always available. Improved critical care could have a significant effect on the burden of disease and effects of ill health. Research into the most cost-effective treatments and methods of caring for critically ill patients is urgently needed.
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Trop. Med. Int. Health · Oct 2008
ReviewNon-communicable diseases in low- and middle-income countries: context, determinants and health policy.
The rise of non-communicable diseases and their impact in low- and middle-income countries has gained increased attention in recent years. However, the explanation for this rise is mostly an extrapolation from the history of high-income countries whose experience differed from the development processes affecting today's low- and middle-income countries. ⋯ Health policies for non-communicable diseases are considered in terms of interventions to reduce population risk and individual susceptibility and the research needs for low- and middle-income countries are discussed. Finally, the need for health system reform to strengthen primary care is highlighted as a major policy to reduce the toll of this rising epidemic.